• Click here to watch Rosenthal on ABC News Live.

KFF Health News Southern California correspondent Claudia Boyd-Barrett discussed how families of detainees by the U.S. Immigration and Customs Enforcement agency are struggling to find those who have been hospitalized on KQED’s The California Report on Feb. 10.

• Click here to hear Boyd-Barrett on The California Report.
• Read Boyd-Barrett’s “‘I Can’t Tell You’: Attorneys, Relatives Struggle To Find Hospitalized ICE Detainees.”

Céline Gounder, KFF Health News’ editor-at-large for public health, discussed a new study linking daily coffee or caffeinated tea intake to lower dementia risk on CBS News’ CBS Mornings on Feb. 10.

• Click here to watch Gounder on CBS Mornings.

KFF Health News senior correspondent Aneri Pattani discussed differing opinions within the addiction medicine community on WNO’s Louisiana Considered on Feb 6.

• Click here to hear Pattani on Louisiana Considered.
• Read Pattani’s “Inside the Battle for the Future of Addiction Medicine.”

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.

USE OUR CONTENT

This story can be republished for free (details).

Kennedy squeaked through a narrow Senate vote to be confirmed as head of the Department of Health and Human Services, only after making a number of public and private guarantees about how he would handle vaccine funding and recommendations as secretary.

Here’s a look at some of the promises Kennedy made during his confirmation process.

The Childhood Vaccine Schedule

In two hearings in January 2025, Kennedy repeatedly assured senators that he supported childhood vaccines, noting that all his children were vaccinated.

Sen. Elizabeth Warren (D-Mass.) grilled Kennedy about the money he’s made in the private sector from lawsuits against vaccine makers and accused him of planning to profit from potential future policies making it easier to sue.

“Kennedy can kill off access to vaccines and make millions of dollars while he does it,” Warren said during the Senate Finance Committee hearing. “Kids might die, but Robert Kennedy can keep cashing in.”

Warren’s statement prompted an assurance by Kennedy.

“Senator, I support vaccines,” he said. “I support the childhood schedule. I will do that.”

Days later, Sen. Bill Cassidy of Louisiana, chair of the Senate Health, Education, Labor, and Pensions Committee, declared Kennedy had pledged to maintain existing vaccine recommendations if confirmed. Cassidy, a physician specializing in liver diseases and a vocal supporter of vaccination, had questioned Kennedy sharply in a hearing about his views on shots.

“If confirmed, he will maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices’ recommendations without changes,” Cassidy said during a speech on the Senate floor explaining his vote for Kennedy.

A few months after he was confirmed, Kennedy fired all the incumbent members of the vaccine advisory panel, known as ACIP, and appointed new members, including several who, like him, oppose some vaccines. The panel’s recommendations soon changed drastically.

Last month, the CDC removed its universal recommendations for children to receive seven immunizations, those protecting against respiratory syncytial virus, meningococcal disease, flu, covid, hepatitis A, hepatitis B, and rotavirus. The move followed a memorandum from the White House calling on the CDC to cull the schedule.

Now, those vaccines, which researchers estimate have prevented thousands of deaths and millions of illnesses, are recommended by the CDC only for children at high-risk of serious illness or after consultation between doctors and parents.

In response to questions about Kennedy’s actions on vaccines over the past year, HHS spokesperson Andrew Nixon said the secretary “continues to follow through on his commitments” to Cassidy.

“As part of those commitments, HHS accepted Chairman Cassidy’s numerous recommendations for key roles at the agency, retained particular language on the CDC website, and adopted ACIP recommendations,” Nixon added. “Secretary Kennedy talks to the chairman at a regular clip.”

Cassidy and his office have repeatedly rebuffed questions about whether Kennedy, since becoming secretary, has broken the commitments he made to the senator.

Vaccine Funding Axed

Weeks after Kennedy took over the federal health department, the CDC pulled back $11 billion in covid-era grants that local health departments were using to fund vaccination programs, among other initiatives.

That happened after Kennedy pledged during his confirmation hearings not to undermine vaccine funding.

Kennedy replied “Yes” when Cassidy asked him directly: “Do you commit that you will not work to impound, divert, or otherwise reduce any funding appropriated by Congress for the purpose of vaccination programs?”

A federal judge later ordered HHS to distribute the money.

The National Institutes of Health, part of HHS, also yanked dozens of research grants supporting studies of vaccine hesitancy last year. Kennedy, meanwhile, ordered the cancellation of a half-billion dollars’ worth of mRNA vaccine research in August.

A Discredited Theory About Autism

Cassidy said in his floor speech that he received a guarantee from Kennedy that the CDC’s website would not remove statements explaining that vaccines do not cause autism.

Technically, Kennedy kept his promise not to remove the statements. The website still says that vaccines do not cause autism.

But late last year, new statements sprung up on the same webpage, baselessly casting doubt on vaccine safety. “The claim ‘vaccines do not cause autism’ is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism,” the page on autism now misleadingly reads.

The webpage also states that the public has largely ignored studies showing vaccines do cause autism.

That is false. Over decades of research, scientific studies have repeatedly concluded that there is no link between vaccines and autism.

A controversial 1998 study that captured global attention did link the measles, mumps, and rubella vaccine to autism. It was retracted for being fraudulent — though not until a decade after it was published, during which there were sharp declines in U.S. vaccination rates.

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.

USE OUR CONTENT

This story can be republished for free (details).

The Food and Drug Administration is back in the headlines, with a political appointee overruling agency scientists to reject an application from the drugmaker Moderna for a new flu vaccine, and FDA Commissioner Marty Makary continuing to take criticism from anti-abortion Republicans in the Senate for alleged delays reviewing the safety of the abortion pill mifepristone.

Meanwhile, in a very unlikely pairing, Sen. Elizabeth Warren, the Massachusetts Democrat, and Sen. Josh Hawley, the conservative Republican from Missouri, are co-sponsoring legislation aimed at breaking up the “vertical integration” of health care — when a single company owns health insurers, drug middlemen, and clinician practices.

This week’s panelists are Julie Rovner of KFF Health News, Jackie Fortiér of KFF Health News, Lizzy Lawrence of Stat, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• A top FDA official overruled agency staff in refusing to consider Moderna’s application for a new flu vaccine. The rejection, which Moderna is challenging, comes after the company consulted with the agency under President Joe Biden on how to develop the clinical trial for the vaccine and then spent considerable time and money. Clear, consistent federal guidance is important to maintaining the drug development ecosystem, and the decision stands as a warning to other companies developing new treatments.
• With measles cases rising and trust in federal vaccine recommendations falling, the Vaccine Integrity Project, based at the University of Minnesota’s Center for Infectious Disease Research & Policy, and the American Medical Association are launching their own vaccine review process — a parallel vaccine recommendation project offering an alternative to what are seen as ideologically driven federal recommendations.
• President Donald Trump unveiled the new TrumpRx website, billed as helping people save money on prescription drugs. But the site’s offerings are limited and offer limited benefits: It serves only those trying to buy drugs without insurance coverage, and some of the biggest savings are on popular obesity drugs rather than other commonly needed treatments. Nonetheless, it offers Trump a chance to stamp his name on an effort to lower drug prices.
• And more reporting is illuminating the health-related side effects of Trump’s immigration crackdown, including infectious disease outbreaks at detention centers. While at least some of the problems are not new to immigration enforcement, the large numbers of people being detained are intensifying the problems.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: ProPublica’s “The Children of Dilley,” by Mica Rosenberg.  

Alice Miranda Ollstein: Politico’s “Why Washington’s All-In on Smart Rings,” by Amanda Chu.  

Lizzy Lawrence: KFF Health News’ “US Cancer Institute Studying Ivermectin’s ‘Ability To Kill Cancer Cells,’” by Rachana Pradhan.  

Jackie Fortiér: Stat’s “The New Childhood Vaccine Guidelines Have a Paid Leave Problem,” by Ariana Hendrix.  

Also mentioned in this week’s episode:

• Stat’s “Prasad Overruled FDA Staff To Reject Moderna’s Flu Vaccine Application,” by Lizzy Lawrence.
• KFF Health News’ “Public Health Workers Are Quitting Over Assignments to Guantánamo,” by Amy Maxmen.
• KFF Health News’ “‘I Can’t Tell You’: Attorneys, Relatives Struggle To Find Hospitalized ICE Detainees,” by Claudia Boyd-Barrett.

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

Julie Rovner: Hello from KFF Health News and WAMU public radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Feb. 12, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go. 

Today, we are joined via videoconference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hi.  

Rovner: And up early to join us from California, my KFF Health News colleague Jackie Fortiér. Welcome, Jackie.  

Jackie Fortiér: Hey, everyone. 

Rovner: No interview this week, but plenty of news. So let’s jump right in. We will start this week at the Food and Drug Administration, where things are — why don’t we call it — newsmaking. The biggest FDA story that broke this week was controversial vaccine chief Vinay Prasad outright rejecting an application for a new flu vaccine from Moderna, maker of the mRNA covid vaccine that so many anti-vaxxers have criticized. Lizzy, you broke this story. Congratulations. What happened exactly? And why is this such a big deal beyond the flu vaccine? 

Lawrence: This is a big deal because to refuse to file is a pretty rare occurrence in general, because in general the FDA and industry like to have agreed-upon standards for clinical trials before companies embark on them and pour millions of dollars into them. So that was surprising. And then— 

Rovner: And refuse to file means that they said that they’ve got the application and said: Yeah, we’re not accepting that. We’re not going to review this. Right? 

Lawrence: Yes, yes. And Prasad wrote that the grounds for this was that it wasn’t an adequate, controlled trial. Well, Moderna is saying that actually the FDA greenlit this trial back under the Biden administration in 2024. They acknowledged that there was basically a control vaccine that the FDA say they would prefer that Moderna use for the older population. But they said, however, it’s acceptable if you don’t do that. 

Rovner: And I want to make sure I understand this. The complication here is that this is supposed to be a better vaccine for older people, but right now there’s vaccines for older people that start at age 65 and this is a vaccine that’s supposed to start at age 50, right? So it was unclear who they were going to test it against, whether it was going to be the 50-to-64s or the 65s and older. Because there isn’t a vaccine right now that’s approved for 50 and up, right? 

