MAGA Report Cards — Healthcare

Sarah Sanders Hasn't Called the Session That Would Clear Arkansas' Disability Waitlist. Her Republican Predecessor Zeroed Out the Same List for $37 Million.

Thu, 10 Sep 2026 08:51:58 +0000

Landri Hellinga is 15. She has a rare joint condition called Arthrogryposis Multiplex Congenita that locks her joints straight or bent, so she spends most of her day in a motorized wheelchair. She has had more than 40 surgeries. Her mother, Laura, walked away from a career as a national accounts manager at Walmart when Landri was born, because she knew she would be doing all of the caring herself.

Laura Hellinga applied in 2022 to get Landri into an Arkansas program that pays for exactly the things a family like hers needs. She had to apply more than once. She was accepted in 2024.

The last time her mother checked, Landri was number 636 on the waiting list.

There are more than 2,400 people on that list. And Arkansas's leaders are, at the same moment, touting a $655 million surplus.

The program, and the governor who cleared it

The program has a bureaucratic name — the Community and Employment Support Waiver, or CES — and a simple job. Run by the Department of Human Services, it pays for the things ordinary Medicaid does not: a customized wheelchair, a bathtub seat, a ramp, a lift, home modifications, medical supplies. The point of it is to let a disabled person live at home instead of in a nursing home.

Families have waited as long as ten years to get in.

In 2021, Arkansas's previous governor decided that was unacceptable. Republican Asa Hutchinson put up more than $37 million to zero out a waitlist of more than 3,200 disabled Arkansans. The state cleared it over four years. He did not need a special session to do it: the legislature dedicated the $37.6 million during the short fiscal session Arkansas holds in even-numbered years.

Sarah Sanders took the office after him. Four years after Hutchinson left, the list is back above 2,400.

What it would cost, and what she spent instead

State Rep. Andrew Collins, a Little Rock Democrat, has asked Sanders to call a special session to deal with it. Clearing the list means asking federal Medicaid officials to open more slots, and Arkansas paying for them.

"Right now, the estimate is that it would cost somewhere between $35 (million) and $50 million," Collins said. He also noted that Arkansas's share of CES costs runs about 30% — the federal government covers the rest.

So the state's own portion of fixing this is a fraction of a fraction. Collins set that against what Sanders has chosen to fund instead: the LEARNS voucher program, which pays private school tuition for families that do not necessarily need the help — at an estimated cost, the paper notes, approaching $400 million a year — plus tax cuts for the highest earners.

His verdict was one sentence:

"If it was a priority, it would have been done already."

We have put a number on that voucher program before. Sanders' voucher program will cost $367 million this year, and Arkansas has never permanently barred a single school from that program while asking those schools for little more than fire drills, shot records and a flagpole.

Collins was blunter about what the waiting means for families:

"To allow those individuals to be burdened in this way feels morally indefensible," he said. "You're telling them they have to spend years on end waiting for help that may never come."

What answering a letter looks like

Laura Hellinga did the thing citizens are told to do. She wrote to her elected officials.

"I have written Sarah Huckabee Sanders and (Sen.) John Boozman and (Sen) Tom Cotton," she said. "Mostly, I got the same letter back, thanking me for writing."

Boozman, she said, replied that it was not his area of responsibility. Cotton wrote back only after several letters. Sanders, she said, has largely ignored her.

The state office handling Landri's paperwork has lost or misplaced her four-inch binder of medical records more than once. Her place in line moves up and down, and nobody can tell her why, because the office is understaffed. Sometimes no one answers the phone.

What she is asking for is not complicated:

"I just want to talk to the governor, one on one," she said. "Not a photo-op, just a conversation on what her plan is. What is the plan for these thousands of individuals on this list? I just want to know where this is going and what to expect. So far, I have not gotten those answers."

Asked what she would hope for from the waiver if and when Landri is accepted, Laura Hellinga listed a pool membership — Landri has her best range of motion in water — a lift system she can actually operate, and adaptive tools around the house. Then, the reporter noted, her voice trembled.

"And I'd like for her to learn to drive," Laura Hellinga said. "I just want her to be able to do things."

The Arkansas Times sent questions about the CES program to the governor's office by email. They got no response.

Nothing happens until January 2027

Hutchinson fixed this in a scheduled session. Arkansas's next regular session does not start until January 2027. Parents have been pushing publicly for Sanders to call a special session before then. She has not called one for the waitlist. She did call one this spring: on April 30 she summoned the legislature into extraordinary session to cut the top individual income tax rate to 3.7% and the corporate rate to 4.1%.

That is a decision, not a delay. And it is consistent with how Sanders has treated health coverage in Arkansas generally: she cheered the budget bill that ended the state's Medicaid expansion, leaving about 200,000 Arkansans hanging.

What it adds up to

A Republican governor of Arkansas spent more than $37 million in 2021 to clear a waitlist of 3,200 disabled people off the CES waiver. Under Sarah Sanders it has grown back past 2,400, a Little Rock lawmaker puts the cost of clearing it at $35 to $50 million with the state paying about 30%, and the state is touting a $655 million surplus. Sanders has not called the special session parents are asking for, so nothing can happen before January 2027 — though she did call one in the spring to cut income taxes. Her voucher program for private school tuition costs more than $367 million this year. Landri Hellinga is 15, has had more than 40 surgeries, and was number 636 in line the last time her mother checked.

Source

Arkansas Times, Aid program for disabled Arkansans that took priority for Hutchinson languishes under Sanders, by Byron Tate, September 8, 2026. Photo: Laura Hellinga, via Arkansas Times.

State of the State: Texas Is 40th Overall. Greg Abbott and Texan Republicans in Congress Aren't Helping.

Wed, 09 Sep 2026 13:59:28 +0000

Texas is big and Texas is rich. But on the things that decide whether a Texas family gets by — enough food on the table, safe care for a pregnant woman, a fair start for a kid — Texas keeps landing near the bottom.

Click for sources

Add up the 17 measures we track across all 50 states and Texas ranks 40th. That number describes where the state already is. It does not, by itself, prove any one politician put it there.

Greg Abbott has been governor since 2015, and many of the decisions behind those numbers are his rather than Washington's: whether Texas expands health coverage, who regulates the grid, where school money goes, what a doctor is allowed to do for a miscarrying patient.

Republicans also hold 24 of Texas's 37 filled U.S. House seats, both of its Senate seats and the attorney general's office. One House seat is empty, and that's a story too. Here is what all of them did on top of the numbers above, and what each has been busy with instead.

What Texas's Republicans in Congress voted to cut

Texas is already 49th of 50 states on food insecurity, from the USDA's own data — second-worst in the country at feeding people — and it already has the highest uninsured rate of any state, for children and adults alike. Its Republicans in Congress then voted for a budget bill that cut both health coverage and food assistance. Take them one at a time.

KFF's allocation of the Congressional Budget Office's estimates projects that Trump's budget bill will leave 480,000 more Texans without health insurance by 2034 — 1.4 million once you count the Affordable Care Act premium tax credits that expired at the end of 2025 and that the bill did not extend. Texas also stands to lose $27.9 billion in federal Medicaid funding over ten years.

That lands on a state where, in 2024, the Census Bureau's American Community Survey put 13.6% of Texas children and 21.6% of working-age Texas adults without any coverage at all — the highest rate in the country in both cases, against national rates of 6.0% and 11.3%. And the hole is not only Washington's doing. Texas, under Abbott, is one of the few states that never expanded Medicaid, which the Texas Tribune reports has contributed to that rate. Turning the expansion down was a decision made in Austin, and it is his.

Another $10 billion is stuck on top of that. The Trump administration is holding up Medicaid payments Texas hospitals were counting on, which the Texas Hospital Association counts at $27 million a day. Ken Paxton fought that exact case against the Biden administration, won it, and put out a news release calling it a "major nationwide legal victory." Against this administration, he has filed nothing.

On food: 1 in 4 Texas kids faces hunger, and about 3.47 million Texans — 11% of the state — get SNAP benefits every month. The same bill squeezed that program too.

Every Texas House Republican named below voted for it.

What 49th on women's health looks like

Texas ranks 49th of 50 states on women's health and reproductive care, from the Commonwealth Fund's state scorecard. Second-worst in the country. Here is part of why.

Texas has a near-total abortion ban, and Abbott signed it. On May 19, 2021 he signed the law that banned abortion after about six weeks and paid members of the public at least $10,000 to sue any doctor who performed one. "Our creator endowed us with the right to life," he said at the signing ceremony. The law took effect that September. After the Supreme Court overturned Roe, a criminal law followed, threatening doctors with up to 99 years in prison.

Doctors then started waiting. ProPublica's statewide analysis of hospitalizations for second-trimester pregnancy loss found that after the ban, the rate of sepsis in those cases jumped more than 50%.

Josseli Barnica's case is what that waiting looked like. She was 28, a mother, and 17 weeks pregnant when she was admitted to a Houston hospital on September 3, 2021, days after the law took effect, with a miscarriage her doctors recorded as "in progress." More than a dozen medical experts told ProPublica that her doctors should have emptied her uterus then to head off an infection. Instead her husband arrived from a construction site to hear what she said the medical team had told her: "They had to wait until there was no heartbeat. It would be a crime to give her an abortion."

She waited 40 hours. Three days after she delivered, she died of an infection — sepsis, her autopsy said, with "retained products of conception." The experts who reviewed her records called her death preventable, and called the case "horrific," "astounding" and "egregious."

Barnica never asked for an abortion. Neither did Nevaeh Crain, who was 18, or Porsha Ngumezi. Texas's own Medical Board has since disciplined three doctors over the care those last two received — one for discharging Crain while she had a 103-degree fever and had screened positive for sepsis. Each doctor was ordered to take eight hours of continuing education.

Even the Republican-led Legislature conceded something was wrong and passed a bill to clarify the ban's medical exceptions. The ban itself stands.

The data centers

The biggest new fight in Texas isn't in Washington. It's over giant warehouses full of computers that run artificial intelligence, and the electricity and water they drink.

Greg Abbott spent years bringing them here. In November 2025 he stood next to Google's CEO and called Texas "the epicenter of AI development." The grid operator now says companies have asked to pull 474 gigawatts off the Texas grid — more than five times the most electricity Texas has ever used at once — and about 90% of those requests are data centers. We laid out that record here.

Then, in August of an election year, Abbott announced a pause and an audit. Regulators set the delivery date for the report at December 10. Election Day in Texas is November 3. Texans vote 37 days before the state tells them what it found.

Texas's own Agriculture Commissioner, a Republican, called the pause "smoke and mirrors" and said Abbott is stalling so his donors' projects can be grandfathered in.

The public schools

More than nine in ten Texas kids sit in a public school. The state spent this year moving money the other way.

The private school voucher program is Abbott's. He campaigned on it, and on May 3, 2025 he signed the $1 billion bill creating it, telling the crowd he had promised school choice when he ran for reelection in 2022. Texas launched the program for 2026-27 with that $1 billion. In September 2026 the state's comptroller, Don Huffines, asked the Legislature to double the program's base funding to more than $2 billion. Nearly 110,000 students have been funded and more than 106,000 families are on the waitlist. Paying for the waitlist too, the comptroller's office said, would come to about $4 billion over two years.

Here is the part that decides who this is for. State data shows that 70% of the families who have joined the program or hold pending invitations were already in private school or home-schooling. This is not mostly money helping kids leave a failing public school. It is mostly money for families who had already left.

Meanwhile the public schools are cutting. The Legislature put nearly $8.5 billion into schools last year, earmarked for teacher pay, educator training and special education, and districts told a Capitol hearing in June that it did not stop the cuts. Austin ISD is closing a $181 million shortfall. El Paso's district is short nearly $53 million. Before last year's bill, Texas students had gone six years with no comprehensive funding increase at all.

And Texas is short of teachers. The state employs more educators on H-1B visas than any state in the country, and districts use those visas for jobs they have already tried and failed to fill locally — above all bilingual education, which sits on Texas's own official teacher shortage list, in the state with the largest share of students learning English in the country. Abbott says he wants "exactly zero", and he wants it to reach the teachers already standing in Texas classrooms. In the rooms Texas cannot staff, it would become illegal to keep the teacher who took the job.

Three of the Texans below — Keith Self, Randy Weber and Brandon Gill — went a step further and cosponsored a one-sentence bill to abolish the Department of Education outright.

Texans are still paying for the last grid failure

Before the data centers, there was Winter Storm Uri. 246 people died. Craig Goldman chaired the Texas House Energy Resources committee in the session that followed, and his committee advanced a bill that put $3.5 billion of the gas companies' storm costs onto customers' bills through April 2039. The weatherization rules passed after the storm have caught almost nothing, and a 2025 state audit found why: regulators issued two violations across 8,732 inspections, and never compared what companies actually did to the state's own best practices. The gas companies set their own standard, and passed.

Texans will be paying that off for another 13 years, while the grid takes on the biggest new load in its history.

The agency that let that happen is Abbott's too. He appoints the Public Utility Commission's board, which was expanded from three members to five after Uri, and the Tribune reported that he took over the search for the grid operator's chief executive — a process he has no formal role in — with one person involved saying he had "total veto power."

What it costs to live here

On September 4, 2026, in Lubbock, Abbott named the thing Texans tell pollsters they care about most and promised to fix it. "Now I want to make Texas number one for affordability," he said. He has been governor since January 2015. Here is what those eleven years did to three of the bills that arrive at a Texas house.

Property taxes. Abbott signed an $18 billion package in 2023 and called it the largest property tax cut in state history. By the comptroller's own count, statewide property tax levies were $51.2 billion in his first year in office and $89.4 billion in 2025. He is now running on cutting them in half by zeroing out school property taxes on homesteads, a promise that does nothing for the 39% of homesteads that already owe no school tax and nothing for the state's 4.1 million renters.

Homeowners insurance. "The average annual homeowners' insurance premium in Texas has risen 79 percent in six years," Abbott said on August 24, 2026, ordering the insurance commissioner he appointed to do something about it. In 2025 the Legislature killed both bills that would have addressed it: a roof-hardening grant program that passed the House, and a rate-approval bill that passed the Senate. Insurance was not among the seven emergency items Abbott named that February, and not among the eighteen reported on his summer special session call either.

The electric bill. The data centers above run on a sales-tax exemption the comptroller's office says will cost the state $3.2 billion over two years, and the grid operator's own $33 billion transmission expansion shifts long-term costs onto ratepayers. Abbott now says data centers "must operate in ways that reduce costs for residential electricity customers." He also wants to break up the San Antonio utility that says it has the cheapest residential rates in the state, on behalf of retail providers whose political action committees have given his campaign at least $230,000.

Three bills, one shape. The problem built for a decade while he held the office that could act on it, and the answer arrived in the campaign.

The seat that isn't being filled

On April 14, 2026, Republican Tony Gonzales resigned from Texas's 23rd District. He quit amid allegations that he had a sexual relationship with a staffer who later took her own life, an affair he had denied and then essentially admitted in a talk-show interview. Abbott has still not called a special election, and the seat is not on track to be filled until January — roughly 260 days empty. A Democrat resigned in California the same day. Voters there have already picked his replacement.

That is the empty seat: about 800,000 Texans with nobody voting for them.

The Republican nominee waiting for that seat is Brandon Herrera, a gun YouTuber who called a child a "c*m trophy" while attacking Shannon Watts, who founded Moms Demand Action after the Sandy Hook shooting. When reporters asked Texas Republicans about it, they walked away. He has also called Social Security "a joke" after his own campaign website promised to protect it.

The rules of the election itself

Texas ranks 46th of 50 on voter turnout. Its Republicans have spent the year working on the map and the polling places rather than the turnout.

In 2025 the Legislature redrew the congressional map mid-decade to target five Democratic-held seats. Two federal judges blocked it, finding "substantial evidence" that it was racially gerrymandered in a 160-page opinion. The Supreme Court cleared it for use in the 2026 midterms anyway, over the dissents of Justices Kagan, Sotomayor and Jackson.

Underneath that, the same work is happening county by county. Galveston County held its March primary under one map and adopted a different one in June, telling a court the reason was to "increase partisan performance." Tarrant County's Republican majority voted to cut 92 Election Day polling places, taking the state's biggest swing county from 316 sites in 2022 to 224 this November.

The rolls themselves are moving too. More than 1.2 million Texans sit on the state's voter suspense list, over 6% of all registered voters, with the election weeks away. Abbott has said Texas caught 6,500 noncitizens on its voter rolls. His own office had confirmed 581.

The candidates up for reelection

Texas sends 24 Republicans to the U.S. House. The seventeen running for reelection in 2026 have a report card on this site. Here's something about each of them:

August Pfluger chairs the Republican Study Committee and wrote the blueprint for the next budget bill, saying the point of the process is that Democrats can't block it.
Beth Van Duyne called this "the golden age of DOGE." The Government Accountability Office then reported that DOGE couldn't show its work on 96% of its claimed grant savings.
Brandon Gill filed a bill to stop people from buying a hot meal with food stamps. The option he calls a loophole exists for SNAP recipients who are elderly, disabled or homeless.
Brian Babin's campaign paid the Federal Election Commission $26,700 after a donor pleaded guilty to funneling $37,000 in corporate money to it through his own employees.
Craig Goldman — the Uri bill above. His one law in Congress so far killed an efficiency rule the Energy Department said would save $1.3 billion.
Jake Ellzey announced a "historic investment" in rural health care. He voted twice for the law that made it necessary, which cuts $137 billion from rural Medicaid.
John Carter's last in-person town hall was in 2013. When 150 constituents held one for him, they brought a life-size cutout.
Keith Self calls the national debt "an existential threat to our Republic," voted for the $3.4 trillion bill, then introduced a bill to stop bills like it.
Lance Gooden is under House Ethics investigation. The committee won't say what it's about; Gooden says it's his spending. His first move was to call the investigators "dishonest unelected bureaucrats."
Michael Cloud wrote a bill that would put every federal agency on a countdown to abolition — including the ones that warn Texas about hurricanes.
Monica De La Cruz told donors on leaked audio that "it's not that people don't like me, it's that people don't know me yet." She has never held an in-person town hall.
Nathaniel Moran spoke against site-neutral Medicare payment, the one change that would lower what patients pay for the same service. The hospital lobby has given him $20,000.
Pat Fallon sits on the Oversight panel built to work hand in hand with DOGE and went on Fox Business to call it a chance to "fix our Republic".
Pete Sessions put it in writing that a $7 billion Ponzi schemer was "a man of great strength, character and financial stability".
Randy Weber has represented the Texas coast for 13 years. He called $5 million for the Ike Dike a win; the barrier carries a $35 to $57 billion price tag.
Roger Williams, a second-generation auto dealer, slipped an exemption for car dealers into a rental-car safety law at midnight. It got him an ethics investigation and was stripped out.
Ronny Jackson kept paying for a private Amarillo dining club with campaign money after the ethics office told him to stop, and changed what he called it.

And the party's Senate nominee is Ken Paxton, the sitting attorney general, whose own party's voters picked him over a record of indictments, an impeachment and abuse-of-office findings that we laid out in full.

Above them all on the ballot is Greg Abbott, who has been the Governor of Texas since 2015. He signed the six-week abortion ban that pays strangers $10,000 to sue a doctor, in the state that ranks 49th on women's health. He signed the $1 billion voucher bill, where 70% of the families taking the money had already left the public schools. He spent years recruiting the data centers, then flip-flopped when it became politically convenient. And he is running on affordability after property tax levies rose from $51.2 billion in his first year to $89.4 billion, and home insurance premiums rose 79%.

Compare Texas to Other States →

The 18 States That Banned Abortion at Six Weeks or Earlier Now Have Nearly Double the Ectopic Pregnancy Death Rate of the States That Didn't.

Wed, 09 Sep 2026 12:58:55 +0000

An ectopic pregnancy is when a fertilized egg implants somewhere it cannot survive — most often in a fallopian tube instead of the uterus. It is almost never viable. Left alone, it grows until the tube ruptures, and the woman bleeds internally. Treated in time, it is routine. One shot of medication, or a short surgery, and the patient goes home.

Doctors have a phrase for a death from this. "A death related to ectopic pregnancy should really be a never event," Dr. Alice Abernathy, an OB-GYN, told ProPublica.

It is no longer a never event. On September 9, 2026, ProPublica published an analysis of death records showing that almost 200 women died after an ectopic pregnancy from 2020 to 2025 — about twice the roughly 100 who died in the previous six years.

Where the women are dying

The deaths are not spread evenly across the country. ProPublica separated the states that ban abortion at six weeks of pregnancy or earlier from the states that never enacted a ban at all, and compared the death rates for 2023 through 2025. Six states whose bans came later, were struck down quickly or never took effect are in neither group.

	Ectopic pregnancy deaths per million live births
States with a strict abortion ban	13.1
States without a ban	7.1

The eighteen states in the first group are Alabama, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas and West Virginia.

In those states the death rate is close to twice what it is in a state that did not pass a ban.

Texas: 310 more patients who hemorrhaged

Deaths are the end of the line. Before a woman dies after an ectopic pregnancy, she hemorrhages.

ProPublica looked at Texas hospital records and found that 310 more patients suffered substantial blood loss after an ectopic pregnancy in 2023 and 2024 than in 2018 and 2019 — an increase of about 29%.

Those cases will never appear in a death count. They are the near misses, and there are far more of them than there are deaths.

Why a ban would touch this at all

Many of these states' bans say in terms that they do not apply to ectopic pregnancy. Treating one is not an abortion under those laws.

That is not the mechanism. The mechanism is what happens in an emergency room at 2 a.m. when the ultrasound is ambiguous and the doctor is doing arithmetic about a felony.

"Seeing a mass is not the only reason to have high suspicion for an ectopic pregnancy," emergency physician Dr. Rebecca Nerenberg told ProPublica. Early on, an ectopic pregnancy often does not show up clearly on a scan. Experts told ProPublica that doctors should be able to treat when other symptoms are present — plateauing pregnancy hormone levels, bleeding, abdominal pain — because the downside of waiting is a ruptured tube and catastrophic bleeding. Under a criminal ban, waiting for certainty starts to look like the safer choice — for the doctor.

Texas passed the Life of the Mother Act in 2025 to clear this up. The state medical board's guidance still turns on what the ultrasound shows, which is the exact situation where the scan shows nothing yet.

We have a Republican member of Congress who lived this

The mechanism is not a theory. It happened to a sitting Republican congresswoman, and she has described it herself.

In May 2024, Kat Cammack was five weeks pregnant in a Florida emergency room when doctors found the pregnancy was ectopic and her life was at risk. They knew what she needed. By her own account they hesitated because they "were worried about losing their licenses or going to jail." She looked up the Florida statute on her phone and called the governor's office. Hours later she got the drug.

Cammack was a member of Congress with the governor's number. She still waited. Florida is one of the eighteen states in the top row of that table.

Her conclusion was that the law was fine and the doctors were misinformed. ProPublica has now counted what happens to women who do not have the governor's number.

The people who wrote these laws are still going

The eighteen bans are state laws, but the Republicans who run for federal office keep promising to take them national.

Todd Blanche told a private prayer call he would work to make the Dobbs decision "permanent in every single state" before being confirmed as Attorney General. Cammack's own Dismemberment Abortion Ban Act would make a standard second-trimester procedure a federal crime punishable by two years in prison, with no exception for rape, incest or the patient's health. Tom Tiffany backed a national ban and then deleted it from his website when he started running for governor.

