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      This doctor calls LGBTQ+ rights ‘satanic’. He could now undo healthcare for millions

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      Steven Hotze, a Republican donor from Texas, has spent decades fighting against LGBTQ+ rights, with campaigns seeking to roll back protections for people he has deemed “termites”, “morally degenerate” and “satanic”.The Houston-area physician is not well-known in mainstream politics, and his efforts targeting queer and trans people have generally been local, with limited impact.His latest cause could be different. Hotze, 74, has sued the federal government to roll back healthcare coverage for pre-exposure prophylaxis (PrEP), the HIV prevention medication. The case is now before the US supreme court, which is expected to rule in the coming weeks. A decision in his favor could upend healthcare access for LGBTQ+ people across the country – and derail a wide array of preventive treatments for tens of millions in the process.“People will die,” said Kae Greenberg, staff attorney with the Center for HIV Law and Policy, which filed a brief in the case. “Preventive healthcare saves lives, and this case is about whose lives we consider worth protecting. It’s about cutting off people’s care based on them being gay or substance users or living their lives in a way the plaintiffs do not approve of. It’s using the law to legitimize bigotry.”The case, Kennedy v Braidwood, originated with Hotze’s Christian healthcare firm, Braidwood Management, which filed a lawsuit in 2020 objecting to the federal requirement that his company’s insurance plan cover PrEP. Braidwood, another Christian business and two individuals argued the daily PrEP medications “facilitate and encourage homosexual behavior”, saying the government violated their religious beliefs by making them support “sexual promiscuity”.Braidwood challenged the requirement under the Affordable Care Act, also known as Obamacare, that insurers and group health plans cover preventive services, a provision that includes diabetes and cancer screenings, medications to reduce heart disease risks, contraception and vaccinations. Along with opposing PrEP, Hotze explicitly objected to STI screenings, counseling for alcohol use and childhood obesity interventions.A Texas district court sided with Braidwood, saying the US violated the firm’s religious freedom. The ruling also found that a taskforce of medical experts that recommended the preventive services covered by the ACA was unconstitutional because the experts hadn’t been confirmed by the Senate, and therefore health plans should not be required to cover the care.The US government appealed the ruling on the taskforce, which is the issue now before the supreme court. The coverage mandates have remained in effect as the case has progressed, though the individual plaintiffs have been shielded from covering the services. The Trump administration has continued to defend the taskforce’s constitutionality, and the supreme court is not weighing religious objections.If the supreme court sides with Braidwood, it could lead to widespread loss of access to free preventive healthcare, with one study finding 39 million people received the threatened services. A 2023 Yale study estimated the loss of free PrEP could result in more than 2,000 preventable HIV infections within one year.The outcome of the case could threaten coverage for every service recommended by the taskforce, not just the provisions opposed by the right. “We’re talking about people who cannot afford this care, who will have to choose between a mammogram and rent,” added Susan Polan, associate executive director of the American Public Health Association.A decades-long missionThe high-stakes case, and Hotze’s role in it, have flown under the radar. But research from the progressive watchdog organization Accountable.US, which shared its findings with the Guardian, reveal the rightwing activist’s long history of pushing fringe ideologies before getting a signature cause before the supreme court.Hotze and his lawyers did not respond to requests for comment.In 1982, 31-year-old Hotze launched a petition in the city of Austin to legalize housing discrimination against gay people, the AP reported at the time. Heading a group called Austin Citizens for Decency, Hotze called gay residents “criminals” and “sodomites”, saying: “The issue is not housing. The issue is whether we allow our city council to grant public sanction to homosexual activity.” He said protecting LGBTQ+ people from discrimination is “like thieves or murderers trying to gain political power”. Hotze said in one interview he was less concerned about “property rights” and more worried about the “deviant, perverted lifestyle”. Voters overwhelmingly rejected his referendum.In 1985, Hotze backed a group of eight “anti-homosexual” Houston city council candidates identified as the “straight slate”. On ABC News, he stated, “We’re intolerant of those who participate in homosexual activity.” All eight candidates lost.Hotze runs the Hotze Health & Wellness Center, which has been in operation since 1989; Braidwood is his management firm that employs the center’s staff. He has marketed hormone therapies to treat a wide range of conditions and sold a vitamin product called Skinny Pak, the New York Times reported. Over the years, he has donated extensively to the Republican party and Texas politicians, including Senator Ted Cruz.Hotze’s public anti-LGBTQ+ activism picked up after the supreme court legalized gay marriage nationwide in 