Lawrence: Exactly, exactly. So it was there’s the high-dose vaccine, which is recommended for the above-65s, but that is not recommended for the 50-to-64, which is part of why Moderna didn’t use that high-dose vaccine, because the population that they were studying was broader than this over-65s. So anyway, so yeah, so refusing to file is already rare, and then for there to be an overriding refuse to file, where the, I was told, basically, while there may have been individuals who agreed with Dr. Prasad’s assessment, the review team, every discipline, thought that it was reviewable. And the head of vaccines wrote a memo explaining why he thought it was viable, so that the career staff kind of documented their thoughts here. It’s not clear whether this will be made public ever, but one would hope, with radical transparency, but we’ll see. Despite that, Dr. Prasad still refused to review Moderna’s application. 

Rovner: So obviously it’s a big deal for the flu vaccine, but it’s a big deal beyond this. Moderna’s CEO was on cable news this morning, said that, as you said, after consulting with the FDA officials about the trial, they spent a billion dollars on this trial. How do we expect companies to invest in new medicines like this if the FDA is basically acting on vibes? 

Lawrence: I don’t know. Yeah. And it’s interesting. It doesn’t seem like there’s a ton of sympathy from this administration. Even back last year, [FDA] Commissioner [Marty] Makary tweeted something — this was when they were limiting, wanted to require more data for covid vaccines for the under-65 crowd. And I think he said something like: Our goal is not to save companies money. That’s not something we — which of course that isn’t. The FDA’s goal is to promote public health. But it’s definitely a change in tune. I think that in the past, the FDA has understood that you’re really only going to get innovation if you have clear, consistent guidance and that it’s a really worst-case scenario for a company to spend a billion dollars on a clinical trial and then there’s nothing to show for it and nothing for it to benefit patients, either. So. 

Rovner: Is this over? What happens now? 

Lawrence: So now Moderna has requested a meeting to challenge this decision, and now there begins a kind of negotiation. It might be possible that the FDA would, in fact, would review at least the 50-to-64 cohort, because they don’t have any objections there, seemingly. But we’ll have to see. On a call yesterday, a senior FDA official talked about Moderna kind of coming to the agency with humility and acknowledging that the FDA had recommended this high-dose vaccine. And so I don’t know. I think companies are definitely — it’s a lesson that they’re, especially if you’re in the vaccine space, you have to tread very carefully. 

Rovner: Yeah. And I would think others in the drug space, too. It’s not just — that’s the point of this — it’s not just vaccines. Alice, you wanted to say something. 

Ollstein: Oh, yeah. Not only the monetary investment, which we’ve touched on a bunch, but companies spend years. So it’s the time investment as well. And why would you dedicate years of effort to something that you’re not sure if a political appointee is going to swoop in and override career scientific officials’ assessment, if you can’t trust the regulatory system to work as it’s always worked. There really is just a lot of risk there, and you might see people not making these submissions on all kinds of fronts. Of course, this is coming as we’ve had a really bad flu season. I’ve had people in my life get really sick and say it’s been really, really bad. So the prospect of having something that works better to prevent, or even just make it milder, not coming to fruition is rough. 

Rovner: Yeah. And this year, as we know, this year’s flu vaccine was not very well matched to the strains that ended up circulating. And that’s kind of the point of this Moderna vaccine, this mRNA vaccine, is that they say it would be much faster for them to match strains to what’s going around. If it works as the clinical trials suggest it would actually be a better flu vaccine than we have now. 

Well, meanwhile, cases of measles are also continuing to multiply, as they do when people aren’t vaccinated, and not just in the places we’ve talked about, like Texas and South Carolina, but also all around us here in the nation’s capital, apparently, as a result of people traveling here for the anti-abortion March for Life in January. There have been more than 730 confirmed cases of measles in the U.S. already this year. That’s four times more than have been typical for a full year, and it’s not yet the middle of February. Yet that doesn’t seem to be deterring the administration from its anti-vaccine activities. So now, the American Medical Association and the University of Minnesota Vaccine Integrity Project have announced they’ll convene a parallel group of experts to make vaccine recommendations, basically saying they are done following the Centers for Disease Control and Prevention. This has been brewing for a while. Right, Lizzy? 

Lawrence: Yes. As soon as the secretary fired all of the experts who served on the advisory panel to the CDC on vaccines, I think there’s been unease. And now, as you said, there’s an active parallel public health establishment that’s trying to spread credible information and provide an alternative resource, because it’s clear that HHS [the Department of Health and Human Services] has become compromised when it comes to vaccine recommendations. And yet, you’re seeing the spread of infectious diseases right now. 

Fortiér: Having kind of this rival court is not surprising, because they’ve refused to participate in any of the Advisory Committee on Immunization Practices meetings for months and months. I do wonder if this will maybe change some of the tone. We do have an upcoming ACIP meeting in February. Normally we would have a agenda out by now. Before Secretary [Robert F.] Kennedy [Jr.] we would have them weeks in advance, and we haven’t seen one yet, so we’re really not totally sure what they’re going to be talking about. But Dr. [Mehmet] Oz did say this week that he finally advised people — he’s the CMS [Centers for Medicare & Medicaid Services] director— to take the vaccine. And there’s been over 933 cases in just South Carolina during this outbreak that started last October. And so when I talk to people on the ground who are treating folks in South Carolina and have been treating them for months, and they’ve been doing vaccine clinics and things like that, they were just so fed up with Dr. Oz and the administration, because they partially blame them for these various outbreaks. And I had one of them tell me, like, well, it’s like a band-aid on a bullet hole. Like, now they’re finally encouraging people to get vaccinated when we could have had this months ago. 

Rovner: And, of course, the CDC doesn’t have a director at the moment, because the Senate-approved director was summarily fired and/or quit, not clear which, after refusing to basically rubber-stamp the immunization panel’s recommendations that had not been made at the time. So the American Academy of Pediatrics is suing to stop this February ACIP meeting. I did not hear what the last decision was on that, but I know that there’s still a lot of movement around here. I guess the big worry is: Who should the public trust now? Is it going to be this sort of grouping of medical societies led by the AMA, or the CDC, which people and doctors are used to following the advice of? 

Ollstein: And there’s all these state alliances forming to do the same thing. And so I think, yeah, the more competing recommendations the average person hears, the more they just sort of throw their hands up and say: I don’t even know who to trust anymore. I’m not listening to any of these people. And the trust that’s eroded in the federal government, that’s going to be really hard to recuperate in the future. You can’t just flip a switch and say: OK, it’s a different government. We trust them again. Once those seeds of doubt are planted in people’s minds, it’s really hard to unearth. And so, if not permanent damage, all of this is doing at least very long-term damage to the idea of expertise and authoritative information. 

Rovner: And science, which this administration insists it wants to follow. Well, turning to FDA-related “MAHA” [“Make America Healthy Again”] news, the agency said last week it would relax enforcement of its food additive regulations to make it easier for manufacturers to say they’re not using artificial dyes. Now this was a huge deal when the agency announced the phaseout of artificial coloring. Looking at you, fancy-colored Froot Loops. Now the administration says it’s going to allow foodmakers to say they’re not using artificial colors as long as they’re not using petroleum-based dyes. Apparently, natural dyes are OK. But even that is controversial, and it appears that this whole effort really relies on manufacturers’ willingness to comply rather than, you know, actual regulation, which is kind of what the FDA does for a living. It’s a regulatory agency. 

Ollstein: Well, every time the word “natural” comes up, I always laugh because there is no definition of that. And there are plenty of things that are natural that could kill you or hurt you very badly. And there are plenty of things that are synthetically manufactured that are helpful and fine for you. And so it has this veneer of safety, veneer of health with no actual substance. So my red flags go up whenever I hear that word, and I think everyone should be skeptical. 

Rovner: But it goes with RFK Jr.’s quest now that you should, quote, “eat real food.” 

Lawrence: Right. Yeah. I was going to say same with “chemical.” I feel like, “chemical” abortion drug, “chemical.” And it’s like, a lot of things are chemicals. That’s not— 

Ollstein: Yeah, like in your own body, naturally. 

Lawrence: Yeah. 

Ollstein: You have chemicals. 

Lawrence: We are chemicals. 

Ollstein: We are chemicals. 

Rovner: You guys are all too young to remember the Dow Chemical advertising line “Better Living Through Chemistry,” which at the time, in the ’60s and ’70s, was true. There was, there — we’ve had a lot of better living through chemistry. And some of it has turned out to be maybe not so good for us, but a lot of it has turned out to be pretty darn good for us. 

Well, finally, in FDA land, Commissioner Marty Makary this week met with anti-abortion senators about that ongoing review of the abortion pill mifepristone, which senators want the FDA to remove from the market. Alice, how’d that meeting go? 

Ollstein: Not great for the FDA, from what I was told. I got on the phone with Sen. Josh Hawley after it, and he was extremely frustrated. He said he didn’t get answers to any of the questions he’s been sending in public letters to the FDA for months and now asking in this briefing behind closed doors that they held on Capitol Hill this week. He said he didn’t get answers about what the timeline is for this review of the abortion pill mifepristone, what the review consists of, whether it’s even begun, really, whether it’s even underway. And so he is sort of concluding that this is not going anywhere, and he wants Congress to step in and take action. Now, Congress has tried to step in and take action before. They’ve tried to put restrictions on mifepristone in the FDA funding bill. That didn’t pass. So I don’t know if this is even plausible in this environment where Congress can’t really pass much of anything anymore. 

But Hawley is not just another Republican senator. He is very intertwined with the anti-abortion movement. His wife is an extremely prominent anti-abortion lawyer who’s led a lot of the major cases trying to restrict or ban mifepristone. They founded their own anti-abortion advocacy group. And so it really shows that the tensions, clashes, whatever we want to call them, between the anti-abortion movement and the Trump administration, so after backing the Trump administration for years and years, they’re really getting fed up. And they’re fed up that even after they achieved their grand goal of overturning Roe v. Wade, there are actually more abortions happening now than before, and that’s largely through these pills and people’s ability to get them. And so they’re getting increasingly impatient with the Trump administration, who has been sort of stringing them along and saying: Yeah, we’re working on it. We’re working on it. But they want to see results. Now, of course, if there were some sort of restrictions imposed, that could have a big political effect. And so a lot of Republicans are very torn about that. But not Sen. Hawley. Sen. Hawley wants to see it.  

Rovner: That’s right. Well, moving to what I call FDA-adjacent news, one of the many thorny issues that FDA has been dealing with is the compounding of those very popular and very pricey obesity drugs. When the drugs were in shortage, it was legal for compounders to make their own copies. But now the shortage for both of the leading medications — semaglutide, made by Novo Nordisk, and tirzepatide, made by Eli Lilly — is over, and those cheaper copycats were supposed to be pulled from the market. So it was a bit of a surprise when the company Hims, one of those direct-to-consumer drug sites, announced the unveiling of a semaglutide tablet just weeks after the first such drug was approved by the FDA, by Novo Nordisk. The FDA promptly referred the company to the Justice Department for possible violation of federal drug laws, after which Hims said, Oh, maybe we won’t start selling the drug after all. Oh, and Novo is suing for patent infringement. But I would think that the war over the “fat” drugs, as President [Donald] Trump likes to call them, is likely to lower prices just as effectively as government regulation might. Or am I misreading that? Lizzy, this has been quite the sideshow, if you will. 

