Covid, for instance, is now linked in studies to possible autism in children of mothers who were infected during pregnancy, as well as a decline in mental cognition and greater risk of heart problems. It’s even been shown to trigger the awakening of dormant cancer cells in people who are in remission.  

Policies around covid and vaccination have economic ramifications. The annual average burden of the disease’s long-term health effects is estimated at $9,000 per patient in the U.S., according to a report published in November in the journal NPJ Primary Care Respiratory Medicine. In this country, the annual lost earnings are estimated to be about $170 billion. 

The virus that causes covid, SARS-CoV-2, leaves damage that can linger for months and sometimes years. In the brain, the virus leads to an immune response that triggers inflammation, can damage brain cells, and can even shrink brain volume, according to research on imaging studies published in March 2022 in the journal Nature.  

Ziyad Al-Aly, a clinical epidemiologist who has studied longer-term health effects from covid, estimated the virus may have increased the number of adults in the U.S. with an IQ less than 70 from 4.7 million to 7.5 million — a jump of 2.8 million adults dealing with “a level of cognitive impairment that requires significant societal support,” he wrote. 

Meanwhile, data from more than a dozen studies suggests covid vaccines can help reduce risk of severe infection as well as longer-lasting health effects, although researchers say more study is needed. But last May, Health and Human Services Secretary Robert F. Kennedy Jr. said on X that the Centers for Disease Control and Prevention would stop recommending covid shots for healthy children and pregnant women, citing a lack of clinical data. The FDA has since issued new guidelines limiting the vaccines to people 65 and older and individuals 6 months or older with at least one risk factor, though many states continue to make them more widely available. 

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Federal officials in May 2023 declared an end to the national covid pandemic. But more than two years later, a growing body of research continues to reveal information about the virus and its ability to cause harm long after initial infections resolve, even in some cases when symptoms were mild.

The discoveries raise fresh concerns about the Trump administration’s covid policies, researchers say. While some studies show covid vaccines offer protective benefits against longer-term health effects, the Department of Health and Human Services has drastically limited recommendations about who should get the shot. The administration also halted Biden-era contracts aimed at developing more protective covid vaccines.

The federal government is curtailing such efforts just as researchers call for more funding and, in some cases, long-term monitoring of people previously infected.

“People forget, but the legacy of covid is going to be long, and we are going to be learning about the chronic effects of the virus for some time to come,” said Michael Osterholm, an epidemiologist who directs the University of Minnesota’s Center for Infectious Disease Research and Policy.

The Trump administration said that the covid vaccine remains available and that individuals are encouraged to talk with their health providers about what is best for them. The covid vaccine and others on the schedule of the Centers for Disease Control and Prevention remain covered by insurance so that individuals don’t need to pay out-of-pocket, officials said.

“Updating CDC guidance and expanding shared clinical decision-making restores informed consent, centers parents and clinicians, and discourages ‘one size fits all’ policies,” said HHS spokesperson Emily Hilliard.

Although covid has become less deadly, because of population immunization and mutations making the virus less severe, researchers say the politicization around the infection is obscuring what science is increasingly confirming: covid’s potential to cause unexpected, possibly chronic health issues. That in turn, these scientists say, drives the need for more, rather than less, research, because over the long term, covid could have significant economic and societal implications, such as higher health care costs and more demands on social programs and caregivers.

The annual average burden of the disease’s long-term health effects is estimated at $1 trillion globally and $9,000 per patient in the U.S., according to a report published in November in the journal NPJ Primary Care Respiratory Medicine. In this country, the annual lost earnings are estimated to be about $170 billion.

One study estimates that the flu resulted in $16 billion in direct health costs and $13 billion in productivity losses in the 2023-2024 season, according to a Dec. 30 report in medRxiv, an online platform that publishes work not yet certified by peer review.

Covid’s Growing Reach

Much has been learned about covid since the virus emerged in 2019, unleashing a pandemic that the World Health Organization reports has killed more than 7 million people. By the spring of 2020, the term “long covid” had been coined to describe chronic health problems that can persist post-infection.

More recent studies show that infection by the virus that causes covid, SARS-CoV-2, can result in heightened health risks months to more than a year later.

For example, researchers following children born to mothers who contracted the virus while pregnant have discovered they may have an increased risk for autism, delayed speech and motor development, or other neurodevelopmental challenges.

Another study found babies exposed to covid in utero experienced accelerated weight gain in their first year, a possible harbinger of metabolic issues that could later carry an increased risk for cardiovascular disease.

These studies suggest avoiding severe covid in pregnancy may reduce risk not just during pregnancy but for future generations. That may be another good reason to get vaccinated when pregnant.

“There are other body symptoms apart from the developing fetal brain that also may be impacted,” said Andrea Edlow, an associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School who was involved in both studies. “We definitely need more research.”

Epidemiologists point to some specific, emerging challenges.

A U.K. study in the New England Journal of Medicine found people who fully recovered from mild covid infections experienced a cognitive deficit equal to a three-point drop in IQ. Among the more than 100,000 participants, deficits were greater in people who had persistent symptoms and reached the equivalent of a nine-point IQ drop for individuals admitted to intensive care.

Ziyad Al-Aly, a clinical epidemiologist who has studied longer-term health effects from covid, did the math. He estimated covid may have increased the number of adults in the U.S. with an IQ of less than 70 from 4.7 million to 7.5 million — a jump of 2.8 million adults dealing with “a level of cognitive impairment that requires significant societal support,” he wrote.

“People get covid-19, some people do fine and bounce back, but there are people who start experiencing problems with memory, cognition, and fuzzy brain,” he said. “Even people with mild symptoms. They might not even be aware.”

Diane Yormark, 67, of Boca Raton, Florida, can relate. She got covid in 2022 and 2023. The second infection left her with brain fog and fatigue.

“I felt like if you had a little bit too much wine the night before and you’re out of it,” said Yormark, a retired copywriter, who said the worst of her symptoms lasted for about three months after the infection. “Some of the fog has lifted. But do I feel like myself? Not like I was.”

Data from more than a dozen studies suggests covid vaccines can help reduce risk of severe infection as well as longer-lasting health effects, although researchers say more study is needed.

But vaccination rates remain low in the U.S., with only about 17% of the adult population reporting that they got the updated 2025-2026 shot as of Jan. 16, based on CDC data.

Trump administration officials led by Health and Human Services Secretary Robert F. Kennedy Jr. have reduced access to covid vaccines despite the lack of any new, substantiated evidence of harm. Though the shots were a hallmark achievement of the first Trump administration, which led the effort for their development, Kennedy has said without evidence that they are “the deadliest vaccine ever made.”

In May he said on X that the CDC would stop recommending covid shots for healthy children and pregnant women, citing a lack of clinical data. The Food and Drug Administration has since issued new guidelines limiting the vaccine to people 65 or older and individuals 6 months or older with at least one risk factor, though many states continue to make them more widely available.

The Trump administration also halted almost $500 million in funding for mRNA-based vaccines. Administration officials and a number of Republicans question the safety of the Nobel Prize-winning technology — heralded for the potential to treat many diseases beyond covid — even though clinical trials with tens of thousands of volunteers were performed before the covid mRNA vaccines were made available to the public.

And numerous studies, including new research in 2025, show covid vaccine benefits include a reduction in the severity of disease, although the protective effects wane over time.

Following the Findings

Researchers say more and broader support is important because much remains unknown about covid and its impact on the body.

The growing awareness that, even in mild covid cases, the possibility exists for longer-term, often undetected organ damage also warrants more examination, researchers say. A study published this month in eBioMedicine found people with neurocognitive issues such as changes in smell or headaches after infection had significant levels of a protein linked to Alzheimer’s in their blood plasma. EBioMedicine is a peer-reviewed, open-access journal published by The Lancet.

In the brain, the virus leads to an immune response that triggers inflammation, can damage brain cells, and can even shrink brain volume, according to research on imaging studies that was published in March 2022 in the journal Nature.

An Australian study of advanced brain images found significant alterations even among people who had already recovered from mild infections — a possible explanation for cognitive deficits that may persist for years. Lead study author Kiran Thapaliya said the research suggests the virus “may leave a silent, lasting effect on brain health.”

Al-Alay agreed.

“We don’t know what will happen to people 10 years down the road,” he said. “Inflammation of the brain is not a good thing. It’s absolutely not a good thing.”

That inflammatory response has also been linked to blood clots, arrhythmias, and higher risk of cardiovascular issues, even following a mild infection.

