
CMS Innovation Center plans hiring spree after cuts
With Simon Levien
Driving the Day
HELP WANTED — CMS's Innovation Center plans to expand its workforce as it prepares to launch new health care payment models, POLITICO's Ruth Reader and Robert King report.
The decision comes after CMS cut nearly 300 people, about 5 percent of its workforce, earlier this year as part of a massive HHS reorganization.
'The CMS Innovation Center is hiring passionate leaders eager to make meaningful change in the healthcare delivery and outcomes in Medicare and Medicaid,' Sarah Fogler, director for the center's Patient Care Models Group, wrote on LinkedIn recently.
The Innovation Center wants to fill roughly 100 positions, according to former and current staffers at CMS granted anonymity to discuss internal operations.
'There will be a mix of new hires with subject matter expertise in economics, clinical and data,' according to an official granted anonymity to speak freely on the hiring blitz.
Although the center didn't lose staff in the reduction-in-force, it lost probationary employees in February.
Two former CMS workers fired as part of the reduction-in-force said they tried to apply for the new positions but were told the agency can't hire RIF-ed employees.
One shared an email from Fogler with POLITICO.
'We aren't able to hire individuals who were affected by the reduction in force,' Fogler wrote to one of the former employees who attempted to submit their resume. 'We'll have two postings for direct hire (economist and nurse) otherwise we'll be hiring through the CMS Fellow pathway.'
Fellowships are intended to be temporary; the center's payment models are time-limited and sometimes end early. Fellows stay on for at least one year.
CMS said in a statement that all hiring decisions follow federal guidelines and 'reflect CMS commitment to program integrity and fiscal responsibility.'
Background: The Innovation Center was established under the Affordable Care Act in 2010. It has long promoted creative models of preventive care and has piloted some 50 payment models.
Why it matters: The hiring blitz, which will occur in phases, comes as the center is developing new payment models to implement agency policies, with chronic disease prevention a major priority.
WELCOME TO MONDAY PULSE. An Indiana Amish community is 'considered one of the least allergic populations ever measured in the developed world,' The Washington Post reports. I'm Carmen Paun, POLITICO's global health reporter, filling in today for Kelly Hooper and Sophie Gardner.
Send your surprise reaction, tips, scoops and feedback to cpaun@politico.com, khooper@politico.com, sgardner@politico.com and follow along @carmenpaun, @kelhoops and @sophie_gardnerj.
In Congress
DEMS DIG IN THEIR HEELS — Congressional Republicans seek to pass a bipartisan health care package by year's end.
But Democrats are playing hardball, suggesting that Republicans poisoned the well with their party-line domestic policy megabill, POLITICO's Ben Guggenheim reports.
One demand they're making as a condition of engagement: a costly extension of expanded tax credits for Affordable Care Act insurance premiums set to expire at the end of the year.
The tax credits, which Democrats enacted over Republican objections during the Biden administration, reduced insurance costs on the 2010 health law exchanges for millions of middle- and upper-income people for the first time. Extending them will be a tough pill to swallow for Republicans, particularly in the House, where Ways and Means Chair Jason Smith of Missouri recently suggested it could be a nonstarter for his conference.
Why it matters: There's been chatter for months about reviving a sweeping bipartisan health care package that was on track for passage last December as part of a larger government funding bill, but House GOP leaders dropped the health care provisions after President Donald Trump and billionaire Elon Musk said the funding bill was overly broad and threatened to tank it.
A major part of the health package included proposals to crack down on pharmacy benefit managers, which critics accuse of charging health plans more for drugs than the reimbursements they send to pharmacies, among other things. PBMs negotiate drug prices among manufacturers, pharmacies and health plans.
It remains to be seen whether Republicans want a PBM overhaul badly enough to trade an extension of the subsidies.
RURAL HOSPITAL LIFELINE? Republicans clinched a $50 billion fund to blunt blowback from a near $1 trillion Medicaid rollback — but some rural health experts say it's not nearly enough.
The Rural Health Transformation Program, tucked in President Donald Trump's One Big Beautiful Bill Act, aims to offset deep Medicaid cuts with allotments of $10 billion per fiscal year from 2026 through 2030. Rural communities are expected to lose $155 billion in Medicaid support over the next decade, according to KFF.