Lawrence: Yeah. It might. I think that the compounding, the FDA’s crackdown on Hims was very interesting to me because I think before the commissioner had come into his role, there was some speculation. He had worked for a telehealth company that prescribed compounded drugs. And there’s also, I think compounders have tried to tap into a little bit of the MAHA medical freedom aspect. But clearly that’s not been the case, at least at the FDA. They are clearly very upset about this and mean business, and I think it’s tying into their crackdown on direct-to-consumer drug advertising as well. But as far as price, yeah. I think the deals that Trump has managed to strike with the companies could actually be reducing price for patients. I think we’ll have to see. I know there’s obviously drug pricing programs as well that they could pursue. So, yeah, we’ll have to see.  

Rovner: All right. Well, we’re going to take a quick break. We will be right back. 

OK. We’re back. And speaking of President Trump, there’s also drug news this week that’s not directly related to the FDA. That’s the official unveiling of TrumpRx, the website the president says will lower drug prices like no one’s “ever seen before.” That’s a direct quote, by the way. Except it turns out that’s not quite the case. First, these discounts are only for people who are paying out-of-pocket, not those with insurance, which makes them valuable mostly for people who have no coverage or people who take drugs that insurance often doesn’t cover, like those for obesity or infertility. Yet of the 43 drugs so far that are promoted on the TrumpRx website, about half already have cheaper generic copies available through sites like GoodRx and Mark Cuban’s Cost Plus Drugs. And really, the website just points people to already existing manufacturer websites that were already offering those lower prices. So what is the point of TrumpRx? 

Lawrence: Great question. Yeah. This administration has been very focused on, obviously, media and wins and attaching President Trump’s name to things. So it accomplishes that goal. Maybe it does raise awareness for these other sites that already exist. But that’s a theme of a lot of the movement on health care so far, has been — there’s been a lot of chaos, and then there’s also sometimes things that they announce as like a grand, brand-new, no-one’s-ever-thought-of-it-before policy, but then there are already, of course, existing programs or avenues for that. 

Rovner: And to be fair, Trump has jawboned down some prices, including some prices for the obesity drugs, by basically dragging in the CEOs of these companies and saying, You will lower prices. 

Lawrence: Yeah, yeah. The dealmaking has been effective. And I think the question is: Will this last beyond his administration? Will there be a legacy there? 

Ollstein: I think there’s also some danger in overpromising, because he’s out there saying things that don’t comport with how math works. He’s basically suggesting prices will come down so many percents that we’ll be getting paid to take drugs, because that’s what more than 100% is. And people who are hearing that, voters who are hearing that, if they aren’t seeing that show up in their bills, if they’re not actually seeing those drastic, drastic drops that they’re being promised by the president, are they going to get upset? And is that going to impact how they vote? So yes, there has been some, on the margins, improvements, but when you’re out there promising 600% reductions and not delivering, there’s a risk to that. 

Rovner: Jackie, you wanted to add something. 

Fortiér: Well, I was going to say, I think it’s also confusing for a lot of people, from a consumer perspective, because you log on and I think people, they hear these huge promises, like Alice is talking about, and then they think that they can, necessarily, buy the drugs through there and immediately get them shipped, what these third parties like Hims and Weight Watchers are doing a lot of with the GLP-1s. And that’s not how this works. You still have another step of getting a prescription and then going to the pharmacy and using these to potentially get discounts and lower prices, in the same way that these have been available from pharmaceutical manufacturers and other things like GoodRx for years. But it’s that disconnect between, even if you can get a discount, actually getting the discount and crediting the Trump administration for that that I think is going to be really difficult for a lot of voters to make that connection in the way that the administration wants them to. 

Rovner: And this was ever the case with rebates — for other consumer products, not just talking about drugs. We’ll give you a $15 rebate, but you have to fill out 87 forms and send it to this place and get it exactly right, do it before the end date, and we’ll send you back $15. Because they count on most people not being able or willing to follow all of the various steps. So instead of giving everybody the discounted price, they make you really basically work for your discount, which is a consumer thing, but it’s pretty popular in the drug space as well. Rather than just lowering prices, they’re going to say, We will give you a discount, but you’re going to have to do this, that, and the other thing in order to get it. 

Fortiér: Right. But when you’re president and you want credit for it, it’s going to be a little more — it’s harder in order to make that connection. Sorry. 

Rovner: Yes, that’s true. That is a good point. All right, moving on. We have talked a lot about consolidation in the health care industry, particularly companies like UnitedHealthcare, which used to be just an insurer, now owns its own PBM [pharmacy benefit manager], its own claims processing company, and thousands of medical practices around the country. Well, now an extremely unlikely pair in the Senate, Massachusetts Democrat Elizabeth Warren and Missouri Republican Josh Hawley, have joined to introduce something called the Break Up Big Medicine Act, which would basically outlaw so-called vertical integration, like that of United and, to a somewhat lesser extent, Cigna and CVS Health, which owns Aetna, the insurer. Some are referring to this as the health version of the 1932 Glass-Steagall Act, which separated commercial from investment banking — and, side note, whose repeal in 1999 is considered a major factor setting off the financial crisis of 2008. But that was a risk thing. It was done to prevent another stock market crash like the one in 1929. This is a cost thing. This is to go after high health care costs. Could it work? Could it pass? And is this the beginning of the next big thing in health reform? 

Lawrence: Perhaps. Yeah. Last year, I worked with my colleagues on a series kind of examining UnitedHealth Group and the effects of consolidation on doctors and patients. And at the time, I think, there were some vocal lawmakers on either side of the aisle who were criticizing this, especially in the wake of the murder of the UnitedHealth CEO, and which had a surprising — the public sort of had this reaction and to— 

Rovner: Not in United’s favor. 

Lawrence: Not in United’s favor. And so I think that there is, this is a political issue that affects everyone, Republican and Democrat, the, well, cost in general, but I think there’s a lot of resentment and anger, and it seems like that is bringing together these unlikely and pretty powerful senators. I’m not an expert on the Hill. I don’t know if this has a chance. Especially, it’s targeting massive, powerful companies with hands in every part of the health care system. So it’s something that you would imagine the entire health care industry would fight against. But, yeah, I don’t know. 

Rovner: And I will point out that Sen. Josh Hawley, in addition to all his anti-abortion activities, last year, when Congress was debating the Medicaid cuts, kept vowing not to vote for those Medicaid cuts. So he’s — which, of course, in the end, he did — but he’s been sort of on the consumer side of health care for a while now. It’s just this is not brand new to him. 

Lawrence: Right. And I’m not sure how many other Republican senators would follow him down this path. But it’s definitely a noteworthy development, and curious to see where it goes. 

Rovner: Yeah, I’m curious to see sort of if the populist part of health care costs sort of rises to the fore. We’ll have to, we will have to watch that space. Well, finally this week, more on the impact of the Trump administration’s immigration crackdowns and health. My KFF Health News colleague Amy Maxmen has a story about health professionals in the U.S. Public Health Service Commissioned Corps actually resigning rather than accepting postings to Guantánamo Bay, Cuba, where some immigrants are being detained in prisons that used to hold al-Qaida suspects. Another KFF Health News story by Claudia Boyd-Barrett describes how when people detained by ICE [Immigration and Customs Enforcement] end up in the hospital, often their immediate families and their lawyers aren’t even allowed to know where. And remember, last week we talked about cases of measles in some immigration detention facilities. Well, now there are two confirmed cases of tuberculosis at the ICE facility at Fort Bliss in El Paso, Texas. I’m thinking maybe the health part of this is starting to kind of get to people as much as the whole depriving-civil-liberties part. 

Fortiér: Yeah, and there’s also been cases of covid-19, which makes sense. You’re going to have respiratory viruses as you get hundreds of people grouped together. That makes sense. A judge in California a couple days ago ordered that there had to be adequate health provided to detainees in one specific California — it was a prison and now it’s an ICE detainee facility. That’s specific to there, but it’s — more and more senators, I think, are also looking at this and pointing out that they’re just not providing the health facilities that people need. And especially ongoing care — a lot of folks need diabetes treatment, and that treatment just isn’t really happening in many cases. 

Rovner: Yeah, we’ve talked about this at some length, over many weeks, that people in detention are not getting health care, even though it is required, that we keep hearing stories about people not getting needed health care. I didn’t know until I read this story that people who actually end up being hospitalized, that their family members are not allowed to know. That’s allegedly, well, it is because of security, because the idea is that if somebody who’s in detention is in a hospital, you don’t necessarily want bad people knowing that and being able to come to the hospital. But these are people often who are, as we have documented at length, do not have criminal records, and it’s hard to find out where they are. Alice, you wanted to add something. 

Ollstein: Yeah. So there was a recent GAO [Government Accountability Office] report about this, and it found that people were not getting evaluated when they entered a facility to see if they were medically vulnerable and at risk of having a really bad episode or emergency, and that even children, pregnant women, vulnerable populations weren’t getting that initial evaluation, which then led to problems down the road. And it also said that people upon their release — either deportation or release within the United States if that’s what a court ordered — they weren’t being given their medical records, their prescriptions. And so the continuity of care was disrupted. And it’s important to note that that GAO report was about a few years ago under the Biden administration. So this isn’t new. These problems aren’t new, but they’re getting much worse, because the number of people detained is at record levels and so everything’s just getting multiplied. 

Rovner: Yeah, it is. Well, we will keep watching that space. OK, that’s this week’s news. Before we get to our extra credits, I am pleased to present the winner of our annual KFF Health News Health Policy Valentine contest. It’s from [Andrew Carleen] of Massachusetts, based on a story about Medicare Advantage overpayments. And it goes like this: “I thought it was love. My heart felt spring-loaded. Turns out our relationship was significantly upcoded.” Congratulations, and happy Valentine’s Day to all. 

OK, now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Alice, why don’t you start us off this week? 

Ollstein: Sure. So I have a kind of fun story [“Why Washington’s All-In on Smart Rings”] from my co-worker Amanda Chu about how the Oura ring has taken over D.C. They have been heavily lobbying the Trump administration and Congress to prevent tough regulations. Basically, there’s a debate about whether it should be regulated as a medical device or not. 

