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Category: Medicaid

California’s Billionaire Tax Promises Healthcare Relief. The Fine Print Is Murkier.

The pitch behind California’s billionaire tax proposal is simple: Tax the richest residents in the nation’s wealthiest state to offset steep federal cuts to healthcare, food assistance, and education.

But if approved by voters in November, it’s unclear how much money the ballot initiative would raise, how quickly the funding would become available, and how lawmakers would spend it.

The measure would steer proceeds from a first-in-the-nation wealth tax to a state healthcare fund, giving the governor and lawmakers the power to decide how to spend what California’s nonpartisan legislative analyst estimated would be “tens of billions of dollars.” Backers say it could raise up to $100 billion over five years to keep hospitals and emergency rooms open and preserve insurance coverage for millions of Californians. Yet, community health centers, doctors, and other healthcare entities that might benefit from such a cash infusion argue that the union spearheading the measure has readied a blank check for politicians.

“I’m not sure that you can say, with full security, that this will stop clinics from being closed or healthcare workers from being laid off, or people from losing their healthcare,” said Chris Hoene, executive director of the California Budget & Policy Center, a left-leaning nonprofit.

Taxing the Ultrarich

Put on the ballot by one of California’s largest healthcare unions, Proposition 40 would impose a one-time 5% tax on roughly 200 Californians with a net worth of at least $1 billion, including most of their stock holdings, yachts, and artwork. It would apply to those who were residents of California on Jan. 1, 2026. Real estate, pensions, and retirement accounts would generally be exempt.

The revenue raised is intended to offset the roughly $30 billion a year in anticipated losses to the Golden State from congressional Republicans’ One Big Beautiful Bill Act. Over the next four years, state and federal funding cuts are projected to nearly double California’s uninsured population, which stands at about 2.4 million people, according to the University of California-Berkeley Labor Center.

Securing additional tax revenue is essential because state lawmakers have yet to come up with a way to pay for healthcare services that will be affected by the cuts, said Dave Regan, president of Service Employees International Union-United Healthcare Workers West, which represents hospital workers and got the wealth tax on the ballot. It would earmark 90% of the tax revenue for healthcare, while the remaining 10% would be split between food assistance and education at lawmakers’ discretion. Regan said such broad categories would give politicians flexibility to be more responsive to the looming cuts.

“Figuring out or predicting exactly what the fallout will be, of where reductions and cuts get made, in a complicated healthcare system, it’s just too difficult to predict,” Regan said.

Among the choices the next governor and lawmakers will face are whether to provide healthcare to people cut off by the new federal Medicaid work requirements, reverse state rollbacks limiting coverage for immigrants with legal status, or raise the low physician reimbursement rates that make some providers reluctant to accept patients enrolled in Medi-Cal, the state’s version of Medicaid.

Lawmakers could also shore up subsidies on Covered California, the state’s health insurance marketplace, whose enrollees have seen their premiums skyrocket after losing millions in federal assistance after Congress last year let enhanced subsides expire.

Most of the money must be spent on health, but healthcare experts said the measure’s ambiguous language could allow lawmakers to use the new billionaire health fund to replace existing state dollars, contrary to the text of the proposition.

“A lot of times these propositions are written in a way to get attention and get support,” said Glenn Melnick, a healthcare economist at the University of Southern California. “But in fact, they can be used for other things later.”

Instead, the healthcare industry is pushing for a long-term funding plan. René Bravo, a pediatrician in San Luis Obispo County and the president of the California Medical Association, worries that a one-time infusion of tax dollars “is going to run out.”

“We need to work on a more sustainable, durable funding mechanism for the Medi-Cal system,” he said.

At the same time, doctors are asking him what will happen when the biggest Medi-Cal eligibility cuts begin to take effect next year. Even if voters approve the ballot measure, the money wouldn’t be available for at least a few months while the state collects the tax. And billionaires could spread their payments over five years.

Californians Divided

Pasadena resident Lynne Wines, a 72-year-old retired banker, knows the state needs the money. But she worries that wealthy investors will see the measure as a precedent and flee the state. Even though the ballot measure is clear that it’s a one-time tax, Wines said it’s a slippery slope.

“Taxes have a way of being needed over and over, and politicians have a way of finding those needs,” Wines said. “So, I don’t really feel secure that this is just a one-time thing.”

She noted that Google co-founder and billionaire Sergey Brin bought a home in Nevada and moved some of his businesses to the Silver State late last year. He is backing ad campaigns opposing the measure. Brin has given more than $100 million to a nonprofit promoting two competing measures, Propositions 41 and 42, designed to blunt or block it, according to contributions filed with the secretary of state’s office. One would count some new state taxes toward California’s overall spending limit and require the state auditor to review new state tax proposals before voters weigh in. The other would prohibit new state taxes on personal property, intellectual property, retirement accounts, and other assets.

GOP gubernatorial candidate Steve Hilton, who has been endorsed by President Donald Trump, warned on CNN in June that just the threat of the tax “has sent trillions of dollars, by some estimates, of wealth leaving the state.” A March study by the conservative Hoover Institution at Stanford University projected that the billionaire tax would cost California $25 billion, citing, in part, the lost revenue from billionaires who have already left the state.

California voters appear torn over departing billionaires. Two independent September polls suggested voter support for Proposition 40 varied from a low of 45% to a high of 52%.

Pasadena resident Steve Erler, 74, works full-time as a building manager because he can’t afford to retire. He worries that federal cuts will hurt children and seniors.

Steve Erler of Pasadena, California, works full-time as a building manager because he can’t afford to retire. He worries that federal cuts will hurt children and seniors, and he supports a California ballot measure that would tax billionaires. (Jackie Fortiér/KFF Health News)

“These people who are making all this money, they can never spend it all. What are they going to do, buy another house in the Hamptons, buy another jet? They don’t need that,” Erler said while out walking his dog in August. “They need to be able to say when they go to bed at night, ‘I helped a child with healthcare. I helped a senior get fed.’ That’s what’s important,” he said.

Democrats are divided — one of many ideological fights playing out nationwide this election cycle as progressives take on more centrist candidates. U.S. Sen. Bernie Sanders (I-Vt.) and the California Democratic Party have endorsed Proposition 40, while Gov. Gavin Newsom, who is exploring a presidential bid, and Democratic gubernatorial nominee Xavier Becerra oppose it while saying that ultrawealthy or high-earning people should pay more. “It’s time for an economic reset, a true minimum tax on billionaires that, well, ensures the people at the very top pay at least the tax rate their own workers pay,” said Newsom, who supports a federal wealth tax, although legislation for a federal wealth tax in Congress has stalled.

If voters approve the ballot measure, political analysts said, it could show other states that taxing the wealthy may help close budget gaps and pay for essential services. Already several Democratic states, including Hawai‘i, Maine, Massachusetts, and Rhode Island, have approved millionaire taxes, but those have been limited to income, not overall wealth. Voters in Washington state will decide this fall whether to keep their millionaire tax.

“I do think this is just the beginning of these proposals nationwide,” said Melnick, the USC healthcare economist.

