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    Trans youth fight for care as California clinics cave to Trump: ‘How can this happen here?’

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    Eli, a 16-year-old Los Angeles student, is spending his summer juggling an internship at a natural history museum, a research project, a physics class and cheer practice – and getting ready to apply for college.But in recent weeks, he has been forced to handle a more urgent matter: figuring out how he is going to access vital medical treatments targeted by the Trump administration.Last month, Eli was stunned to get an email alerting him that Children’s hospital Los Angeles (CHLA) was shutting down its Center for Transyouth Health and Development, which had provided him critical healthcare for three years. The center, which has served transgender youth for three decades, offered Eli counseling and helped him access gender-affirming hormone therapy that he said allowed him to live as himself and flourish in school.CHLA said it was shuttering the center due to the federal government’s threats to pull funding, part of the president’s efforts to eradicate trans youth healthcare. The move has forced Eli and his mother to scramble for alternatives, taking time out of his busy summer to contact new providers and ensure he doesn’t run out of medications.California became the first sanctuary state for trans youth healthcare in 2022 and has long positioned itself as having the strongest protections for LGBTQ+ children. Now, for families like Eli’s, it feels like that safety is rapidly disappearing.View image in fullscreen“I was always worried for people in conservative states and had a lot of fear for my community as a whole. But I never thought it would directly affect me in California,” Eli said on a recent afternoon, seated with his mom at a Latino LGBTQ+ organization in Boyle Heights. “I wish people understood they’re doing so much more harm than they could possibly imagine – that so many lives will be hurt and lost and so many people torn apart.”Eli is one of nearly 3,000 patients who learned on 12 June they would be abruptly losing their healthcare at CHLA, one of the largest and most prominent centers in the nation to treat trans kids. Then, on 24 June, Stanford Medicine revealed it had also paused gender-affirming surgeries for trans minors and 18-year-olds, with reports that some families had appointments suddenly canceled and leaving other patients fearful it was the beginning of a wider crackdown on their care.Families across California told the Guardian they were exploring options to stockpile hormones, researching how to get care outside the US, growing increasingly fearful that parents could face government investigations or prosecutions, and discussing options to permanently flee the country.CHLA, in a letter to staff, said its decision to close the trans center was “profoundly difficult”, but as California’s largest pediatric safety net provider, it could not risk losing federal dollars, which makes up a majority of its funds and would affect hundreds of thousands of patients. Stanford said its disruption in services followed a review of “directives from the federal government” and was done to “protect both our providers and patients”.“This is Los Angeles – how can this be happening here?” said Emily, Eli’s mother, who is an educator; the Guardian is identifying them by only their first names to protect their privacy. “My parents left their Central American countries for a better life – fleeing poverty and civil war, and I cannot believe I’m sitting here thinking: what would be the best country for my family to flee to, as so many immigrant families have done? I never thought I might have to leave the US to protect my son.”‘This care gave me my life’Katie, a 16-year-old film student who lives two hours outside Los Angeles, started going to CHLA for gender-affirming care in 2018 when she was nine. For several years, the care involved therapy and check-ins, but no direct medical interventions. Throughout that time, Katie was consistent about her identity as a girl, which CHLA providers supported.“It was so meaningful and incredible for them to say: ‘We see you for who you are, but also you can be who you are,’” recalled Katie, who asked to go by a pseudonym to protect her privacy. “It was like, I have a future. I’ll get to have my life.”In gender-affirming care, young children may first socially transition by using new names, pronouns and clothes. When youth are persistent about their gender, doctors can consider prescribing puberty blockers, which pause puberty, and eventually hormone therapies that allow for medical transition. Trans youth surgeries are rare.View image in fullscreenThe treatment has for years been considered the standard of care in the US, endorsed by major medical groups, including the American Academy of Pediatrics and the American Medical Association, and linked to improved mental health. In recent years, Republicans have passed bans on gender-affirming care in more than 25 states, and Trump has called the treatments “chemical and surgical mutilation”. There has also been a growing international backlash against the care, including in the UK, which has banned puberty blockers for trans kids.Last month, the US supreme court upheld Tennessee’s ban on gender-affirming care for trans youth. Families and civil rights groups have argued the bans are discriminatory, as cisgender children can still receive the same treatments; cis boys with delayed puberty may be prescribed testosterone, for example, while trans boys cannot.Katie, who was eventually prescribed puberty blockers and hormones, broke down crying recounting how the care saved her. “Sometimes I think: What would my life be if I never got this?” she said. “And I just don’t see myself here. I can’t see myself at 16 if I didn’t come out and transition … Losing this now would destroy my life.”Sage Sol Pitchenik, a 16-year-old CHLA patient, who is non-binary, said the care helped them overcome debilitating depression caused by their severe gender dysphoria: “Every day, I couldn’t even get up because I just didn’t want to see myself, not even my reflection in the window. I was so terrified to look at my body.”They compared the care to the essential treatment their twin brother had earlier received at the same institution: a liver transplant. “CHLA saved my life, just like they saved my brother,” they said.Eli, who came out as trans while in middle school during pandemic lockdowns, said it was hard to return to school when he felt so uncomfortable in his body. At the start of high school, he avoided making friends: “I’m really sociable. I love talking to people and joining clubs, but I felt restricted because of how embarrassed I felt and scared of how people would react to me.”The testosterone therapy helped restore his confidence, he said, recounting “euphoric moments” of his transition: growing facial hair, his voice deepening, staying in the boys’ cabin at camp. His friends celebrated each milestone, and his mom said the positive transformation was obvious to his whole family: “It was like day and night – we are a traditional Latino Catholic family, but they were all loving and accepting, because he is such a happier kid.”View image in fullscreen‘Treating our kids as disposable’CHLA started treating trans children around 1991, and that legacy was part of its appeal for parents. “It’s not just the best place in LA to get care, it’s also one of the most important research centers in the country,” said Jesse Thorn, a radio host who has two trans daughters receiving care there.Critics of gender-affirming care have claimed that vulnerable youth are rushed into transitioning without understanding treatment consequences, and that there is not enough research to justify the care. CHLA, Thorn said, countered those claims; families have appointments and build long-term relationships with doctors, psychologists, psychiatrists and social workers. The process is slow and methodical, and the center was engaged in extensive research on the effects of treatments, he said.