Agentes del Servicio de Inmigración y Control de Aduanas (ICE) también se han presentado en clínicas comunitarias.

Proveedores de salud dicen que intentaron entrar en un estacionamiento donde había una clínica móvil, apuntaron a las caras de médicos que atendían a personas sin hogar y detuvieron a un transeúnte, subiéndolo a un auto sin identificación, frente a un centro comunitario de salud.

En respuesta a estas actividades de control migratorio alrededor de clínicas y hospitales, el gobernador demócrata Gavin Newsom promulgó el mes pasado la ley SB 81, que prohíbe a los centros médicos permitir el acceso de agentes federales a áreas privadas, incluidos los lugares donde los pacientes reciben tratamiento o hablan sobre temas de salud, sin una orden judicial o de registro válidas.

Si bien el proyecto de ley recibió un amplio apoyo de grupos médicos, trabajadores de salud y defensores de los derechos de los inmigrantes, expertos legales afirman que California no puede impedir que las autoridades federales realicen sus funciones en lugares públicos, como vestíbulos y salas de espera de hospitales, estacionamientos de centros de salud y vecindarios aledaños: lugares donde las recientes actividades del ICE han generado indignación y temor.

En enero, la administración Trump revocó las restricciones federales previas sobre la aplicación de las leyes de inmigración en o cerca de áreas sensibles, incluidos los establecimientos de salud.

“El problema que enfrentan los estados es la cláusula de supremacía”, dijo la abogada Sophia Genovese, profesora en la Facultad de Leyes de Georgetown. Explicó que el gobierno federal tiene derecho a realizar actividades de control migratorio y que existen límites a lo que el estado puede hacer para impedirlas.

La ley de California designa el estatus migratorio y el lugar de nacimiento de un paciente como información protegida, la cual, al igual que los expedientes médicos, no puede divulgarse a las autoridades sin una orden judicial.

Además, requiere que los centros de salud establezcan procedimientos claros para gestionar los pedidos de las autoridades de inmigración, incluyendo la capacitación del personal para notificar de inmediato a un administrador designado o a un asesor legal si los agentes intentan entrar a un área privada o revisar los expedientes de los pacientes.

Otros estados gobernados por demócratas han promulgado leyes para proteger a los pacientes en hospitales y centros de salud.

En mayo, el gobernador de Colorado, Jared Polis, promulgó la  Protect Civil Rights Immigration Status, que penaliza a los hospitales por compartir sin autorización información sobre personas que se encuentran en el país de manera irregular y prohíbe a los agentes del ICE ingresar a áreas privadas de los centros de salud sin una orden judicial.

En junio, entró en vigencia en Maryland una ley que exige al fiscal general crear directrices para mantener al ICE fuera de los centros de salud. Nuevo México ha implementado nuevas protecciones para los datos de pacientes, y Rhode Island ha prohibido a los establecimientos de salud preguntar a los pacientes sobre su estatus migratorio.

Los estados gobernados por republicanos se han alineado con los esfuerzos federales para evitar que se gaste en atención médica de inmigrantes sin papeles.

Estos inmigrantes no son elegibles para la cobertura integral de Medicaid, pero los estados sí facturan al gobierno federal por la atención de emergencia en ciertos casos. Bajo una ley que entró en vigencia en 2023, Florida exige que los hospitales que aceptan Medicaid pregunten sobre el estatus migratorio del paciente. En Texas, los hospitales ahora deben informar cuánto gastan en la atención de inmigrantes indocumentados.

“Los texanos no deberían tener que asumir el costo de la atención médica de los inmigrantes ilegales”, declaró el gobernador Greg Abbott al emitir su orden ejecutiva el año pasado.

Los esfuerzos de California por limitar la aplicación de la ley federal se producen en un momento en que el estado, donde más de una cuarta parte de los residentes han nacido en el extranjero, se ha convertido en blanco de la represión migratoria del presidente Donald Trump.

Newsom promulgó la SB 81 como parte de un paquete de leyes que prohíbe a los agentes de inmigración entrar en las escuelas sin una orden judicial, exige que los agentes se identifiquen y prohíbe el uso de máscaras. La SB 81 se aprobó con una votación partidista sin oposición formal.

“No somos Corea del Norte”, expresó Newsom durante una ceremonia de firma de leyes en septiembre. “Estamos rechazando estas tendencias y acciones autoritarias de esta administración”.

Algunos partidarios del proyecto de ley y expertos legales afirmaron que la ley de California puede impedir que el ICE viole los derechos de privacidad de los pacientes ya existentes.

Entre estos derechos se incluye la Cuarta Enmienda, que prohíbe los registros sin orden judicial en lugares donde las personas tienen una expectativa razonable de privacidad. Las órdenes judiciales válidas deben ser emitidas por un tribunal y firmadas por un juez. Sin embargo, con frecuencia los agentes del ICE utilizan órdenes administrativas para intentar acceder a áreas privadas para las que no tienen autoridad, dijo Genovese.

“La gente no siempre entiende la diferencia entre una orden administrativa, que es un simple documento, y una orden judicial, que es ejecutable”, dijo Genovese. Añadió que las órdenes judiciales rara vez se emiten en casos de inmigración.

El Departamento de Seguridad Nacional (DHS) ha dicho que no acatará la prohibición del uso de máscaras ni los requisitos de identificación para los agentes del orden público en California, calificándolos de inconstitucionales. El departamento no respondió a la solicitud de comentarios sobre las nuevas normas estatales para centros de salud, que entraron en vigencia de inmediato.

Tanya Broder, asesora principal del National Immigration Law Center, afirmó que las detenciones de inmigrantes en centros de salud parecen ser relativamente raras. Sin embargo, la decisión federal de revocar las protecciones en torno a áreas sensibles, dijo, “ha generado temor e incertidumbre en todo el país”.

Muchos de los informes periodísticos más destacados sobre agentes de inmigración en centros de salud ocurrieron en California, principalmente en relación con pacientes detenidos que habían sido trasladados a un establecimiento de salud para recibir atención médica.

La California Nurses Association, el sindicato de enfermeras más grande del estado, copatrocinó el proyecto de ley y expresó su preocupación por el trato que recibió Milagro Solis-Portillo, una salvadoreña de 36 años que estuvo bajo vigilancia constante del ICE en el Hospital Glendale Memorial durante el verano.

Los líderes sindicales también condenaron la presencia de agentes en el California Hospital Medical Center, al sur del centro de Los Ángeles. Según Anne Caputo-Pearl, enfermera de parto y representante sindical principal del hospital, los agentes llevaron a una paciente el 21 de octubre y permanecieron en su habitación durante casi una semana. El diario Los Angeles Times informó que a Carlitos Ricardo Parias, creador de contenido de TikTok, lo llevaron al hospital ese mismo día tras resultar herido durante un operativo de control migratorio en el sur de Los Ángeles.

La presencia del ICE intimidó tanto a enfermeras como a pacientes, aseguró Caputo-Pearl, y motivó restricciones de visitas en el hospital. “Queremos una explicación más clara”, dijo. “¿Por qué se permite que estos agentes estén en la habitación?”.

Sin embargo, representantes de hospitales y clínicas dijeron que ya cumplen con los requisitos de la ley, los cuales refuerzan en gran medida las extensas directrices publicadas por el fiscal general del estado, Rob Bonta, en diciembre.

Las clínicas comunitarias a lo largo del condado de Los Ángeles, que atienden a más de dos millones de pacientes al año, incluyendo una gran proporción de inmigrantes, han estado implementando las directrices del fiscal general durante meses, según dijo Louise McCarthy, presidenta y directora ejecutiva de la Asociación de Clínicas Comunitarias del Condado de Los Ángeles.

Agregó que la ley debería ayudar a garantizar estándares unificados en todos los establecimientos de salud a los que las clínicas derivan pacientes y brindarles la tranquilidad de que hay procedimientos para protegerlos.

Aun así, no se puede evitar que se produzcan redadas migratorias en la comunidad, lo que ha provocado que algunos pacientes e incluso trabajadores de salud teman salir a la calle, señaló McCarthy. Se han producido algunos incidentes cerca de clínicas, incluyendo el arresto de un transeúnte frente a una clínica en el este de Los Ángeles, que un guardia de seguridad grabó en video, contó.

“Hemos escuchado a personal de las clínicas preguntar: ‘¿Es seguro para mí salir?'”, dijo.