October 14, 2026
Pediatric Innovation Isn’t a Small-Market Problem, It’s an Incentive Problem

The case for investing in children’s health should be self-evident. As a society we have a responsibility to invest in the next generation, and few investments carry greater long-term benefit than helping children reach their healthiest possible futures.

When we diagnose and treat conditions early, we do more than improve a child’s health in the moment. We are altering the trajectory of their entire life: development of their personal confidence, resilience, mental wellbeing, learning capacity, and in many cases, also reducing decades of downstream public and private healthcare costs.

Yet, pediatric innovation remains chronically and systemically undervalued in healthcare.

That is not because the market for pediatric healthcare is small, it is because the incentives are misaligned. The cost of treating a child’s condition is incurred immediately. However, when early pediatric interventions are effective, their benefits often compound over decades.

No single stakeholder is incentivized to properly and accurately consider the full return on early pediatric interventions and support their adoption. The average tenure of a person staying on the same health plan is two to three years. As a result, private insurers are focused on cost savings that will be realized within that time frame, which for pediatric treatments especially, may only represent a small proportion of the overall benefit.

On the public insurance side, children are largely covered by Medicaid, and while pediatric health is a central tenet of Medicaid’s mission, the program is too often hamstrung by its structure. Unlike Medicare, which is entirely financed at the federal level, Medicaid is jointly financed between the federal government and each individual state. The program is often left underfunded, as its budget is subject to annual appropriations decisions by state legislators who have limited fiscal flexibility. Priorities are constantly changing, making long-term planning next to impossible for Medicaid decision makers.

That misalignment has consequences well before a new technology ever reaches a payer’s desk. When long-term pediatric outcomes are undervalued, the ripple effect moves backward through the entire innovation pipeline, shaping what gets funded, what gets studied, and what ultimately reaches patients.

Investors, wary of uncertain reimbursement and lower near-term returns, often direct capital toward adult indications with clearer paths to market. Drug and device developers may follow the same logic, deprioritize pediatric programs or skip pediatric studies. The result is a self-reinforcing cycle: limited investment leads to fewer pediatric success stories, which then reinforces the false perception that pediatric markets are too small or too risky to justify meaningful investment.

This is why pediatric innovation in healthcare must be evaluated differently.

Payers should require robust clinical evidence to make responsible coverage decisions. But the decision making framework for pediatric products should reflect the unique realities of childhood conditions: the value of early intervention, the long-term costs and consequences of undertreatment, and the potential for a therapy to alter a child’s life path before preventable challenges become permanent ones.

Policy leaders should also examine whether existing pediatric coverage pathways are actually keeping pace with modern innovation. In theory, we already have a powerful mechanism for this: the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. Under federal law, EPSDT mandates that Medicaid-enrolled children receive all medically necessary services to correct or ameliorate important pediatric conditions, regardless of whether those services are explicitly covered in a state’s standard plan. It is a visionary policy designed to ensure that no child is left behind by the structural limitations of our healthcare system. In practice, awareness of the EPSDT benefit among Medicaid beneficiaries is low, and Medicaid plans need to do more to streamline the approval process for EPSDT-covered technologies.

Investing in pediatric care is not simply a moral imperative. It is one of the most practical long-term investments the healthcare system can make.

The question is not whether children’s health is worth the investment, that answer is self-evident. The real question is whether our healthcare ecosystem has the foresight to correct these incentive structures before another generation of children bear the cost of our delay.

Photo: Suriyapong Thongsawang, Getty Images

Scott Xiao

Scott Xiao is the co-founder and CEO of Luminopia, a therapeutics company developing software-based interventions at the intersection of ophthalmology and neuroscience. Luminopia’s lead product is a novel FDA-cleared prescription digital therapeutic for amblyopia, the leading cause of vision loss in children, affecting approximately 1 in every 30 children. Scott founded Luminopia after leaving Harvard University at age 17, inspired by a classmate’s experience with amblyopia and the limitations of traditional treatment. He has led the company from early development through clinical validation, regulatory clearance and national commercialization, with the therapy now prescribed to more than 12,000 patients by 1,300+ providers at 600+ top eye institutes, children’s hospitals and private practices. Under his leadership, Luminopia became the first FDA-cleared virtual reality–based treatment for any medical condition. Scott has also spearheaded Luminopia’s real-world evidence strategy, including the development of the PUPiL Registry, which has been instrumental in securing both FDA label expansion and major payer coverage decisions. Scott has been recognized on Forbes 30 Under 30 list in Healthcare, MIT Technology Review Innovators Under 35, and Modern Healthcare’s 40 Under 40. Luminopia was also named one of TIME’s Best Inventions of 2023. Scott is a strong advocate for the role of technology in improving patient engagement and outcomes and is focused on expanding Luminopia’s pipeline to address additional neuro-visual conditions, including strabismus and vision loss following stroke or traumatic brain injury.

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.

October 12, 2026
Hidden Risks and Costs of Maternal/Infant Health that Health Plans Miss

Pregnancy and neonatal care are complex healthcare journeys requiring specialized insight to address and navigate the unique challenges involved. From clinical risks to social and non-clinical drivers of health, member engagement to the potential for overbilling, the need to control costs and improve outcomes has never been greater.

Access to reliable transportation can be an overlooked but critical barrier to maternal care. A missed prenatal visit can lead to complications that send the mother into labor well ahead of the due date, leading to a prolonged NICU stay. A long NICU stay can generate high medical costs, not to mention the stress on families potentially facing substantial medical expenses, the future health of the mother and child, and billing complexities. ProgenyHealth sees the bigger picture and understands how to work with health plans to manage these risks.

A new report from ProgenyHealth offers a window into how the business works with commercial and Medicaid health plans to close gaps in maternity and NICU care management that traditional programs overlook. Health plans benefit from the company’s experience and insight to address these challenges.

The process involves turning information gathered from extensive claims and clinical data, as well as case management interactions, into timely interventions that enhance the member experience, improve outcomes and manage costs. To download the white paper Beneath the Surface: The Hidden Risks and Costs Commercial and Medicaid plans Are Missing, fill in the form below:

Photo: Morten Falch Sortland, Getty Images

October 6, 2026
The MAHA Metamorphosis

[Editor’s note: This transcript was generated using transcription software. It has been edited for style and clarity.]

Julie Rovner: Hello, from KFF Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for KFF Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Oct. 1, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go.

Today we are joined via videoconference by Rachel Roubein of The Washington Post.

Rachel Roubein: Hey, everybody.

Rovner: Shefali Luthra of The 19th.

Shefali Luthra: Hello.

Rovner: And my KFF Health News colleague Rachana Pradhan.

Rachana Pradhan: Hi, Julie.

Rovner: Later in this episode, we’ll have my interview with Dr. Aaron Carroll of AcademyHealth about the undoing of the federal Agency for Healthcare Research and Quality, AHRQ, where most of the staff has been laid off or retired, and hundreds of grants have been canceled midcycle. But first, this week’s news.

