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      Former CDC official ‘only sees harm’ to public health under RFK Jr’s leadership

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      The former immunizations director of the Centers for Disease Control and Prevention has warned of the future of American health under the leadership of Donald Trump’s health secretary, Robert F Kennedy Jr.In an interview on Sunday with ABC, Demetre Daskalakis – who resigned this week in protest over the White House’s firing of CDC director Susan Monarez – said: “From my vantage point as a doctor who’s taken the Hippocratic Oath, I only see harm coming.”He went on to add: “I may be wrong, but based on what I’m seeing, based on what I’ve heard with the new members of the Advisory Committee for Immunization Practices, or ACIP, they’re really moving in an ideological direction where they want to see the undoing of vaccination.”Daskalakis’s interview comes amid growing chaos across US health agencies and rare bipartisan pushback towards the White House’s firing of Monarez, which came amid steep budget cuts to the CDC’s work as well as growing concerns of political interference.There have also been growing public calls for Kennedy to resign, particularly as he has continued to make questionable medical and health claims – and be lambasted in response by experts and lawmakers alike.Explaining his resignation, Daskalakis said: “I didn’t think that we were going to be able to present science in a way free of ideology, that the firewall between science and ideology has completely broken down. And not having a scientific leader at CDC meant that we wouldn’t be able to have the necessary diplomacy and connection with HHS to be able to really execute on good public health.”Daskalakis also criticized Kennedy’s recent changes to the childhood Covid-19 vaccine schedule, noting that the vaccine is currently approved only for people aged 65 and older, as well as for children and adults with underlying health conditions.“That’s not what the data shows. Six months old to two years old, their underlying condition is youth. 53% of those children hospitalized last season had no underlying conditions. The data say that in that age range, you should be vaccinating your child. I understand that not everybody does it, but they have limited access by narrowing that recommendation. Insurance may not cover it,” Daskalakis said.He also cast doubt on Jim O’Neill, the new CDC chief who was a top aide to Kennedy and has no training in medicine or infectious disease science.In response to whether or not he trusts O’Neill saying that he is in favor of vaccines, Daskalakis said: “Honestly, I really want to trust it … But based on the very first post that I’ve seen from him on X where he says that CDC scientists manipulated data to be able to follow an ideology or an agenda in the childhood schedule, makes me think that I know what leader he serves, and that leader is one that does not believe in vaccination.”In a Saturday op-ed for the New York Times, Vermont senator Bernie Sanders accused Kennedy of “endangering the health of the American people now and into the future”, adding: “He must resign.”Since he assumed leadership over the health department, Kennedy – a longtime anti-vaccine advocate – has fired health agency workers and entertained conspiracy theories. Last week, more than 750 current and former employees at US health agencies signed a letter in which they criticized Kennedy as an “existential threat to public health”.The health agency workers went on to accuse the health secretary of being “complicit in dismantling America’s public health infrastructure and endangering the nation’s health by repeatedly spreading inaccurate health information”.The letter comes after a deadly shooting at the CDC headquarters in Atlanta earlier this month, when a 30-year-old gunman fired more than 180 rounds into the buildings, killing a police officer before dying from a self-inflicted gunshot wound. The shooter had been struggling with mental health issues and was influenced by misinformation that led him to believe the Covid-19 vaccine was making him sick, according to the gunman’s father. More

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      US health department moves to strip thousands of employees of collective bargaining rights

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      The US Department of Health and Human Services (HHS) has moved to strip thousands of federal health agency employees of their collective bargaining rights, according to a union that called the effort illegal.HHS officials confirmed Friday that the department is ending its recognition of unions for a number of employees and reclaiming office space and equipment that had been used for union activities.It’s the latest move by the Trump administration to put an end to collective bargaining with unions that represent federal employees. Previously affected agencies include the Department of Veterans Affairs (VA) and the Environmental Protection Agency (EPA).In May, an appeals court said the administration could move forward with Donald Trump’s executive order that the president aimed at ending collective bargaining rights for hundreds of thousands of federal employees while a lawsuit plays out.“This action ensures that HHS resources and personnel are fully focused on safeguarding the health and security of the American people,” department spokesperson Andrew Nixon said in a statement.Officials with the American Federation of Government Employees said strong union contracts do not hinder strong responses to public health emergencies. Rather, they help make agencies like the Centers for Disease Control and Prevention (CDC) have a stable, experienced and supported workforce, the union said.Some CDC employees said the union has been a source of information and advocacy for the agency’s employees during layoffs this year and in the wake of the 8 August shooting attack at the CDC’s main campus in Atlanta.Since then, the union has been trying to advocate for a better emergency alert system and better security.Other affected agencies include the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Administration for Strategic Preparedness and Response and the Office of Refugee Resettlement within the Administration for Children and Families. More