“The youth most in danger with the clinic closing are those with parents who aren’t sure about this care,” Thorn added. “That’s a lot of parents. They’re not hateful bigots. They’re overwhelmed and scared, and the institution means a lot.”View image in fullscreenOne LA parent, who requested anonymity to protect her trans son’s privacy, said she knew parents who traveled from Idaho to get CHLA’s care: “It really was a beacon of the entire western United States. It is a remarkable loss.”Parents told the Guardian that they were putting their children on waitlists at other clinics and beginning intake processes, but remained worried for families who have public health insurance and fewer resources.Like CHLA, Stanford has long researched and championed trans youth healthcare. The prestigious university’s recent pullback on care only affects surgeries, which are much more rare than hormone therapy and puberty blockers. But families whose care has remained intact, for now, say they are on edge.“There’s a constant feeling of not knowing what you need to prepare for,” said one mom of a 17-year-old trans boy, who said her son waited six months to first be seen by Stanford. “We all understand the pressures the doctors and institutions are under. But ceding the surgeries doesn’t mean the pressure will end. It’s just showing us our kids are seen as disposable.”Parents and advocates say they fear that other institutions could follow CHLA and Stanford, particularly as the White House significantly escalates attacks in ways that go far beyond funding threats.Fears of prosecutionTrump’s focus on California trans youth and gender-affirming care has been relentless. The president has directly attacked a 16-year-old trans track runner, with the US justice department and federal Department of Education fighting, so far unsuccessfully, to force the state’s schools to ban trans female athletes and bar trans girls from women’s facilities. Trump has threatened to withhold billions of dollars in education funding over a state law meant to prevent schools from forcibly outing LGBTQ+ youth to their parents.Perhaps most troubling for families and providers, the FBI has said it is investigating providers who “mutilate” children “under the guise of gender-affirming care”, and the DoJ said this week it had issued subpoenas to trans youth clinics and doctors.This has led to growing fears that the US will seek to prosecute and imprison clinicians, similar to efforts by some Republican states to criminally charge abortion providers. Many parents say they worry they could be targeted next.“There’s an outcry of terror,” said another LA mother of a trans child. “It feels like there is a bloodlust to jail any doctor who has ever helped an LGBTQ+ kid. There’s this realization that the world is constricting around us, and that any moment they could be coming for us.”Some families hope that California will fight back, but are wary of how committed the governor, Gavin Newsom, really is. Newsom faced widespread backlash in March when he hosted a podcast with a conservative activist and said he agreed with the suggestion that trans girls participating in sports was “deeply unfair”.California’s department of justice, meanwhile, has repeatedly emphasized that when institutions withhold gender-affirming care for trans youth, they are violating the state’s anti-discrimination laws.A spokesperson for Rob Bonta, the state’s attorney general, said Trump was “seeking to scare doctors and hospitals from providing nondiscriminatory healthcare”: “The bottom line is: this care remains legal in California … While we are concerned with the recent decisions by CHLA, right now we are focused on getting to the source of this problem – and that’s the Trump administration’s unlawful and harmful threats to providers.”A CHLA spokesperson shared a copy of its staff letter, noting that Trump’s threats to its funding came from at least five federal departments, and saying it was working with patients to identify alternative care and would “explore” reassigning affected employees to other roles. A Stanford spokesperson did not answer questions about how many patients were affected by its recent changes, but said in an email it was “committed to providing high quality, thorough and compassionate medical services for every member of our community”.Kush Desai, a White House spokesperson, said in an email that Trump has a “resounding mandate” to end “unproven, irreversible child mutilation procedures”, adding: “The administration is delivering.”Katie’s mother said she expected the state’s leaders to do more: “The quiet from the governor and others on trans rights is very unsettling. My husband and I grew up in California, went to public schools here, and always thought we’d be safe here and that the state would hold the line. It’s hard to tell right now if that’s true.”Izzy Gardon, Newsom’s spokesperson, defended the governor, saying in an email that his “record supporting the trans community is unmatched”.“Everyone wants to blame Gavin Newsom for everything. But instead of indulging in Newsom-derangement syndrome, maybe folks should look to Washington.”‘We can’t be quiet’Affected youth are increasingly speaking out. Since the news broke, protesters have organized weekly demonstrations in front of CHLA to call for the healthcare to be restored.At one recent evening rally, organized by the LA LGBT Center, families and supporters marched and chanted outside the busy hospital on Sunset Boulevard, holding signs saying “Trans joy is resistance” and “blood on your hands”, and at one point shouting: “Down with erasure, down with hate, shame on CHLA!”View image in fullscreen“We can’t be quiet any more. We’ve been polite for too long and taken so much bullshit from people who hate us,” said Sage, who spoke at an earlier rally. “I didn’t stand up just for myself or the people affected by this, but also for the trans people who came before us who still have incorrect names on their graves, who don’t have a voice.” Sage, who is now in a creative writing program, said they hoped to become a journalist.Katie, who aspires to be a television writer in LA, said she could not be silent as anti-trans advocates force families to consider fleeing: “How dare you try to drive me out of the place where I was born, where my best friends are, where the job I want to do is, where I’ve experienced my whole life? This is my home.”Eli said he didn’t feel as if he was being an activist. He was simply asking for the “bare minimum”: to be left alone and able to access basic healthcare. “Trans services like hormone therapy truly saves lives,” he said. “We just want people to be able to live their lives. I’m just asking for what is commonsense.” More