So we haven’t talked about the Make America Healthy Again movement in a while. It was a big week for MAHA here in Washington, D.C., with a gigantic summit at what used to be the Trump [International] Hotel, down the street from the White House. But it was hardly the event you’d expect if you still think of MAHA as moms who want their kids to have access to healthier food grown with fewer pesticides. Rather, this event featured representatives from health companies with business before the federal government, paying sponsorships of up to $300,000 each to sit on panels with officials from said government to talk about everything from the use of psychedelic drugs to fraud-fighting to wearables and AI [artificial intelligence]. The panel featuring Medicare and Medicaid chief Dr. [Mehmet] Oz was somewhat bizarrely moderated by comedian Russell Brand, who’s awaiting trial on sexual misconduct charges back in England. What was this event supposed to accomplish?

Roubein: I think you kind of hit the nail on the head in terms of just thinking about the MAHA movement and sort of where it’s going next, because you had some people, more sort of MAHA activists, who were upset that it didn’t talk about some of the core issues of the MAHA base, like vaccines, like pesticides. There have been some influential MAHA activists who’ve been upset at the administration and disillusioned that it hasn’t done more to crack down on pesticide use, etc., have been upset at the Trump administration, and have been saying just weeks before the midterm elections that Republicans may lose some of these votes, and some so-called MAHA moms might sit out the elections. And I don’t think this summit did anything to persuade them to go and vote Republican in the midterms.

Rovner: Yeah, it did seem, it seemed a great get-together if you wanted to sort of commune with the people who regulate your products, on a public stage. But both the president and Health and Human Services Secretary Robert F. Kennedy Jr. have felt free of late to talk about vaccines, although obviously not at this summit. But it seems that the issue that had united most of MAHA that we were just talking about, pesticides and ultraprocessed food, have been back-burnered by the White House. Rachel, you wrote a story about this. What happened to the food agenda?

Roubein: Pretty notably, one of the big potential parts of the food agenda is this petition that was filed by David Kessler. He’s the former head of the FDA [Food and Drug Administration] under both Republican and Democratic administrations. And his petition, essentially — I talked to food safety experts about it — could have launched a process that could have forced the industry to reformulate some ultraprocessed foods eventually. So that could have been a big deal. The status of it: It was filed August 2025, and Kennedy earlier this year had done a response to it, where he wanted to have food companies produce any detailed safety studies showing that certain ingredients common in ultraprocessed foods are generally safe. And what I had heard from talking to people is that that potential push had been slow-walked at the White House. I obtained a March draft of the letter that Kennedy sent to the White House for review. Now, HHS pushed back on the assertion that it was slow-walked, but this isn’t the first time that administration officials had wanted to and planned to announce something. They had been working on a definition of ultraprocessed foods that they wanted to release back in August, and that was delayed at the last minute, them just putting out more information about this draft definition.

Rovner: I feel like there’s this tension between the MAHA movement, which started as a grassroots movement to crack down on corporate power, and the White House is sort of wanting to deregulate everything. Those two things seem to be kind of at loggerheads, and it looks for now like the corporations are winning. We saw this with the pesticides earlier in the year, with glyphosate, that the agricultural community fought back and said, You can’t make us stop using it, because we need it to produce food. And now it seems that the food producers are saying: You have a deregulatory agenda. Why are you talking about regulating us more? Is that, am I reading this right that the corporate power is winning, at least so far?

Pradhan: It’s still a Republican administration, right? Regardless of Secretary Kennedy’s sort of mandate and passions, he’s still working with and for people who do not like to use government to restrict or regulate or ban things. Even, if you think about, we’ve come a long way since this point. But when former first lady Michelle Obama tried to put healthier foods in schools, she was roundly criticized for embodying a nanny state and all these things. And now, the political winds have shifted. But I still think to go up against the party’s kind of traditional views on regulating business and corporate interests, it’s a swamp. What are you going to do? They’re not going to want to regulate a lot. And like you said, Julie, there are ample actions to date that show that there isn’t necessarily a desire to impose more regulations. It’s also an election year. They may not want to antagonize corporate interests when you’re trying to not see huge losses, especially in potentially the House and maybe even the Senate.

Rovner: Yeah, they have enough people who are mad at them. They don’t want to add to it.

Pradhan: Exactly.

Rovner: Well, of course, with every political split comes a new political opportunity. In Michigan, Democratic Senate nominee Abdul El-Sayed, who’s a prominent supporter of “Medicare for All,” is now trying to grab back some of those Democrats who gravitated to MAHA by unveiling something he’s calling the “Building a Healthier America” agenda, focusing on fewer pesticides, cleaner water, and healthier food. Rachel, you wrote about this. Might it work? Might Democrats be able to sort of reclaim some of these people who drifted to the Republicans along with RFK Jr.?

Roubein: I think it’s something that particularly some progressive Democrats are looking to, and they might look to do if they win back the House. In the Farm Bill, you saw Republicans and — some Republicans — and Democrats push back against giving pesticide makers immunity liability shields. But I think it remains an open question. And I think it also depends on the different groups, in terms of MAHA. Tony Lyons at MAHA Action has said that they want there to be an alliance with Republicans. But you also see this with Rep. Alexandria Ocasio-Cortez trying to court some MAHA activists her way. So I think it’s an open question in terms of how this movement unfolds and whether there are any deviations towards the left. But it is a hard sell in some ways. Vaccines are a big part of a lot of people in the MAHA base. And when I asked El-Sayed about this, he said they’re, like, We’re going to agree to disagree on vaccines.

Rovner: Yeah, he’s trained as a doctor and he does believe in vaccines. And he was the head of public health at the city of Detroit. He’s definitely not with the anti-vaccine types. But it’s important to remember that the original anti-vax movement was a combination of people from the far right and from the far left. So there have always been a lot of Democrats in the anti-vax movement, and this has been a group that’s been kind of up for grabs. And we will, I guess we’ll see how it will all shake out.

Roubein: And some of the things on food Sen. Bernie Sanders has said for a long time, too. So there has always sort of been some of that intersection on certain issues.

Rovner: Yeah. Well, originally RFK Jr. was running as a Democrat before he took up with the Trump team. All right. Moving on. Today is Oct. 1, the start of the fiscal year. Happy FY 2027, everyone. The Trump administration marked the day a little early, informing Congress last Friday that it was declining to spend more than $800 billion, in what’s called a pocket rescission. That’s when an administration declines to spend money appropriated by Congress so close to the end of the fiscal year that it basically can’t be spent at all and Congress doesn’t have time to disapprove it. The majority of this funding is from HHS, largely for programs to help noncitizens and for what the administration calls, quote, “overfunded and unaligned” HHS research programs. That includes many related to minority health. Congressional spending leaders, including Senate Appropriations Chair Susan Collins of Maine, complained that pocket rescissions are illegal under a law called the Impoundment Control Act, and the Government Accountability Office issued an opinion this week backing that claim up. But, as we know, this administration likes to dare courts to stop it from doing things that just about everybody else acknowledges is illegal. And I guess that’s where we are here?