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      ‘Distracting the public’: group of health professionals call for RFK Jr to be removed

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      A grassroots organization of health professionals have released a report outlining major health challenges in the US and calling for the removal of Robert F Kennedy Jr from the US Department of Health and Human Services (HHS).The report from Defend Public Health, a new organization of about 3,000 health professionals and allies, is an attempt to get ahead of misinformation and lack of information from health officials.In an effort to keep making progress in public health, Defend Public Health’s report was slated to coincide with that of the anticipated second US report to “make America healthy again” (Maha). The first Maha report was released in May, and a second report was expected this week – but amid turmoil at the health agencies, it has reportedly been delayed for several weeks.“The Maha report is essentially a distraction from the real causes of poor health,” said Elizabeth Jacobs, professor emerita at the University of Arizona and a founding member of Defend Public Health.“This administration does not want to address things like poverty and education and access to healthcare. Instead, they’re distracting the public with information on solutions to problems that don’t actually exist. When the foundation of your policy is not evidence-based, it will collapse.”The Defend Public Health report diverges from the previous Maha focus on issues such as processed foods and environmental chemicals, but it covers familiar ground in public health.The group highlights the importance of food safety, security and access to food, including through the Supplemental Nutrition Assistance Program (Snap), and improved opportunities for physical activity.They seek to ensure equitable access to vaccines; expand access to healthcare, including comprehensive sexual and reproductive healthcare access; and build strategies for clean air.The report also recommends fully funding scientific research and public health systems; combatting scientific misinformation, including from the US government; and strengthening pandemic preparedness. They call for reductions in gun violence, now the number one cause of death for children.And their last recommendation is to remove Robert F Kennedy Jr, secretary of the US Department of Health and Human Services (HHS), from office, calling his removal “the single most important step toward improving the health of Americans”.The recommendations are exactly what the US needs to address to become healthier, said Georges Benjamin, executive director of the American Public Health Association (APHA). If you “look at the things that actually kill people, from the 10 leading causes of death, that is indeed the right list”.The US spends twice as much on healthcare as the next industrialized country, despite having poorer health outcomes, Benjamin pointed out.“The fracturing of our healthcare system undermines the accessibility of healthcare,” Benjamin said before noting that the US also spends less than other countries on the social determinants of health and social supports, and invests less in primary care and prevention.Such gaps are getting worse under the second Trump administration, with huge cuts to Medicaid, affordable housing, and nutrition programs like Snap.“If they’re serious about making America healthy again, I would suggest that we first begin by feeding children,” Jacobs said. “When, for example, RFK Jr is talking about food dyes, I don’t think that that is anywhere near as important as the fact that 13 million children in the United States do not know where their next meal is coming from.”Scientific misinformation is an “existential threat” to Americans, and the US government is a “major source” of misinformation and disinformation now, Jacobs said.The first Maha report “contains misinformation and uses references that don’t even exist”, she noted. The Defend Public Health report has a tongue-in-cheek note that it was “created by real human experts relying on real rigorous data”.Jacobs recommended working with social media companies, “one of the biggest amplifiers of misinformation”, to address the spread of harmful information. Educating children on how to evaluate the quality and accuracy of information is also important, she said.But one of the biggest purveyors of health misinformation is Kennedy himself.“Everything that he is doing is horrifying,” Jacobs said. “There is a saying in public health, ‘saving lives a million at a time’, and he is doing the opposite of that.”skip past newsletter promotionafter newsletter promotionShe called him a “genuine threat” who is “devastating” public health.“He has no knowledge, training or experience in any type of science. He’s never done an experiment, he’s never written a paper, he’s never gotten a grant to study anything. He has no understanding of the underlying causes of poor health in the United States,” Jacobs said.Defend Public Health launched in November, after Trump’s re-election because, as Jacobs said, “it was very clear to us that public health specifically was going to be under attack.”“We knew that it was going to be a tough fight. I don’t think that any of us knew how bad this was going to get, how quickly. But we are doing everything in our power to support our fellow researchers, public health workers, anybody that we can, and also continue to get accurate information out to the public,” Jacobs said.The group joins other established health organizations as well as other newcomers like the Vaccine Integrity Project to serve as reliable sources of information.There’s a long history of groups like these providing outside perspectives on official recommendations, Benjamin said. But the federal government is uniquely positioned to speak to the health of all Americans.“Pediatricians certainly have the nation’s trust around vaccines for kids, but there’s a big debate about at what point does a kid become an adolescent, become an adult? At what point do they go into the adult health system?” he said.That creates confusion around which advice a patient should follow. The same may be true of a patient who becomes pregnant, or someone who may fall under the purview of multiple health organizations. It’s not always easy to know who belongs in which group.“We have to be careful that each of these private sector organizations align our recommendations, so that we don’t further confuse the public,” Benjamin said.Yet, Benjamin continued, “as the federal government withdraws in its responsibility to protect the public, groups like ours will become more influential in filling that void until we can get the federal government again to step up into that place as a trusted advisor.”Benjamin and Jacobs – and other experts in these groups – hope that the federal government will once again become a source of reliable information.“We really wanted to start building a framework so that we’re ready when we have the opportunity to start putting some of our policy recommendations in place,” Jacobs said.“There is just rampant chaos right now around public health and science related to this administration, and we have got to stand firm and keep bringing the conversation back to the actual causes of poor health among Americans. I can’t control what the government is going to decide to do. What we can do is continue to provide accurate information to the public.” More