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      US posts highest annual measles case tally in 33 years amid Texas outbreak

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      The annual tally of measles cases in the US is the highest in 33 years, as an ongoing outbreak in west Texas continues to drive cases.The latest figures mean Americans will have to look back to 1992 to find a worse year with the vaccine preventable disease. The official tally very likely undercounts the scope of the outbreak, experts told the Guardian.“When you talk to people on the ground, you get the sense that this outbreak has been severely underestimated,” said Dr Paul Offit, director of the vaccine education center at the Children’s Hospital of Philadelphia. Confirmed cases appear to be the “tip of a much bigger iceberg”, he said.Measles was declared eliminated in the US in 2000. However, as the pandemic disrupted routine childhood visits to the doctors and anti-vaccine organizations saw their coffers swell during the pandemic, measles vaccination rates have fallen below a critical threshold to prevent outbreaks in some communities.As of 4 July, Johns Hopkins University’s Center for Outbreak Response Innovation counted 1,277 measles cases. The Centers for Disease Control and Prevention (CDC) reports 1,267 cases, but has not updated its data since 2 July.“The number of new cases has slowed down, but I don’t think there’s any reason to suggest this will be our last,” said Dr Peter Hotez, a vaccine expert and dean for the national school of tropical medicine at Baylor College of Medicine in Houston, Texas.He later added: “It’s a very dark epidemic that never had to happen.”The latest national tally will eclipse 2019, when unvaccinated members of New York City’s isolated orthodox Jewish community drove a large outbreak, and the nation ended the year with 1,274 confirmed measles cases.Americans will need to look back to 1992 to find a higher annual measles tally. In 1992, the CDC confirmed 2,126 cases, with the largest outbreaks in Kentucky and Texas. Texas has confirmed 753 cases in 2025, according to the state health department, opening up the possibility that Texas could exceed the 1992 annual total as well.The enormous outbreak comes as Donald Trump’s health secretary, Robert F Kennedy Jr, who once ran an influential anti-vaccine group, has injected upheaval into US vaccine policy and spread misinformation about treatments for the disease.Measles is a viral disease characterized by a top-down rash, high fever, runny nose and red, watery eyes. The virus is one of the most infectious diseases known to medicine. There is no cure for measles. The best way to prevent measles is by getting vaccinated with the measles, mumps and rubella vaccine (MMR), which is 97% effective with two doses.Although most people recover, as many as one in five infected children require hospitalization; one in 20 get pneumonia and one in 1,000 can develop encephalitis, which can lead to lifelong disability, according to the CDC. The disease can also weaken the host’s immune system and lead to more future infections. In rare cases, measles can cause an incurable degenerative brain disorder. The US has already seen three deaths from measles this year, both in otherwise healthy children.Before a measles vaccine was licensed in 1963, an estimated 3-4 million Americans were sickened each year, 48,000 were hospitalized and an estimated 400-500 died, according to the CDC. From 1994 to 2023 in the US alone, the CDC estimates the measles vaccine saved 85,000 lives and prevented 104m illnesses.Although the vaccine has been wildly successful, it has also been the target of sustained misinformation by people who have a financial stake in reduced vaccine uptake.In 1998, a British doctor hypothesized a link between the MMR and increasing autism rates. The doctor, Andrew Wakefield, was later found to have committed fraud, failed to report conflicts of interest and lost his license. The article was retracted.Reams of science has since examined and re-examined the evidence, and found no link between the MMR vaccine and autism. Still, the debunked connection has found an afterlife as a talking point for anti-vaccine groups who have attracted a vocal minority of parents. The overwhelming majority of Americans still vaccinate children against measles.Now, alongside longtime anti-vaccine talking points about autism and “medical freedom”, Hotez said a new threat was the, “very pernicious health and wellness and influencer movement that’s got a big profit motive”.Outbreaks appear to be “occurring in the same [parts] of the US that had some of the lowest Covid vaccination rates”, said Hotez, introducing the possibility that anti-vaccine sentiment is “spilling over to childhood immunizations”.In June, Kennedy unilaterally fired all 17 expert members of a CDC advisory panel on vaccines and stacked the committee with seven ideological allies. The advisory committee is a key link in the vaccine distribution pipeline.Among those allies now serving on the committee are medical professionals with fringe beliefs and known anti-vaccines advocates. In June, the group met for the first time, and said it would form a new committee to re-evaluate the childhood vaccine schedule.“We’ve not only eliminated measles, we’ve eliminated the memory of measles,” said Offit. “People don’t remember how sick this virus can make you – or how dead it can make you.” More

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      Trump expected to sign tax-and-spending bill in win for administration

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      Donald Trump is expected to sign his sweeping spending package into law on Friday during a Fourth of July picnic at the White House, setting up significant cutbacks on federal safety-net programs and increasing funds for aggressive immigration enforcement.Trump has touted the legislation’s passage as a “birthday present for America”, speaking before a crowd at a campaign-style rally in Iowa on Thursday evening, even as Democrats expressed their displeasure at the spending package.After months of deliberations, the bill passed by a single vote in the Senate and later passed the House with a 219 to 213 vote on Thursday, with only two Republicans voting against it. The sweeping legislation accomplishes what rightwingers have pushed for, for decades, as the Guardian explained this week, and provides Trump a huge legislative win.The bill, once signed into law, will significantly cut taxes, building on the 2017 tax cuts during Trump’s first term. Although temporary tax exemptions for tips, overtime pay and car loan interest are included, research from the Center on Budget and Policy Priorities shows that the bill is skewed to the rich, with the wealthiest in the US benefiting the most from the tax relief.Additionally, the law, once signed by Trump, will add new restrictions to Medicaid, which provides healthcare to low-income and disabled people, and Snap, also known as food stamps, which helps low-income people afford food. Researchers estimate that the Medicaid cutbacks will leave as many as 11.8 million people without healthcare, while 8 million people will lose their Snap benefits. Critics say that the Medicaid cuts will have massive ripple effects on healthcare nationwide.“This is highway robbery,” the Democratic senator Raphael Warnock posted on X, formerly known as Twitter. “The bill Republicans just passed steals from you to give to the rich.”Proponents of the bill say that the Medicaid and Snap changes are designed to root out waste and abuse.Additionally, the spending package will allocate $170m to immigration enforcement, a monumental amount of money that will help support the Trump administration’s push to engage in “mass deportations”.“This disgraceful, anti-immigrant budget hands the Trump administration a blank check to further ramp up its shameful efforts to terrorize American communities and separate families,” said Nicole Melaku, the executive director of the National Partnership for New Americans, an immigrants’ rights organization. “Instead of safeguarding people’s access to healthcare and wellness, the bill gives tax cuts to big corporations and funnels billions of dollars to hire more immigration agents, build more immigration jails and deny people their fair day in court.”Already, the Trump administration has engaged in widespread attacks on immigrant communities, by increasing resources to immigration enforcement operations.“This budget promises to supercharge US Immigration and Customs Enforcement arrests that disappear community members, leave children parentless and threaten constitutional and due-process rights for all of us,” said Meg McCarthy, executive director of the National Immigrant Justice Center, alegal organization.A recent Guardian analysis shows that undocumented immigrants without any criminal history have been arrested at an exponentially increasing rate, after top White House officials instructed agents to increase arrests.Trump temporarily walked back some of Ice’s aggressive immigration enforcement actions after complaints from leaders in the farming and hospitality industries: last month, the Trump administration engaged in a short-lived pause on raids at farms, restaurants and hotels. But at Thursday’s event, Trump again brought up the idea of pausing large-scale enforcement on farms.“If a farmer is willing to vouch for these people in some way, Kristi, I think we’re going to have to just say that’s going to be good, right?” Trump said to the secretary of homeland security, Kristi Noem. “We don’t want to do it where we take all of the workers off the farms.”In addition to tax cuts, restrictions on Medicaid and Snap and the aggressive supercharging of immigration enforcement, the bill seeks to end green energy incentives created under Joe Biden, seen as a further blow against efforts to combat the climate crisis.The US budget deficit will increase with this bill, leading to opposition by some Trump allies. The non-partisan congressional budget office estimates the bill will add $3.3tn to the country’s debt through 2034, leading to clashes with some rightwingers.One of the two Republicans who voted against the bill, Thomas Massie, said he opposed the spending bill “because it will significantly increase US budget deficits in the near term, negatively impacting all Americans through sustained inflation and high interest rates”.Elon Musk, the rightwing billionaire who established the federal government’s office tasked with slashing federal spending during the first few months of the Trump administration, has also publicly called out the spending bill. Days before Congress passed the bill, Musk repeated his call for the creation of a new political party to oppose the Republicans and Democrats. More