Luthra: No, I was just thinking, right? It’s October. Everything that happens now, we also think about in the context of an election, and I think a dynamic that we have talked about a lot is this effort by the administration to just sort of do what it would like to do with funding, even when many people might say that is not how the laws and separation of powers are supposed to work. And I think something really interesting for us to consider is whether those dynamics do, in fact, change in the new year. Given what Rachana mentioned earlier, there is a very good chance that Democrats control both chambers of Congress, not just one. And [does] that possibility of conflict with another branch in Washington change what behavior we see from the White House? I think that’s a really interesting question and something that we should be thinking about as the election gets closer, and then again depending on what the results end up being.

Rovner: Yeah, one of the really weedy issues here is who gets to sue the administration to say that, Hey, you’re not allowed to not spend money that we’ve appropriated. It was important that they came out and said that this was illegal, because the GAO, under the law, has standing to sue. But they don’t have a confirmed leader at this point, and Susan Collins was asked about this and said they may be a little bit wary to kind of get out in front of Congress. But I think it’s probably fair to say that if Democrats take back the House and Senate, that they would be more likely to want to either — I think that the Congress itself can sue the administration, can go to court and say, Hey, you can’t do this, which obviously the Republican Congress hasn’t wanted to do. But a Democratic Congress might.

Pradhan: What — has GAO ever been known to sue?

Rovner: That’s a good question. I can’t remember. We’ve had fights about rescissions before.

Pradhan: Yeah.

Rovner: But it’s — Russell Vought, the head of the White House Office of Management and Budget, says publicly that he thinks that the Impoundment Control Act is unconstitutional and therefore they don’t have to obey it. That’s clearly something for a court to determine. That’s clearly something for the Supreme Court to determine. We haven’t gotten there yet, but most of the time, I think, we’ve had lower courts that have warned the administration: Um, hey, there’s this law that says you can’t do that. You have to spend money the way Congress says you should spend money. The last time we had a pocket rescission, I looked it up, was last year when this administration did the same thing. That was the USAID [U.S. Agency for International Development] money. So before that, I’m not sure when. I may go back and have a look. Shefali, to your point, that was my next question anyway. It’s like, I would think that the one thing that is likely to change if the Democrats take Congress — obviously, we have two more years of the Trump administration — but I would think they would be a lot more zealous in guarding their spending power than this Congress has been.

Luthra: One would imagine. It seems hard to abdicate the power that one might want. That’s how separation of powers, in theory, is supposed to work.

Rovner: And it is kind of written into the Constitution.

Pradhan: I do wonder, though, if they think that, if they wouldn’t get a good, friendly decision from a court …

Rovner: The Supreme Court. Yeah.

Pradhan: Yeah. That could be far more damaging in the long term, right?

Rovner: Yes. There is the concern that the Supreme Court would agree with Russell Vought that the Impoundment Control Act …

Pradhan: Right.

Rovner: … is unconstitutional. That is a risk that they would run.

Pradhan: Right.

Rovner: Well, that will happen. We will see what happens with that. All right. So, obviously these latest cuts aren’t the only ones to HHS that have been made since [President Donald] Trump returned to office in 2025. We will talk more about what’s happened at the Agency for Healthcare Research and Quality in this week’s interview, but I want to talk a little bit right now about the Centers for Disease Control and Prevention, whose workforce we now know is down by almost a third, according to The New York Times. Quote: “The changes have hindered the C.D.C.’s ability to respond to outbreaks as measles spreads at home and Ebola abroad,” while, quote, “entire divisions have been shuttered, including teams that worked on smoking, sexual violence, child abuse and falls among older adults.” Separately, but not really separately, the CDC’s advisory committee on vaccine practices has ground to a halt after a judge struck down Kennedy’s replacement members as unqualified. Medical societies have stepped in with their own vaccine recommendations for this fall, but the official CDC guidance is already out of date because there’s no ACIP [Advisory Committee on Immunization Practices] to make recommendations. This is all going to come home to roost the next time we have a bad flu season, I imagine.

Pradhan: Yeah, I think that the Times, the New York Times, story, what I thought was really, kind of what they led with, was that even though last year you had these widespread firings across HHS and different agencies, including the CDC — the CDC at that time we know lost about 1 in 5 workers — but really the true scale of the losses is much higher. It’s about 30% fewer employees. But the CDC has really had a rough go of it. I think it probably was the — it was the poster child for everything that went wrong during the pandemic, in Republicans’ view. And so they’ve been very keen on dismantling a lot of that agency, more so than the FDA and more so than the NIH [National Institutes of Health], for example, even though they’ve also seen a lot of staff reductions. But CDC, I think, has been so crippled for so long, both because of the staff reductions and just the awful morale at the agency because of everything that the current political leadership has done since. Yeah.

Rovner: I would say, and the politicization of its leadership, things that were long run by career scientists in Democratic and Republican administrations that are now being run by political appointees, who are rather pointedly not scientists …

Pradhan: Yeah.

Rovner: … running this very scientifically driven agency. And of course we’ve had a fifth measles death in Pennsylvania now, that apparently the CDC is still not acknowledging the measles deaths in Pennsylvania. So there are still a lot of questions. The CDC does have, unlike several of the other HHS agencies, does have a Senate-confirmed leader. But so far, we haven’t heard very much from her. I guess we are all still sort of waiting to see what happens, but in the meantime, I can just imagine if we have a bad flu season or some other respiratory ailment that could have been prevented if CDC had been up to date with its vaccine recommendations, things could get rather loud and nasty later this winter.

Roubein: Some of the vaccine recommendations, some of this is very much tied into the lawsuit, just like the high-level ACIP not putting more vaccine recommendations out. And this part has had somewhat of a snowball effect, like the Vaccines for Children Program, giving out free vaccines to uninsured, underinsured kids, that was held up for about a month. That is now going through, but they had to kind of work through: What are the recommendations going to be? And they ended up going with prior recommendations because there is not an ACIP to meet. So some of this has been tied up in legal limbo. And yeah, on the measles deaths, CDC is now acknowledging two out of the five that Pennsylvania has reported.

Rovner: There we go. We’re finally hearing something. All right, we’re going to take a quick break. We will be right back.

Turning to reproductive health, the Hyde Amendment — that’s the annual appropriations rider that bars federal funding for abortion in most cases — turns 50 this week, which, as one abortion rights group pointed out, means that the ban itself has now been in effect longer than Roe v. Wade was in force. Shefali, what’s been the impact of the Hyde Amendment on the ground? What does it actually mean for people who are seeking reproductive care?