The program's rollout, however, remains murky, POLITICO's Amanda Friedman reports.
CMS will administer the grants, with half the funds distributed equally to states with approved plans. The other half will be allocated at the discretion of CMS Administrator Mehmet Oz, based on each state's rural population, number of rural facilities and the overall 'situation' facing a hospital.
In a statement to POLITICO, CMS didn't provide requested details about how Oz would assess which states receive more money and how the agency will remain impartial throughout the approval process.
'The program is under development, and CMS is working in coordination with whole-of-government partners,' CMS spokesperson Alexx Pons said via email. 'Additional details will be shared as implementation advances.'
Michael Topchik, a national leader of the Chicago-based consulting firm Chartis Center for Rural Health, which counts hospitals among its clients, told POLITICO the grant program will bring hospitals 'closer to whole,' though he doubts most will escape unscathed.
Eligible providers include rural hospitals, clinics, community mental health centers and federally qualified health centers. But because funding must be shared among them, rural hospitals — which bring in more than $12 billion a year from Medicaid, according to Chartis — are expected to face major shortfalls.
States have a Dec. 31 deadline to submit a 'detailed rural health transformation plan' outlining how they'll improve rural health access and outcomes, use technology and recruit health care workers.
OZ ON THE HILL — CMS Administrator Mehmet Oz is scheduled to meet with members of the House Ways and Means Committee on Wednesday, Ben reports.
A meeting notice viewed by POLITICO says committee members are invited 'to discuss the priorities' of CMS on July 23, including issues 'involving health care matters' that fall within the panel's jurisdiction.
Hospitals
'TOUGH TIMES AHEAD' — NASHVILLE — The American Hospital Association announced the head of a large rural hospital system will become board chair in 2027 at what was likely the largest gathering of health care leaders since President Donald Trump signed into law his 'big, beautiful bill' — which drives deep cuts into Medicaid, Simon reports.
The mood among some attendees was understandably dour.
The AHA Leadership Summit, which drew about 1,200 hospital C-suite executives and managers, began with a commiseration. Tina Freese Decker, the group's board chair, said they 'did everything they could' to stop the cuts, noting her team's sleepless nights working to blunt the bill's impacts.
'There are very tough times ahead,' she said, calling the current health care system unsustainable and then rallying members to reform it.
One health care executive in attendance granted anonymity to speak candidly gave their read on the opening speeches, which featured dire predictions of health care under the cuts. 'AHA must show it recognizes that bad shit happened,' the executive told POLITICO. 'But now we have work to do.'
A new leader: Bill Gassen, president and CEO of Sanford Health in Sioux Falls, South Dakota, will be the AHA's board chair-elect, taking over in 2027, Decker announced. Gassen, who says he leads the largest rural health system in the U.S., will begin his tenure as hospitals — particularly those in remote areas with slim margins — could suffer huge financial hits when many cuts take effect after the 2026 midterms.
Trump's law will disburse around $50 billion to rural health providers, but many industry groups say the fund isn't enough to offset the cuts. Rural clinics rely on Medicaid to a greater degree than other providers.
In his remarks Sunday, Rick Pollack, AHA president, warned to expect potential clinic closures, a slimmer workforce, fewer patients and fewer services if Medicaid cuts aren't negotiated down or repealed.
PHARMA WATCH
THE TARIFF EFFECT ON DRUGS — If President Donald Trump implements the tariffs on foreign-made drugs he's been threatening, the U.S. could see a shortage of critical medicines, the generic drugs sector and analysts have warned.
Trump said he'll impose a low tariff on drugs coming from abroad as of next month and give drugmakers a year to build up production capacity in the U.S. After that, tariffs could rise to 200 percent, he's warned.
But while the higher-value, branded pharmaceutical sector might gradually adapt, Europe's generics manufacturers — operating on razor-thin margins and cheaper competition from India and China — face a stark choice: absorb massive costs or abandon the U.S. market entirely, POLITICO's Giedre Peseckyte reports.
Why it matters: The U.S. relies heavily on imported generic drugs. Generics account for 92 percent of all prescriptions filled in the U.S., dominating by volume but not by revenue due to their low cost.