None of them are proposing to ban treatment for ectopic pregnancy. That was never the danger. The danger is the criminal penalty sitting next to the doctor's decision, and every one of these proposals adds more of it.

What the record shows

Almost 200 women died after an ectopic pregnancy in the United States from 2020 to 2025, roughly double the number in the previous six years. In the eighteen states that ban abortion at six weeks or earlier, the death rate for 2023 through 2025 was 13.1 per million live births, against 7.1 in states without a ban. In Texas alone, 310 more patients suffered substantial blood loss after an ectopic pregnancy in 2023 and 2024 than in 2018 and 2019. These bans make exceptions for treating an ectopic pregnancy. They did not have to ban it — attaching a prison sentence to the decision was enough.

Source

"Ectopic Pregnancy Deaths Have Nearly Doubled. It's Worse in States With Abortion Bans," ProPublica, September 9, 2026. Chart: ProPublica.

Roger Marshall's Medical Practice Sued More Than 700 of His Own Patients Over Their Bills. 81 of Them Were Arrested.

Wed, 09 Sep 2026 12:50:15 +0000

Before he was a United States Senator, Roger Marshall delivered babies in Great Bend, Kansas. He still runs on it. It is the first thing his campaign tells you about him.

On September 8, 2026, The New York Times reported what else he did in those years. Marshall and his medical practice sued more than 700 of their own patients over unpaid bills. At least 81 of those patients were arrested after missing a court date. The practice garnished paychecks and bank accounts, charged 18 percent interest a year on what people owed, and went to court over bills as small as $101.

These were not wealthy people. They were his patients in Barton County, a rural part of Kansas the Times describes as having above-average poverty and uninsured rates. Some were new mothers with unpaid bills from their own deliveries.

What it looked like for the people he sued

The cases are not abstract. Reporters found the patients and asked them.

Kellie Clutts was taken to court over a $129 bill from a postpartum checkup — the visit a woman has after giving birth. Her baby was nine months old. Marshall's side eventually garnished her bank account. She told the Times: "I told them I could make partial payments, but it seemed like no matter what I said, they wanted the full amount at once."

Joe Vasquez and his wife were arrested over Easter weekend in 2007. The bill was $4,561, for an emergency hysterectomy she had needed three years earlier. They missed a court appearance. Marshall's lawyers asked a judge for a warrant. The couple spent two days in jail while their son borrowed the money to bail them out. The police took them, Vasquez told the Times, as their grandchildren were getting ready for an egg hunt.

Another woman, sued in 2004 over $1,200, wrote to the court asking not to be held liable for care she had received "for me and my twins (who I lost)."

That is the record. A doctor's office, in a small Kansas town, asking the county to arrest the women he had treated.

"Judges issue warrants, not doctors"

Marshall did not deny any of it. His spokeswoman, Payton Fuller, said that he had spent decades caring for patients regardless of their ability to pay, and that "judges issue warrants when people repeatedly miss court dates, not doctors."

That is true, and it is beside the point. A judge cannot issue a warrant nobody asked for. Marshall's lawyers were the ones who filed the cases, and they were the ones who asked for the warrants — dozens of times.

Nothing here required him to do any of it. Plenty of doctors write off small unpaid bills. Plenty of practices never sue a patient at all. Marshall's did it more than 700 times, and kept doing it for years.

He did well out of it

While this was happening, Marshall and eight other doctors opened a four-bed surgical center in Great Bend that grew into a full-service hospital generating tens of millions of dollars in revenue. He chaired its board. His most recent financial disclosure puts his worth between $3 million and $9.8 million.

He stopped practicing medicine in 2016, when he was elected to Congress.

What he has done with the seat

Marshall sits in the Senate as a physician on both committees that write health care law — Finance, including its Health Care subcommittee, and Health, Education, Labor and Pensions. Here is what he has done with that.

In March 2017, he explained to the health care news site STAT why some people go without medical care. "There is a group of people that just don't want health care and aren't going to take care of themselves," he said, in remarks TIME picked up. He had spent the previous two decades suing people who could not pay him.

In December 2025, he said he expects the health insurance subsidies to expire, shrugging on Newsmax that "some people's premiums are going to go up some."

And when Kansas doctors warned him that his vote on Trump's budget bill would cost their patients care, he said there were no Medicaid cuts at all and called the claim a lie — while Kansas is projected to lose $3.9 billion, $2.7 billion of it out of hospitals.

Kansans who want to ask him about any of this have had a hard time finding him. He has not held an open town hall in more than 500 days, despite once bragging about holding 105 of them.

What a medical bill does to a family

Medical debt is not like other debt. Nobody chooses an emergency hysterectomy. Nobody shops around during labor. You get the care, and the bill comes later, and it is a number you had no way to plan for.

What Marshall's practice added to that was 18 percent interest, a court summons, money taken out of a paycheck, and — for 81 people — a jail cell. A $129 bill for a postpartum visit became a garnished bank account. A $4,561 bill became an arrest on Easter weekend.

Marshall is now asking Kansas to send him back to Washington for another six years to make health care policy for the country.

What the record shows

Roger Marshall's medical practice took more than 700 of its own patients to court over unpaid bills, charged them 18 percent annual interest, garnished their wages and bank accounts, and asked judges for arrest warrants when they missed a hearing. At least 81 patients were arrested. The bills ran as low as $101, and some belonged to new mothers in one of the poorer parts of Kansas. The doctor who did that now sits on both Senate committees that write health care law, has said poor people "just don't want health care," and voted for a bill projected to cost his state $3.9 billion in Medicaid.

Source

Reporting by Sarah Kliff, "Roger Marshall Sued 700 Patients for Debts; 81 Were Arrested. Now He's a Senator.", The New York Times, September 8, 2026. Photo: official U.S. Senate portrait, via Wikimedia Commons.

Andy Barr Says the $50 Billion Rural Health Fund Will Save Kentucky's Hospitals. Kentucky's Governor Says the Rules Forbid Spending It on the Hospitals at Risk.

Sun, 06 Sep 2026 06:00:05 +0000

Governor Andy Beshear has said since June 2025 that 35 Kentucky rural hospitals are at risk of closing because of the 2025 Republican budget bill — Barr's own office dates the first statement to June 23 of that year. On September 4, 2026, Andy Barr stood at the Lexington Clinic with Dr. Mehmet Oz, who runs Medicare and Medicaid for the Trump administration, and said the premise is simply false.

"This idea that the governor here in Kentucky and others around the country, the critics of the president, the critics of our law, are saying that somehow this is a cut is wrong."

Barr is running for Mitch McConnell's Senate seat. He voted for the bill. We wrote in August about the letter he sent Beshear demanding he prove the 35 hospitals are at risk — a letter that never mentioned his own vote.

This is the next round, and it turns on one specific claim.

Barr's defense is a $50 billion fund

Barr's argument is that the study naming 35 at-risk Kentucky hospitals was done before Congress created the Rural Health Transformation Program, which puts $50 billion into rural health care between 2026 and 2030. Kentucky's first-year share is $212.9 million, awarded by the Trump administration on December 29, 2025. Barr's own letter says the state "has now received" it.

In other words: yes, Medicaid is changing, but here is money to cover it.

Beshear answered that in a letter Barr's office received on Tuesday. His answer is not that the money is too small. It is that the money is not allowed to go where the problem is.

Under the program's federal guidelines, Beshear wrote, the funds are barred from being used on financially struggling hospitals.

What he pointed to, Beshear said, was the op-ed Health and Human Services Secretary Robert F. Kennedy Jr. and Oz published when the program was announced. Their words: "Throwing money at struggling hospital operations is like a Band-Aid on a severed artery, leaving a broken system in place."

That is the whole argument in one sentence. Barr's proof that the at-risk hospitals will be fine is a fund the state says cannot be spent on hospitals in financial trouble.

What is actually changing

Barr describes the changes as saving Medicaid from fraud, waste and abuse, and says Medicaid spending will rise by $250 billion over ten years.

Here is what the law does to people in Kentucky, with the effective date the law itself sets for each:

Work requirements, by December 31, 2026 — adults covered by the Medicaid expansion have to complete 80 hours a month of work or a qualifying activity. Where the state cannot verify that from data it already holds, it must send a notice of noncompliance and drop the person if they cannot show compliance within 30 days.
Six-month eligibility renewals, for renewals scheduled on or after December 31, 2026 — twice the paperwork of the annual renewal it replaces.
Minimum out-of-pocket payments, October 1, 2028 — up to $35 a service for expansion adults earning between 100 and 138 percent of the poverty line. This one is two years out, not next year.

Barr's framing for the first one:

"We want work requirements so that people can graduate out of Medicaid into work-provided health insurance, commercial health insurance that reimburses providers, physicians, hospitals, and nurses on a more market-based level."

"Graduate" is doing a lot of work in that sentence. A person who loses coverage because they missed a renewal deadline has not graduated into anything.

Oz threatened to take the money back

The most striking thing said at that press conference did not come from Barr.

Oz explained that the rural health money goes to governors because people trust governors to spend it correctly. Then he added a condition:

"I don't want to do it. But if the money is not used wisely to improve the state of health in rural parts of Kentucky ... then we're going to have to take steps that we don't want to have to take."

So the $212.9 million that Barr is holding up as the answer to the hospital closures comes with a federal official standing beside him saying that "if for whatever reason the governor cannot use the money as promised in the grant, it will be taken by the federal government" — while the state says the rules already forbid spending it on the hospitals most at risk.

The part that hasn't changed

Barr's whole position rests on the claim that a law he voted for will not close hospitals. His evidence is a fund the state says it cannot aim at the hospitals in question, administered by an official who says he may take it back.

Meanwhile the changes themselves — work paperwork and six-month renewals from the end of this year, new out-of-pocket costs for low-income Kentuckians in 2028 — are not in dispute. Barr is not arguing they won't happen. He is arguing they are not a cut.

What the record shows

Andy Barr voted for the 2025 budget bill and now says its Medicaid changes are not cuts. His evidence is Kentucky's $212.9 million first-year share of a $50 billion rural health fund, awarded last December. Governor Beshear says federal rules bar that money from going to financially struggling hospitals, which are the ones the closure warnings are about. Standing next to Barr, the federal official who runs Medicaid warned the money could be taken back. Work requirements and six-month renewals start at the end of this year; the new out-of-pocket costs follow in 2028.

Sources

Hannah Pinski, Andy Barr and Dr. Oz defend changes coming to the Medicaid program, Lexington Herald-Leader (September 4, 2026).
Oz says rural health funding responsibility falls to governor, WKYT (September 4, 2026).
Christian Wohlfeil, Gov. Beshear defends rural hospital funding after scathing letter from Rep. Barr, LEX 18.
Barr Calls Out Beshear Over Inaccurate Rural Hospital Claims, Office of Rep. Andy Barr (August 25, 2026).
Robert F. Kennedy Jr. and Mehmet Oz, Rural America's health care is collapsing. Here's how we transform it., USA TODAY (September 15, 2025).
Congressman Rogers Announces Nearly $213 Million Award for Rural Healthcare in Kentucky, Office of Rep. Hal Rogers (December 29, 2025).
Health Provisions in the 2025 Federal Budget Reconciliation Law, KFF.

The Trump Administration Cancelled 16 Health Grants Worth $38 Million, Including Nurse Visits for New Mothers, Because They Did Not Focus on Low Sperm Count and Erectile Dysfunction

Sat, 05 Sep 2026 07:05:11 +0000

On August 25, 2026, the federal office responsible for improving health outcomes among minority Americans sent letters cancelling more than half of the grants it was funding.

Sixteen grants. $38 million over four years. The recipients had already been paid for two of those years.

The reason given was that the work no longer matched the administration's priorities. Going forward, according to the letters, an award has to directly advance "reducing overmedicalization in health care by addressing the root causes of infertility." The letters listed those causes: hormonal imbalances, endometriosis, uterine fibroids, low sperm count, low testosterone and erectile dysfunction. Programs promoting "regular physical activity and exercise" also qualify.

NOTUS reported the terminations on September 4.

What the cancelled grants were doing

Cancer screenings.
Home visits by nurses to women who had just given birth, to check on the mother and the newborn.
Suicide prevention among first responders.
Reducing obesity among Native American youth.
Blood pressure monitoring at home for people with hypertension, paired with fresh produce delivery.
Preventing infant and maternal deaths among Black families in the Arkansas Delta.

None of that is a boutique concern. CDC figures for 2024 put the maternal death rate for Black women at 44.8 per 100,000 live births, against 14.2 for white women — more than three times higher.

Jillian Fabricius co-directs Illuminate Colorado, which sends nurses into new mothers' homes. Her reaction to the letter was the reaction of someone who assumed this was uncontroversial.

"It was news to us that maternal and infant fatality prevention wasn't a priority."

Christopher Joseph runs EngageWell, which administered a grant that helped hypertension patients monitor their blood pressure at home and delivered fresh produce to 150 New Yorkers every two weeks under a program called Food as Medicine. Feeding people vegetables to control blood pressure is close to the literal text of Health Secretary Robert F. Kennedy Jr.'s Make America Healthy Again agenda, and Joseph said so.

"When MAHA came about we thought great, this aligns with their priorities."

The grant was cancelled anyway.

What is left

The Office of Minority Health now lists two funding opportunities for the year: one for lupus research and one for chronic disease among Native Americans. Under the previous administration it funded dozens of grants a year.

The administration tried to shut the office down entirely last year.

The Department of Health and Human Services did not respond to NOTUS's request for comment.

The trade being made

Set the two lists side by side.

Cancelled: screening people for cancer. Checking on new mothers and their babies. Keeping first responders from killing themselves. Getting produce to people with high blood pressure. Keeping Black infants in the Arkansas Delta alive.

Prioritized: low sperm count, low testosterone, erectile dysfunction, and encouraging exercise.

There is a coherent argument for federal research into declining fertility. There is no version of that argument that requires cancelling postpartum nurse visits to pay for it, and the letters do not attempt one. They simply say the old work no longer counts.

What the record shows

The federal office charged with minority health cancelled 16 grants worth $38 million on August 25, two years into their four-year terms, because the work did not address infertility or exercise. Among the cancelled programs were cancer screenings, postpartum nurse visits, first-responder suicide prevention, and infant and maternal mortality prevention among Black families in the Arkansas Delta. The office now advertises two funding opportunities for the entire year, where the previous administration funded dozens of grants a year.

Source

HHS Cancels Infant Mortality, Postpartum Grants to Focus on Sperm Counts, ED, by Paige Winfield Cunningham and Eric Katz, NOTUS, September 4, 2026. Photo: Rogelio V. Solis / AP.

Ken Paxton Sued Biden Over Exactly This and Called It a 'Major Nationwide Legal Victory.' Trump Is Now Holding Back $10 Billion From Texas Hospitals and Paxton Has Said Nothing.

Sat, 05 Sep 2026 06:57:18 +0000

Texas hospitals are losing $27 million a day, the Texas Hospital Association says.

The Trump administration is holding up $10 billion in Medicaid payments the state's hospitals were counting on. The money comes from a federal program that tops up what hospitals are paid for treating Medicaid patients, because the base rate does not cover what the care costs.

Three years ago, the Biden administration threatened to withhold the same money over the same legal objection. Ken Paxton took that fight to federal court and won.

Last year he put out a news release calling it a "major nationwide legal victory."

"This is not only a win for the integrity of Texas health care, but it's also a defeat of Joe Biden's unlawful overreach. This rule is just one example of the Biden administration's misuse of CMS, which was employed to target conservative states."

This week, with the identical dispute and a Republican in the White House, the Texas Tribune reported that Paxton has not filed a lawsuit, has not said whether he intends to, and has not commented at all. Neither has his campaign.

What the fight is actually about

Texas hospitals pay about $4.2 billion a year in local taxes, which the state uses as its share of the program. Since 2013, state law has also let hospitals make informal agreements with one another, so a hospital hit harder by the Medicaid shortfall can be helped out by one in better shape.

Federal regulators say a tax has to be broad-based and applied uniformly. Their objection, both times, is that those agreements effectively shield some hospitals from the tax.

Texas has argued that the agreements are private contracts and the federal government has no business policing them. That argument won in federal court last September, in a case Texas itself had brought against CMS in 2023. Here is how his office described the win in last year's news release:

"These agreements were permitted by the Legislature in 2013 and are allowed by federal law... Biden's CMS attempted to force Texas and other states to police purely private contracts, imposing unlawful federal overreach that could have led to a massive cut in critical Medicaid funding."

Every word of that applies to what the Trump administration is doing now. This time the demand goes further — regulators appear to want Texas to rewrite its tax structure entirely, which state officials say is unnecessary.

Paxton has not answered whether he will sue.

Even Greg Abbott is fighting this one

Governor Greg Abbott, who is not known for crossing Trump, has publicly backed the state's position. His spokesperson said on Wednesday that Texas was not backing down. That is a rare thing in Texas — a Republican in office publicly fighting for Medicaid.

Brandon Rottinghaus, a political scientist at the University of Houston, told the Tribune he is not surprised Paxton is the one staying quiet. Paxton is in a close race against Democratic state Rep. James Talarico, early voting begins October 19, and the Republican midterm convention opens in Dallas next week.

"He's in a very politically delicate situation, and he doesn't want the story to be, Trump versus Paxton. He's biding his time in a way that is useful as a delay tactic to not make this a story that could splash back up on him."

Rottinghaus also said the money is too big to walk away from. "It's gonna be politically messy for the Republicans, especially for Greg Abbott and for Ken Paxton, but it's a fight that they have to have."

One of them is having it.

What the money pays for

Medicaid covers 4 million Texans, most of them low income. About a third of all children in Texas are on it. So are two-thirds of Texans in nursing homes.

The Texas Hospital Association says that without this funding stream, hospitals are at risk of shutting down their neonatal intensive care units and maternity wards. Those are among the most expensive services a hospital runs.

At Parkland Health in Dallas, where a third of the patients at Parkland Memorial Hospital are on Medicaid, chief executive Dr. Frederick Cerise told Dallas County commissioners on Tuesday what the number looks like for one hospital system: $528,000 every day for the coming fiscal year, which starts October 1.

He said there are no immediate service cuts, but that the first casualty will be capital improvements, and that it gets worse the longer the standoff lasts. He does not expect the state to fill the hole.

"The state depends heavily on this as a financing mechanism and... it's hard to imagine the state's going to backfill that with general revenue."

He is also less hopeful than usual that it gets sorted out. In the past, he said, the funding has been approved late and applied retroactively. "There's a lot more uncertainty right now than we've ever had."

The job he is running to leave

Paxton is the attorney general of Texas. Suing the federal government over Medicaid funding is not a favor he does for hospitals; it is the work of the office he currently holds, and it is work he has already done successfully on this exact question against a different president.

He is asking Texans to promote him to the Senate. The argument for doing that rests on his record as the state's lawyer.

His record on this dispute, so far, is silence.

Voters have seen this shape before. We wrote about him investigating America's pediatricians for taking money from donors, and about the Republican mega-donors who will not touch his campaign.

What the record shows

Ken Paxton sued the Biden administration to stop it from withholding this exact Medicaid funding, won, and issued a news release calling it a major nationwide legal victory and an act of unlawful federal overreach. The Trump administration is now withholding the same $10 billion on the same legal theory, at a cost of $27 million a day to Texas hospitals and $528,000 a day to Parkland Health alone. Governor Greg Abbott has publicly backed the state's position. The attorney general has filed nothing and said nothing, six weeks before early voting begins in his Senate race.

Source

Ken Paxton quiet about Texas' $10B Medicaid cut, by Terri Langford, The Texas Tribune, September 4, 2026. Photo by Shelby Tauber for The Texas Tribune.

Your Health Premiums Jumped 58%. House Republicans Came Back and Voted to Tell Colleges What They're Allowed to Boycott.

Fri, 04 Sep 2026 13:06:57 +0000

Your health insurance costs more than it used to. A lot more. When Congress let the enhanced premium tax credits expire at the end of 2025, what Marketplace enrollees pay toward their own premiums rose by an average of 58%, from $113 to $178 a month, according to KFF. Deductibles went up 37% — about $1,027 a person — to a record $3,786, the steepest jump this market has ever seen. And it is not done: insurers have filed for a median premium increase of another 15% in 2027, the second straight year of double-digit hikes.

The House came back from its August recess on August 31. Over the next four days it held twelve recorded votes. Not one of them was about your premiums.

Here is what the House did vote on instead, according to the Clerk's own record: a resolution condemning socialism, a constitutional amendment to freeze the Supreme Court at nine seats, a bill fast-tracking mining permits, a bill delaying protections for the endangered North Atlantic right whale, and — on Thursday morning — a bill that strips federal student aid from any college that boycotts Israel.

That last one is H.R. 4795, and it passed 237–169. House Republicans voted for it 203–2.

What the bill actually does

Read the text and the reach of it is the point. The bill amends the Higher Education Act so that any college taking part in a "nonexpressive commercial boycott" of Israel loses eligibility for federal student aid — Pell Grants, federal student loans, the money most students actually use to go to school. A second section says that if a school takes federal foreign-language and international-education funding, it has to file a certification every July 31 promising it will let students and faculty study in Israel on the same terms as anywhere else, and let Israeli students and faculty into its own programs on the same terms as students and faculty from any other foreign university. Miss the deadline and the money stops.

The operative text never says the word "Israel." It says "major strategic partner," and defines that by pointing at a 2014 law — the United States-Israel Strategic Partnership Act. The bill's official title says Israel out loud.

What counts as a boycott is a "commercial action" meant to limit business with Israel that "is not based on a valid business reason." So a university has to be prepared to explain, to the federal government, that its business decisions had a valid business reason and not a political one.

Nobody is doing the thing the bill bans

At the Rules Committee markup, Democrats made a simple point. "There has not been a single case of an American college or university administration adopting the BDS movement policies that are described in the bill. Not one," Rep. Bobby Scott said.

Morgan Griffith, who voted yes, answered that argument by embracing it. "Let's take my colleagues on the other side of the aisle and their argument, and that is the bill does nothing, and there's nothing to see here," he said at the markup. "Then there's no harm in passing it."

That is the whole defense: a federal speech rule aimed at conduct nobody has engaged in, and the case for it is that it might not do anything.

This is control, not freedom

The bill is called the Protect Economic and Academic Freedom Act. It does the opposite. It tells private and public institutions what political positions they are allowed to take with their own money, and puts their students' tuition aid on the table if they get it wrong.

The word doing the work is "nonexpressive." Boycotting is speech — that is why people do it. Congress can't punish speech, so the bill relabels the boycott as commercial conduct and punishes that instead. The ACLU told Congress exactly what that is: "Many of those engaged in boycotts of Israel do so not for commercial reasons, but because they wish to express their political opposition to the policies of the Israeli government... HR 4795's labeling such boycotts as 'non-expressive' does nothing to change this reality."

Rep. Jerry Nadler, who opposes the boycott movement and said so at length, called the bill "a direct and gross violation of the First Amendment." His reason is the one that should matter to everybody, whatever they think about Israel: "The First Amendment right to free speech does not apply only to agreeable speech... I will always fight to protect Americans' right to speech with which I disagree. It is the only way to ensure speech I do agree with is equally protected." Nadler also warns that the bill's definition sweeps in the occupied West Bank, treating it as part of Israel and erasing the Green Line.

And the certification requirement flips a ban into a mandate. Lara Friedman of the Foundation for Middle East Peace put it plainly: "The goal here is to basically say every university not only cannot refuse cooperation with Israel but must actively seek every opportunity to cooperate with Israel... And if they're not doing that, they're pro-BDS and anti-Israel." She notes that any group that wants to can go hunting for a missing Israeli partnership and accuse a school of lying on its federal certification.