Luthra: It’s a bit more complicated than I think people might initially realize. The Hyde Amendment prohibits the use of federal funds to pay for abortion — functionally, Medicaid. And so Medicaid programs are jointly funded by state governments and federal governments. If you are in a state where the state government does not want to put money into paying for Medicaid coverage of abortion, your abortion will not be covered, especially if you are low-income. Most people who get abortions are people who cannot afford another child. They are parents already. They are largely people who are low-income and rely on something like Medicaid. However, there are states, the Californias, etc., of the world, that have made a point of putting state funds into their Medicaid programs. So in some states, you can get Medicaid to cover your abortion. That’s really helpful. It makes this procedure much more affordable. It can cost hundreds of dollars, sometimes a lot more, depending on where you are in your pregnancy, to get an abortion. But, of course, the fact that this has existed for so long has absolutely made it harder for people, often those who are most financially vulnerable, to get abortions. What you often hear from those patients, though, when I speak to them, is, like, This is something I really can’t afford right now, but I will pay for it anyway because I really can’t afford another child. I think the Hyde Amendment is really striking in that it makes this thing much harder to get. But for a lot of people, it doesn’t necessarily stop them from getting it, because it is just so important to them.

Rovner: It’s ironic that something that has to, literally Congress has to pass every year — it is a rider on a spending bill. Democrats have tried various ways to get rid of it, always failed. Even when we had a Congress that supported abortion rights, they could not get this out. It is just sort of part of the landscape now, isn’t it?

Luthra: And part of it is, I think, demonstrative of one of the more effective anti-abortion lines a lot of Republicans have. Abortion public opinion is very complicated. And people support abortion rights in the abstract, but when you get into more specifics, their views become more complicated. And one framing a lot of the GOP has really found success with is saying, We don’t support taxpayer funding of abortion. And that really works because people will hear that and they say: Oh, well, that sounds very extreme. I support this for other people, but, like, my tax dollars, they can’t fund that. And that is the line that has been used to keep Medicaid from paying for abortions, to keep the Hyde Amendment intact, and to keep other federal programs as well from making this more available. And I think it’s perhaps more politically complicated than first blush at abortion polling data might suggest to undo something like this,

Rovner: I absolutely agree. Well, still, anti-abortion forces remain intent on cutting off the main remaining source of access to abortion, the abortion pill mifepristone. This week, the attorneys general of Louisiana, Alabama, and Arkansas filed suit in federal district court — not at the Supreme Court, which the group’s press release says — to strike down the shield laws in New York, Massachusetts, and California. Those are the laws that enable doctors in those states to provide telehealth appointments to people in ban states seeking to terminate their pregnancies. Shefali, there’s already a lawsuit on mifepristone making its way through the courts, and it’s from Louisiana. How is this one different?

Luthra: This one is different because it specifically goes after shield laws and it challenges their constitutionality. That is a different argument. It is more sweeping. It could be the thing that finally gets the Supreme Court to weigh in on this issue. Right? It’s a very, very big legal question, something that constitutional scholars have believed, since the enactment of shield laws will ultimately be settled by the Supreme Court. However, I think it’s really important for us to take this suit with context. As you mentioned, there are so many cases making their way through the courts right now around how people get abortions, the provision of mifepristone, shield laws, etc., etc. We don’t know which one will end up at the Supreme Court. We don’t know how courts will rule. This is just one more quiver in the bow that abortion opponents are trying to use to stop this telehealth model that has found quite a bit of success. We will see which one lands. It very well could be this one, but, at this point, we just don’t know.

Rovner: Yeah, and I should point out that the other Louisiana case is about FDA and its approval of mifepristone to be prescribed via telehealth. So, and of course, we’re also waiting for the administration to do, to finish its FDA safety review, which we expect to see sometime after the election. Speaking of which, abortion is not quite the high-profile electoral issue this year that it was in 2024, but there’s still several abortion-related ballot initiatives to be voted on this year. Shefali, any that you’re watching particularly closely? Or any of the others of you?

Luthra: I am personally very interested in the Idaho measure and the Missouri one. I spent a bit of time in both of those states learning about what’s happening there over the past month. I think it’s really fascinating. In Missouri, it’s a very strange case. Two years ago, voters amended their constitution and said, We will protect abortion rights. Abortion is now legal in Missouri, a state run by very, very anti-abortion lawmakers. Those same lawmakers were horrified by this finding, and so they have put forth a new ballot measure that would overturn the 2024 result, and it would amend the state constitution to ban abortion. And if that passes, Missouri’s constitution would be the only state constitution to explicitly ban abortion. That’s a really big deal. If this passes, it could set an example to other states where voters have said, We support abortion rights and lawmakers have felt very frustrated by that. Polling right now is a very even split. There is a lot of money. We will see what happens. But I think this is a really interesting case for us to be following.

Rovner: And it’s super confusing because they just voted on this.

Luthra: It’s so confusing. And it’s called Amendment 3. If you look at two years ago, the abortion rights measure was also called Amendment 3, and so you might be like: Well, I just voted on Amendment 3. I voted for it. I should vote for it again. And in fact, that would be the opposite. And I’ve spoken to people …

Pradhan: That’s very confusing. That’s very confusing. How are people supposed to keep up with all this? I can barely keep up with it.

Luthra: How are they supposed to keep up with all of it? That’s such a good question.

Pradhan: It’s a lot.

Luthra: But no, and I’ve spoken to people who work in politics in the area, and they had no idea this was even on the ballot. And I was like, That’s also really striking that abortion has faded from a lot of the political consciousness. But actually there’s this measure that could have really sweeping consequences and really inspire similar action in other states. And the Idaho measure, I think, also very interesting. That would actually not amend the constitution. It would just pass a law that would overturn Idaho’s very, very strict abortion ban, which has sparked all these headlines — women being airlifted to Utah for medical emergencies, doctors leaving, labor and delivery wards shutting down because the law is so strict there. It’s really an open question, but there is some polling that suggests that this could pass. They have gotten a lot of support from Democrats, but also independents, also Republicans. A lot of people in Idaho who were never really politically engaged very deeply are, because this abortion ban has been so sweeping, affected so many of them so personally. If it passes, the legislature could vote to overturn it, and we’ve seen that happen in states around the country. But I think we don’t know, A) if it will pass and, B) if it did how lawmakers might react. There’s a real chance — right? — that they are just so surprised that this happens that maybe you do reconsider the politics of instituting an abortion ban when voters rejected one. But absolutely worth following and seeing what happens in this case, for political reasons but also because a lot of people’s lives could be really, really fundamentally changed as a result of it.

Roubein: Missouri sounds like such an interesting test case, because I remember back in 2022, after the Supreme Court decision, abortion rights groups were really grasping for a strategy, so they were throwing a bunch of different things at the wall, lawsuits, and then they tried the ballot measures, and it just seemed to work and take off steam. So that’s pretty interesting.

Rovner: Yeah, and of course, as you pointed out, Missouri has some of the most strident anti-abortion lawmakers in Congress. Josh Hawley, the senator whose wife is one of the lawyers for the anti-abortion, for the main anti-abortion legal group. So Missouri is one of those states that’s got all of the poles represented, and we will have to see how that all comes out.

Pradhan: Can I make one last addendum on the abortion thing, which is because I’m a Virginia resident? Actually, I was talking to my husband the other day. I said, “Oh, this is how you know that Democrats are in charge,” or we have a relatively new Democratic governor. So now there’s a proposed constitutional amendment on the ballot to amend the state constitution to codify abortion being legal until 28 weeks, so basically through the first two trimesters. Which, you know, Virginia is interesting. I’m biased because I live here, but it’s, of course, trended blue with many prior elections, like leading up to now. But parts of the state are very, very conservative.

