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.

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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.

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After a routine doctor visit revealed Josie had lead poisoning, Hess quickly traced the source to the crumbling paint in her family’s century-old home in the Bayou St. John neighborhood. While it underwent lead remediation, the family stayed in a newer, lead-free house near Markey.

“Everyone was telling us the safest place to play was outside at playgrounds, so that’s where we went,” Hess said. Josie became a Markey regular, playing on the swings and slides.

Josie’s next blood test was a shock. “It skyrocketed,” Hess said. Josie’s lead levels had leaped to nearly five times the national health standard. The likely culprit, according to scientists at the time, was Josie’s favorite park. Soil testing found it had dangerously high levels of lead.

City officials took no action to inform Markey’s users or make the park safe. But parents started posting warning signs at the park and flooded City Hall with calls and emails. With Josie on her hip, Hess made an impassioned speech at a City Council meeting.

In short order, the city hired a company to test Markey and other parks and pledged to fix the lead problem wherever it was found.

“My impression was they were going to make them all lead-free parks,” Hess said.

But a Verite News investigation conducted over four months in 2025 found that lead pollution in New Orleans parks not only persists — it is more widespread than previously known. Dozens of city parks with playgrounds remain unsafe, including Markey and other parks that underwent a city-sponsored lead remediation in 2011.

The findings indicate that city officials fell short in their cleanup efforts then, and that a very large number of New Orleans children are exposed to excessive amounts of lead, said Howard Mielke, a retired Tulane University toxicologist and one of the nation’s top experts on lead contamination.

“It’s a failed program,” he said. “They didn’t do what they needed to do to bring the lead levels down in a single park.”

Verite News reporters tested hundreds of soil samples from 84 city parks with playgrounds in fall 2025. Adrienne Katner, a lead-contamination researcher with Louisiana State University, verified the results. The testing found that about half the parks had lead concentrations that exceeded the federal hazard level established in 2024 for soil in urban areas.

“If there’s evidence of kids playing in soils that are as high as you described, that’s kind of horrifying,” Gabriel Filippelli, an Indiana University biochemist who studies lead exposure, told Verite News.

Public health researchers and doctors say that children under 6 absorb lead-laden dust more easily than adults, contaminating their blood and harming the long-term development of their brains and nervous systems. There is no known safe exposure level for children, and even trace amounts can result in behavioral problems and lower cognitive abilities.

Larry Barabino is the CEO of the New Orleans Recreation Development Commission, which oversees most of the city’s parks. He said the city doesn’t routinely test for lead in parks, and he confirmed that the last significant effort to do so was in 2011.

He called Verite’s results “definitely concerning” and pledged to work with city officials, local experts, and a city environmental consultant, Materials Management Group, to potentially remediate unsafe parks.

“It’s definitely concerning if it’s at the level that’s considered a true risk or threat, and we would get it to Capital Projects immediately to get MMG out there,” Barabino said, referring to the News Orleans Capital Projects Administration. “If there’s anything that’s a true environmental concern or risk, that’s something that we believe in definitely making sure we take action.”

But New Orleans is in financial straits, with a budget deficit of about $220 million, and it’s unclear what resources new mayor Helena Moreno would be able to devote to restart lead remediation efforts. In response to the financial crisis, Moreno has already eliminated dozens of positions and plans to furlough 700 employees one day per pay period to save money. Moreno’s administration did not respond to requests for comment.

Andrea Young heard pledges similar to Barabino’s 15 years ago. Like Hess, Young had a child who frequented Markey and had high lead levels in her blood. Alongside other mothers, she helped push the city to take action. Young thought they had succeeded but said she now realizes that the city didn’t do enough.

“It makes me question the value” of the work the city did, Young said, “and the safety we felt in letting our kids play there again.”

Testing New Orleans Parks

Lead is typically found in very small amounts in natural soil. The average lead abundance in U.S. soils is 26 parts per million, equivalent to less than an ounce of lead per ton of soil.

But New Orleans, like many other cities, has a long history of lead contamination in its soil, from sources including lead-based paint, leaded gasoline, and emissions from waste incinerators and other industrial facilities. Lead particles spread easily by wind, eventually settling in the topsoil.

The federal hazard level for lead in soil was 400 ppm until early 2024, when the Environmental Protection Agency lowered it to 200 ppm for most residential areas and 100 ppm in urban areas like New Orleans with multiple sources of lead exposure. Last fall, the Trump administration eliminated the lower 100-ppm limit, arguing it was confusing to have two thresholds. It didn’t argue that the 100-ppm level was safe.

More of a guide than a mandate, the EPA screening levels can steer federal cleanup actions and are often adopted by state and city governments to inform local responses to lead contamination. California has long had a much lower standard of 80 ppm.

Mielke said the Trump administration’s change doesn’t align with the science, which has long shown that children are harmed when exposed to soil with levels below 100 ppm. He was one of several scientists who had pushed for lower thresholds after the EPA established its first screening levels more than 30 years ago.

He said the 100-ppm level should still be applied in urban areas, especially New Orleans.

Verite conducted soil tests on the 84 city parks that property inventories and maps list as having play structures. Samples were taken from surface soil, which is most likely to come into contact with children’s hands and toys or be inhaled when kicked up during play or blown by the wind.

The average soil sample collected by Verite contained lead levels of about 121 ppm. Elevated lead levels tended to follow the age of the neighborhood. The city’s older neighborhoods, including the Irish Channel and Algiers Point, had some of the highest lead levels, while places like Gentilly and New Orleans East, developed mostly after the 1950s, tended to have lower levels, according to Verite’s findings.

The highest lead levels were found at Evans Park in the Freret neighborhood. Beside a low-hanging oak branch, on ground worn bare by children’s play, Verite recorded lead at 5,998 ppm, nearly 60 times the 100-ppm urban soils threshold.

Verite spoke to more than a dozen parents at playgrounds throughout the city, and most were surprised at the levels of lead in the parks.

In the Irish Channel, Meg Potts watched her son run around the dusty Brignac playground. All of Verite’s samples at that park surpassed the threshold the EPA deemed safe for urban areas, reaching nearly 600 ppm.

Potts knew high lead levels existed in the city but said she didn’t realize her neighborhood park could be a source of exposure for her son.

“ I’m just, like, thinking about all of this now because he’s had to go in and have his lead tested,” she said. “He’s like right on the cusp of having too-high lead.”

Katner, the LSU researcher, said Verite’s results can serve as a starting point for city officials to conduct more comprehensive testing in parks, noting that even a single lead hot spot in a park is concerning.

“The kid playing in that part of the park is going to get the highest dose,” she said.

A Legacy of Lead

Before the 1970s, lead was ubiquitous. A 2022 study estimated that most of the U.S. population born before the 1980s was poisoned by dangerously high levels of lead in early childhood, resulting in an average loss of at least one IQ point.

Lead pollution from cars spread into areas near roads, especially major thoroughfares, until leaded gasoline was phased out by 1996. Similarly, emissions from trash incinerators and industrial sites contaminated the surrounding soil in some New Orleans neighborhoods until they were closed in the 1970s and ’80s.

Today, the most pervasive source of lead in soil is degraded paint. Lead-based paint was used extensively for homes and buildings until it was banned in 1978. In New Orleans, most of the houses were built before 1980, according to the 2024 American Community Survey. As the paint deteriorates, Tulane University epidemiologist Felicia Rabito said, it can chip or turn into toxic dust.

“ The leaded paint goes straight into the dust and it goes straight into the soils, which is a major source of exposure for young children in the city,” said Rabito, who studies lead poisoning and other health conditions.