A University of Southern California study published in October 2024 in the journal Arteriosclerosis, Thrombosis, and Vascular Biology found the risk for a major cardiac event remains elevated nearly three years after covid infection. The findings held even for people who were not hospitalized.

“We were surprised to see the effects that far out” regardless of individual heart disease history, said James R. Hilser, the study’s lead author and a postdoctoral fellow at the UCLA David Geffen School of Medicine.

Covid can also reactivate cancer cells and trigger a relapse, according to research published in July in the journal Nature. Researchers found that the chance of dying from cancer among cancer survivors was higher among people who’d had covid, especially in the year after being infected. There was nearly a twofold increase in cancer mortality in those who tested positive compared with those who tested negative.

The potential of the covid virus to affect future generations is yielding new findings as well. Australian researchers looked at male mice and found that those who had been infected with and then recovered from covid experienced changes to their sperm that altered their offspring’s behavior, causing them to exhibit more anxiety.

Meanwhile, many people are now living — and struggling — with the virus’ after-effects.

Dee Farrand, 57, of Marana, Arizona, could once run five miles and was excelling at her job in sales. She recovered from a covid infection in May 2021.

Two months later, her heart began to beat irregularly. Farrand underwent a battery of tests at a hospital. Ultimately, the condition became so severe she had to go on supplemental oxygen for two years.

Her cognitive abilities declined so severely she couldn’t read, because she’d forget the first sentence after reading the second. She also had to leave herself reminders that she is allergic to shrimp or that she likes avocados. She said she lost her job and returned to her previous occupation as a social worker.

“I was the person who is like the Energizer bunny and all of a sudden I’d get so tired getting dressed that I had to go back to bed,” Farrand said.

While she is better, covid has left a mark. She said she’s not yet able to run the five miles she used to do without any problems.

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En mayo de 2023, funcionarios federales declararon el fin de la pandemia nacional de covid. Pero más de dos años después, un número creciente de investigaciones sigue revelando información sobre el virus y su capacidad de causar daño mucho tiempo después de que se resuelve la infección inicial, incluso en algunos casos en los que los síntomas fueron leves.

Estos hallazgos generan nuevas preocupaciones sobre las políticas relacionadas con covid durante la administración Trump, según investigadores.

Aunque algunos estudios muestran que las vacunas contra covid ofrecen beneficios protectores frente a efectos a largo plazo en la salud, el Departamento de Salud y Servicios Humanos (HHS, por sus siglas en inglés) ha limitado drásticamente las recomendaciones sobre quiénes deben vacunarse.

Además, la administración frenó contratos impulsados durante el gobierno de Joe Biden que buscaban desarrollar vacunas contra covid más protectoras.

El gobierno federal está reduciendo estos esfuerzos justo cuando investigadores piden más fondos y, en algunos casos, seguimiento a largo plazo de personas previamente infectadas.

“La gente lo olvida, pero el legado de covid será duradero, y estaremos aprendiendo sobre sus efectos crónicos por mucho tiempo”, dijo el epidemiólogo Michael Osterholm, director del Centro de Investigación y Política de Enfermedades Infecciosas de la Universidad de Minnesota.

La administración Trump afirmó que la vacuna contra covid sigue estando disponible y que se alienta a las personas a hablar con sus proveedores de salud sobre lo que es mejor para ellas.

La vacuna contra covid y otras del calendario de vacunación de los Centros para el Control y la Prevención de Enfermedades (CDC,por sus siglas en inglés) siguen estando cubiertas por los seguros, de modo que no es necesario pagar del propio bolsillo, indicaron funcionarios.

“Actualizar la guía de los CDC y ampliar la toma de decisiones clínicas compartidas restaura el consentimiento informado, da protagonismo a padres y proveedores de salud, y desalienta políticas ‘iguales para todos’”, dijo Emily Hilliard, vocera del HHS.

Aunque covid se ha vuelto menos letal, debido a la inmunización de la población y a mutaciones que han debilitado al virus, investigadores señalan que la politización en torno a la infección está oscureciendo lo que la ciencia confirma cada vez más: el potencial de covid de causar problemas de salud inesperados y posiblemente crónicos.

Esto, a su vez, según los científicos, impulsa la necesidad de más investigación, no menos, ya que a largo plazo covid podría tener importantes consecuencias económicas y sociales, como mayores costos en el sistema de salud y más demandas sobre programas sociales y personas cuidadoras.

El impacto económico promedio anual de los efectos prolongados de covid se estima en $1.000 millones a nivel global y $9.000 por paciente en Estados Unidos, según un informe publicado en noviembre en la revista NPJ Primary Care Respiratory Medicine. En este país, las pérdidas anuales por ingresos no percibidos se calculan en unos $170.000 millones.

Un estudio estima que la gripe generó $16.000 millones en costos directos de salud y $13.000 millones en pérdidas de productividad durante la temporada 2023-2024, según un informe del 30 de diciembre publicado en medRxiv, una plataforma en línea que difunde trabajos aún no revisados por colegas.

El alcance creciente de covid

Desde que surgió en 2019, desatando una pandemia que, según la Organización Mundial de la Salud, ha causado la muerte de más de 7 millones de personas, se ha aprendido mucho sobre covid. Para la primavera de 2020, ya se usaba el término “covid prolongado” para describir problemas de salud crónicos que pueden persistir tras la infección.

Estudios más recientes muestran que la infección por el virus que causa el covid, el SARS-CoV-2, puede generar riesgos elevados para la salud desde varios meses hasta más de un año después.

Por ejemplo, investigadores que han seguido a niños nacidos de madres que contrajeron el virus durante el embarazo han descubierto que podrían tener mayor riesgo de autismo, retrasos en el habla y el desarrollo motor, u otros desafíos del neurodesarrollo.

Otro estudio halló que los bebés expuestos a covid en el útero experimentaron un aumento de peso acelerado durante su primer año de vida, lo cual podría ser un indicador temprano de problemas metabólicos y un mayor riesgo de enfermedades cardiovasculares en el futuro.

Estos estudios sugieren que evitar una infección grave por covid durante el embarazo puede reducir riesgos no solo durante la gestación, sino también para futuras generaciones. Eso podría ser otra buena razón para vacunarse durante el embarazo.

“Hay otros sistemas del cuerpo, además del cerebro fetal en desarrollo, que también pueden verse afectados”, dijo Andrea Edlow, profesora asociada de obstetricia, ginecología y biología reproductiva en la Facultad de Medicina de Harvard, quien participó en ambos estudios. “Definitivamente necesitamos más investigación”.

Los epidemiólogos señalan algunos desafíos emergentes específicos.

Un estudio del Reino Unido publicado en la revista New England Journal of Medicine encontró que personas que se habían recuperado por completo de infecciones leves de covid presentaban un déficit cognitivo equivalente a una disminución de tres puntos en el coeficiente intelectual. Entre los más de 100.000 participantes, estos problemas fueron mayores en quienes tenían síntomas persistentes, llegando a una caída de nueve puntos en quienes fueron hospitalizados en cuidados intensivos.

Ziyad Al-Aly, epidemiólogo clínico que ha estudiado los efectos a largo plazo de covid, hizo cálculos y estimó que el virus pudo haber aumentado el número de adultos con un coeficiente intelectual menor a 70 en Estados Unidos de 4,7 millones a 7,5 millones, es decir, un incremento de 2,8 millones de personas con un nivel de deterioro cognitivo que requiere apoyo social significativo, escribió.

“La gente se contagia y desarrolla covid-19, algunas personas se recuperan bien, pero otras empiezan a tener problemas de memoria, concentración o confusión mental”, dijo. “Incluso personas con síntomas leves. Puede que ni siquiera se den cuenta”.

Diane Yormark, de 67 años, residente de Boca Raton, Florida, lo entiende bien. Tuvo covid en 2022 y en 2023. La segunda vez, le quedaron secuelas como fatiga y una mente nublada.

“Me sentía como cuando tomas un poco más de vino de la cuenta la noche anterior y no estás del todo bien”, dijo Yormark, redactora publicitaria retirada, quien afirmó que los peores síntomas duraron unos tres meses tras la infección. “Algo de la mente nublada ha desaparecido. ¿Pero me siento como antes? No como era yo”.

Datos de más de una docena de estudios sugieren que las vacunas contra covid pueden ayudar a reducir el riesgo de infecciones graves, así como efectos de salud a largo plazo, aunque los investigadores indican que se necesitan más estudios.

Pero las tasas de vacunación siguen siendo bajas en Estados Unidos: solo alrededor del 17% de la población adulta reportó haberse aplicado la dosis actualizada para 2025-2026, según datos de los CDC al 16 de enero.