A government that decides which boycotts you may join, and requires you to prove your cooperation with a foreign country every July to keep your students' financial aid, is not protecting freedom. It is rationing it.

Two Republicans said no

Warren Davidson and Thomas Massie were the only two Republicans who voted against the bill. Thirty-three Democrats voted for it, and the bill's sole cosponsor is a Democrat, Josh Gottheimer. This was not a party-line vote. It was a vote where two Republicans out of 205 were willing to say that the federal government does not get to police what a college may boycott.

The bill now goes to the Senate.

The choice they made

Nobody has to guess at the priorities here. In the same four days the House found floor time to condemn socialism, to fast-track mines, to delay whale protections, to try to lock the Supreme Court at nine seats, and to police what colleges say about a foreign country, the premium bills already sitting on kitchen tables went up 58% and are set to climb again next year. The House has taken 295 recorded votes in 2026. It has not used one of them to put the premium tax credits back.

Every Republican we track who voted yes

These 184 members have a report card on this site and voted yes on H.R. 4795. (Kevin Kiley left the Republican Party in March 2026 but still caucuses with Republicans; he voted yes.)

Alabama: Barry Moore, Dale Strong, Gary Palmer, Mike Rogers, Robert Aderholt

Alaska: Nick Begich

Arizona: Abraham Hamadeh, Andy Biggs, David Schweikert, Eli Crane, Paul Gosar

Arkansas: Bruce Westerman, French Hill, Rick Crawford, Steve Womack

California: David Valadao, James Gallagher, Ken Calvert, Kevin Kiley, Tom McClintock, Vince Fong, Young Kim

Colorado: Gabe Evans, Jeff Crank, Jeff Hurd, Lauren Boebert

Florida: Aaron Bean, Anna Paulina Luna, Brian Mast, Carlos Gimenez, Greg Steube, Gus Bilirakis, Jimmy Patronis, John Rutherford, Kat Cammack, Laurel Lee, Maria Elvira Salazar, Mario Diaz-Balart, Mike Haridopolos, Randy Fine, Scott Franklin

Georgia: Andrew Clyde, Austin Scott, Brian Jack, Clay Fuller, Mike Collins, Rich McCormick, Rick Allen

Idaho: Mike Simpson, Russ Fulcher

Illinois: Darin LaHood, Mike Bost

Indiana: Erin Houchin, Jefferson Shreve, Jim Baird, Mark Messmer, Marlin Stutzman, Rudy Yakym

Iowa: Ashley Hinson, Zach Nunn

Kansas: Derek Schmidt, Ron Estes, Tracey Mann

Kentucky: Andy Barr, Brett Guthrie, Hal Rogers, James Comer

Louisiana: Clay Higgins, Julia Letlow, Mike Johnson, Steve Scalise

Maryland: Andy Harris

Michigan: Bill Huizenga, Jack Bergman, John James, John Moolenaar, Lisa McClain, Tim Walberg, Tom Barrett

Minnesota: Brad Finstad, Michelle Fischbach, Pete Stauber, Tom Emmer

Mississippi: Michael Guest, Mike Ezell, Trent Kelly

Missouri: Ann Wagner, Bob Onder, Eric Burlison, Jason Smith, Mark Alford

Montana: Troy Downing

Nebraska: Adrian Smith, Mike Flood

New Jersey: Chris Smith, Jeff Van Drew, Tom Kean Jr.

New York: Andrew Garbarino, Claudia Tenney, Mike Lawler, Nick LaLota, Nick Langworthy, Nicole Malliotakis

North Carolina: Brad Knott, Chuck Edwards, David Rouzer, Greg Murphy, Mark Harris, Pat Harrigan, Richard Hudson, Tim Moore, Virginia Foxx

North Dakota: Julie Fedorchak

Ohio: Bob Latta, David Joyce, David Taylor, Jim Jordan, Max Miller, Michael Rulli, Mike Carey, Mike Turner, Troy Balderson

Oklahoma: Frank Lucas, Josh Brecheen, Kevin Hern, Stephanie Bice, Tom Cole

Oregon: Cliff Bentz

Pennsylvania: Brian Fitzpatrick, Dan Meuser, Glenn Thompson, Guy Reschenthaler, John Joyce, Lloyd Smucker, Mike Kelly, Rob Bresnahan, Ryan Mackenzie, Scott Perry

South Carolina: Ralph Norman, Russell Fry, Sheri Biggs, William Timmons

Tennessee: Chuck Fleischmann, David Kustoff, Diana Harshbarger, John Rose, Matt Van Epps, Scott DesJarlais, Tim Burchett

Texas: August Pfluger, Beth Van Duyne, Brandon Gill, Brian Babin, Craig Goldman, Jake Ellzey, John Carter, Keith Self, Lance Gooden, Michael Cloud, Monica De La Cruz, Nathaniel Moran, Pat Fallon, Pete Sessions, Randy Weber, Roger Williams, Ronny Jackson

Utah: Blake Moore, Celeste Maloy, Mike Kennedy

Virginia: Ben Cline, Jen Kiggans, John McGuire, Morgan Griffith, Rob Wittman

Washington: Michael Baumgartner

West Virginia: Carol Miller, Riley Moore

Wisconsin: Bryan Steil, Derrick Van Orden, Glenn Grothman, Scott Fitzgerald, Tom Tiffany, Tony Wied

Wyoming: Harriet Hageman

How they voted

Rob Wittman Bragged About Voting 60 Times to Repeal the Affordable Care Act. Asked This Week Whether He'd Vote to Repeal It Again, He Wouldn't Say.

Fri, 04 Sep 2026 06:45:32 +0000

Back in 2017, Rob Wittman was proud of the number. He had voted to repeal and replace the Affordable Care Act 60 times, and he said so.

Nearly a decade later, on January 8, 2026, he did something different. He was one of just 17 Republicans in the entire House to vote for a three-year extension of the ACA's enhanced premium subsidies. The bill passed 230 to 196 over the objections of Speaker Mike Johnson. Then the Senate let it die, and the subsidies stayed expired.

Virginia Mercury's Charlotte Rene Woods put the two facts next to each other this week and asked Wittman the obvious follow-up: would he back a future repeal effort?

He didn't answer.

What he said instead

Asked to explain the January vote, Wittman gave a reason about his own constituents. "I did not believe families should face dramatic increases in their health insurance costs without a transition," he said.

Asked whether he'd vote to repeal the law again, he offered a paragraph of goals instead of a yes or a no — competition, patient choice, price transparency, "greater control over their healthcare decisions."

That is not a small dodge. The whole question voters in Virginia's 1st District have to answer this November is which Rob Wittman they are electing: the one who counted 60 repeal votes as an accomplishment, or the one who cast a single vote the other way nine years later. He was asked directly and he would not say.

University of Virginia's Larry Sabato read the January vote as a calculation rather than a conversion. Wittman's district, he said, is "competitive enough that he can't stick to (President Donald) Trump and GOP congressional positions 100% of the time."

The vote came after the damage was locked in

Timing matters here, and it does not flatter him.

The enhanced subsidies expired on December 31, 2025. Wittman's vote to extend them came on January 8, 2026 — eight days after they were already gone, in a bill his own party's leadership opposed and the Senate never brought to a vote. A similar measure had already failed in the Senate on December 11, when a cloture motion on S. 3385 was rejected 51 to 48.

Since last year, 94,000 Virginians have dropped their ACA insurance. That is the number of people who looked at what a plan cost without the subsidies and walked away.

Nationally, about 2.6 million people have lost ACA coverage as the same math played out in nearly every state — New Mexico, which replaced the federal subsidies with its own, was the only one where enrollment went up. Virginia's 94,000 is Virginia's share of a bill that Congress chose not to pay.

The other health care vote he did cast

While the subsidy vote was one vote against his party, Wittman's vote on Trump's budget bill was one with it — and it is the vote with the bigger price tag.

He and Representative Jen Kiggans both pushed back on parts of the bill while it was being debated. Both then voted for it.

What that bill does to Virginia, per Virginia Mercury's reporting:

About 300,000 Virginians are at risk of losing Medicaid coverage next year.
5,800 lawful immigrants are guaranteed to lose it next month.
A projected $31 billion cut to the state's Medicaid funding over the next decade.
Changes to how hospitals are paid that may push rural hospitals toward closing or cutting services.

This is also not the first time Wittman's stated position and his recorded vote have pointed in opposite directions on Medicaid. In April 2025 he signed a letter promising he would not support any bill that reduced coverage for vulnerable people, told a columnist a month later that Virginians were protected, and then voted yes.

"A different pathway" that analysts read as another repeal

Wittman has also backed the Lower Health Care Premiums For All Americans Act, which passed the House last December and has not become law. It would let small businesses and self-employed people band together to buy insurance through association health plans.

Wittman describes it as bulk buying. "Anything that you buy in bulk or in mass quantities, you get a reduction in price," he said.

Some analysts describe it as a way to chip away at the ACA. The reason is not complicated. Since the ACA passed, insurers have not been allowed to charge you more because of your health. Pooling healthy people separately from sick people undoes that quietly, without a repeal vote.

Georgetown researcher Sabrina Corlette explained why the shared pool is the point. "We all get older and sicker," she said. The Democrats' approach "is recognizing that you might be subsidizing a sicker person today, but someone else will be subsidizing you down the road."

His Democratic opponent, prosecutor Shannon Taylor, put the political read plainly: "Now, with an election around the corner and families facing higher premiums, he wants to try and change his tune."

What the record shows

Rob Wittman touted 60 votes to repeal and replace the Affordable Care Act, then cast one vote to extend its subsidies eight days after they had already expired, in a bill that died in the Senate. Asked this week whether he would vote to repeal the law again, he would not answer. In between, he voted for Trump's budget bill, which puts about 300,000 Virginians at risk of losing Medicaid and cuts a projected $31 billion from the state's Medicaid funding over ten years, and 94,000 Virginians have already dropped their insurance since the subsidies lapsed.

Source

Wittman voted 60 times to undo the Affordable Care Act. Then he backed extending its subsidies. — Charlotte Rene Woods, Virginia Mercury, September 3, 2026. Photo by Charlotte Rene Woods / Virginia Mercury.

Indiana Has Dropped More of Its Children From Medicaid Than Any Other State. All Seven of Its Republicans in Congress Voted for the Law That Cuts Another $900 Billion.

Wed, 02 Sep 2026 06:55:29 +0000

Nearly 2.5 million children in the United States have lost Medicaid or Children's Health Insurance Program coverage since January 2025, according to data published on September 1, 2026 by the Georgetown University Center for Children and Families.

No state has shed a larger share of its kids than Indiana.

And the part that should worry everyone: none of this is the 2025 budget bill's Medicaid cuts. Those have not started yet.

What has already happened

Georgetown's researchers have been tracking child enrollment state by state since the start of Trump's second term. Their June 2026 report found Indiana at the top of the list — an enrollment decline of 19.8%, or over 174,000 children, comparing April 2026 to January 2025. By the data released this week, Indiana's drop had passed 23%.

Five states have now seen declines of 10% or more. Ten states — California, Texas, Indiana, Florida, Georgia, Illinois, Ohio, Arizona, Virginia and Kentucky — account for two thirds of the losses. In the June report, only two states in the country were holding steady or rising.

Georgetown's own words on the timing:

"these enrollment losses are occurring BEFORE Medicaid cuts associated with H.R. 1 are coming into play, which is alarming as more declines will be on the way."

The causes Georgetown lists are paperwork and fear: more red tape and less help getting through it, anti-immigrant policies producing a chilling effect on families whose children are citizens, federal coverage protections that are not being enforced, state eligibility systems making mistakes, and families who assume the cuts are already in force and do not renew.

Joan Alker, who directs the Georgetown center, put the consequence simply: "when Medicaid child enrollment declines, the number of uninsured kids typically goes up."

Paperwork is the mechanism, and it is not an accident

This is the part that gets lost when people argue about eligibility rules. Nowhere in its list of likely causes does Georgetown say these children were found ineligible. Every item on that list is about the process, not about whether a child qualifies.

Eileen Appelbaum of the Center for Economic and Policy Research says the same thing will happen when the new federal rules start next year: "The best guesses from the experts are that two-thirds of the people that will be disqualified will actually be eligible, but they just couldn't handle the paperwork."

Brown University epidemiologists Abdullah Shihipar and Brandon DL Marshall put it in the terms that matter to a family: "Paperwork here is not merely an annoyance, it is a matter of life or death for millions with Medicaid coverage."

A child who loses coverage does not stop getting sick. The asthma inhaler, the ear infection, the well-child visit that catches something early — those either get paid for out of pocket, or they do not happen.

What Indiana's members of Congress voted for

Indiana is already the worst in the country at this, and every Republican it sends to the U.S. House voted to make the national version harder.

On July 3, 2025, the House voted on final passage of H.R. 1, Trump's budget bill. The clerk's roll call records all seven Indiana Republicans voting aye:

Jim Baird
Erin Houchin
Mark Messmer
Jefferson Shreve
Victoria Spartz
Marlin Stutzman
Rudy Yakym

That law cuts an estimated $900 billion from Medicaid over ten years. It also does nationally, starting next year, the same kind of thing Georgetown says is already pulling Indiana's rolls down — a 2025 state law that "added additional red tape and reporting requirements." H.R. 1 doubles how often people have to re-prove eligibility, from once a year to twice, and adds an 80-hour-a-month work or volunteer reporting requirement for certain adults.

Indiana has spent the last year and a half running a live demonstration of what happens when you add paperwork to children's health coverage. Its answer was 174,000 kids. Its congressional delegation voted to add more of it, nationwide.

They were told

This is not hindsight. The scale of the Medicaid cuts in H.R. 1 was public before the vote, and it has been the single most-covered consequence of that bill since.

Missouri's Mark Alford voted for the bill in July 2025, then introduced legislation eight months later to keep rural hospitals open — a bill with three cosponsors that has never moved. Kansas Sen. Roger Marshall, an OB/GYN, told a reporter "there are no Medicaid cuts" and called the opposite claim a lie, with his state projected to lose $3.9 billion.

The Indiana seven are on the same roll call. What is different in Indiana is that the state has already produced the number, before the law they passed has done anything at all.

What the record shows

Nearly 2.5 million American children have lost Medicaid or CHIP coverage since January 2025, and Indiana has lost a larger share of its children than any other state — more than 174,000 of them as of April 2026, driven by red tape, fear and confusion rather than by anyone being found ineligible. All of that happened before the Medicaid cuts in the 2025 budget bill took effect. All seven Indiana Republicans in the U.S. House voted for that bill, which cuts $900 billion from Medicaid and doubles how often families must re-prove they qualify.

Source

"Nearly 2.5 Million Children Have Lost Medicaid and CHIP—So Far—During Trump's Second Term", Common Dreams, September 1, 2026. State data: Georgetown University Center for Children and Families, "Which States Are Seeing the Largest Declines in Child Medicaid/CHIP Enrollment?", June 10, 2026. Vote record: U.S. House Clerk, Roll Call 190, July 3, 2025.

ICE Stopped Paying for Detainees' Medical Care Eleven Months Ago. One Colorado Hospital Is $4 Million in the Hole.

Tue, 01 Sep 2026 07:14:02 +0000

If a person in immigration detention has a heart attack, the detention center calls an ambulance and a local hospital treats them. That is how it is supposed to work, and it is how it did work for about two decades.

On October 3, 2025, U.S. Immigration and Customs Enforcement abruptly stopped paying the third parties who provide that care. Eleven months later, many of them still have not been paid.

Who is holding the bag

UCHealth University of Colorado Hospital, in Aurora, has treated ICE detainees across roughly 150 hospital admissions, clinic appointments and emergency visits since last fall. It has not been paid for any of them, and is now carrying almost $4 million in unpaid bills.

Moshannon Valley EMS is a nonprofit ambulance service in Philipsburg, Pennsylvania. As of June, it had answered 43 calls to a local ICE detention center since October 2025. It has not been paid for any of that work either.

An ambulance company in rural Pennsylvania does not have a cushion for 43 unpaid runs. Neither of these organizations chose to take on ICE as a client. They answered calls.

How the system worked before, and why it stopped

Payment for detainee medical care used to be processed by the Department of Veterans Affairs, under an arrangement dating back to the George W. Bush administration. It was a paperwork pipeline: the VA already ran a large medical claims operation, so ICE used it.

That was not small. In 2024 the VA processed more than $246 million in medical claims for people detained by ICE and, in much smaller numbers, by Customs and Border Protection. Records obtained by American Oversight show it processed $96 million in 2025 before the relationship ended.

The VA terminated it after right-wing activists attacked the arrangement, claiming immigrants were draining resources from veterans. What the VA was actually doing was processing paperwork ICE paid for.

The replacement has not processed the claims

Three weeks after the shutoff, ICE signed an emergency contract with a company called Acentra Health to take over claims processing. The federal contract record, dated October 25, 2025, shows ICE has committed $53 million to it and paid out more than $40 million.

ICE originally said claims processing would begin on April 30, 2026. That date has been pushed back repeatedly, with no current estimate.

So the government has paid a contractor more than $40 million to build a system that has not yet paid a hospital.

People are dying in this system

The unpaid bills are the accounting problem. There is a human one underneath.

In the 500 days between the inauguration on January 20, 2025 and June 4, 2026, 52 people died in ICE custody in the United States, according to a June 2026 report by Human Rights Watch and Physicians for Human Rights. That mortality rate, the report says, "is nearly four times that of the Biden administration, and more than two and a half times as high as that of the first Trump administration."

Those two facts belong in the same paragraph. The agency in whose custody people are dying at nearly four times the previous rate stopped paying the outside doctors and ambulance crews who treat them — and has not fixed it in eleven months.

A hospital cannot legally turn away an emergency patient. But an ambulance service that goes broke stops existing, and a hospital that eats $4 million makes it up somewhere. In Aurora, that somewhere is other patients.

What the record shows

ICE stopped paying hospitals, clinics and ambulance services for detainee medical care on October 3, 2025, after the Department of Veterans Affairs ended a claims-processing arrangement that had run since the Bush administration and handled more than $246 million in 2024 alone. Eleven months on, a single Colorado hospital is owed almost $4 million across roughly 150 visits, and a nonprofit Pennsylvania ambulance service has gone unpaid for 43 calls. ICE has paid a replacement contractor more than $40 million and has still not begun processing the claims. In the same period, 52 people died in its custody.

Sources

UPDATE: ICE is leaving hospitals with millions in unpaid bills — Popular Information, September 1, 2026. Photo: Alex Wong / Getty Images.

ICE hasn't paid UCHealth hospital since last year for immigrant health care — CPR News, August 18, 2026.

Dying in Detention: Rising Deaths in an Expanding US Immigration Detention System — Human Rights Watch and Physicians for Human Rights, June 25, 2026.

Byron Donalds Says Florida Can Replace Its Haitian Caregivers With High School Interns and Adult Retraining

Tue, 01 Sep 2026 07:01:12 +0000

Temporary Protected Status for Haitians has ended. More than 330,000 Haitian immigrants nationwide held that status. About 35,000 Haitian immigrants work in Florida's health care system — many as certified nursing assistants and registered nurses in long-term care — according to the Florida Health Care Association, the trade group for the state's nursing homes.

On August 23, 2026, CBS's Margaret Brennan asked Byron Donalds, the Republican nominee for governor of Florida, a direct question about it.

Brennan: "So, do you have a plan to replace the loss of 100,000 Haitians who work in healthcare in Florida if they are deported?"

Donalds: "Well, let's just be very clear. You're talking about the labor force in Florida. What we want to do is, the number one, we want to make sure that our kids coming out of high school are having internships and apprenticeships..."

That is his LaunchPad initiative — a program to connect high school juniors and seniors with internships so that, in his words, "by the time you graduate high school, you're walking directly into the job."

Brennan pressed him on the immediate shortage. Donalds added a second item — retraining adults. "We want to change adult re-education, adult education, career source," he said. "Have that really be supercharged so people can transition from one job or going into those fields." He named no target, no timeline and no cost for either half. Pressed a third time for a state plan, his answer was, "I just gave you the plan, Margaret."

The 100,000 figure in Brennan's question is not the Florida Health Care Association's. The Caribbean Television Network, reviewing the interview, called it out: the larger number "appears to describe Florida's overall healthcare staffing gap rather than the Haitian workforce specifically, and its basis was not explained."

The people he is talking about are already trained

The workers Florida is losing are not high school students who need a foot in the door. They are certified nursing assistants and registered nurses already working in long-term care. The certification is the thing that takes time, and they already have it.

Margarette Nerette is vice president of Long-Term Care South for 1199SEIU, the largest union of health care workers in Florida. She put the stakes plainly:

"This will have a devastating impact on the lives of thousands of healthcare workers and their families now facing possible deportation to a gravely dangerous situation in Haiti."

The people on the other end of that care are nursing home residents. Donalds' answer to losing tens of thousands of their caregivers is a pipeline that starts in eleventh grade, plus an unspecified expansion of adult retraining.

Florida was already running out of nurses

This is not a shortage that has room to absorb a shock.

The Florida Hospital Association estimates the state could be short 60,000 nurses by 2035. That projection was made before Haitian TPS ended. Donalds offered no number of workers his programs would produce, no timeline for producing them, and no cost.

An internship program that places graduating seniors into jobs may be a fine idea on its own terms. It is not a replacement plan for tens of thousands of licensed and certified adults being removed from the workforce this year.

He also defended taking the status away

Donalds is not a bystander to the shortage he was asked to solve.

Earlier in the same interview, he defended ending Haitian TPS directly. "TPS is a temporary program," he told Brennan. "The Biden administration, through enforcement, took the T off the program. They turned that into a permanent program... The Trump administration, in my view, making sure that it's a temporary program is correct." He pointed to Haiti's transitional government as evidence the country is stabilizing — the same country the union representing these workers describes as "a gravely dangerous situation."

So the position is complete, and both halves were stated in the same half-hour: end the legal status that lets these caregivers work, then answer the resulting shortage with a workforce-training pitch carrying no numbers. Both halves are his.

He has taken the employer's side against these workers before

This is a pattern with Donalds, not a one-off answer to a hard question on live television. It ran twice inside this one broadcast.

He co-sponsored a bill to block the first federal heat protections for Florida's outdoor workers. And this was the second Florida health question Brennan put to him in this one interview that came back as immigration: minutes earlier, asked whether his message to parents was to vaccinate their children against measles, he said no and blamed the outbreaks on "rampant illegal immigration." Florida had 141 measles cases by late July.

The through line is consistent. Asked about a health care problem in his own state, Donalds answers with immigration — and when Florida workers are on one side of a policy, he has not been on theirs.

What the record shows

Florida is losing roughly 35,000 Haitian health care workers who staff its nursing homes and long-term care facilities, in a state the Florida Hospital Association already expects to be 60,000 nurses short by 2035. Asked on national television how he would replace them, Byron Donalds named a high school internship program and a supercharged adult-education system, and gave no number, no timeline and no cost for either. Earlier in the same interview he defended ending the legal status that is removing those workers in the first place.

Source

Byron Donalds Says Florida Can Replace Its Haitian Caregivers; Nurses and Unions Push Back — Caribbean Television Network, August 30, 2026, and the CBS "Face the Nation" transcript of the August 23, 2026 interview. Photo: CBS News.