Rovner: Yeah, Virginia is still the South in a lot of ways.

Pradhan: Yeah. Oh, yeah. And it doesn’t take you long to figure that out once you leave the D.C. area, and there’s a lot of religious-based opposition to abortion. So I’m not sure how it’ll do, whether people will support it or not.

Rovner: I’m curious whether — if we really are looking at a blue wave, and we certainly see a lot of Democrats in unlikely states who seem to have at least a chance of getting elected because of the frustration, mostly with the economy — whether that will bring along some of these other issues in a way that it might not have. Because, as we say all the time, midterms are about turnout, and it looks like the motivated voters this time are bluer than redder. But I guess that’s another thing that we will have to wait and see.

All right, that is this week’s news. Now we’ll play my interview with Aaron Carroll of AcademyHealth, and then we will come back and do our extra credits.

I am pleased to welcome back to the podcast Dr. Aaron Carroll, president and CEO of AcademyHealth, which supports the health services research community. Aaron Carroll, thank you so much for being here.

Aaron Carroll: Always a pleasure.

Rovner: So I’ve asked you here to talk about the Trump administration’s effective dismantling of the Agency for Healthcare Quality and Research, which even many of our very nerdy listeners might not have heard of. But first, tell us what health services research is and how it differs from the biomedical research that most people are more familiar with.

Carroll: I think everybody really gets what we might call discovery research, which is about learning new things at a cellular, molecular, you know, body level — the creation of drugs, the creation of new procedures. You know, everybody sort of understands why we need to do that. But that’s only part of the problem. The bigger problem is how do we actually get that to where people are? So health services research focuses on: How do we improve the access, the quality, and the cost of a healthcare system? Another way I like to think about it is that everything that people hate about healthcare is what health services research focuses on. It costs too much? Yeah, that’s health services research. You can’t get in to see the clinician you want? Wait times are too long? That’s health services research. You feel like you’re not getting the quality that you should, or you’re worried that you know chronic diseases on …? That’s health services research. We spend very little time and very little money, unfortunately, on that type of research. But it’s just as important as discovery research, and I think that one of the reasons why we continue to be so dissatisfied with the healthcare system is because we’re not committed to studying and improving those things in the same way we are discovery.

Rovner: So how does AHRQ facilitate that, or how has AHRQ facilitated that?

Carroll: Sure. So, I mean, some of it is by creating and maintaining some of the big databases that people use to study the healthcare system, things like MEPS or other related databases.

Rovner: MEPS is the Medical Expenditures …

Carroll: Medical Expenditure Panel Survey. Yes, but I think the bigger way is that they give out independent investigator grants the same way that the NIH does. It just focuses more on health services research, and sometimes they have, you know, different areas that they choose to focus on, depending on the administration, because every administration should get to set priorities or, you know, decide what they think are most important. But they usually give out lots of grants, and I’ve had some over my career, that allow you to do all kinds of research to try to examine how you might improve the way that people receive care or pay for care or get care.

Rovner: And some of that research has actually created improvements in the healthcare system, is that fair to say?

Carroll: Absolutely. Yeah, I mean, the reason that, like, we landed on, say, $35 for insulin is because of health services research. It’s because of research that was done that found that that was sort of the inflection point. That when out-of-pocket costs got above that amount, people stopped taking their insulin as they should. And I understand the need for some copays — and obviously, we have a healthcare system. … But it’s, like, finding that kind of stuff out is health services research. And, you know, even some of the grants that were canceled this year would make sense to any, everyday Americans. Like, how do we improve the way that hospitals use antibiotics so we get less resistance, or how do we improve care using telehealth so that kids can get better asthma care or autism diagnoses? These are not discoveries in the sense of new medications, but they are things that we need to learn how to do to make the healthcare system work for everyone.

Rovner: So I actually covered the creation of not just AHRQ, but of its predecessor agency, the Agency for Health Care Policy and Research, way back in 1989, when I was a baby healthcare reporter. It was not just a bipartisan agency. Its creation was spearheaded by Republicans who wanted to know, basically, which medical interventions worked and whether the U.S. was getting its money’s worth on medical procedures. The reinvention of the agency 10 years later was led by Sen. Bill Frist, a Republican former transplant surgeon who later served as the Senate’s majority leader. So, how did the Trump administration come to view this agency as so “woke” that it basically needed to be disassembled?

Carroll: I don’t know. And again, if you don’t like the research priorities, it is perfectly reasonable for an administration to say, Let’s change them. And if they decided they wanted to focus on cost, OK. If they decided they wanted to focus on access, OK. There’s so many different ways to do this, but what they’ve done instead is apparently cancel a ton of grants that were already ongoing — and I’d be happy to talk about more specifics about that — but also they just are not spending the money. In fiscal year 2025, there was a significant amount of money that wasn’t spent. Many believe that’s an illegal impoundment, and there’s a case working its way through the courts right now, led by the Society for General Internal Medicine and Public Citizen, and they actually folded in some of the cancellation grants. But in fiscal year 2026, almost no money has been given out for new grants. Today, as we’re taping this, it is the last day of the fiscal year. I have no idea how possibly they’re going to spend the $345 million that was appropriated in 2026. A lot of that is not going to go out the door. In answer to that, they have said that 97% is being on track to be spent. I don’t know how that’s possible. And it’s very, very likely, again, we’re going to see a ton of money unspent, and I imagine lawsuits and more yelling will follow.

Rovner: So, Congress appropriated this money. The president signed the appropriations bill. What can Congress do, and why isn’t Congress doing something?

Carroll: So I ask those same questions every day. I don’t understand how Congress is not out of its mind. I mean, this is not something, again, from the “woke” Biden administration. This is this Congress, this House, this Senate passed a budget in a bipartisan manner, that was then signed by the president of the United States — this president — into law. The money’s been appropriated. … In fact, there was specific language in the budget that required HHS to staff up to make sure that they could spend this money. They have not staffed up. They have not spent the money. I don’t know how Congress is not losing their minds. It is an absolute ignoring the law. It is absolutely ignoring Congress’ will. I know there’s a GAO investigation. I know questions have been asked, and I don’t think answers have been given. It makes no sense whatsoever. I don’t know, again, why Congress isn’t screaming and yelling and taking action. Now, what action should they take? Hearings, oversight, make sure that all of this happens. Haul people in to session and find out why are they not following the law, and force the executive branch, as the legislative branch should do, as an equal part of our government, to follow the law.

Rovner: And it’s not just the grants. I mean, most of the staff has now been basically terminated.