Funcionarios de la administración Trump, encabezados por el secretario de Salud y Servicios Humanos Robert F. Kennedy Jr., han reducido el acceso a las vacunas contra covid a pesar de la falta de evidencia nueva que respalde posibles daños. Aunque las vacunas fueron uno de los logros clave de la primera administración Trump, que lideró su desarrollo, Kennedy ha afirmado sin pruebas que son “la vacuna más mortal jamás creada”.

En mayo, escribió en X (antes Twitter) que los CDC dejarían de recomendar la vacuna contra covid para niños sanos y mujeres embarazadas, citando la falta de datos clínicos. Desde entonces, la Administración de Alimentos y Medicamentos (FDA, por sus siglas en inglés) emitió nuevas directrices que limitan la vacuna a personas de 65 años o más y a individuos de 6 meses o más con al menos un factor de riesgo, aunque muchos estados siguen ofreciéndola de manera más amplia.

La administración Trump también detuvo casi $500 millones en fondos destinados a vacunas basadas en ARNm. Funcionarios y algunos legisladores republicanos han cuestionado la seguridad de esta tecnología, que ha sido reconocida con el Premio Nobel por su potencial para tratar diversas enfermedades más allá de covid, aunque se realizaron ensayos clínicos con decenas de miles de voluntarios antes de que las vacunas de ARNm estuvieran disponibles para el público.

Numerosos estudios, incluidos algunos nuevos de 2025, muestran que los beneficios de la vacuna contra covid incluyen la reducción de la gravedad de la enfermedad, aunque su protección disminuye con el tiempo.

Seguir los hallazgos

Investigadores afirman que se necesita más apoyo —y de mayor alcance— porque todavía hay mucho que no se sabe sobre covid y su impacto en el cuerpo.

La creciente conciencia de que, incluso en casos leves, existe la posibilidad de daño de órganos a largo plazo y muchas veces no detectado, también justifica una mayor investigación, según especialistas.

Un estudio publicado este mes en eBioMedicine halló que personas con problemas neurocognitivos —como cambios en el olfato o dolores de cabeza después de la infección— tenían niveles significativos de una proteína vinculada al Alzheimer en el plasma sanguíneo. eBioMedicine es una revista de acceso abierto, revisada por colegas, publicada por The Lancet.

En el cerebro, el virus provoca una respuesta inmunitaria que genera inflamación, puede dañar células cerebrales e incluso reducir el volumen cerebral, según una investigación con estudios por imágenes publicada en marzo de 2022 en la revista Nature.

Un estudio australiano con imágenes cerebrales avanzadas encontró alteraciones significativas incluso en personas que ya se habían recuperado de infecciones leves, lo cual podría explicar déficits cognitivos que persisten durante años. El autor principal del estudio, Kiran Thapaliya, señaló que la investigación sugiere que el virus “podría dejar un efecto silencioso y duradero en la salud cerebral”.

Al-Aly estuvo de acuerdo.

“No sabemos qué pasará con estas personas dentro de 10 años”, dijo. “La inflamación del cerebro no es algo bueno. Definitivamente no lo es”.

Esa respuesta inflamatoria también se ha vinculado con coágulos sanguíneos, arritmias y mayor riesgo de problemas cardiovasculares, incluso después de una infección leve.

Un estudio de la Universidad del Sur de California, publicado en octubre de 2024 en la revista Arteriosclerosis, Thrombosis, and Vascular Biology, encontró que el riesgo de sufrir un evento cardíaco importante sigue siendo elevado casi tres años después de una infección por covid. Estos resultados se observaron incluso en personas que no fueron hospitalizadas.

“Nos sorprendió ver efectos tanto tiempo después”, dijo James R. Hilser, autor principal del estudio y becario postdoctoral en la Facultad de Medicina David Geffen de la UCLA. “Independientemente del historial individual de enfermedades cardíacas”.

El covid también puede reactivar células cancerígenas y provocar una recaída, según una investigación publicada en julio en la revista Nature.

Los investigadores encontraron que el riesgo de morir de cáncer entre sobrevivientes de esta enfermedad era mayor en personas que habían tenido covid, especialmente durante el año posterior a la infección. La mortalidad por cáncer casi se duplicó en quienes dieron positivo, en comparación con quienes dieron negativo.

También se están descubriendo nuevos hallazgos sobre el potencial del virus para afectar a generaciones futuras. Investigadores australianos estudiaron ratones machos y descubrieron que aquellos que se infectaron y luego se recuperaron de covid presentaban cambios en su esperma que alteraron el comportamiento de su descendencia, haciéndola más propensa a la ansiedad.

Mientras tanto, muchas personas viven —y luchan— contra las secuelas del virus.

Dee Farrand, de 57 años, residente de Marana, Arizona, solía correr cinco millas y le iba muy bien en su trabajo en ventas. Se recuperó de una infección por covid en mayo de 2021.

Dos meses después, su corazón comenzó a latir de forma irregular. Farrand se sometió a una batería de pruebas en un hospital. Finalmente, su condición empeoró tanto que necesitó oxígeno suplementario durante dos años.

Su capacidad cognitiva disminuyó tanto que no podía leer, porque olvidaba la primera oración después de leer la segunda. También debía dejarse recordatorios de que es alérgica a los camarones o que le gustan los aguacates. Dijo que perdió su empleo y regresó a su ocupación anterior como trabajadora social.

“Yo era como el conejito de las baterías y, de repente, me cansaba tanto al vestirme que tenía que volver a la cama”, dijo Farrand.

Aunque ha mejorado, covid dejó una huella. Dijo que todavía no puede volver a correr las cinco millas que antes hacía sin dificultad.

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At the same time, congressional Republicans are eyeing health issues from the “Make America Healthy Again” perspective, hoping it will provide a boost in the midterm elections. 

Here’s why. 

Republicans see the MAHA constituency as critical in the midterms and beyond because its supporters include desirable voting demographics: independents and some Democrats, many of whom are women, younger voters, or suburbanites. 

The strategy risks backfiring, though, because polls show voters care more about reducing health care costs than about MAHA’s war on junk food or efforts to roll back access to vaccines. The affordability issue was thrust center stage last year when enhanced subsidies for Affordable Care Act marketplace plans expired. 

As a result, many of the roughly 23 million people who buy coverage on the health law’s marketplaces are now facing premium payments more than double what they faced last year. Congress is continuing to wrestle with what has emerged as a key kitchen table issue. 

Democrats are strategizing about how to use public support for MAHA priorities to their own advantage. They’re hoping to expose GOP policies that run counter to MAHA priorities; trumpet Democrats’ efforts to tackle health care costs; and highlight their own party’s work on such MAHA goals as cracking down on pesticide-makers, according to some Democratic strategists. 

Democrats are talking about their continuing fight to address health care costs while largely avoiding direct attacks on Health and Human Services Secretary Robert F. Kennedy Jr. or MAHA, because the movement resonates with the public. Meanwhile, cracks are starting to threaten the Make America Great Again coalition and the lockstep support Trump has enjoyed from Capitol Hill Republicans. 

For Republicans, the next batch of MAHA events and summits is already scheduled. After taking a political back seat in recent years, health care may dominate the 2026 election races.

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The daylong, invitation-only event in November featured a who’s who of MAHA luminaries. Vice President JD Vance attended, as did Health and Human Services Secretary Robert F. Kennedy Jr., the leader of the ad hoc movement whose members rail against vaccines, Big Pharma, and ultraprocessed food.

During a fireside chat that organizers broadcasted online, Vance extolled MAHA’s impact on the Trump administration, calling it “a critical part of our success in Washington.”

The summit underscored just how closely Republicans have hitched themselves to the MAHA campaign, banking on its popularity to give them an electoral bounce in the midterms. But the strategy carries risks, because support for Kennedy is cratering and polls show voters care more about reducing health care costs than MAHA priorities such as ending vaccine mandates and promoting raw milk.

“Polls show clearly MAHA issues are not the top issues for people,” said Robert Blendon, a professor emeritus of health policy and political analysis at Harvard University. “The top health care voting issue is cost, and costs are actually rising.”

The disconnect was on display Nov. 12, the day of the MAHA summit, where attendees picked up swag bags and mingled amid the hotel’s blue-velvet couches and crystal chandeliers.

A few blocks away at the White House, President Donald Trump that day signed legislation to reopen the federal government. The 43-day shutdown centered on disagreement over expiring Affordable Care Act subsidies, which Democrats wanted to extend and GOP congressional leadership declined to take up. The government went back to business and, in the midst of a political and legislative push and pull, those subsidies expired at the end of 2025. That has fueled the national affordability debate, as many of the roughly 24 million people who buy coverage on the health law’s marketplaces are now facing premium payments more than double what they faced last year. In January, Congress continues to wrestle with what has emerged as a key kitchen table issue.