En St. John’s Community Health, una red de 24 centros de salud comunitarios y cinco clínicas móviles en el sur de Los Ángeles y el Inland Empire, el director ejecutivo Jim Mangia coincidió en que la nueva ley no puede prevenir toda la actividad de control migratorio, pero afirmó que sí les brinda a las clínicas una herramienta para defenderse si se presentan agentes, algo que su personal ya ha tenido que hacer.

Mangia dijo que el personal de St. John’s tuvo dos encuentros con agentes de inmigración durante el verano. En uno de ellos, impidió que agentes armados ingresaran a un estacionamiento con rejas en un centro de rehabilitación de adicciones donde médicos y enfermeras atendían a pacientes en una clínica móvil.

Otro incidente ocurrió en julio, cuando agentes de inmigración llegaron a MacArthur Park a caballo y en vehículos blindados, en una demostración de fuerza por parte del gobierno de Trump.

Mangia dijo que agentes enmascarados con equipo táctico completo rodearon una carpa de atención médica callejera donde el personal de St. John’s atendía a personas sin hogar, les gritaron que se fueran y les apuntaron con un arma. Según Mangia, los proveedores quedaron tan conmocionados por el incidente que tuvieron que recurrir a profesionales de salud mental para ayudarlos a sentirse seguros al regresar de nuevo a la calle.

Un vocero del DHS declaró a CalMatters que, en raras ocasiones, cuando los agentes entran a ciertos lugares sensibles, los oficiales necesitan la aprobación de un supervisor secundario.

Desde entonces, St. John’s ha intensificado sus esfuerzos para brindar apoyo y capacitación al personal y ha ofrecido a los pacientes con miedo a salir la opción de visitas médicas a domicilio y entrega de alimentos. Los temores de los pacientes y la actividad del ICE han disminuido desde el verano, afirmó Mangia, pero con el DHS planeando contratar a 10.000 agentes adicionales, duda que esta situación se mantenga.

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U.S. Immigration and Customs Enforcement agents have also shown up at community clinics. Health providers say that officers have tried to enter a parking lot hosting a mobile clinic, waved a machine gun in the faces of clinicians serving the homeless, and hauled a passerby into an unmarked car outside a community health center.

In response to such immigration enforcement activity in and around clinics and hospitals, Democratic Gov. Gavin Newsom last month signed SB 81, which prohibits medical establishments from allowing federal agents without a valid search warrant or court order into private areas, including places where patients receive treatment or discuss health matters.

But while the bill received broad support from medical groups, health care workers, and immigrant rights advocates, legal experts say California can’t stop federal authorities from carrying out duties in public places, which include hospital lobbies and general waiting areas, health facility parking lots, and surrounding neighborhoods — places where recent ICE activities have sparked outrage and fear. Previous federal restrictions on immigration enforcement in or near sensitive areas, including health care establishments, were rescinded by the Trump administration in January.

“The issue that states encounter is the supremacy clause,” said Sophia Genovese, a supervising attorney and clinical teaching fellow at Georgetown Law. She said the federal government does have the right to conduct enforcement activities, and there are limits to what the state can do to stop them.

California’s law designates a patient’s immigration status and birthplace as protected information, which like medical records cannot be disclosed to law enforcement without a warrant or court order. And it requires health care facilities to have clear procedures for handling requests from immigration authorities, including training staff to immediately notify a designated administrator or legal counsel if agents ask to enter a private area or review patient records.

Several other Democratic-led states have also taken up legislation to protect patients at hospitals and health centers. In May, Colorado Gov. Jared Polis signed the Protect Civil Rights Immigration Status bill, which penalizes hospitals for unauthorized sharing of information about people in the country illegally and bars ICE agents from entering private areas of health care facilities without a judicial warrant. In Maryland, a law requiring the attorney general to create guidance on keeping ICE out of health care facilities went into effect in June. New Mexico has instituted new patient data protections, and Rhode Island has prohibited health care facilities from asking patients about their immigration status.

Republican-led states have aligned with federal efforts to prevent health care spending on immigrants without legal authorization. Such immigrants are not eligible for comprehensive Medicaid coverage, but states do bill the federal government for emergency care in certain cases. Under a law that took effect in 2023, Florida requires hospitals that accept Medicaid to ask about a patient’s legal status. In Texas, hospitals now have to report how much they spend on care for immigrants without legal authorization.

“Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants,” Gov. Greg Abbott said in issuing his executive order last year.

California’s efforts to rein in federal enforcement come as the state, where more than a quarter of residents are foreign-born, has become a target of President Donald Trump’s immigration crackdown. Newsom signed SB 81 as part of a bill package prohibiting immigration agents from entering schools without a warrant, requiring law enforcement officers to identify themselves, and banning officers from wearing masks. SB 81 was passed on a party-line vote with no formal opposition.

“We’re not North Korea,” Newsom said during a September bill-signing ceremony. “We’re pushing back against these authoritarian tendencies and actions of this administration.”

Some supporters of the bill and legal experts said California’s law can prevent ICE from violating existing patient privacy rights. Those include the Fourth Amendment, which prohibits searches without a warrant in places where people have a reasonable expectation of privacy. Valid warrants must be issued by a court and signed by a judge. But ICE agents frequently use administrative warrants to try to gain access to private areas they don’t have the authority to enter, Genovese said.

“People don’t always understand the difference between an administrative warrant, which is a meaningless piece of paper, versus a judicial warrant that is enforceable,” Genovese said. Judicial warrants are rarely issued in immigration cases, she added.

The Department of Homeland Security has said it won’t abide by California’s mask ban or identification requirements for law enforcement officers, slamming them as unconstitutional. The department did not respond to a request for comment on the state’s new rules for health care facilities, which went into immediate effect.

Tanya Broder, a senior counsel with the National Immigration Law Center, said immigration arrests at health care facilities appear to be relatively rare. But the federal decision to rescind protections around sensitive areas, she said, “has generated fear and uncertainty across the country.” Many of the most high-profile news reports of immigration agents at health care facilities have been in California, largely involving detained patients brought in for care.

The California Nurses Association, the state’s largest nurses union, was a co-sponsor of the bill and raised concerns about the treatment of Milagro Solis-Portillo, a 36-year-old Salvadoran woman who was under round-the-clock ICE surveillance at Glendale Memorial Hospital over the summer.

Union leaders also condemned the presence of agents at California Hospital Medical Center south of downtown Los Angeles. According to Anne Caputo-Pearl, a labor and delivery nurse and the chief union representative at the hospital, agents brought in a patient on Oct. 21 and remained in the patient’s room for almost a week. The Los Angeles Times reported that a TikTok streamer, Carlitos Ricardo Parias, was taken to the hospital that day after he was wounded during an immigration enforcement operation in South Los Angeles.

The presence of ICE was intimidating for nurses and patients, Caputo-Pearl said, and prompted visitor restrictions at the hospital. “We want better clarification,” she said. “Why is it that these agents are allowed to be in the room?”

Hospital and clinic representatives, however, said they are already following the law’s requirements, which largely reinforce extensive guidance put out by state Attorney General Rob Bonta in December.

Community clinics throughout Los Angeles County, which serve over 2 million patients a year, including a large portion of immigrants, have been implementing the attorney general’s guidelines for months, said Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County. But she said the law should help ensure uniform standards across health facilities that clinics refer out to and reassure patients that procedures are in place to protect them.

Still, it can’t prevent immigration raids from happening in the broader community, which have made some patients and even health workers afraid to venture outside, McCarthy said. Some incidents have occurred near clinics, including an arrest of a passerby outside a clinic in East Los Angeles, which a security guard caught on video, she said.

“We’ve had clinic staff say, ‘Is it safe for me to go out?’” she said.

At St. John’s Community Health, a network of 24 community health centers and five mobile clinics in South Los Angeles and the Inland Empire, CEO Jim Mangia agreed that the new law can’t prevent all immigration enforcement activity, but he said it does give clinics a tool to push back if agents show up, something his staff has already had to do.

Mangia said St. John’s staff had two encounters with immigration agents over the summer. In one, he said, staff stopped armed officers from entering a gated parking lot at a drug and alcohol recovery center where doctors and nurses were seeing patients at a mobile health clinic.

Another occurred in July, when immigration agents descended upon MacArthur Park on horses and in armored vehicles, in a show of force by the Trump administration. Mangia said masked officers in full tactical gear surrounded a street medicine tent where St. John’s providers were tending to homeless patients, screamed at staff to get out, and pointed a gun at them. The providers were so shaken by the episode, Mangia said, that he had to bring in mental health professionals to help them feel safe going back out on the street.