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      Trump’s Medicaid cuts are coming for rural Americans: ‘It’s going to have to hit them first’

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      When Hurricane Helene drowned western North Carolina in muck and floodwater last year, it caught folks off-guard.Now, local leaders in places like Asheville expect the Republican-led reconciliation bill – called the “big, beautiful bill” by Donald Trump – to bear down on rural America. And they wonder whether people are missing the warning signs.“It’s going to have to hit them first,” said Laurie Stradley, CEO of Impact Health in Asheville, a Medicaid-funded non-profit providing social services to some people still digging out from the flood.Medicaid is the single largest health insurance program in the US. The public program covers 71 million low-income, disabled and elderly US residents. It pays for half of all US births and the care of six in 10 nursing home residents.When Trump’s sprawling tax-and-spending bill passed on Thursday, it heralded more than $1tn in federal cuts to Medicaid, which experts worry will push Republican-led states to abandon parts of the program and leave people without access to timely healthcare.“This is an extraordinarily regressive bill,” said Joan Akler, executive director and co-founder of Georgetown University’s Center for Children and Families. “This is the largest rollback of healthcare coverage that we’ve ever seen and all in service of an agenda to drive tax cuts that will disproportionately benefit wealthy people and corporations.”Medicaid “expansion” is a key provision of Obamacare, formally called the Affordable Care Act of 2010. The expansion provides largely no-cost health insurance to people earning up to 138% of the federal poverty level, or $36,777 for a family of three. Although Obamacare has been the law for more than a decade, Medicaid expansion proved politically divisive in Republican states, and many only recently decided to accept enormous federal subsidies to cover their residents.North Carolina will lose $32bn in the next decadeThe Medicaid cuts in the bill could have particularly acute consequences in North Carolina, a politically competitive state, where experts said the bill could trigger a “kill switch” to end Medicaid expansion.“If the state spends any state dollars to implement the expansion population or expansion coverage, it triggers an automatic ending to Medicaid expansion,” said Kody Kinsley, North Carolina’s former secretary of health and an architect of the state’s Medicaid expansion.North Carolina is set to lose $32bn in federal funding in the next decade, according to an analysis by the office of the Republican senator Thom Tillis, who represents the state. He’s one of just three Senate Republicans who voted against the bill on Tuesday.North Carolina’s expansion only went into effect in December 2023, and in less than 19 months it enrolled more than 650,000 people – all of whom will lose coverage if the program ends.Those North Carolinians are only some of the 17 million people expected to lose health insurance by 2034 across the country, according to estimates from the non-partisan Congressional Budget Office. Nearly 12 million people will lose insurance because of attacks on Medicaid.“Ultimately, Medicaid being cut is going to kill people,” said Molly Zenkler, a nurse at Mission hospital in Asheville. “I deal with people getting their feet literally amputated because they don’t have access to diabetic care. This is just going to get increasingly worse.”The reconciliation bill cuts state funding through a number of provisions. On healthcare specifically, the bill attacks complex financial maneuvers states use to draw down federal funds. It also requires states to spend enormous sums – perhaps tens of millions of dollars per state – implementing work requirements, effectively adding layers of expensive red tape.Congressional Republicans in favor of the bill argue it targets “waste, fraud and abuse”. However, it is already well-known that most Medicaid beneficiaries who can work do, and that Medicaid is one of the most cost-efficient health programs in the US, according to the American Hospital Association.North Carolina is one of a dozen conservative states that wrote a “trigger” law into Medicaid expansion. Not all function like North Carolina’s – the laws are, in the words of an expert with Georgetown University’s McCourt School of Public Policy, a “lesson in federalism” – but they nevertheless underscore the difficult choices state legislators will face because of congressional Republicans’ cuts.One such program that could be on the chopping block is a pilot with Impact Health, which uses Medicaid expansion funds for social needs that affect health – an effort to reduce long-term costs. Stradley gave the example of a Medicaid-covered child with severe asthma who hit the local emergency room three times a week for breathing treatments.Impact’s program used Medicaid funds to replace moldy rugs with laminate flooring in the child’s home, and to buy a vacuum with a Hepa filter. The cost to Impact Health was about $5,000, “but now this child is going to the emergency room a couple times a year instead of a couple times a month. And so, every month we’re saving about $4,500.”The program’s knock-on effects boost the local economy: the work to replace the rug was done by a local carpenter, and the child’s mother isn’t calling out from work, increasing her job stability.“One of the ways that we talk about this program is that it’s a hand up rather than a handout,” she said. “Almost half of the folks that are recipients in our program are children … Then you look at the adults. Most of them are working multiple jobs, and those jobs don’t come with benefits, because they’re working two or three part-time jobs in order to make ends meet.”The enormity of Medicaid means large cuts to the program imperil not only patients, but the institutions that serve them – especially rural hospitals and clinics hanging on “by a thread”, according to Kinsley.One of US residents’ few rights to healthcare is in emergency departments, where hospitals are required to stabilize patients regardless of ability to pay. That makes emergency departments the go-to source for healthcare for the uninsured.An analysis released by the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill earlier this year showed that 338 rural hospitals around the country were at risk of imminent closure with the cuts to Medicaid contained in the bill.‘Hospitals will be forced to restrict services, or close’Rural states such as Kentucky are expected to be disproportionately hard-hit as well. Thirty-five of the rural hospitals at risk of closure – about 10% – are in Kentucky, even though Kentucky’s 4.5 million residents comprise about 1.3% of the US’s population. About a third of Kentucky residents are on Medicaid, according to figures from Kentucky’s cabinet for health and family services. The program benefits about 478,900 adults.The situation is similarly dire in Arizona, another battleground state, which also has a trigger law on the books. Although the reconciliation bill may not “trigger” a rollback of Medicaid expansion, it does undermine a key financing mechanism for the state’s program called a “provider tax”.“We estimate Arizona’s healthcare system would lose over $6bn over the next seven years,” said Holly Ward, a spokesperson for the Arizona Hospital and Healthcare Association, in a statement.“In other words, more than 55% of Arizona hospitals would be operating in the red,” she said. “Hospitals will be, at best, forced to restrict services such as obstetrics, behavioral healthcare and other complex services, and at worst, will close their doors altogether.”Another issue is the potential for Republicans’ cuts to drive up the cost of healthcare for Americans who are privately insured, including through employers. As hospitals fight to survive, they will try to extract as much money as possible from other sources of funding – namely, commercial insurance.In addition, rural healthcare providers worry the water will be muddied by the sheer complexity of US healthcare. Private companies have a hand in managing – and therefore branding – state Medicaid programs.“A lot of our rural voters may not even realize that what they have is Medicaid, because there are so many names for it,” said Stradley. However, the precarious situation is already worrying people whose lives have been stabilized because of Medicaid.Amanda Moynihan is a single mother of three children – ages nine, 12 and 16 – living in Kuna, Idaho. Medicaid expansion has helped her become a “functioning human in society”, she said. Routine medical care for herself and her children, along with other assistance programs, has meant the difference between grinding poverty and a shot at the middle class.Idaho, one of the most politically conservative states in the union, expanded Medicaid in 2018 with an overwhelming ballot-referendum vote of 61-39. Even if Idaho’s “trigger law” does not go into effect, the state could face similar fiscal challenges to Arizona.“Back two years ago, before I started school, I was just in fight-or-flight, just trying to pay the bills there. I didn’t ever see a future of what I could do. And then I just started with one class,” she said.Moynihan has completed an associate degree in psychology and is starting the social work bachelor’s degree program at Boise State University in the fall. For now, she’s working part time with the Idaho Commission for the Blind and Visually Impaired and planning to pick up work at a gas station because it has a college scholarship benefit.But without stability to pursue higher education, her future “would be making the minimum wage, which is about $15 an hour, barely paying rent in a low-income household”. More