Children under 6 are especially vulnerable, in part because they like to stick their hands in their mouths. A child eating a dropped Cheerio or putting their thumb in their mouth after playing on a seesaw can be enough to cause harm. Rabito recommended that parents avoid contaminated playgrounds.

The only way to know whether a child has lead poisoning is a medical test. By state law, Louisiana health care providers are required to ensure every child between 6 months and 6 years of age receives at least two blood tests, recommended at age 1 and age 2.

But the law does not include a way to enforce those testing requirements, so many health care providers don’t test, according to a 2017 report from the Louisiana Department of Health. In 2022, fewer than 1 in 10 children under 6 were screened for lead poisoning in the city, according to data from the Centers for Disease Control and Prevention.

“ There’s not anything that we can say about lead poisoning or lead levels in children in Orleans Parish with any scientific certainty,” Rabito said. “ Parents really need to get their children tested.”

Limited Soil Testing, Patchy Fixes

In 2011, the last time there was outcry over lead pollution in parks, the New Orleans health commissioner at the time, Karen DeSalvo, said the city should do “everything we can to understand what the risk might be and to remediate it.” But she also called it “not the greatest challenge, honestly,” according to The Times-Picayune.

Then-Mayor Mitch Landrieu promised a comprehensive response.

“The city will take all necessary measures to investigate possible lead contamination in other parks and playgrounds and remediate them as soon as possible,” he said in March 2011.

Two months later, testing and remediation were completed at several parks. Parents brought their children back to the reopened playgrounds.

Despite city leaders’ assurances of a broad response, only 16 parks were tested in 2011 and the city’s piecemeal cleanup covered only patches of contaminated soil rather than entire parks, according to documents obtained through public records requests.

That stunned the vocal group of parents who had pushed for cleaning up the Markey playground. Young, one of the mothers, said the scope of the 2011 testing and remediation was much more limited than she thought.

“If the majority of the parks they tested were high, what would make them think all the others are fine?” she said.

Verite’s testing found high levels of lead at several playgrounds that were remediated in 2011, including Markey.

The results disturbed Mielke, the Tulane toxicologist.

In 2010, Mielke led an effort to reduce lead exposure at 10 private child care center playgrounds in New Orleans. He and his team covered the entire footprint of each playground with water-pervious plastic fabric and then 6 inches of Mississippi River sediment from the Bonnet Carré Spillway, a source of clean, cheap, and easily accessible soil. Lead levels fell, with most playgrounds testing below 10 ppm.

In contrast, the city’s remediation was mostly limited to areas with lead levels above 400 ppm, leaving many hazardous areas exposed. Testing and remediation reports obtained by Verite typically showed MMG focused on two or three spots in each park, with the rest going untreated.

At Easton Park in Bayou St. John, for instance, the 2011 remediation covered four areas totaling about 4,700 square feet, but the park’s playground was left untouched. Verite measured four samples around the playground that exceeded the 100-ppm threshold, including 1,060-ppm and 603-ppm readings near Easton’s swing set.

One park, Evans in the Freret neighborhood, wasn’t remediated despite lead levels as high as 610 ppm in 2011. The reason wasn’t clear in progress reports submitted by MMG. In Verite’s 2025 tests, Evans recorded the highest level, with 5,998 ppm in one location.

MMG did not respond to requests for comment.

Landrieu did not respond to a request for comment. DeSalvo, who retired last summer as Google’s chief health officer, said “extremely limited resources” forced the city to weigh its response to lead contamination in parks with the many other health threats residents faced.

“We worked to address the range of exposures whenever possible with the resources we could muster,” she said.

A Road Map for Cleanup?

Filippelli, of Indiana University, said the city should conduct comprehensive testing of every park and do regular checkups.

But because lead contamination in New Orleans parks is extensive and city leaders are struggling to close a large budget deficit, Filippelli recommends that the city remediate the worst parks first.

He and Mielke don’t believe the city must go the expensive route of full remediation, which involves digging up lead-tainted soil and trucking it to a hazardous waste landfill. It’s usually unnecessary if a park is properly capped with clean soil, Filippelli said.

Verite obtained cost estimates for 10 of the 13 parks targeted for remediation in 2011. The total cost was $83,000 in 2011, or about $120,000 today. The work covered just more than 1.3 acres across the 10 properties. Filippelli estimated that similar work could be done today for about $20,000 per acre — about a fifth of what was spent to remediate just over an acre at New Orleans parks.

Remediation should be coupled with efforts to reduce contamination from nearby sources, primarily old houses shedding lead-based paint, Rabito said.

“When you clean up soil, you’re not going to do it much good if you haven’t identified what’s contaminating the soil,” she said.

Cleaning up New Orleans parks is also likely to require sustained public pressure, said the parents involved with the lead issue in 2011.

“I was not intending to kick butts or make anybody look bad,” Claudia Copeland said of her efforts to alert parents about the dangers at Markey. “But nothing would have happened unless all these parents were calling in to the city.”

Methodology

Verite News reporters Tristan Baurick and Halle Parker were trained to use an X-ray fluorescence analyzer, or XRF, a handheld device that can detect the unique traits of lead at trace levels, down to 10 parts per million. The analyzer is widely used by government and university scientists.

The reporters tested 531 soil samples over a month in late 2025, following protocols developed by retired Tulane University toxicologist Howard Mielke and vetted by three other lead-contamination researchers. The reporters tested surface soil in and around play structures and other areas of parks that children use. Of the more than 110 parks in New Orleans, Verite concentrated on the 84 that city property inventories and maps list as having play structures. The reporters took between three and 11 samples at each park, depending on the size, site accessibility, and levels of contamination. A GPS device was used to record each sample’s location.

Verite’s results were reviewed by Adrienne Katner, a lead-contamination researcher at Louisiana State University. She verified the accuracy of the testing by comparing it with a smaller set of park soil samples collected by her team last summer.

While valid, the method did have limitations. The results can’t be used to determine the state of a whole park. But even one elevated soil sample can provide a starting point for city officials to conduct more comprehensive testing.

This article was produced in collaboration with Verite News. The four-month investigation was supported by a Kozik Environmental Justice Reporting grant funded by the National Press Foundation and the National Press Club Journalism Institute. It was also produced as a project for the USC Annenberg Center for Health Journalism’s National Fellowship fund and Dennis A. Hunt Fund for Health Journalism.

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For those in or near Columbia Memorial, the city’s only hospital, there will soon be a different plan: Shelter in place. The hospital is building a new facility next door with an on-site tsunami shelter — an elevated refuge atop columns deeply anchored in the ground, where nearly 2,000 people can safely wait out a flood.

Oregon needs more shelters like the one that Columbia Memorial is building, emergency managers say. Hospitals in the region are likely to incur serious damage, if not ruin, and could take more than three years to fully recover in the event of a major earthquake and tsunami, according to a state report.

Columbia Memorial’s current facility is a single-story building, made of wood a half-century ago, that would likely collapse and sink into the ground or be swallowed by a landslide after a major earthquake or a tsunami, said Erik Thorsen, the hospital’s chief executive.

“It is just not built to survive either one of those natural disaster events,” Thorsen said.

At least 10 other hospitals along the Oregon coast are in danger as well. So Columbia Memorial leaders proposed building a hospital capable of withstanding an earthquake and landslide, with a tsunami shelter, instead of relocating the facility to higher ground. Residents and state officials supported the plans, and the federal government awarded a $14 million grant from the Federal Emergency Management Agency to help pay for the tsunami shelter.