A DHS spokesperson told CalMatters that in the rare instance where agents enter certain sensitive locations, officers would need “secondary supervisor approval.”

Since then, St. John’s has doubled down on providing support and training to staff and has offered patients afraid to go out the option of home medical visits and grocery deliveries. Patient fears and ICE activity have decreased since the summer, Mangia said, but with DHS planning to hire an additional 10,000 ICE agents, he doubts that will last.

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Their victory in Held v. Montana, later upheld by the state Supreme Court, resounded across the country, showing that young people have a stake in the issue of climate change, advocates say. Yet, state policies to address the causes of climate change in Montana — home to large coal, oil, and natural gas deposits — haven’t changed in the wake of the case.

On Sept. 17, some of those plaintiffs are scheduled to appear in federal court to request that U.S. District Judge Dana Christensen block a series of President Donald Trump’s executive orders on energy issues. They argue the orders violate their Fifth Amendment rights and will cause nearly 200,000 additional deaths over the next 25 years and lead to more heart, respiratory, and other health problems. They are joined by other plaintiffs ages 7 to 24 from California, Florida, Hawaii, and Oregon, and are backed by the climate-focused nonprofit Our Children’s Trust.

“Trump’s fossil fuel orders are a death sentence for my generation,” Eva Lighthiser, a 19-year-old resident of Livingston, Montana, wrote in the complaint filed on May 29. “I am not suing because I want to, I am suing because I have to. My health, my future and my right to speak the truth are all on the line.”

She added that a warming climate has led to an increase in summer wildfire smoke and contributed to the flooding of the Yellowstone River (a warmer atmosphere holds more precipitation). At the heart of the case, Lighthiser v. Trump, is the claim that young people are being denied their Fifth Amendment rights under the U.S. Constitution — life, liberty, and the pursuit of happiness — because of the health effects of fossil fuel development and climate change. And they say the Montana Supreme Court’s decision in December to uphold their right to a clean and healthful environment buttresses their claim.

Montana Attorney General Austin Knudsen, a Republican, along with 18 other states and Guam, a U.S. territory, have sided with the Trump administration, filing a motion supporting the government’s request to dismiss the case. They argue the plaintiffs do not have standing to file the lawsuit, and that there is no constitutional right to a specific energy policy. “The state of Montana has an interest in this case because it will directly impact the business done in the energy sector within its borders,” Knudsen argued in his motion.

A hearing on the motion to dismiss, as well as the plaintiffs’ call for a stay of the executive orders, is scheduled for next week in federal court in Missoula.

Olivia Vesovich, 21, one of the plaintiffs, who is in her senior year at the University of Montana in Missoula, told KFF Health News she struggles with severe spring pollen allergies, which research shows are exacerbated by climate warming and will likely worsen.

“My eyes were swollen shut every single day, every single night,” Vesovich said. “When I wake up in the morning, I couldn’t open my eyes for 10 minutes. It’s not fun at all, and it’s exacerbated by climate change and by the fossil fuel industry.”

She also has exercise-induced asthma as well as feelings of suffocation from the smoke-filled skies during wildfire season — the intensity and frequency of which are magnified by climate change. And Trump’s executive orders are already being implemented and causing harm, Vesovich said.

“We are making an argument that Olivia’s state constitutional right to a safe climate system should also be protected under the federal Fifth Amendment as part of her liberty right,” said Andrea Rodgers, a senior attorney for Our Children’s Trust.

Our Children’s Trust was also behind the climate change case Juliana v. the United States, filed in 2015 by 21 young plaintiffs who argued their rights had been violated. In 2024, the 9th U.S. Circuit Court of Appeals ordered the federal district court to dismiss the case, ruling that the courts were not the appropriate venue for climate policy.

They believe the victory in Held v. Montana gives American youth more standing this time. If they prevail, the result would be more far-reaching than the Montana case, creating a national precedent.

The plaintiffs are asking the court to declare Trump’s three related executive orders — “Unleashing American Energy,” “Declaring a National Energy Emergency,” and “Reinvigorating America’s Beautiful Clean Coal Industry” — unconstitutional and to block their implementation. They also claim that Trump has overstepped his authority by attempting to undo laws such as the Clean Air Act. A coalition of 14 states’ attorneys general has also filed a lawsuit against the order that declares an energy emergency.

Trump came into office in January primed to support traditional energy sources and to back off efforts to usher in an era of renewable energy, which he claims are not viable. He has also issued orders rolling back environmental regulations. “We are driving a dagger into the heart of the climate change religion to drive down the cost of living for American families, unleash American energy, bring auto jobs back to the U.S., and more,” Environmental Protection Agency Administrator Lee Zeldin said in a March news release.

In July, the EPA proposed repealing its 2009 “endangerment finding” that concluded climate-warming gases “endanger both the public health and the public welfare of current and future generations.”

The finding established that greenhouse gases are a pollutant and create adverse effects, such as extreme weather and risks to human health and ecosystems. And it created a foundation to regulate automobiles and the energy sector to address climate change.

Zeldin said that eliminating the rule would save Americans “$1 trillion or more in hidden taxes.”

Unleashing fossil fuels will come with costs, as well. The health effects of a warming world are thoroughly established in scientific literature, said Kristie Ebi, a University of Washington professor of global health and an expert in the health risks of climate variability. Mosquito-borne diseases such as dengue, chikungunya, and malaria are spreading, and flooding, droughts, and wildfire, exacerbated by climate change, pose threats. And research has shown an increase in deaths.

“There’s a long list of adverse health outcomes” from a warming world, she said. “The data are clear.”

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Hasta este año.

El plan de la administración Trump de retirar más de $550 millones en fondos federales para salud pública y pandemias en Texas hizo que se cancelara el evento, justo antes de su inicio programado para el 21 de julio.

“Hay personas que vienen todos los años y dependen de este evento”, dijo Dairen Sarmiento Rangel, directora del Departamento de Salud y Servicios Humanos del condado de Hidalgo. “Algunas personas incluso acampan afuera de Operación Salud Fronteriza para ser las primeras en recibir servicios. Este evento es muy importante para nuestra comunidad”.

Los gobiernos estatales y locales ya han tenido que hacer dolorosos recortes a sus programas, luego de importantes reducciones en la financiación federal para salud que ya han entrado en vigor. Ahora, se preparan para enfrentar los golpes financieros que están por venir —algunos no ocurrirán hasta finales del próximo año o incluso después— como resultado de la ley fiscal y de gasto aprobada por los republicanos en el Congreso en julio, conocida como la One Big Beautiful Bill, que pone en marcha gran parte de la agenda nacional del presidente Donald Trump.

Texas, por ejemplo, anticipa una reducción de hasta $39.000 millones en fondos federales para Medicaid durante los próximos 10 años debido a nuevas barreras para la inscripción, como revisiones de elegibilidad más frecuentes, según un análisis publicado en julio por KFF.

En conjunto, estas reducciones representan un cambio radical en la forma en que se financian y se ofrecen los programas estatales de salud. En la práctica, la administración está trasladando una parte importante de los costos de salud a los estados. Esto obligará a sus líderes a tomar decisiones difíciles, ya que muchos presupuestos estatales ya están presionados por la disminución en la recaudación de impuestos, la desaceleración del gasto federal por covid y la incertidumbre económica.

Más de una docena de estados han bajado sus proyecciones de ingresos para el año próximo, según un informe publicado en junio por Pew.

“Es casi inevitable que los estados recorten varios servicios de salud debido a la presión fiscal”, dijo Wesley Tharpe, asesor principal en política fiscal estatal del Centro para Prioridades Presupuestarias y Políticas (CBPP), una organización de tendencia progresista.

Algunos estados tratan de suavizar el impacto de forma proactiva.

En Hawaii, los legisladores se han propuesto ayudar a organizaciones sin fines de lucro que ya enfrentan disminución en fondos federales. Repartirán $50 millones en subvenciones a organizaciones de salud, servicios sociales y otras que hayan sufrido recortes. Para acceder a los fondos, deben demostrar que su financiación fue eliminada, reducida o afectada por los recortes.

“No es justo que organizaciones dedicadas a ayudar al pueblo de Hawaii se vean obligadas a reducir sus servicios por los recortes federales”, declaró el gobernador demócrata Josh Green en un comunicado.

Otros estados recortan proyectos para enfrentar la situación.