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      No one wanted Trump’s devastating budget bill. Of course it passed | Moira Donegan

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      The budget reconciliation bill that passed the US House of Representatives on Thursday and was promptly to be signed into law by Donald Trump represents the particular perversity of national politics in America: seemingly no one wants it, everyone hates it, and it is widely agreed to be devastating for staggering numbers of Americans. And yet, the bill felt inevitable: it was a foregone conclusion that this massive, malignant measure was something that everyone dreaded and no one had the capacity to stop.They didn’t really even try. In the Senate, a few conservative Republicans made noise about the bill’s dramatic costs: the congressional budget office estimates that the bill will add $3.3 tn to the deficit over the coming decade, and the senator Rand Paul, a budget hawk from Kentucky, declined to vote for it for this reason. But other Republicans, who used to style themselves as fiscally responsible guardians against excessive government spending, engaged in a bit of freelance creative accounting in order to produce an estimate that falsely claimed the cost of the bill would be lower. Most of them quickly found themselves on board.Moderate Republicans, or what remain of them, also quickly quit the field. Thom Tillis, a Republican from North Carolina facing down an uncertain re-election bid, expressed concerns about the bill’s massive cuts to Medicaid, the federal low-income healthcare program on which many Americans – and many of his constituents – rely. When Donald Trump threatened to secure a primary challenge to Tillis in retaliation, the senator announced that he would not seek re-election after all; he voted against the bill, but also ended his political career. Susan Collins, of Maine – she of the perennial “concern” about the sadistic Republican agendas that she continues to support – made a rare departure from her usual formula and voted against the bill, a move that came close on the heels of polling showing her dismal approval rating among her constituents. That left just Lisa Murkowski, of Alaska, who agreed to play ball: she would vote for the bill, which she had publicly disparaged, in exchange for some money for her state. The result was that Alaska will be exempted, at least temporarily, from new rules associated with the Supplemental Nutrition Assistance Program, or Snap, which helps low-income Americans buy enough food to keep themselves alive. Republicans threw in a tax deduction for Alaskan whaling captains – of all things – and with that, her vote was secured.When the bill was sent to the House, a handful of Republicans threatened to withhold their votes over budget and Medicaid concerns. But no one believed them. They were always going to cave, abandon their stated principles and follow Trump’s orders, and they did. Trump, after all, had said that he wanted the bill passed in time for the Fourth of July; it passed on the third. He says jump, and the Congress asks: How high?They do so even when the demands that Trump makes are morally grotesque. The bill will devastate Americans. Its massive cuts to Medicaid, combined with expiring Obamacare subsidies, will result in an estimated 17 million Americans losing health coverage over the next 10 years, effectively undoing the expansion of healthcare coverage that was achieved with Barack Obama’s health law. Cuts to Snap are so profound that they cannot be made up with additional state spending; some people who are eating today because they have food assistance will go hungry in the future. There are deep cuts to federal loans and grants for college students, and a near-reversal of the Biden-era Inflation Reduction Act’s investments in green energy, with tax breaks now going to climate-damaging sectors like coal and oil instead. Because the bill creates a dramatic budget deficit, law requires that Medicare, the healthcare program for seniors, will face cuts, too.All of this is to say nothing of the downstream effects of the legislation. The steep cuts to Medicaid, in particular, will devastate America’s already fragile and partial healthcare system. Planned Parenthood is now excluded from federal Medicaid dollars, meaning that about 200 of its roughly 600 clinics will probably have to close, making abortion less accessible even in states where it is legal, and putting contraception and STD and cancer screenings out of reach for untold numbers of American women. Many rural hospitals will likely have to close, too, along with nursing homes. Those healthcare clinics that remain will have longer wait times and more crowding, and offer more expensive care. Ultimately, fewer people will be going to the doctor, and more of them will suffer and die needlessly of treatable and preventable conditions.But the bill does have winners. It has been called, among other things, the largest tax cut in the nation’s history, although the benefit is disproportionately to billionaires. The budget of Ice, Trump’s anti-immigrant secret police force, is also expanded exponentially: from $3.5bn to $48.5bn, making it the nation’s largest law enforcement agency, though still no more accountable.The bill, in other words, steals from the sick, the elderly, the hungry and the curious, and gives that plundered loot to billionaires and jackboots. It will warp American life – already sickly and impoverished by the standards of our peer nations – in cruel and enfeebling ways. It will make us sicker, poorer, more fearful, more ignorant and more endangered. It will make the rich, meanwhile, even richer.Why are Republicans voting for a bill that will hurt their own constituents? A bill that undermines their stated values and threatens their careers and will immiserate people they care about – if only themselves?One of the more confounding aspects of the Trump era is his ability to vacate what the constitution’s authors – and indeed most reasonable adults – would have assumed would be a defining feature of the contest among the branches: self-interest. Republicans will follow him anywhere, even to unpopular votes, even to self-sabotage, and frequently to the diminishment of their own branch’s relevance. Some say that now, he is leading them to a midterm defeat. Democrats made a show of their opposition to the bill – in the minority, shows are about all they can accomplish – with the minority leader Hakeem Jeffries delivering an eight-and-a-half-hour, filibuster-style speech on the floor telling the stories of Americans who will be hurt by the legislation, laying out the bill’s cruelty and recklessness. But you could also detect a hint of pleasure in his voice as he read out the testimonies of Americans who live in what the Democrats see as particularly vulnerable districts for Republicans in 2026.The bill is unpopular now, and it is likely to become much more so as the full breadth of its cuts to social services, and its impacts on Americans seeking to get healthcare, buy food, secure an environmentally livable future or go to school, become clear. Many of the politicians who ultimately voted for it criticized it sharply just days or hours before. They will be attacked about this in the midterms: the suffering that the bill will cause will be cut into television and social media ads and played incessantly on networks in what the Democrats believe are winnable districts. But it is unclear, in the end, if hurting Americans, including their own voters, really will come back to bite the Republican party. It hasn’t for a long time.