2015, with Hotze launching a “Faith Family Freedom Tour” and using the same homophobic language from his activism decades prior. Hotze said he was fighting a “wicked, evil movement” that celebrates anal sex, telling the Houston Chronicle: “Kids will be encouraged to practice sodomy in kindergarten.”View image in fullscreenDuring the tour, he said “satanic cults” were behind gay rights, brandished a sword during a speech, and likened his fight to battling Nazis, the Texas Observer reported. That year, he and other rightwing activists successfully campaigned to repeal an equal rights Houston ordinance.At a 2016 evangelical conference, Hotze was filmed describing the LGBTQ+ rights movement as “termites [that] get into the wood of the house and … eat away at the moral fabric”. In 2017, Hotze rallied for Roy Moore, the failed Alabama senate candidate accused of sexually coercing teenagers in the 1970s.Hotze has also recently promoted anti-trans causes, testifying in 2023 in favor of a school district policy requiring staff to notify parents if students change their names or pronouns. Trans people, he said, “have a reprobate, perverted and morally degenerate mind”.His ACA case was not his first effort to undo federal civil rights protections. In a case that began in 2018, Braidwood sued the Equal Employment Opportunity Commission (EEOC), challenging a ban on anti-LGBTQ+ discrimination in the workforce. Braidwood said it enforces a “sex-specific dress code that disallows gender-non-conforming behavior”, the courts summarized, prohibiting women from wearing ties and men from wearing nail polish. Hotze said he would not employ candidates engaged in “sexually immoral” behaviors.In 2023, an appeals court ruled that a religious freedom law protected Hotze’s rights to enforce dress codes and refuse to hire LGBTQ+ people.In that case, and in the one now before the supreme court, Hotze has been represented by America First Legal, the rightwing legal group co-founded by Stephen Miller, Donald Trump’s influential adviser. The organization has brought a string of lawsuits, including efforts to undo trans rights and complaints accusing companies of discriminating against white men.Hotze has also been represented by Jonathan Mitchell, an anti-abortion lawyer behind Texas’s so-called “bounty hunter law” that allows private citizens to sue providers or people who “aid or abet” the procedure.America First Legal and Mitchell did not respond to inquiries.Gabbi Shilcusky, Accountable.US senior investigative specialist, noted that Hotze’s supreme court case was founded on hypotheticals: “He’s not hiring men who wear nail polish or are asking for PrEP. This is manufactured to build upon his most fringe beliefs and not about actual issues he’s being confronted with in his company.”Hotze has in recent years made headlines outside of anti-LGBTQ+ advocacy. In 2020, during George Floyd protests, he left a voicemail for the Texas governor urging that he “kill the son of a bitches”, referring to demonstrators. Later that year, the Food and Drug Administration sent his company a warning advising it was promoting “unapproved and misbranded products” for Covid.In 2022, Hotze was charged with unlawful restraint and aggravated assault with a deadly weapon in an elections dispute. Hotze hired a contractor who claimed a local air conditioner repairman was holding fraudulent ballots in his truck. The contractor ran his vehicle into the man’s car and held him at gunpoint, according to prosecutors, who said the voter fraud claims were false. Hotze was later charged with aggravated robbery and organized criminal activity from the incident.View image in fullscreenHotze pleaded not guilty, and this week, a newly elected DA dropped the charges, accusing his predecessor of bringing a politically motivated case. The criminal case did not stop his attacks on voting rights; in October, just before the election, he filed a lawsuit against the local registrar seeking to invalidate tens of thousands of voters.It’s unclear if Hotze will succeed at the supreme court. In oral arguments last month, some justices, including conservatives, appeared skeptical of the arguments by Hotze’s lawyers. The case hinges on whether the taskforce members who make ACA recommendations are akin to department heads requiring Senate approval or are “inferior” officers. Brett Kavanaugh and Amy Coney Barrett at times appeared sympathetic to the notion that the experts are not sufficiently independent so as to merit a congressional vote.The case is part of longstanding attacks against the ACA, with legal strategies focused on religious claims as well as objections to how the law was crafted. Hotze previously challenged the ACA in a failed lawsuit that began in 2013, an effort he promoted with a bizarre original song called God Fearing Texans Stop Obamacare.Even if Hotze fails, the threats to PrEP and LGBTQ+ healthcare will continue, said Jeremiah Johnson, executive director of advocacy group PrEP4All, noting the Trump administration’s continued funding cuts and dismantling of HIV prevention, and ongoing rightwing efforts to attack civil rights under the guise of religious liberty.The case also comes as the FDA is considering a new injectable PrEP considered a major prevention breakthrough, he said. “We’re at the precipice of science delivering real pathways to ending this epidemic, but if we turn our backs now on all these protections, including private insurance through the ACA, we’re not just going to backtrack on progress, we’re going to lose out on that promise for the future.” More