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      Gunman in CDC attack fired over 180 shots at building and broke 150 windows

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      The man who attacked the CDC headquarters in Atlanta on Friday fired more than 180 shots into the campus and broke about 150 windows, with bullets piercing “blast-resistant” windows and spattering glass shards into numerous rooms, according to information circulated internally at the agency.It may take weeks or even months to replace windows and clean up the damage, Centers for Disease Control and Prevention personnel said.A Georgia man who had blamed the Covid-19 vaccine for making him depressed and suicidal opened fire late on Friday, killing a police officer. No one at CDC was injured.The shooter was stopped by CDC security guards before driving to a nearby pharmacy and opening fire late Friday afternoon, a law enforcement official has told the AP. The official wasn’t authorized to publicly discuss the investigation and spoke on condition of anonymity. The 30-year-old man, Patrick Joseph White, later died, but authorities haven’t said whether he was killed by police or killed himself.The US health secretary, Robert F Kennedy Jr, traveled to Atlanta and on Monday met with the agency’s director, Susan Monarez.Monarez posted a statement on social media on Friday night that said at least four CDC buildings were hit in the attack.The extent of the damage became more clear during a weekend CDC leadership meeting. Two CDC employees who were told about what was discussed at the meeting described details to the Associated Press on condition of anonymity because they weren’t authorized to reveal the information. Details also were also in an agency memo seen by an AP reporter.Building 21, which houses Monarez’s office, was hit by the largest number of bullets. CDC officials did not say if her office was hit.CDC employees were advised to work from home this week.Kennedy issued a statement on Saturday that said “no one should face violence while working to protect the health of others,” and that top federal health officials were “actively supporting CDC staff”.He did not speak to the media during his visit on Monday.A retired CDC official, Stephan Monroe, said he worried about the long-term impact the attack would have on young scientists’ willingness to go to work for the government.“I’m concerned that this is going to be a generational hit,” said Monroe, speaking to a reporter near the corner where a poster had been set up in honor of David Rose, the officer who was killed.Kennedy was a leader in a national anti-vaccine movement before Donald Trump selected him to oversee federal health agencies, and has made false and misleading statements about the safety and effectiveness of about Covid-19 shots and other vaccines.Years of false rhetoric about vaccines and public health was bound to “take a toll on people’s mental health”, and “leads to violence”, said Tim Young, a CDC employee who retired in April.Dr Jerome Adams, the US surgeon general during President Trump’s first administration, said on Sunday that health leaders should appreciate the weight of their words.“We have to understand people are listening,” Adams told Face the Nation on CBS. “When you make claims that have been proven false time and time again about safety and efficacy of vaccines, that can cause unintended consequences.” More