The project broke ground in October 2024. Within six months, the Trump administration had canceled the grant program, known as Building Resilient Infrastructure and Communities, or BRIC, calling it “yet another example of a wasteful and ineffective FEMA program … more concerned with political agendas than helping Americans affected by natural disasters.”

Molly Wing, director of the expansion project, said losing the BRIC grant felt like “a punch to the gut.”

“We really didn’t see that coming,” she said.

This summer, Oregon and 19 other states sued to restore the FEMA grants. On Dec. 11, a judge ruled that the Trump administration had unlawfully ended the program without congressional approval.

The administration did not immediately indicate it would appeal the decision, but Department of Homeland Security spokesperson Tricia McLaughlin said by email: “DHS has not terminated BRIC. Any suggestion to the contrary is a lie. The Biden Administration abandoned true mitigation and used BRIC as a green new deal slush fund. It’s unfortunate that an activist judge either didn’t understand that or didn’t care.” FEMA is a subdivision of DHS.

Columbia Memorial was one of the few hospitals slated to receive grants from the BRIC program, which had announced more than $4.5 billion for nearly 2,000 building projects since 2022.

Hospital leaders have decided to keep building — with uncertain funding — because they say waiting is too dangerous. With the Trump administration reversing course on BRIC, fewer communities will receive help from FEMA to reduce their disaster risk, even places where catastrophes are likely.

More than three centuries have passed since a major earthquake caused the Pacific Northwest’s coastline to drop several feet and unleashed a tsunami that crashed onto the land in January 1700, according to scientists who study the evolution of the Oregon coast.

The greatest danger is an underwater fault line known as the Cascadia Subduction Zone, which lies 70 to 100 miles off the coast, from Northern California to British Columbia.

The Cascadia zone can produce a megathrust earthquake, with a magnitude of 9 or higher — the type capable of triggering a catastrophic tsunami — every 500 years, according to the U.S. Geological Survey. Scientists predict a 10% to 15% chance of such an earthquake along the fault zone in the next 50 years.

“We can’t wait any longer,” Thorsen said. “The risk is high.”

Building for the Future

The BRIC program started in 2020, during the first Trump administration, to provide communities and institutions with funding and technical assistance to fortify their structures against natural disasters.

Joel Scata, a senior attorney with the environmental advocacy group Natural Resources Defense Council, said the program helped communities better prepare so they could reduce the cost of rebuilding after a flood, tornado, wildfire, or extreme weather event.

To qualify for a grant, a hospital had to show that the project’s benefits were greater than the future danger and cost. In some cases, that benefit might not be readily apparent.

“It prevents bad disasters from happening, and so you don’t necessarily see it in action,” Scata said.

Scata noted that the Trump administration has also stopped awarding grants through FEMA’s Hazard Mitigation Grant Program, which predates BRIC.

“There really is no money going out the door from the federal government to help communities reduce their disaster risk,” he said.

A recent KFF Health News investigation using proprietary data from Fathom, a global leader in flood modeling, found that at least 170 U.S. hospitals are at risk of significant and potentially dangerous flooding from more intense and frequent storms. That count did not include Columbia Memorial, as Fathom’s data did not account for tsunamis. It models flooding from rivers, sea level rise, and extreme rainfall.

In recent days, an atmospheric river — a narrow storm band carrying significant amounts of moisture — dumped more than 15 inches of rain on parts of Oregon and Washington, causing catastrophic flooding along rivers and the coast. In the Washington town of Sedro-Woolley, which sits along the Skagit River, the PeaceHealth United General Medical Center evacuated nonemergency patients.

High winds battered Astoria, leaving the city with some minor landslides, according to news reports. But flooding on the road to the nearby beach town of Seaside made the drive nearly impassable.

The Trump administration is leaning on states to take greater responsibility for recovering from natural disasters, Scata said, but most states are not financially prepared to do so.

“The disasters are just going to keep on piling up,” he said, “and the federal government’s going to have to keep stepping in.”

A Hospital at Risk

Columbia Memorial is blocks from the southern shore of the Columbia River, near the Washington border, where the area’s natural hazards include earthquakes, tsunamis, landslides, and floods. A critical access hospital with 25 beds, it opened in 1977 — before state building codes addressed tsunami protections.

Thorsen said the new facility and shelter would be a “model design” for other hospitals. Design plans show a five-level hospital built atop a foundation anchored to the bedrock and surrounded by concrete columns to shield it from tsunami debris.

The shelter will be on the roof of the second floor, above the projected maximum tsunami inundation. It will be accessible via an outdoor staircase and interior staircases and elevators, with enough room for up to 1,900 people, plus food, water, tents, and other supplies to sustain them for five days.

With most patient care provided on the second and third levels, generators on the fourth level, and utility lines underground, the hospital is expected to remain operational after a natural disaster.

Thorsen said an earthquake and tsunami threaten not only vast flooding but also liquefaction, in which the ground loosens and causes structures above it to collapse. Deep foundations, thick slabs, and other structural supports are expected to protect the new hospital and tsunami structure against such failure.

Through the years, hospital administrators and civic leaders in Astoria have sought other locations for Columbia Memorial. But relocation wasn’t economical. Columbia Memorial committed to invest in a new hospital and tsunami shelter to protect not only patients and staff but also nearby residents.

“Your community should count on your hospital to be a safe haven in a natural disaster,” Thorsen said.

Fighting To Restore Funds

The estimated construction budget for Columbia Memorial’s expansion is $300 million, mostly financed through new debt from the hospital. The tsunami shelter is budgeted at about $20 million, for which FEMA’s BRIC program awarded nearly $14 million, with a $6 million matching grant from the state, which has maintained its support.

The shelter and the building’s structural protections — featuring reinforced steel, deeper foundations, and thicker slabs — are integral to the design and cannot be removed without compromising the rest of the structure, said Michelle Checkis, the project architect.

“We can’t pull the TVERS [tsunami vertical evacuation refuge structure] out without pulling the hospital back apart again,” she said. “It’s kind of like, if I was going to stack it up with Legos, I would have to take all those Legos apart and stack it up completely differently.”

Columbia Memorial has sought help from Oregon’s congressional delegation. In a letter to Department of Homeland Security Secretary Kristi Noem and former FEMA acting administrator David Richardson, the lawmakers demanded that the agencies restore the hospital’s grant.

The hospital’s leadership is seeking other grants and philanthropic donations to make up for the loss. As a last resort, Thorsen said, the board will consider removing “nonessential features” from the building, though he added that there is little fat to trim from the project.

The lawsuit brought by states in July alleged that FEMA lacks the authority to cancel the BRIC program or redirect its funding for other purposes.

The states argued that canceling the program ran counter to Congress’ intent and undermined projects underway.

In their response to the lawsuit, the Trump administration said repeatedly that the defendants “deny that the BRIC program has been terminated.”

The lawsuit cites examples of projects at risk in each state due to FEMA’s termination of the grants. Oregon’s first example is Columbia Memorial’s tsunami shelter. “Neither the County nor the State can afford to resume the project without federal funding,” the lawsuit states.

In response to questions about the impact of canceling the grant on Astoria and the surrounding community, DHS spokesperson Tricia McLaughlin said BRIC had “deviated from its statutory intent.”

“BRIC was more focused on climate change initiatives like bicycle lanes, shaded bus stops, and planting trees, rather than disaster relief or mitigation,” McLaughlin said. DHS and FEMA provided no further comment about BRIC or the Astoria hospital.

Preparing for a Tsunami Disaster

Located near the end of the Lewis & Clark National Historic Trail, Astoria sits on a peninsula that juts into the Columbia River near the Pacific Ocean.