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      Key takeaways: RFK Jr’s ‘Maha’ report on chronic disease in children

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      Donald Trump’s health secretary and long-time vaccine skeptic, Robert F Kennedy Jr, presented a highly anticipated report on children’s health this week.The “Maha commission” report, referring to the “Make America healthy again” movement, was required by a presidential executive order in February. The report focuses on chronic disease among children.The 68-page report broadly summarizes five areas affecting children’s health, with a focus on ultra-processed foods, environmental chemical exposure, lack of physical activity, “overmedicalization”, and “capture” of regulatory agencies.It notably omits some of the most common causes of chronic disease and death in children, insinuates there could be harms where there is lack of evidence, and avoids discussing how Republicans have already changed the health system in ways researchers believe are harmful.Art Caplan, a professor of bioethics at New York University’s Grossman School of Medicine, told the Guardian that the report has “interesting ideas about health and children’s health and crackpot fringe tin-hat-wearing nonsense – it’s got it all”.Here are five of the key takeaways from the report.1. The report ignores some common dangers to childrenThe most common causes of death among children are car crashes and firearm accidents. The report ignores these issues, as well as behaviors that often start in adolescence and lead to chronic disease in adulthood, such as smoking and alcohol use. It also criticizes water fluoridation, without mentioning its protective effects against cavities.Also, absent from the report is a discussion of how the administration has already changed the health department in ways that advocates argue will benefit industry and could exacerbate chronic disease.For instance, Kennedy eliminated two smoking prevention offices at the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) in what one former regulator told Stat was “the greatest gift to the tobacco industry in the last half century”. He also eliminated a world-leading sexually transmitted infection laboratory.In another example, one of the nation’s leading researchers of ultra-processed foods quit his “dream job” after facing what he described as censorship from the administration (the health department reportedly asked him to return). In a similar vein, the Trump administration cut a program that delivered local whole foods to schools soon after taking office, in spite of Kennedy calling for healthier school meals.2. The report focuses on issues key to Kennedy’s view of healthThe report is roughly broken up into five sections focusing on ultra-processed foods, environmental chemical exposures, children’s mental health, “overmedicalization” and “corporate capture” of regulators by the industries they are supposed to oversee.Kennedy has harped on many of the issues listed in the report for months in public appearances and even though his defunct presidential campaign – especially including ultra-processed foods and obesity. Although some of these concerns may find bipartisan support – such as the focus on “forever chemicals” such as Pfas – it also pushes into areas where the science is unsettled.For instance, the report mentions that high levels of fluoride are potentially associated with reduced IQ, but does not mention its well-established protective effects against cavities – the most common chronic condition in children, according to the National Institute of Dental and Craniofacial Research.Similarly, the report argues that the childhood vaccine schedule is causing concern among parents for,“their possible role in the growing childhood chronic disease crisis” – without citing evidence that vaccines are linked to any specific chronic disease.3. It’s likely to face diverse pushback – and create new alliancesEven before the report was published, congressional lawmakers were being bombarded by calls from agricultural and chemical lobbyists wary of how the report would criticize their products – and indeed it did.One of the report’s sections questions whether “crop protection tools” including “pesticides, herbicides and insecticides” could harm human health. It then specifically name-drops glyphosate, the key ingredient in Roundup, and atrazine, a common herbicide. That is sure to make for strange political bedfellows and consternation within the Republican party. Similarly, the report cites synthetic dyes and ultra-processed foods are potentially harmful.Chemicals and food additives have been issues of concern for decades on the left. However, the Maha movement has also catalyzed opposition to them on the right.4. The report’s authors are not namedThe commission’s members are made up of the heads of intersecting agencies, including Kennedy at the Department of Health and Human Services, and the heads of the departments of agriculture, housing, education, veterans affairs and the Environmental Protection Agency, among others.However, the exact authors of the report are unknown. This contrasts with Kennedy’s repeated promise at his confirmation hearing that his health department would practice “radical transparency”.The work of the “Maha” commission was reportedly spearheaded by senior Kennedy adviser Calley Means, a former food lobbyist and healthcare entrepreneur who rose to prominence as a Maha truth-teller. Means co-wrote a bestselling book with his sister, current US surgeon general nominee Casey Means, which blames many of America’s ills on sedentary lifestyle and poor diet.5. Changing any of the issues identified is likely to be toughOne of the key issues the report identifies is the influence of food, pharmaceutical and chemical companies on American policy. They are monied and powerful.As a result, getting real change through Congress is certain to be tough – especially in an administration devoted to reducing regulations. More

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      Forget the DEI hires – meet Trump’s latest WTF hire | Arwa Mahdawi