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      Top medical body concerned over RFK Jr’s reported plans to cut preventive health panel

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      A top US medical body has expressed “deep concern” to Robert F Kennedy Jr over news reports that the health secretary plans to overhaul a panel that determines which preventive health measures including cancer screenings should be covered by insurance companies.The letter from the the American Medical Association comes after the Wall Street Journal reported on Friday that Kennedy plans to overhaul the 40-year old US Preventive Services Task Force because he regards them as too “woke”, according to sources familiar with the matter.During his second term, Donald Trump has frequently raged against organizations and government departments that he considers too liberal – often without any evidence. The US president, and his cabinet members such as Kennedy, have also overseen huge cuts and job losses across the US government.The taskforce is made up of a 16-member panel appointed by health and human services secretaries to serve four-year terms. In addition to cancer screenings, the taskforce issues recommendations for a variety of other screenings including osteoporosis, intimate partner violence, HIV prevention, as well as depression in children.Writing in its letter to Kennedy on Sunday, the AMA defended the panel, saying: “As you know, USPSTF plays a critical, non-partisan role in guiding physicians’ efforts to prevent disease and improve the health of patients by helping to ensure access to evidence-based clinical preventive services.”“As such, we urge you to retain the previously appointed members of the USPSTF and commit to the long-standing process of regular meetings to ensure their important work can be continued without disruption,” it added.Citing Kennedy’s own slogan of “Making America healthy again,” the AMA went on to say: “USPSTF members have been selected through an open, public nomination process and are nationally recognized experts in primary care, prevention and evidence-based medicine. They serve on a volunteer basis, dedicating their time to help reduce disease and improve the health of all Americans – a mission well-aligned with the Make America Healthy Again initiative.”According to the Affordable Care Act, public and private insurance companies must cover any services recommended by the Preventive Services Task Force without cost sharing.In a statement to MedPage Today, Department of Health and Human Services spokesperson Andrew Nixon did not confirm the reports, instead saying: “No final decision has been made on how the USPSTF can better support HHS’ mandate to Make America Healthy Again.”Reports of Kennedy’s alleged decision to overhaul the taskforce come after the American Conservative published an essay earlier this month that described the taskforce as advocating for “leftwing ideological orthodoxy”.It went on to accuse the panel of being “packed with Biden administration appointees devoted to the ideological capture of medicine”, warning that the “continued occupation of an important advisory body in HHS – one that has the capacity to force private health insurers to cover services and procedures – by leftwing activists would be a grave oversight by the Trump administration”.In response to the essay, 104 health organizations, including the American Medical Association, issued a separate letter to multiple congressional health committees in which they urged the committees to “protect the integrity” of the taskforce.“The loss of trustworthiness in the rigorous and nonpartisan work of the Task Force would devastate patients, hospital systems, and payers as misinformation creates barriers to accessing lifesaving and cost effective care,” the organizations said.In June, Kennedy removed all 17 members of a US Centers for Disease Control and Prevention panel of vaccine experts. Writing in a Wall Street Journal op-ed, he accused the committee of having too many conflicts of interest.Kennedy’s decision to overhaul the immunization panel was met with widespread criticism from health experts, with the American Public Health Association executive director Georges Benjamin calling the ouster “a coup”.“It’s not how democracies work. It’s not good for the health of the nation,” Benjamin said. More

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      Democrats use new tactic to highlight Trump’s gutting of Medicaid: billboards in the rural US