Tariffs would worsen ongoing U.S. shortages for essential hospital medicines and injectables and deepen America's reliance on Chinese and Indian suppliers, according to Medicines For Europe, Europe's generics drug lobby.
Public Health
MAHA CELEBRATES — HHS Robert F. Kennedy Jr. and other proponents of his Make America Healthy Again movement celebrated over the weekend the latest announcements from food companies about eliminating artificial food dyes and other ingredients considered harmful over the next few years.
Kennedy posted a Reuters report to the social platform X about PepsiCo planning to remove artificial dyes and flavors from its potato and tortilla chips, which it sells under the brands of Lay's and Tostitos.
WK Kellogg, the maker of Froot Loops cereals, said Friday it would remove artificial dyes from its cereals by the end of 2027.
WHAT WE'RE READING
The New York Times' Brian M. Rosenthal and Julie Tate report about how a push for more organ transplants is putting donors at risk.
Reuters' Bhanvi Satija reports that Sarepta Therapeutics won't comply with the FDA's request to stop shipping its Duchenne muscular dystrophy gene therapy after the death of a clinical trial patient.
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The Hill
2 hours ago
- The Hill
Memo pushes back on bill's impact to rural hospitals
A new memo shared first with The Hill argues the law 'contains unprecedented levels of federal assistance to rural and other vulnerable hospitals' through its five-year, $50 billion Rural Health Transformation Program. The administration notes that Medicaid has historically invested very little in rural hospitals. According to figures from the Centers for Medicare and Medicaid Services (CMS), Medicaid spent just $19 billion on rural hospitals in 2024. The rural health fund will provide an additional $10 billion each year from 2026 through 2030. But it ends after 2030, with no phaseout period. The memo argues the fund is a 'flexible' source of investment because it's not tied directly to reimbursement for services. Indeed, as experts have noted, the fund will not make direct payments to rural hospitals. Instead, the money will go to states, which will need to first file detailed 'rural health transformation plans' and get approval from CMS Administrator Mehmet Oz. The law gives Oz broad discretion on what he can approve, and there is no specific requirement for states to direct funds to rural hospitals or CMS to approve only funding for rural districts. States also need to make funding decisions quickly, as the federal government can claw back unobligated money before the program ends. The new law cuts about $1 trillion from Medicaid, primarily through stringent work requirements as well as reductions to how states can fund their Medicaid programs through provider taxes and state-directed payments. Rural hospitals rely heavily on Medicaid funding because many of the patients they care for are low income. But the administration noted that rural hospitals only account for 7 percent of overall Medicaid spending. According to a KFF analysis, federal Medicaid spending in rural areas is estimated to decline by $155 billion over a decade because of the law.


Politico
2 hours ago
- Politico
An explosion of AI lobbying
With Daniel Lippman LOBBYING BY AI STARTUPS STILL GROWING: Some of the biggest players in artificial intelligence continued to ramp up their spending on federal lobbying last quarter, ahead of the sweeping federal AI blueprint released by the White House today. — The roadmap hands the tech sector a massive win by slashing red tape in order to cement the U.S. as a global AI leader, including by reviving a version of the state and local AI moratorium that was dropped by Republicans in their reconciliation bill earlier this month. It also calls for expedited approvals to speed up the construction of data centers and other infrastructure to support AI technology, POLITICO's Mohar Chatterjee reports. It also calls for AI models to root out 'ideological bias' if they want to contract with the federal government. — Ahead of today's rollout, ChatGPT maker OpenAI spent $620,000 on lobbying in Q2, up 30 percent from the same period a year ago, and up 11 percent from the first three months of this year, according to a PI analysis of lobbying disclosures. OpenAI also picked up a new outside lobbying firm during Q2. It retained former Rep. Cheri Bustos of Mercury Public Affairs beginning in May to lobby the House, Senate and White House Office of Administration on AI policy, according to a disclosure. — Anthropic, the startup behind AI chatbot Claude, dropped $910,000 on lobbying last quarter — a massive spike from the beginning of the year (when Anthropic reported $360,000 in