Josh Brecheen Said 'I Don't Know Your Facts' When a Constituent Raised the 45 Oklahoma Hospitals at Risk of Closing. Oklahoma Ranks Third Worst in the Country.

Mon, 31 Aug 2026 12:10:18 +0000

On Wednesday, August 26, 2026, Josh Brecheen held a town hall at the Donald W. Reynolds Community Center in Poteau, Oklahoma. He came to talk about the national debt, and that is where he put most of his focus.

His constituents wanted to talk about hospitals.

One of them raised a number: 45 hospitals in Oklahoma are at risk of closing. That is not a rumor from the internet. It is the finding of a report from the Center for Healthcare Quality and Payment Reform, released weeks earlier, which found 45 Oklahoma rural hospitals at risk of closure and 18 at immediate risk. Oklahoma ranks third worst in the country, behind only Texas and Kansas.

Here is how the congressman answered.

"I don't know your facts. All I can tell you is Medicaid spending was going to increase year over year. The curve was crazy. It was like the system was being built."

"I don't know your facts" is a remarkable thing for a member of Congress to say about the hospitals in his own district. The report had been public for weeks and had been covered in Oklahoma news. He voted for the Medicaid cuts that the state's hospital association calls the biggest challenge facing those hospitals.

The facts he said he didn't know

Rich Rasmussen, who runs the Oklahoma Hospital Association, has laid out why Oklahoma's hospitals are in trouble: Medicare pays less than care costs, Medicaid rates are low, Medicare Advantage plans delay payments and deny care — and the Medicaid cuts Congress approved are, in his words, the biggest challenge of all.

More than 90 Oklahoma hospitals already lose money treating patients. They stay open because of supplemental Medicaid payments that make up part of the gap.

Which brings us to what happened in July. The Oklahoma Health Care Authority filed a $218 million cut with the federal government — a 20 percent reduction to the Supplemental Hospital Offset Payment Program. That is the exact money keeping those 90 hospitals open. The filing came days after the agency had endorsed a flat budget, and it caught the Oklahoma Hospital Association by surprise.

The town hall was in Poteau, and Poteau has a hospital: Eastern Oklahoma Medical Center. EOMC is not on the at-risk list. But the proposed $218 million cut means a 52 percent reduction in what it receives — $750,000 a quarter, $3 million a year. Its CEO, Tiffany Griffis, said on August 18 that would be tough to deal with.

So the hospital in the town where Brecheen was standing stands to lose more than half of a payment stream, and the congressman's answer to a question about hospitals at risk was that he didn't know the facts.

The rescue fund, and the man from the hospital who was in the room

Brecheen did have an answer ready. He pointed to the $50 billion for rural health care that states got in last year's budget bill — $10 billion a year for five years — and said Oklahoma's share is $248 million, through something called the Rural Health Transformation Program.

That is the standard Republican answer to this question, and we have heard it in a lot of districts. It has a hole in it. The $50 billion fund was created by the same budget bill that cut $911 billion from Medicaid, including $137 billion from rural areas — so the fund covers roughly a third of the rural damage the same law caused, and the law does not require the money to reach rural hospitals at all.

This time, someone in the room could answer him directly.

Logan Hayes, the chief operating officer of Eastern Oklahoma Medical Center, told Brecheen that his hospital has applied for every Rural Health Transformation grant available so far — and that only about 10 percent of hospitals have been awarded anything.

That is the rescue fund, described by a person whose job is to apply to it.

"Hospitals are states' responsibility"

Brecheen's response was to move the problem. He said hospitals are the states' responsibility, and that he had tried to find solutions for hospitals back when he was a state senator. He started to make the constitutional case:

"There's nothing in those 18 enumerated powers of the Constitution — tax regulation, coining money, counterfeit enforcement, piracy, post…"

Set aside the constitutional theory for a moment and look at the timing.

Brecheen is telling Oklahomans that hospitals belong to the state — weeks after the state's own Medicaid agency filed to cut $218 million out of hospital payments. The state is not picking this up. The state is moving to cut too. And Brecheen's own answer to what the federal government has done is a grant program that the hospital in that same town has applied to repeatedly without success.

There is also the matter of what the federal government did to Oklahoma on his watch. An estimated 174,000 Oklahomans are at risk of losing SoonerCare coverage under the budget bill — the bill Brecheen voted for and then toured his district promoting. When a hospital loses insured patients, it does not stop treating them. It treats them for free and absorbs the loss. That is how a hospital gets onto a list like the one his constituent was reading from.

He was a state senator in Oklahoma, where he says he looked for hospital solutions. He has been in Congress since 2023, where he voted for the cuts. In both jobs the answer points somewhere else.

What the record shows

A constituent at Josh Brecheen's August 26 town hall in Poteau cited a report finding 45 Oklahoma hospitals at risk of closing and 18 at immediate risk — figures that put Oklahoma third worst in the nation. Brecheen replied, "I don't know your facts," argued that hospitals are the states' responsibility, and pointed to a $50 billion rural fund created by the same budget bill that cut $911 billion from Medicaid. The chief operating officer of the hospital in that town told him they had applied for every one of those grants and that only about 10 percent of hospitals have received anything. In July, Oklahoma's Medicaid agency had filed to cut $218 million from the supplemental payments that keep more than 90 money-losing Oklahoma hospitals open — a 52 percent cut for the Poteau hospital alone.

Source

"Brecheen on hospitals at risk: 'We've got it backwards;' says they're states' responsibility" — Tom Firme, Poteau Daily News, August 29, 2026. Brecheen's remarks on tariffs at the same town hall are covered here. Photo: official congressional portrait, 118th Congress.

The Trump Administration Is Withholding $1.7 Billion From California's Home Care Program for Disabled People Because It Grew Too Fast.

Mon, 31 Aug 2026 11:57:35 +0000

There is a program in California called In-Home Supportive Services. It pays someone — often a family member — to help an elderly, blind or disabled person bathe, eat, take their medication and get through the day at home, instead of in a nursing facility. It serves roughly 875,000 to 900,000 Californians.

Everyone in health policy, in both parties, has spent decades saying this is the right way to do it. It is cheaper than institutional care and it is what people want.

The Trump administration is now treating the program's growth as evidence of fraud, and it is holding back the money.

The numbers

Federal Medicaid money reaches a state as reimbursement. The Centers for Medicare and Medicaid Services can "defer" a payment — hold it while it reviews whether the spending qualifies. Deferrals are a normal, boring part of oversight.

These are not normal. According to an accounting by Andy Schneider at Georgetown's Center for Children and Families, CMS has deferred:

California: $2.21 billion — $1.34 billion on May 13, then $867.5 million on July 21.
Minnesota: $550 million — across three deferrals in February, April and July.

The largest single item in the July deferral is $646.4 million tied to Community First Choice and Personal Care Services — home care. NOTUS reports that the administration is now holding $1.7 billion from California's in-home program specifically, more than it is holding from any other single health program in the country.

The stated reason is that the program grew

CMS's justification for the larger part of that item, in its own words, is "significant growth observed in California's CFC-PCS claiming, which between federal fiscal year (FFY) 2023 and FFY 2025 exceeded the average growth rate of all other states by 11.23%."

Dr. Mehmet Oz, who runs CMS, has put the same point more plainly: California's in-home spending rose 24 percent over two federal fiscal years, against about 12 percent on average for the rest of the country. The administration also refers to "statistical anomalies" in the state's data.

That is the case. Not a billing scheme. Not a phantom provider. Not a single named bad actor. A growth rate.

California gave CMS an explanation for the growth: the caseload went up, the number of hours each person needed went up, and the cost per hour went up. Those are the three variables in the program. There is no fourth.

Tyler Sadwith, California's Medicaid director, told NOTUS: "If CMS is able to point out strong or major fraud concerns, we'd be happy to know about it. Unfortunately, they haven't done that."

CMS did not respond to NOTUS's requests for comment.

What "fraud" is being used to mean

Vice President JD Vance has described the fight this way: "We've got a party that is fighting for fraud, and a party that is fighting against fraud."

Oz, in a social media video, questioned the premise of paying family members — saying these services "help Medicaid patients do something that our families would normally do for us, like carrying groceries."

Hagar Dickman, an advocate at Justice in Aging, said the most generous interpretation of that is that it is "out of touch with what Americans and what Californians need financially." It is worth sitting with why. A parent who quits a job to provide round-the-clock care for a disabled adult child is not being handed a windfall. They are doing full-time work that the state would otherwise have to pay a stranger to do, in a facility, for more money.

NOTUS's story names two of the people on the other end of this. Ligia Andrade Zúñiga, 47, has been paralyzed from the chest down since a 2009 car accident and has struggled to find consistent caregivers. Amanda Andresen, 28, has severe cognitive and physical disabilities and depends entirely on her mother Rosa, who earns about $5,560 a month through the program for caring for her.

Schneider, who spent years watching CMS do this job properly, does not think this is oversight. Deferrals, he writes, have "long been a routine part of CMS oversight" — and these are "anything but routine." He calls it a weaponization of fraud.

Why it matters beyond California

Two states are being squeezed right now. Both have Democratic governors. But the standard being used against California has nothing to do with California specifically — it is a finding that a program growing faster than average is presumptively fraudulent, applied by an agency that has not identified the fraud.

Home-care spending is rising across the country — Oz's own comparison put the rest of the country at about 12 percent over the same two years — because the population is aging and because federal policy has spent more than four decades pushing care out of institutions and into homes. Under this standard, that growth is the offense.

It also arrives on top of the Medicaid cuts Republicans passed last year, which are still phasing in. States are being told to absorb those cuts while the federal government holds back money they have already spent.

The bottom line

CMS has deferred $2.21 billion in Medicaid payments to California and $550 million to Minnesota, with $1.7 billion of the California total — including the largest single item in the July round, $646.4 million — tied to home care for elderly and disabled people. The stated basis is that California's in-home care claims grew about 24 percent over two years against about 12 percent for the rest of the country. California's explanation is that its caseload, its hours per person, and its cost per hour all rose. California's Medicaid director says CMS has not pointed to any strong or major fraud concerns, and CMS did not respond to NOTUS's requests for comment. The program in question serves roughly 875,000 to 900,000 Californians who cannot bathe, eat or take their medication without help.

Source

The Push Toward At-Home Care Is Caught in Trump's Anti-Fraud Crusade — Paige Winfield Cunningham and Natalie Alms, NOTUS, August 31, 2026. Deferral figures from Andy Schneider, Georgetown University Center for Children and Families. Photo: Vice President JD Vance and CMS Administrator Mehmet Oz at a May news conference on safety-net fraud (Jacquelyn Martin/AP).

The Trump Administration Has Exempted More Than 70 Chemical Plants From the Rule That Was Supposed to Cut Their Neighbors' Cancer Risk From Toxic Air by 96 Percent.

Mon, 31 Aug 2026 11:52:47 +0000

In April 2024, Tish Taylor and her father Robert stood behind the head of the Environmental Protection Agency while he signed a rule they had spent years asking for. They live in St. John the Baptist Parish, Louisiana — in the 85-mile stretch between New Orleans and Baton Rouge that people call Cancer Alley. The parish has the highest risk of cancer from air pollution of anywhere in the country: nearly 50 times the national average.

The rule they were watching get signed was designed to fix exactly that. Two years later, most of it is being taken apart.

What the rule actually did

It's called the HON rule, and here is what it does.

The rule covered about 220 large petrochemical plants, which make the ingredients for plastics, paint, antifreeze, detergent and shampoo. In making them, those plants release six chemicals that Tracey Woodruff — a Stanford epidemiology professor who used to do toxic assessments for the EPA — calls "the classic bad guys": ethylene oxide, chloroprene, benzene, ethylene dichloride, vinyl chloride and 1,3-butadiene. They raise the risk of breast cancer, liver cancer, leukemia, lymphoma and reproductive problems. "We've known about their toxicity for decades," Woodruff said.

The rule made those plants do three things:

Upgrade their pollution controls to cut ethylene oxide and chloroprene emissions by almost 80 percent.
Put air monitors on the fence line so the people living next door could see what was actually coming over it — and fix leaks when readings went over the limit.
Stop dumping during startups and shutdowns. Plants had long been let off the emissions rules while powering down for maintenance or ahead of a storm. With storms getting worse, that loophole has "a massive impact on what is actually getting released," said Shiv Srivastava of the Houston group Fenceline Watch.

The EPA's own estimate was that the rule would prevent 6,200 tons of toxic air pollution a year and cut the cancer risk from air toxics in nearby communities by 96 percent.

Nearly 60 percent of the covered plants are in Texas and Louisiana. The rest are in Alabama, Illinois, Kentucky, Ohio, Tennessee, West Virginia and elsewhere.

How it is being undone

Weeks into Trump's second term, the EPA invited chemical companies to email the agency and ask to be let out.

Last year, Trump granted two-year exemptions to more than 50 petrochemical facilities. This July he issued 20 more. The EPA has said it will propose a rewrite of the rule this fall, and nobody expects the new version to be stronger.

The HON rule was one of nine air-toxics rules the Biden EPA issued, covering everything from steelmaking to copper smelting to tire manufacturing to coal plants. As Yale E360 reports, all nine have been or are now being rescinded, revised, or reconsidered.

To grant the exemptions, Trump used a provision of the Clean Air Act that environmental lawyers say has never been used before — one that lets a president waive a standard for two years if the technology to comply is not available and he determines that granting the exemption is "in the national security interests of the United States." His proclamations asserted that the rule "imposes substantial burdens on chemical manufacturers already operating under stringent regulations" and that "maintaining a robust domestic chemical industry is vital to safeguarding the supply chains that underpin our economy."

The orders offered no evidence for any of it. "That's not how this works," said Annie Fox, a staff attorney at the Clean Air Council. The law requires a president to lay out specifics behind each claim, "not just state it." She added: "These are supposed to be rare exceptions that are well-grounded in research and facts."

Last October, a coalition including the Taylors' group, Concerned Citizens of St. John, sued Trump and the EPA in federal court in Washington, arguing the national-security claim is a pretext to spare polluters while the administration dismantles the rule.

It is not only this rule

The EPA has also proposed undoing Biden-era strengthening of the Risk Management Program — the safety rule that let workers handling hazardous substances stop operations they believed were dangerous, required chemical plants to prepare for natural disasters, made them undergo independent audits after accidents, and required them to share information with the public.

There were 131 accidents involving reportable chemical releases nationally last year. For people living near the nearly 700 chemical plants around Houston, Srivastava said, "there are constant explosions, there are constant fires, there are constant black, dark plumes that linger over our communities." Easing the safety rules, he said, "makes us extremely, extremely vulnerable to having a massive, catastrophic disaster."

The administration also took down the online tool that let people near a petrochemical plant look up its accident history, its emergency response plan, and which chemicals it handles. Srivastava says that without it, neighbors cannot find out even the names and locations of the plants around them.

And in March, the EPA proposed weakening a separate 2024 rule limiting ethylene oxide at facilities that use it to sterilize medical equipment — arguing that the Clean Air Act gives regulators very little room to update rules when the science on health risks changes.

Who wanted this

The American Chemistry Council, the petrochemical industry's trade group, called the HON rule "overly stringent" and said it "exceeds the EPA's statutory authority." The exemptions, it said, "offer a pathway for relief for some sources from some of the unrealistic timelines" in the rule.

That trade group does not only write statements. In January, the House committee chaired by Kentucky's Brett Guthrie released a draft rewrite of the nation's toxic chemicals law and the American Chemistry Council cheered it; in May, the ACC filed an $80,276 independent expenditure for TV ads running in Guthrie's district. Kentucky is one of the states where HON-covered plants sit.

The EPA's own answer, in a statement, was that its air-toxics proposals aim to "protect American industry and supply chains, while still minimizing Americans' unnecessary exposure to hazardous air pollutants."

Woodruff, who watched the agency from the inside, reads the record differently. Former fossil fuel and petrochemical industry representatives now hold top jobs across the EPA, she noted, and the message to industry has been that "whatever the industry wants to do, that's what we want to do." The policy changes, she said, "will lead to people getting sicker and dying."

Who is living with it

A disproportionate share of the people breathing the highest concentrations of these chemicals in Cancer Alley are Black. Hillcrest, the predominantly Black and Latino neighborhood in Corpus Christi, Texas, is ringed by petrochemical plants — one of which was granted a two-year exemption from the rule.

Sharon Lavigne, who founded RISE St. James Louisiana, still has the pen the EPA administrator handed her after he signed the rule in 2024. Her group is a plaintiff in the lawsuit. She said she thinks the president's disregard for the rule reflects a belief that "we are nothing."

Tish Taylor put it more simply. Everything the Biden administration did to protect her community, she said in July, was "pretty much just thrown in the garbage" and replaced with "a death sentence."

What the record shows

The EPA finalized a rule in April 2024 requiring about 220 petrochemical plants to cut emissions of six cancer-causing chemicals, monitor their fence lines, and stop venting during shutdowns — protections the agency estimated would prevent 6,200 tons of toxic pollution a year and cut nearby communities' air-toxics cancer risk by 96 percent. The Trump administration has since exempted more than 70 of those plants, using a Clean Air Act provision lawyers say has never been invoked before and offering no supporting evidence, and has said it will propose a rewrite this fall that is all but certain to scale the rule back. All nine of the Biden EPA's air-toxics rules have been or are now being rescinded, revised, or reconsidered. The parish the Taylors live in has the highest air-pollution cancer risk in the country, nearly 50 times the national average.

Source

Trump Is Unraveling a Hard-Won Rule to Reduce Toxic Pollution From Chemical Plants — Beth Gardiner, originally published by Yale E360 and reproduced by Mother Jones as part of the Climate Desk collaboration, August 2026. Photo: petrochemical plants in Ascension Parish, Louisiana (Gerald Herbert/AP).

Mike Rogers Wants to Charge You $50 for Preventive Care Your Insurance Has to Cover for Free. 'That's Probably Okay, Right?'

Mon, 31 Aug 2026 11:38:04 +0000

Right now, if you have health insurance, your blood pressure check is free. So is your diabetes screening. So is your mammogram, your colonoscopy, your cervical cancer screening. If you are a woman, so is the yearly well-woman visit itself. You do not pay a copay. You do not pay a deductible. That is not a favor your insurance company does for you — it is the law, and it has been since the Affordable Care Act took effect: nearly all private plans have to cover a defined list of preventive services at no cost to the patient.

Mike Rogers (MI) would like to change that.

At a private event in Macomb County on March 21, 2026, Michigan's Republican Senate nominee took a question from someone in the audience about how to bring down the cost of health care. He said he would release a full plan in the coming weeks that would "embrace the freedom of the free market." Then he explained one of the ways he would do it.

"You know," Rogers said, "if you go up and have to pay the doctor $50 for your annual physical, that's probably okay, right?"

Bridge Michigan reviewed a recording of the event and reported the quote in April. On Sunday, in a piece for The Bulwark, Jonathan Cohn asked the Rogers campaign to confirm whether charging people for preventive care is still what Rogers wants to do.

The campaign did not answer.

He compared your cancer screening to a burned-out blinker

In the same recorded remarks, Rogers explained why he thinks free preventive care is a bad deal. He said covering it was like having "an auto insurance plan that would pay for your blinker's light going out." A nice thing to have, he argued — but something that drives everyone's costs up.

"We need to start changing the way we look at health care," he said.

The comparison gives away the whole argument. A blinker bulb is a small annoyance you can put off. A colonoscopy is how you find a tumor while it is still small enough to remove. Congress made preventive care free precisely so that people with high-deductible plans would have no reason to skip the visit that catches the thing early.

We know what happens when you put a price on it, because researchers have measured it. Dr. Mark Fendrick directs the Center for Value-Based Insurance Design at the University of Michigan. He told Bridge Michigan that "our work shows very clearly that even increasing cost sharing by a few dollars leads to decreased utilization of services." Not fifty dollars. A few.

Fendrick gave Rogers the narrow point: free preventive services do add to what a health plan spends, and Rogers "is exactly right" about that. The disagreement is about what happens next. Charge copays for preventive care and "in the short term, costs go down," Fendrick said — but overall, "the health of individuals and populations get worse."

Anand Parekh, chief health policy officer at the University of Michigan School of Public Health, who helped formulate the ACA's prevention initiatives, put the money side of it plainly: when people skip screenings, undiagnosed disease gets worse and more expensive. "We end up paying for more costly care for things that could have been prevented, or at least treated at less expense," he said.

So the savings are real for a while, and then the bill comes back bigger, with sicker people attached to it.

There is also an obvious place to look for waste that is not the cancer screening. Fendrick's advice to politicians is to go after care that does nothing — piles of lab tests, or, in his example to Bridge, "CT scans for uncomplicated back pain." Rogers went after the annual physical instead.

He also wants to put sick people in a separate pool

The copay was not the only idea Rogers floated that day. He also proposed what he called "catastrophic funds" for the sickest Americans — separate insurance arrangements for people who need the most care.

"So we're going to pay our premium based on what a normal life would be, not including these people who are really, really sick," Rogers said. And: "We take the really sick people and put them in this fund that we all pay a little bit. The government pays, the hospital pays, Medicare would pay a little bit."

That idea has a name and a history. Before the Affordable Care Act, 35 states ran high-risk pools for people who could not get insurance any other way. The ACA made them unnecessary by simply requiring insurers to cover people with pre-existing conditions. KFF's look back at how those pools actually worked is not a close call: premiums were often double what healthy people paid, nearly all of them refused to cover the pre-existing condition you joined for — usually for six to twelve months — most capped what they would pay over your lifetime, and some states limited how many people could get in at all. Republicans put the idea back on the table in the 2017 repeal bills, and it has been proposed steadily since.

Parekh told Bridge that pulling sick patients out does lower premiums for healthier people — but the sick patients still need care, and covering it takes large subsidies. "This turns out to be expensive for consumers and government," he said.

Fendrick was shorter about it. Going back to high-risk pools would be, he said, "just so crazy."

Four months later, he released a plan. It does not mention any of this.

Rogers said in March that the full plan was weeks away. It arrived on July 30, announced through a press release that quotes a friendly column at Townhall describing it. Its three pillars are affordability, accessibility and transparency. What is actually in it: make hospitals and insurers publish their prices and fine the ones that don't, expand a federal bulk-buying program for prescription drugs, speed up approval of generics, and require insurers to publish how often they deny claims.

There is no $50 copay in it. There are no catastrophic funds, no high-risk pools, nothing about preventive care at all. The two ideas Rogers described to a private room in March simply are not in the document he released to the public in July — and his campaign will not say whether he dropped them or just stopped mentioning them.

That is the whole problem. Cohn asked. Bridge asked in April. Neither got an answer.

This fits a twenty-five-year record

None of this is a departure for Rogers. He represented Michigan in the House from 2001 to 2015. He voted against the Affordable Care Act when it came to the floor in March 2010, then voted to repeal it in 2011, again in 2012, and again in 2013. In 2012 the Michigan Republican Party sent out a mailer with his name on it in capital letters: "MIKE ROGERS IS COMMITTED TO REPEALING OBAMACARE."

He has not softened since. In January, Michigan Advance asked him about the ACA tax credits that had expired at the start of the year. He answered, in an emailed statement, that he would start by "phasing out insurance company taxpayer subsidies and giving that money back to patients so they are in charge of their own healthcare." Those credits are what kept marketplace premiums affordable for people who buy their own insurance. They are gone now, which is what 197 Republicans voted for, and in Michigan the individual-market plans they applied to went up about 20 percent this year.