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      The road to four struggling rural hospitals now hosts a political message: “If this hospital closes, blame Trump.”In a series of black-and-yellow billboards erected near the facilities, the Democratic National Committee (DNC) seeks to tell voters in deep red states “who is responsible for gutting rural healthcare”.“UNDER TRUMP’S WATCH, STILWELL GENERAL HOSPITAL IS CLOSING ITS DOORS,” one sign screams. The billboards are outside hospitals in Silex, Missouri; Columbus, Indiana; Stilwell, Oklahoma; and Missoula, Montana.The fate of rural hospitals has become a politically contentious issue for Republicans, as historic cuts pushed through by the GOP are expected to come into effect over the next decade. Donald Trump’s enormous One Big Beautiful Bill Act (OBBBA) cut more than $1tn from Medicaid, the public health insurance program for low-income and disabled Americans, insuring more than 71 million adults.“Where the real impact is going to be is on the people who just won’t get care,” said Dave Kendall, a senior fellow for health and fiscal policy at Third Way, a center-left advocacy organization.“That’s what used to happen before we had rural hospitals – they just don’t get the care because they can’t afford it, and they can’t get to the hospital.”In response to criticism, Republicans added a $50bn “rural health transformation fund” just before passage of the OBBBA. The fund is expected to cover about one-third of the losses rural areas will face, and about 70% of the losses for the four hospitals where Democrats now have nearby billboards. The rural health fund provides money through 2030, while the Medicaid cuts are not time-bound.That is already becoming a political football, as Democrats argued in a letter that the money is a “slush fund” already promised to key Republican Congress members.“We are alarmed by reports suggesting these taxpayer funds are already promised to Republican members of Congress in exchange for their votes in support of the Big, Ugly Betrayal,” wrote 16 Democratic senators in a letter to Dr Mehmet Oz, Trump’s head of Medicare and Medicaid.View image in fullscreen“In addition, the vague legislative language creating this fund will seemingly function as your personal fund to be distributed according to your political whims.”Rural hospitals have been under financial strain for more than a decade. Since 2010, 153 rural hospitals have closed or lost the inpatient services which partly define a hospital, according to the University of North Carolina Sheps Center for Health Services Research.“In states across the country, hospitals are either closing their doors or cutting critical services, and it’s Trump’s own voters who will suffer the most,” said the DNC chair, Ken Martin, in a statement announcing the billboards.The OBBBA is expected to further exacerbate those financial strains. A recent analysis by the Urban Institute found rural hospitals are likely to see an $87bn loss in the next 10 years.“We’re expecting rural hospitals to close as a result – we’ve already started to see some hospitals like, ‘OK, how are we going to survive?’” said Third Way’s Kendall.skip past newsletter promotionafter newsletter promotionA June analysis by the Sheps Center found that 338 rural hospitals, including dozens in states such as Louisiana, Kentucky and Oklahoma, could close as a result of the OBBBA. There are nearly 1,800 rural hospitals nationally, according to the Kaiser Family Foundation (KFF), a healthcare research non-profit.That perspective was buttressed by the CEO of the National Rural Health Association, Alan Morgan, who in a recent newsletter said 45% of rural hospitals are already operating at a loss.“When you remove $155bn over the next 10 years, it’s going to have an impact,” he said.In the fragmented US healthcare ecosystem, Medicaid is both the largest and poorest payer of healthcare providers. Patients benefit from largely no-cost care, but hospitals complain that Medicaid rates don’t pay for the cost of service, making institutions that disproportionately rely on Medicaid less financially stable. In rural areas, benefit-rich employer health insurance is harder to come by; therefore, more hospitals depend on Medicaid.But even though Medicaid pays less than other insurance programs, some payment is still better than none. Trump’s OBBBA cut of more than $1tn from the program over the coming decade is expected to result in nearly 12 million people losing coverage.When uninsured people get sick, they are more likely to delay care, more likely to use hospital emergency rooms and more likely to struggle to pay their bills. In turn, the institutions that serve them also suffer.“This is what Donald Trump does – screw over the people who are counting on him,” said Martin, the DNC chair. “These new DNC billboards plainly state exactly what is happening to rural hospitals under Donald Trump’s watch.” More

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      ‘We need some hope’: can a rural hospital on the brink survive Trump’s bill?