lobbying outlays) and the same period last year, when the firm spent just $150,000 lobbying Washington. — Anthropic also added a new outside lobbying firm, Continental Strategy, at the beginning of the quarter. Anthropic paid Continental $90,000 to lobby the House, Senate, Treasury and Executive Office of the President on issues related to AI and national security, according to a disclosure filing. — Anthropic and OpenAI's lobbying expenditures still pale in comparison to their more established Silicon Valley peers like Meta, whose $5.8 million in lobbying spending last quarter led the tech industry, or Amazon, which spent $4.5 million in Q2. (Both companies reported lobbying on a wide range of issues last quarter, and it's impossible to tell how much of their total spending went toward advocacy on AI.) — In all, nearly 500 different entities reported lobbying Washington on AI policy last quarter, according to a PI analysis, including other giant tech companies like Microsoft, Google, Oracle, IBM, Qualcomm and Nvidia. — Trade groups representing Silicon Valley and beyond — such as the U.S. Chamber of Commerce, American Medical Association, PhRMA, the Alliance for Automotive Innovation, Edison Electric Institute and the National Association of Realtors — also dropped tens of millions of dollars lobbying on issues that included AI policy, as did major corporations from a broad cross section of industries, civil liberties and labor groups, and universities. Happy Wednesday and welcome to PI. Send tips. Add me on Signal at caitlinoprysko.17, email me at coprysko@ and be sure to follow me on X: @caitlinoprysko. SPEAKING OF: The New York Times, which resumed federal lobbying in April for the first time in a decade — in part to engage on the intellectual property issues posed to news outlets by the explosion of AI use — has joined the Copyright Alliance. The coalition includes individual creators and other stakeholders affected by copyright issues, such as professional athletes, photographers, musicians, actors, authors, movie studios and more. — 'In a time when many tech companies are routinely violating copyright protections to boost their valuations by billions, the work of the Copyright Alliance couldn't be more crucial,' Diane Brayton, the Times' executive vice president and chief legal officer, said in a statement. MORE NOTES FROM THE LOBBYING DEADLINE: 'Renewable energy lobbyists dumped millions of dollars over the past few months in a frenzied push to save green energy priorities,' E&E News' Timothy Cama and Kelsey Brugger report. But 'in the end, they didn't get much bang for their buck.' — 'As Republicans ramped up their efforts to roll back tax credits, the top renewable energy advocacy organization in the country, the American Clean Power Association, spent a record $3.8 million lobbying federal officials for the second quarter that ended in June. That's more than six times as much that they spent a year ago in the same time period, new disclosures show.' — 'ACP was far from the only group that significantly boosted its advocacy work' last quarter, with groups like the Solar Energy Industries Association and the Zero Emission Transportation Association reporting big increases as well. — The health care industry also spent record sums last quarter, as hospitals, insurers, and drugmakers worked to fend off Republicans' proposed Medicaid cuts and anti-vaccine rhetoric from officials like HHS Secretary Robert F. Kennedy Jr., per POLITICO's Amanda Chu. PhRMA 'spent $7.58 million on lobbying in the second quarter, its highest for the period,' Amanda writes, while two of its members, Bristol-Myers Squibb and Merck, 'recorded their highest spending for any quarter.' — 'Insurance companies have also boosted their spending. AHIP, the health insurance industry group, spent $4.05 million in the second quarter, its highest for the period on record, while United Healthcare and Centene reported their second- and third-highest lobbying expenditures for any quarter, respectively. The American Hospital Association, meanwhile, reported $6.15 million, its second-highest for the period.' NEWS FROM THE THINK TANK WORLD: 'A South Korean nonprofit affiliated with Seoul's foreign ministry has funneled at least $9.4 million to U.S. think tanks in recent years … making it one of the top global funders of American policy research despite avoiding registration under foreign agent laws,' according to a new investigation from Korea Pro's Chad O'Carroll and Ifang Bremer. — 'The findings show that the Korea Foundation (KF), which maintains offices in Washington and Los Angeles, provided grants to at least 31 different organizations from 2019 to 2023. But while KF claims to be a non-governmental body and a 'nonprofit public