He also praised the Republicans' "One Big Beautiful Bill," the law that cut Medicaid — his campaign built an entire video series around it, under the friendlier name "Working Families Tax Cuts." In the same January statement he called the law a "historic, $50 billion investment in rural healthcare, including $173 million for Michigan alone." Michigan Advance noted that the claim rural communities come out ahead is disputed by health care providers themselves, including the state hospital association.

Cohn asked Rogers's campaign to confirm that he still stands behind letting the subsidies expire, behind the Medicaid cuts, and whether he still supports repealing the law outright. He got no response to any of it.

Michigan is already living with the answer

The numbers moved while the campaign was declining to comment.

About 357,000 Michiganders had active ACA marketplace coverage in February — 130,000 fewer than a year earlier, a 27 percent drop, down from a record 501,806 in June 2025. That is roughly one in four people covered by the program, gone in a year. Michigan had the sixth-largest loss of any state.

The Medicaid cuts have not fully arrived yet. When Republicans were drafting them in May 2025, the state health department warned that more than 700,000 Michiganders could lose Medicaid — nearly a third of everyone enrolled — if the full $880 billion in cuts then on the table landed on the program. KFF's estimate of the law that actually passed is that it leaves about 300,000 more Michiganders uninsured by 2034, or 390,000 once the expired premium credits are counted alongside it.

This is the state where Rogers wants to charge people $50 to see a doctor who is well.

What his campaign will say

Asked about the recording, Rogers's communications director Alyssa Brouillet told Bridge Michigan that Rogers "is exploring ideas with voters to increase affordability of health care, whether that's investing in rural hospitals, ensuring the wealthiest Americans cover their own copays, or improving transparency and access."

Read that again. "Ensuring the wealthiest Americans cover their own copays" is not what Rogers said. He did not say the wealthy should pay $50 for a physical. He said you should — "if you go up and have to pay the doctor $50 for your annual physical" — to a room of supporters, as an illustration of ordinary people having more skin in the game.

To be fair to him, one idea from that March meeting was a good one: forgive medical school debt for doctors who spend five years at a federally qualified health center, the clinics that treat low-income patients and struggle to recruit. Rogers called them "one of those government programs that actually functions." It is a real proposal and it would help. It also, like the price transparency in his July plan, would not change what anybody pays for a mammogram.

There is one more thing worth putting next to a $50 copay. Rogers is a wealthy man who has been collecting a taxpayer-funded state pension while worth millions. And at a town hall last year, he mocked the complaint about prices before it even arrived — "Oh my gosh, coffee went up," he said, imitating what he expected to hear from Democrats.

Fifty dollars is a rounding error to him. It is a reason to skip the appointment for a lot of people in Michigan.

He is not the only one with this record

Cohn offers three other Republicans running statewide this year as case studies, and the record is the same in each.

In Texas, where marketplace enrollment fell by nearly 150,000 people after the credits expired, Senate nominee Ken Paxton spent years trying to erase the law entirely — including the 20-state lawsuit he co-led in 2018 that the Supreme Court rejected 7–2. In Iowa, Ashley Hinson voted for the Medicaid cuts and has publicly defended the new work requirements — while a MercyOne clinic on the south side of Des Moines closed in June, citing staffing shortages, rising costs and pending cuts to Medicaid reimbursement. In Ohio, Jon Husted voted for a law projected to pull roughly $33 billion in Medicaid money out of his state over a decade.

None of this is settled history. If Democrats take either chamber in November, restoring the premium credits and undoing the Medicaid cuts is at the top of the list, and in a Senate this close it can come down to a single seat. Michigan is one of the seats.

The bottom line

Mike Rogers (MI) told a private audience in March that charging people $50 for an annual physical is "probably okay," and floated moving the sickest patients into a separate insurance pool — two ideas that, as Bridge Michigan put it, would undo two promises of the Affordable Care Act. University of Michigan researchers say even a few dollars of cost-sharing makes people skip preventive care, and that the short-term savings evaporate when the undiagnosed illness shows up later. The health care plan Rogers finally released in July does not mention either idea, and his campaign has refused, twice, to say whether he still holds them. Meanwhile he spent his House career voting four times against or to repeal the law that made those screenings free, told a reporter he wants the premium credits phased out, and campaigned on the bill that cut Medicaid — while 130,000 Michiganders lost marketplace coverage in a single year.

Sources

Mike Rogers Wants $50 Copays for Routine Screenings — Jonathan Cohn, The Bulwark, August 30, 2026. Original reporting on the March recording by Simon D. Schuster, Bridge Michigan, April 2, 2026. Michigan enrollment figures from Eli Newman, Bridge Michigan, July 13, 2026, citing federal effectuated-enrollment data. Rogers's July plan as announced by his campaign. Photo illustration by Bill Kuchman/The Bulwark (photos: Getty, Shutterstock).

Kansas Doctors Told Roger Marshall His Vote Would Cost Their Patients Care. The OB/GYN Kansas Sent to the Senate Said 'There Are No Medicaid Cuts' and Called It a Lie.

Sun, 30 Aug 2026 07:08:47 +0000

Roger Marshall is a doctor. He practiced medicine in Great Bend, Kansas, for more than 25 years as an OB/GYN and delivered more than 5,000 babies, and it is the first thing his own Senate biography tells you about him.

On Thursday, Kansas doctors held a press conference to say that a law he voted for is going to take care away from their patients. His answer the next day, on camera, was that they are lying.

"There are no Medicaid cuts"

At a virtual press conference, Dr. Christa Balanoff, a Kansas surgeon, laid the coming Medicaid losses directly at Marshall's feet.

"When the Medicaid cuts that Senator Marshall supported take full effect next year, more Kansans will go without care. Senator Marshall should be working to fix the problem. A physician in the United States Senate should be leading the effort to expand access to care, not taking a victory lap on policies that make coverage harder to afford, and harder to keep."

The next day, KSNT's Capitol Bureau asked Marshall to respond. He did not soften it, qualify it, or point to a program he was trying to protect.

"There are no Medicaid cuts," Marshall said. "We spent more money on Medicaid this year than last year, we're going to spend more money next year than we are this year as well. There are not any Medicaid cuts. I think that's a lie and you can look at the numbers to see that we're increasing spending every year on Medicaid."

The numbers he says to look at

So look at them.

The Congressional Budget Office estimates the 2025 budget law will reduce federal Medicaid spending by more than $1 trillion over ten years. KFF, allocating those CBO estimates state by state, puts Kansas's share at about $2.85 billion in lost federal Medicaid money over the decade — 8% of what Kansas would otherwise have received.

Independent modeling done for Kansas specifically lands in the same place. Manatt Health, commissioned by the United Methodist Health Ministry Fund and the REACH Healthcare Foundation, ran the final version of the law through Kansas's KanCare program and projected the state would lose $3.9 billion in Medicaid funding over ten years, with $2.7 billion of that coming out of Kansas hospitals. The analysts noted their own estimates are understated, because the model doesn't capture everything the law changes.

Marshall's defense is that total Medicaid spending goes up each year. That is true and beside the point. Spending was already scheduled to rise as costs and enrollment rose; the law cuts roughly a trillion dollars off that path. Saying there is no cut because the line still slopes upward is the same argument as saying a pay cut isn't a pay cut as long as you got a smaller raise than you were promised.

Sheena Schmidt, a senior analyst at the non-partisan Kansas Health Institute, described where the money actually comes from:

"The Medicaid cuts in H.R 1 are going to be primarily related to what providers or hospitals receive to increase access to care across the state of Kansas."

And she said when Kansans will feel it: some changes start around the beginning of 2027, but "the bulk of the changes that I think will result in the most funding loss will start to happen beginning in 2028."

That timing matters. Marshall voted for the law in 2025. The hospitals lose the money starting after the 2026 election.

He has said the quiet part before

This is not the first time Marshall has told Kansans that the people worried about losing coverage have it wrong.

Back in 2017, as a freshman congressman helping lead the Republican effort to replace the Affordable Care Act, he told the health care news site STAT that he did not believe Medicaid had helped people: "There is a group of people that just don't want health care and aren't going to take care of themselves."

In December 2025 he told Newsmax he expects the enhanced ACA subsidies to expire, shrugging that "some people's premiums are going to go up some."

The pattern is consistent: when Kansans stand to lose coverage, Marshall's position is that the loss is either imaginary, or their own fault, or not that big.

Other Republicans are running the same play

Marshall isn't alone in this. When a hospital CEO in his district warned that the budget bill would cost him his intensive care unit, Rick Allen said he was "dead wrong". Jeff Hurd signed a written promise not to cut Medicaid and then voted for the cuts twice. Michael Guest spent his August recess promoting $206 million for Mississippi's rural hospitals after voting for the law projected to take billions out of the state's Medicaid funding.

The difference in Marshall's case is the credential. When a surgeon tells a senator the cuts will hurt patients, most senators have to argue policy. Marshall is a physician, and he used that standing to tell Kansas health care workers that what they are describing is a lie.

What the record shows

Roger Marshall voted for a law that the Congressional Budget Office scores as cutting more than $1 trillion from Medicaid over ten years — about $2.85 billion of it in Kansas, 8% of the federal money the state would otherwise get. Independent modeling for Kansas puts the total loss at $3.9 billion, with $2.7 billion coming out of the state's hospitals, and the non-partisan Kansas Health Institute says the biggest losses hit starting in 2028. When Kansas doctors said so publicly, Marshall — a physician himself — told a reporter there are no Medicaid cuts and that saying there are is a lie.

Source

"There are no Medicaid cuts": Sen. Marshall responds to criticism about Medicaid changes passed in H.R 1 — KSNT 27 News Capitol Bureau, August 28, 2026, by Brayden Day. Photo: KSNT.

Mariannette Miller-Meeks Says Nobody Has Complained to Her About Higher Health Costs. Iowa's Marketplace Premiums Went Up 15.3% This Year.

Sat, 29 Aug 2026 07:36:13 +0000

On Friday, August 28, 2026, Mariannette Miller-Meeks stood on the floor of Cemen Tech in Indianola, accepted the U.S. Chamber of Commerce's endorsement, and told the assembled employees why she voted for Trump's 2025 budget bill.

Not for the business groups, she said. Not for the owners.

"It was for you, who make this country great, who keep this country moving forward, who allow us to keep globally economic (power)."

She said this while flanked by the Midwest regional manager of the U.S. Chamber of Commerce and the vice president of public policy for the Iowa Association of Business and Industry, who were there to endorse her.

The business organizations were not upset about the framing. They were the ones holding the event.

Then there were the health costs

Miller-Meeks said she had not heard from Iowa businesses or workers facing higher health care costs and premiums — from the budget bill itself or from the expiration of the Affordable Care Act tax credits.

What she said, as reported by the Iowa Capital Dispatch:

"First and foremost, I hadn't had any business coming and complaining to me. The majority of Americans, over 130 million Americans, are on employer-based health insurance. And extending the expanded COVID-era tax credits, which went directly to profitable insurance companies, did nothing to lower the premiums for the individuals here, or for these businesses who provide those benefits."

Here is the number she did not mention. After those federal subsidies expired, insurers raised premiums for Iowa's ACA-marketplace customers by an average of 15.3% for 2026.

Not a projection. The rates Iowans are paying now.

Miller-Meeks is a physician. She knows the difference between "nobody has complained to me" and "nobody is being harmed." The first is a statement about who gets access to her. The second is a claim about Iowa, and it is not true.

She also knows why nobody at a Chamber of Commerce endorsement event was complaining about the individual marketplace: the people on it are not in that room. They are self-employed, they work for small businesses that don't offer coverage, they're between jobs, they're farming. Her "over 130 million Americans are on employer-based insurance" answer is a way of saying the Iowans who lost the subsidy are a minority — which is true, and is not a defense.

This was not one state's bad luck. House Republicans voted 216–211 for a health bill whose text never mentions the expiring tax credits, and Miller-Meeks was one of the 216.

The rural hospital fund she is touting exists because of the bill she voted for

Miller-Meeks pointed to two things she is doing on health care: a bill she calls the Lower Health Care Premiums for All Americans Act, and money she has secured for rural hospitals through the federal Rural Health Transformation Program.

That second one deserves a closer look, because the Iowa Capital Dispatch described exactly what the program is: it "was created to help offset the projected decline in rural Medicaid spending due to changes made through the OBBBA."

In other words, the fund exists because the budget bill cut rural Medicaid. Miller-Meeks voted for the cut, and is now campaigning on the patch.

We covered what the cut has already done in her district. A year after her vote, nearly 25,000 fewer Iowans were on food assistance, her district's hospital had stopped delivering babies, and she had told a booing town hall crowd that her committee voted "to strengthen and preserve Medicaid".

That was in July. The answer in August is that nobody has complained.

What the endorsement is actually for

The Chamber's Micah Olson explained why the group is backing her. She has "aligned U.S. Chamber priorities on issues like pro-growth tax policy, eliminating burdensome regulations, streamlining our federal permitting process, and investing in America's workforce and infrastructure."

That is a fair and accurate description of her record, offered by the people whose priorities she aligned with. It is also the exact opposite of what she told the workers at Cemen Tech at the same event — that the vote was "not for business organizations or owners."

Both things were said in the same room, at the same event, to the same audience.

The Chamber also endorsed Iowa's Zach Nunn earlier in August. Both districts are among the most competitive in the country this November, and Miller-Meeks faces Christina Bohannan for the third straight cycle. Bohannan's response to the event: "Rep. Miller-Meeks has been bad for business in Iowa, and it's affected everyone: small businesses, workers, and families."

What the record shows

Mariannette Miller-Meeks voted for a budget law that cut rural Medicaid and let the ACA tax credits lapse. Iowa's marketplace insurers then raised premiums an average of 15.3% for 2026. Asked about it at a U.S. Chamber of Commerce endorsement event on August 28, she said no business had come to complain to her, and told the workers in the room she had cast that vote "not for business organizations or owners" but for them — with the business organizations standing beside her, endorsing her for it.

Source

Robin Opsahl, U.S. Rep. Miller-Meeks says 2025 GOP tax cuts help Iowa manufacturing workers, Iowa Capital Dispatch, August 28, 2026. Photo: Robin Opsahl / Iowa Capital Dispatch.

Fourteen Republican Senators We Track Confirmed RFK Jr. After He Said His Samoa Trip Had 'Nothing to Do With Vaccines.' He Had Already Written the Prime Minister Asking to Study Samoa's MMR Vaccines.

Fri, 28 Aug 2026 07:08:16 +0000

In late January 2025, Robert F. Kennedy Jr. sat in front of two Senate committees and needed Republican votes to become health secretary. One of the questions senators kept coming back to was about a trip.

In 2019, Kennedy — then the chairman of an anti-vaccine nonprofit — flew to Samoa. Months later, the island nation had a measles outbreak that killed 83 people, most of them children under five. Senators wanted to know what he had been doing there.

He told them it had nothing to do with vaccines.

Asked by Sen. Ron Wyden, he said: "I went there, nothing to do with vaccines. I went there to introduce a medical informatics system that would digitalize records in Samoa and make health delivery much more efficient." The next day Sen. Ed Markey asked the same thing. "My purpose in going down there had nothing to do with vaccines," Kennedy said.

On August 27, 2026, The Associated Press and The Guardian published a letter that Kennedy wrote to Samoa's prime minister on January 20, 2019 — before the trip, on the letterhead of his anti-vaccine group. In it he asked to send his team to Samoa to run a "detailed health informatics assessment" of "what happened with your MMR vaccines." He used the word vaccine or vaccination eight times.

The prime minister wrote back a month later and welcomed the visit, saying Samoa would benefit from an "independent health assessment of our MMR Vaccines."

What Kennedy did not tell the senators

The backstory matters, because the letter fits into it exactly.

In July 2018, two Samoan children died after being given an MMR shot that had been mixed incorrectly. Two nurses were criminally charged and later pleaded guilty to manslaughter. Samoa stopped all vaccinations for ten months while it sorted it out. Vaccination rates collapsed.

Kennedy's organization, Children's Health Defense, started contacting the Samoan government during that shutdown. Kennedy's letter told the prime minister he suspected the deaths might have come from problems with the vaccine itself — with particular batches — and offered to have his team check.

By the time Kennedy actually arrived in May and June of 2019, Samoa's own top health official had already announced the answer: human error, not the vaccine. Kennedy went anyway, and while he was there he met with anti-vaccine activists. Months later, with vaccination rates still dangerously low, measles broke out and swept the country.

Kennedy's department told the AP the visit "was unrelated to vaccines" and called any suggestion that he lied "outright defamatory." Kennedy was not under oath at his confirmation hearings. Knowingly giving materially false testimony to Congress is a crime anyway, sworn or not, though the AP notes it is rarely prosecuted.

The fourteen votes

On February 13, 2025, the Senate confirmed Kennedy 52 to 48. Every yes vote was a Republican. Mitch McConnell was the only Republican to vote no.

Fourteen of those yes votes came from Republicans we track:

Marsha Blackburn of Tennessee, now running for governor
Shelley Moore Capito of West Virginia
Susan Collins of Maine
Tom Cotton of Arkansas
Bill Hagerty of Tennessee
Jon Husted of Ohio
Cindy Hyde-Smith of Mississippi
Roger Marshall of Kansas
Ashley Moody of Florida
Pete Ricketts of Nebraska
Jim Risch of Idaho
Mike Rounds of South Dakota
Dan Sullivan of Alaska
Tommy Tuberville of Alabama, now running for governor

Thirteen of these fourteen voted again this month, at 4:17 in the morning, to make Trump's personal lawyer the attorney general. Collins was the one who did not. Confirmation votes are where a senator's private assurances meet the public record, and the assurances keep losing.

What Susan Collins was promised

Two days before the vote, Collins told Maine Public why she was voting yes. Kennedy had assured her the polio vaccine works and that he would not restrict access to it. He had promised to back research on a Lyme disease vaccine. He had said he would revisit the administration's cuts to research funding that Maine labs depend on. And Sen. Bill Cassidy, the Louisiana doctor who chairs the Senate health committee, had assured her that the committee would hold regular oversight hearings on whatever Kennedy did.

"Based on all of that, I reached the decision to vote for him," Collins said.

She also explained the underlying rule she was following: "In general, I give deference to presidents to build their own team, whether they are Democratic presidents or Republican presidents." She has voted against roughly ten of nearly 200 nominees in her career. More than 180 Maine doctors had signed a national letter, endorsed by about 22,000 physicians, calling Kennedy "actively dangerous" to public health. She voted for him anyway.

That is the same senator the Bangor Daily News found had cast 200 deciding votes in her Senate career. Maine Democrats count 19 of them as deciding votes for Trump nominees, and none against one.

What happened to the promises

Cassidy's stated reason for voting yes was that Kennedy had pledged to leave the government's vaccine advisory committee "without changes." Once in office, Kennedy removed all 17 members of that committee and named his own advisers.

By August of 2025, the Trump administration had fired the CDC director three weeks into the job, after she reportedly refused to sign off on vaccine changes. Collins said she was "alarmed." She said she did not agree with Kennedy's approach to the vaccine committee, which she said "is likely to weaken the independent and professional recommendations of the committee." Then she added: "But, I do believe that he has some valid points about ultra-processed foods and their impact on obesity and the health of many Americans."

Her proposed remedy was oversight. Cassidy's was oversight. Neither of them has a vote to take back.

By June of 2026, Cassidy was on CBS saying flatly that the commitments made to him had been violated, and accusing Kennedy of building public health "upon a foundation of lies."

Roger Marshall celebrated instead. Marshall is a physician, and on the day of the vote he put out a statement calling it "a great day for America, particularly for our nation's children" and thanking the "Make America Healthy Again movement" for pushing Kennedy "across the finish line." He is also the senator who spread COVID misinformation for years and is still saying it.

The MMR vaccine is now the target

Here is what the Samoa letter is worth reading next to.

On August 10, 2026, with Kennedy standing beside him, President Trump signed an executive order telling federal officials to draw up plans, within 90 days, for splitting combination childhood shots into separate injections — the MMR shot specifically — and for spreading vaccine appointments further apart.

There are no separate measles, mumps or rubella vaccines sold in the United States. Every version the FDA has approved is a combination shot, and has been since the 1970s. Breaking the MMR apart would turn two doctor visits into six, and would require drug companies to spend years and tens of millions of dollars on new studies and new factories to make shots nobody has asked for.

"To date, there has been no published scientific evidence that shows any benefit in separating the combination MMR vaccine into three individual shots," Merck said.

Dr. Anna Durbin of Johns Hopkins put the consequence plainly: "It's going to be less convenient, more expensive and you're going to have fewer people getting vaccinated."

Meanwhile, the CDC's own count says the United States has confirmed 2,777 measles cases in 2026 as of August 20 — more than the 2,289 recorded in all of 2025, with four months of the year still to run. Ninety-four percent of this year's cases are in people who were unvaccinated or whose vaccination status is unknown. Kindergarten MMR coverage has slid from 95.2 percent in the 2019–20 school year to 92.4 percent in 2025–26, which the CDC estimates leaves about 280,000 kindergartners unprotected.

This is the same secretary who headlined a May fundraiser in San Antonio for a Republican congressional candidate, six weeks after a judge ruled his vaccine rollbacks unlawful. And it is the same political movement that produced a nominee for governor of Florida who, asked directly whether parents should vaccinate their children against measles, answered "No".

Who would have to investigate

Wyden, the top Democrat on the Senate Finance Committee, says he will press Republicans to refer the matter to the Justice Department, and that he will pursue it if Democrats take the Senate this fall. "There are consequences for lying to Congress," he said.

Attorneys told the AP that lawmakers could use Kennedy's statements as the basis for hearings, an investigation, or an impeachment inquiry. The AP also noted the obvious: none of that is likely to happen in a Republican Congress aligned with the administration.

That is not an abstract institutional problem. It is a decision that belongs to specific people. Collins sits on the health committee that was promised regular oversight hearings on exactly this. Capito, Cotton, Hagerty, Husted, Hyde-Smith, Marshall, Moody, Ricketts, Risch, Rounds and Sullivan all still hold the seats they voted from, and any of them can ask for a hearing.

What the record shows

Fourteen Republican senators we track voted to confirm Robert F. Kennedy Jr. after he told Congress his 2019 Samoa trip had nothing to do with vaccines. A letter he wrote before that trip, obtained by the AP and the Guardian, asked Samoa's prime minister to let his team study the country's MMR vaccines and used the word vaccine or vaccination eight times. Once in office he removed all 17 members of the vaccine advisory committee whose survival was the stated condition of Bill Cassidy's vote, and this month he stood beside the president as Trump ordered planning to break the MMR shot into three. There have been 2,777 confirmed measles cases in the United States so far this year, more than in all of 2025, and the AP reports that an investigation is unlikely in a Republican Congress.

Source

Ali Swenson, "Exclusive: RFK Jr. said a Samoa trip had nothing to do with vaccines. New documents refute that," The Associated Press, August 27, 2026. Photo: Misiona Simo / Samoa Observer via AP.

Andy Barr Voted for the Bill Kentucky's Own Hospitals Called Devastating. Now He Wants the Governor to Prove They're Closing.

Fri, 28 Aug 2026 07:03:43 +0000

Andy Barr has represented central Kentucky in Congress since 2013. He is now running for the U.S. Senate.