Said Blendon: “MAHA is not lowering the cost.”

MAHA was mainstreamed as part of the political platform embraced by Kennedy, an environmental lawyer and anti-vaccine activist who ran for president in 2023 and 2024. When he suspended his campaign and endorsed Trump, Kennedy united MAHA with conservatives, marrying the “health freedom” movement with MAGA.

But the movement took root before then, during the covid pandemic, grounded in the idea that the U.S. is in the throes of a chronic disease epidemic caused by corruption in the food, medical, and pharmaceutical industries, as well as federal agencies. Some adherents also are skeptical of or opposed to vaccines.

“Covid was really eye-opening for people,” said Andrea Nazarenko, a psychologist and MAHA supporter who co-authored a book on food as medicine. “They realized, ‘Wait a minute — the systems I trusted may not be as trustworthy as I thought.’ At its core, people are noticing the systems they relied on are failing them.”

MAHA has since emerged as an influential force for the GOP, gaining significant clout in a short time. Case in point: Early this month, Kennedy announced new dietary guidelines and updated childhood vaccine recommendations, which were both part of the movement’s wish list and departures from existing frameworks.

In addition, members of Congress have founded a MAHA caucus. Lawmakers in Republican-led states are introducing or passing legislation to advance the MAHA agenda, including laws to restrict mRNA vaccines or ban certain additives in food. And food manufacturers including Nestle, General Mills, and Kraft Heinz have pledged to remove artificial dyes or additives.

Republicans see the MAHA constituency as critical in the 2026 midterm elections and beyond. Its supporters include desirable voting demographics — independents and some Democrats, many of whom are women, younger voters, or suburbanites. About 21% of independent voters and 8% of Democratic voters held a favorable or somewhat favorable view of MAHA as of early fall, according to a poll by Change Research.

“I think one reason I won reelection was that I advocated for the covid-vaccine-injured and was an ally of Bobby Kennedy back then when he was being vilified,” Sen. Ron Johnson (R-Wis.) said. “People appreciated that. It’s about basic health.”

Republicans are counting on a MAHA bounce, and political analysts say they may need it. The party took a drubbing in November’s statewide races, and Trump’s approval rating has slumped from 47% in early 2025 to 36% by December, according to Gallup polls. Those are ominous trends for the GOP, since the party with the presidency has lost ground in 20 of the past 22 midterm House elections.

Meanwhile, cracks are starting to threaten the Make America Great Again coalition and the lockstep support Trump has enjoyed from Capitol Hill Republicans. While MAGA shows signs of weakening, MAHA is flourishing.

“Kennedy has ratified the Republican agenda around health and food,” said David Mansdoerfer, who served in HHS leadership during the first Trump administration. “We sound very much like the issues Democrats were into in the 1990s and 2000s. We’ve almost done a 180 and co-opted a topic under a Republican agenda.”

Kennedy is expected to soon check another item off MAHA’s list by pressing states to remove fluoride from the water supply, according to a source who asked to remain anonymous because he isn’t authorized to speak to the media.

But Republicans’ embrace of MAHA in the run-up to the November midterm elections could also cost them, political strategists say.

Polling shows popular support for MAHA initiatives such as ridding food of synthetic dyes, but voters are far less enthusiastic about Kennedy and his denouncements of vaccines and efforts to limit access to them. Almost 60% of adults disapprove of his work as head of HHS, according to polling released in October by KFF, a health information nonprofit that includes KFF Health News.

And only 26% of registered voters support defunding mRNA vaccine research, according to a September survey by left-leaning pollster Navigator Research. In the same poll, 3 in 4 reported feeling positively toward the measles vaccine.

Still, the Trump administration has broadened and accelerated its attack on vaccines. The Food and Drug Administration’s top vaccine official in November said in a memo that the agency would overhaul vaccine regulation, asserting without evidence that at least 10 children had died from covid shots.

In December, a federal vaccine advisory panel handpicked by Kennedy voted to stop recommending routine vaccination of newborns against hepatitis B. Medical groups denounced the panel’s actions, saying the vaccine is safe and that the recommendation would lead to more infections with the virus, which causes serious liver damage.

Democrats see an opening. The Democratic Doctors Caucus, a group of medical doctors in Congress, issued a statement condemning the federal advisory panel’s changed recommendation on the hepatitis B vaccine, calling it an attack on basic science. And Democratic Reps. Frank Pallone of New Jersey, Diana DeGette of Colorado, and Yvette Clarke of New York wrote to the FDA commissioner demanding data from the agency on the covid death claims.

Highlighting the risks of the Trump administration’s anti-vaccine initiatives is only part of Democrats’ game plan to counter Republicans’ alliance with MAHA.

Strategists describe three aims: Expose GOP policies that run counter to MAHA priorities; trumpet Democrats’ efforts to tackle health care costs; and highlight their own party’s work on such MAHA goals as cracking down on pesticide-makers.

“If people want to be healthier, they need affordable health care, and Democrats are the only ones pushing for affordable health care,” said C.J. Warnke, communications director for the House Majority PAC, a fundraising group that works to elect more Democrats.

Most notably, the strategy so far hasn’t really involved attacks on Kennedy or MAHA itself.

“If Democrats focus on attacking Kennedy, saying he’s crazy and he has a brain worm, some voters hear that as reinforcing the notion that Democrats are wedded to Big Pharma and Big Ag,” said Justin Zorn, a senior adviser at the Center for Economic and Policy Research, a progressive nonprofit focused on economic policy.

So Democrats will talk about their continuing fight to address health care costs, such as with a possible retroactive fix to the now-expired ACA subsidies, or a bill by Sen. Cory Booker (D-N.J.) to prevent pesticide manufacturers from getting legal immunity against health claims. And they plan to discuss Trump administration actions that seemingly run counter to the MAHA agenda, such as a decision by the Environmental Protection Agency to relax the health assessments of the carcinogen formaldehyde.

“Everything they’re doing actually makes people sicker with higher bills, dirtier air, and fewer people covered with insurance,” said Jesse Ferguson, a Democratic strategist. “Democrats do need to take MAHA seriously and can’t brush it off. The core is to show Democrats are focused on health and health care and exposing what the Republican agenda means.”

For Republicans, the next batch of MAHA events and summits is already scheduled. After taking a political back seat in recent years, health care may dominate the 2026 election races.

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“Este país quiere que seamos máquinas de parir, pero están recortando los pocos recursos que existen”, dijo Olcott, de 20 años. “¿Y un bono de $1.000 por tener un bebé? ‘¿De verdad?’  Eso ni siquiera cubre un mes de renta”.

El gobierno quiere que los estadounidenses tengan más hijos y está impulsando políticas públicas para revertir la caída en la tasa de natalidad en el país.

A mediados de octubre, la Casa Blanca presentó un plan para ampliar el acceso a tratamientos de fertilización in vitro. El presidente  Trump ha promocionado estas iniciativas, y se ha llamado a sí mismo “el presidente de la fertilización”.

Sin embargo, grupos de derechos reproductivos y otras organizaciones de defensa afirman que estos esfuerzos por aumentar la natalidad no compensan el rumbo general del gobierno, que apunta a recortar planes federales como Medicaid, el Programa de Seguro de Salud Infantil (CHIP) y otras iniciativas que apoyan a mujeres y niños.

Según estos grupos, el enfoque “pro familia” no se limita a fomentar que las personas tengan más hijos. Más bien, afirman, ese discurso se está utilizando como herramienta para impulsar una agenda conservadora que amenaza la salud de las mujeres, los derechos reproductivos y la participación femenina en el mercado laboral.

Algunos expertos pronostican que estas políticas podrían desalentar la maternidad y aumentar la mortalidad materna.

“La derecha religiosa quiere más bebés blancos cristianos y está tratando de restringir la libertad reproductiva de las mujeres para lograrlo”, dijo Marian Starkey, vocera de Population Connection, una organización sin fines de lucro que promueve la estabilización demográfica mediante el acceso a anticonceptivos y el aborto. “El verdadero peligro es el recorte constante de los derechos reproductivos”, afirmó.

La Casa Blanca no respondió a múltiples solicitudes de entrevista.

Un paquete de programas federales que por años han apoyado a mujeres y niños también está en la mira de Trump y de miembros de su gabinete, que dicen impulsar políticas pro natalidad.