El gobernador de Delaware, Matt Meyer, demócrata, supo en marzo que la administración Trump retiraría $38 millones en fondos de salud pública al estado. Como consecuencia, un mes después, los líderes legislativos estatales frenaron un proyecto para renovar y ampliar el complejo del Capitolio estatal.

“Reconocimos que los recortes federales irresponsables a la red de protección social de miles de habitantes de Delaware nos obligaban a ahorrar recursos para proteger a los más vulnerables”, dijo David Sokola, presidente temporal del Senado estatal.

En Nuevo México, el estado con el mayor porcentaje de residentes inscritos en Medicaid, un grupo bipartidista de legisladores votó a favor de crear un fondo fiduciario para reforzar el financiamiento del programa. Según algunas estimaciones, aproximadamente el 10% de los más de 800.000 residentes que están cubiertos por Medicaid y el Programa de Seguro Médico para Niños (CHIP, en inglés) podrían perder su cobertura bajo esta nueva ley federal.

Algunos líderes estatales advierten a sus comunidades que lo peor está por venir.

En un evento realizado el 18 de agosto en un hospital del sur del Bronx, en la ciudad de Nueva York, la gobernadora demócrata Kathy Hochul subió al escenario junto a trabajadores de salud para criticar la nueva ley de Trump.

“Lo que los republicanos en Washington han hecho con la ‘Ley Más Horrible’ que he visto es, literalmente, perjudicar a los neoyorquinos”, dijo. El sistema de salud del estado se prepara para enfrentar recortes cercanos a los $13.000 millones al año.

En California, los legisladores analizaron el impacto de los recortes en una audiencia del comité de la Asamblea General el 20 de agosto, donde algunos legisladores demócratas señalaron que programas estatales como los de salud reproductiva estaban en peligro.

“Nos hemos preparado para esta realidad: la llamada ‘Big Beautiful Bill’ del presidente Trump ahora es ley”, dijo el legislador demócrata Gregg Hart durante la audiencia, calificándola como “un ataque directo a los programas fundamentales de California y a nuestros valores”.

“Lamentablemente, la realidad es que el estado no tiene la capacidad para compensar todos estos recortes federales draconianos con el presupuesto actual”, agregó. “No podemos simplemente firmar un cheque y hacer que esto desaparezca”.

La radical ley presupuestaria, que fue aprobada sin apoyo demócrata, reducirá el gasto federal en Medicaid en aproximadamen $1.000 millones durante la próxima década, según estimaciones de la Oficina de Presupuesto del Congreso (CBO). Las reducciones en el gasto vienen en gran medida de la imposición de un requisito laboral para las personas que obtuvieron Medicaid con la expansión promovida por la Ley de Cuidado de Salud a Bajo Precio (ACA), además de otras nuevas barreras para acceder a la cobertura.

Según la CBO, más de 7,5 millones de personas perderán la cobertura de Medicaid y quedarán sin seguro, mientras se extienden recortes fiscales para personas ricas que, según los demócratas, no los necesitan.

Por su parte, los republicanos y el presidente Trump afirman que el paquete fiscal y los recortes en los programas son necesarios para evitar el fraude y el despilfarro, y para garantizar la sostenibilidad de Medicaid, un programa federal-estatal que brinda cobertura a personas con discapacidades y de bajos ingresos.

“La One Big Beautiful Bill elimina a los inmigrantes ilegales, aplica requisitos laborales y protege a Medicaid para los verdaderamente vulnerables”, anunció la Casa Blanca en un comunicado del 29 de junio.

Los recortes a Medicaid no comenzarán hasta después de las elecciones legislativas de mitad de mandato en noviembre de 2026, pero ya se han aplicado otros recortes.

La administración Trump ha intentado recuperar $11.000 millones en fondos federales de salud pública destinados a los estados durante la pandemia, lo que provocó una batalla legal con una coalición de estados gobernados por demócratas. También recortó unos $1.000 millones en subvenciones federales para servicios de salud mental en las escuelas y detuvo los fondos de los Institutos Nacionales de Salud (NIH) que financiaban a más de 90 universidades públicas.

Un análisis de KFF Health News demuestra que las cancelaciones han afectado a todo el país, sin importar la afiliación política o la ubicación geográfica. De las organizaciones que sufrieron recortes en el primer mes, aproximadamente el 40% se encuentran en estados que Trump ganó en noviembre.

La secretaria de prensa del Departamento de Salud y Servicios Humanos (HHS), Emily Hilliard, dijo que la agencia prioriza las inversiones que respalden el mandato de Trump de enfrentar las enfermedades crónicas. Defendió algunos de los recortes y afirmó, erróneamente, que la nueva ley no reduce Medicaid.

“La pandemia de covid-19 ya terminó, y el HHS no seguirá desperdiciando miles de millones de dólares de los contribuyentes en una crisis que los estadounidenses superaron hace años”, dijo.

Líderes estatales señalan que los fondos federales por la pandemia, que la administración busca recuperar, se habían destinado a otras medidas de salud pública, como la vigilancia de enfermedades emergentes, la respuesta ante brotes y la contratación de personal. En mayo, fiscales estatales ganaron una orden de restricción temporal contra la administración.

“Lo que estamos viendo ahora es que los estados anticipan grandes recortes a Medicaid, pero también enfrentan una serie de recortes federales más pequeños, pero significativos, en programas de salud pública”, dijo Larry Levitt, vicepresidente ejecutivo de políticas de salud en KFF. (KFF Health News es uno de los programas de KFF)

Parte del desafío para los estados es simplemente entender los cambios.

“Creo que es justo decir que hay preocupación, confusión e incertidumbre”, afirmó Kathryn Costanza, experta en Medicaid en la Conferencia Nacional de Legislaturas Estatales.

Los estados intentan entenderlo todo, creando grupos asesores para seguir los cambios federales, presentando demandas para intentar bloquear los recortes y reasignando fondos.

En Colorado, los legisladores aprobaron una ley que permite que fondos estatales de Medicaid se usen para servicios de salud —excluyendo abortos— en clínicas de Planned Parenthood of America, después de que la nueva ley de Trump prohibiera la financiación federal para este tipo de atención. Aún está por verse si esa prohibición se mantiene en los tribunales.

La legislatura de Louisiana asignó $7,5 millones a universidades estatales para compensar los recortes en financiación federal para la investigación, gran parte de ella relacionada con temas de salud.

Y en Dakota del Sur, el banco de alimentos más grande del estado pidió a los legisladores que destinen $3 millones para compensar recortes en fondos del Departamento de Agricultura de Estados Unidos.

Los estados deben equilibrar sus presupuestos cada año, por lo que los recortes ponen en riesgo muchos servicios si los legisladores no están dispuestos a aumentar impuestos. El trabajo comenzará en serio en enero, cuando muchos estados inicien sus nuevas sesiones legislativas.

Y es probable que las decisiones difíciles continúen. Los republicanos en la Cámara de Representantes del Congreso consideran nuevas leyes que podrían traer más recortes, como la reducción al generoso financiamiento federal que actualmente reciben 20 millones de adultos inscritos en Medicaid gracias a la expansión de ACA.

Como resultado, algunos estados revertirán sus expansiones de Medicaid y recortarán aún más programas de salud.

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Until this year. The Trump administration’s plan to strip more than $550 million in federal public health and pandemic funds from Texas helped prompt cancellation of the event just before its scheduled July 21 start.

“Some people come every year and rely on it,” said Hidalgo County Health and Human Services Director Dairen Sarmiento Rangel. “Some people even camp out outside of Border Health so they can be the first in line to receive services. This event is very important to our community.”

States and local governments have made painful program cuts in the wake of major reductions in federal health funding that have already taken effect. Now, they’re sizing up the financial hits to come — some not until late next year or beyond — from the “One Big Beautiful Bill Act,” the tax and spending law congressional Republicans passed in July that enacts much of President Donald Trump’s domestic agenda.

Texas, for instance, expects to see its federal Medicaid funds reduced by as much as $39 billion over 10 years due to new barriers for enrollment, such as more frequent eligibility checks, according to a July analysis by KFF.

Taken together, the reductions amount to a seismic shift in how state health programs are provided and paid for. The administration is, in effect, pushing a significant amount of health costs to states. That will force their leaders to make difficult choices, as many state budgets are already strained by declining tax revenues, a slowdown in federal pandemic spending, and economic uncertainty.

Revenue forecasters in more than a dozen states have lowered expectations for the coming year, according to a June report by Pew.