Governor Andy Beshear has said for more than a year that 35 Kentucky rural hospitals are at risk of closing because of the budget bill Republicans passed in 2025. On August 25, 2026, Barr sent him a letter demanding that he produce his evidence. Barr wants the receipts, hospital by hospital, and wants Beshear to "publicly correct the record" if he can't produce them.

Two days later Beshear answered. He called the letter misleading and inaccurate, and then said the part Barr's letter never mentions.

The vote the letter leaves out

Barr's letter runs to a list of demands and several hundred words about what the governor should have to prove. It does not mention that Barr voted for the bill.

Beshear did mention it.

"Doing the president's bidding, [he] cut $21 billion over 10 years in Medicaid funding for Kentucky. Of course it's going to force closures where the margins are the smallest; that is just basic math."

Kentucky is not a random example. When the bill passed, KFF's analysis found it would hit Kentucky's rural health care harder than any other state in the country. The Kentucky Center for Economic Policy projects about 210,000 Kentuckians will lose Medicaid coverage, and rural Kentucky will lose $12.3 billion in Medicaid spending.

Barr's response to all of that, at the time, was that the law was "protecting and strengthening Medicaid for Kentuckians who truly need it — not ineligible recipients or illegal immigrants."

"They're still open"

Barr's central argument is that the warnings have not come true. He put it this way after Beshear responded:

"Medicaid spending is rising year-over-year, Kentucky's $212.9M is year-one funding, not five-year funding, and all 35 hospitals he said, 'will close' are still open."

Read that again. The cut Beshear describes runs over ten years. The law was signed a little over a year ago. Barr's evidence that a decade of cuts will not close hospitals is that the hospitals have not closed in the first year.

The other half of the argument does the same trick with a bigger number. Barr's letter notes that federal Medicaid and CHIP spending is projected to rise from $668 billion in 2026 to $892 billion in 2036. That is true, and it is beside the point. Health costs and enrollment both grow on their own. The cut is measured against what would otherwise have been spent — and in Kentucky that is $12.3 billion out of rural Medicaid and coverage gone for about 210,000 people. A budget that grows more slowly than the need it covers is still a cut to the person who loses coverage.

The fund he keeps pointing at

Barr's letter is built around $212.9 million Kentucky received from the Rural Health Transformation Program — the $50 billion fund Republicans created in the same bill. If hospitals are really in danger, Barr asks, why doesn't Beshear's plan spend the money on those 35 hospitals?

Beshear's answer is that he isn't allowed to.

He said Trump administration officials published an op-ed in USA Today when the program launched, telling states plainly that the fund was not for propping up struggling hospitals and that plans routing money to rural hospitals would not be approved. A Kentucky health official testified in June 2026 that the federal government had set strict rules demanding systemic change rather than more money for existing models.

"Next time before firing off letters, Barr should do a quick Google search," Beshear said. "Because you can find all of those statements, understand where money can and can't be sent from the administration that he supports."

This is not a Kentucky quirk. The fund covers roughly a third of the rural damage the same law does — $50 billion against $137 billion cut from rural Medicaid, by KFF's estimate — and the law never required the money to reach rural hospitals at all.

Barr is also not the first Republican to vote for the cuts and then campaign on the fund. Jake Ellzey of Texas announced a "historic investment" in rural health care from the same program he voted twice to pay for with Medicaid cuts. Mark Alford of Missouri voted for the bill and then, nearly eight months later, introduced legislation to keep rural hospitals open.

What the hospitals themselves say

Barr's letter attacks the source of the 35-hospital number, arguing that the Sheps Center analysis identified financially vulnerable hospitals nationally and never concluded that Kentucky's would close.

Beshear pointed him to the hospitals' own trade group. That group, Beshear said, "has been clear in their warnings, even stating that our state faces the highest number of rural hospitals at risk of shutting down [in] the country." Beshear said 350,000 Kentuckians would lose health coverage and 20,000 health care workers could lose their jobs.

A spokesperson for Barr said his office has talked with the association and continues to work with it, and that the group endorsed the House version of the bill — the version the Sheps Center analyzed. The spokesperson also said the association raised concerns about Senate changes, and that Barr's office helped preserve state-directed payment rates worth an additional $5.2 billion for Kentucky hospitals.

That is an admission, not a defense. The bill got worse for hospitals in the Senate. Barr voted for the final version anyway.

The short version

Andy Barr voted for a law that Governor Beshear says cuts $21 billion in Medicaid from Kentucky over ten years, in the state KFF found would be hit hardest in the country, with about 210,000 Kentuckians projected to lose coverage. More than a year later he wrote the governor demanding proof that rural hospitals are in danger, and offered as his own evidence that none of them have closed yet. His letter never mentions his vote.

Source

Margaret Vancampen, WHAS11: "Beshear, Barr trade barbs over Medicaid cuts to rural hospitals" (August 27, 2026). Photo credit AP/WHAS11 News.

Ashley Moody Authorized the Deal That Took $10 Million From Poor Kids' Health Care. Her Office Objected First, Then Settled for Taking Its Name Off the Paperwork.

Thu, 27 Aug 2026 12:38:45 +0000

For seven months, Florida's Republican leaders refused to even acknowledge that a grand jury report existed. On Wednesday, August 26, 2026, CBS News Miami got a copy of it anyway.

The report is about $10 million that was supposed to pay for health insurance for poor Florida children. It says that money was "misappropriated" and that the transfer was "part of a sophisticated scheme to fund political activities."

We laid out the money trail a month ago, back when the report was still locked up. The new part is what the grand jury says about the person Florida just sent to the U.S. Senate.

Ashley Moody was Florida's attorney general when this happened. According to the grand jury, she knew about the plan to divert the $10 million, and she personally gave her top deputy the green light to sign.

What the grand jury actually found

Start with the finding itself, because it is blunt.

"Despite our finding that the money was misappropriated, we find insufficient evidence to charge anyone criminally."

Nobody was charged. That is not the same as nothing happened. The grand jury explained exactly why it couldn't charge anyone:

"Nobody will take responsibility for deciding the $10 million of taxpayer money would go to Hope Florida… or had any memory of who made it."

And then it said what it could see anyway:

"While we can't prove who is responsible, we can plainly see that taxpayer money was misused for political purposes and we would like to see changes made to prevent this from happening again."

Moody was never called to testify. Neither was Governor Ron DeSantis. Neither was James Uthmeier, the governor's chief of staff at the time, who is now Florida's attorney general and whose political committee ended up with most of the money.

The objection — and the fix

Here is the part that has never been public before.

The money came from a settlement with the health care giant Centene, which had been overbilling Florida for prescription drugs in a program that covers children. Florida was owed $67,048,611. In September 2024, state officials rewrote the deal so that only $57 million came back to taxpayers and $10 million went instead to the Hope Florida Foundation — the nonprofit built around First Lady Casey DeSantis' signature initiative.

Centene's own lawyers were uneasy. They wanted the settlement to say plainly that the Florida attorney general was the one directing them to send $10 million to a charity tied to the governor's wife.

Moody's office did not want that.

Her chief deputy, John Guard, told the grand jury he had "reservations" about the deal. He said that "esoterically" he agreed the $10 million was taxpayer money that "belonged to the state of Florida." He said "Florida Statutes require the legislature to decide how money is spent."

He also, according to the report, raised the political risk with his boss:

"[Guard] did have political concerns about the dedication of $10,000,000 to Hope Florida, which he raised with AG Moody, because he knew the deal would be viewed by the legislature as a constraint on their spending authority."

So Moody's chief deputy understood three things: the money belonged to taxpayers, the legislature is the branch that decides how taxpayer money gets spent, and lawmakers would be angry if they found out.

Now read what happened next, in the grand jury's words:

"His political concerns were resolved by the change to the agreement making the settlement AHCA's agreement rather than the AG's settlement agreement, as the problem would now be AHCA's problem rather than the AG's problem."

Nothing about the money changed. The $10 million still left the taxpayers. It still went to Hope Florida. The only thing that changed was whose name was on the paper. Instead of the attorney general directing Centene, it would now be the governor's health agency — the Agency for Health Care Administration — directing Centene.

That satisfied Guard. And then, the report says:

"after consulting AG Moody, she authorized Mr. Guard to sign the settlement agreement in its final form."

The grand jury added that Guard signed it "without conducting his due diligence to ensure the proper appropriation of taxpayer funds."

Why the rush

The grand jury was also unimpressed by the timing.

Florida sat on this case for three years. A draft settlement returning the full $67 million was sent to state officials on July 14, 2021. Ohio and Mississippi settled in 2021. Indiana, Massachusetts and California settled in 2023. Florida did nothing — and ignored Centene's own requests to wrap it up.

Then, in early September 2024, Florida suddenly wanted it done immediately. The grand jury did the arithmetic:

"The Centene settlement itself seems rushed as it materialized rapidly after years of inactivity. Then, once reached, it took a mere 7 days to fund. We believe the rush was due to the impending election which was just 45 days away."

The settlement gave Centene seven days to wire the $10 million to Hope Florida. It gave Centene more than a year to repay the $57 million owed to Florida taxpayers.

The grand jury also noticed what did not happen. There was no press release from the health agency or the governor's office bragging about recovering millions for taxpayers, the way other states did. And there was "no notification to the Legislature of the Centene settlement" at all.

Two of the officials who signed the agreement did so on September 27, 2024 — the day after Hurricane Helene made landfall. Cassandra Pasley, chief of staff at the Florida Department of Health, testified she was working at the state's Emergency Operations Center when she was pulled aside and asked to sign. She had never seen the document and did not know a settlement was in the works. She signed it that evening. She told the grand jury she was not aware any of the money would end up in a political action committee, and that she would not have signed if she had known.

Where the money went

Centene wired the $10 million on October 4, 2024. Within 25 days it was gone.

Two outside groups applied for $5 million grants each. Both got them, one within hours of applying. Both had written in their applications that the money would not be used for political purposes. A forensic accountant who analyzed the bank records for the grand jury traced $8.5 million of it into Uthmeier's political committee, Keep Florida Clean. From there, $7 million went to the Republican Party of Florida and $1.23 million to another committee Uthmeier chaired.

That money went into the campaign against Amendment 3, the marijuana legalization initiative. Amendment 3 got 5,950,589 votes — 55.90%. Florida requires 60%. It failed.

Moody had spent years trying to keep marijuana legalization away from Florida voters. In December 2019 she took an earlier initiative to the Florida Supreme Court, arguing its ballot summary was misleading, and in April 2021 the court kept that one off the 2022 ballot. Her office made the same case against Amendment 3, urging the court to reject it as misleading and not limited to a single subject — and lost, 5-2, in April 2024. Six months later, settlement money was paying for ads against it.

Two months after the amendment failed, DeSantis appointed her to the United States Senate.

Seven months of silence, and counting

The report was filed under seal with the Leon County Clerk's Office on January 28. One source familiar with the investigation told CBS News Miami that multiple people named in it, including Uthmeier, have spent the seven months since blocking its release through closed court proceedings. The Florida Center for Government Accountability asked the court to let it argue for release. That request is still pending.

She is not the only Republican attorney general whose record is sitting behind a seal. In Texas, the only two known occasions when Ken Paxton has had to answer questions about his own conduct under oath are two depositions sealed in a Collin County courthouse, which his Democratic opponent's campaign said it would ask a court to unseal on the same day this report surfaced.

Moody has refused repeated requests to talk about Hope Florida. Not to CBS Miami, which sent written questions to her Senate office and her campaign. And not to state Rep. Alex Andrade, the Republican who uncovered the diversion in the first place and who told CBS Miami in July that she has never responded to him either. Meanwhile the foundation at the center of it has kept moving further out of reach — its financial records now live at the office of a Republican compliance firm in Alabama — the same firm that keeps the books for the super PAC supporting her Senate campaign.

DeSantis was asked about Hope Florida at a news conference on Wednesday. "I wasn't involved in the settlement agreement, but I'm very happy with how everything was done," he said. He called the whole thing a hoax. Uthmeier has called it a "big nothingburger."

The grand jury that heard the testimony disagreed. Its closing line:

"As taxpayer money, it should have been treated as such instead of being allocated for partisan political purposes and without transparency."

What the record shows

A Florida grand jury found that $10 million owed to taxpayers — money that came from a company caught overbilling a health program for poor children — was misappropriated and spent on a political campaign. The report says Ashley Moody's chief deputy told the grand jury the money belonged to the state and that only the legislature decides how state money is spent, that he raised his political concerns about the deal with Moody directly, and that those concerns were resolved not by stopping the transfer but by rewriting the paperwork so another agency would carry the blame. Moody then authorized him to sign. Taxpayers got $57 million instead of $67 million, on a repayment schedule that gave Centene a year — while the $10 million bound for a political committee had to be wired in seven days. Moody is asking Floridians for a full Senate term in November and has not answered a single question about any of it.

Source

Jim DeFede, Grand jury finds DeSantis administration "misappropriated" $10 million in taxpayer money to Hope Florida, CBS News Miami, August 26, 2026. Photo: Getty Images.

In Her Victory Speech, Darline Graham Called Government Health Care 'Bad Idea After Bad Idea.' 235,000 South Carolinians Have Already Lost Their Coverage.

Thu, 27 Aug 2026 12:36:48 +0000

Darline Graham won South Carolina's Republican Senate runoff on Tuesday, August 25, 2026. What she chose to talk about that night was health care.

"Government run health care…. bad idea after bad idea," she told the crowd, naming her Democratic opponent. "Annie Andrews backs it all."

Then she explained why she felt that way, using her own family. Her parents ran the Sanitary Cafe in Central, South Carolina — a bar, pool hall and liquor store; she and her brother grew up in a single room behind it. There were no vacations.

"If they were sick, they had to get up and go to work, because if the doors weren't open, we weren't making money."

She followed it with this: "My mother passed away when I was 11, and my father just over a year later."

She told that as a story about grit. Common Dreams' Julia Conley reported it on August 26. What it actually describes is two people who could not afford to stop working when they were sick, and who did not live long.

Andrews — who is a pediatrician — answered: "No family should have to suffer simply because generations before them did."

What is happening in South Carolina right now

Graham is not describing a hypothetical future under a plan nobody has passed. She is a sitting senator, appointed in July to the seat her late brother Lindsey Graham held, and the health care in her state is already coming apart.

The advocacy group Protect Our Care put together a fact sheet for every state, and South Carolina's numbers are these:

235,000 people have lost their ACA subsidies or their coverage under Medicaid or the Children's Health Insurance Program.
Premiums have doubled for more than 587,000 South Carolinians in the past year.
14 hospitals, clinics and nursing homes have shut down or are on the verge of it.
Health care facilities in the state face a $1.5 billion loss in funding.
Hospitals and clinics are facing a 26.9% spike in demand for uncompensated care — treatment nobody pays them for.

That last one is worth pausing on. A 26.9% spike in demand for uncompensated care means more people walking into an emergency room with no coverage at all — the most expensive way in the world to get sick, and the bill lands on everyone else's premiums.

None of this is the result of "government run health care." It followed the Republican health care cuts, on both tracks Protect Our Care counts: 74,940 South Carolinians pushed off Medicaid or CHIP, and 159,190 who dropped their ACA coverage after premiums skyrocketed. Nationally, 2.6 million Americans have already lost their health insurance as marketplace enrollment fell 12%.

What she did with her first month

Graham's remarks aren't just rhetoric she is stuck with. She has a voting record now, and it is short enough to read in full.

Two days into the job, on July 16, 2026, the Senate voted on whether to take up a resolution overturning the administration's WISeR model, which brings prior authorization into traditional Medicare for a set of services. Prior authorization is the step where an insurance company decides whether you get the care your doctor already ordered. The motion failed 46–50. Graham voted no.

We laid out that vote and the others in her first weeks in a look at how her Senate record compares to her career — and the comparison is the strange part. Graham spent 12 years at South Carolina's Vocational Rehabilitation Department as its business services and communications director, and since 2019 has led the state's Commission for the Blind. In 2022 she was part of the bipartisan South Carolina effort to end subminimum wage for workers with disabilities. Disability advocates in the state speak well of her.

Then she got to Washington and voted to leave insurance-company gatekeeping inside Medicare — a program that is, definitionally, government-run health care.

Which raises the obvious question about "bad idea after bad idea." Medicare is government-run. So is Medicaid. So is the VA, and so is the CHIP coverage sitting right there on the list of things 235,000 South Carolinians just lost. The phrase does a lot of work precisely because it never has to name any of them.

The argument she is actually making

Strip the applause line away and Graham's runoff-night speech contains a real claim: that going to work sick because the doors have to stay open is how it's supposed to be, and that anything designed to spare people that is a bad idea.

Journalist Ahmed Baba summarized what that sounds like from the outside: "'Government-provided healthcare is a bad idea. I'd rather Americans work long, hard hours, not receive sick leave, and die young' is one hell of a message."

Her parents didn't have a choice. That's the part of her story that's true and that nobody should make light of. The choice is the one in front of her now — she holds a Senate seat, 235,000 people in her state have lost coverage, and 14 facilities have closed or are close to it. She can vote to change that. So far she has voted the other way, and campaigned on it.

What the record shows

Protect Our Care counts 235,000 South Carolinians who have lost their ACA subsidies or their Medicaid and CHIP coverage, premiums doubled for more than 587,000 others, 14 hospitals, clinics and nursing homes shut down or on the verge of it, $1.5 billion in funding lost, and a 26.9% spike in demand for uncompensated care. Darline Graham used her runoff victory speech to call government-run health care "bad idea after bad idea," offering her parents' inability to take a sick day as the reason. She has been a U.S. senator since July. Two days into the job she voted against overturning a rule that puts insurance-company prior authorization into traditional Medicare.

Source

Julia Conley, "Trump-Backed Darline Graham Bashes 'Government-Run Healthcare,' Glorifies Working While Sick", Common Dreams, August 26, 2026. Photo via Common Dreams: Graham gives her election victory speech in Columbia, South Carolina, on August 25, 2026 (Megan Varner/Getty Images).

Rick Jackson Says Uninsured Georgians Still Have Healthcare. A Doctor in the Legislature Called That 'Battlefield Triage.'

Tue, 25 Aug 2026 10:07:01 +0000

Rick Jackson is the Republican nominee for governor of Georgia. He made his fortune in healthcare staffing.

At an event in Buckhead on August 20, he explained his approach to Georgians who have no health insurance.

"You need to understand: Not having insurance in Georgia does not mean you don't have healthcare. There's a huge difference. Some people equate it. That is not true."

And on Medicaid:

"What I'm going to be doing is helping each of these people get off of Medicaid."

What he's actually describing

There is one thing that makes Jackson's first claim technically true. A federal law requires hospital emergency rooms to treat and stabilize anyone who comes in, regardless of whether they can pay.

That's it. That's the entire healthcare system he is describing.

State Rep. Michelle Au — a Democrat from Johns Creek who is also a practicing anesthesiologist — responded on X:

"That is not 'healthcare' in the sense that most people think of it. That is battlefield triage."

Au pointed out what an emergency room is not required to do: cancer screenings, annual physicals, ongoing maintenance, or preventive care.

An ER will stop you from dying today. It will not catch your tumor at stage one. It will not adjust your blood pressure medication. It will not keep your diabetes from taking your foot.

Leah Chan of the Georgia Budget and Policy Institute put the cost in plain terms: "When you're unable to take care of manageable health conditions, and to prevent sickness or injury, you are paying more down the line for more costly acute care, both as an individual and then we as a society."

That's the part that should matter to every Georgia taxpayer, insured or not. Treating a condition after it has turned acute costs more than managing it early — that is Chan's point — and the bill doesn't disappear. It lands on hospitals, as uncompensated care.

"Get off of Medicaid"

Jackson says he supports what he calls "intelligent Medicaid expansion." Asked what that means, he described it this way:

"That's what I'm going to be doing is helping each one of these people to get off of Medicaid. If they get onto commercial insurance that's a first stop of success for them so they can grow their career."

Georgia is one of a small number of states that has never expanded Medicaid under the Affordable Care Act. That decision is why the state has a "coverage gap" — people who earn too much to qualify for Georgia's very limited Medicaid, and too little to get much help buying a plan on their own.

Jackson's answer to that gap is that people in it should move onto commercial insurance so they can "grow their career." He did not say how someone whose job does not offer coverage is supposed to buy it.

And it's about to get worse

Georgia isn't holding steady on coverage. It's losing ground.

An estimated 150,000 Georgians will lose health coverage under Trump's budget bill, 32,000 of them losing Medicaid specifically. If the enhanced ACA premium tax credits are also allowed to expire, a Georgia-specific analysis projects that 492,000 Georgians will lose coverage and become uninsured by 2034.

Those are the people Jackson is telling to use the emergency room.

His website says two words about healthcare

Jackson's campaign site promises to "transform healthcare."

That is the whole healthcare policy. There is nothing else on it.

For a candidate whose entire public identity is that he is a healthcare businessman, that is a remarkable amount of nothing — and it isn't the first time. At the Georgia Chamber's annual luncheon in August, he pitched property-tax-free data centers while personally invested in one, and rejected Medicaid expansion in the same speech.

The staffing business that made him a billionaire has its own record with the people who actually deliver care. A company he owns paid $3 million to settle claims it trapped more than 5,000 immigrant workers in contracts they couldn't leave, with allegations it threatened to report nurses to immigration authorities if they tried to quit — while his campaign ran ads promising immigrants who break the law would be "deported or departed."

What we know

Rick Jackson, a healthcare billionaire running to govern Georgia, told an audience that not having insurance "does not mean you don't have healthcare," and that his plan is to help people get off Medicaid. The only thing backing that claim is a federal law requiring emergency rooms to stabilize patients — no screenings, no checkups, no chronic care. A physician in the state legislature called it battlefield triage. Georgia has never expanded Medicaid, 492,000 Georgians are projected to lose coverage and become uninsured by 2034, and Jackson's campaign website's entire healthcare policy is the phrase "transform healthcare."

Source

Jackson campaign website promises to "transform healthcare," but nominee shuns Medicaid expansion — Doug Richards, 11Alive, August 24, 2026.

Asked If Florida Parents Should Vaccinate Their Kids Against Measles, Byron Donalds Said No — and Blamed Immigrants

Tue, 25 Aug 2026 10:03:47 +0000

Byron Donalds is the Republican nominee for governor of Florida. On Sunday, August 23, he sat down with Margaret Brennan on CBS's Face the Nation.

She asked him a simple question about a disease that is spreading in his own backyard. Here is what he said.

The exchange

MARGARET BRENNAN: …nearly all of Florida is below the 95% immunization rate for herd immunity for measles. So, is your message to Florida parents, get your kids vaccinated against that one?

REP. BYRON DONALDS: No, actually, my message to Floridians and, quite frankly, to Americans is the reason why we have seen a measles outbreak in certain parts of the country is because of rampant illegal immigration into the United States from the previous administration.

MARGARET BRENNAN: What evidence do you have of that?

REP. BYRON DONALDS: …we've seen the outbreaks in El Paso, Texas, in Southwest Florida, where I live, and many other parts where you know that you have a situation. People have come into the country illegally, have not had that vaccination schedule…

The question was whether parents should vaccinate their children. The answer was "No."

Brennan asked him for evidence. He named two places where outbreaks have happened. That is not evidence that immigrants caused them — it is a list of places measles is spreading.

What is actually happening in Florida

Measles is not an abstraction in Florida this year.

By the end of July, the CDC had recorded 141 measles cases in Florida, putting the state fifth in the country for the most cases. One of the outbreaks Florida's surgeon general has publicly discussed is in Collier County — part of the 19th Congressional District Donalds has represented since January 2021, and the "Southwest Florida, where I live" he pointed to on national television.