Por ejemplo, los requisitos laborales para acceder a Medicaid, establecidos por la ley de presupuesto de los republicanos, One Big Beautiful Bill Act, aprobada en julio, exigirán más trámites y más requisitos que, según la Oficina de Presupuesto del Congreso, harán que millones de beneficiarios que ahora califican pierdan su cobertura. Medicaid cubre más del 40% de los nacimientos.

Esa misma ley también recorta fondos federales para un programa nacional que proporciona beneficios mensuales en alimentos. Casi el 40% de quienes recibieron esa ayuda en el año fiscal 2023 fueron niños.

Los recortes presupuestarios y el congelamiento de contrataciones promovidos por los republicanos han afectado al programa Head Start, una iniciativa educativa federal que ofrece guardería y preescolar a niños pequeños de familias de bajos ingresos, en momentos en que adultos en todo el país piden al gobierno que reduzca los crecientes costos del cuidado infantil.

Además, los republicanos suspendieron por un año el financiamiento de Medicaid para Planned Parenthood of America debido a que ofrece servicios de aborto, lo que obligó al cierre de unas 50 clínicas en todo el país desde comienzos de 2025.

Planned Parenthood brinda una amplia gama de servicios de salud para mujeres, que incluyen exámenes médicos generales, pruebas para detección de cáncer de mama y atención prenatal inicial.

Grupos que abogan por la salud y los derechos reproductivos de las mujeres sostienen que las acciones de la administración y del Congreso republicano están dificultando que las familias accedan al apoyo y atención médica que necesitan.

“Se habla mucho sobre quiénes ‘merecen’ recibir asistencia pública y, para muchos legisladores, no son las madres solteras”, señaló Allyson Crays, analista en derecho y políticas de salud pública de la Escuela de Salud Pública del Instituto Milken de la Universidad George Washington.

La perspectiva pro natalidad, en general, promueve que el gobierno intervenga para fomentar la procreación, a partir de la creencia de que la cultura moderna ha dejado de valorar la célula familiar. Sus defensores también afirman que estas políticas son necesarias desde el punto de vista económico.

Menos nacimientos

La tasa de natalidad nacional ha mostrado una tendencia en baja desde 2007.

Entre 2015 y 2020, el número de nacimientos disminuyó en promedio un 2% anual, según los Centros para el Control y Prevención de Enfermedades (CDC, por sus siglas en inglés), aunque desde entonces hubo fluctuaciones.

Las ideas centrales de este movimiento están plasmadas en el Proyecto 2025, una iniciativa política liderada por la organización conservadora Heritage Foundation, cuyas propuestas han sido adoptadas en gran parte por el gobierno de Trump. El documento afirma que los niños se desarrollan mejor en un “matrimonio heterosexual y estable”.

“Los hombres y mujeres casados representan la estructura familiar ideal y natural, porque todos los niños tienen derecho a ser criados por el hombre y la mujer que los concibieron”, indica el texto

El Proyecto 2025 también propone medidas que, según los críticos, son perjudiciales para la salud de las mujeres. Por ejemplo, busca eliminar el acceso a la mifepristona, un medicamento utilizado habitualmente tanto para realizar abortos como para el manejo de abortos espontáneos. También alienta a los estados a impedir que clínicas de Planned Parenthood reciban fondos de Medicaid.

El lema “más bebés” se ha adoptado en los más altos niveles del gobierno federal. “No recuerdo otra administración tan alineada con el movimiento pro natalidad”, dijo Brian Dixon, vicepresidente senior de asuntos gubernamentales y políticos de Population Connection.

Días después de asumir el cargo, el vicepresidente JD Vance declaró: “Quiero más bebés en Estados Unidos”. También ha criticado las decisiones de hombres y mujeres que han optado por no tener hijos.

En octubre, la Casa Blanca anunció descuentos en ciertos medicamentos utilizados en tratamientos de fertilización in vitro a través de TrumpRx.gov, un sitio web del gobierno, aún no lanzado, que busca conectar a los consumidores con medicamentos a más bajo precio.

Mehmet Oz, actual director de Medicare y Medicaid, celebró la posible llegada de “bebés Trump” gracias a los fármacos de fertilidad más baratos.

La administración también anunció que animaría a los empleadores a ofrecer beneficios en las prestaciones por fertilidad como una opción independiente en la que los empleados puedan inscribirse.

Pero esa medida está lejos de la promesa anterior de Trump de hacer que los tratamientos de fertilización sean gratuitos y puede que no sea suficiente para contrarrestar otras preocupaciones financieras a largo plazo que a menudo influyen en la decisión de tener hijos.

Angel Albring, quien tiene seis hijos, dice que su sueño de tener una familia numerosa siempre dependió de poder trabajar y evitar los costos del cuidado de los niños. Su carrera como escritora freelance le permitió contribuir al ingreso familiar trabajando durante las siestas de sus hijos o por la noche, cuando el resto de la familia dormía.

“La frase ‘duerme cuando el bebé duerma’ nunca aplicó en mi caso”, comentó.

Pero dijo que algunas de sus amigas no tienen esa misma suerte. Temen no poder tener hijos por el alto costo del cuidado, además de los alimentos y de la vivienda.

Mientras tanto, la administración Trump ha impulsado otra política que busca dar a los pequeños un respaldo financiero futuro.

La ley de presupuesto creó una “Cuenta Trump”, financiada inicialmente con $1.000 del gobierno federal —lo que se conoce popularmente como “bono por bebé”— para cada niño estadounidense que cumpla con los requisitos.

Los primeros depósitos están previstos para 2026, y el gobierno abrirá automáticamente una cuenta para niños nacidos entre el 1 de enero de 2025 y el 31 de diciembre de 2028.

Los padres podrán aportar hasta $5.000 anuales a la cuenta y los empleadores hasta $2.500. Se prevé que estas cuentas funcionen como un ahorro a largo plazo, con restricciones para retirar los fondos antes de que el niño cumpla 18 años. Después de eso, se convertirían probablemente en cuentas de jubilación tipo IRA.

Esta tendencia pro natalidad también ha llegado a otras agencias del gobierno federal.

El secretario de Transporte, Sean Duffy —padre de nueve hijos—, ordenó a su departamento priorizar fondos federales para comunidades con altas tasas de matrimonios y nacimientos, aunque aún no se han anunciado proyectos directamente vinculados a la iniciativa. Durante un tiempo, la administración incluso consideró entregar medallas nacionales a madres con seis o más hijos.

Sin embargo, hay un problema: los datos indican que las políticas y programas propuestos por el gobierno de Trump no necesariamente funcionarán.

Otros países han implementado planes más sólidos para fomentar la natalidad y apoyar la crianza, sin lograr que suban sus tasas de nacimientos, explicó Michael Geruso, economista de la Universidad de Texas-Austin, quien es partidario de que crezca la población global.

Por ejemplo, Israel ha ofrecido tratamientos gratuitos de fertilización in vitro por casi tres décadas, y aun así su tasa de natalidad se ha mantenido estancada, con menos de tres hijos por mujer, explicó Geruso.

Francia y Suecia tienen redes de apoyo social para familias muy extendidas —incluyendo licencias de maternidad y paternidad pagas, así como cuidado infantil y atención de la salud subsidiados—, pero sus tasas de natalidad también están disminuyendo, señaló Peggy O’Donnell Heffington, profesora adjunta de Historia en la Universidad de Chicago y autora de un libro sobre la decisión de no ser madre.

“Nadie ha descubierto aún cómo evitar que la población siga disminuyendo”, explicó Geruso.

Algunos proponen una solución distinta para revertir la caída poblacional en el país: aumentar la inmigración para asegurar una fuerza laboral joven y una base tributaria más sólida.

Sin embargo, la administración Trump está haciendo lo contrario, revocando visas y creando un ambiente en el que incluso los inmigrantes que están legalmente en el país se sienten cada vez más inseguros.

En 2025, la población inmigrante del país cayó por primera vez desde la década de 1960, según un análisis del Pew Research Center.

Mientras tanto, según los críticos del gobierno, el énfasis en promover los nacimientos le sirve a la administración Trump y a los republicanos para dar la impresión de que realmente ayudan a las familias.

“No estamos viendo políticas que realmente apoyen a las familias con hijos”, opinó Amy Matsui, vicepresidenta de seguridad económica y cuidado infantil del Centro Nacional de Leyes para la Mujer (National Women’s Law Center), una organización sin fines de lucro enfocada en los derechos de género. “Lo que se está promoviendo es un matrimonio blanco, heterosexual, cristiano fundamentalista y con dos padres”.