Much of the city is not in the tsunami inundation area. But Astoria’s downtown commercial district — where gift shops, hotels, and seafood restaurants line the streets — is nearly all an evacuation zone.

Two hospitals — Ocean Beach Health in nearby Washington, and Providence Seaside Hospital in Oregon — are about 20 miles from Columbia Memorial. Both are 25-bed hospitals, and neither is designed to withstand a tsunami.

Ocean Beach Health regularly conducts drills for mass-casualty and natural disasters, said Brenda Sharkey, its chief nursing officer.

“We focus our planning and investments on areas where we can make a real difference for our community before, during, and after an event — such as maintaining continuity of care, ensuring rapid triage, and coordinating with regional emergency partners,” Sharkey said in an email.

Gary Walker, a spokesperson for Providence Seaside, said in a statement that the hospital has a “comprehensive emergency plan for earthquakes and tsunamis, including alternative sites and mobile resources.”

Walker added that Providence Seaside has hired “a team of consultants and experts to conduct a conceptual resilience study” that would evaluate the hospital’s vulnerabilities and recommend ways to address them.

Oregon’s emergency managers advise residents and visitors in coastal communities to immediately seek higher ground after a major earthquake — and not to rely on tsunami sirens, social media, or most technology.

“There may not even be cellphone towers operating after an event like this,” said Jonathan Allan, a coastal geomorphologist with the Oregon Department of Geology and Mineral Industries. “The earthquake shaking, its intensity, and particularly the length of time in which the shaking persists, is the warning message.”

The stronger the earthquake and the longer the shaking, he said, the more likely a tsunami will head to shore.

A tsunami triggered by a Cascadia zone earthquake could strike land in less than 30 minutes, according to state estimates.

Many of Oregon’s seaside communities are near high-enough ground to seek safety from a tsunami in a relatively short time, Allan said. But he estimated that, to save lives, Oregon would need about a dozen vertical tsunami evacuation shelters along the coast, including in seaside towns that attract tourists and where the nearest high ground is a mile or more away.

Willis Van Dusen’s family has lived in Astoria since the mid-19th century. A former mayor of Astoria, Van Dusen stressed that tsunamis are not a hypothetical danger. He recalled seeing one in Seaside in 1964. The wave was only about 18 inches high, he said, but it flooded a road and destroyed a bridge and some homes. The memory has stayed with him.

“It’s not like … ‘Oh, that’ll never happen,’” he said. “We have to be prepared for it.”

KFF Health News correspondent Brett Kelman contributed to this report.

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

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How To Excise Politics From Health Care

More than a decade after the Affordable Care Act took effect, we’re still trapped in a confusing and costly health care maze (“Readers Take Congress to Task and Offer Their Own Health Policy Fixes,” Nov. 12). The ACA expanded coverage and protected people with preexisting conditions, but it also layered subsidies, narrow networks, and rising premiums on top of an already fragmented system. Millions still face deductibles so high that “coverage” often means financial anxiety instead of security.

The problem isn’t our doctors or hospitals — it’s the structure. America spends nearly twice as much per person on health care as other developed countries, yet our life expectancy is shorter and our outcomes worse. We’ve allowed a tangle of private insurers, billing rules, and monopoly pricing to replace coordination with chaos.

We don’t need “socialized medicine.” We need organized medicine that guarantees coverage, controls costs, and cuts red tape. Other nations have done it — efficiently, fairly, and without eliminating private choice.

Here’s what would work (with a little help from my friend ChatGPT):

1. Universal, automatic coverage. Everyone should be enrolled from birth or residency, independent of job or income. Basic care would be guaranteed, while private insurance could supplement it.

2. Rational pricing. Hospitals, doctors, and drugmakers should follow transparent, regulated price schedules — like the all-payer systems used abroad — ending the markups and cost-shifting that drive U.S. prices sky-high.

3. Streamlined administration. We spend five times as much on billing and insurance overhead as our peers. A single set of rules and electronic standards would save billions and free doctors from paperwork.

4. Invest in primary and mental health care. Paying for outcomes instead of volume would improve health and reduce preventable hospitalizations.

5. Protect families from financial ruin. National catastrophic and long-term care coverage would stop medical bills from destroying lives.

These reforms aren’t radical — they’re what nearly every successful country already does. The obstacle isn’t feasibility; it’s politics. Every dollar saved is a dollar someone currently earns, and entrenched lobbyists fight to preserve that status quo.

The ACA was a step forward, but it left us with a patchwork of subsidies, mandates, and unaffordable premiums. America already spends enough to cover everyone. The challenge now is to spend it wisely — through a rational, universal, and efficient system that works for people, not paperwork.

— Luis Albisu, Warrenton, Virginia

Beating Back Mold

There are only three ingredients to mold: spores, cellulose, and water (“A Hidden Health Crisis Following Natural Disasters: Mold Growth in Homes,” Nov. 19). The spores are floating in the air when construction is taking place. No exceptions. Cellulose is in paper and wood. Its most damaging use is in drywall or gypsum board (gyp board). A single drop of water, from a roof leak or plumbing/sewer pipe, is all that’s needed to start the mold process.

The use of drywall after World War II to build housing quickly is a primary culprit. USG and similar manufacturers make an alternative product without paper sheathing that will not react with water. USG calls it “Mold Tough,” and it uses fiberglass mat instead of paper.

As an architect, I have a simple solution: Stop the use of drywall with paper sheathing.

— Marc Brewster, Bastrop, Texas

Help Is Still Wanted

I am writing in response to the article “Help Wanted: California Looked to Them To Close Health Disparities, Then It Backpedaled” (July 28), in which Vanessa G. Sánchez explained the issues regarding health disparities among immigrant populations — such as chronic diseases, a high uninsured rate, and the more dire fact that the community health workers who do their best to support these people are paid very little for a crucial job. They offer assistance and trust to those who may not be as comfortable asking for it or are unaware that it exists because they are not from here.

She also wrote about a path opening up with the professionalization of these community health workers — how certification programs were opening up, and funding was going to increase. But it has been cut because of the budget cuts going on during this Trump administration, and programs have been slashed or abandoned.

I want to thank you for shedding light on this issue. These community health workers serve as the middle stop for health care for so many people who face immigration and language barriers. This is the workforce they appeal to and go to, and that in and of itself is honorable work that needs to be done and should be paid at a higher rate than it currently is. One could even argue it’s as important as a doctor’s visit, because even to go to the doctor, you need insurance. And who helps you with that and then sends you to the doctor? The community health workers, exactly!

I am part of the Hispanic community and care about the health disparities that exist within it, such as diabetes, and am also very aware of the language barrier that exists in the hospital field. Working together, is there a way to reinstate some certifications or training to promote higher wages and improve health for all Hispanics/immigrants?

— Avelino Cortes, San Leandro, California

Where To Draw the Line on ‘Urgent’ Care?

As a pediatric emergency medicine physician who regularly works shifts in a community hospital, I read the article on a short “nonurgent” but expensive ambulance ride for a child with interest and horror (“Bill of the Month: Not Serious Enough To Turn on the Siren, Toddler’s 39-Mile Ambulance Ride Still Cost Over $9,000,” Nov. 25). I would not have come close to guessing that an Advanced Life Support, or ALS, ambulance would cost over $9,000. Often, patients’ costs vary based on which ambulance company arrives, their insurance plan, whether they are uninsured, etc. We, at least as doctors, rarely have that information at our disposal.