Carroll: Yeah. Well, that’s what I mean. And there are now minimum staffing requirements in the law, and those are not being followed. I mean, depending upon whose estimates you believe, somewhere between 75% and 90% of AHRQ staff have either been let go or have left the organization. We can’t get exact numbers because they won’t release them. But there aren’t enough people even to process or put the money out the door. Even if they decided today we’ve got to get all the money, it’s not possible. There just aren’t people there to fill out the forms, check the budgets, do all the due diligence, administer the grants, oversee it. There’s no one there, and it’s an absolute abdication of their responsibility to enact the budget and the law as Congress has appropriated and put forth.

Rovner: Last question: What would it mean — I mean, what would the loss, basically, of what AHRQ has been doing for these last 26 years mean — to the healthcare system and how it runs?

Carroll: I mean, we spend $40-some billion a year on the NIH — I think about $47 billion. AHRQ, again, is $345 million. So we have been massively underspending on sort of what I would call “delivery” research on how the healthcare system works. And it’s one of the reasons why Americans are getting angrier and angrier every year because they’re, like, Why won’t things get better? Well, we’re not funding it enough. We’re not doing enough. And then, what little we were doing, they canceled in July and refused to spend now. So, what’ll happen? We will remain just as angry, if not angrier, about how much we’re paying for healthcare. We will remain just as angry, if not angrier, about how we can’t get what we need, and we’ll remain just as angry, if not angrier, about the fact that we can spend all this money that we do, $5 trillion-plus, and still feel like we’re not getting the quality, and continue to complain about how unhealthy we all are. AHRQ is the solution to a lot of these problems, and, for some reason, we just won’t use it.

Rovner: Aaron Carroll, we will stay on top of this. We will revisit it. I promise.

Carroll: I’m glad to hear that.

Rovner: Thank you.

Carroll: Thank you.

Rovner: OK, we’re back. Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Rachel, why don’t you go first this week?

Roubein: My extra credit is headlined “Once Described as Obesity Medicines for ‘Patients,’ GLP-1s Are Increasingly Lifestyle Drugs for ‘Customers.’” It was in Stat by Elaine Chen. I thought it was a really fascinating story because we’ve all seen the cultural shift toward GLP-1s, and we’ve all heard the drugs praised as a way to address obesity as a medical issue. But Elaine reports that the drugs are now being increasingly marketed as a way to look and feel better. I thought there were some notable examples. The story explored how Novo Nordisk, which is one of the drugs’ makers, has particularly leaned into the shift. For instance, the company had advertisements this summer with slogans that include “live lighter” and “a summer glow-up.” And instead of labeling the drug as a drug for weight management, it sometimes is referring to it as a weight loss drug. And Elaine talked to some doctors and patient advocates that think the drug’s being talked about more as a retail product, run against the industry’s sort of initial goals of trying to convince the greater public that obesity is a disease and that the drug should be covered by insurance. For Novo Nordisk’s part, a spokeswoman told Elaine that how people expect to access and experience care has changed in recent years, and the company recognizes that healthcare needs to become more responsive, relevant, and easier to fit into everyday life.

Rovner: I would just note, and it’s a very good story, that if the drugmakers lowered the price of the drugs, it would be easier to get it covered by insurance. But that’s just an aside. Shefali.

Luthra: My story is from The Atlantic by Caitlin Dickerson. The headline is “The Babies Left Behind in America.” It’s a great story. It is about when parents are deported without their children, what happens to those children? This is the kind of reporting that is really hard to do because you have to spend time with children who have lost their parents. But I think it’s really important, especially as we see this uptick in detaining and deporting, in particular, people with children. I’ve spoken to a lot of mothers who have been deported when they had children here, and the consequences will last probably people’s whole lives. There are health consequences, especially when you have young children. There is PTSD, and I think Caitlin Dickerson has done some of the best reporting on immigration in the past decade, maybe longer. And this is absolutely an essential addition to that canon.

Rovner: It is indeed. Rachana.

Pradhan: My story is a trifecta from my colleagues Phil Galewitz, Andrew Jones, and Claudia Boyd-Barrett, who wrote a story about, as of today, hundreds of thousands likely of immigrants who are lawfully present in the United States but who have low incomes are now no longer eligible for Medicaid. This is part of President Trump’s signature One Big Beautiful Bill Act, which will enact greater coverage reductions next year, starting in 2027. But this group of people is now no longer eligible for Medicaid. It includes refugees, some people who have been granted asylum, and also, you know, victims of domestic violence and/or human trafficking. So the story gets into how we have our beloved Congressional Budget Office here in Washington that sort of estimates the impacts of tons of legislation. And they estimated previously that about 100,000 immigrants would be uninsured by 2034 because of this provision. But based on figures that my three colleagues got from state governments or state Medicaid agencies, the figure is likely to be higher of the numbers of immigrants with legal status who are going to now not be able to receive Medicaid. So yeah. So it’s a great read, and I know Julie will put the link in the podcast and in the comments.

Rovner: I will indeed. Yes, there’s the continuing, you know, “immigration is a health issue, too” theme that we have this week. All right, my extra credit is actually an update to an extra credit from last month. Like last month’s story, it’s from The New York Times, and it’s called “U. of Michigan Halts New Grading Plan After Backlash From Critics,” by Madaleine Rubin. And it seems that my alma mater — also, full disclosure, the alma mater of my editor and several of our panelists — has rethought the idea of letting incoming freshmen complete their first semester without letter grades to ease them into college life. According to a statement from interim university president Domenico Grasso, there was concern that students would be, quote, “unfairly portrayed as coddled or unprepared for the demands of a rigorous Michigan education.” Yeah, I would add that a lot of the backlash came from my fellow alums, and that even though I attended Michigan well back in the 20th century, even in the olden days, we had the option to take classes pass/fail if we wanted to. Although I would note that under the original proposal here, the students wouldn’t have failed, but they would either have gotten a pass or a “no credit.” Good job rethinking this, guys, and Go Blue.

OK, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X @jrovner, or on Bluesky @julierovner. Where are you guys hanging about these days? Shefali.

Luthra: I guess I’m on Bluesky @shefali, but you can also email me.

Rovner: There you go. Rachana.

Pradhan: @rachanadpradhan, both on Bluesky and on X, and you can always email me at RachanaP@kff.org.

Rovner: Rachel.

Roubein: Yes. X: @rachel_roubein; Bluesky: @rachelroubein; and Signal is always good too: RachelRoubein.28.

Rovner: Great. Thank you all. We will be back in your feed next week. Until then, be healthy.

October 1, 2026
Rural MAHA Followers Say Trump Health Policies Haven’t Reached Their Communities

About half of rural voters identify with Make America Healthy Again, a sprawling political movement championed by the Trump administration, but most said President Donald Trump’s healthcare policies have not benefited their communities, according to a new poll from The Associated Press in partnership with KFF.

About 8 in 10 rural voters — an important voting bloc for Trump and fellow Republicans in recent elections — said the Trump administration’s policies have had a negative effect or no impact on the health of people where they live. Most MAHA supporters, 68%, also feel this way, according to the national survey of more than 2,000 rural registered voters.

The findings signal an apparent disconnect between the Trump administration’s MAHA-branded policy priorities and rural America’s perception of their reach and effectiveness.

