Medicaid cuts' disproportionate toll
ADVOCATES WORRY — Medicaid cuts in President Donald Trump's tax and spending law could disproportionately harm Black women and children who depend on the program, advocates warn.
And the looming changes in the One Big Beautiful Bill Act could worsen already disparate health outcomes among Black Americans, POLITICO's Cheyanne M. Daniels reports.
Although Black people represent about 14 percent of the U.S. population, they account for more than 20 percent of Medicaid enrollees, according to Pew Research Center — and almost 60 percent of all Black children are enrolled in Medicaid, according to a recent analysis from the NAACP and other advocacy organizations.
Why it matters: Advocates say the enacted megabill's Medicaid cuts could limit resources in schools with high percentages of students eligible for free or reduced-price lunch, exacerbate maternal mortality rates and leave Black families without critical care.
'States right now are having to make decisions on what services they're going to cut ... and their allocation of funding toward this population,' said Patrice Willoughby, chief of policy and legislative affairs for the NAACP. 'It is unconscionable that Congress would leave American children, which are the future of the country, without the supports that they need and the interventions that they need to contribute meaningfully to develop to their fullest potential.'
Background: Medicaid — which is the fourth largest federal funding source for K-12 schools, according to a 2025 report by the School Superintendents Association — supports more than $7.5 billion of school-based health services each year for low-income students, including screenings for learning disabilities.
Thirty-seven percent of Black students attend high-poverty schools, according to a 2023 analysis by the National Center for Education Statistics.
Through Medicaid, high-poverty schools are also able to provide medical care. They can also provide insight into whether a student needs additional screening for a more accurate diagnosis.
But one report from a coalition of education groups earlier this year found that the Medicaid cuts could force schools to reduce the number of school nurses, limit access to early intervention programs or impact funding for special education programs for those with learning disabilities.
Zooming out: Advocates say the cuts are part of a broader pattern of the American medical system inadequately serving Black patients.
'These cuts really are continuing a pattern of forcing Black families to take care of ourselves without the proper support,' said Brittany Packnett, an equity strategist who co-founded Campaign Zero, a police reform initiative, and supported Vice President Kamala Harris in the 2024 presidential campaign.
In a statement to POLITICO, HHS said the claims 'misrepresent' the One Big Beautiful Bill Act.
'The OBBB is a decisive step toward building a stronger, more resilient healthcare system,' an HHS spokesperson said. 'This legislation modernizes Medicaid to deliver greater efficiency and long-term sustainability, while expanding access to high-quality care for those most in need, in every community across the nation.'
A spokesperson for the White House also dismissed the worries of advocates, arguing they were coming from supporters of Trump's defeated 2024 opponent.
Even so: It remains to be seen what the long-term impacts of the cuts will be. Many of the cuts aren't set to go into effect for years, and Congress has a track record of approving reductions and changing eligibility rules, only to later extend deadlines or revise the law entirely.
WELCOME TO TUESDAY PULSE. HHS is tracking its Make America Healthy Again wins with a new online tool. Send your tips, scoops and feedback to khooper@politico.com and sgardner@politico.com, and follow along @kelhoops and @sophie_gardnerj.
In Congress
FIRST IN PULSE: MEGABILL HOSPITAL IMPACTS — Liberal nonprofit Protect Our Care is teaming with Sen. Chris Murphy (D-Conn.) to unveil a new report today that details how hospitals could be impacted by the GOP's recently enacted One Big Beautiful Bill Act.
Why it matters: The megabill includes more than $1 trillion in health care cuts, mostly to Medicaid. The new law will take a $340 billion bite out of hospital budgets over a decade to pay for tax cuts and other Trump priorities — though hospitals and their lobbyists and allies on Capitol Hill are gearing up to use the next two and a half years to persuade lawmakers to rescind the provisions, most of which don't go into effect until 2028.
As part of that effort, Protect Our Care is working with Murphy to relaunch its 'Hospital Crisis Watch' tracker, which monitors the impact of the megabill on hospitals and care facilities across the country, including whether they're closing or making cuts.
The findings: The group highlights its findings in a report out today, shared first with POLITICO, that found more than 330 hospitals are at immediate risk of closing or scaling back their services, and more than 750 hospitals are at risk of closing in the years to come because of the new law. An estimated 477,000 health workers will lose their jobs because of the Medicaid cuts, according to the report.