I try to have parents drive their children to the referral hospital when it is safe and feasible, but this is not always possible. What risk of your child dying would you accept if you went by car? 10%? 1%? 0.1%? 0.01%? Just because no treatment was administered during this ambulance ride does not mean that the ambulance was not needed.

What makes us good at our jobs in medicine is worrying about the worst-case scenarios. Do providers sometimes overreact and send kids by ambulance who don’t need it? Absolutely. But there are also too many cases in which children die or become critically ill because someone didn’t recognize how sick the child was or the risks. If we send you in an ambulance, or admit you to the intensive care unit, because we are worried you are at risk of something like shock or respiratory failure, it doesn’t mean you will definitely need intensive care. But, if you go into shock or stop breathing while in your parents’ car, you are much less likely to survive than if we are watching for it and treat it right away. The same way that when we tell you it is a virus, after doing lots of tests, it doesn’t mean we didn’t need to do those tests. The absence of needing treatment doesn’t mean the admission or testing we recommend was unnecessary.

Perpetuating the impression that it is wasteful treatment just because everything works out well is a luxury you have when you don’t regularly see how quickly kids can go from looking relatively well to critically ill and at risk of dying. Those of us who are good at what we do know when to worry and when not to worry. Please don’t disparage our caution or treatment without even asking for our rationale. Ask this doctor why he said the baby absolutely had to go by ambulance. Maybe he didn’t have a good reason. But maybe he did. Maybe if a similar child had been sent by car and the child had gone into shock, this article would instead be talking about how incompetent he was in missing the risk of sepsis and causing the child’s death by letting the parents drive him to the hospital.

We are doing our best to provide good care in a broken, overloaded system. If we are going to work together to fix it, we all must work to understand one another’s points of view. Thank you for helping us understand these unexpected and incredibly burdensome costs our patients face. Please try to understand that caution may not be us dismissing the burden or cost but knowing the risks.

— Samantha Rosman, Boston

Investing in Your Own Health Care

About 20 years ago, I switched to a high-deductible health plan and a health savings account. It was the best decision I ever made for health care for my family (“Trump’s Idea for Health Accounts Has Been Tried. Millions of Patients Have Ended Up in Debt,” Dec. 9).

Today, after years of contributions (compounded with investment gains), the dividends and gains return a higher amount than our health care withdrawals. We’re also still contributing the max family amount per year.

We’re in the process of retiring now, and we’ll continue to select an HDHP and max out our HSA contributions. Once on Medicare, our premium payments can be made with our HSA account. Also, it’s another form of IRA once we reach age 65. It’s a double-tax-advantage account.

I don’t understand the resistance to switching to an HDHP and an HSA. The more you insure yourself, the more money you save. Long-term, it compounds into serious money. At my workplace, I try to talk as many people as possible into choosing an HDHP. They’re all so thankful years later.

I believe people are just afraid of change — not realizing it can seriously be the best health care decision they ever made.

— Tim Eckel, Toledo, Ohio

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

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“Había moho en mi dormitorio, en mi cama, en mi cartera más cara”, contó Daniels. “Moho en el clóset, en el baño, literalmente en todas partes”.

Durante su ausencia, una serie de graves desastres naturales había azotado el área de Tallahassee y dejado daños extendidos. Según los National Centers for Environmental Information, esas tormentas del verano de 2024 causaron daños valuados en miles de millones de dólares, obligaron a mudarse a muchas familias y dejaron en ruinas a numerosas empresas.

Pero el daño no fue solo material. Mientras la comunidad trabajaba para recuperarse, el moho se instaló en viviendas y edificios de toda la ciudad, y convirtió el desastre natural en una crisis prolongada con consecuencias para la salud pública.

“Si cualquier parte de una casa se expone a inundaciones o filtraciones y no se seca completamente en un plazo de 24 a 48 horas, es casi seguro que aparecerá moho”, explicó Parham Azimi, investigador asociado de la Harvard T.H. Chan School of Public Health, que estudia la relación entre la exposición al moho y la salud respiratoria, especialmente cuando ocurren desastres naturales.

“Después de una tormenta importante, con frecuencia vemos un incremento de las enfermedades respiratorias, especialmente en los hogares que se inundaron”, explicó.

Una base para el problema

Se estima que el 47% de los edificios residenciales de Estados Unidos tiene humedad o moho. Así que, aunque la última temporada de huracanes esté por terminar, siguen presentes los problemas de salud asociados al moho.

Como el 29 % de la población del país vive en condados costeros propensos a las inundaciones, hay un riesgo considerable a exponerse a esporas de moho y alérgenos capaces de desencadenar enfermedades respiratorias. Eso deja a unos 95 millones de personas vulnerables cuando ocurren fenómenos climáticos extremos.

Esta cifra ni siquiera incluye a quienes viven en zonas del interior del país que también sufren crecidas, como las montañas de Carolina del Norte y Tennessee, que tuvieron inundaciones severas tras el paso del huracán Helene el año pasado, ni a quienes vieron sus casas anegadas por las lluvias en la región montañosa de Texas este verano.

Las consecuencias para la salud van desde reacciones alérgicas leves hasta afecciones respiratorias graves. Según los Centros para el Control y la Prevención de Enfermedades (CDC), entre los síntomas comunes se encuentran la congestión nasal, las crisis asmáticas y la irritación en la piel.

Una exposición prolongada puede generar complicaciones más serias, como la neumonitis por hipersensibilidad —una inflamación poco común en los pulmones— y enfermedades causadas por micotoxinas, que pueden afectar el sistema nervioso, el hígado y los riñones.

Ahora, debido a los recortes y los cambios de política del presidente Donald Trump, está en duda la continuidad de un importante programa federal que ayuda a reparar viviendas afectadas por desastres naturales, así como la asistencia de la Federal Emergency Management Agency (FEMA).

Un enemigo invisible

Uno de los mayores peligros del moho es que muchas veces pasa inadvertido durante meses o incluso años, dejando a las personas expuestas sin que se den cuenta.

Lauren Lowenstein, residente de Houston, lo sabe muy bien. “Durante cinco años, la salud de mi familia empeoraba y no sabíamos por qué”, dijo.

Después de realizar una prueba del Environmental Relative Moldiness Index, Lowenstein descubrió que esporas tóxicas de moho estaban creciendo dentro de las paredes de su casa debido a la condensación excesiva en el sistema de aire acondicionado. Ella, su esposo y sus dos hijos se vieron obligados a abandonar la vivienda de inmediato y a empezar de nuevo.

“El moho no era visible y no teníamos ninguna señal de que estaba creciendo”, relató.

Es más: incluso cuando se detecta el moho, eliminarlo es un desafío costoso. En promedio, la remoción de moho cuesta entre $1.222 y $3.751, según la plataforma de servicios del hogar Angi. Sin embargo, en casos graves el precio puede superar los $30.000. Muchas veces, las personas que han contratado seguros que cubren daños por moho deben asumir parte del gasto.

Daniels, por ejemplo, tuvo que dejar su apartamento en Tallahassee y alojarse un mes en un hotel mientras esperaba ser reubicada en una unidad renovada. Además, tuvo que reemplazar todas sus pertenencias.

El costo de una eliminación satisfactoria es inalcanzable para muchas familias, señaló Azimi, y puede ser difícil encontrar viviendas alternativas accesibles. Estas dificultades implican seguir expuestos al moho.

“Para las comunidades de bajos ingresos y marginadas, los riesgos son aún mayores”, manifestó Azimi.