Rovner: Tell us again what it does. 

Ollstein: It’s a ring you wear on your finger that monitors different health metrics. And so the Trump administration MAHA movement has gone all in on this. They love it. The Pentagon has a huge contract with them. Other government agencies are looking at it, too. I think it’s interesting because it is this very sort of conservative mindset of individual responsibility in health care and, oh, if you could just track your own metrics and do the right things. That’s an approach that is sort of counter to the idea of public health and government protecting your health through policy. 

Rovner: And we know HHS Secretary Kennedy is a big fan of wearables. 

Ollstein: Exactly, and this is one of the most popular ones right now. And so this story does a good job digging into all the lobbying and also into concerns about data privacy and pointing out that these technologies are moving much faster than government can regulate them. And that is leaving some lawmakers really concerned about who could have access to this data. 

Rovner: Jackie. 

Fortiér: Mine is by Ariana Hendrix. She’s a writer based in Norway. It’s entitled “The New Childhood Vaccine Guidelines Have a Paid Leave Problem.” It was published in Stat. And she writes eloquently about being a parent in Norway and knowing that her children wouldn’t go to day care until they were about 16 months old, because Norway has paid parental leave. And she points out, beyond the vaccine debate there’s a bigger issue, that the U.S. lacks universal health care and federal paid parental leave. So changes in infant vaccines in the U.S. have a large effect, because babies in the U.S. often go to day care, when they’re around a lot of other kids when they’re just a few weeks old. So she points to the, in January, the infant RSV [respiratory syncytial virus] vaccine was moved to the high-risk category of shots, so now it isn’t routinely recommended for all babies in the U.S. And RSV, of course, is the most common cause of hospitalizations for infants, and that’s due to the fact that they’re exposed to the virus in day care a lot earlier than other children in other countries like Norway and Denmark whose vaccine schedules U.S. officials are now kind of trying to emulate. So she does a really great job of laying out how families face greater health and financial risks in the U.S. without the same safety net that other countries have. 

Rovner: Or just the same social policies that other countries have. 

Fortiér: Yeah, it reminded me— 

Rovner: It’s hard to, right, it’s hard to import another country’s — part of another country’s — policies without importing all of them. It is really good story. Lizzy. 

Lawrence: Yeah. So my piece is by Rachana Pradhan and KFF Health News, and it’s about the “US Cancer Institute Studying Ivermectin’s ‘Ability To Kill Cancer Cells.’” And I thought this piece was very interesting, just because in general I’ve been fascinated by — politicization of medicine isn’t new — but just like right-wing-coded products and left-wing-coded products. And in this piece, Rachana talks about NIH [National Institutes of Health] Director Jay Bhattacharya kind of talking about how, It’s the people’s NIH and if a lot of people are using it, well, we want to investigate it. So she just, she does a really good job of kind of unpacking why this is problematic, that they’re kind of just choosing a random medication and there’s not really any scientific reason to be investing in it as much as they are. And she got a response from NIH after the fact as well, kind of where they were trying to defend this decision to pour this much investment. And so, yeah, I think it’s just a really interesting development in NIH land. 

Rovner: It is. My extra credit this week is from ProPublica, by Mica Rosenberg, and it’s called “The Children of Dilley.” It’s about what immigration detention looks like from the point of view of children being held at a family facility in Dilley, Texas. That’s the one where the two cases of measles were diagnosed earlier this winter. The story includes some pretty wrenching letters and video calls from kids who were living elsewhere in the U.S., while their parents were mostly working within the immigration system. And these kids had been ripped from their daily lives, their other parents and siblings in some cases, their schools and their classmates, and in many cases, from hope itself. Wrote one 14-year-old from Hicksville, New York, quote: “Since I got to this Center all you will feel is sadness and mostly depression.” It really is a must-read story. 

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

Fortiér: Bluesky mainly, @jackie-fortier. 

Rovner: Alice. 

Ollstein: Mainly on Bluesky, @alicemiranda, and still on X, @AliceOllstein. 

Rovner: Lizzy. 

Lawrence: On X, @LizzyLaw_. On Bluesky, @lizzylawrence. 

Rovner: We’ll be back in your feed next week. Until then, be healthy. 

Credits

Click here to find all our podcasts.

And subscribe to “What the Health? From KFF Health News” on Apple Podcasts, Spotify, the NPR app, YouTube, Pocket Casts, or wherever you listen to podcasts.

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.

USE OUR CONTENT

This story can be republished for free (details).

To ensure it tastes good and is safe to drink, a small team of scientists and technicians is constantly testing the water for pH, odors, heavy metals, and microbes.

But unlike many smaller municipal utilities in the U.S., Louisville Water regularly checks for PFAS — per- and polyfluoroalkyl substances.

That’s a class of chemicals used by manufacturers for decades to make things like nonstick pans, cosmetics, raincoats, food wrappers, and firefighting foam.

Research studies have linked PFAS to health risks like cancer, reduced immune system functioning, high cholesterol, and developmental delays in children.

They’re also known as “forever chemicals” because their strong chemical structures make them degrade incredibly slowly in the environment.

Today, they litter soil and water sources around the world and can be found in the blood of almost everyone in the U.S.

One type of PFAS that the Louisville water technicians are tracking is HFPO-DA, also known by a trade name, GenX.

Just over a year ago, workers noticed an unexpected increase in the level of GenX detected in a sample of the raw, untreated water drawn from the Ohio River for filtering and processing.

The GenX levels Louisville found in December 2024 were 15 times the reading from the previous month: 52 parts per trillion versus 3.4 ppt.

“A part per trillion is like one second in 32,800 years. Put your head around that, right?” said Peter Goodmann, the city utility’s director of water quality and research.

He offered another way to think of it: One part per trillion would be a single drop of water in 20 Olympic swimming pools.

Goodmann told KFF Health News and NPR he wasn’t worried about local customers’ safety, because the increased levels were still pretty low.

Risks posed by low PFAS concentrations are measured over a lifetime of exposure, he said. And recent data from Louisville shows the PFAS levels in city drinking water fell back within planned federal safety limits.

Plus, water is just one way people can be exposed to PFAS, Goodmann added. “Because you get a lot more of these pollutants from packaging, from prefixed food, cake mixes, weird things, you know, popcorn boxes,” he said.

Louisville Water’s data showed that the elevated levels of GenX in the water sample drawn in December 2024 fell once the water underwent typical treatment and filtering.

Federal Regulation Fight

The federal government has long regulated the levels of certain contaminants in drinking water, such as arsenic, E. coli, and lead.

But the Environmental Protection Agency didn’t issue regulations regarding PFAS until 2024, during the final year of the Biden administration. The new limits applied to six types of PFAS in drinking water. Starting in 2029, utilities that exceeded the limits would have been required to treat the water to reduce the contamination.

But after Donald Trump’s reelection, new EPA administrator Lee Zeldin announced the agency will keep the rules for only two types of PFAS, called PFOA and PFOS, but drop the restrictions on the other four types, including GenX.

In addition, the EPA announced it will give water utilities two additional years, until 2031, to comply with the remaining rules, attributing the change in part to the financial burden on rural water plants.

Many utilities, large and small, may need to invest in infrastructure to remove PFAS.

A federal study estimated about 45% of U.S. tap water contains at least one type of PFAS.

When it announced the final PFAS limits, the Biden administration anticipated that up to 10% of the estimated 66,000 U.S. public drinking water systems affected by these regulations might have PFAS levels high enough to require them to take action to reduce the contamination.

Finding the Source

Goodmann’s team traced the increased levels of PFAS up the Ohio River, past Cincinnati, and through Appalachian forests, all the way to a West Virginia factory about 400 miles upstream.

There, the Chemours Co. uses GenX to make fluoropolymers, a plastic critical to the semiconductors that power phones.

Its Washington Works facility near Parkersburg, West Virginia, has a history of PFAS pollution.

A lawyer, Robert Bilott, fought the plant’s previous owner, DuPont, in court, ultimately revealing the company knew that a type of PFAS it was using, PFOA, was toxic but didn’t disclose that information.

DuPont went on to settle various lawsuits that claimed it contaminated local environments with forever chemicals. The company has repeatedly denied wrongdoing.

Chemours was spun off from DuPont in 2015.

The Louisville Water team’s calculations eventually showed that the December 2024 spike in GenX levels corresponded to publicly available data from Chemours about its chemical discharges into the Ohio River.

In Chemours’ responses to a lawsuit filed by a West Virginia environmental group, the company denied its discharges were connected to Louisville’s GenX spike. (Louisville is not a party in the lawsuit.)

The company also contended that sampling data showed levels of GenX in the river and in downstream utilities’ treated drinking water are “indisputably safe.”

PFAS Removal Will Challenge Water Utilities

Under current federal environmental regulations, Chemours can release some chemicals into the Ohio River. But it has exceeded the legal limits repeatedly over several years, according to court filings and the EPA.

That’s why the West Virginia Rivers Coalition filed its lawsuit in 2024.

The EPA took enforcement action in 2023, when it said it found Chemours’ West Virginia factory had repeatedly exceeded permit limits for two types of forever chemicals, GenX and PFOA.

But the West Virginia Rivers Coalition said in a court filing that the EPA’s consent order for Chemours “is not being diligently prosecuted.”

Chemours declined to answer questions from KFF Health News and NPR, citing ongoing litigation, except to point out that Louisville’s “finished drinking water is safe for consumption,” with PFAS levels below the EPA’s regulatory limits, as stated on Louisville Water’s website and in the annual water quality report from Cincinnati, which also draws from the Ohio River.

As research into the health effects of PFAS exposure continues, environmental advocates say it’s imperative for companies to meet the limitations set by government permits.

“Environmental regulatory permitting is a license to pollute,” said Nick Hart, the water policy director for the Kentucky Waterways Alliance.

“You’re permitting someone to put something into the atmosphere, into water, into soil that would not be there otherwise. And so when we talk about the safe levels,” he said, “stop using the word ‘safe,’ right? This is the maximum allowable limit.”

It is possible to remove PFAS from drinking water. For example, Louisville’s utility is spending about $23 million to redesign its powdered activated carbon system, which is one method used to take out PFAS.

But PFAS removal can get expensive, especially for small, rural towns, Hart said. Preventing contaminants such as PFAS from getting into a community’s drinking water supply is easier and less costly compared with removing it on the back end, he added.

In Chemours’ responses to the lawsuit, the company acknowledged that its violating its current permit but noted it’s working with government regulators on an eventual fix.