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      When her severely allergic toddler, Josie, began gasping for breath in the middle of the night, Krissy Cunningham knew there was only one place she could get to in time to save her daughter’s life.For 74 years, Pemiscot Memorial hospital has been the destination for those who encounter catastrophe in Missouri’s poorest county, a rural stretch of farms and towns in its south-eastern Bootheel region. Three stories of brown brick just off Interstate 55 in the town of Hayti, the 115-bed hospital has kept its doors open even after the county’s only Walmart closed, the ranks of boarded-up gas stations along the freeway exit grew, and the population of the surrounding towns dwindled, thanks in no small part to the destruction done by tornadoes.For many in Pemiscot county, its emergency room is the closest available without taking a 30-minute drive across the Mississippi river to Tennessee or the state line to Arkansas, a range that can make the difference between life and death for victims of shootings, overdoses or accidents on the road. In the wee hours of one spring morning, it was there that Josie received the breathing treatments and a racemic epinephrine shot that made her wheezing subside.“There is no way I would have made it to one of the farther hospitals, if it wouldn’t have been here. Her airway just would have closed off, and I probably would have been doing CPR on my daughter on the side of the road,” recalled Cunningham, a nurse who sits on the hospital’s board.View image in fullscreenYet its days of serving its community may be numbered. In May, the hospital’s administration went public with the news that after years of struggling with high rates of uninsured patients and low reimbursement rates from insurers, they may have to close. And even if they do manage to navigate out of their current crisis, Pemiscot Memorial’s leaders see a new danger on the horizon: the “big, beautiful bill” Republicans pushed through Congress earlier this month, at Donald Trump’s request.Centered around an array of tax cuts as well as funds for the president’s mass deportation plans, the bill will mandate the largest funding reduction in history to Medicaid, the federal healthcare program supporting low-income and disabled Americans. That is expected to have ripple effects nationwide, but will hit particularly hard in Pemiscot county and other rural areas, where hospitals tend to have frail margins and disproportionately rely on Medicaid to stay afloat.“If Medicaid drops, are we going to be even collecting what we’re collecting now?” asked Jonna Green, the chairwoman of Pemiscot Memorial’s board, who estimated 80% of their revenue comes from Medicaid as well as Medicare, another federal health program primarily for people 65 and older. “We need some hope.”The changes to Medicaid will phase in beginning in late 2026, and require enrollees to work, volunteer or attend school 80 hours a month, with some exceptions. States are also to face new caps on provider taxes, which they use to fund their Medicaid programs. All told, the non-partisan Congressional Budget Office forecasts that 10 million people nationwide will lose their healthcare due to the bill, which is nonetheless expected to add $3.4tn to the federal budget deficit through 2034.Trump carried Missouri, a midwestern state that has veered sharply away from the Democratic party over the past three decades, with more than 58% of the vote last November. In Pemiscot county, where census data shows more than a quarter of residents are below the poverty line and the median income is just over $40,000 a year, he was the choice of 74% of voters, and Republican lawmakers representing the county played a notable role in steering his tax and spending bill through Congress.Senator Josh Hawley publicly advocated against slashing the healthcare program, writing in the New York Times: “If Republicans want to be a working-class party – if we want to be a majority party – we must ignore calls to cut Medicaid and start delivering on America’s promise for America’s working people.” He ultimately supported the bill after a $50bn fund to help rural hospitals was included, but weeks later introduced legislation that would repeal some of the very same cuts he had just voted for.“I want to see Medicaid reductions stopped and rural hospitals fully funded permanently,” the senator said.View image in fullscreenJason Smith, whose district encompasses Pemiscot county and the rest of south-eastern Missouri, oversaw the crafting of the measure’s tax provision as chairman of the House ways and means committee, and has argued they will bring prosperity rural areas across the state. Like others in the GOP, he has said the Medicaid cuts will ferret out “waste, fraud and abuse”, and make the program more efficient.It’s a gamble for a state that has seen nine rural hospitals close since 2015, including one in a county adjacent to Pemiscot, with a further 10 at immediate risk of going under, according to data from the Center for Healthcare Quality and Payment Reform policy group.The Missouri Budget Project thinktank estimates that the bill will cost 170,000 of the state’s residents their health coverage, largely due to work requirements that will act as difficult-to-satisfy red tape for Medicaid enrollees, while the cap on provider taxes will sap $1.9bn from the state’s Medicaid program.