And Brennan's premise was correct. Just 88.9% of Florida's kindergarteners had completed their required vaccinations before the 2025-26 school year, according to WLRN, and nearly all of the state is below the roughly 95% measles immunization rate public health officials say is needed to stop the disease spreading through a community. Vaccine exemptions in Florida are at their highest level in a decade.

Measles is one of the most contagious diseases known. When enough children in a community are unvaccinated, it spreads. That is the mechanism. It does not require anyone to have crossed a border.

The state's own health department has been trying to make it worse

Donalds is not making this argument in a vacuum.

In September 2025, Florida Surgeon General Joseph Ladapo announced he wanted to eliminate every vaccine mandate in the state — a move that would have made Florida the first in the country to do it.

It didn't happen, and not because anyone changed their mind. Some of the required shots are written into Florida law and would need the legislature to act. Others are set by the Department of Health, which Ladapo runs — and his own department has yet to file the paperwork to complete the rule change. The mandates survived on a technicality.

So this is the backdrop for Donalds's answer: a state where the top health official tried to scrap vaccine requirements, where kindergarten vaccination rates have been sliding, where exemptions are at a ten-year high, and where measles is now spreading in the district he represents.

Asked what he'd tell parents, the man who wants to run all of it said "No."

He has made a habit of this

This is not the first time Donalds has answered a question with something other than the facts.

Days before the primary he told a rally that "even the American Medical Association has finally realized that this is insanity," claiming the country's largest doctors' group had turned against gender-affirming care for minors. The AMA told The Advocate it still believes parents, families and medical professionals should decide together.

A PAC supporting him ran an ad that deceptively edited a David Jolly clip on gender-affirming care to make Jolly appear to endorse surgery for children — PolitiFact found he was quoting someone else and never mentioned surgery, and rated the ad False.

And he told Floridians that the state's new data center law "ensures that utility rates will not go up due to data centers" — PolitiFact rated that Half True, because the law outlines ways to protect consumers but doesn't guarantee it, and doesn't cover rural cooperatives or municipal utilities at all.

In summary

Asked on national television whether Florida parents should vaccinate their children against measles — in a state with 141 cases by late July, a kindergarten vaccination rate of 88.9%, and an active outbreak in his own congressional district — Byron Donalds said "No," and blamed the outbreaks on "rampant illegal immigration." When Margaret Brennan asked what evidence he had, he named two places where measles is spreading. He offered nothing else.

Source

Transcript: Rep. Byron Donalds on "Face the Nation with Margaret Brennan," Aug. 23, 2026 — CBS News. Reported by Yahoo News.

Jon Husted Told Disabled Ohioans His Medicaid Vote Wouldn't Hurt Them. He Skipped Their Forum and Went Shooting Clay Targets.

Sun, 23 Aug 2026 12:56:58 +0000

On Thursday, August 20, Ohio's disability community set aside four hours to hear from the people who want to run their state.

The Ohio Disability Candidates Forum ran from noon to 4 p.m. at the Fawcett Center in Columbus. It was organized by the Ohio Olmstead Task Force, billed as nonpartisan, and built to be easy to attend: ASL interpreters, live captioning, a universal changing station, and a request that everyone come fragrance-free. Fourteen statewide candidates were invited — the Republican and the Democrat for every office on the November ballot. The questions were written and shared in advance, so nobody could be ambushed.

Jon Husted was on the list. He did not come.

At 3:10 p.m., an attendee typed into the event's question channel asking whether Husted was joining. Staff answered that he was not — that he was "unable to participate."

At 8:19 p.m., Husted's verified account posted photographs of him at the Black Wing Shooting Center, north of Columbus, shooting clay targets. "It's National Shooting Sports Month!" the post read. "It was great to be at the Black Wing Shooting Center in Columbus today with fellow Ohio sportsmen and hear about the issues that matter most to them."

He had time that day to hear about the issues that mattered most to somebody. Just not to them.

The vote behind the empty chair

This forum mattered because of a vote Husted already cast.

Husted voted for Trump's budget bill — the one Republicans called the One Big Beautiful Bill Act — which carries the largest cut to Medicaid in the program's history. KFF puts Ohio's share of that at roughly $33 billion in lost federal Medicaid money over the next decade, about a 13% cut against what the state spends now.

The piece of it disability groups have spent a year warning about takes effect January 1, 2027. Roughly 769,000 Ohioans will have to prove, every month, that they worked or studied or volunteered 80 hours. The Urban Institute projects that paperwork alone could cost as many as 356,000 Ohioans their coverage by 2028.

That is on top of the people Ohio has already lost. When the Obamacare tax credits expired, 161,385 Ohioans dropped their plans — and Ohio lost a larger share of its ACA enrollment than any other state in the country.

And more than 45,000 Ohioans with disabilities are on Medicaid waivers. Waivers are the thing that pays for a caregiver to come to your house so you don't have to live in an institution. Under federal law, waiver services are optional. That is exactly why advocates are frightened: when a state budget gets squeezed, the optional things go first. Ohio has already seen where that road ends — we've written about how Husted helped nursing homes make themselves harder to sue for abuse and wrongful death.

"There's nothing in this bill that would impact them"

Husted has told Ohioans, over and over, that none of this reaches disabled people.

In July 2025, as the bill moved through Congress, he told News 5 Cleveland that people with disabilities would not be affected: "There's nothing in this bill that would impact them." His office told NBC4 the same week that "Disabled Americans, children, and their caretakers are at no risk for losing benefits because of this bill."

Later that month he posted a statement on his Senate website saying there were "whoppers of a lie" going around about Medicaid, and that the law would leave Ohioans with more health care than ever.

Here is the problem with that. The 80-hour work rule is the specific provision disability groups flag as the danger, and the Center for American Progress found it reaches at least 2.6 million adults nationally who have trouble working because of a disability or illness but who don't get SSI or disability insurance — so they get no automatic exemption. Those people keep their coverage only if they fill out the forms correctly, every month, forever.

On a Columbus radio show in October 2025, Husted called the Medicaid changes "purposeful." "So I love fighting for those things," he said. "I love doing that kind of stuff."

The forum on August 20 was four hours in a room where people living on those waivers could have asked him about that. He was not there.

This is not new for him

Husted's record on disability benefits did not start in the Senate. It started when he ran the Ohio House.

In April 2005, three months into his speakership, Husted led a House budget proposal that eliminated the Disability Medical Assistance program — which paid for prescriptions and doctor visits for about 15,000 very low-income adults described at the time as destitute and chronically ill. The same proposal cut off Medicaid for 25,000 working-poor parents earning between 90% and 100% of the poverty line.

The next March, he voted for Senate Bill 7, an overhaul of Ohio's workers' compensation system that made it harder for injured workers to qualify and shorter for them to collect. It:

required objective medical proof that a workplace injury had made a pre-existing condition substantially worse, instead of a worker's own report of more pain;
narrowed who counts as permanently and totally disabled, overturning an Ohio Supreme Court ruling that had treated the loss of a single limb as the loss of two body parts;
capped non-working wage-loss payments at 52 weeks, down from a 200-week allowance.

It passed the House 58 to 37 and became law.

The hug

In June 2025, a Columbus attorney named Sarah Bloom Anderson brought her 14-year-old daughter Audrey to Husted's Washington office. Audrey has PURA Syndrome, a chromosomal disorder. She relies on a waiver that pays for a full-time caregiver at home.

Husted hugged her. His office posted the photo.

Then he voted for the bill.

Bloom Anderson told the story months later at a campaign event in Columbus. "You can't hug my daughter, look her in the eyes and tell her Medicaid won't be cut," she said, "and then sign that bill."

One more thing

Three years ago, as lieutenant governor, Husted stood in front of a camera and handed CareSource the 2023 Governor's Inclusive Employer Award for hiring people with disabilities. "Governor DeWine and I have made working with Ohioans with disabilities an important priority in our administration," he said.

CareSource was a listed sponsor of Thursday's forum. Its logo sits on the event page, a few inches above the roster of candidates — a roster with Husted's name on it.

A photo op with a disabled teenager is easy. An award ceremony is easy. Four hours of pre-written questions from the people your vote actually lands on is not, and he skipped it. It's the same pattern we've seen from him on electric bills, where his own party's internal memo calls data centers an "anchor" around his campaign — the appearances are managed, and the accounting never happens in public.

Ohio votes November 3.

Source

Husted skips disability forum, posts clay-shooting photos hours later — R.L. Porter, TiffinOhio.net, August 21, 2026. Photo: screenshot via Senator Jon Husted / YouTube.

Protesters Say 220,200 People in Mike Carey's District Are on Medicaid and His Vote Puts 33,000 at Risk of Losing Coverage. His Office Didn't Answer the Reporter.

Thu, 20 Aug 2026 07:02:31 +0000

Susan Cavendish has four kids. One of them, her five-year-old son, is autistic.

"There was a time when he was considered nonverbal," she said, standing outside Mike Carey's Columbus office. "But in large part, due to the services and support he has received, he has made progress that at one time seemed unobtainable."

Those services come through Medicaid, public schools, and publicly funded childcare. Her family's food help has already been cut.

"It has become increasingly difficult to make up the differences and make sure my children are getting the nutrition they need," she said. "When you cut SNAP, people do not suddenly need less food. Children do not suddenly become less hungry."

More than a dozen people were out there with her. Carey's office did not respond when the Ohio Capital Journal asked for comment.

What his vote did to his own district

Carey voted for the One Big Beautiful Bill Act — Trump's budget bill. Here is what the event's organizers say that means in Ohio's 15th Congressional District, which covers Madison County and parts of Franklin, Fayette, Clark, Shelby and Miami counties:

220,200 residents in the district are on Medicaid.
12% of households in the district get SNAP food benefits.
An estimated 33,000 people in the district could lose health coverage by 2034.
$40.4 million in special education funding is at risk.

Statewide, the damage has already started. More than 100,000 Ohioans — including more than 50,000 children — have lost their SNAP benefits since the bill made the deepest cuts to food aid in the program's history. Ohio's Affordable Care Act enrollment has fallen by 161,385 — nearly a third, the biggest drop in the country — after the tax credits that made insurance affordable expired. And the bill's new Medicaid work requirements could push 356,000 Ohioans off their coverage.

Carey's own description of that bill, back in May 2025:

"The One Big Beautiful Bill Act offers momentous tax relief that will help workers, families, seniors, farmers, and small businesses live the American Dream."

Momentous tax relief. Susan Cavendish is trying to buy groceries.

"Congressman Carey, our people matter too"

The protest was part of the Center for Popular Democracy's national "Care Over Cruelty" August recess campaign, joined locally by Progress Grove City, Parents United for Public Schools, and the Ohio Organizing Campaign.

Kate Terenzi of the Center for Popular Democracy laid out the ask plainly:

"Health care, education, and food must come before tax cuts for billionaires, ICE, data centers, and another endless war. We need care over cruelty."

Michelle Bolzenius, whose daughter has special needs, made the education point:

"Public schools are asked to educate every child who comes through their doors. That promise matters tremendously to families of children with disabilities. But we cannot expect schools to fulfill that responsibility without giving them the resources to do so."

And Jen Belt, an organizer with Protect Grove City, put the question directly to him:

"We hear about jobs. We hear about economic development, we hear about winning the race for artificial intelligence, and yes, economic growth matters, jobs matter, investment matters, but Congressman Carey, our people matter too."

The pattern: he doesn't answer

"Carey's office did not respond to a request for comment" is not a one-off line in one story.

We wrote in August about his telephone town hall — the one he promised on Facebook and X to post the call-in number for, and then never did. His office put out a press release afterward celebrating that 12,000 people joined. WOSU has tried to interview him 17 times, knocked on his door, and left a note at his office.

This is a congressman who is happy to tell you what he did. He is much harder to reach when you want to ask him about it.

It fits the rest of the record. Before Congress, Carey was a registered lobbyist on House Bill 6 — the law at the center of Ohio's biggest bribery scandal, whose coal subsidies and the earlier charges it locked in took more than $683 million from Ohio utility customers. And two weeks after taking a $3,500 check from Les Wexner, he voted to keep the Epstein files sealed.

Who's asking

Carey faces Democrat Don Leonard in November. Leonard beat former state Rep. Adam Miller in the primary with nearly 53% of the vote.

"I'm a Medicaid kid," Leonard told the Ohio Capital Journal. "Those programs gave me a shot at the American Dream. Why would he take that same opportunity away from kids today?"

Carey won the seat in a 2021 special election and has held it since. The Cook Political Report rates the district "Likely Republican" — which is another way of saying he has not had to answer for much.

Ohio's Republicans in Congress voted for this together, and we've laid out what the whole delegation's votes are costing the state. But the numbers those organizers read out — 220,200 Medicaid enrollees, $40.4 million in special education funding — describe Mike Carey's constituents and Mike Carey's district.

He can keep not returning calls. The bills are still arriving.

Source

Megan Henry, "Ohioans criticize Ohio US Rep. Mike Carey for cuts to SNAP, Medicaid, and education", Ohio Capital Journal, August 20, 2026. Photo by Megan Henry, Ohio Capital Journal.

Ken Paxton Voted Against Texas's $3 Billion Cancer Program Twice. It Has Since Caught 58,507 Cases of Cancer.

Thu, 20 Aug 2026 07:00:31 +0000

In 2007, cancer was killing about 35,000 Texans a year. So Texas did something about it.

Republican Governor Rick Perry pushed a plan to spend $3 billion in public money on cancer research and cancer prevention. It was called the Cancer Prevention and Research Institute of Texas. Republicans and Democrats backed it together. The Republican state representative who introduced the bill called it "one of the most positive actions we can take this session, to cure cancer in our lifetime."

It passed both chambers of the Texas Legislature overwhelmingly. Then it went to the voters, and 61% of Texans said yes.

Ken Paxton said no. Twice.

He Was One of 26

Paxton was a state representative from Collin County at the time. About two dozen of the Texas House's 150 members voted against the cancer program each time it came up. Paxton was one of them — one of just 26 no votes on the measure putting it on the ballot, and one of 24 against the bill that organized the institute.

He never explained why. According to Mother Jones, which dug up the votes, Paxton did not take part in any public debate on the bill. He did not respond when asked about it now.

Some lawmakers did raise a real objection at the time — they didn't like that the state would borrow money to pay for it. One Democrat proposed paying for it out of the regular budget instead. When that idea failed, most of the lawmakers who had backed it decided a disagreement over financing wasn't worth killing a cancer program over.

Paxton didn't. He voted no anyway.

What He Voted Against

Nineteen years later, we know exactly what that program did.

By the state's own count, it has detected 58,507 cases of cancer, funded 282 child and teenage cancer research projects, and pulled in an additional $12.5 billion in outside funding. The institute says it has helped "save tens of thousands of lives."

Texans liked it enough to do it again. In 2019, voters approved a second $3 billion — by an even bigger margin than the first time. Today it is a $6 billion, 20-year program, and the state describes it as "the largest state cancer research investment in the history of the United States."

That is the thing Ken Paxton voted against. Not a partisan bill. Not a culture-war fight. A cancer program that his own party's governor proposed, that his own party's legislature passed, and that his own state's voters approved twice.

The Same Session, the Other Cancer Vote

The cancer institute wasn't the only cancer measure Paxton opposed that year.

In that same 2007 session, Perry had used an executive order to require the HPV vaccine for sixth-grade girls. HPV is a virus, and it is linked to 99% of cervical cancers. The vaccine prevents it.

Paxton co-authored HB 1098, the bill that stripped Perry of the power to require it. Conservative activists had campaigned against the vaccine, arguing in part that protecting girls from a sexually transmitted infection would encourage them to have sex.

The bill passed. Perry let it become law. And Texas has been paying for it ever since.

The University of Texas System's own public health office, in its analysis of CDC survey data for 2016, found Texas ranked 47th out of the 50 states and the District of Columbia for up-to-date HPV vaccination. The share of Texas teens who had gotten at least one dose ran 10.6 points below the national average for girls and 11.7 points below for boys.

Cervical cancer is one of the few cancers we know how to prevent outright. Texas has been close to last in the country at doing it.

He Has Not Changed

You might argue that 2007 was a long time ago, and people's views move.

Paxton's haven't. As attorney general, he is now formally investigating the American Academy of Pediatrics — the country's largest group of children's doctors — over its childhood vaccine advice, in the middle of the worst measles outbreak the country has seen in thirty years.

And when Trump's budget bill passed the House last year — the one that cut more than a trillion dollars from health care programs to pay for tax cuts, and that one study projected could mean a million fewer cancer screenings — Paxton cheered it on X. He called it "an incredible moment for our nation's future" and "HISTORIC legislation."

Federal cancer research is being cut right now. Mother Jones notes that the Trump administration has pulled hundreds of millions of dollars out of medical research, including $500 million in mRNA work, and points to a New York Times piece from last fall warning that Trump "is shutting down the War on Cancer."

Paxton has put no distance at all between himself and that.

Why This Matters in November

Paxton is asking Texans to send him to the U.S. Senate, where he would vote on federal cancer research funding, on Medicaid, and on whether people can afford treatment at all.

He is running on affordability. We've already looked at what his affordability plan actually is — a stack of tax deductions that about nine out of ten taxpayers can't claim, because you have to itemize your taxes to use any of them.

Here's the simplest way to put it. Texas built the biggest state cancer-fighting program in the country. It has found more than 58,000 cancers. Republicans built it, Democrats backed it, and voters approved it twice.

Ken Paxton voted against it — and then voted to make it harder to prevent cervical cancer, too.

His full record is the one Texas Republicans nominated him on. This is another line in it.

Source

Tim Murphy, "A Texas Program Has Poured Billions Into Cancer Research. Ken Paxton Voted Against It.", Mother Jones, August 19, 2026. Illustration: Mother Jones; photo by Zach D Roberts/NurPhoto/ZUMA.

2.6 Million Americans Have Already Lost Their Health Insurance. These Republicans Voted to Let It Happen.

Wed, 19 Aug 2026 12:09:54 +0000

For four years, people who buy their own health insurance got enhanced tax credits that held their premiums down. Those credits expired at the end of 2025. Congress could have extended them. It didn't.

We now know exactly what that cost.

Nationally, the number of people actually enrolled and paying for ACA coverage fell from 21,776,626 to 19,169,147 — a loss of 2,607,479 people, or 12%, in a single year. That's the first drop in seven years, and it's KFF's own July 28 analysis of federal data, not a projection.

What enrollees actually paid — premiums net of tax credits — rose an average of 58%. Enrollment fell in 49 of 50 states. The only exception was New Mexico, which spent state money to fill the gap.

Here is what it cost the twelve states represented by the Republicans below:

State	Lost coverage	Drop
Ohio	161,385	−32%
Oklahoma	85,557	−32%
Arizona	107,183	−30%
South Carolina	159,190	−29%
Indiana	78,096	−28%
Michigan	130,789	−27%
Mississippi	68,658	−26%
Missouri	86,425	−25%
North Carolina	164,682	−21%
Kansas	36,040	−20%
Florida	442,785	−10%
Texas	146,345	−4%

Two votes decided this. On December 11, 2025, Senate Republicans blocked S. 3385, which would have extended the credits — the motion to even begin debate got 51 of the 60 votes it needed. Six days later, on December 17, the House passed H.R. 6703, 216–211, a bill titled the "Lower Health Care Premiums for All Americans Act" that contains no extension of the credits at all.

Ten of those twelve states lost a bigger share of their coverage than the country did, and Ohio and Oklahoma lost the biggest shares in America. These are the members who represent them — and who voted for it anyway.

Jim Jordan — Ohio, −32%

No state lost a larger share of its coverage than Ohio — 32.4%, just ahead of Oklahoma's 32.3%. That is 161,385 Ohioans, nearly a third of the state's marketplace, gone in a single year. Only Florida and North Carolina lost more people outright, and both are far bigger states.

Jim Jordan voted yes on the House bill.

Ohio's own numbers were not a surprise to anyone in its delegation. An estimated 356,000 Ohio residents are projected to lose health coverage under the Trump spending law — a projection that comes on top of the 161,385 Ohioans above, who had already lost marketplace coverage when the tax credits were allowed to expire. The state also stands to lose an estimated $33 billion in federal Medicaid funds over the next decade.

Jordan is not a backbencher who got rolled by leadership. He is chairman of the House Judiciary Committee, a founder of the Freedom Caucus, and one of the handful of members who can genuinely move House Republicans when he wants to. When Jordan decides something matters, the conference hears about it.

He has been in Congress since 2007 — nineteen years — and in that time has never sponsored a single bill that became law. Not one.

That is the record he brings to the worst-hit state in the country: maximum leverage, and nothing built with it.

Stephanie Bice — Oklahoma, −32%

Stephanie Bice voted yes on the House bill. Oklahoma lost 85,557 people, tied for the steepest percentage drop in the country.

Bice went to Congress saying she would fight for affordable health care. She then voted against capping insulin at $35 a month and against letting Medicare negotiate lower drug prices — in a state where 13.2% of adults have been told they have diabetes.

But the case that captures this best is a household the Oklahoma Policy Institute modeled. A 60-year-old Oklahoma couple earning $85,000 would pay $30,784 a year without the enhanced credits, against $7,225 with them.

That is not a rate increase. That is a family being priced out of the insurance market. And $85,000 for a couple is precisely the income the enhanced credits were designed to reach — people who earn too much for the old subsidy cliff and nowhere near enough to absorb a $30,000 premium.

Oklahoma hospital leaders also warn that the budget bill Bice voted for will cut reimbursements to Oklahoma hospitals by $8.7 billion over the next decade and eliminate nearly 15,000 jobs. Ten Oklahoma hospitals have closed since 2005, one of those hospital leaders noted, and he expects the cuts to bring more.

Juan Ciscomani — Arizona, −30%

Juan Ciscomani voted yes. Arizona lost 107,183 people, a 30% collapse.

Ciscomani represents a swing district and has spent two years insisting he's a moderate on health care. The arithmetic doesn't care about positioning. Arizona's marketplace shed nearly a third of its enrollment in twelve months — 107,183 people who were paying for coverage in 2025 and are not in 2026.

That is the part that gets missed about the subsidy expiration. When 107,000 people lose insurance, they don't stop getting sick. They show up at an emergency room uninsured, and the hospital absorbs the bill. In rural Arizona there isn't much hospital left to absorb it.

It also fits his pattern. Six weeks after 700 people in Casa Grande lost their jobs, Ciscomani brought the Speaker of the House there to celebrate. The announcement and the aftermath keep pointing in opposite directions.

Sheri Biggs — South Carolina, −29%

Sheri Biggs voted yes. South Carolina lost 159,190 people — the fourth-largest raw loss in the country, from a state of five million.

Biggs is a nurse practitioner. She has spent a career in exam rooms with patients who couldn't afford care.

In her own district, an estimated 27,623 people in SC-03 are projected to lose health coverage — 24,900 of them losing ACA marketplace coverage, 2,723 losing Medicaid, according to the Joint Economic Committee's House Minority staff.

She, more than almost anyone who cast this vote, knows exactly what happens to a person who stops being able to afford their medication. She voted for it anyway.

Victoria Spartz — Indiana, −28%

Indiana lost 78,096 people, more than a quarter of its marketplace. Victoria Spartz voted yes.

On top of that, an estimated 650,000 Hoosiers on Medicaid expansion are at risk of losing coverage under the budget bill — a number that would devastate hospitals and rural communities across the state.