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      The US health secretary doesn’t think you should really listen to him when it comes to health issues. During an appearance before House and Senate committees this week, Robert F Kennedy Jr, famous for his unconventional views about medicine and his revelation that a parasite ate part of his brain, seemed to think it was strange that lawmakers were asking him about vaccines.“What I would say is my opinions about vaccines are irrelevant,” Kennedy said when pressed on whether he would vaccinate his child for measles. “I don’t want to seem like I’m being evasive, but I don’t think people should be taking advice, medical advice, from me.” The US health secretary repeated his refrain about not wanting to give advice a number of other times.I, on the other hand, am desperate to dole out a bit of advice. Namely: it would probably be a good idea if a few people who actually knew what they were talking about were brought into the US government. I know, I know. Look at me being a crazy idealist! Still, at the very least, it might be wise to at least ensure that the people who are in charge of health issues know a thing or two about medicine.Alas, judging by some of Donald Trump’s latest appointments, it would seem that I am asking far too much. See, for example, Dr Casey Means, who was nominated for US surgeon general last week. Means has got “Dr” in front of her name, which sounds promising, but she’s more of an influencer than a practitioner. Though she trained as a surgeon at Stanford, she never completed her medical residency afterward. Why? She says it’s because she was disillusioned with traditional medicine, but a former colleague told the Los Angeles Times that it was due to anxiety. Means also doesn’t have an active medical license. In short: she wouldn’t be able to get a job as a doctor at your local hospital but she’s being considered for the role of “the nation’s doctor”. As for experience working in government? She doesn’t have any of that, either.What Means does have, Trump announced in a recent social media post, are “impeccable ‘MAHA’ credentials”. That’s the “Make America healthy again” movement: a movement that is preoccupied with some very valid issues (processed food, corruption in the health industry) but mired in conspiracist thinking. Means has been on TV a lot to talk about Maha obsessions such as removing fluoride from drinking water. She also makes money from dietary supplements that she promotes on social media and has co-authored a book with her brother that claims “almost every chronic health symptom that Western medicine addresses is the result of our cells being beleaguered by how we’ve come to live”. Which, of course, isn’t completely false but has been accused of being overly simplistic. Means’s brother, by the way, is also a prominent adviser to Kennedy.So are all the Maha crowd rejoicing in the streets at the idea of Means becoming surgeon general? Not quite. Her nomination has actually sparked Maha infighting. Some Maha voices think Means is not extreme enough, particularly when it comes to the Covid shot. These people seem to want a surgeon general who declares Covid was a hoax and bans vaccines altogether.The far-right conspiracy theorist Laura Loomer, meanwhile, who seems to have become one of Trump’s most influential albeit unofficial advisers, isn’t happy with Means because she thinks she’s unserious. Writing on Twitter/X, Loomer said Means “PRAYS TO INANIMATE OBJECTS, COMMUNICATES WITH SPIRIT MEDIUMS, USES SHROOMS AS ‘PLANT MEDICINE’ AND TALKS TO TREES! SHE ALSO DOESN’T EVEN HAVE AN ACTIVE MEDICAL LICENSE.”Loomer isn’t the only one a little worried about Means’s enthusiasm for psychedelic drugs including magic mushrooms – which the prospective surgeon general once suggested in a newsletter helped her find a romantic partner. Psilocybin, a psychedelic compound found in certain mushrooms, is currently listed as a schedule I drug, defined as a substance “with no currently accepted medical use and a high potential for abuse”.Means should probably be a little worried about what Loomer thinks, as Loomer may have played a part in ousting Trump’s original pick for the position. That was Janette Nesheiwat, a former Fox News medical contributor and the sister-in-law of Mike Waltz, the former national security adviser. On X this month, Loomer called Nesheiwat “a pro-Covid vaccine nepo appointee” who “didn’t go to medical school in the US”. (Nesheiwat has said that she got a degree from the University of Arkansas School of Medicine, but it would seem that she actually earned her medical degree from a school in Sint Maarten.)Will Loomer topple Means before her confirmation (which hasn’t been scheduled yet) as well? I don’t know but I can tell you that if she does, it’s unlikely that her successor will be any more qualified. The Trump administration, as we all know, has been waging war on diversity, equity and inclusion (DEI). If you’re a (non-Trump-loving) woman or a minority, it doesn’t seem to matter how many qualifications you have, you’re automatically considered a “DEI hire” and looked upon with suspicion. Many prominent people in the Trump administration, meanwhile, seem to be WTF hires. They are there because they’re white, Trumpy and often in the family of someone influential (or they have been on Fox News). Whether we get Means or not, you can be sure that whoever is confirmed as the nation’s top doctor will be completely unqualified to treat the US’s Trump-induced ailments.

      Arwa Mahdawi is a Guardian columnist More

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      Conservatives are trumpeting a new abortion-pill study. One problem: it’s bogus | Moira Donegan