“It’s almost inevitable that states will enact a number of cuts to health services because of the fiscal pressure,” said Wesley Tharpe, senior adviser for state tax policy at the left-leaning Center on Budget and Policy Priorities.

Some are proactively trying to stanch the impact.

Hawaii lawmakers are looking to aid nonprofits that are already contending with federal funding cuts. They’re doling out $50 million in grants to health, social service, and other nonprofits hit by federal funding cuts. To get the money, nonprofits must show a termination or drop in funding, or that they have otherwise been harmed by the cuts.

“It is not fair that organizations dedicated to supporting the people of Hawaii are being forced to scale back due to federal funding cuts,” Democratic Gov. Josh Green said in a statement.

Other states are scaling back projects to contend with cuts. Delaware Gov. Matt Meyer, a Democrat, received notice in March that the Trump administration was cutting $38 million in public health funding from the state. The next month, state legislative leaders halted a planned project to upgrade and expand the Capitol complex as a result.

“We recognized that the reckless federal cuts to the social safety nets of thousands of Delawareans called for us to hold back resources to protect our most vulnerable,” said David Sokola, president pro tempore of the Delaware Senate.

In New Mexico, the state with the highest percentage of residents enrolled in Medicaid, a bipartisan group of lawmakers voted to create a trust fund to boost funding for the program. About 10% of the more than 800,000 state residents covered by Medicaid and the related Children’s Health Insurance Program could lose their health coverage under the federal spending law, based on some estimates.

Some state leaders are warning constituents that the worst may be yet to come.

At an Aug. 18 event at a hospital in the South Bronx section of New York City, New York Gov. Kathy Hochul, a Democrat, stood on stage among health care workers in white coats to skewer Trump’s new law.

“What Republicans in Washington have done through the ‘Big Ugliest Bill’ I’ve ever seen is literally screwing New Yorkers,” she said. The state’s health system is bracing for nearly $13 billion in annual cuts.

And in California, lawmakers weighed the impact of the coming cuts from the federal law at a general assembly committee hearing on Aug. 20, where some Democratic legislators said state efforts to protect reproductive health services and other programs were in jeopardy.

“We’ve been bracing for this reality: President Trump’s so-called ‘Big, Beautiful Bill’ is now law,” Democratic lawmaker Gregg Hart said at the hearing, calling it a “direct assault on California’s core programs and our values.”

“Sadly, the reality is, the state does not have the capacity to backfill all of these draconian federal funding cuts in the current budget,” Hart said. “We cannot simply write a check and make this go away.”

The sweeping budget law, which passed without any Democratic support, will reduce federal spending on Medicaid by about $1 trillion over the next decade, based on estimates from the Congressional Budget Office. The spending reductions largely come from the imposition of a work requirement on people who’ve obtained Medicaid under the Affordable Care Act’s expansion, as well as other new barriers to coverage.

The law will mean more than 7.5 million people will lose Medicaid coverage and become uninsured, according to the Congressional Budget Office, while extending tax cuts for wealthy people who, Democrats say, don’t need them. Republicans and Trump have said the spending package and its accompanying program cuts were necessary to prevent fraud and waste, and to sustain Medicaid, a state-federal program for people with disabilities and lower incomes.

“The One Big Beautiful Bill removes illegal aliens, enforces work requirements, and protects Medicaid for the truly vulnerable,” the White House said in a June 29 statement.

The Medicaid cuts won’t begin until after the midterm elections in November 2026, but other cuts have already hit.

The Trump administration has sought to claw back $11 billion in federal public health funds earmarked to states because of the pandemic, spurring a legal fight with a coalition of Democratic-led states. It also cut about $1 billion in federal grants for mental health services in schools, and halted grants from the National Institutes of Health that provided money to more than 90 public universities.

HHS press secretary Emily Hilliard said the agency is prioritizing investments that advance Trump’s mandate to confront chronic disease. She defended some of the cuts and said, erroneously, that the spending law doesn’t cut Medicaid.

“The covid-19 pandemic is over, and HHS will no longer waste billions of taxpayer dollars responding to a crisis that Americans moved on from years ago,” she said.

State leaders say the pandemic funding the administration wants returned was earmarked for other public health measures, such as tracking emerging diseases, outbreak responses, and staffing. State attorneys general in May won a temporary restraining order against the administration.

“What we’re seeing now is states anticipating big cuts in Medicaid coming, but they’re also dealing with a whole variety of federal cutbacks in public health programs that are smaller but still quite meaningful,” said Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes KFF Health News.

Part of the challenge for states is simply understanding the changes.

“I think it’s fair to say there is concern, confusion, and uncertainty,” said Kathryn Costanza, a Medicaid expert at the National Conference of State Legislatures.

States are struggling to sort it all out, forming advisory groups that are tracking federal changes, suing to try to block the cuts, and reallocating funding.

In Colorado, lawmakers passed a bill to let state Medicaid dollars pay for non-abortion care at Planned Parenthood of America clinics after Trump’s law banned federal funding for such care. Whether the ban holds up in court remains to be seen.

The Louisiana Legislature sent $7.5 million to state universities to make up for cuts to federal research funding, much of which goes to health-related research.

And in South Dakota, the state’s largest food bank has asked lawmakers to spend $3 million to make up for funding cuts to the U.S. Department of Agriculture.

States must balance their budgets every year, so cuts put many services at risk if state lawmakers are unwilling to raise taxes. The work will begin in earnest in January, when many states begin new legislative sessions.

And the tough choices are likely to continue. Congressional House Republicans are considering legislation that could bring more cuts, including by slashing the generous cost sharing the federal government provides for 20 million adults who enrolled in Medicaid under the ACA’s Medicaid expansion.

Some states will roll back their Medicaid expansions and cut more health programs as a result.

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For more than a decade, the University of California-San Francisco researcher relied on federal grants without incident. But Thakur, a doctor and a scientist, suddenly found herself leading the charge for public health science against President Donald Trump’s political ideology.

Thakur, 45, a pulmonologist who also is medical director of the Zuckerberg San Francisco General Hospital Chest Clinic, is the lead plaintiff among six UC researchers who in June won a class-action preliminary injunction against the efforts of several federal agencies to carry out Trump’s executive orders seeking to eliminate research grants deemed to focus on areas of diversity, equity, and inclusion. The administration has filed a notice of appeal, and the outcome, whether or not she and her colleagues prevail, could influence both the future of academic research and the health of those she’s spent her life trying to help.

“When this moment hit us, where science was really under attack and lives are at stake, it doesn’t surprise me that she stepped up,” said Margot Kushel, who directs the UCSF Action Research Center for Health Equity and has known Thakur for more than a decade through their work at the center and San Francisco General, the public county hospital.

“We don’t think our work should be political, to be honest,” Kushel said. “Saving people’s lives and making sure people don’t die doesn’t seem to me that it should be a partisan issue.”

Thakur said that after the abrupt funding cuts, she and the other researchers “felt pretty powerless and found that the class-action lawsuit was a way for us to join together and sort of take a stance.”

The suit was filed independently by the researchers and allowed them to show the harm inflicted not just on their own work “but more broadly on public health and public health research,” she said.

Thakur’s study, which received more than $1.3 million in funding from the Environmental Protection Agency and was set to run through November, explores the impact of increased wildfire smoke on low-income communities and communities of color, populations that already experience heightened pollution and other environmental health disparities. The goal is to find ways to help residents limit their smoke exposure, Thakur said, adding that the results could help people no matter their circumstances.

Preliminary findings show that smoke can trigger breathing emergencies among children days after exposure, knowledge that could lead to better treatment, and that smoke intensity may peak during just a few hours when protection is most needed, indicating the need for more precise and timely safety messaging.

Thakur said her studies on health equity and health disparities saw growing federal support during the covid pandemic and a national focus on racism spurred by the murder of George Floyd. The EPA had solicited the grant in 2021 for her and her team to research how climate change affects underserved communities.

Trump, in one of several executive orders blocking federal funding for DEI programs, said they “use dangerous, demeaning, and immoral race- and sex-based preferences” that he said have “prioritized how people were born instead of what they were capable of doing.”

EPA Administrator Lee Zeldin said in March that, in cooperation with the Department of Government Efficiency, the administration had canceled more than 400 grants topping $2 billion “to rein in wasteful federal spending.”

The order by U.S. District Judge Rita Lin in San Francisco temporarily blocking the grant terminations covered the EPA, as well as grants by the National Endowment for the Humanities and the National Science Foundation. Lin’s ruling was not a nationwide injunction of the sort restricted by the U.S. Supreme Court in a June decision.