institution,' Korea Pro's findings show that the foundation is closely tied to the South Korean government and explicitly seeks to advance Seoul's interests, at times pressuring scholars to promote the positions of the administration in power.' — 'KF's activities reportedly caught the attention of U.S. authorities before, and last year's indictment of Korea expert Sue Mi Terry, a former CIA analyst accused of failing to register as a foreign agent for Seoul, has exacerbated KF's fears of being seen as a foreign agent itself, Korea Pro's investigation found.' A spokesperson for the foundation told Korea Pro that it is 'not a government entity,' but a ''non-classified public institution' that provides academic, cultural and policy research grant programs.' Jobs report — Allyson Jones-Brimmer has been appointed executive director of the Northeast Dairy Producers Association, per Morning Agriculture. She has served as the group's vice president of regulatory and legislative affairs since November 2023. — Joe Murphy and Christine Ravold are now directors of strategic communications at the National Association of Manufacturers. Murphy was previously NAM's director of rapid response and Ravold was previously regional communications manager at Stand Together, managing day-to-day media relations for Americans for Prosperity. — Geoffrey Pyatt has joined the Partnership to Address Global Emissions as an advisory council member. He most recently served as assistant secretary of State for energy resources and is a former U.S. ambassador to Greece and Ukraine. — Binance CEO Richard Teng has joined the advisory board at The Digital Chamber. — Cecili Wake, Anna Dardick, Melody Mohebi and Ade Salami have joined Democracy 2076. Wake, now the group's deputy director, was previously a strategy consultant at NTI. Dardick, now program director of A Constitution for 2076, was previously a campaign strategist at the ACLU. Mohebi, now program director of Imagining 2076, was previously the director of social impact, measurement and insights at Participant Media. Salami, now program director of Pro-Democracy Political Coalitions in 2076, was previously a senior policy aide for the City of Minneapolis. — Joel Graham is now associate administrator for the Office of Legislative and Intergovernmental Affairs at NASA. He previously was a partner at Meeks, Butera and Israel. — Avery Blank is joining Qualcomm's AI legal team as senior legal counsel. She was previously counsel for the Senate Homeland Security & Governmental Affairs Committee. — Mary Springer Sforza is now senior vice president of government relations for Rolls-Royce. She previously was director of legislative affairs at Lockheed Martin. New Joint Fundraisers None. New PACs Battleground Alliance PAC (Super PAC) Democratic Action Network (Hybrid PAC) LONE STAR PAC (Super PAC) PAC (Super PAC) NATIONAL OILSEED PROCESSORS ASSOCIATION PAC (NOPA PAC) (PAC) South Dakota Values PAC (Super PAC) A STRONG AMERICA PAC (Super PAC) New Lobbying REGISTRATIONS Banner Public Affairs, LLC: The P3I Group Batie & Associates, LLC: Franklin County Government - Ohio Bracewell LLP: Aquestive Therapeutics Cassidy & Associates, Inc.: Gfs LLC Cassidy & Associates, Inc.: Sacramento County Department Of Airports Db3, LLC (Fka The Daschle Group): Bwc Consulting (On Behalf Of Moca Financial, Inc.) Foley & Lardner LLP: Par Health USa, LLC Frontera Group: Crow Industries Fs Vector LLC: Smartcontract Inc. Fulcrum Public Affairs LLC: Reproductive Freedom For All Hall Booth Smith P.C.: Scout LLC Hance Scarborough: Packsize International, LLC Holly Strategies Incorporated: 202 Group Bluevoyant Mr. Michael R. Pawlowski: Capitol Counsel, LLC On Behalf Of Share Our Strength Ms. Amelia Kegan: C Street Navigators Global LLC (Formerly Dc Navigators, LLC): Csmi, LLC Navigators Global LLC (Formerly Dc Navigators, LLC): International Association Of Plumbing & Mechanical Officials Oculus Strategies, LLC: Quantum Knight Orica Australia Pty Ltd: Orica Australia Pty Ltd Policy Integration Partners, LLC: Ser Capital Polsinelli Pc: American Glaucoma Society Polsinelli Pc: Cerapedics, Inc. Polsinelli Pc: National Board For Health And Wellness Coaching Polsinelli Pc: Procept Biorobotics Polsinelli Pc: Sonex Health, Inc. Prime Policy Group: Bleu Garde Prime Policy Group: Kedrion Biopharma Sirona Strategies LLC: Remote Monitoring Leadership Council The Consilio Group: N Brereton Medical Technologies The Raben Group: Tides Network Think Policy Consulting, LLC: Todd Strategy Group: Bridgebio Pharma Todd Strategy Group: Vaxart Inc. New Lobbying Terminations Banner Public Affairs, LLC: Stakeholder Labs Blank Rome Government Relations: Delfin Midstream Inc. Blank Rome Government Relations: International Group Of P&I Clubs