What separates Spartz from most of this list is that she actually showed up to hear about it.

In late March 2025, after Republican leaders advised members against holding town halls at all, Spartz held two anyway on back-to-back days, in Westfield and Muncie. Credit where it's due; most of her colleagues hid.

Then she stood there while her constituents chanted "Do your job!" and protested outside.

Showing up is the first step. It isn't the whole job. Spartz heard directly from Hoosiers about what these cuts would do, in a room, to her face — and nearly nine months later voted for the bill that let their premiums jump anyway.

Lisa McClain — Michigan, −27%

Michigan lost 130,789 people. Lisa McClain voted yes.

McClain is not a rank-and-file member. She serves as House Republican Conference Chair — the fourth-highest position in House Republican leadership. She is in the room where the conference decides what it will and won't bring to the floor.

Michigan was already exposed. Gov. Gretchen Whitmer estimated 200,000 Michiganders could lose Medicaid coverage under the budget bill, and a report from the state Senate warned it could blow a $2 billion hole in the state budget — because 70% of Michigan's Medicaid spending comes from federal dollars.

Stack that on 130,789 people already out of the marketplace, and Michigan is absorbing losses from two directions at once. The member of its delegation with the most influence over what House Republicans do next is the one who helped set the agenda that produced it.

Michael Guest — Mississippi, −26%

Michael Guest voted yes. Mississippi lost 68,658 people — in the state that can least afford it.

Mississippi already runs on Medicaid: 714,600 people, or 24.2% of the entire state population, were covered by it in FY 2024. It is also one of the ten states that never expanded Medicaid, so working-age adults who lose marketplace coverage there usually have nowhere else to go.

Guest has form on this. He spent his August recess promoting $206 million for Mississippi's rural hospitals — after voting for the law projected to take billions out of the state's Medicaid funding. The pattern repeats: vote for the cut, announce the crumb.

Jason Smith — Missouri, −25%

Missouri lost 86,425 people. Jason Smith voted yes — and he is the single member on this list with the clearest jurisdiction over the thing that expired.

Smith chairs the House Ways and Means Committee, the most powerful tax committee in Congress. He writes the nation's tax laws.

The enhanced ACA premium tax credits are, literally, a tax credit. They live in the tax code. Extending them is a Ways and Means matter. When people ask which committee could have moved an extension through the House, the answer is his — and he has held the gavel since 2023.

Missouri's own reporting matches the federal numbers almost exactly: more than 86,000 Missourians dropped ACA marketplace coverage between February 2025 and February 2026 — a nearly 25% decline, among the steepest in the country — explicitly attributed to the expiration of the enhanced credits. That reporting draws on the same CMS release, so it is the federal number seen up close rather than a second one.

And the forecast was published before the vote. An estimated 160,000 more Missourians are projected to be uninsured by 2034 under the budget bill — rising to 230,000 if the enhanced ACA premium tax credits were also allowed to expire.

They were allowed to expire. The chairman of the committee that writes tax law voted for the bill that didn't extend them.

Virginia Foxx — North Carolina, −21%

North Carolina lost 164,682 people — the largest raw loss of any state in this group, and second nationally only to Florida.

Virginia Foxx voted yes. And of everyone on this list, she is the one who most directly controlled whether the House got to vote on anything else.

Foxx chairs the House Rules Committee. That is the panel that decides what reaches the floor and which amendments may even be offered — Speaker Johnson appointed her to it. Nothing gets a vote in the House of Representatives without going through her committee first.

So consider what the House actually voted on in December. Not an extension of the expiring credits. A substitute bill that doesn't extend them, brought to the floor under a rule.

Foxx has been in Congress since 2005 — twenty-one years — and is the former chair of the Education and the Workforce Committee, which writes the rules for employer health plans. She is not a member who lacks the standing or the procedural knowledge to force a health care vote. She is the member who decides which ones happen.

Meanwhile North Carolina stands to lose an estimated $49.9 billion in federal Medicaid funds over the next decade, with up to another 195,000 residents at risk of losing coverage on top of the 164,682 already gone.

Roger Marshall — Kansas, −20%

Roger Marshall is the one who said the quiet part out loud, and he's a doctor.

Marshall is an OB-GYN who sits on the Senate's health committee. He voted to block the extension. Kansas lost 36,040 people, a 20% drop.

Asked about the expiring subsidies in December 2025, he shrugged: some people's premiums, he said, "are going to go up some."

What people pay went up 58% on average. For the Oklahoma couple in OK Policy's model, it is 326%.

This is the same senator who once explained the uninsured this way: "There is a group of people that just don't want health care and aren't going to take care of themselves."

A physician is allowed to hold conservative views about how health care should be financed. What's harder to defend is a physician who describes a 58% premium spike as going up "some," and who ascribes the resulting uninsurance to people not wanting coverage.

Florida — 442,785 people, the biggest loss in America

Florida's −10% looks mild next to Ohio's −32%. Don't be fooled by the percentage. Florida's marketplace is enormous — 4.3 million people were enrolled and paying in February 2025, more than in any other state — so a 10% drop means 442,785 Floridians lost coverage, nearly three times as many as any other state on this list.

No state has more people on this coverage than Florida. That is why the two Florida members below matter more than their percentage suggests.

Ashley Moody

Ashley Moody was one of the senators who blocked the extension. On December 11, 2025, she voted against even taking up a three-year extension of the ACA premium tax credits. The motion drew 51 votes — nine short of the 60 needed to advance.

She cast that vote knowing more of her own constituents rely on this coverage than in any other state.

It isn't a new position for her. As Florida's Attorney General, Moody kept the state in the lawsuit seeking to strike down the entire Affordable Care Act — a position she maintained in May 2020, in the middle of the COVID pandemic, with more than a million Floridians having filed unemployment claims since mid-March.

First she tried to have the law struck down in court. Then, in the Senate, she voted to let the part holding premiums down expire. The method changed; the outcome she was working toward did not.

Gus Bilirakis

Gus Bilirakis voted yes on the House bill. He has been in Congress 19 years, chairs the Energy and Commerce Subcommittee on Commerce, Manufacturing and Trade, and sits on that committee's Health Subcommittee — the panel with jurisdiction over much of federal health policy.

His donor list is where this gets uncomfortable. GuideWell, the parent company of Florida Blue, has given his campaign $22,500 — and Florida Blue is the dominant insurer on the very ACA marketplace that just shed 442,785 customers. BioMarin Pharmaceutical has given $47,500, from a drugmaker whose approvals and pricing run through his Health Subcommittee.

The Florida Policy Institute, working from KFF's projections, puts the combined effect of the budget bill and the ACA marketplace changes at 1.5 million Floridians losing their health insurance — an estimated range of 1.1 million to 1.9 million — of which 1.4 million, 93%, is down to the marketplace changes rather than the Medicaid cuts. Florida's uninsured rate is projected to go from a historic low of 10.7% in 2023 to 16.7% starting in 2026.

A member on the Health Subcommittee, funded by the health industry, representing the state with the most to lose, voted for it.

Texas — the thinnest safety net in America, cut anyway

Texas lost 146,345 people — a 4% drop that sounds small and isn't, because of where it landed.

Texas already had the highest uninsured rate in the United States: 19.2% among people under 65, nearly double the national rate of 9.8%, according to KFF's read of 2024 Census data. The Texas Tribune counts nearly 5 million children and adults under 65 there without coverage. Texas is also one of the ten states that never expanded Medicaid.

That combination is what makes a "mild" percentage brutal. In a state with expanded Medicaid, some people who lose marketplace coverage land somewhere. In Texas, most of them land nowhere.

And the forecast was ugly before this vote: KFF projects 480,000 more uninsured Texans by 2034 because of the budget bill, with Texas set to lose $27.9 billion in federal Medicaid funding over ten years.

Every Texas Republican in the House voted for H.R. 6703. Two of them stand out.

Monica De La Cruz

Monica De La Cruz represents TX-15 in South Texas, and she sits on the Ways and Means Committee — the same committee Jason Smith chairs, the one with jurisdiction over the tax credits that expired.

Her own district is among the hardest hit in the country. An estimated 65,193 people in TX-15 are projected to lose health coverage, per the same Joint Economic Committee minority analysis — and note the split: 61,700 of them losing ACA marketplace coverage, against 3,493 losing Medicaid.

This is not a Medicaid story in her district. It is almost entirely a marketplace story — which is to say, it is almost entirely about the credits her own committee could have extended.

Ronny Jackson

Ronny Jackson is a doctor. He served as White House physician to three presidents before taking TX-13 in 2021.

He is the third clinician on this list, after a nurse practitioner in South Carolina and an OB-GYN in Kansas. All three voted the same way.

There is no version of a medical career that leaves you unaware of what happens when a patient's coverage lapses. You see it directly: the delayed scan, the rationed insulin, the condition that was manageable in March and is not in September. Jackson spent decades close enough to that to know.

He voted yes.

The through-line

Look at the vote counts again. The Senate blocked the extension by nine votes short of cloture. The House passed its substitute 216–211. Neither outcome was inevitable; a handful of members in either chamber could have changed it.

Then look at who these fourteen people are. This is not a list of backbenchers who got steamrolled:

Jason Smith chairs Ways and Means, the committee that writes tax law — and these were tax credits. Monica De La Cruz sits on it too.
Virginia Foxx chairs Rules, the committee that decides what reaches the floor at all.
Lisa McClain is Conference Chair, fourth in House Republican leadership.
Jim Jordan chairs Judiciary and founded the Freedom Caucus.
Gus Bilirakis sits on the Energy and Commerce Health Subcommittee.
Roger Marshall is a physician on the Senate health committee, and Ronny Jackson was White House physician to three presidents.
Sheri Biggs is a nurse practitioner.

Four of them held the gavels or the leadership posts that control what the House votes on. Two sit on the committee that writes tax law, and two more on the health panels themselves. Three of them treat patients for a living. If any group in Congress had both the power and the knowledge to force a different result, it was these fourteen — and their own states include the two that lost the biggest share of their coverage in America, and the one that lost the most people outright.

And notice what the House actually passed. Not a repeal. A bill named "Lower Health Care Premiums for All Americans Act," which loosens rules on association health plans and does nothing about the credits whose expiration was about to raise what enrollees pay by 58%. It exists so that members can say they voted to lower premiums.

Every member above can now go home and say exactly that. The 2.6 million people who lost coverage this year are the reason it isn't true.

We've documented what this looks like on the ground in Alabama, Wisconsin, Arkansas and Ohio, and the full national tally of both votes is here.

The credits are gone. The people are uninsured. The votes are on the record with names attached — and in 2026, so are the members who cast them.

95,000 Alabamians Just Lost Their Obamacare Coverage. Here's How Each of Their Republicans Voted.

Wed, 19 Aug 2026 11:53:50 +0000

Alabama lost 95,000 people from its Affordable Care Act health plans this year — a 23% drop, the Alabama Reflector reports, citing a late-July analysis from KFF.

They didn't stop needing insurance. They got priced out. When the enhanced premium tax credits expired at the end of 2025, premiums rose an average of 58%.

This was not weather. It was a series of recorded votes, and every Alabamian can look up how their own member of Congress cast one.

Who loses coverage

Before the roll calls, it's worth being clear about who these 95,000 people are, because "ACA enrollees" is an abstraction and they are not.

Matt McGough, a KFF policy analyst, described the marketplace as a "last best option." Most enrollees are:

small business owners
people working multiple jobs that don't offer insurance
retirees who aren't yet old enough for Medicare

"This is a group of people who, just by the nature of their work, don't have health insurance benefits. Every other potential door in our fragmented health insurance system is closed to them."

And in Alabama, that door is narrower than almost anywhere. Alabama is one of only ten states that never expanded Medicaid. The program here covers children, the elderly and people with disabilities almost exclusively. An adult with children qualifies only if the family makes 18% of the poverty level — $5,940 a year for a family of four.

So for a working Alabamian earning more than $5,940 and less than a comfortable living, the ACA marketplace wasn't one option among several. It was the only one.

Nationally, 49 states saw enrollment fall. The single exception was New Mexico, which spent its own state money to replace the lost federal help. Alabama did not.

The Senate vote: Tommy Tuberville

On December 11, 2025, the Senate voted on whether to even begin debating S. 3385, a bill to extend the expiring tax credits.

It needed 60 votes to proceed. It got 51. The motion was rejected and the bill died without ever receiving an up-or-down vote.

Tommy Tuberville voted no, according to the official Senate roll call.

Tuberville is now running for governor of Alabama — asking to lead the state whose hospitals absorb the cost of the uninsured he helped create.

The House vote: the bill with the reassuring name

Six days later, on December 17, 2025, House Republicans passed their own health bill and called it the "Lower Health Care Premiums for All Americans Act." It passed 216–211.

It does not extend the enhanced premium tax credits. As the Association of American Medical Colleges documented, the bill contains no extension at all. Instead it loosens the rules on "association health plans," lets employers set aside pre-tax dollars for employees to buy marketplace coverage, and lets employers buy stop-loss insurance.

Association health plans are cheaper largely because they don't have to cover everything a normal plan covers — plans with large-group status are exempt from the requirement to cover all ten essential health benefits.

So the name says "lower health care premiums." The bill leaves the premium increase exactly where it is.

Here is how Alabama's delegation voted, per the official House roll call:

Member	District	Vote
Robert Aderholt	4th	Yea
Barry Moore	1st	Yea
Mike Rogers	3rd	Yea
Dale Strong	5th	Yea
Gary Palmer	6th	Not Voting

Four Alabama Republicans voted for the bill that doesn't extend the credits. Gary Palmer was recorded "Not Voting" on passage — six minutes after he voted no on the Democrats' motion to recommit the same bill, and with premiums about to jump 58% on average.

Alabama's two Democrats, Terri Sewell and Shomari Figures, voted no.

What it does to the hospitals

The damage doesn't stop with the 95,000. Debbie Smith, who directs Cover Alabama at Alabama Arise, explained the chain reaction:

"What that means is more people are going to the ER without health insurance coverage. The hospital has to pick up that cost, and that makes it more likely for that hospital to not be able to absorb it, and possibly have to get rid of services at that hospital, or even shut down."

That isn't hypothetical in Alabama. Hospitals here are already struggling, and some have closed in the past year. Jackson Hospital in Montgomery was set to close in July after filing for bankruptcy — a safety-net hospital in a state that never expanded Medicaid. It survived only by reaching an agreement with Blue Cross and Blue Shield of Alabama. (It's the same hospital a Georgia billionaire lent $35 million at 14% interest and called "venture philanthropy.")

Every uninsured Alabamian who walks into an emergency room is a bill somebody pays. Right now that somebody is a hospital system already running on fumes.

"They knew in advance"

Smith's summary is the fairest description of what happened:

"This was a policy choice by Congress to let these extra tax credits expire... For Congress to just let these tax credits expire and allow that many people to lose their health coverage, they knew in advance that this would cause a lot of people across the country and here in Alabama to lose their health insurance."

That's the part worth holding onto. Nobody was surprised. KFF's March poll had already found that 17% of returning enrollees weren't confident they could afford their 2026 premiums. The projections were published. The votes happened anyway.

Alabama is not alone, and that's the point

We've now written this same story about state after state:

197 Republicans voted to spike health insurance premiums — the full national tally of both votes.
14,441 Arkansans lost Obamacare and their Republicans let it happen.
In Wisconsin, 45,000 people lost coverage while their congressman defended the cuts.

Alabama's 95,000 is among the worst of them, in the state least equipped to absorb it, because there's no expanded Medicaid underneath to catch anyone.

For the fuller accounting of what this delegation costs the state, see what Alabama's Republicans in Congress are costing you.

What to ask them

The tax credits may come back in some form — McGough notes it's "really hard for the government to offer a benefit to someone and then actually take it away," and it will be an issue through the midterms.

Until then, Alabamians have five specific questions for five specific people:

To Aderholt, Moore, Rogers and Strong: you voted for a bill named "Lower Health Care Premiums." Premiums went up 58%. What exactly did your vote lower?
To Palmer: you voted on the motion to recommit at 6:21 that evening and were not recorded on final passage at 6:27. What happened in those six minutes?
To Tuberville: you blocked the extension, and now you want to be governor. What's your plan for the 95,000?

Alabama deserves representatives who read the bill, not just the title.

Sources

Alabama Obamacare enrollment drops 23% after tax credits expire — Anna Barrett, Alabama Reflector, August 19, 2026.
Senate Roll Call Vote 644, S. 3385 cloture, December 11, 2025
House Roll Call 349, H.R. 6703, December 17, 2025
House Passes Health Care Bill Without Extending Enhanced ACA Subsidies — AAMC

Zach Lahn Calls Agribusiness a 'Cartel.' He Built His Career at the Koch Brothers' Political Shop — and Still Sits on a Koch-Funded Board.

Wed, 19 Aug 2026 11:49:33 +0000

Zach Lahn has built an unusual campaign for a Republican in Iowa. He calls agribusiness multinationals "cartels" that "have pillaged our state." He wants to break them up with antitrust lawsuits. He promises to "tax the heck" out of Wall Street hedge funds. He says the EPA has been captured by corporate interests.

He told Tucker Carlson it sometimes makes him sound like a "hippie."

A new investigation by Mother Jones and the Food & Environment Reporting Network asks the obvious question about a man who says all that: where was he before?

The answer is that he was working for the other side.

He ran the Koch brothers' Montana operation

In 2014, Lahn was hired to direct the Montana branch of Americans for Prosperity — the Koch brothers' flagship political advocacy group.

What did he do there? He urged Montana's Republican legislators to vote against the state's Medicaid expansion. When some of them supported it anyway, he tried to run them out of office.

Lahn is singled out by name in the award-winning 2018 documentary Dark Money as an example of how the Koch political operation works.

That is not ancient history that a man can simply grow out of. It is a career spent doing the specific thing Iowa's rural communities are still paying for. He's still defending privatized Medicaid today, after Iowa's own state auditor found it caused an 891% jump in illegal denials.

And he still sits on a Koch-financed board

In 2018, Lahn co-founded a private school in Kansas with Annie Koch, wife of Koch scion Chase Koch, who financed the project. Lahn and Annie later married.

Lahn still serves on that school's board of directors.

Now hold that next to his stump speech. Lahn wants the agribusiness "cartels" broken up. Koch Industries is one of them: its fertilizer arm, Koch Ag & Energy Solutions, is one of just four companies — with CF Industries, Nutrien and Yara — holding 84% of North America's nitrogen fertilizer capacity. Farmer advocacy groups have accused it of monopolistic practices in Iowa specifically.

To be fair and precise: Lahn did not work in the Koch family's agricultural business. He worked in their politics. But the distinction is thinner than it sounds — the politics existed to protect the business, and Americans for Prosperity was campaigning in Iowa too, for Republican candidates Mother Jones describes as friendly to Big Ag and corporate interests.

Austin Frerick, an expert on Iowa agricultural antitrust and author of Barons, offered the most economical summary:

Lahn, "at his core, is an all-star, major league political operative."

The crisis he's campaigning on is real

None of this means Iowa's problem is invented. It is severe, and both parties have avoided it for decades.

Iowa has the nation's second-highest cancer rate, and is one of only three states where the rate is increasing. The Iowa Environmental Council has explicitly tied that trend to agricultural pollution.
Pesticides, high-nitrogen fertilizers and hog-manure lagoons have laced the majority of Iowans' drinking water with unsafe contaminants.
The average farmer now makes less than 15 cents of every food dollar consumers spend.
Agribusiness spent about $224 million on lobbying last year — often outspending defense and oil and gas.

"When you live in these areas, you're living in a crisis," Frerick says. Aaron Lehman, a fifth-generation Iowa farmer and president of the Iowa Farmers Union, puts it this way: "We have hit a level of corporate control that we've never gone through before."

That's why Lahn's pitch works. The grievance is genuine. The question is whether the messenger will act on it.

The test he's already failing

Here's the cleanest way to judge whether Lahn will actually take on the powerful: watch what he says about the administration he's tied himself to.

Because on the specific issue at the center of his campaign — glyphosate, the weed killer in Roundup that Lahn says the EPA won't admit causes cancer — the Trump administration has gone the other way, repeatedly:

Trump signed an executive order declaring the production of glyphosate critical to U.S. national security.
The nation's top pesticide regulator and its undersecretary for food safety are both former Big Ag lobbyists.
In June, the Supreme Court ruled that states cannot sue Bayer, glyphosate's producer, over failing to warn consumers about the herbicide's alleged dangers.

Lahn accepted Trump's endorsement as a "patriot." He has not, so far as the reporting shows, challenged any of it.

The same goes for the rest of what Washington has done to Iowa farm country: tariffs crushing farmers, fertilizer costs climbing as the war in Iran drags on, DOGE's cuts to USDA services and regenerative farming programs, and the Medicaid and SNAP cuts in Trump's budget bill that agricultural communities increasingly rely on.

One Iowa soybean farmer told Mother Jones what he wants: "We need a governor who will stand up for Iowa when our Iowa interests are being ignored" — including, he added, by the president.

Who's paying for the anti-corporate campaign

Lahn deserves credit for one thing: unlike his primary opponent and his general-election rival, he didn't fund his primary campaign with big checks from Big Ag. He put in roughly $2.5 million of his own money.

But the money coming in now is not grassroots either. A PAC associated with the Republican Governors Association contributed $5 million. Steak 'n Shake CEO Sardar Biglari gave $25,000.

The party establishment does not write $5 million checks to candidates it expects to break up its donors' companies.

The rest of the platform

Lahn's anti-corporate message travels with positions that have nothing to do with fertilizer monopolies:

He's vowed to pull mRNA Covid shots off the market and end every childhood vaccine requirement in Iowa schools — during the worst measles year since 1991.
He's pushing a life-at-conception law, which would effectively end abortion access in Iowa.
He promises to drive "Marxists" out of Iowa schools, after running a school with no accreditation, no state tests and no licensed teachers.
He accepted an endorsement from former Rep. Steve King, who lost his seat in 2020 after questioning why "white nationalist" and "white supremacist" are offensive terms.

And the man presenting himself as a sixth-generation Iowa farmer didn't register to vote in Iowa until October 2024 — barely clearing the state's two-year residency requirement — as the Wall Street Journal documented. The Des Moines Register reported in May that he still flies to Kansas about once a week. The Daily Beast reported he has never claimed the Belle Plaine farm as his primary residence.

Lahn's campaign declined Mother Jones' interview request, and declined to answer questions about his role in the farm's day-to-day operations.

Lahn rails against out-of-state owners of Iowa farmland, and his critics note that he was one of them until recently. Silvia Secchi, a natural resources economist at the University of Iowa, put it this way: "It takes one to know one."

What Iowa should ask

Iowa farmers are right to be furious, and they are right that nobody has been fighting for them. If Lahn has genuinely changed his mind about the Kochs, monopolies and corporate power, that would be worth something.

But a conversion is proved by what you give up, not by what you say. Lahn is still on the board of a Koch-financed school. He has not criticized a president who declared glyphosate a national security priority. And on Medicaid he has not moved: he campaigned against expansion in Montana, and he is defending Iowa's privatized system now.

Iowa deserves a governor who fought Big Ag before it was popular, not one who joined the fight after checking the polling.

Source

Zach Lahn Is MAHA's Great Farm Country Hope. Is He the Populist Hero He Claims to Be? — Teresa Cotsirilos, Mother Jones, in partnership with the Food & Environment Reporting Network, August 18, 2026. Top image illustration by Mark Harris.