What's next: Murphy and Protect Our Care will present the report during a virtual press conference today at 11 a.m.
At the Agencies
DEFUNDING MRNA TECHNOLOGY — NIH Director Jay Bhattacharya agrees with HHS Secretary Robert F. Kennedy Jr.'s decision last week to defund research into the mRNA technology that produced Covid-19 vaccines in record time, he told POLITICO in an interview.
Vaccine experts argued the move would put at risk America's leading position in vaccine development and potential cures for diseases from cancer to diabetes by pulling the government's $500 million. But Bhattacharya said Kennedy's critics have the story backward.
Here's some of Bhattacharya's conversation with our Axel Springer colleague Tim Röhn, edited for length and clarity.
Paul Offit, the leading vaccine expert, told me the mRNA funding cuts were 'politicization of science.' Is he right?
No, he's not right. In my view, the key question for any vaccine platform that we fund and support is: How acceptable is it to the public? If you have the very best science in the world, but the public doesn't trust it, then it's useless as a vaccine platform.
Your boss, Robert F. Kennedy Jr., called the Covid vaccines in December 2021 'the deadliest vaccine ever made.' Couldn't statements like this be the reason for the public distrust?
Secretary Kennedy's statement before he was appointed reflects the distrust of the population, rather than the cause of it. More important were the disastrous and unscientific vaccine mandates and exaggerated claims of Covid vaccine efficacy by high public health officials in power at the time.
Aren't we potentially slowing our response to the next pandemic by not investing in mRNA?
We have other new technologies that we're working on. Why marry yourself to a single platform when the platform has lost trust with the public? We're not saying we're not going to do vaccinations. We're saying that we're moving to a different platform that is more promising.
Public Health
A DECLARATION IN TEXAS — Texas's measles outbreak has ended, the state health department said Monday, Sophie reports.
The outbreak, which spurred nationwide fears about a resurgence of the disease, infected at least 762 people and caused two deaths in school-age children. A third person, from a New Mexico county near the outbreak's Texas epicenter, tested positive for measles after his death.
New cases haven't been reported in more than 42 days in any of the counties that had ongoing transmission, the health department said in a statement. That's twice the disease's maximum incubation period, or the longest time it can take between exposure to the virus and illness onset.
Even so: The department noted it would continue watching the situation closely.
'The end of this outbreak does not mean the threat of measles is over,' the department said. 'Since there are ongoing outbreaks of measles in North America and around the world, it is likely that there will be additional cases of measles this year in Texas.'
Zooming out: As of Aug. 5, the CDC has recorded 1,356 measles cases this year — more than any year since 1992.
Public health experts point to waning measles, mumps and rubella vaccination rates as a factor in the high measles case count. Some blame Health Secretary Robert F. Kennedy Jr. — who has spent much of his career questioning vaccine safety — for sowing distrust in the MMR vaccine.
WHAT WE'RE READING
The Wall Street Journal's Brianna Abbott reports on a new reality for terminal cancer.
For Undark, Joanne Kenen reports on how proposed NASA cuts could affect public health research.