The federal judge in the case, Joseph Goodwin, decided that wasn’t fast enough.

In August, he ordered Chemours to immediately stop overpolluting. The company quickly filed an appeal.

The West Virginia Rivers Coalition declined to speak with KFF Health News and NPR but did point to its August news release on the judge’s ruling.

“This is a victory for public health and the Ohio River,” Autumn Crowe, the organization’s deputy director, said in the statement. “The Court recognized what communities have known for years: Chemours has been polluting our water and ignoring its legal obligations.”

In a court filing for the case, Goodmann said that elevated levels of GenX could make it more challenging for water utilities such as Louisville’s to comply with federal rules for safe drinking water.

In regard to Chemours specifically, Goodmann told KFF Health News and NPR that when government regulators issue the company’s next permit, he wants them to take into account the water treatment plants downstream.

“So what we do is manage risk, and we start that at the river,” he said. “It sounds weird, but source water protection — keeping the stuff out of the river — is a big deal.”

This article is from a partnership that includes Louisville Public Media, NPR, and KFF Health News.

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.

USE OUR CONTENT

This story can be republished for free (details).

Ese destino reunía dos promesas de Trump: su viejo anhelo de usar la base que está fuera del país para sacar a “tipos malos” de Estados Unidos y el compromiso, que hizo poco después de asumir la presidencia el año pasado, de llevar allí a miles de personas sin ciudadanía estadounidense. La base naval es conocida por el uso de tortura y el trato inhumano hacia hombres sospechosos de terrorismo después de los ataques del 11 de septiembre de 2001.

“Las asignaciones normalmente no se pueden rechazar”, dijo Stewart. Pero le rogó a la oficina de coordinación y finalmente encontraron a otra enfermera para reemplazarla.

Oficiales del Servicio de Salud Pública que trabajaron en Guantánamo el año pasado describieron las condiciones en las que se encontraban los detenidos, algunos de los cuales se enteraron de que estaban en Cuba gracias a los médicos y enfermeros enviados para atenderlos.

Estos funcionarios dijeron que habían tratado a inmigrantes que estaban detenidos en una prisión oscura llamada Camp 6, donde no entra la luz del sol.

KFF Health News acordó no revelar los nombres de estos oficiales porque temen sufrir represalias por lo que han contado. Antes, esa cárcel había albergado a personas con supuestos vínculos con al-Qaeda. Los oficiales dijeron que no recibieron información previa sobre las tareas que podrían desempeñar en la base.

Aunque el Servicio de Salud Pública no es parte de las Fuerzas Armadas de Estados Unidos, sus oficiales —unos 5.000 médicos, enfermeras y otros trabajadores de salud— están uniformados y actúan como soldados con estetoscopio en situaciones de emergencia. El gobierno los despliega ante catástrofes naturales, como huracanes, o en el caso de incendios forestales, tiroteos masivos y brotes de sarampión. En tiempos normales, ocupan puestos en distintas agencias federales.

Las detenciones masivas ordenadas por el gobierno de Trump para frenar la inmigración han creado una nueva clase de emergencia de salud pública, ya que la cantidad de personas en custodia alcanza cifras récord. Según datos de la Oficina de Inmigración y Control de Aduanas (ICE, por sus siglas en inglés), actualmente hay unos 71.000 inmigrantes encarcelados; la mayoría sin antecedentes penales.

Kristi Noem, secretaria de Seguridad Nacional, recordó: “El presidente Donald Trump ha sido muy claro: Guantánamo albergará a lo peor de lo peor”. Sin embargo, varios medios han informado que muchos de los hombres enviados a la base no tienen condenas criminales. Un informe preliminar de ICE, publicado en mayo, reveló que hasta el 90% fue clasificado como “de bajo riesgo”.

Según The New York Times, el gobierno de Trump ha enviado a Guantánamo, de manera irregular y por etapas, a unos 780 no ciudadanos. La cifra varía a medida que llegan nuevos detenidos y otros son devueltos a Estados Unidos o deportados a terceros países.

Si bien algunos oficiales del Servicio de Salud Pública ya habían brindado atención médica a inmigrantes detenidos en el pasado, esta es la primera vez en la historia de Estados Unidos que Guantánamo se utiliza para alojar a inmigrantes que residían en el país. Los oficiales dijeron que las asignaciones a ICE se están volviendo cada vez más frecuentes. Tras esquivar Guantánamo, a Stewart se le ordenó presentarse en un centro de detención de ICE en Texas.

“A los oficiales de salud pública se nos está pidiendo que contribuyamos a una crisis humanitaria creada deliberadamente”, afirmó.

Como no encontró la manera de rechazar misiones que consideraba inaceptables, Stewart, tras una década de servicio, renunció. Esto significó que también perdió la posibilidad de obtener una pensión que se otorga después de 20 años en esa función.

“Fue una de las decisiones más difíciles que he tomado”, contó. “Era el trabajo de mis sueños”.

Una de sus colegas en el Servicio de Salud Pública, la enfermera Dena Bushman, enfrentó un dilema moral similar cuando recibió una notificación para presentarse en Guantánamo pocas semanas después del tiroteo en los Centros para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglés) en agosto. Bushman, que trabajaba en los CDC, pospuso su presentación gracias a un permiso médico debido al estrés y al duelo. Pero comenzó a preguntarse si debía renunciar y finalmente lo hizo.

“Puede sonar exagerado”, dijo Bushman. “Pero cuando estaba tomando esta decisión, no podía evitar pensar que quienes alimentaban a los prisioneros en los campos de concentración también eran parte del régimen nazi”.

Aunque otros han renunciado, muchos oficiales decidieron permanecer en sus cargos. Están alarmados por las tácticas de Trump, pero también piensan que las personas detenidas necesitan atención médica, argumentaron varios oficiales del Servicio de Salud Pública a KFF Health News.

“Hacemos lo mejor que podemos para atender a la gente en este desastre”, dijo una enfermera que trabajó en centros de detención el año pasado.

“Respeto a las personas y las trato como seres humanos”, añadió. “Intento ser una luz en la oscuridad, la mujer que logra sacar una sonrisa en medio de este horrible caos”.

Los oficiales admitieron que su capacidad para proteger a los detenidos es limitada, en un sistema que se caracteriza por el hacinamiento, la desorganización y el trauma psicológico derivado de la incertidumbre, las separaciones familiares y la privación del sueño.

“Garantizar la seguridad, protección y bienestar de quienes están bajo nuestra custodia es una máxima prioridad para el ICE”, dijo Tricia McLaughlin, vocera principal del Departamento de Seguridad Nacional, en un comunicado enviado por correo electrónico a KFF Health News.

El almirante Brian Christine, secretario adjunto de Salud del Departamento de Salud y Servicios Humanos (HHS, por sus siglas en inglés), que supervisa el Servicio de Salud Pública, escribió en un correo electrónico: “Nuestro deber es claro: decir ‘¡Sí, señor!’, saludar con firmeza y cumplir la misión: presentarse, brindar atención humanitaria y proteger la salud”. Christine fue designado recientemente. Hasta hace poco era urólogo, especializado en testosterona y fertilidad masculina.

“En la búsqueda de una moralidad subjetiva o de demostraciones públicas de virtud —agregó—, corremos el riesgo de abandonar a las mismas personas a las que prometimos servir”.

Hacia lo desconocido

En los meses previos a su renuncia, Stewart reflexionó sobre misiones que tuvo durante el primer mandato de Trump, cuando la enviaron a centros de procesamiento migratorio operados por la Oficina de Aduanas y Protección Fronteriza. Recordó una celda de cemento en Texas donde se encontraban detenidas 50 mujeres.

“Lo más significativo que logré fue convencer a los guardias de que les permitieran a las mujeres, que llevaban una semana allí, tomar una ducha”, dijo. “Presencié enormes sufrimientos, sin tener muchas herramientas para aliviarlos”.

Stewart conversó con Bushman y otros oficiales del Servicio de Salud Pública que estaban en los CDC el año pasado. Allí colaboraban en la respuesta a brotes de sarampión o investigaciones sobre infecciones de transmisión sexual, entre otras tareas. Su presencia se volvió crucial luego de que la administración Trump despidiera a gran parte de los empleados de los CDC.

Stewart, Bushman y algunos otros funcionarios del Servicio de Salud Pública en los CDC contaron que se reunieron con mandos intermedios para pedir información sobre las asignaciones.

Si iban a Guantánamo y a centros del ICE, ¿cuánta autoridad tendrían para brindar la atención médica que consideraban necesaria? Si veían algo poco ético, ¿cómo podían denunciarlo? ¿Se investigaría? ¿Estarían protegidos contra las represalias?

Stewart y Bushman dijeron que solo les dieron el número de teléfono de una oficina del USPHS al que podían llamar si tenían alguna queja mientras estuvieran asignados. Por lo demás, afirmaron que sus preguntas quedaron sin respuesta. Renunciaron y, por lo tanto, nunca fueron a Guantánamo.

Oficiales del PHS que sí fueron enviados a la base dijeron a KFF Health News que no recibieron detalles sobre sus posibles funciones —ni sobre los protocolos para la atención médica— antes de llegar.

Stephen Xenakis, general retirado del Ejército y psiquiatra que ha asesorado sobre atención médica en Guantánamo durante dos décadas, dijo que eso era preocupante. Señaló que el personal de salud debería saber qué se espera de ellos antes de ser enviado.

Las consecuencias de una preparación insuficiente pueden ser graves.

En 2014, la Marina amenazó con llevar a una corte marcial a uno de los enfermeros destinados a Guantánamo porque se había negado a alimentar por la fuerza a prisioneros en huelga de hambre, que protestaban por el trato inhumano y la detención indefinida.

El protocolo era brutal: el prisionero era inmovilizado en una silla con cinco puntos de sujeción mientras los enfermeros le introducían una sonda por la nariz hasta el estómago para administrarle alimento líquido.

“No recibió instrucciones claras sobre cómo se realizarían estos procedimientos en Guantánamo”, explicó Xenakis. “Hasta que lo vio, no entendía lo doloroso que era para los detenidos”.

La Asociación Estadounidense de Enfermeros y la organización Médicos por los Derechos Humanos respaldaron al enfermero, afirmando que su objeción se basaba en principios éticos profesionales. Un año después, el ejército retiró los cargos.

El poder de un médico o de un enfermero uniformado suele depender de su rango, de su supervisor y de las cadenas de mando, agregó Xenakis. Él ayudó a poner fin a algunas prácticas inhumanas en Guantánamo hace más de una década, cuando junto con otros generales y almirantes retirados expresaron públicamente su rechazo a ciertas técnicas de interrogatorio, por ejemplo, una conocida como “walling”, en la que los interrogadores golpeaban la cabeza de personas detenidas sospechosas de terrorismo contra una pared, provocándoles leves conmociones cerebrales.