      Moira Donegan is a Guardian US columnist More

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      CDC vaccine panel to review ingredient RFK Jr has targeted for removal

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      A key vaccine advisory panel reconstituted by health secretary and vaccine skeptic Robert F Kennedy Jr is slated to discuss thimerosal-containing influenza vaccines in its first meeting – an ingredient which has been a fixation of anti-vaccine activists for decades.The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) will hold two separate votes later this month: one on “influenza vaccines” and one on influenza vaccines that contain thimerosal.Thimerosal is an ethylmercury preservative used in multi-dose vaccine vials to prevent fungi and bacteria growth. The preservative has been studied and deemed safe, but was nevertheless removed from all routine childhood vaccines in 2001 as a precaution.“I was there when we went through this the first time,” said Dr Paul Offit, director of the vaccine education center and an attending physician in the division of infectious diseases at Children’s Hospital of Philadelphia, about debates over the preservative in the early 2000s.Offit served on the ACIP panel in question from 1998 to 2003. He said the issue of thimerosal was vigorously debated and found safe then, prompting him to ask: “What’s the point?”In a short history of the thimerosal controversy published in the New England Journal of Medicine, Offit described how some parents became convinced thimerosal gave their children autism, resulting in thousands of autistic children receiving heavy metal chelation treatments each year.Studies have found no link between thimerosal and autism, according to the American Academy of Pediatrics. The National Vaccine Injury Compensation Program has also denied claims of a thimerosal-autism link. Kennedy, however, has written a book arguing against the use of thimerosal.Offit said the discussion of thimerosal appeared to geared to, “accomplish [Kennedy’s] goals of making vaccines less affordable, less accessible and more feared”, he said.“Here’s what you do know – you do know RFK Jr is an anti-vaccine, science-denying conspiracy theorist. He is devoted to this, he is a zealot, there is no middle ground with him,” said Offit. “He believes we have merely substituted infectious diseases for chronic diseases.”The panel’s advisory recommendations are critical because they result in vaccine “schedules”. These schedules are relied on by health insurers to determine which vaccines to cover and by clinicians who use them as an evidence-based guide on immunization – effectively giving the American public access to the medicines.Although the CDC does not always take the panel’s advice, the CDC typically affirms the panel’s decisions. However, the agency is currently without a leader, as Senate hearings have not yet been held for nominee and CDC career official Susan Monarez. As a result, Kennedy has signed off on some previous ACIP recommendations.Kennedy wrote a book on the preservative thimerosal in 2014 called Thimerosal: Let the Science Speak, in which he argues that “there is a broad consensus among research scientists that thimerosal is a dangerous neurotoxin that should be immediately removed from medicines”. Kennedy said in the book he is “pro-vaccine”.Until 9 June, the ACIP was an independent panel of 17 experts who served staggered terms and were rigorously vetted by career CDC staff. Kennedy broke with tradition when he fired the entire panel, claiming in a Wall Street Journal editorial that he was working to “restore public trust in vaccines”.The same week, Kennedy appointed eight new members to the committee, including medical professionals with little vaccine expertise and known vaccine skeptics.A wide spectrum of groups criticized the decision, from MomsRising, who said they were “alarmed and disgusted”, to major doctors’ groups such as the American Academy of Pediatrics, to public health leaders who described Kennedy’s actions as “a coup,” to the former members of the committee, who warned the independent panel was at “a crossroads”.The group is scheduled to meet the last week of June. Prior to Kennedy’s changes, they had been expected to discuss reducing the number of shots needed for human papilloma virus (HPV) and a meningococcal vaccine.On Wednesday, the panel released a draft agenda for its upcoming meeting. A wide range of vaccines will be discussed – including those against influenza; the tropical disease chikungunya; the measles, mumps, rubella and varicella (chickenpox) vaccine; anthrax; Covid and respiratory syncytial virus (RSV).The agenda scheduled a vote on recommendations for flu vaccines, including the multidose versions that still contain thimerosal. These vaccines are used only in adolescents and adults. The panel is also scheduled to vote on recommendations for maternal and pediatric versions of the respiratory syncytial virus (RSV).Notably, despite Kennedy’s repeated pledges of “radical transparency”, the draft agenda does not include the names of many speakers, which are listed as “TBD” (to be determined) for instance on “Covid-19 safety update”.New ACIP members have not been added to a conflict of interest tracker for ACIP members developed by the Trump administration. A spokesperson for HHS said the new members ethics agreements “will be made public” before they start work with the committee.In addition to the new draft agenda, there have also been changes to the committee’s meeting times not reflected in the Federal Register, according to Politico. The group will meet for two days instead of three, and there does not appear to be a vote scheduled on Covid vaccines. More