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Vox
21 minutes ago
- Vox
How conservatives help their young thinkers — and why liberals don't
is a senior correspondent at Vox, where he covers ideology and challenges to democracy, both at home and abroad. His book on democracy,, was published 0n July 16. You can purchase it here. Attendees look on during Turning Point USA's Culture War event at the Ohio State University in Columbus, Ohio, on October 29, 2019. Megan Jelinger/AFP via Getty Images Last week, two young liberals asked for help finding a job in the ideas industry. And I didn't have a great answer. It made sense that they were asking: We were at a conference for liberals, dedicated to building a version of the doctrine that works in the 21st century. They were interested in studying ideas professionally, and I was there to moderate a panel about political philosophy. Yet I found myself struggling to give good advice. Sure, they could try for an internship at a liberal publication or think tank, but those are fiercely competitive and don't pay much. They could apply for a PhD program, but teaching jobs were scarce even before President Donald Trump took a hammer to American academia. What's really missing are programs of a specific kind — ones that help college students and recent grads engage with Big Ideas and connect with Important People. If my young acquaintances were right-wing, I might have told them to apply for National Review's Buckley and Rhodes journalism fellowships — multiyear paid opportunities to write for a national audience straight out of college. For a lesser commitment, they could have tried for the Claremont Institute's Publius Fellowship — a three-week program where you receive $1,500, a $700 travel stipend, free housing, paid meals, and an opportunity to study with some of the most influential (and radical) figures of the Trump era. On the Right The ideas and trends driving the conservative movement, from senior correspondent Zack Beauchamp. Email (required) Sign Up By submitting your email, you agree to our Terms and Privacy Notice . This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Those are two examples of numerous well-funded programs explicitly designed to usher as many bright young people into the institutional conservative world as possible. If you're an ambitious young college grad, and anywhere on the spectrum from libertarian to hardcore Trumpist, you've got tons of options to get into the ideas game. My young acquaintances really wanted a liberal version of such a thing. But as far as I can tell, it doesn't seem to exist. Where there should be a talent pipeline from universities to liberal public intellectualism, there is a giant sucking sound instead. And, increasingly, it's giving the right a leg up in winning the future. The right's winning formula for training youth It is true, as conservatives have long alleged, that America's intellectual institutions are pretty left-leaning places. They often overstate the case — professors are more likely to be Elizabeth Warren Dems than 'globalize the intifada' socialist revolutionaries — but data confirms that liberals outnumber conservatives in academia and the media by pretty significant margins. This is, of course, not at all new. One of the founding texts of the postwar conservative movement, William F. Buckley's God and Man at Yale, is all about how academia is full of socialists who are chipping away at the eternal truths of capitalism and Christianity. Buckley founded National Review as an antidote to what he saw as the liberal tilt of the mainstream American press. The legacy of Buckley-style thinking is the rise of a conservative ideas industry. A young person nowadays could attend college at right-wing Hillsdale, build their law school life around membership in the Federalist Society, and then get a job writing right-wing papers for the Heritage Foundation — all while getting their news from Fox News and Mark Levin's radio show. As part of these pipeline programs, older right-wingers get to know young up-and-comers as people, and thus develop a personal stake in their success. At the same time, the right also invested in the kinds of 'pipeline' programs our young liberals are desperate for. These aren't designed to replace traditional education or media institutions, but rather to identify young people interested in ideas and expose them to the right-wing alternatives. These work, in large part, by being intellectually exciting. It's not just that you get to go on all-expenses-paid trips with nice meals; it's that you are put in an environment where you're reading and debating classic works of political thought and literature with other people who share those interests. If you're the kind of nerd who wants to debate the finer points of Locke and Hamilton during undergrad summers, you're the kind of nerd who might one day be someone who matters in US politics — and the right's fellowships are there to help make sure you're mattering on their side. The people these young people are meeting are important and famous (well, DC famous). In a 2021 episode of the Know Your Enemy podcast, Nate Hochman — a radical young conservative writer who later staffed both Gov. Ron DeSantis and Sen. Eric Schmitt — talks at length about 'the masterful things the conservative movement institutionally has done in terms of mentorship.' Hochman, who was raised in a liberal household and moved to the right in college, describes how the movement's fellowship programs brought him in direct and meaningful contact with conservatism's leading lights. 