Asistencia lenta y limitada

Para quienes buscan ayuda del gobierno, los tiempos de espera pueden ser bastante largos, afirmó el reverendo Mac Legerton, fundador de la Disaster Survivaland Resiliency School, del condado de Robeson en North Caroline. “En muchos casos, las familias deben elegir entre vivir en condiciones inseguras o quedarse sin hogar”, lamentó.

Una revisión realizada en 2019 y financiada por el Department of Housing and Urban Development sobre 88 subsidios por desastres, reveló que el programa Community Development Block Grant Disaster Recovery comenzó a distribuir los fondos solicitados, en promedio, 20 meses después del desastre inicial. En muchos casos, los desembolsos tardaron dos años o más.

“En nuestro sistema de respuesta a desastres, la eliminación del moho es una de las áreas más desatendidas a nivel local, estatal y nacional”, afirmó Legerton.

La organización de Legerton dirige un programa llamado “cazadores de moho”, una iniciativa de capacitación y educación práctica que brinda a las personas del condado de Robeson las herramientas y el conocimiento necesarios para eliminar el moho de forma segura en viviendas, iglesias y negocios después de los desastres naturales.

El programa también ofrece servicios gratuitos de remoción de moho para comunidades vulnerables. Explicó que lo crearon en respuesta a la falta de ayuda oportuna en esta zona del centro de North Caroline.

La espera pasa factura

Tanya Locklear vivió esta situación tras los daños importantes que provocaron los huracanes Matthew y Florence en su casa, en Pembroke, North Caroline, en 2016 y 2018, respectivamente.

Finalmente, su vivienda quedó contaminada por moho.

Solicitó asistencia a través del programa estatal ReBuild NC en agosto de 2021, pero, según relató, su pedido no fue aprobado hasta noviembre de 2023. Los trabajos de reparación comenzaron en febrero de 2024, más de dos años después de haber presentado la solicitud.

Locklear afirmó que su caso solo avanzó después de los esfuerzos de los defensores locales, incluida la presión de líderes comunitarios y la organización de Legerton.

Sin embargo, los retrasos iniciales ya habían afectado la salud y el bienestar de su familia. Mientras esperaban la ayuda, Locklear y sus hijos siguieron viviendo en condiciones insalubres por el moho. Ella cuenta que todos sufrieron problemas como dolores de cabeza, hemorragias nasales y dificultades respiratorias.

Todavía hoy, aseguró Locklear, sigue teniendo problemas respiratorios, lo que demuestra los perjuicios a largo plazo de vivir en casas infestadas de moho.

Legerton, que está trabajando con su equipo directamente con los afectados en North Caroline, insiste en que los legisladores y funcionarios tienen que enfocarse en simplificar los programas de ayuda por desastres para garantizar que la asistencia llegue de manera efectiva y rápida a las familias y comunidades afectadas en todo el país.

Según Legerton y otros expertos en salud pública, los funcionarios del gobierno también deberían aumentar los fondos para la limpieza y eliminación del moho para evitar que la gente tenga que mudarse y prevenir problemas de salud a largo plazo.

Igualmente, plantea la necesidad de aplicar normas más estrictas de construcción y promover diseños de vivienda resistentes a inundaciones para reducir el riesgo de moho en zonas vulnerables a desastres.

Sin políticas preventivas, dijo Azimi, millones de personas podrían quedar expuestas por mucho más tiempo a condiciones de vida insalubres.

“A medida que el cambio climático se intensifica, los huracanes y las tormentas fuertes serán más frecuentes y destructivos, lo que incrementa el riesgo de enfermedades relacionadas con el moho”, aseguró Azimi.

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

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“There was mold in my bedroom, on my bed, mold in my expensive purse,” Daniels said. “Mold in my closet, my bathroom — literally everywhere.”

During her absence, a series of severe natural disasters had swept through the Tallahassee area, leaving widespread damage. According to the National Centers for Environmental Information, those storms in summer 2024 caused billions of dollars in destruction, displacing families and leaving businesses in ruin.

It caused more than just property damage. While the community worked to recover, mold took hold in homes and other buildings across the city, turning the natural disaster into a prolonged crisis with public health implications.

“If any part of a home is exposed to flooding or leaks and is not fully dried within 24 to 48 hours, mold growth is almost certain,” said Parham Azimi, a research associate at Harvard T.H. Chan School of Public Health, who studies the link between mold exposure and respiratory health, particularly in the wake of natural disasters. “After major storms, we often see spikes in respiratory illnesses, particularly in homes that were affected by flooding.”

A Foundation for Trouble

An estimated 47% of residential buildings in the United States contain mold or dampness. So even as the latest hurricane season winds down, the threat of mold-related health risks lingers.

And with 29% of the nation’s population living in flood-prone coastal counties, the risk of exposure to mold spores and allergens that can trigger respiratory illnesses is immense, leaving some 95 million people vulnerable when extreme weather strikes. That doesn’t count people in inland areas that flood, like in the North Carolina and Tennessee mountains that experienced massive flooding from Hurricane Helene last year — or those whose homes were drenched from the Hill Country flooding in Texas this summer.

The health consequences of mold exposure range from mild allergic reactions to severe respiratory conditions. Common symptoms include congestion, asthma flare-ups, and skin irritation, according to the Centers for Disease Control and Prevention. Prolonged exposure can lead to more serious complications, such as hypersensitivity pneumonitis — a rare lung inflammation — and mycotoxin-related illnesses, which can cause neurological damage, liver disease, and kidney dysfunction.

Now, a key federal program that helps repair housing after disasters and aid from the Federal Emergency Management Agency are in question amid President Donald Trump’s cutbacks and policy changes.

One of the greatest dangers of mold is that it often goes undetected for months or years, leaving people unknowingly exposed.

Lauren Lowenstein in Houston knows that all too well. “For five years, my family’s health kept declining, and we had no idea why,” she said.

After conducting an Environmental Relative Moldiness Index test, Lowenstein said, she discovered that toxic mold spores had been growing inside the walls of her home due to excessive condensation in the HVAC system. She, her husband, and their two children vacated immediately and had to start over again.

“The mold wasn’t visible, and we had no indication that it was growing,” Lowenstein said.

Even when mold is detected, removing it is an expensive challenge. On average, mold remediation costs between $1,223 and $3,751, according to the home service clearinghouse Angi, but in severe cases, the price can reach $30,000 or more. Even with home insurance coverage for mold, people may bear some cost.

Daniels, for example, was forced to leave her Tallahassee apartment and get a hotel for a month while waiting to be moved into a newly renovated unit. She had to replace all her belongings.

The cost of remediation remains out of reach for many households, Azimi said, and alternative yet affordable housing can be hard to find, which means continued mold exposure.

“For low-income and marginalized communities, the risks are even greater,” Azimi said.

For those seeking government assistance, the wait times can be extensive, according to the Rev. Mac Legerton, founder of the Robeson County Disaster Survival and Resiliency School in North Carolina. “In many cases, families are left to choose between living in unsafe conditions or homelessness.”

A 2019 review funded by the U.S. Department of Housing and Urban Development of 88 disaster grants found that its Community Development Block Grant Disaster Recovery program began distributing funds to applicants on average 20 months after the initial disaster, with disbursements taking two years or longer.

“When it comes to our disaster response system, mold remediation is one of the most neglected areas at the local, state, and national levels,” Legerton said.

Legerton’s organization runs a “mold busters” program, a hands-on training and education initiative that helps give people in Robeson County the tools and knowledge they need to safely remove mold from homes, churches, and businesses following natural disasters. The program also provides free mold remediation services to vulnerable communities. He said it was created in response to the lack of timely aid in the central North Carolina community.