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      CDC official in charge of Covid data resigns ahead of vaccine meeting

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      The scientist responsible for overseeing the CDC team that collects data on Covid and RSV hospitalizations resigned on Monday.Dr Fiona Havers told colleagues in an email that she no longer had confidence the data would be used “objectively or evaluated with appropriate scientific rigor to make evidence-based vaccine policy decisions”, according to Reuters.She resigned before a planned meeting of a new vaccine panel put in place by Robert Kennedy Jr after he fired all 17 members of the CDC’s independent vaccine advisory panel. Kennedy also dropped a recommendation to get the Covid shot for healthy children and pregnant women.Havers, leader of the Resp-Net hospitalization surveillance team, did not respond to requests for comment.Her resignation follows moves by Kennedy, the health secretary, to abruptly fire all 17 members of the CDC’s independent vaccine advisory panel and drop a recommendation for administering Covid shots to healthy children and pregnant women.Kennedy, who has long sown doubt about the safety and efficacy of vaccines, replaced the advisory board with eight members of his own choosing, some of whom have histories of objecting to Covid shots or vaccines in general.Havers said in her email that the Covid and RSV data collected by her team had been used in more than 20 peer-reviewed manuscripts and 15 Morbidity and Mortality Weekly Reports issued by the CDC.The newly installed vaccine panel, known as the advisory committee on immunization practices, is expected to meet 25-27 June to vote on the use of Covid-19 boosters and other vaccines by the American public.A Health and Human Services spokesperson told Reuters that the agency is committed to “gold standard science” and that the vaccine policy will be based on objective data, transparent analysis and evidence. More

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      DC rally protests cuts to US veterans programs: ‘Promises made to us have come under attack’

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      A flurry of red, white and blue American flags fluttered across the National Mall on Friday as more than 5,000 military veterans and their allies descended on Washington to protest against the planned elimination of 80,000 jobs at the Department of Veterans Affairs (VA) and the cancellation of hundreds of contracts for veterans services with community organizations.“I hope that in the future veterans will be able to get their benefits,” said David Magnus, a navy veteran who decided to travel from Pittsburgh, Pennsylvania, after his doctor told him she was quitting during a recent mental health appointment. Before Donald Trump returned to office in January, “the VA was good”, he said, but since then medical staff have faced harassment that puts the entire system at risk.“It used to be, you’d call and get an answer,” he said. “Now, so much is going on that they don’t know where to put you.”Organizers said that in addition to the march in Washington, there were more than 200 corresponding actions across the country, from watch parties to vigils held at VA clinics. Many veterans told the Guardian they came to the nation’s capital on their own after hearing about the rally online.The VA secretary, Doug Collins, has said the efforts are designed to trim bureaucratic bloat and will have no impact on veterans’ healthcare or benefits. Reporting by the Guardian last month found the agency, which provides healthcare to more than 9 million veterans, has already been plunged into crisis. Across the nation, appointments have been cancelled, hospital units closed, the physical safety of patients put at risk.View image in fullscreenDemonstrators said the Trump administration is seeking to destroy the VA, the largest integrated healthcare system in the United States, with 170 government-run hospitals and more than 1,000 clinics, and replace it with a private voucher program that will provide substandard care.“We’re a generation of service. We volunteered and stepped up to lead. Now we are seeing the promises made to us come under attack,” said Kyleanne Hunter, the chief executive of Iraq and Afghanistan Veterans of America and a Marine Corps veteran who flew multiple combat missions as an AH1-W Super Cobra attack pilot.The administration’s proposed budget for the VA, released on Friday, slashes spending for “medical services” by $12bn – or nearly 20% – an amount offset by a corresponding 50% boost in funding for veterans seeking healthcare in the private sector.“We’re already being starved,” said Sharda Fornnarino, a Navy veteran and one of about three dozen nurses brought to the rally by the National Nurses United union. Fornnarino, who works at the VA in Denver, Colorado, said that while politicians in Washington debate permanent staff reductions, essential healthcare positions are being left vacant.With fewer staff on the floor, veterans on hospice “are being left to die in their own piss and shit”, said Teshara Felder, a Navy veteran and nurse at the agency’s hospital in Atlanta, Georgia, said.A blue-ribbon commission established by the agency last year found veterans received significantly better care at lower cost from the public system. Private providers operated with little oversight, they wrote, and “are not required to demonstrate competency in diagnosing and treating the complex care needs of veterans nor in understanding military culture, which is often critical to providing quality care for veterans”.The VA says the budget submission “prioritizes care for our most vulnerable veterans, including those experiencing homelessness or at risk of suicide” and “eliminates nonessential programming and bureaucratic overhead that does not directly serve the veteran”.View image in fullscreenThe march was held on the 81st anniversary of D-day, when Allied troops stormed the beaches of Normandy, a decisive turn in the war against Nazi Germany during the second world war. Organizers said their inspiration goes back even further – to the “Bonus Army” march on Washington in 1932 during the depths of the Great Depression, when thousands of first world war veterans gathered on the National Mall to demand promised benefits, only to have the US military deployed against them.Christopher Purdy, an Afghanistan war veteran and organizer of today’s march, said the Bonus Army rally helped set the stage for the New Deal social programs and eventually the GI Bill, which provided higher education, healthcare and home ownership to veterans returning from the second world war.Other speakers criticized Trump’s decision to impose a travel ban on visitors from 12 countries, including Afghanistan, where many of the demonstrators served alongside translators who risked their lives for the US. Shortly after taking office in January, Trump ordered a pause on the US refugee admissions program, putting translators’ safety in doubt.“We all left behind people who are now marked,” said Nadim Yousify, who immigrated to the United States in 2015 after working as a US government translator in Afghanistan and later joined the Marine Corps. More