'All of a sudden, you're at dinner with people you've looked up to for years, staying up until 1 am drinking wine with them and asking them questions and getting to talk to them. And they're taking you seriously,' Hochman says. As part of these pipeline programs, older right-wingers get to know young up-and-comers as people, and thus develop a personal stake in their success. When you stay up late drinking with someone, talking about shared ideas, you come to care about them in a way you don't if they sent you a cold email. When they come looking for help getting a job writing about conservative ideas, you'll work that much harder to place them in one. And the right has built its institutions to ensure that such positions are available. Right-wing publications and think tanks are much more open to debating big-picture questions — say, what kind of a nation is America? — than their left-wing peers (more on that in a second). Claremont, for example, was founded by students of conservative political philosopher Harry Jaffa, and it shows in the kind of work they put out (even when it strikes me as substantively ridiculous). Liberals are suffering from success There is no parallel culture in American liberalism — a function, in part, of liberalism's longtime intellectual dominance. There wasn't much of a need for liberal donors to create programs to cultivate liberal thought, as people interested could simply go get a PhD or an entry-level reporting job. However, these institutions were not avowedly liberal in character. They styled themselves as politically neutral, focused more on quality research and reporting, than as contributing to a particular ideological cause. This means that while liberals in such fields were in left-leaning environments, many were trained to see themselves primarily as professionals working a craft. So while there are plenty of internships available to young liberals, they're mostly focused on professional training (or coffee-fetching) rather than staying up late swapping ideas with big names. More broadly, the liberal professional approach also produced a kind of intellectual siloing. If you were a young liberal interested in political philosophy, odds are that you end up going to a PhD program and pursuing a career in academia. If you're interested in policy, odds are that you ended up studying a set of applied skills (like law or economics) that prepared you for very specific policy discussions in your area of expertise. But the conservative intellectual model bridges the philosophy-policy gap. It trains young people in the big-picture ideas, like conservative visions of political morality and religion, and teaches them to connect those things to everyday policy discussions. You aren't learning about abstract ideas or concrete policy, but rather learning a comprehensive worldview that treats policy issues as downstream of specific values. You are, in short, learning an ideology. Liberalism has plenty of brilliant theorists who work at a largely abstract level, and policy wonks who work on the most applied issues. But in the middle area of ideology, one bridging the gap between principle and policy, they've basically ceded the field to conservatism. The pipeline problem for young people is a symptom of the movement's blind spot: liberals, as a collective, don't care to cultivate a youth ideological cadre. This might not have been a problem in the past — and maybe even a benefit. Ideological thinking tends to produce rigidity, an unwillingness to adjust one's policy thinking based on new evidence. The right's longtime insistence that tax cuts can reduce deficits, or addiction to proposing military solutions to foreign policy problems, are two examples of curdled ideology. But we're at a moment where liberalism is in a particular kind of crisis: under threat from new ideologies that challenge not specific liberal policy ideas, but the basic premises of a liberal political system. Liberals need a new and compelling vision: one that explains why our ideas are not merely a defense of an unpopular status quo, but a broader politics that can be used to address cardinal problems of the 21st century. At this moment, liberals lack the personnel to articulate such a vision — while the right's radical thinkers, at places like Claremont, seize the field.
San Francisco Chronicle
22 minutes ago
- San Francisco Chronicle
As hurricane season collides with immigration agenda, fears increase for those without legal status
If a major hurricane approaches Central Florida this season, Maria knows it's dangerous to stay inside her wooden, trailer-like home. In past storms, she evacuated to her sister's sturdier house. If she couldn't get there, a shelter set up at the local high school served as a refuge if needed. But with aggressively accelerating detentions and deportations of immigrants across her community of Apopka, 20 miles (32 kilometers) northwest of Orlando, Maria, an agricultural worker from Mexico without permanent U.S. legal status, doesn't know if those options are safe. All risk encountering immigration enforcement agents. 'They can go where they want,' said Maria, 50, who insisted The Associated Press not use her last name for fear of detention. 'There is no limit.' Natural disasters have long posed singular risks for people in the United States without permanent legal status. 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On top of meeting law enforcement at FEMA recovery centers, mixed-status households that qualify for help from the agency might hesitate to apply for fear of their information being accessed by other agencies, said Esmeralda Ledezma, communications associate with the Houston-based nonprofit Woori Juntos. 