Xenakis sostuvo que la ciencia no respaldaba el “walling” como un método eficaz de interrogatorio y que, además, era una práctica poco ética, equivalente a la tortura.

No se han denunciado casos de tortura en la operación migratoria  en Guantánamo, pero informes internos de ICE, obtenidos a través de una solicitud de la Freedom of Information Act (Ley de Libertad de Información) por parte de American Oversight, un grupo que vigila acciones gubernamentales, apuntan a la preocupación por los detenidos que recurren a huelgas de hambre y autolesiones.

“Controles de bienestar ante posibles huelgas de hambre de IA”, indica una nota del 30 de abril de un contratista que trabaja con el ICE. IA es la sigla de illegal aliens (extranjeros en situación irregular). El informe agrega que, “en caso de una huelga de hambre u otras emergencias”, el Servicio de Salud Pública (PHS) y el ICE coordinarán políticas y procedimientos.

“Reducción de la posible huelga de hambre a nivel del módulo/posibles disturbios”, dice un registro del 8 de julio. “Hablar con el extranjero que se encuentra bajo vigilancia por riesgo de suicidio para evaluar su bienestar”.

Informes e investigaciones han señalado demoras en la atención médica y condiciones peligrosas en centros de detención migratoria, como hacinamiento y falta de higiene.

En 2025, murieron 32 personas bajo custodia del ICE, lo que lo convirtió en el año más letal en dos décadas.

“Están arrestando y deteniendo a más personas de las que sus instalaciones pueden albergar”, comentó un oficial del Servicio de Salud Pública. El problema más frecuente que este oficial observó entre los inmigrantes encarcelados es psicológico. Les preocupaba no volver a ver a sus familias o ser deportados a países donde temían ser asesinados. “La gente está aterrada”, dijo el oficial.

Sin la luz del sol

Los oficiales que estuvieron en Guantánamo dijeron que los hombres detenidos se alojaban en barracas de baja seguridad, con unas pocas personas por cuarto, o en Camp 6, una instalación de alta seguridad que no tiene luz natural.

Los informes del ICE distinguen las dos áreas por su ubicación en la isla: Leeward para las barracas y Windward para Camp 6. Unos 50 cubanos enviados a Guantánamo entre diciembre y enero han permanecido en Camp 6.

Un hospital naval de la base atiende principalmente a personal militar y residentes que no están detenidos, y tiene capacidad limitada, contaron los oficiales.

Para evitar costosas evacuaciones médicas a Estados Unidos, los inmigrantes fueron evaluados antes de ser trasladados a Guantánamo. En general, se excluyeron a personas mayores de 60 años o que requerían medicación diaria para diabetes o hipertensión. Aun así, algunos detenidos han tenido que ser evacuados de regreso a Florida.

Médicos y enfermeros del Servicio de Salud Pública dijeron que volvían a evaluar a los detenidos cuando llegaban y ofrecían atención continua, tratando casos de malestar gastrointestinal y depresión. Un informe mensual del ICE señala: “El psicólogo del USPHS inició un grupo de ejercicio” para los detenidos.

Las solicitudes de estudios médicos solían ser rechazadas por obstáculos logísticos y por la cantidad de agencias involucradas en la base. Incluso una prueba de laboratorio común, como un hemograma completo, tardaba semanas, cuando en Estados Unidos toma solo unas horas.

El Departamento de Seguridad Nacional y el Departamento de Defensa, que coordinan la operación migratoria en Guantánamo, no respondieron a solicitudes de comentarios.

Un oficial que ayudaba en los chequeos médicos iniciales dijo que muchos detenidos se sorprendían al enterarse de que estaban en Guantánamo.

“Les decía: ‘Lamento que estés aquí’”, contó. “Nadie se alteraba. Era la enésima vez que los trasladaban”. Algunos llevaban cinco o seis meses detenidos en distintos centros y querían volver a sus países. El personal de salud no tenía respuesta ni solución.

A diferencia de los centros del ICE en Estados Unidos, Guantánamo no ha estado sobrepoblado. “Nunca he estado tan desocupada”, dijo una oficial. Guantánamo, una base militar en una isla tropical, ofrece actividades como esnórquel, yoga y kickboxing para quienes no están presos. Aun así, la oficial dijo que preferiría estar en su casa y no en esa misión pagada con fondos públicos.

Transportar personal e insumos a la isla y mantenerlos en la base es sumamente costoso. Según un análisis de The Washington Post de 2025 basado en datos del Departamento de Defensa, el gobierno gastaba unos $16.500 al día por cada detenido en Guantánamo. (En comparación, el costo promedio por detenido en un centro del ICE en Estados Unidos es de $157 diarios).

Aun así, el presupuesto ha aumentado: el Congreso otorgó al ICE una cifra récord de $78.000 millones para el año fiscal 2026, muy por encima de los $9.900 millones de 2024 y los $6.500 millones de hace casi una década.

El año pasado, la administración Trump también derivó más de $2.000 millones del presupuesto de defensa nacional hacia operaciones migratorias, según un informe de congresistas demócratas. De ese monto, unos $60 millones se destinaron a Guantánamo.

“Detener a no ciudadanos en Guantánamo es mucho más costoso y complejo logísticamente que hacerlo en centros del ICE dentro de Estados Unidos”, escribió Deborah Fleischaker, ex subdirectora del ICE, en una declaración presentada como parte de una demanda de la Unión Americana de Libertades Civiles (ACLU, por sus siglas en inglés) a comienzos del año pasado.

En diciembre, un juez federal rechazó la petición del gobierno de Trump para desestimar otro caso de la ACLU que cuestionaba la legalidad de detener inmigrantes fuera del país.

Anne Schuchat, quien sirvió en el Servicio de Salud Pública por 30 años antes de jubilarse en 2018, advirtió que estas misiones podrían tener consecuencias para la seguridad del país. “Una de las mayores preocupaciones siempre ha sido tener suficientes oficiales disponibles para emergencias de salud pública”, recordó.

Andrew Nixon, vocero del Departamento de Salud y Servicios Humanos, afirmó que las asignaciones migratorias no afectan la capacidad de respuesta del Servicio de Salud Pública ante otras emergencias.

En el pasado, estos oficiales han montado refugios médicos durante huracanes en Louisiana y Texas, implementado pruebas de covid en los primeros meses de la pandemia, y brindado apoyo tras la masacre en la escuela Sandy Hook y el atentado en la Maratón de Boston.

“Es importante que la gente sepa cuántos recursos del gobierno se están usando para que la administración actual pueda llevar adelante esta agenda”, dijo Stewart, una de las enfermeras que renunció. “Esta es una de las cosas que probablemente nos está convirtiendo en el tipo de países contra los que alguna vez estuvimos en guerra”.

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.

USE OUR CONTENT

This story can be republished for free (details).

“There are enough reports of it, enough interest in it, that we actually did — ivermectin, in particular — did engage in sort of a better preclinical study of its properties and its ability to kill cancer cells,” said Anthony Letai, a physician the Trump administration appointed as NCI director in September.

Letai did not cite new evidence that might have prompted the institute to research the effectiveness of the antiparasitic drug against cancer. The drug, largely used to treat people or animals for infections caused by parasites, is a popular dewormer for horses.

“We’ll probably have those results in a few months,” Letai said. “So we are taking it seriously.”

He spoke about ivermectin at a Jan. 30 event, “Reclaiming Science: The People’s NIH,” with National Institutes of Health Director Jay Bhattacharya and other senior agency officials at Washington, D.C.’s Willard Hotel. The MAHA Institute hosted the discussion, framed by the “Make America Healthy Again” agenda of Health and Human Services Secretary Robert F. Kennedy Jr. The National Cancer Institute is the largest of the NIH’s 27 branches.

During the covid pandemic, ivermectin’s popularity surged as fringe medical groups promoted it as an effective treatment. Clinical trials have found it isn’t effective against covid.

Ivermectin has become a symbol of resistance against the medical establishment among MAHA adherents and conservatives. Like-minded commentators and wellness and other online influencers have hyped — without evidence — ivermectin as a miracle cure for a host of diseases, including cancer. Trump officials have pointed to research on ivermectin as an example of the administration’s receptiveness to ideas the scientific establishment has rejected.

“If lots of people believe it and it’s moving public health, we as NIH have an obligation, again, to treat it seriously,” Bhattacharya said at the event. According to The Chronicle at Duke University, Bhattacharya recently said he wants the NIH to be “the research arm of MAHA.”

The decision by the world’s premier cancer research institute to study ivermectin as a cancer treatment has alarmed career scientists at the agency.

“I am shocked and appalled,” one NCI scientist said. “We are moving funds away from so much promising research in order to do a preclinical study based on nonscientific ideas. It’s absurd.”

KFF Health News granted the scientist and other NCI workers anonymity because they are not authorized to speak to the press and fear retaliation.

HHS and the National Cancer Institute did not answer KFF Health News’ questions on the amount of money the cancer institute is spending on the study, who is carrying it out, and whether there was new evidence that prompted NCI to look into ivermectin as an anticancer therapy. Emily Hilliard, an HHS spokesperson, said NIH is dedicated to “rigorous, gold-standard research,” something the administration has repeatedly professed.

A preclinical study is an early phase of research conducted in a lab to test whether a drug or treatment may be useful and to assess potential harms. These studies take place before human clinical trials.

The scientist questioned whether there is enough initial evidence to warrant NCI’s spending of taxpayer funds to investigate the drug’s potential as a cancer treatment.

The FDA has approved ivermectin for certain uses in humans and animals. Tablets are used to treat conditions caused by parasitic worms, and the FDA has approved ivermectin lotions to treat lice and rosacea. Two scientists involved in its discovery won the Nobel Prize in 2015, tied to the drug’s success in treating certain parasitic diseases.

The FDA has warned that large doses of ivermectin can be dangerous. Overdoses can cause seizures, comas, or death.

Kennedy, supporters of the MAHA movement, and some conservative commentators have promoted the idea that the government and pharmaceutical companies quashed ivermectin and other inexpensive, off-patent drugs because they’re not profitable for the drug industry.

“FDA’s war on public health is about to end,” Kennedy wrote in an October 2024 X post that has since gone viral. “This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma.”

Previous laboratory research has shown that ivermectin could have anticancer effects because it promotes cell death and inhibits the growth of tumor cells. “It actually has been studied both with NIH funds and outside of NIH funds,” Letai said.