The Trump administration agencies affected by the order have reinstated the UC grants as the lawsuit proceeds. The government filed a motion for a temporary stay on the order pending the outcome of its appeal, but a decision had not been issued as of publication.

The EPA declined to comment on the judge’s order blocking the attempted cancellation of the research funding, citing the ongoing litigation, and attorneys representing the government did not respond to requests for comment.

Thakur defends the need for research that spotlights disadvantaged communities. Her interest in health equity stems from childhood experiences. The daughter of immigrants from India, with a physician and an engineer as parents, she grew up relatively well-off in a mixed-income neighborhood in Phoenix. While she prospered, however, she had friends who couldn’t afford college or became pregnant as teenagers.

“I see my research being directed towards trying to understand how where you live and what you experience impacts your health,” Thakur said.

When the grants were suspended in April, the researchers were unable to finish identifying ways to help protect communities from wildfire smoke. Thakur had to dismiss a student intern and dip into discretionary funds to pay her postdoctoral fellow. At least three research papers that could have directly affected public health were in danger of going unpublished without the funding, she said.

The government reinstated her team’s grants about three weeks after the judge’s order, and Thakur is in the process of picking up the pieces. She’s hopeful that researchers can publish two of the three studies they were working on.

Thakur said she is now cautiously optimistic after experiencing “a roller coaster of emotions.” Putting together a project and conducting the research takes years, she said, so “to have all of that end suddenly, it brought me a range of emotions one thinks about when folks are experiencing grief. There’s denial, anger.”

But the Trump administration’s actions have already sapped morale in the field. Rebecca Sugrue, Thakur’s postdoctoral fellow and an expert in health equity and climate change, is rethinking her entire career path.

“I kind of came to the realization that all the expertise I had built up were the kind of things that were being deprioritized,” Sugrue said. She said she and other postdoctoral students and more junior members of the research team even had discussions about leaving academia: “‘Unstable’ and ‘uncertain’ were words that were used a lot.”

The lasting damage is not lost on Thakur. If the grants ultimately disappear, universities won’t have the typical programs to train students or to support academic research, she said, adding that, “I think there are concerns that the sort of divestment from science and research in these particular areas will cause generations of impact.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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“I want people to not kill themselves for who they are,” said organizer Myk Mendez, a trans and two-spirit citizen of the Fort Hall Shoshone-Bannock Tribes in Idaho. “I want people to love their lives and grow old to tell their stories.”

“Two-spirit” is used by Native Americans to describe a distinct gender outside of male or female.

The conference in Elko reflects how some tribal citizens are supporting their LGTBQ+ community members as President Donald Trump rolls back protections and policies. In March, the National Indian Health Board, which represents and advocates for federally recognized Native American and Alaska Native tribes, passed a resolution declaring tribal sovereignty over issues affecting the Native American community’s health, including access to gender-affirming care.

The resolution calls on the federal government to preserve and expand programs that support the health and well-being of two-spirit and LGBTQ+ Native Americans. Tribes and tribal organizations are navigating how to uphold their sovereignty without jeopardizing the relationships and resources that support their communities, said Jessica Leston, the owner of the Raven Collective, a Native public health consulting group, and a member of the Ketchikan Indian Community.

In January, Trump signed an executive order recognizing only two sexes — male and female — and another to terminate diversity, equity, and inclusion programs within the federal government.

An Indian Health Service website describing two-spirit people was removed this year but restored following a court order. The page now has a disclaimer at the top that declares any information on it “promoting gender ideology” is “disconnected from the immutable biological reality that there are two sexes, male and female.”

Two-spirit is not a sexual orientation but refers to people of a “culturally and spiritually distinct gender exclusively recognized by Native American Nations,” according to a definition created by two-spirit elders in 2021. According to two-spirit leaders, people who did not fit into the Western binary of male and female have lived in their communities since before colonization.

Already, tribal citizens and leaders say some people have had trouble accessing gender-affirming care in recent months, with some community members being denied hormone treatments or having their medications delayed, even in places where gender-affirming care remains legal. Panic has spread, and tribal citizens have considered leaving the country.

“There is a chilling effect,” said Itai Jeffries, who is trans, nonbinary, and two-spirit, of the Occaneechi people from North Carolina, and a consultant for the Raven Collective.

Mendez said he requested hormone treatment at his local Indian Health Service clinic at the end of June and was told by his provider that the facility has had trouble receiving the treatment for patients.

Lenny Hayes, a two-spirit citizen of the Sisseton-Wahpeton Oyate in South Dakota, said the Indian Health Service clinic on the reservation also isn’t dispensing hormone treatment, though it is legal for people 18 and older. Hayes is the owner and operator of Tate Topa Consulting and provides educational training on two-spirit and LGTBQ+ Native Americans and Alaska Natives.

The National Congress of American Indians passed a resolution in 2015 to encourage the creation of policies to protect two-spirit and LGBTQ+ communities. And the organization adopted a resolution in 2021 to support providing gender-affirming care in Indian Health Service, tribal, and urban facilities.

The National Indian Health Board’s resolution cites homophobia and transphobia as contributing to higher rates of truancy, incarceration, self-harm, attempted suicide, and suicide among two-spirit young people. The board also lists health disparities among the broader Native LGBTQ+ population, including increased risks of anxiety, depression, and suicide.

Two-spirit and LGBTQ+ Native American and Alaska Native young people are particularly vulnerable to depression, suicidality, and sexual exploitation. In Minnesota, a 2019 state survey found that two-spirit and LGBTQ+ Native American and Alaska Native students had the highest rates of those ages 15-19 who responded “yes” to having traded sex or sexual activity for money, food, drugs, alcohol, or shelter.

Tribal leaders are also concerned that Medicaid cuts recently approved in Trump’s budget law will undercut efforts to expand testing and treatment for HIV infection in Native American communities.

The rates of HIV diagnosis among Native American and Alaska Native gay and bisexual men increased 11% from 2018 to 2022, according to the Centers for Disease Control and Prevention.

Despite this increase, Native American and Alaska Native gay and bisexual men are among the groups with the least access to HIV tests outside of health care settings, such as community-based organizations, mobile testing units, and shelters.

As tribes respond to state and federal regulations of two-spirit and LGBTQ+ people, organizations and communities are focused on providing information and resources to protect those in Indian Country, even from the president.

“He will never, ever wipe out our identity, no matter what he does,” Hayes said.

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The case has drawn national attention to Georgia’s six-week abortion ban and its impacts on pregnancy care.

Adriana Smith was put on life support at Emory University Hospital in Atlanta in February. The then-30-year-old Atlanta nurse was more than eight weeks pregnant and suffering dangerous complications.

Her condition deteriorated as doctors tried to save her life, Smith’s mother told Atlanta TV station WXIA.

“They did a CT scan, and she had blood clots all in her head,” April Newkirk said. “So they had asked me if they could do a procedure to relieve them, and I said yes. And then they called me back and they said that they couldn’t do it.”

She said doctors declared Smith brain-dead and put her on life support without consulting her.

“And I’m not saying that we would have chose to terminate her pregnancy,” Newkirk said, “but what I’m saying is, we should have had a choice.”

Emory Healthcare declined to comment on the specifics of Smith’s case. After doctors removed Smith from life support, Emory issued a statement.

“The top priorities at Emory Healthcare continue to be the safety and wellbeing of the patients and families we serve,” the health system said. “Emory Healthcare uses consensus from clinical experts, medical literature and legal guidance to support our providers as they make medical recommendations. Emory Healthcare is legally required to maintain the confidentiality of the protected health information of our patients, which is why we are unable to comment on individual matters and circumstances.”

In a previous statement, Emory Healthcare said it complies “with Georgia’s abortion laws and all other applicable laws.”

Abortion Laws and Fetal Personhood

Georgia’s HB 481 — the Living Infants Fairness and Equality, or LIFE, Act — passed in 2019. It took effect shortly after the U.S. Supreme Court overturned Roe v. Wade with its ruling in Dobbs v. Jackson Women’s Health Organization on June 24, 2022.

The law bans abortion after the point at which an ultrasound can detect cardiac activity in an embryo. Typically, this occurs about six weeks into pregnancy, often before women know they’re pregnant.

The law also gave fetuses the same rights as people.

It says that “unborn children are a class of living, distinct persons” and that the state of Georgia “recognizes the benefits of providing full legal recognition to an unborn child.”