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      Almost two-thirds of US abortions are induced with pills. The drug mifepristone blocks the pregnancy hormone progesterone, ending the growth of the fetus. Mifepristone was designed for abortions: its primary purpose, from its development through its regulatory approval and now on the market, has always been to allow women to control their own bodies and lives by ending their pregnancies. Because it exists as a tool of women’s independence, mifepristone has been the object of controversy, misinformation and intense scrutiny for the entirety of its existence. Originally synthesized by French pharmaceutical researchers in 1980, the drug went through a rigorous, prolonged and heavily politicized approval process in the US, and wasn’t approved by the Food and Drug Administration (FDA) for the US market until 2000.The anti-abortion movement – including several prominent Republican lawmakers – is looking to undo that. Since the 2022 Dobbs v Jackson Women’s Health Organization decision that eliminated the nationwide right to abortion, women living in anti-choice states have relied increasingly on mifepristone, particularly pills shipped by mail from providers in pro-choice states who prescribe the drug via telehealth. It is estimated that as many as 20% of abortions in the US are now accessed via telehealth appointments, a technological marvel that has allowed many people living in anti-choice states to avert the worst consequences to their lives, health and dignity that were threatened by the Dobbs decision by circumventing the unjust abortion bans that their states have attempted to impose on them. Dobbs has already been devastating for American women, causing needless deaths, driving up maternal mortality, derailing women’s lives, constraining their prospects, and injuring their standing as equal citizens. The post-2022 explosion of telehealth abortion using mifepristone is the reason why the consequences have not been even worse.Now, Trump’s new FDA commissioner, Marty Makary, is under pressure to restrict access to the drug. Pressed by reporters at the Semafor World Economy Summit late last month, Makaray said that he had “no plans” to review the status of mifepristone. But he added a crucial caveat: that he would reconsider the drug’s accessibility if new information emerged about the drug’s safety. “If the data suggests something or tells us that there’s a real signal, we can’t promise that we’re not going to act on that data,” he said.As if on cue, a conservative thinktank published a new study just days later that purported to find that mifepristone caused serious adverse effects in more than 10% of patients. The study – which contradicts all previous tests of the drug and the resounding consensus of the medical field – was published by the Ethics and Public Policy Center, a rightwing advocacy group that aims to “apply the richness of the Jewish and Christian traditions to contemporary questions of law” and “push back against the extreme progressive agenda while building a consensus for conservatives”.The study was rapidly amplified on conservative social media, and was pushed by several Republican senators who had previously called on Makaray to ban mifepristone at his March confirmation hearing. Missouri’s Josh Hawley, the author of a book on “manhood” who once raised a fist in solidarity with the January 6 insurrectionists, declared in a statement directed at Makaray: “Well, the new data is here. And it’s a signal that can’t be missed: Mifepristone is not safe.” Hawley went on to urge the FDA to restrict access to the drug and revert to pre-pandemic regulations, in which mifepristone could only be dispensed by a doctor after multiple in-person visits: a regulatory regime that would cut off abortion access to millions of women in anti-choice states.But the study that is being proposed as a pretext for restricting abortion access has come under scrutiny from doctors and statisticians for its questionable methodology. Drawing from insurance claim data from 2017 to 2023, the EPPC study claims that 10% of women who take mifepristone experience “sepsis, infection, hemorrhaging, an emergency room visit, or another serious adverse event within 45 days”. This would be alarming if it were true, but it isn’t.Instead, the study seems to have been designed to dramatically overstate the side-effects of mifepristone, in part by counting the normal and intended functioning of the drug – such as vaginal bleeding as the pregnancy terminates and post-medication doctor visits to confirm the completion of the miscarriage – as serious adverse effects. The study also claimed that a vast range of health experiences in the 45 days following the medication – such as mental health symptoms – were caused by the drug, a claim that the data does not support. The EPPC study also seems to include those who were prescribed mifepristone for non-abortion uses, such as miscarriage management, as well as those who took it alone, without the standard misoprostol dose that accompanies it. The study is not peer-reviewed and has not been published in a medical journal, because its authors could not meet the standards that such publication requires: their work is not up to snuff. Dr Stella Dantas, the president of the American College of Obstetricians and Gynecologists, called the paper “seriously flawed” and said that it “manipulates data to drive a myth that medication abortion isn’t safe”.The truth is that abortion pills have a lower rate of serious complications than Tylenol, and that the anti-abortion movement is in fact a great danger to American women’s health. It is because of abortion bans – not abortion access – that women in America are facing dramatically rising rates of “sepsis, infection, hemorrhaging” and death in pregnancy. In Texas alone, the rate of sepsis in pregnant women experiencing second-trimester miscarriages increased by more than 50% in the years since the state’s near-total abortion ban went into effect, and experts say that the laws prohibiting abortion are the cause. The adverse effects that the anti-abortion movement sees in mifepristone’s availability is not a matter of women’s health, which they are indifferent to. It is women’s freedom.

      Moira Donegan is a Guardian US columnist More

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      Trump health cuts create ‘real danger’ around disease outbreaks, workers warn