However, there is no evidence that ivermectin is safe and effective in treating cancer in humans. Preliminary data from a small clinical trial that gave ivermectin to patients with one type of metastatic breast cancer, in combination with immunotherapy, found no significant benefit from the addition of ivermectin.

Some physicians are concerned that patients will delay or forgo effective cancer treatments, or be harmed in other ways, if they believe unfounded claims that ivermectin can treat their disease.

“Many, many, many things work in a test tube. Quite a few things work in a mouse or a monkey. It still doesn’t mean it’s going to work in people,” said Jeffery Edenfield, executive medical director of oncology for the South Carolina-based Prisma Health Cancer Institute.

Edenfield said cancer patients ask him about ivermectin “regularly,” mostly because of what they see on social media. He said he persuaded a patient to stop using it, and a colleague recently had a patient who decided “to forgo highly effective standard therapy in favor of ivermectin.”

“People come to the discussion having largely already made up their mind,” Edenfield said.

“We’re in this delicate time when there’s sort of a fundamental mistrust of medicine,” he added. “Some people are just not going to believe me. I just have to keep trying.”

A June letter by clinicians at Cincinnati Children’s Hospital Medical Center in Ohio detailed how an adolescent patient with metastatic bone cancer started taking ivermectin “after encountering social media posts touting its benefits.” The patient — who hadn’t been given a prescription by a clinician — experienced ivermectin-related neurotoxicity and had to seek emergency care because of nausea, fatigue, and other symptoms.

“We urge the pediatric oncology community to advocate for sensible health policy that prioritizes the well-being of our patients,” the clinicians wrote.

The lack of evidence about ivermectin and cancer hasn’t stopped celebrities and online influencers from promoting the notion that the drug is a cure-all. On a January 2025 episode of Joe Rogan’s podcast, actor Mel Gibson claimed that a combination of drugs that included ivermectin cured three friends with stage 4 cancer. The episode has been viewed more than 12 million times.

Lawmakers in a handful of states have made the drug available over the counter. And Florida — which, under Republican Gov. Ron DeSantis, has become a hotbed for anti-vaccine policies and the spread of public health misinformation — announced last fall that the state plans to fund research to study the drug as a potential cancer treatment.

The Florida Department of Health did not respond to questions about that effort.

Letai, previously a Dana-Farber Cancer Institute oncologist, started at the National Cancer Institute after months of upheaval caused by Trump administration policies.

“What you’re hearing at the NIH now is an openness to ideas — even ideas that scientists would say, ‘Oh, there’s no way it could work’ — but nevertheless applying rigorous scientific methods to those ideas,” Bhattacharya said at the Jan. 30 event.

A second NCI scientist, who was granted anonymity due to fear of retaliation, said the notion that NIH was not open to investigating the value of off-label drugs in cancer is “ridiculous.”

“This is not a new idea they came up with,” the scientist said.

Letai didn’t elaborate on whether NCI scientists are conducting the research or if it has directed funding to an outside institution. Three-quarters of the cancer institute’s research dollars go to outside scientists.

He also aimed to temper expectations.

“At least on a population level,” Letai said, “it’s not going to be a cure-all for cancer.”

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.

USE OUR CONTENT

This story can be republished for free (details).

Ballad Health announced in January that it would spend about $44 million to rebuild the 10-bed Unicoi County Hospital in a field behind a Walmart in Unicoi, Tennessee, about 7 miles from the shuttered hospital that was the site of catastrophic flooding and a daring helicopter rescue on Sept. 27, 2024.

But the new location also faces significant flood risk, according to a KFF Health News review of information from Fathom and First Street, two climate data companies whose flood modeling is considered more sophisticated than outdated flood maps published by the Federal Emergency Management Agency. Both Fathom and First Street estimate that a 100-year flood — a weather event more common and less intense than Helene — could cover much of the hospital site with more than 2 feet of water.

“The proposed site is so obviously a flood plain geomorphologically,” said Oliver Wing, chief scientific officer at Fathom. “You don’t need a model to see that.”

Wing said the new hospital site was actually more likely to flood than the old site and “very risky” for development due to a nearby creek and potential storm runoff from mountains to the west. But the flooding would be less powerful than at the old site, Wing said, and its impact could be lessened by elevating the hospital or building earthen embankments.

Ballad Health confirmed the new hospital location but did not respond to questions about flood risk or defenses planned for the site. In a brief written statement, spokesperson Molly Luton said Ballad was working with geotechnical professionals, Zurich Insurance Group, and a high-profile architecture firm in Nashville, Earl Swensson Associates, to “plan and build a safe hospital for the Unicoi County community.” Luton said Ballad is also working with FEMA, which is providing about $7.4 million for the rebuild.

FEMA has served as the nation’s de facto authority for estimating flood risk for half a century, and its flood maps generally determine which buildings must be designed to withstand a flood. But those maps are often incomplete and do not account for the impacts of climate change. FEMA’s flood maps of Unicoi, last updated in 2008, do not identify the new hospital site as a flood hazard zone.

Nationwide, FEMA maps don’t capture much of the flood risk identified by Fathom and First Street, which use sophisticated computer models and detailed terrain data to create flood simulations that are relied on by major developers, insurance companies, and government agencies. First Street publishes much of its modeling online, while Fathom shared data with KFF Health News through a data-use agreement.

Chad Berginnis, executive director of the Association of State Floodplain Managers, said that while the hilly terrain of northeastern Tennessee may limit Ballad’s options to rebuild, it should not ignore the data from Fathom and First Street or rely purely on FEMA’s maps, which suggest the hospital could be built with minimal flood protections.

If Ballad builds behind the Walmart, Berginnis said, it should follow the latest standards from the American Society of Civil Engineers, which recommend elevating hospitals enough to withstand a 1,000-year flood — like the one caused by Helene.

According to those standards and Google Earth elevation data, that could require earthwork to raise the ground of the Unicoi site by at least 8 feet and as much as 18 feet before construction.

“It’s going to require some elevation, and there is going to be some cost,” Berginnis said. “But, my God, you just lost your dang hospital.”

The destruction of Unicoi County Hospital in 2024 prompted a KFF Health News investigation into hospital flood risk, which used Fathom data to identify more than 170 hospitals across the nation that face the greatest risk of significant or dangerous flooding. Of those hospitals, at least 39 faced circumstances similar to Unicoi’s: Nearby rivers or creeks were predicted to swell beyond their banks and engulf the facility.

Ballad Health, which owns Unicoi and 19 other hospitals in Tennessee and Virginia, is the nation’s largest state-sanctioned hospital monopoly and the only option for hospital care for most residents in a 29-county region of Appalachia.

In a news release announcing the Unicoi reconstruction, Ballad said it was finalizing a land purchase for the new hospital site and expected construction to begin in the spring and last two years. Ballad Health Chief Operating Officer Eric Deaton said the reconstruction announcement was “a long-awaited step toward healing.”

“Rebuilding Unicoi County Hospital is about more than bricks and mortar,” Deaton said in the release. “It’s about keeping care close to home for people who have been through so much.”

Tennessee state Rep. Renea Jones, a Republican whose district includes both the old and new Unicoi hospital sites, praised the reconstruction plan in Ballad’s news release. The release did not mention that Ballad would buy about 15 acres of land for the new hospital from Jones’ family, which was first reported by local television station WJHL and later confirmed by Tennessee public records.

Jones did not agree to be interviewed about the sale of the property or its flood risk.

The destroyed Unicoi County Hospital, which cost $30 million, was built along a bend of the Nolichucky River even though FEMA had labeled that area a flood zone for decades. Mountain States Health Alliance began construction in 2017, then later became Ballad Health, which opened the hospital in 2018.

Alan Levine, who was the CEO of Mountain States and now leads Ballad, told KFF Health News in a 2024 interview that Mountain States was aware of the flood risk when Unicoi was built but believed levees could protect the facility.

“I feel like everything we did when we built it was done the right way,” Levine said.

Helene proved too much to handle. As the hurricane carved a deadly path across Southern states and into Appalachia, heavy rainfall caused the Nolichucky to overspill its banks and engulf the hospital in as much as 12 feet of water.

Floodwater pushed inside the hospital and cut the power, forcing patients and staff to evacuate to the roof in hopes of rescue. Ultimately, helicopters plucked 70 people from the roof and the rushing water, narrowly avoiding fatalities.

Angel Mitchell, a Unicoi survivor who was airlifted to safety with her ailing mother, said she was appalled that the hospital would be rebuilt in an area vulnerable to another flood.

But the worst part, Mitchell said, was that locals would have little choice but to tolerate the risk because of Ballad’s monopoly.

“It’s ridiculous,” Mitchell said. “We want to go somewhere to heal, not somewhere to worry.”

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.

USE OUR CONTENT

This story can be republished for free (details).

This posting combined Donald Trump’s longtime passion to use the offshore base to move “some bad dudes” out of the United States with a promise made shortly after his inauguration last year to hold thousands of noncitizens there. The naval base is known for the torture and inhumane treatment of men suspected of terrorism in the wake of 9/11.

“Deployments are typically not something you can say no to,” Stewart said. She pleaded with the coordinating office, which found another nurse to go in her place.

Other public health officers who worked at Guantánamo in the past year described conditions there for the detainees, some of whom learned they were in Cuba from the nurses and doctors sent to care for them. They treated immigrants detained in a dark prison called Camp 6, where no sunlight filters in, said the officers, whom KFF Health News agreed not to name because they fear retaliation for speaking publicly. It previously held people with suspected ties to al-Qaida. The officers said they were not briefed ahead of time on the details of their potential duties at the base.

Although the Public Health Service is not a branch of the U.S. armed forces, its uniformed officers — roughly 5,000 doctors, nurses, and other health workers — act like stethoscope-wearing soldiers in emergencies. The government deploys them during hurricanes, wildfires, mass shootings, and measles outbreaks. In the interim, they fill gaps at an alphabet soup of government agencies.

The Trump administration’s mass arrests to curb immigration have created a new type of health emergency as the number of people detained reaches record highs. About 71,000 immigrants are currently imprisoned, according to Immigration and Customs Enforcement data, which shows that most have no criminal record.

Homeland Security Secretary Kristi Noem has said: “President Donald Trump has been very clear: Guantanamo Bay will hold the worst of the worst.” However, several news organizations have reported that many of the men shipped to the base had no criminal convictions. As many as 90% of them were described as “low-risk” in a May progress report from ICE.