Iowa pastor Mike Jager, 58, is a registered Republican and considers himself part of the MAHA movement. The Trump administration’s health policies have had “minimal” impact on the health of his community, Jager said, but he added that Trump’s health secretary, Robert F. Kennedy Jr., is moving the needle “in the right direction.”

“It’s a beginning,” Jager said. “It’s a big ship to try and turn around and course-correct.”

Kennedy has used the MAHA label to support various agendas, including abandoning long-standing vaccine guidance, researching ultraprocessed foods, and investing in regenerative agriculture.

Jager lives in Sumner, Iowa, “less than a quarter mile from where the corn ends and the city begins.” He’s seen family members and neighbors develop diseases that he believes resulted in part from exposure to agricultural chemicals and consumption of unhealthy, processed foods.

In the June Republican primary for governor, Jager voted for Zach Lahn, a businessman and farmer, who ran on a MAHA platform and beat out Trump-backed U.S. Rep. Randy Feenstra. He plans to vote for him again in November.

Jager said that President Donald Trump’s health secretary, Robert F. Kennedy Jr., is moving the needle “in the right direction.” (Miriam Alarcón Avila for KFF Health News)

Many Rural Voters Are Prioritizing Health Issues

About two-thirds of rural voters who support MAHA said it’s “extremely” or “very” important to them to vote for a candidate who does, too, while only 4 in 10 rural voters overall said the same.

Trump sought to seize on MAHA support during his campaign for another term two years ago. Now, amid tight midterm races, Kennedy has campaigned to galvanize the movement’s support. In May, he attended a MAHA bill signing with Iowa Republican Gov. Kim Reynolds, and in August, he went fishing with Lahn, posting about it on social media.

Yet the survey indicates voters are noticing “this weird split in the Trump administration” between what Kennedy messages and what Trump says and does, said David Peterson, a political science professor at Iowa State University.

“It’s this mix of things coming out of D.C., out of different pieces of the administration, that’s confusing people,” Peterson said.

In Iowa, concerns about what’s causing rising cancer rates are “a big deal,” he said. For many people who identify with MAHA, being healthy includes taking on corporate agriculture and pharmaceutical companies that they think cause cancer, he added.

“The sort of populist messaging around that is appealing right now,” Peterson said.

In the poll, views on healthcare access and costs largely diverged along party lines. Most Democratic and independent voters said the Trump administration’s healthcare policies have had a negative impact on their healthcare costs and the health and well-being of people in their communities. Republicans were likelier to say there hasn’t been an impact.

Talking on the phone from her 200-acre farm in Carroll County, Iowa, 71-year-old Donna Klocke said that her husband had died from cancer and that she has neighbors who also have cancer.

“It’s just very prevalent,” Klocke said. “We’re in a farming community. We use chemicals and pesticides and all kinds of things that aren’t necessarily good for us.”

Klocke, a Democrat, said the MAHA movement is a good idea because she cares about being healthy, but she does not consider herself part of it and will not be voting for a candidate who represents the movement.

Kennedy, who was an anti-vaccine activist before entering politics and has sent mixed messages to Americans about getting the measles vaccine, scares her.

“Measles are coming back and polio,” Klocke said. “It’s the measles that really gets me. It’s like, do you not understand how dangerous it is?”

Donna Klocke cares about being healthy but does not consider herself part of the Make America Healthy Again movement. Her husband died from cancer after a life spent farming the family’s 200 acres in Carroll County, Iowa. (Kathyrn Gamble for KFF Health News)

Survey Reflects Angst Over Healthcare

About half of rural voters said their communities don’t have enough doctors or other healthcare providers, and even more said there aren’t enough mental health workers specifically. The share of rural voters who said their community does not have enough hospitals increased to 35% from 21% in a similar question asked in a KFF-Washington Post survey in 2017.

And as with the general population, healthcare, gas, and grocery costs are top pain points. More than 6 in 10 rural voters said they were worried about healthcare costs.

The level of worry varied based on coverage, with rural voters enrolled in employer plans or Medicare less likely to be worried. The survey found that 80% of working-age rural voters on Medicaid were very or somewhat worried about healthcare costs. Last year, Republicans passed a tax and spending bill that cut over $900 billion in projected Medicaid spending over a decade and mandated new eligibility requirements.

Among rural voters who purchase their own insurance, such as the individual coverage plans available on Affordable Care Act marketplaces, 77% said they were worried.

In the tiny community of Lipan, Texas, west of Dallas, Kim Solis and her husband have a handyman-and-home-remodel business and get their insurance on the marketplace. Since Trump was elected again, their premium payment jumped from zero to $166 a month. Their copays went up, and their deductibles each increased by $2,000.

Solis, 62, said she worries what will happen if they get a big medical bill.

“Certainly, we’d be in a world of hurt trying to take money out of savings or getting it out of our 401(k) just to be able to do something about it,” she said.

Most MAHA Voters Are Also MAGA — But Not All

Like the general population, rural voters said they trust their own doctors and healthcare providers for health information over government agencies or officials, according to the poll.

Trust in Kennedy and Trump fell largely along partisan lines. About 10% of rural Democratic voters reported having a “great deal” or “fair amount” of trust in Kennedy, compared with 74% of rural Republican voters. About 5% of rural Democrats and 69% of rural Republicans said they trust Trump a “great deal” or “fair amount” for reliable health information.

While Make America Great Again and MAHA identities are “linked in a lot of ways,” the rising costs of healthcare and groceries pose a challenge for those committed to the MAHA principles that Kennedy promotes, said Peterson, the Iowa State professor.

Buying healthy food “becomes, ‘I can’t afford to do that because of Trump’s policies,’” he said.

In Stamping Ground, Kentucky, Alma Johnson, 65, works as night security at a horse farm. Johnson said gas had gone up but her overall cost of living had decreased since Trump took office.

Johnson voted for Trump in 2016, 2020, and 2024 and said she “pretty much” likes how Trump is running the country. But she said she is not a MAGA devotee, preferring to “think for myself.”

MAHA, however, is an easy sell for Johnson because, she said, she doesn’t think people should be able to buy junk food through the Supplemental Nutrition Assistance Program, or SNAP.

Still, she said she hasn’t seen much impact from the Trump administration’s healthcare policies, including the new food pyramid.

“It takes a long time to change people, their habits, their thoughts, or the things they do,” Johnson said.

About the Poll

The KFF-AP Rural Voters Survey was conducted online and by telephone Aug. 12-24, 2026, among 2,241 registered voters living in rural areas, defined as census tracts that fall within codes 5-10 of the U.S. Department of Agriculture’s 2020 Rural-Urban Commuting Area codes. Voters were reached through a combination of the probability-based SSRS Opinion Panel and a registration-based sample from the L2 voter file. Overall results have a margin of sampling error of plus or minus 3 percentage points, including design effects due to weighting. Error margins are larger for subgroups. In collaboration with the AP, KFF researchers worked to design the survey sample and questionnaire and analyze and report findings.

This report is from a collaboration between KFF Health News and The Associated Press.

September 30, 2026