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“Our country wants us to be birthing machines, but they’re cutting what resources there already are,” said Olcott, 20. “And a $1,000 baby bonus? It’s low-key like, what, bro? That wouldn’t even cover my month’s rent.”

The Trump administration wants Americans to have more babies, and the federal government is debuting policy initiatives to reverse the falling U.S. fertility rate. In mid-October, the White House unveiled a plan to increase access to in vitro fertilization treatment. President Donald Trump has heralded such initiatives, calling himself “the fertilization president.”

But reproductive rights groups and other advocacy organizations say these efforts to buttress the birth rate don’t make up for broader administration priorities aimed at cutting federal programs such as Medicaid, its related Children’s Health Insurance Program, and other initiatives that support women and children. The pro-family focus, they say, isn’t just about boosting procreation. Instead, they say, it’s being weaponized to push a conservative agenda that threatens women’s health, reproductive rights, and labor force participation.

Some predict these efforts could deter parenthood and lead to increases in maternal mortality.

“The religious right wants more white Christian babies and is trying to curtail women’s reproductive freedom in order to achieve that aim,” said Marian Starkey, a spokesperson for Population Connection, a nonprofit that promotes population stabilization through increased access to birth control and abortion. “The real danger is the constant whittling down of reproductive rights.”

The White House did not respond to repeated interview requests.

A slate of federal programs that have long helped women and children are also being targeted by Trump and Cabinet members who say they champion pronatalist policies.

Medicaid work requirements, for instance, put in place by the Republicans’ One Big Beautiful Bill Act, a budget law enacted in July, will lead to extra paperwork and other requirements that, according to the Congressional Budget Office, will cause millions of eligible enrollees to lose coverage. Medicaid covers more than 4 in 10 births in the U.S.

The measure also cuts federal funding for a national program that provides monthly food benefits. Almost 40% of recipients in fiscal 2023 were children.

GOP spending cuts and staffing freezes have hampered Head Start, a federal education program that provides day care and preschool for young, low-income children, even as U.S. adults implore the government to curtail ballooning child care costs.

And the GOP halted Medicaid funding to Planned Parenthood of America for one year because it provides abortion services, forcing roughly 50 clinics around the country to close since the beginning of 2025. Planned Parenthood provides a wide range of women’s health services, from wellness exams to breast cancer screenings and initial prenatal care.

Groups that advocate for women’s health and reproductive rights say the actions by the administration and congressional Republicans to attack these programs are making it harder for families to get the support and medical care they need.

“There is a lot of rhetoric about who is worthy of public assistance, and to many policymakers, it’s not the single mother,” said Allyson Crays, a public health law and policy analyst at the Milken Institute School of Public Health at George Washington University.

The pronatalist perspective generally supports government intervention to encourage procreation and is rooted in a belief that modern culture has failed to celebrate the nuclear family. The movement’s supporters also say policies to encourage childbearing are an economic necessity.

A Declining Birth Rate

The national birth rate has largely been on a downward trajectory since 2007, with the number of births declining by an average 2% per year from 2015 through 2020, according to the Centers for Disease Control and Prevention, although the rate has fluctuated since.

The concepts that shape the movement can be found in Project 2025, a political initiative led by the conservative Heritage Foundation that has seen many of its proposals adopted by Trump. The document asserts that children fare best in a “heterosexual, intact marriage.”

“Married men and women are the ideal, natural family structure because all children have a right to be raised by the men and women who conceived them,” it says.

Project 2025 also includes many proposals that critics say aren’t friendly toward women’s health. For instance, it calls for eliminating access to mifepristone, a drug commonly used in abortions as well as in the management of miscarriages, and encourages states to block Planned Parenthood facilities from receiving Medicaid funding.

The “more babies” mantra is being embraced at the highest levels of the federal government.

“I can’t remember any other administration being so tied to the pronatalist movement,” said Brian Dixon, Population Connection’s senior vice president for government and political affairs.

Just days after he was sworn in, Vice President JD Vance declared, “I want more babies in the United States of America.” He has also criticized the decision-making of women and men who opt not to start families.

The White House in October did announce a discount on certain drugs used in IVF treatments through TrumpRx, a yet-to-debut government website that aims to connect consumers with lower-priced drugs. Mehmet Oz, who heads Medicare and Medicaid, heralded a possible future of “Trump babies,” resulting from the lower-priced infertility drugs.

The administration also announced it would encourage employers to move to a new model for offering fertility benefits as a stand-alone option in which employees can enroll. But that is far from Trump’s earlier pledge to make infertility treatments free and may not be enough to overcome other long-term financial worries that often guide decisions about whether to have children.

Angel Albring, a mother of six, says her dream of having a big family always hinged on her ability to work and avoid child care costs. Her career as a freelance writer enabled her to do so while still contributing to the family’s income, working during nap times and at night, while the rest of her household slept.

“The whole thing of ‘sleep when the baby sleeps’ never applied to me,” Albring said.

Some of her friends, though, aren’t so fortunate. They fear they cannot afford children because of climbing costs for day care, groceries, and housing, she said.

Delivering on ‘Baby Bonuses’?

The Trump administration, meanwhile, has advanced another policy aimed at giving children a future financial boost.

The One Big Beautiful Bill Act establishes a tax-advantaged “Trump account” seeded with $1,000 in federal funds — often called a “baby bonus” — on behalf of every eligible American child. The initial deposits are scheduled to start in 2026 with the federal government automatically opening an account for children born after Dec. 31, 2024, and before Jan. 1, 2029.

Parents could contribute up to $5,000 a year initially to the account, with employers able to annually contribute up to $2,500 of that amount. The accounts reportedly would be vehicles for long-term savings. Details are still being ironed out, but funds could not be withdrawn before the child turns 18. After that, the accounts would likely become traditional IRAs.

On Tuesday, billionaires Michael and Susan Dell of Dell computer fame said they would give $250 to 25 million children age 10 and under in the U.S. The donations will be aimed at encouraging participation in the Trump accounts.

Pronatalism extends to other parts of the federal government, too.

Transportation Secretary Sean Duffy, who has nine children, instructed his department to prioritize federal funds for communities with high marriage and birth rates, though it has not yet announced any projects directly related to the initiative. For a time, the administration considered bestowing national medals on mothers with six or more children.

Except there’s one hitch: Data suggests the policies and programs the Trump administration has proposed won’t necessarily work.

Other countries have offered more robust programs to encourage childbearing and ease parenting but haven’t seen their birth rates go up, noted Michael Geruso, an economist for the University of Texas-Austin who hopes to see the global population increase. Israel, for example, has offered free IVF treatment for roughly three decades, yet its birth rates have stayed statistically stagnant, at just under three children for every woman, he said.

France and Sweden have extensive social safety-net programs to support families, including paid time off and paid paternity and maternity leave, and subsidized child care and health care, but their fertility rates are also falling, said Peggy O’Donnell Heffington, a University of Chicago assistant senior instructional professor in the history department who wrote a book on non-motherhood.

“Nobody yet knows how to avoid depopulation,” Geruso said.

Some point to a different solution to reverse the United States’ declining population: boost immigration to ensure a younger labor force and stronger tax base. The Trump administration, however, is doing the opposite — revoking visas and creating an environment in which immigrants who are in the U.S. legally feel increasingly uncomfortable because of heavy-handed policies, analysts say.

The country’s immigrant population this year fell for the first time since the 1960s, according to a Pew Research Center analysis.

Meanwhile, to critics of the administration, the focus on encouraging childbirth allows the Trump administration and Republicans to sound as if they support families.

“You’re not seeing policies that support families with children,” said Amy Matsui, vice president of income security and child care at the National Women’s Law Center, a nonprofit focused on gender rights. “It’s a white, heterosexual, fundamentalist Christian, two-parent marriage that’s being held up.”

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Fast-forward to the congressional stalemate that has closed the federal government for more than a month. Democrats, entrenched on one side of the legislative battle, staked their political future on merely preserving parts of the Affordable Care Act — a far cry from the systemic health policy changes that party members once described as crucial for tackling the high price of care.

Democrats succeeded in focusing national attention on rising health insurance costs, vowing to hold up funding for the federal government until a deal could be made to extend the more generous tax subsidies that have cut premiums for Obamacare plans. Their doggedness could help them win votes in midterm elections next year.

But health care prices are rocketing, costly high-deductible plans are proliferating, and 4 in 10 adults have some form of health care debt. As health costs reach a crisis point, a yawning gulf exists between voters’ desire for more aggressive action and the political urgency in Washington for sweeping change.