In fits and starts, the Trump administration has sent about 780 noncitizens to Guantánamo Bay, according to The New York Times. Numbers fluctuate as new detainees arrive and others are returned to the U.S. or deported.

While some Public Health Service officers have provided medical care to detained immigrants in the past, this is the first time in American history that Guantánamo has been used to house immigrants who had been living in the U.S. Officers said ICE postings are getting more common. After dodging Guantánamo, Stewart was instructed to report to an ICE detention center in Texas.

“Public health officers are being asked to facilitate a man-made humanitarian crisis,” she said.

Seeing no option to refuse deployments that she found objectionable, Stewart resigned after a decade of service. She would give up the prospect of a pension offered after 20 years.

“It was one of the hardest decisions I ever had to make,” she said. “It was my dream job.”

One of her PHS colleagues, nurse Dena Bushman, grappled with a similar moral dilemma when she got a notice to report to Guantánamo a few weeks after the shooting at the Centers for Disease Control and Prevention in August. Bushman, who was posted with the CDC, got a medical waiver delaying her deployment on account of stress and grief. She considered resigning, then did.

“This may sound extreme,” Bushman said. “But when I was making this decision, I couldn’t help but think about how the people who fed those imprisoned in concentration camps were still part of the Nazi regime.”

Others have resigned, but many officers remain. While they are alarmed by Trump’s tactics, detained people need care, multiple PHS officers told KFF Health News.

“We do the best we can to provide care to people in this shit show,” said a PHS nurse who worked in detention facilities last year.

“I respect people and treat them like humans,” she said. “I try to be a light in the darkness, the one person that makes someone smile in this horrible mess.”

The PHS officers conceded that their power to protect people was limited in a detention system fraught with overcrowding, disorganization, and the psychological trauma of uncertainty, family separations, and sleep deprivation.

“Ensuring the safety, security, and well-being of individuals in our custody is a top priority at ICE,” said Tricia McLaughlin, chief spokesperson for the Department of Homeland Security, in an emailed statement to KFF Health News.

Adm. Brian Christine, assistant secretary for health at the Department of Health and Human Services, which oversees the Public Health Service, said in an email: “Our duty is clear: say “Yes Sir!”, salute smartly, and execute the mission: show up, provide humane care, and protect health.” Christine is a recent appointee who, until recently, was a urologist specializing in testosterone and male fertility issues.

“In pursuit of subjective morality or public displays of virtue,” he added, “we risk abandoning the very individuals we pledged to serve.”

Into the Unknown

In the months before Stewart resigned, she reflected on her previous deployments, during Trump’s first term, to immigration processing centers run by Customs and Border Protection. Fifty women were held in a single concrete cell in Texas, she recalled.

“The most impactful thing I could do was to convince the guards to allow the women, who had been in there for a week, to shower,” she said. “I witnessed suffering without having much ability to address it.”

Stewart spoke with Bushman and other PHS officers who were embedded at the CDC last year. They assisted with the agency’s response to ongoing measles outbreaks, with sexually transmitted infection research, and more. Their roles became crucial last year as the Trump administration laid off droves of CDC staffers.

Stewart, Bushman, and a few other PHS officers at the CDC said they met with middle managers to ask for details about the deployments: If they went to Guantánamo and ICE facilities, how much power would they have to provide what they considered medically necessary care? If they saw anything unethical, how could they report it? Would it be investigated? Would they be protected from reprisal?

Stewart and Bushman said they were given a PHS office phone number they could call if they had a complaint while on assignment. Otherwise, they said, their questions went unanswered. They resigned and so never went to Guantánamo.

PHS officers who were deployed to the base told KFF Health News they weren’t given details about their potential duties — or the standard operating procedure for medical care — before they arrived.

Stephen Xenakis, a retired Army general and a psychiatrist who has advised on medical care at Guantánamo for two decades, said that was troubling. Before health workers deploy, he said, they should understand what they’ll be expected to do.

The consequences of insufficient preparation can be severe. In 2014, the Navy threatened to court-martial one of its nurses at Guantánamo who refused to force-feed prisoners on hunger strike, who were protesting inhumane treatment and indefinite detention. The protocol was brutal: A person was shackled to a five-point restraint chair as nurses shoved a tube for liquid food into their stomach through their nostrils.

“He wasn’t given clear guidance in advance on how these procedures would be conducted at Guantánamo,” Xenakis said of the nurse. “Until he saw it, he didn’t understand how painful it was for detainees.”

The American Nurses Association and Physicians for Human Rights sided with the nurse, saying his objection was guided by professional ethics. After a year, the military dropped the charges.

A uniformed doctor or nurse’s power tends to depend on their rank, their supervisor, and chains of command, Xenakis said. He helped put an end to some inhumane practices at Guantánamo more than a decade ago, when he and other retired generals and admirals publicly objected to certain interrogation techniques, such as one called “walling,” in which interrogators slammed the heads of detainees suspected of terrorism against a wall, causing slight concussions. Xenakis argued that science didn’t support “walling” as an effective means of interrogation, and that it was unethical, amounting to torture.

Torture hasn’t been reported from Guantánamo’s immigration operation, but ICE shift reports obtained through a Freedom of Information Act request by the government watchdog group American Oversight note concerns about detainees resorting to hunger strikes and self-harm.

Inmates and investigations have reported delayed medical care at immigration detention facilities and dangerous conditions, including overcrowding and a lack of sanitation. Thirty-two people died in ICE custody in 2025, making it the deadliest year in two decades.

“They are arresting and detaining more people than their facilities can support,” one PHS officer told KFF Health News. The most prevalent problem the officer saw among imprisoned immigrants was psychological. They worried about never seeing their families again or being sent back to a country where they feared they’d be killed. “People are scared out of their minds,” the officer said.

No Sunlight

The PHS officers who were at Guantánamo told KFF Health News that the men they saw were detained in either low-security barracks, with a handful of people per room, or in Camp 6, a dark, high-security facility without natural light. The ICE shift reports describe the two stations by their position on the island, Leeward for the barracks and Windward for Camp 6. About 50 Cuban men sent to Guantánamo in December and January have languished at Camp 6.

A Navy hospital on the base mainly serves the military and other residents who aren’t locked up — and in any case, its capabilities are limited, the officers said. To reduce the chance of expensive medical evacuations back to the U.S. to see specialists quickly, they said, the immigrants were screened before being shipped to Guantánamo. People over age 60 or who needed daily drugs to manage diabetes and high blood pressure, for example, were generally excluded. Still, the officers said, some detainees have had to be evacuated back to Florida.

PHS nurses and doctors said they screened immigrants again when they arrived and provided ongoing care, fielding complaints including about gastrointestinal distress and depression. One ICE monthly progress report says, “The USPHS psychologist started an exercise group” for detainees.

Doctors’ requests for lab work were often turned down because of logistical hurdles, partly due to the number of agencies working together on the base, the officers said. Even a routine test, a complete blood count, took weeks to process, versus hours in the U.S.

DHS and the Department of Defense, which have coordinated on the Guantánamo immigration operation, did not respond to requests for comment about their work there.

One PHS officer who helped medically screen new detainees said they were often surprised to learn they were at Guantánamo.

“I’d tell them, ‘I’m sorry you are here,’” the officer said. “No one freaked out. It was like the ten-millionth time they had been transferred.” Some of the men had been detained in various facilities for five or six months and said they wanted to return to their home countries, according to the officer. Health workers had neither an answer nor a fix.

Unlike ICE detention facilities in the U.S., Guantánamo hasn’t been overcrowded. “I have never been so not busy at work,” one officer said. A military base on a tropical island, Guantánamo offers activities such as snorkeling, paddleboard yoga, and kickboxing to those who aren’t imprisoned. Even so, the officer said they would rather be home than on this assignment on the taxpayer’s dime.

Transporting staff and supplies to the island and maintaining them on-base is enormously expensive. The government paid an estimated $16,500 per day, per detainee at Guantánamo, to hold those accused of terrorism, according to a 2025 Washington Post analysis of DOD data. (The average cost to detain immigrants in ICE facilities in the U.S. is $157 a day.)

Even so, the funding has skyrocketed: Congress granted ICE a record $78 billion for fiscal year 2026, a staggering increase from $9.9 billion in 2024 and $6.5 billion nearly a decade ago.

Last year, the Trump administration also diverted more than $2 billion from the national defense budget to immigration operations, according to a report from congressional Democrats. About $60 million of it went to Guantánamo.

“Detaining noncitizens at Guantanamo is far more costly and logistically burdensome than holding them in ICE detention facilities within the United States,” wrote Deborah Fleischaker, a former assistant director at ICE, in a declaration submitted as part of a lawsuit brought by the American Civil Liberties Union early last year. In December, a federal judge rejected the Trump administration’s request to dismiss a separate ACLU case questioning the legality of detaining immigrants outside the U.S.

Anne Schuchat, who served with the PHS for 30 years before retiring in 2018, said PHS deployments to detention centers may cost the nation in terms of security, too. “A key concern has always been to have enough of these officers available for public health emergencies,” she said.

Andrew Nixon, an HHS spokesperson, said the immigration deployments don’t affect the public health service’s potential response to other emergencies.

In the past, PHS officers have stood up medical shelters during hurricanes in Louisiana and Texas, rolled out covid testing in the earliest months of the pandemic, and provided crisis support after the deadly shooting at Sandy Hook Elementary School and the Boston Marathon bombing.

“It’s important for the public to be aware of how many government resources are being used so that the current administration can carry out this one agenda,” said Stewart, one of the nurses who resigned. “This one thing that’s probably turning us into the types of countries we have fought wars against.”

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.

USE OUR CONTENT

This story can be republished for free (details).

• Click here to watch Rayasam on CBS News 24/7.
• Click here to hear Rayasam on The Georgia Health Report.
• Read Rayasam’s “It’s 2026 and You’re Uninsured. Now What?”

KFF Health News editor-at-large for public health Céline Gounder discussed protein intake on CBS News Texas on Feb. 2.

• Click here to watch Gounder on CBS News Texas.

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.

USE OUR CONTENT

This story can be republished for free (details).

Billing mistakes. Stigma. Doctors who aren’t keeping up with the latest research. Those are just some of the hurdles that keep HIV prevention medication out of reach for many Americans.

The Centers for Disease Control and Prevention estimates more than 2 million Americans could benefit from a treatment known as PrEP, but only a quarter of them are getting a form of the drug. Zach Dyer appeared on WAMU’s “Health Hub” on Feb. 4 to share tips patients can use to avoid those pitfalls and find a doctor who knows more about PrEP.

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.

USE OUR CONTENT

This story can be republished for free (details).