Blank Rome Government Relations: Municipality Of Anchorage Davenport Policy: Meridian Implementation Fund Federal Business Group: Nextgen Federal Systems Fs Vector LLC: Audenzia Advisors LLC Fs Vector LLC: Sf Operations, Inc Jtr Strategies LLC: Aero Technologies, Inc. Kilpatrick Townsend And Stockton: Danimer Scientific Kilpatrick Townsend And Stockton: Freeman Capital Kpmg LLP: Bristol Bay Economic Development Corporation Merchant Mcintyre & Associates, LLC: Citizens Medical Center Merchant Mcintyre & Associates, LLC: Jefferson Community Health & Life Merchant Mcintyre & Associates, LLC: Mcalester Regional Health Center Merchant Mcintyre & Associates, LLC: United Way Of Tarrant County Mwmurray Consulting LLC: Unicef USa Onmessage Public Strategies: The Hague Initiative For International Cooperation (Thinc.) Platinum Advisors Dc, LLC: Glydways, Inc Platinum Advisors Dc, LLC: Shaolin Capital Management, LLC Strategic Health Care: Paragonix Technologies Terrapin Strategy, Inc: Satoshi Action Fund


Fox News
2 hours ago
- Fox News
Fox News Poll: Trump facing headwinds at six-month mark
Six months into Donald Trump's second presidency, the political tea leaves are muddled. Voters disapprove of the job he is doing, dislike his new budget law, and doubt his dealings with Iran are making the U.S. safer. At the same time, ratings of the economy show signs of improvement, feelings on the direction of the country are inching upward, and the president's job approval ratings are holding steady, according to a new Fox News national survey. Thirty-two percent of voters rate economic conditions positively. That's the highest number, by one percentage point, in about a year. On a personal level, 44% rate their financial situation positively, up from 39% in March and 38% in December. Majorities continue to give the economy (67%) and their family finances (56%) negative ratings. While 71% say inflation caused them financial hardship in the last six months, that is the lowest number since 2021 – and down from a high of 78% in 2022. The hardship is widespread, as large shares of Democrats (79%), independents (74%), and Republicans (62%) say they feel it, as do those with yearly income both below $50,000 (81%) and $50,000 and higher (64%). Overall, 56% are dissatisfied with the direction the country is taking. The silver lining is that's an improvement: 68% were dissatisfied at the end of last year, and it was 66% last summer. On the other hand, 44% are happy with the way things are going. As is typical for the incumbent president's party, Republicans (77%) are much more likely than Democrats (15%) and independents (32%) to feel pleased. The president calls the budget legislation he recently signed into law "The One Big Beautiful Bill," but beauty is in the eye of the beholder. More disapprove (58%) than approve (39%) by 19 percentage points, and more than twice as many think the law will hurt rather than help their family. Opposition to the budget comes from a large majority of Democrats (89%), most independents (70%), and one in five Republicans (21%). Significant shares of Trump's base also oppose the bill, including 52% of rural voters, 46% of White men without a college degree, and 37% of White evangelical Christians. Topping the list of things in the law that voters dislike is increasing the debt ceiling (74%), as three-quarters disapprove. More than half also disapprove of reducing food stamp funding (65%), making tax cuts permanent for those with higher incomes (64%), increasing spending for immigrant detention centers (59%) and the border wall (55%), ending wind and solar tax credits (58%), and increasing work requirements for Medicaid (53%). Popular elements include removing taxes on tips (70% approve), making tax cuts permanent for those with yearly income of less than $250,000 (68%), and increasing military spending (61%). The survey reveals the greatest ideological agreement is on ending taxes on tips and making tax cuts to lower-income individuals permanent, as majorities of Democrats, Republicans, and independents approve -- as well as on increasing the debt limit, as majorities of each disapprove. Big picture: what message do voters want to give to the government? More than half, 52%, would say "lend me a hand." Forty-five percent would ask Washington to "leave me alone." The number of Democrats who would ask Uncle Sam to "lend me a hand" has declined 10 points compared to a year ago and stands at 58%. The opposite is true among Republicans, as a record high 48% would ask for a hand, up 16 points since 2024. "This is Trump's signature piece of legislation, and it is emblematic of why it's so hard for any Congress, but especially a Republican Congress, to get anything done these days," says Republican