Waiting Takes Its Toll

Tanya Locklear faced this reality after Hurricanes Matthew and Florence severely damaged her home in Pembroke, North Carolina, in 2016 and 2018, respectively, ultimately leaving it contaminated with mold.

She applied for assistance through North Carolina’s ReBuild NC governmental program in August 2021 but said she did not receive approval until November 2023. She said repairs finally began in February 2024 — more than two years after her application.

It was only after local advocacy efforts — including pressure from community leaders and Legerton’s organization — that her case moved forward, Locklear said.

However, she said, the initial delays had already taken a toll on her family’s health and well-being. While waiting for aid, Locklear and her children remained in the hazardous conditions of the moldy home. She said she and her family suffered health complications such as headaches, nose bleeds, and difficulty breathing.

Even today, Locklear said, she has various respiratory issues, showing the long-term risks of remaining in mold-infested homes.

Legerton, working with his group on the ground in North Carolina, believes that lawmakers and policymakers must focus on streamlining disaster relief programs to ensure effective and timely aid distribution for affected families and communities nationwide.

Government officials should also increase funding for mold remediation to help prevent displacement and long-term health consequences, and implement stronger building codes and flood-resistant housing designs to mitigate mold risk in disaster-prone areas, according to Legerton and public health experts. Without proactive policies, Azimi said, millions more will face prolonged exposure to unhealthy living conditions.

“As climate change intensifies, hurricanes and severe storms will become more frequent and destructive, increasing the risk of mold-related illnesses,” Azimi said.

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Both patients, a man and a woman, had agreed to donate their brains after they died for further research. “An amazing gift,” said Edward Lee, the neuropathologist who directs the brain bank at the university’s Perelman School of Medicine. “They were both very dedicated to helping us understand Alzheimer’s disease.”

The man, who died at 83 with dementia, had lived in the Center City neighborhood of Philadelphia with hired caregivers. The autopsy showed large amounts of amyloid plaques and tau tangles, the proteins associated with Alzheimer’s disease, spreading through his brain.

Researchers also found infarcts, small spots of damaged tissue, indicating that he had suffered several strokes.

By contrast, the woman, who was 84 when she died of brain cancer, “had barely any Alzheimer’s pathology,” Lee said. “We had tested her year after year, and she had no cognitive issues at all.”

The man had lived a few blocks from Interstate 676, which slices through downtown Philadelphia. The woman had lived a few miles away in the suburb of Gladwyne, Pennsylvania, surrounded by woods and a country club.

The amount of air pollution she was exposed to — specifically, the level of fine particulate matter called PM2.5 — was less than half that of his exposure. Was it a coincidence that he had developed severe Alzheimer’s while she had remained cognitively normal?

With increasing evidence that chronic exposure to PM2.5, a neurotoxin, not only damages lungs and hearts but is also associated with dementia, probably not.

“The quality of the air you live in affects your cognition,” said Lee, the senior author of a recent article in JAMA Neurology, one of several large studies in the past few months to demonstrate an association between PM2.5 and dementia.

Scientists have been tracking the connection for at least a decade. In 2020, the influential Lancet Commission added air pollution to its list of modifiable risk factors for dementia, along with common problems like hearing loss, diabetes, smoking, and high blood pressure.

Yet such findings are emerging when the federal government is dismantling efforts by previous administrations to continue reducing air pollution by shifting from fossil fuels to renewable energy sources.

“‘Drill, baby, drill’ is totally the wrong approach,” said John Balmes, a spokesperson for the American Lung Association who researches the effects of air pollution on health at the University of California-San Francisco.

“All these actions are going to decrease air quality and lead to increasing mortality and illness, dementia being one of those outcomes,” Balmes said, referring to recent environmental moves by the White House.

Many factors contribute to dementia, of course. But the role of particulates — microscopic solids or droplets in the air — is drawing closer scrutiny.

Particulates arise from many sources: emissions from power plants and home heating, factory fumes, motor vehicle exhaust, and, increasingly, wildfire smoke.

Of the several particulate sizes, PM2.5 “seems to be the most damaging to human health,” Lee said, because it is among the smallest. Easily inhaled, the particles enter the bloodstream and circulate through the body; they can also travel directly from the nose to the brain.

The research at the University of Pennsylvania, the largest autopsy study to date of people with dementia, included more than 600 brains donated over two decades.

Previous research on pollution and dementia mostly relied on epidemiological studies to establish an association. Now, “we’re linking what we actually see in the brain with exposure to pollutants,” Lee said, adding, “We’re able to do a deeper dive.”

The study participants had undergone years of cognitive testing at Penn Memory. With an environmental database, the researchers were able to calculate their PM2.5 exposure based on their home addresses.

The scientists also devised a matrix to measure how severely Alzheimer’s and other dementias had damaged donors’ brains.

Lee’s team concluded that “the higher the exposure to PM2.5, the greater the extent of Alzheimer’s disease,” he said. The odds of more severe Alzheimer’s pathology at autopsy were almost 20% greater among donors who had lived where PM2.5 levels were high.

Another research team recently reported a connection between PM2.5 exposure and Lewy body dementia, which includes dementia related to Parkinson’s disease. Generally considered the second most common type after Alzheimer’s, Lewy body accounts for an estimated 5% to 15% of dementia cases.

In what the researchers believe is the largest epidemiological study to date of pollution and dementia, they analyzed records from more than 56 million beneficiaries with traditional Medicare from 2000 to 2014, comparing their initial hospitalizations for neurodegenerative diseases with their exposure to PM2.5 by ZIP codes.

“Chronic PM2.5 exposure was linked to hospitalization for Lewy body dementia,” said Xiao Wu, an author of the study and a biostatistician at the Mailman School of Public Health at Columbia University.

After controlling for socioeconomic and other differences, the researchers found that the rate of Lewy body hospitalizations was 12% higher in U.S. counties with the worst concentrations of PM2.5 than in those with the lowest.

To help verify their findings, the researchers nasally administered PM2.5 to laboratory mice, which after 10 months showed “clear dementia-like deficits,” senior author Xiaobo Mao, a neuroscientist at the Johns Hopkins School of Medicine, wrote in an email.

The mice got lost in mazes that they had previously dashed through. They had earlier built nests quickly and compactly; now their efforts were sloppy, disorganized. At autopsy, Mao said, their brains had atrophied and contained accumulations of the protein associated with Lewy bodies in human brains, called alpha-synuclein.

A third analysis, published this summer in The Lancet, included 32 studies conducted in Europe, North America, Asia, and Australia. It also found “a dementia diagnosis to be significantly associated with long-term exposure to PM2.5” and to certain other pollutants.

Whether so-called ambient air pollution — the outdoor kind — increases dementia because of inflammation or other physiological causes awaits the next round of research.

Although air pollution has declined in the United States over two decades, scientists are calling for still stronger policies to promote cleaner air. “People argue that air quality is expensive,” Lee said. “So is dementia care.”

President Donald Trump, however, reentered office vowing to increase the extraction and use of fossil fuels and to block the transition to renewable energy. His administration has rescinded tax incentives for solar installations and electric vehicles, Balmes noted, adding, “They’re encouraging continuing to burn coal for power generation.”

The administration has halted new offshore wind farms, announced oil and gas drilling in the Arctic National Wildlife Refuge in Alaska, and moved to stop California’s plan to transition to electric cars by 2035. (The state has challenged that action in court.)

“If policy goes in the opposite direction, with more air pollution, that’s a big health risk for older adults,” Wu said.

Last year, under the Biden administration, the Environmental Protection Agency set tougher annual standards for PM2.5, noting that “the available scientific evidence and technical information indicate that the current standards may not be adequate to protect public health and welfare, as required by the Clean Air Act.”