“There isn’t a lot of eagerness among politicians,” said Jonathan Gruber, an economist who played a key role in drafting the ACA. “Why aren’t they being more bold? Probably scars from the ACA fights. But health care is a winning issue. The truth is we need universal coverage and price regulation.”

Voters rank lowering health care costs as a top priority, above housing, jobs, immigration, and crime, according to a September poll by Hart Research Associates for Families USA, a consumer health advocacy group.

And costs are climbing. Premiums for job-based health insurance rose 6% in 2025 to an average of $26,993 a year for family coverage, according to an annual survey of employers released Oct. 22 by KFF, a health information nonprofit that includes KFF Health News. For all the attention given to grocery, gas, and energy prices, health premiums and deductibles in recent years have risen faster than overall inflation and wages.

Democratic Headwinds

The appetite for big, bold ideas to drive down such high costs has waned in part because Democrats lack political leverage, according to economists, political strategists, and health care advocates. They’ve also been burned before for backing significant changes.

After the ACA was enacted in 2010, for example, a backlash over the law — and its mandate that most everyone have insurance — helped Republicans win the House and gain seats in the Senate. In 2016, Democratic presidential candidate Hillary Clinton backed the public option, a proposed government-run plan that would compete against commercial insurance. She lost to Donald Trump.

Democrats are also outnumbered in Congress. Sweeping changes to health care, such as the creation of Medicaid and Medicare and passage of the ACA, historically have occurred when one party has controlled both Congress and the presidency. Republicans currently have all that muscle. So for now, Democrats are fighting to preserve the status quo while portraying Republicans as a threat to Americans’ insurance coverage.

If the ACA subsidies aren’t extended, many of the roughly 24 million people who buy coverage on the health law’s marketplaces will see their premiums more than double next year, according to KFF. A KFF Health Tracking Poll released Nov. 6 found that three-quarters of the public supported extending them.

“There’s no doubt people believe the current system needs reform,” said Jesse Ferguson, a Democratic strategist. “Protecting people from premium increases is part of that. You don’t win the future by losing the present.”

Even bipartisan legislative proposals aimed at lowering health costs have fizzled in an environment defined by political threats and partisan social media attacks.

Bills that would have improved health care price transparency and reined in companies that manage prescription drug benefits gained traction in late 2024 as part of a spending package. Then Elon Musk, who was serving as a senior adviser to President-elect Trump, took to his social media platform, X, to rally opposition, deriding the budget bill for what he asserted was excessive government spending.

GOP leaders dropped the health provisions, prompting Sen. Patty Murray (D-Wash.) to say on X that Musk “tweeted to kill” the bipartisan health policies that Congress had hammered out.

But Democrats’ focus on health care has cut both ways. Their messaging amid efforts to save the ACA from repeal and to preserve the law’s protections for those with preexisting conditions helped the party take back the House in the 2018 midterm elections. “I still have PTSD from the experience,” Republican Mike Johnson, now the House speaker, said recently.

And voters want relief. Six in 10 Americans are extremely or very worried about health care costs rising next year, according to an Associated Press-NORC Center for Public Affairs Research poll.

Hagen Wenzek, 56, is among them. The chief executive of GI Digital, a high-tech startup, felt a pain in his calf in late summer and asked OpenAI’s ChatGPT what it might be. It suggested he could have deep-vein thrombosis, or a blood clot. He went to the emergency room and obtained an ultrasound that confirmed the diagnosis, so doctors monitored him and gave him blood thinners.

His insurance was billed $7,422, and Wenzek got a bill for $890. The average cost of an ultrasound is about $400 without insurance, according to GoodRx, a digital health platform.

“The hospital is making thousands for a procedure that costs $500. It’s kind of ridiculous,” said Wenzek, of Sleepy Hollow, New York. “I have a $40 copay just to go see a doctor for anything, and I’m on a startup budget.”

‘Defending the Status Quo’

The lack of bolder ideas to tackle spiraling costs could also work against Democrats, some critics say. Comedian and political commentator Jon Stewart, in an episode of his podcast in October, accused Democrats of committing “malpractice” by not presenting ideas to fix what people hate about the health care system. Instead, he said, they’re shutting the government down to protect a system that voters already believe is failing them.

“Once again, the Democrats are in a position of defending the status quo of policies that most people in the United States think suck,” he said. “Meanwhile, on the same day, Trump rolls out TrumpRx. Hey, I’ll just threaten Pfizer with 100% tariffs and then just open up a prescription drug outside of the middle managers and sell directly to the public at a discount.”

TrumpRx, which is intended to help patients find lower-priced drugs, and pledges by Big Pharma to lower drug prices could help the GOP with voters, though Democrats are also hammering Republicans over the One Big Beautiful Bill Act, the bill the president signed into law in July that reduces Medicaid spending by about $1 trillion over a decade.

Republicans are promising fixes, using the shutdown to try to leverage voter frustration. Vice President JD Vance said on Newsmax in October that “we do have a plan, actually,” in reference to a question about health care reform. (Trump has promised repeatedly that he would produce a plan to replace the ACA but never has.)

Senate Majority Leader John Thune said on CNBC in October that Trump wants to overhaul the ACA and “give people health insurance that is higher-quality and more affordable.”

The White House did not respond to an email requesting comment from Vance.

“It’s not that Democrats are focusing on tax credits to the exclusion of bigger, bolder reforms,” said Anthony Wright, executive director of Families USA. “If you can get the conversation on health care, if we can prevent premiums from spiking, then we can focus on why health care costs so darn much to begin with.”

But some Democrats say voters are hurting and want bigger and bolder ideas now. Earlier this year, Minnesota Gov. Tim Walz said on the podcast “Fast Politics” that the party needs to offer more on health care in the next election.

“I’ll tell you what people are going to expect,” he said. “They’re not going to expect us to tinker around the edge with the ACA. They’re going to expect universal health care.”

For now, at least, there are more innovative ideas in states. Oregon has established a governing board to set up a single-payer health system in which the state would take on health care financing — eliminating private insurance, premiums, and all deductibles for all residents as soon as 2027. The question is whether it will work. Vermont abandoned a similar effort in 2014.

“With the political environment we’re in, there isn’t currently an appetite for big reform, but we know it needs to happen,” said Mona Shah, the senior director of policy and strategy at Community Catalyst, a health advocacy group. “Across party lines, people want government intervention in health care and people want universal coverage. The pain point that people are feeling, the public sentiment is where we were at before the ACA.”

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Kennedy is expected to create a task force to recommend possible federal action, according to a former agency official, an internal agency memo obtained by KFF Health News, and a consultant who says he helped with the memo. 

“HHS does not comment on future or potential policy decisions and task forces,” agency spokesperson Emily Hilliard said by email. 

The plans show how rumors and conspiracy theories can gain an air of legitimacy under the Trump administration, where researchers say that unscientific ideas have unusual power to take hold and shape public health policy. 

The concept posits that airplane vapor trails are really “chemtrails” that harm public health. Another version alleges planes or devices are being deployed by the federal government, private companies, or researchers to trigger big weather changes, such as hurricanes, or to alter the Earth’s climate, emitting hazardous chemicals in the process. 

HHS is expected to appoint a special government employee to investigate climate and weather control, according to Gray Delany, former head of the department’s Make America Healthy Again agenda. He said he drafted the internal agency memo. HHS has interviewed applicants to lead a “chemtrails” task force, said Jim Lee, a blogger focused on weather and climate who Delany said helped edit the memo, which Lee confirmed. 

Delany, who was ousted in August from HHS, said Kennedy has expressed strong interest in chemtrails. The memo alleges that “aerosolized heavy metals such as Aluminum, Barium, and Strontium, as well as other materials such as sulfuric acid precursors, are sprayed into the atmosphere under the auspices of combatting global warming,” through a process of stratospheric aerosol injection. 

“That is a pretty shocking memo,” said Daniel Swain, a climate scientist at the University of California. “It doesn’t get more tinfoil hat. They really believe toxins are being sprayed.” 

Deploying chemtrails to poison people is just one of many baseless conspiracy theories that have found traction among Trump administration health policy officials led by Kennedy, a longtime anti-vaccine activist before entering politics who embraces a range of such ideas. 

In April, Kennedy was asked on “Dr. Phil Primetime” about chemicals being sprayed into the stratosphere to change the Earth’s climate. “It’s done, we think, by DARPA,” Kennedy said, referring to a Department of Defense agency that develops emerging technology for the military’s use. “And a lot of it now is coming out of the jet fuel. Those materials are put in jet fuel. I’m going to do everything in my power to stop it. We’re bringing on somebody who’s going to think only about that.” 

DARPA officials didn’t return a message seeking comment.