pollster Daron Shaw, who conducts Fox News surveys with Democrat Chris Anderson. "Many elements of the OBBB are popular, yet any spending cuts or anything that can be characterized as tax cuts for the rich craters support with Democrats and independents." Currently, 46% of voters approve of Trump's performance, while 54% disapprove. That's exactly where things stood last month, and better than at this point 8 years ago when 41% approved. Since last month, his approval mostly held firm with his strongest backers: it is up one point among Republicans (88%), down one point among 2024 Trump voters (90%), and down two points among MAGA supporters (96%). Trump gets his best marks on handling border security: 56% approve vs. 44% disapprove. Voters are more disapproving of the job he is doing on other top issues such as immigration (48% approve, 51% disapprove), foreign policy (45-54%), the economy (44-55%), and inflation and tariffs (36-62% on both). On foreign policy, attitudes on the U.S. decision to strike Iran's nuclear facilities are mixed. Voters are split over whether they approve or disapprove of launching the strikes (47% vs. 50%) and whether the strikes were mostly successful or mostly a failure (31% vs. 27%). The highest share, 42%, think it's too soon to say. Bottom line, 43% think Trump's dealings with Iran have made the U.S. less safe, which is 15 points higher than the 28% who say the country is safer. The survey finds 38% want the U.S. to do more for Ukraine, a 15-point jump since last fall, with increases among Democrats (+22 points), independents (+14), and Republicans (+9). By a 23-point margin, more voters think Russian President Vladimir Putin (58%) has the upper hand in the situation in Ukraine than Trump (35%). Republicans are more likely to say Trump (by 19 points), while Democrats (by 62 points) and independents (by 25 points) say Putin. Only 13% think the government has been open and transparent about the Jeffrey Epstein case, while more than five times as many, 67%, disagree – including 60% of Republicans and 56% of MAGA supporters. One voter in five says they haven't been following the case. A majority, 62%, don't think former President Joe Biden was particularly involved in making important decisions during the final year of his presidency, yet views are divided over investigating Biden's advisors for using an autopen to sign documents without his awareness. Fifty-one percent say investigate and 47% say it is time to move on. Among Democrats, 41% think Biden wasn't that involved in decisions and 30% support looking into the autopen. Forty-six percent of voters approve of the job Trump is doing as president. Why do they approve? The survey asks voters to explain in their own words what's behind their approval (or disapproval). Most were able to give specific answers, detailed below. The main reasons for approving of Trump's job performance are he's "getting things done" (18%), "keeping his promises" (14%), "helping the economy" (13%), immigration/border security (13%), and "putting America first" (12%). For those who disapprove, the top reasons are "the economy/tariffs" (14%), "doesn't have the temperament" (13%), "not following the Constitution" (10%), "separating families"/immigration (8%), "he favors the rich" (7%), generally disliking what he's doing (7%), and "too many government cuts" (6%). Only 1% mention "Jeffrey Epstein case," and all of that comes from Democrats and independents. A comparison with responses from when the same question was asked during Trump's first term provides insight into how his second term differs. In 2018, far more of those who approved of Trump's job performance cited that he was helping the economy (24% vs. 13% today). Among those who disapproved, many more were likely to mention personal characteristics and only small numbers mentioned immigration (4%) and the economy (3%). Conducted July 18-21, 2025, under the direction of Beacon Research (D) and Shaw & Company Research (R), this Fox News survey includes interviews with a sample of 1,000 registered voters randomly selected from a national voter file. Respondents spoke with live interviewers on landlines (114) and cellphones (636) or completed the survey online after receiving a text (250). Results based on the full sample have a margin of sampling error of ±3 percentage points. Sampling error for results among subgroups is higher. In addition to sampling error, question wording and order can influence results. Weights are generally applied to age, race, education, and area variables to ensure the demographics are representative of the registered voter population. Sources for developing weight targets include the American Community Survey, Fox News Voter Analysis, and voter file data.