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      Mass terminations and billions of dollars’ worth of cuts at the Department of Health and Human Services (HHS) have gutted key programs – from child support services to HIV treatment abroad – and created a “real danger” that disease outbreaks will be missed, according to former workers.Workers at the HHS, now led by Robert F Kennedy Jr, and in public health warned in interviews that chaotic, flawed and sweeping reductions would have broad, negative effects across the US and beyond.While Donald Trump’s administration is cutting the HHS workforce from 82,000 to 62,000 through firings and buyouts, grant cuts by Elon Musk’s so-called “department of government efficiency” (Doge) have also had a stark impact on state governments – and resulted in firings at state public health agencies.At the South Carolina department of public health, for example, more than 70 staff were laid off in March due to funding cuts.“Disease surveillance is how we know when something unusual is happening with people’s health, like when there are more food-poisoning cases than usual, or a virus starts spreading in a community,” an epidemiologist at the department, whose role was eliminated, said. “It’s the system that lets us spot patterns, find outbreaks early, and respond before more people get sick.”“When you lose public health staff, you lose time, you lose accuracy, you lose responsiveness, and ultimately that affects people’s health,” they added. “Without us, outbreaks can fly under the radar, and the response can be delayed or disorganized. That’s the real danger when these roles get cut.View image in fullscreen“It’s invisible work, until it’s not. You may not think about it day to day, but it’s protecting your drinking water, your food, your kids’ schools and your community.”A spokesperson for South Carolina’s public health department declined to comment on specifics, but noted employees hired through grants are temporary. “When funding for grants is no longer available, their employment may end, as happened with some temporary grant employees who were funded by these grants,” they said.In Washington, the HHS has been cut harder by Doge than any other federal department. Hundreds of grants to state, local and tribal governments, as well as to research institutions, have been eliminated, worth over $6.8bn in unpaid obligations.The HHS receives about a quarter of all federal spending, with the majority disbursed to states for health programs and services such as Medicare and Medicaid, the insurance programs; medical research; and food and drug safety. Trump’s budget proposal calls for cutting the department’s discretionary spending by 26.2%, or $33.3bn.RFK Jr, who has a history of promoting conspiracy theories and medical misinformation, was nominated by Trump and approved by the Senate along party lines, with Mitch McConnell the sole Republican dissenter.Following a reduction in force of 10,000 employees on 1 April, Kennedy Jr claimed 20% of the firings were in error and that those workers would be reinstated, though that has not happened.An HHS spokesperson blamed any such errors on data-collection issues, and did not comment on any other aspects of the Guardian’s reporting.Aids relief program ‘dismantled’At the Centers for Disease Control and Prevention, an operating division of the HHS, employees working on maternal and child health at the President’s Emergency Plan for Aids Relief (Pepfar) program were shocked to be included in the reduction in force, as earlier in the administration their work had received a waiver for parts of the program from federal funding freezes.All federal experts on HIV prevention in children overseas were fired as part of the reduction in force.“Our concern initially was that it was a mistake with the name. We hoped around that time it came out that there were 20% errors, that we would be included,” said an epidemiologist who was included in the reduction in force, but requested to remain anonymous as they are currently on administrative leave. They also noted that they were in the middle of planning and delivering a new pediatric HIV treatment medication set to be dispersed this year, and that that work was now at risk.View image in fullscreenThey said 22 epidemiologists in the branch of their CDC division had been fired. Pepfar was created in 2003 by George W Bush to prevent mother-to-child HIV transmission and credited with saving 26 million lives.“We were very shocked on April 1 that we were put immediately on admin leave,” said another epidemiologist affected by the reduction in force at the CDC. “We really feel our branch being cut was a mistake. The state department had said services were a priority and needed to continue, but then we were cut by HHS.”They noted HIV treatment had already stopped in regions of countries that had been reliant on USAID programs, such as Zambia.“It is one of the most successful global health programs in history, data driven with high levels of accountability and the dollars spent achieve impact. Our concern now is, yes, they are continuing Pepfar in name, but they are dismantling all the systems and structure that allowed it to succeed,” they added. “The US made a huge investment in this program in 20 years and a lot of it is now undone. We’ve now disrupted those systems that could have reduced and eventually removed US investment in these programs.”‘Long-term impact’ on US familiesInside the HHS, the Administration for Children and Families is responsible for enforcing court-ordered child-support payments. For every dollar it receives in federal funding, ACF says it is able to collect $5 in child support.A child-support specialist with the HHS, who requested to remain anonymous for fear of retaliation, said reductions in force at the department have increased workloads on those who were not fired by multiple times, making it so state and tribal agencies have no way of ensuring they are compliant with federal requirements.“The regional staff with direct oversight of the program are gone,” they said. “There are entire regions that have two staff members managing a quarter of the work for the program with no management, no support, no knowledge of the program.”After the Trump administration took office, the agency was under an unofficial stop-work order, where staff were not permitted to provide guidance or support to grantees or even answer phones, until late February, the specialist said. A reduction in force followed on 1 April, when, the child-support specialist claimed, about half the ACF staff working on child support were fired.Their department is responsible for overseeing child-support programs at state, tribal and local levels. States “could very well lose millions of dollars in funding” if ACF does not provide key training and assistance and the states do not have qualified staff, the specialist cautioned. “And that is the long-term impact to vulnerable children and families in the country.”They added: “The entire function of the program is to give economic stability to children and families, so that they do not depend on any other government program, or their reliance on these programs is lower, because the children are supported by both parents.”‘A living hell’At the Centers for Medicare and Medicaid Services, also within the HHS, one of 300 workers terminated as part of a reduction in force claimed it had been illegal, and had not followed any proper procedures. The National Treasury Employees Union has filed a grievance over how the firings were carried out, including incorrect information on notices.They explained that, on 1 April, they received a generic letter informing them of an intent of reduction in force. Hours later, they were locked out of their government logins. “We started emailing the management that was left, trying to get clarification on what our status was. Nobody could give us an answer,” the worker said.On 7 April, they discovered through their paystub that they had been placed on administrative leave, despite never receiving a notice. They didn’t receive an RIF notice until weeks later, after requesting it.“Based on my tenure, and as a disabled veteran, I should at least have a chance of reassignment,” they said. “I’m not mad about losing my job. It happens. I’ve been laid off. The first time was in the private sector, and it was way more humane, more empathetic, and I was given different offers.“This, on the other hand, is unbridled hate. This administration has gone out of their way to make it a living hell for all of its public servants.” More

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      Indiana passes law threatening non-profit status of expensive hospitals