Nineteen states now ban abortion at or before 19 weeks of gestation; 13 of those have a near-total ban on all abortions with very limited exceptions, according to the Guttmacher Institute, a nonpartisan research group that supports abortion rights.

Like Georgia, some of these states built their abortion restrictions around the legal concept of “personhood,” thus conferring legal rights and protections on an embryo or fetus during pregnancy.

Smith’s case has represented a major test of how this type of law will be applied in certain medical situations.

Despite mainly being unified in their opposition to abortion, conservatives and politicians in Georgia do not publicly agree on the scope of the law in cases like Smith’s.

For example, Georgia Attorney General Chris Carr, a Republican, said that the law should not restrict the options for care in a case like Smith’s and that removing life support wouldn’t be equivalent to aborting a fetus.

“There is nothing in the LIFE Act that requires medical professionals to keep a woman on life support after brain death,” Carr said in a statement. “Removing life support is not an action ‘with the purpose to terminate a pregnancy.’”

But Republican state Sen. Ed Setzler, who authored the LIFE Act, disagreed. Emory’s doctors acted appropriately when they put Smith on life support, he told The Associated Press.

“I think it is completely appropriate that the hospital do what they can to save the life of the child,” Setzler said. “I think this is an unusual circumstance, but I think it highlights the value of innocent human life. I think the hospital is acting appropriately.”

Mary Ziegler, a law professor at the University of California-Davis and author of “Personhood: The New Civil War Over Reproduction,” said the problem is that Georgia’s law “isn’t just an abortion ban. It’s a ‘personhood’ law declaring that a fetus or embryo is a person, that an ‘unborn child,’ as the law puts it, is a person.”

The legal concept of “personhood” has implications beyond abortion care, such as with the regulation of fertility treatment, or the potential criminalization of pregnancy complications such as stillbirth and miscarriage.

Under Georgia’s law, extending rights of personhood to a fetus changes how child support is calculated. It also allows an embryo or fetus to be claimed as a dependent on state taxes.

But the idea of personhood is not new, Ziegler said.

“It has been the goal for virtually everyone in the anti-abortion movement since the 1960s,” she said. “That doesn’t mean Republicans like that. It doesn’t necessarily mean that that’s what’s going to happen. But there is no daylight between the anti-abortion movement and the personhood movement. They’re the same.”

The personhood movement has gained more traction since the Dobbs ruling in 2022.

In Alabama, after the state’s Supreme Court ruled that frozen embryos are people, the state legislature had to step in to allow fertility clinics to continue their work.

“This is sort of the future we’re looking at if we move further in the direction of fetal personhood,” Ziegler said. “Any state Supreme Court, as we just saw in Alabama, can give them new life,” she said referring to personhood laws elsewhere.

Fetal Personhood Laws Can Delay Care  

In Georgia, dozens of OB-GYNs have said that the law interferes with patient care — in a state where the maternal mortality rate is one of the worst in the U.S. and where Black women are more than twice as likely to die from a pregnancy-related cause than white women. 

Members of Georgia’s Maternal Mortality Review Committee — who were later dismissed from the panel — linked the state’s abortion ban to delayed emergency care and the deaths of at least two women in the state, as ProPublica reported.

The personhood provision is having a profound effect on medical care, said Atlanta OB-GYN Zoë Lucier-Julian.

“These laws create an environment of fear and attempt to coerce us as providers to align with the state, as opposed to aligning with our patients that we work so hard to serve,” Lucier-Julian said.

Lucier-Julian said that’s what happened to Emory Healthcare in Smith’s case.

Cole Muzio, president of the Frontline Policy Council, a conservative Christian group, said the state’s abortion law shouldn’t have affected how Emory handled Smith’s care.

“This is a pretty clear-cut case, in terms of how it’s defined in the language of HB 481,” he said. “What this bans is an abortion after a heartbeat is detected. That is the scope of our law.”

“Taking a woman off life support is not an abortion. It just isn’t,” Muzio said.“Now, I am incredibly grateful that this child will be born even in the midst of tragic circumstances. That is a whole human life that will be able to be lived because of this beautiful mother’s sacrifice.”

A suit challenging Georgia’s law and its impact on public health is working its way through the courts. A coalition of physicians, the American Civil Liberties Union of Georgia, Planned Parenthood, the Center for Reproductive Rights, and other groups filed the suit.

Newkirk said her daughter had initially gone to a different Atlanta-area hospital for help with severe headaches, was given some medicine, and was sent home, where her symptoms quickly worsened.

“She was gasping for air in her sleep, gargling,” she told WXIA in May. “More than likely, it was blood.”

Now, Newkirk said, the family is praying for her grandson to make it after the stress from months of life support. 

He is fighting, she said.

“My grandson may be blind, may not be able to walk, wheelchair-bound,” she said. “We don’t know if he’ll live.”

She added that the family will love him no matter what.

This article is from a partnership with WABE and NPR.

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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Colorado, California, and Montana are among the states that have recently required safeguarding brain data collected by devices outside of medical settings. That includes headphones, earbuds, and other wearable consumer products that aim to improve sleep, focus, and aging by measuring electrical activity and sending the data to an app on users’ phones.

A report by the Neurorights Foundation, an advocacy group that aims to protect people from the misuse of neurotechnology, found that 29 of 30 companies with neurotechnology products that can be purchased online have access to brain data and “provide no meaningful limitations to this access.” Almost all of them can share data with third parties.

In June, the American Medical Association called for greater regulation of neural data. In April, several Democratic members of the U.S. Senate Committee on Commerce, Science, and Transportation asked the Federal Trade Commission to investigate whether companies are exploiting consumers’ brain data. Juliana Gruenwald Henderson, a deputy director of the FTC’s Office of Public Affairs, said the agency had received the letter but had no additional comment.

Although current devices gather relatively basic information like sleep states, advocates for brain data protection caution that future technologies, including artificial intelligence, could extract more personal and sensitive information about people’s medical conditions or innermost thoughts.

“If you collect the data today, what can you read from it five years from now because the technology is advancing so quickly?” said Democratic state Sen. Cathy Kipp, who sponsored Colorado’s 2024 neural data protection bill when she was in the state House of Representatives.

As both excitement and trepidation about AI build, at least 28 states and the U.S. Virgin Islands have enacted some type of AI regulation separate from the privacy bills protecting neural data. President Donald Trump’s “One Big Beautiful Bill” included a 10-year halt on states passing laws to regulate AI, but the Senate stripped that provision out of the budget reconciliation bill before voting to approve it on July 1.

The spirit of laws in Colorado, California, and Montana is to protect the neural data itself, not to regulate any algorithm or AI that might use it, said Sean Pauzauskie, medical director for the Neurorights Foundation.

But neurotechnology and AI go hand in hand, Pauzauskie said. “A lot of what these devices promise is based on pattern recognition. AI is really driving the usability and significance of the patterns in the brain data.”

Cristin Welle, a professor of neurosurgery at the University of Colorado School of Medicine, said that AI’s ability to identify patterns is a game changer in her field. “But contribution of a person’s neural data on an AI training set should be voluntary. It should be an opt-in, not a given.”

Chile in 2021 became the first country to adopt a constitutional amendment for neurorights, which prioritize human rights in the development of neurotechnology and collection of neural data, and UNESCO has said that neurotechnology and artificial intelligence could together pose a threat to human identity and autonomy.

Neurotechnology can sound like science fiction. Researchers used a cap with 128 electrodes and an AI model to decode the brain’s electric signals from thoughts into speech. And two years ago, a study described how neuroscientists reconstructed the Pink Floyd song “Another Brick in the Wall” by analyzing the brain signals of 29 epilepsy patients who listened to the song with electrodes implanted in their brains.

The aim is to use neurotechnology to help those with paralysis or speech disabilities, as well as treat or diagnose traumatic brain injuries and brain disorders such as Alzheimer’s or Parkinson’s. Elon Musk’s Neuralink and Synchron, funded by Bill Gates and Jeff Bezos, are among the companies with clinical trials underway for devices implanted in the brain.

Pauzauskie, a hospital neurologist, started worrying four years ago about the blurring of the line between clinical and consumer use of neural data. He noted that the devices used by his epilepsy patients were also available for purchase online, but without protections afforded by the Health Insurance Portability and Accountability Act in medical settings.

Pauzauskie approached Kipp two years ago at a constituent meetup in his hometown of Fort Collins to propose a law to protect brain data in Colorado. “The first words out of her mouth that I’ll never forget were, ‘Who would be against people owning their own brain data?’” he said.