'Even if you have the right to federal aid, you're afraid to be punished for it,' Ledezma said. In past emergencies, DHS has put out messaging stating it would suspend immigration enforcement. The agency's policy now is unclear. DHS Assistant Secretary Tricia McLaughlin said in an email that CBP had not issued any guidance 'because there have been no natural disasters affecting border enforcement.' She did not address what directions were given during CBP's activation in the Texas floods or whether ICE would be active during a disaster. Florida's Division of Emergency Management did not respond to questions related to its policies toward people without legal status. Texas' Division of Emergency Management referred The Associated Press to Republican Gov. Greg Abbott's office, which did not respond. Building local resilience is a priority In spite of the crackdown, local officials in some hurricane-prone areas are expanding outreach to immigrant populations. 'We are trying to move forward with business as usual,' said Gracia Fernandez, language access coordinator for Alachua County in Central Florida. The county launched a program last year to translate and distribute emergency communications in Spanish, Haitian Creole and other languages. Now staffers want to spread the word that county shelters won't require IDs, but since they're public spaces, Fernandez acknowledged there's not much they can do if ICE comes. 'There is still a risk,' she said. 'But we will try our best to help people feel safe.' As immigrant communities are pushed deeper into the shadows, more responsibility falls on nonprofits, and communities themselves, to keep each other safe. Hope Community Center in Apopka has pushed local officials to commit to not requiring IDs at shelters and sandbag distribution points. During an evacuation, the facility becomes an alternative shelter and a command center, from which staffers translate and send out emergency communications in multiple languages. For those who won't leave their homes, staffers do door-to-door wellness checks, delivering food and water. 'It's a very grassroots, underground operation,' said Felipe Sousa Lazaballet, the center's executive director. Preparing the community is challenging when it's consumed by the daily crises wrought by detentions and deportations, Sousa Lazaballet said. 'All of us are in triage mode,' he said. 'Every day there is an emergency, so the community is not necessarily thinking about hurricane season yet. That's why we have to have a plan.' ___
San Francisco Chronicle
22 minutes ago
- San Francisco Chronicle
Letters: Recall of Supervisor Joel Engardio is a warning shot to other S.F. politicians
Regarding 'Endorsement: No on Joel Engardio recall. Yes on charter reform' (Editorials, Aug. 16): The editorial board disagrees with over 10,000 District 4 voters who signed the recall petition: San Francisco Supervisor Joel Engardio's offenses warrant an immediate vote rather than waiting until the 2026 election to remove him from office. The disconnect is not surprising: For months, the thrust of the Chronicle's news reporting and opinion writers has been that the reason for the recall is that Engardio championed Proposition K to turn the Great Highway into a park. He did not notify District 4 voters about plans to introduce Prop K. Months before submitting Prop K, he met with groups supporting the highway closure, but gave no opportunity to those opposed to lobby or argue through public meetings or other venues. He submitted Prop K at the last minute, so that no competing proposition could be placed on the ballot. He promised traffic issues would be addressed before the Great Highway was closed. Many District 4 voters disagree with the editorial board and view Engardio's 'insufficient outreach' not as a 'political misstep' but as a callous disregard for basic democratic processes. A successful recall sends a warning to politicians: They ignore and disrespect their constituents at their political peril. John Higgins, San Francisco Have hybrid elections Before the city first switched to district elections in 1977, supervisors were concentrated in a few wealthy neighborhoods. The first district elections corrected that, but without a high voter turnout, it resulted in more fringe candidates. Maybe now is the time to retain residency diversity for selecting the top two candidates per district, but make them accountable to all the city voters in a runoff. To me, this is better than adding new at-large supervisors Ann Carberry, Sacramento Trump's claims are baseless Regarding 'Oakland leaders should listen to what Trump's criticism gets right about city' (Letters to the Editor, Aug. 19): While Oakland has problems — like most cities — the headline for the letter in the print edition ('Trump's criticisms are based on reality') is wrong. For one thing, President Donald Trump did not mention and does not pretend to address the issues the letter raises — businesses closing and underfunding of schools — issues that the city government is addressing and that the president's policies are exacerbating. Trump just talks about crime, when the reality is that crime is down in Oakland. So his criticism is not based on reality at all; rather, it is based on his desire to sow fear and to establish what he hopes will be a police state through the deployment of military force in American cities. Trump doesn't care about Oakland; he cares about power. That is reality. Clyde Leland, Berkeley Penalize Sen. Schiff Regarding 'Trump's motivation for accusing Adam Schiff of fraud is clear. But the legal case is not' (Politics, Aug. 15): As the law states, you can have only one primary residence, it has zero exemptions, and the language is quite simple. You can have only one and meeting the requirements is clearly spelled out. Sen. Adam Schiff has zero special status, just like the other 534 members of the House and Senate, nor do the head of any corporation, legal firm, state, local or city government. The story's attempt to present Schiff's side on a clear violation of tax law falls on deaf ears. Schiff should pay all back taxes, penalties and be happy he's not expelled from the Senate. James Sandler, Pleasanton