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      Indiana’s governor, Mike Braun, has signed a landmark bill that would strip charity hospitals of their non-profit status if they continue to charge high prices.The legislation, the first of its kind in the United States, followed uproar across the state after a Guardian series in October that investigated how one major Indiana non-profit hospital system bought up its competition, then hiked its prices, leaving businesses and patients struggling to pay their medical costs.In the wake of the Guardian investigation, Braun, then the Republican gubernatorial candidate, and his Democratic rival both criticized the hospital system, Parkview Health, for its high prices, and lawmakers vowed to take action against the non-profit chain, which charged some of the highest prices in the country despite being based in Fort Wayne, Indiana, the US’s most affordable metro area.Braun signed the legislation into law on Tuesday. It comes at a time of growing concern across the US about healthcare costs and medical debt.To implement the law, the Indiana office of management and budget will first study prices across the state and come up with a price benchmark for non-profit hospitals in consultation with the legislature, according to the bill’s author, Martin Carbaugh, a Republican representative who represents a district that includes Fort Wayne. Non-profit hospitals will then have until 2029 to get their prices under that average, though Carbaugh hopes some will lower their prices before then as they negotiate with insurers.“We’ll start to see the downward pressure put on them right away,” he said. “The hospitals know they can’t just go for broke and raise costs, only to have to lower it again in 2029.”According to data compiled by Hoosiers for Affordable Healthcare, an Indiana advocacy group, the legislation could result in average price reductions as large as 40% for Parkview, and similarly sized cuts for other large state hospital systems.“It’s gonna be beneficial to everybody,” said Doug Allen, a small business owner who has struggled to keep up with Parkview’s healthcare costs for his employees. “Maybe people won’t be hurting so bad. Maybe they won’t think twice before coming to the hospital. Almost everybody around here is on a payment plan with Parkview. Everybody owes money to Parkview.”Parkview Health did not respond to requests for comment but has previously said it is committed to lowering healthcare costs.In a statement, the Indiana Hospital Association said it was “concerned by the potential loss of non-profit status for hospitals based on meeting an unknown statewide average commercial price in the future. This does not take into consideration the uncertainty of rising cost pressures such as tariffs, inflation, and other significant economic factors that will further threaten the financial stability of Indiana’s health care ecosystem.”The group added that it looks forward to “continuing our work with legislators and Gov Braun’s administration on future solutions that strike the right balance of lowering costs while maintaining access for Hoosier patients”.The US spends far more on healthcare than other large, wealthy countries, a trend that has been exacerbated by decades of hospital consolidation limiting competition in the healthcare sector. Carbaugh said he was aware of how high healthcare prices are across the country and said Indiana’s legislation might be a model for other states too.“It’s great to be a leader,” he said. “I’m happy to be part of leading that charge.” More

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      in US Politics

      Protecting democracy is not enough: five things Americans must fight for | Huck Gutman

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      A recent dinner was peaceable until it was just about over, when a friend’s son spoke up in praise of a middle-of-the-road columnist and how his opposition to Donald Trump’s attack on democracy revealed that we were all on the progressive left now.“Not true,” I responded with more vehemence than I expected. “Wanting democratic norms is not sufficient; it is merely a precondition for meaningful change.” Making sure the US’s plumbing was secure did not mean that anything of importance would pass through the pipes.There has been a great outcry about the erosion of democratic practices during these first hundred days of the second Trump presidency. Many Americans, probably a solid majority, are appalled at the attack on our courts and judges, at the willful ignoring of habeas corpus, at the intrusion of unelected figures – not just Elon Musk, but his whole “department of government efficiency” (Doge) team – into the privacy of American lives, at the undoing of the independence of agencies intended to protect the public.But protecting democracy is not enough. It is a rearguard action, one that fights against incursions that would transform the United States into an oligarchic state serving special interests. It does not address the needs of the larger public. Fighting for procedures and not substance is insufficient.Those who fight for the future of our nation need to fight not just against threats, but for a just and equitable future. Too often the well-deserved plaudits for those who fight against do not extend to articulating a program of what the American nation needs, in addition to democratic institutions.Here are five specific suggestions for what we should be fighting for. Without these reforms, defenses of democracy ring hollow, elevating a defense of form while denying any attention to substance.First, the nation needs a new minimum wage, a living wage, not the residue of 1938 legislation called the Fair Labor Standards Act. No one can live on $7.25 an hour, which translates to about $15,000 a year.Second, Americans deserve healthcare as a right. A Medicare for All system would extend healthcare to every person. Its cost would be more than offset by eliminating the 25% of healthcare spending that goes for overhead in our private-insurance-dominated system. Cutting $1tn of needless bureaucratic expenses and bill-keeping would ensure that we have the money to provide healthcare to everyone.Third, Americans should find it easy to join unions if they wish. The decline in unionization is a major reason why, as the wealthy get ever wealthier, wages have been flat or declining for almost 50 years. As it stands, the table is tilted toward management. Corporations regulate all employee concerns, from wages to healthcare to retirement benefits, leaving workers little to no chance to say what they actually want. We must level that playing field so that workers together can fight for their needs.Fourth, we need to increase taxes on the wealthy. There is no reason that Warren Buffett, as he has said, should pay a lower tax rate than his secretary. Increasing the marginal tax rate for the highest earners, limiting the exorbitant pass-throughs of the inheritance tax, and ending the unhealthy practice of taxing paper gains in wealth, or capital gains, less than the money earned by workers would diminish the federal deficit and at the same time fund many needed services to Americans. Removing the cap on income subject to social security taxes would ensure the solvency of the nation’s pension program for generations.Fifth, we should reverse the deeply damaging Citizens United decision, which enabled the wealthy and their special interests to buy elections. Currently, money and not votes determines the priorities of the United States. If the supreme court does not reverse this decision, a constitutional amendment limiting contributions – one person, one vote, with a low limit on individual contributions and no contributions by corporations – would fix this loophole, which has corrupted all of American politics.skip past newsletter promotionafter newsletter promotionThere is, rightly, much concern about the undemocratic moves made by the Trump administration. But unless we demand changes in what the United States does, unless we do more than just defending the practices of democracy, our society will remain dysfunctional. Those who focus only on the process of maintaining the pipes required for quenching our thirst, without giving us actual water to drink, are fighting only a small part of the battle.What’s giving me hope nowWe need to fight for democracy, but we also need to fight for the achievable goals democracy can bring us, particularly economic justice for all Americans. Raising wages, providing healthcare to all, fostering unions, taxing the wealthy and corporations, preventing big money from buying elections: these are the things the renewal of democracy can and should bring us.