Brain data protection is one of the rare issues that unite lawmakers across the political aisle. The bills in California, Montana, and Colorado passed unanimously or nearly unanimously. Montana’s law will go into effect in October.

Neural data protection laws in Colorado and California amend each state’s general consumer privacy act, while Montana’s law adds to its existing genetic information privacy act. Colorado and Montana require initial express consent to collect or use neural data and separate consent or the ability to opt out before disclosing that data to a third party. A business must provide a way for consumers to delete their data when operating in all three states.

“I want a very hard line in the sand that says, you own this completely,” said Montana state Republican Sen. Daniel Zolnikov, who sponsored his state’s neural data bill and other privacy laws. “You have to give consent. You have the right to have it deleted. You have complete rights over this information.”

For Zolnikov, Montana’s bill is a blueprint for a national neural data protection law, and Pauzauskie said support of regulatory efforts by groups like the AMA pave the way for further federal and state efforts.

Welle agreed that federal regulations are needed in addition to these new state laws. “I absolutely hope that we can come up with something on a national level that can enshrine people’s neural rights into law, because I think this is going to be more important than we can even imagine at this time.”

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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Colorado, California y Montana están entre los estados que recientemente han exigido la protección de los datos neurales recopilados por dispositivos fuera del ámbito médico. Esto incluye auriculares, audífonos y otros productos electrónicos personales que se usan para mejorar el sueño, la concentración, o el envejecimiento, mediante la medición de la actividad eléctrica y el envío de los datos a una aplicación en los teléfonos de los usuarios.

Un informe de la Neurorights Foundation, un grupo de defensa que tiene como objetivo proteger a las personas del uso indebido de la neurotecnología, reveló que 29 de las 30 empresas que venden este tipo de productos por internet tienen acceso a datos cerebrales y “no imponen limitaciones significativas a este acceso”.

Casi todas esas empresas pueden compartir los datos con terceros.

En junio, la American Medical Association (AMA)  pidió una mayor regulación de datos “tomados” del cerebro. En abril, varios miembros demócratas del Comité de Comercio, Ciencia y Transporte del Senado de Estados Unidos pidieron a la Federal Trade Commission (FTC) que investigara si las empresas están sacando provecho de los datos cerebrales de los consumidores.

Juliana Gruenwald Henderson, subdirectora de la Oficina de Asuntos Públicos de la FTC, admitió que la agencia había recibido la carta, pero no hizo ningún comentarios al respecto.

Aunque los dispositivos actuales recopilan información relativamente básica, como los estadios de sueño, quienes promueven la protección de estos datos advierten que las tecnologías futuras, incluida la inteligencia artificial (IA), podrían extraer datos más personales y sensibles sobre las condiciones médicas o los pensamientos íntimos de las personas.

“Si recolectan la información hoy, ¿qué se podrá leer en ellos dentro de cinco años, con lo rápido que avanza la tecnología?”, se preguntó la senadora estatal demócrata Cathy Kipp, que patrocinó el proyecto de ley de protección de datos neuronales de Colorado en 2024, cuando formaba parte de la Cámara de Representantes del estado.

Mientras crecen tanto el entusiasmo como el temor por la inteligencia artificial, al menos 28 estados y las Islas Vírgenes de EE.UU. han promulgado algún tipo de regulación de esta tecnología, independientemente de los proyectos de ley de privacidad que protegen los datos neuronales.

El llamado “One Big Beautiful Bill” del presidente Donald Trump impedía que, durante diez años los estados, aprobaran leyes para regular la inteligencia artificial. Pero el Senado eliminó esa disposición del proyecto de ley de medidas económicas antes de votar a favor de su aprobación el 1 de julio.

El espíritu de las leyes de Colorado, California y Montana es proteger los datos neuronales en sí mismos sin regular ningún algoritmo o IA que pueda utilizarlos, según explicó Sean Pauzauskie, director médico de la Neurorights Foundation.

Pero la neurotecnología y la inteligencia artificial van de la mano, dijo Pauzauskie. “Mucho de lo que prometen estos dispositivos se basa en el reconocimiento de patrones. La IA está revelando realmente la utilidad y la importancia de los patrones presentes en la actividad neuronal”.

Cristin Welle, profesora de neurocirugía en la Escuela de Medicina de la Universidad de Colorado, dijo que la capacidad de la IA para identificar patrones significa un cambio revolucionario en su campo.

“Pero la contribución de los datos neuronales de una persona a una base de entrenamiento de IA debe ser voluntaria. Debe ser una opción, no algo que se da por sentado”, añadió.

Por su parte, la UNESCO sostuvo que la neurotecnología y la inteligencia artificial, juntas, podrían suponer una amenaza para la identidad y la autonomía humanas.

En 2021, Chile se convirtió en el primer país que adoptó una enmienda constitucional sobre los derechos neuronales, que otorga prioridad a los derechos humanos en el desarrollo de la neurotecnología y la recopilación de estos datos.

Por ahora, la neurotecnología puede parecer ciencia ficción. Los investigadores utilizaron un casco con 128 electrodos y un modelo de IA para decodificar las señales eléctricas del cerebro y convertir los pensamientos en palabras. Y hace dos años, un estudio describió cómo los neurocientíficos reconstruyeron la canción de Pink Floyd Another Brick in the Wall analizando las señales cerebrales de 29 pacientes epilépticos que escucharon ese tema con electrodos implantados en el cerebro.

En definitiva, el objetivo es utilizar la neurotecnología para ayudar a las personas con parálisis o discapacidades del habla, así como para tratar o diagnosticar lesiones cerebrales traumáticas y trastornos cerebrales como el Alzheimer o el Parkinson.

Neuralink, una empresa de Elon Musk, y Synchron, financiada por Bill Gates y Jeff Bezos, se encuentran entre las compañías que están realizando ensayos clínicos con dispositivos implantados en el cerebro.

Pauzauskie, que es neurólogo en un hospital, comenzó a preocuparse hace cuatro años por cómo se iba esfumando la frontera entre el uso clínico y el uso comercial de los datos neuronales.

Observó que los dispositivos utilizados por sus pacientes con epilepsia también se podían comprar por Internet, pero sin las garantías que ofrece el Health Insurance Portability and Accountability Act en entornos médicos.

Hace dos años, Pauzauskie se acercó a la senadora Kipp en una reunión de electores en su ciudad natal, Fort Collins, para proponer una ley que protegiera los datos cerebrales en Colorado. “Las primeras palabras que salieron de su boca y que nunca olvidaré fueron: ‘¿Quién estaría en contra de que las personas sean dueñas de sus propios datos cerebrales?’”, recordó.

La protección de los datos cerebrales es una de las pocas cuestiones que unen a los legisladores de todos los partidos políticos. Los proyectos de ley de California, Montana y Colorado se aprobaron por unanimidad, o casi. La ley de Montana entrará en vigor en octubre.

Las leyes de protección de datos neuronales de Colorado y California modifican la ley general de privacidad del consumidor de cada estado, mientras que la de Montana se suma a la ley de privacidad de la información genética ya existente.

Colorado y Montana exigen el consentimiento expreso inicial para recopilar o utilizar datos neuronales, y un consentimiento adicional o la posibilidad de que el consumidor no acepte revelar esos datos a un tercero.

Las empresas deben proporcionar a los consumidores una forma de eliminar sus datos cuando operan en cualquiera de los tres estados.

“Quiero una línea muy clara que diga: esto es completamente tuyo”, dijo el senador estatal republicano de Montana Daniel Zolnikov, quien patrocinó el proyecto de ley sobre datos neuronales de su estado y, también, otras leyes de privacidad. “Tienes que dar tu consentimiento. Tienes derecho a que se eliminen tus datos. Tienes todo el derecho sobre esta información”.

Para Zolnikov, el proyecto de Montana es un modelo para diseñar una ley nacional de protección de datos neuronales. Por su parte, Pauzauskie afirmó que el apoyo a los esfuerzos reguladores de grupos como la AMA allana el camino para que haya nuevos esfuerzos a nivel federal y estatal.

Welle coincidió en que, además de estas nuevas leyes estatales, se necesitan regulaciones federales.

“Espero sinceramente que podamos elaborar una legislación a nivel nacional que consagre los derechos neuronales de las personas, porque creo que esto va a ser más importante de lo que podemos imaginar en este momento”, reflexionó.

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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