“There’s going to be some really hard conversations over the course of the next five years, and I think that healthcare in our region will look a lot different than what it does right now,” said Karen White, CEO of Missouri Highlands Health Care, which operates federally qualified health centers providing primary and dental care across rural south-eastern Missouri. She forecasts 20% of her patients will lose Medicaid coverage through 2030.As the bill was making its way through Congress, she contacted the offices of Smith, Hawley and Missouri’s junior senator, Eric Schmitt, all politicians she had voted for, asking them to reconsider cutting Medicaid. She did not hear back.“I love democracy. I love the fact that we as citizens can make our voices heard. And they voted the way that they felt they needed to vote. Maybe … the larger constituency reached out to them with a viewpoint that was different than mine, but I made my viewpoint heard,” White said.Spokespeople for Schmitt and Smith did not respond to requests for comment. In response to emailed questions, a spokeswoman for Hawley referred to his introduction of the legislation to partially stop the Medicaid cuts.Down the road from the hospital lies Hayti Heights, where there are no businesses and deep puddles form in the potholes and ditches that line roadways after every thunderstorm. Mayor Catrina Robinson has a plan to turn things around for her 500 or so residents, which involves bringing back into service the water treatment plant that is the town’s main source of revenue. But that is unlikely to change much without Pemiscot Memorial.“Half of those people that work at the hospital, they’re my residents. So how they gonna pay their bills? How they gonna pay their water bill, how they gonna pay their light bill, how they gonna pay rent? This is their source of income. Then what will they do?” Robinson said.View image in fullscreenTrump’s bill does include an array of relief aimed at the working-class voters who broke for him in the last election, including tax cuts on tips and overtime pay and deductions aimed at senior citizens. It remains to be seen if whatever financial benefits those provisions bring to the workers of Pemiscot county will outweigh the impact of the stress the Medicaid cuts place on its healthcare system.“The tax relief of server’s tips and all that, that’s not going to change the poverty level of our area,” said Loren Clifton, the hospital’s administrative director. “People losing their healthcare insurance absolutely will make it worse.”Work can be found in the county’s corn, wheat, soybean and rice fields, at a casino in the county seat Caruthersville and at a shipyard along the banks of the Mississippi . But Green questions if those industries would stick around if the hospital goes under, and takes with it the emergency room that often serves to stabilize critical patients before transferring them elsewhere.View image in fullscreen“Our community cannot go without a hospital. Healthcare, employment, industry – it would devastate everything,” Green said.The board is exploring partnerships with other companies to help keep the hospital afloat, and has applied for a federal rural emergency hospital designation which they believe will improve their reimbursements and chances of winning grants, though that will require them to give up other services that bring in revenue. For many of its leaders, the stakes of keeping the hospital open are personal.“This is our home, born and raised, and you would never want to leave it. But I have a nine-year-old with cardiac problems. I would not feel safe living here without a hospital that I could take her to know if something happened,” said Brittany Osborne, Pemiscot Memorial’s interim CEO.One muggy Wednesday morning in July, Pemiscot’s three county commissioners, all Republicans, gathered in a small conference room in Caruthersville’s courthouse and spoke of their resolve to keep the hospital open.“It’s 50-50 right now,” commissioner Mark Cartee said of the hospital’s chances of survival. “But, as long as we have some money in the bank of the county, we’re going to keep it open. We need healthcare. We got to have a hospital.”They were comparatively sanguine about the possibility that the Medicaid work requirements would harm the facility’s finances down the line.“We got a guy around here, I guess he’s still around. He’s legally blind but he goes deer hunting every year,” commissioner Baughn Merideth said. “There’s just so much fraud … it sounds like we’re right in the middle of it.”A few blocks away, Jim Brands, owner of Hayden Pharmacy, the oldest in the county, had little doubt that there were those in the county who took advantage of Medicaid. He also believed that fewer enrollees in the program would mean less business for his pharmacy, and more hardship overall.View image in fullscreen“Just seeing this community, the situation it’s in, the poverty, we’ve got to get people to work. There are a ton of able-bodied people that could work that choose not to,” he said.“To me, there’s got to be a better way to weed out the fraud and not step on the toes of the people who need it.” More

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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