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He shared his concern with reporters, acknowledging it sounded a little like “The X Files,” a science fiction television show.

Academics cite Wallace’s story as one of the catalysts behind a fringe concept that has spread among adherents to the Make America Healthy Again, or MAHA, movement and is gaining traction at the highest levels of the federal government. Its treatment as a serious issue underscores that under President Donald Trump, unscientific ideas have unusual power to take hold and shape public health policy.

The concept posits that airplane vapor trails, or contrails, are really “chemtrails” containing toxic substances that poison people and the terrain. Another version alleges planes or devices are being deployed by the federal government, private companies, or researchers to trigger big weather changes, such as hurricanes, or to alter the Earth’s climate, emitting hazardous chemicals in the process.

Several GOP lawmakers and leaders in the Trump administration remain convinced the concepts are legitimate, though scientists have sought to discredit such claims.

Health and Human Services Secretary Robert F. Kennedy Jr. is planning to investigate climate and weather control, and is expected to create a task force that will recommend possible federal action, according to a former agency official, an internal agency memo obtained by KFF Health News, and a consultant who helped with the memo.

The plans, along with comments by top GOP lawmakers, show how rumors and conspiracy theories can gain an air of legitimacy due to social media and a political climate infused with falsehoods, some political scientists and researchers say.

“When we have low access to information or low trust in our sources of information, a lot of times we turn to our peer groups, the groups we are members of and we define ourselves by,” said Timothy Tangherlini, a folklorist and professor of information at the University of California-Berkeley. He added that the government’s investigation of conspiracy theories “gives the impression of having some authoritative element.”

HHS is expected to appoint a special government employee to investigate climate and weather control, according to Gray Delany, former head of the agency’s MAHA agenda, who said he drafted the memo. The agency has interviewed applicants to lead a “chemtrails” task force, said Jim Lee, a blogger focused on weather and climate who Delany said helped edit the memo, which Lee confirmed.

“HHS does not comment on future or potential policy decisions and task forces,” agency spokesperson Emily Hilliard said in an email.

The memo alleges that “aerosolized heavy metals such as Aluminum, Barium, and Strontium, as well as other materials such as sulfuric acid precursors, are sprayed into the atmosphere under the auspices of combatting global warming,” through a process of stratospheric aerosol injection, or SAI.

“There are serious concerns SAI spraying is leading to increased heavy metal content in the atmosphere,” the memo states.

The memo claims, without providing evidence, that the substances cause elevated heavy-metal content in the atmosphere, soil, and waterways, and that aluminum is a toxic product used in SAI linked to dementia, attention-deficit/hyperactivity disorder, asthma-like illnesses, and other chronic illnesses. The July 14 memo was addressed to White House health adviser Calley Means, who didn’t respond to a voicemail left by a reporter seeking comment.

High-level federal government officials are presenting false claims as facts without evidence and referring to events that not only haven’t occurred but, in many cases, are physically impossible, said Daniel Swain, a climate scientist at the University of California.

“That is a pretty shocking memo,” he said. “It doesn’t get more tinfoil hat. They really believe toxins are being sprayed.”

Kennedy has previously promoted debunked chemtrail theories. This spring, he was asked on “Dr. Phil Primetime” about chemicals being sprayed into the stratosphere to change the Earth’s climate.

“It’s done, we think, by DARPA,” Kennedy said, referring to a Department of Defense agency that develops emerging technology for the military’s use. “And a lot of it now is coming out of the jet fuel. Those materials are put in jet fuel. I’m going to do everything in my power to stop it. We’re bringing on somebody who’s going to think only about that.”

DARPA officials didn’t return a message seeking comment.

Federal Messaging

Deploying chemtrails to poison people is just one of many baseless conspiracy theories that have found traction among Trump administration health policy officials led by Kennedy, a longtime anti-vaccine activist before entering politics. He continues to promote a supposed link between vaccines and autism, as well as make statements connecting fluoride in drinking water to arthritis, bone fractures, thyroid disease, and cancer. The World Health Organization says fluoride is safe when used as recommended.

Delany, who was ousted in August from HHS, said Kennedy has expressed strong interest in chemtrails.

“This is an issue that really matters to MAHA,” said Delany, referring to the informal movement associated with Kennedy that is composed of people who are skeptical of evidence-based medicine.

The memo also alleges that “suspicious weather events have been occurring and have increased awareness of the issue to the public, some of which have been acknowledged to have been caused by geoengineering activities, such as the flooding in Dubai in 2024.” Geoengineering refers to intentional large-scale efforts to change the climate to counteract global warming.

“It is unconscionable that anyone should be allowed to spray known neurotoxins and environmental toxins over our nation’s citizens, their land, food and water supplies,” Delany’s memo states.

Scientists, meteorologists, and other branches of the federal government say these assertions are largely incorrect. Some points in the memo are accurate, including concerns that commercial aircraft contribute to acid rain.

But critics say the memo builds on kernels of truth before veering into unscientific fringe theories. Efforts to control the weather are being made, largely by states and local governments seeking to combat droughts, but the results are modest and highly localized. It isn’t possible to manipulate large-scale weather events, scientists say.

Severe flooding in the United Arab Emirates in 2024 couldn’t have been caused by weather manipulation because no technology could create that kind of rainfall event, Maarten Ambaum, a meteorologist at the University of Reading who studies Gulf region rainfall patterns, said in a statement on the floods. Similar debunked claims emerged this year after central Texas experienced devastating floods.

The Government Accountability Office concluded in a 2024 report that questions remain as to the effectiveness of weather modification.

Research into changing the climate has been conducted, including work by one private company that engaged in field tests. Still, federal agencies say no ongoing or large-scale projects are underway. Study of the concept remains in the research phase. The Environmental Protection Agency says there are no large-scale or government efforts to affect the Earth’s climate.

“Solar geoengineering is not occurring via direct delivery by commercial aircraft and is not associated with aviation contrails,” the agency says on its website.

Widespread Misinformation

Misperceptions about weather, climate control, and airplane contrails extend beyond the Trump administration, scientists said.

In September, a congressional House committee hearing titled “Playing God With the Weather — A Disastrous Forecast” involved two hours of debate on the once-fringe idea. Rep. Marjorie Taylor Greene (R-Ga.), who chaired the hearing, has introduced legislation to ban weather and climate control, with a fine of up to $100,000 and up to five years in prison.

Some Democrats objected to the nature of the discussion. Rep. Melanie Stansbury (D-N.M.) accused Greene of using “the platform of Congress to proffer anti-science theories, to platform climate denialism.”

Frequently citing chemtrails, GOP lawmakers have introduced legislation in about two dozen states to ban weather modification or geoengineering. Florida passed a bill to establish an online portal so residents can report alleged violations.

“The Free State of Florida means freedom from governments or private actors unilaterally applying chemicals or geoengineering to people or public spaces,” GOP Florida Gov. Ron DeSantis said in a press statement this spring.

Meanwhile, the chemtrail conspiracy has permeated popular culture. The title track on singer Lana Del Ray’s seventh studio album is entitled “Chemtrails Over the Country Club.” Bill Maher dove into the chemtrail myth on his podcast “Club Random,” saying, “This is nuts. It’s just nuts.” And “Chemtrails,” a psychological thriller, wrapped filming in July.

Social media has given wing to the chemtrails concept and other fringe ideas involving public health. They include an outlandish belief that Anthony Fauci, who advised both Trump and President Joe Biden on the government response to the covid-19 pandemic, created the AIDS epidemic. There is no evidence of such a link, public health leaders say.

Researchers say another false belief by those on the far right holds that people who received covid vaccines could shed the virus, causing infertility in the unvaccinated. There is no evidence of such a connection, scientists and researchers say.

More severe weather events due to global warming may be driving some of the baseless theories, scientists say. And risks occur when such ideas take hold among the general population or policymakers, some public health leaders say. Climate researchers, including Swain, say they’ve received death threats.

Lee, the blogger, said he disagrees with some of the more far-fetched beliefs and is aware of the harm they can cause.

“There are people wanting to shoot down planes because they think they are chemtrails,” said Lee, adding that some believers are afraid to venture outside when plane vapor trails are visible overhead.

There is also no evidence that plane contrails cause health problems or are related to intentional efforts to control the climate, according to the EPA and other scientists.

The memo and focus at HHS on climate and weather control are alarming because they perpetuate conspiracies, said David Keith, a professor of geophysical sciences at the University of Chicago.

“It’s unmoored to reality,” he said. “I expected there were documents like this, but seeing it in print is nevertheless shocking. Our government is being driven by nonsensical dreck from dark corners of social media.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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