In March, the EPA’s new chairman announced that the agency would be “revisiting” those stricter standards.

The New Old Age is produced through a partnership with The New York Times.

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At a forum Nov. 7 in the Inland Empire, four Democratic candidates vying to succeed Gov. Gavin Newsom vowed to push back against Republican cuts to health care programs and to improve people’s access to medical care, including mental health services. But while some floated taxes, candidates were light on details about how they would bring down health care costs.

Former U.S. Health and Human Services Secretary Xavier Becerra promised to be California’s next “health care governor,” echoing Newsom’s commitment to lower costs and broaden access when he first got into office. State Superintendent of Public Instruction Tony Thurmond pledged to create a single-payer health care system in which everyone is pooled into one program. Former state Controller Betty Yee said she would “build back better” from federal cuts and create a health care system tailored to California’s diverse communities.

And former Los Angeles Mayor Antonio Villaraigosa vowed to fight to preserve safety net health care pared by the Trump administration and Republicans in Congress, although he acknowledged the challenge given limited state resources.

“I’m not gonna sell you snake oil,” he said. “It is going to be tough to provide that care, but I’m absolutely committed to it.”

The candidates’ assurances come amid recent shifts in state and federal policies that, together with a variety of forces, are driving up the cost of health care and making it harder for people to obtain and maintain coverage. In addition to providers raising prices, other inflationary pressures include an aging population, rising chronic conditions, medical advancements, and new technologies, according to analysts. That’s added to a sense of financial precarity for the millions of Californians struggling with the state’s high cost of living and recent inflation spike.

Although the forum was open to up to six candidates, former U.S. Rep. Katie Porter and entrepreneur Stephen Cloobeck declined to participate, citing scheduling or other factors, according to Jon Koriel, an event spokesperson.

Health Care Top Concern

A statewide poll commissioned by the California Wellness Foundation ahead of the Health Matters forum found that nearly 80% of likely voters worry about the cost of health care and that 72% think the next governor should prioritize capping out-of-pocket expenses. Access to affordable mental health care and being able to care for aging family members or friends were also top concerns. Perhaps in an early signal, voters last week in Santa Clara County passed a sales tax to help backfill federal cuts to food and health care safety net programs.

California mirrors much of the nation. Exit polls from the Nov. 4 election show 81% of those who voted for Democrat Abigail Spanberger, winner of the Virginia governor’s race, cited health care as the most important issue facing the state. In a national Reuters/Ipsos poll, health care was cited as the top everyday expense Americans want Congress to prioritize. And 65% of voters said an annual health cost increase of $1,000 would have some impact on their 2026 vote, according to a recent KFF poll.

Some Californians interviewed on Nov. 4, the day of the state’s special election, expressed disappointment in Newsom’s unmet promises on health care. Newsom, a Democrat who is mulling a presidential run as he wraps up his second term in January 2027, had campaigned on single-payer health care.

During his tenure he’s steered billions of dollars and engineered rules to help the neediest Californians afford and access health care. The state also expanded state-funded Medicaid coverage, known as Medi-Cal, to all eligible residents, regardless of immigration status. Medicaid provides free or low-cost health insurance to low-income and disabled people.

But this year, facing rising costs and budget deficits, Newsom and the Democratic-controlled legislature walked back some of that expansion by freezing enrollment for adults without legal status starting in 2026 and implementing premiums. They also resurrected an asset test for older adults and people with disabilities. Meanwhile, health care costs and homelessness remain a huge problem, and many Californians struggle to get basic medical care. And there’s no sign of a single-payer health care system, which Sacramento lawmakers have repeatedly failed to advance amid concerns about cost, including one estimate in 2017 of $400 billion annually.

“I remember him coming and speaking to our members and telling them that he was going to fight with them for single payer,” Michael Cusack, a 30-year-old former health care union worker from Oakland, said as he cast his ballot last week. “And I never saw him deliver on that campaign.”

Paying for Health Care

Becerra, Thurmond, and Yee said they would be open to raising taxes to pay for health care programs. Villaraigosa sidestepped the tax question, saying his focus would be to “grow the pie” economically. Yee also suggested offering tax credits to help struggling families pay for health care and caregiving expenses.

During the forum’s lightning round, Becerra, Thurmond, and Yee also raised their hands when asked whether they supported single-payer care. Becerra said after the event that he doesn’t believe the state would receive support from the Trump administration for a single-payer system, but he said he would push for universal access to health care.

Indeed, all the candidates appeared mindful of Washington’s power over health care resources, even as they vowed to stand up to President Donald Trump, who has an especially adversarial relationship with Newsom.

“Let’s recognize that the federal government is our largest partner,” Becerra said. “We must work with them. We will not take a knee, but we must work with them.”

Currently, the biggest threats to health care costs and accessibility come from the federal government. Republicans in Congress have refused to give in to Democrats’ demand to extend premium tax subsidies for health insurance plans purchased on Affordable Care Act exchanges, the main issue that drove the government shutdown. Enrollees in Covered California, the state’s health insurance exchange, have received notices that their premiums will increase next year. On average, monthly premium payments for people receiving ACA subsidies are expected to double across the nation.

Laura Jones, a small-business owner in Oakland, currently pays the minimum possible for her Covered California plan, but she worries she wouldn’t be able to afford a major medical emergency. She thinks about one of her friends who recently suffered a stroke.

“The hospital bills were just so egregious,” Jones said. “How would I pay for that?”

Meanwhile, an impending $900 billion in federal Medicaid spending reductions under the One Big Beautiful Bill Act and tighter eligibility restrictions are expected to push as many as 3.4 million Californians out of the program. More than a third of Californians are currently enrolled in Medi-Cal.

Oseoba Airewele, 29, of Ventura, a registered Democrat who previously worked as a software engineer, said Medi-Cal became a lifeline after he lost insurance through his job and needed mental health and dental care.

“If I were to lose it, I would be very concerned,” he said. “I’d be in a bad place.”

People with employer-based health coverage also face steep price hikes. Family premiums for employer-based plans averaged almost $27,000 this year, up 6% from 2024, a new KFF report shows. Workers typically pay almost $7,000 of that, the report found. That doesn’t include other out-of-pocket expenses.

“Even though I have a job, it’s still really expensive to pay for the copays,” said Rheema Calloway, 35, a San Francisco independent.

Primary in June

Among the other Democratic candidates vying for governor in 2026, Porter has said she will make fighting federal cuts to Medicaid and Medicare a top priority, along with expanding and improving health care for all residents. Porter’s campaign suffered a blow after viral videos surfaced of her threatening to walk out of a CBS interview and berating a staff member. Former Assemblyman Ian Calderon has said he would protect access to Medi-Cal. And Cloobeck wants to fast-track housing construction.

Republican candidates include Riverside County Sheriff Chad Bianco and Steve Hilton, a former Fox News contributor and policy adviser to David Cameron when he was Britain’s prime minister. Both have pledged to tackle affordability issues, especially housing costs.

Two other high-profile Democrats — former Vice President Kamala Harris and U.S. Sen. Alex Padilla — have said they won’t run. Rick Caruso, a Republican-turned-Democrat and wealthy Los Angeles businessman, has yet to decide whether to run.

The California primary will be held June 2 and the general election on Nov. 3.

KFF Health News correspondent Christine Mai-Duc and ethnic media editor Ngoc Nguyen contributed to this report.

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

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

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

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

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

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

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

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

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

DARPA officials didn’t return a message seeking comment.

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