      Huck Gutman is a former chief of staff to Senator Bernie Sanders and an emeritus professor at the University of Vermont More

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      in US Politics

      Trump nominates Dr Casey Means, influencer close to RFK Jr, for surgeon general

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      Donald Trump has tapped Dr Casey Means, a wellness influencer with close ties to Robert F Kennedy Jr, the US health secretary, as nominee for surgeon general after withdrawing his initial pick for the influential health post.The US president said in a social media post on Wednesday that Means has “impeccable ‘MAHA’ credentials” – referring to the “make America healthy again” slogan – and that she will work to eradicate chronic disease and improve the health and wellbeing of Americans.“Her academic achievements, together with her life’s work, are absolutely outstanding,” Trump said. “Dr Casey Means has the potential to be one of the finest Surgeon Generals in United States History.”The news signals Trump’s withdrawal of his original pick for the post: Janette Nesheiwat, a former Fox News medical contributor. It marks at least the second health-related pick from Trump to be pulled from Senate consideration. Nesheiwat had been scheduled to appear before the Senate health, education, labor and pensions committee on Thursday for her confirmation hearing.Means and her brother, former lobbyist Calley Means, served as key advisers to Kennedy’s longshot 2024 presidential bid and helped broker his endorsement of Trump last summer. The pair made appearances with some of Trump’s biggest supporters, winning praise from conservative pundit Tucker Carlson and podcaster Joe Rogan. Calley Means is currently a White House adviser who appears frequently on television to promote restrictions on Snap benefits, removing fluoride from drinking water and other Maha agenda items.Casey Means has no government experience and dropped out of her surgical residency program, saying she became disillusioned with traditional medicine. She founded a health tech company, Levels, that helps users track blood sugar and other metrics. She also makes money from dietary supplements, creams, teas and other products sponsored on her social media accounts.In interviews and articles, Means and her brother describe a dizzying web of influences to blame for the nation’s health problems, including corrupt food conglomerates that have hooked Americans on unhealthy diets, leaving them reliant on daily medications from the pharmaceutical industry to manage obesity, diabetes and other chronic conditions.Few health experts would dispute that the US diet – full of processed foods – is a contributor to obesity and related problems. But Means goes further, linking changes in diet and lifestyle to a raft of conditions including infertility, Alzheimer’s, depression and erectile dysfunction.“Almost every chronic health symptom that Western medicine addresses is the result of our cells being beleaguered by how we’ve come to live,” Means said in a 2024 book co-written with her brother.Food experts say it’s overly simplistic to declare that all processed foods are harmful, since the designation covers an estimated 60% of US foods, including products as diverse as granola, peanut butter and potato chips.“They are not all created equal,” said Gabby Headrick, a nutrition researcher at George Washington University’s school of public health. “It is much more complicated than just pointing the finger at ultra-processed foods as the driver of chronic disease in the United States.”Means has mostly steered clear of Kennedy’s debunked views on vaccines. But on her website, she has called for more investigation into their safety and recommends making it easier for patients to sue drugmakers in the event of vaccine injuries. Since the late 1980s, federal law has shielded those companies from legal liability to encourage development of vaccines without the threat of costly personal injury lawsuits.She trained as a surgeon at Stanford University but has built an online following by criticizing the medical establishment and promoting natural foods and lifestyle changes to reverse obesity, diabetes and other chronic diseases.If confirmed as surgeon general, Means would be tasked with helping promote Kennedy’s sprawling Maha agenda, which calls for removing thousands of additives and chemicals from US foods, rooting out conflicts of interest at federal agencies and incentivizing healthier foods in school lunches and other nutrition programs.Nesheiwat, Trump’s first pick, is a medical director for an urgent care company in New York and has appeared regularly on Fox News to offer medical expertise and insights. She is a vocal supporter of Trump and shares photos of them together on social media. Nesheiwat is also the sister-in-law of former national security adviser Mike Waltz, who has been nominated to be Trump’s ambassador to the United Nations.Nesheiwat also recently came under criticism from Laura Loomer, a far-right ally of Trump who was instrumental in ousting several members of Trump’s national security council. Loomer posted on Twitter/X earlier this week that “we can’t have a pro-COVID vaccine nepo appointee who is currently embroiled in a medical malpractice case and who didn’t go to medical school in the US” as the surgeon general.Independent freelance journalist Anthony Clark reported last month that Nesheiwat earned her medical degree from the American University of the Caribbean School of Medicine in St Maarten, despite saying that she has a degree from the University of Arkansas School of Medicine.The surgeon general, considered the nation’s doctor, oversees 6,000 US Public Health Service Corps members and can issue advisories that warn of public health threats.In March, the White House pulled from consideration the nomination of former Florida Republican Dave Weldon to lead the Centers for Disease Control and Prevention. His skepticism on vaccines had raised concerns from key Republican senators, and he withdrew after being told by the White House that he did not have enough support to be confirmed.The withdrawal was first reported by Bloomberg News. More