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      ‘This isn’t just about Trump’: the Rev William Barber arrested after prayer-protest against Republican-led budget

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      A police officer’s sense of timing seemed to illuminate the Rev William Barber’s moral mission with startling clarity.During a prayer vigil on Monday in the Capitol Rotunda, close to the very heart of US democracy, Barber was lamenting that Congress starts each day with its own prayers to the Almighty even while preying on the poor. A Capitol police captain, John Hersch, serendipitously choose that very moment to intervene.“Your activity right now is taking the form of a demonstration,” Hersch told Barber and an accompanying gathering of clergy. “It is unlawful to demonstrate in the Capitol Rotunda. If you do not cease your demonstration at this time, there is a possibility you will be placed under arrest.”Moments later, after two further warnings, Barber and seven accomplices – standing in front of the portrait of three 19th-century women’s suffrage campaigners – were arrested as police sealed off the Rotunda.The arrests marked the climax of the latest Moral Monday protest organised by Repairers of the Breach, a group founded by Barber that’s trying to derail Donald Trump’s planned tax and spending bill on the grounds that it will slash vital health and social services to lower-income Americans.It was the third Moral Monday Barber had led at the Capitol since April – and the third time he and his cohorts had been arrested.Barber, a social activist and founding director of Yale Divinity School’s centre for public theology, had earlier led a rally outside the US supreme court attended by an estimated 2,000 protesters.As a band belted out gospel songs, demonstrators held signs with slogans such as “Slashing the safety net is moral murder” and “Don’t cut Snap for 40 million poor people.”Wearing a white robe emblazoned with the words “Jesus was a poor man,” Barber – the son of civil rights workers who campaigned for racial desegregation – enjoined demonstrators to crusade against legislation that the US president has termed his “big, beautiful bill” and deemed essential to extending his 2017 tax cuts, which are due to expire this year.The Republican-controlled House of Representatives passed the bill last month by a single vote, 215 to 214. It now goes forward to the Senate against a chorus of criticism over its potential impact on the most vulnerable.Passage would result in 13.7 million people losing access to Medicaid and health insurance, Barber said.“This bill represents the worst kind of evil, which is the love of money … the root of all evil,” he said “This isn’t just about Trump. Two hundred and fifteen Republicans in the House voted for this bill – and now every senator is going to decide whether they’re going to vote for the ‘we’re all going to just die’ approach to politics.”Barber was referring to remarks by Joni Ernst, a Republican senator for Iowa, who faced criticism for telling a town hall last week that “we’re all going to die” after a constituent warned that health cuts could result in some people dying.Ernst doubled down by issuing a mock “apology” filmed in a cemetery, saying: “For those that would like to see eternal and everlasting life, I encourage you to embrace my lord and saviour, Jesus Christ.”Barber compared Ernst’s rhetoric with justifications used by slaveowners.“That’s the same language that slave masters used to tell slaves,” he said in an interview. “They would say: ‘Don’t fight for freedom, but believe in Jesus so that in the eternal life …’“It’s so cynical. What she said was one of the most contradictory misinterpretations of faith I’ve ever heard. It’s theological malpractice.“As Dr [Martin Luther] King once said, we’re not talking about over yonder. We’re talking about over here and people need healthcare over here. People need food over here. For her to bring up religion and bring up Jesus – if Jesus did anything, he provided everybody he met free healthcare. He never charged a leper, or a sick person, or a blind person, for their healing.”The Moral Monday protests have been adapted from similar demonstrations Barber started in North Carolina in 2013, following the election of rightwing Republican Pat McCrory as governor. The protests lasted two years, recalled Barber, resulting in thousands of arrests for civil disobedience but also spurring thousands more to register to vote.As protests against Trump ramp up, Barber is vowing to make Moral Mondays a regular feature of the landscape of dissent.“Moral Monday is not a one-time event,” he said. “If this budget passes the way it is, it will have a negative impact on this country for 10 years. It could possibly not be fully reversed for up to 50 to 60 years. This is serious business.”The protests are likely to expand to encompass a broader pro-democracy agenda. “Our role is not just the budget passing or not passing, but mobilizing poor and low-wage folk. We stand against any attacks on voting rights, on public education, [or] on healthcare,” said Barber.“Poor and low-wage people now represent 30% of the electorate in this country, and in battleground states, over 40%,” he said, making them the largest potential expansion for voting power in the country.In an acknowledgment of Moral Monday’s growing significance, this week’s rally was addressed by Ezra Levin, co-executive director of the progressive Indivisible movement, which spearheaded nationwide Hands Off protests in April that drew millions of participants.Levin praised protesters for having the courage to overcome fear.“People see us organized, and they say, wow, you are fearless,” he said. “Oh no. If you are fearless in this moment, you’re not paying attention. The authoritarians over there, they’re taking over our democracy.”But congressional Republicans, too, felt fear, he said. “They are projecting strength right now. They’re acting as if this is inevitable. They’re acting as if they have the power, you know, passing a bill through the House in the middle of night. [But] that’s not strength, pushing it through before the public can comment on it“The truth is, they’re terrified. They are terrified their voters are going to see what they’re doing. They’re terrified they’re going to lose their majority. And you know what? They should be terrified.” More