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.

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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Democrats and Republicans are both facing potential political consequences in their continuing standoff over federal government funding. Republicans are likely to face a voter backlash if they refuse to agree to Democrats’ demands that they renew additional tax credits for Affordable Care Act marketplace plans, since the majority of those facing premium hikes live in GOP-dominated states. For their part, Democrats are worried that Republicans will violate the terms of any potential spending deal.

At the same time, the Trump administration is using the shutdown to try to lay off thousands of federal workers, including those performing key public health roles at the Centers for Disease Control and Prevention.

This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Lauren Weber of The Washington Post.

Panelists

Among the takeaways from this week’s episode:

• As the federal government shutdown drags on, there has been little progress toward a deal on government spending — or on the expiring ACA marketplace subsidies Democrats are fighting to renew. Potential subsidy compromises could, for instance, implement a minimal premium in place of $0 premiums, to reduce enrollment fraud, as Republicans want.
• A federal judge halted the Trump administration’s latest layoffs of federal workers amid questions about the layoffs’ legality. The administration in particular dealt a heavy blow this round to the CDC, an agency that has been battered by staff reductions, policy shifts, and even violence.
• New reporting shows the Trump administration explored the feasibility of tracing abortion pill residue in wastewater, following up on an anti-abortion claim that the drugs may be contaminating the water supply. Yet advocates could have an ulterior motive: developing the ability to trace use of the pill to further crack down on abortions.
• And President Donald Trump unveiled a deal with a second drugmaker, AstraZeneca, that allows the company to avoid tariffs in exchange for building a new U.S. facility. But as with the first deal, it’s unclear how much money the agreement will save patients.

Also this week, Rovner interviews health insurance analyst Louise Norris of Medicareresources.org about the Medicare open enrollment period, which began Oct. 15.

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

Julie Rovner: Politico’s “RFK Jr.’s Got Advice for Pregnant Women. There’s Limited Data To Support It,” by Alice Miranda Ollstein.

Anna Edney: The New York Times’ “The Drug That Took Away More Than Her Appetite,” by Maia Szalavitz.

Joanne Kenen: Mother Jones’ “From Medicine to Mysticism: The Radicalization of Florida’s Top Doc,” by Kiera Butler and Julianne McShane.

Lauren Weber: KFF Health News’ “Senators Press Deloitte, Other Contractors on Errors in Medicaid Eligibility Systems,” by Rachana Pradhan and Samantha Liss.

Also mentioned in this week’s podcast:

• The Washington Post’s “She Left the Medical Mainstream and Rose To Be RFK Jr.’s Surgeon General Pick,” by Lauren Weber and Rachel Roubein.
• The Bulwark’s “There’s Something Weirdly Familiar About This New GOP Argument,” by Jonathan Cohn.
• Politico’s “4 GOP Ideas for an Obamacare Subsidies Compromise,” by Benjamin Guggenheim.
• The New York Times’ “The E.P.A. Followed Up on an Unusual Request About Abortion Pills,” by Caroline Kitchener and Coral Davenport.
• Bloomberg News’ “WHO Warns Against Three India-Made Cough Syrups After Child Deaths,” by Satviki Sanjay.

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

Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Oct. 16, at 10 a.m. As always, news happens fast and things might’ve changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi. 

Rovner: And Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine. 

Joanne Kenen: Hey, everybody. 

Rovner: Later in this episode we’ll play my interview with health insurance expert Louise Norris, who will explain some of the changes coming with this year’s open enrollment for Medicare, which began Wednesday. But first, this week’s news. 

So, today is Day 16 of the government shutdown, and there is still no discernible end in sight. This week Republicans shifted their main talking point against Democrats. They were arguing that Democrats are trying to restore eligibility for Medicaid to illegal immigrants. Now it’s become a general takedown of the Affordable Care Act and arguing that in urging continuing the expanded tax credits for ACA premiums, Democrats want to throw good money after bad, because the ACA has made health care more expensive. 

First off, it has not. There’s lots of evidence that the ACA has actually held down health spending increases, although other factors have pushed it up. But more to the point, do Republicans still not get that the expiration of these additional tax credits are going to hurt their voters more than it’s going to hurt Democratic voters? I see arched eyebrows. 

Edney: It doesn’t seem like they get that yet, but I’m not in those strategy rooms, so a little tough to say what their line will be with this game of chicken. They basically are allowing firings of federal workers to continue to go forward in a way that they hope maybe will turn the tide and attention. It doesn’t seem to be working. So I don’t know if they’re having these conversations quite yet, but I know that the notices are starting to go out to some people in some states about these increases, and so it really might depend on what that backlash is from people who are going to see much higher costs for their health care. 

Rovner: Yeah, apparently open enrollment began in Idaho on Wednesday. I didn’t realize that they started early, and so there’s just that one little state where people are actually able to see what these premium increases look like, assuming that they do not continue these extra subsidies. I’m wondering sort of about the Republican strategy of, We couldn’t get any traction with the illegal immigrants, so we’re just going to move to “The ACA is terrible.” Joanne. 

Kenen: Well, I mean, we talked about this a couple of weeks ago. And Julie linked to the story, and I wrote about the politics of this. And one of the issues is [President Donald] Trump is a master of deflection. Are these people going to think it’s really Republican policy? Or are they going to think it’s greedy insurers, leftovers of the flaws of Obamacare itself, it’s Biden’s fault? And also concentration, I mean where the voters are in these states. Are there enough of them who actually are going to turn out to make a difference? They’re not going to flip Texas, right? 

Are there enough of them in swing states or closer-margin states to make any difference? Are there enough in a single congressional district to make any difference? I mean part of it, I think they’re just sort of banking on that they won’t get the blame, that it’s really easy for us to get mad at our insurers. And I think that’s part of what they’re hoping, that they can just say: Blame them. Blame the structure of Obamacare. Because it’s not our fault. So, whether that works as a selling tactic remains to be seen. If they thought it was a huge political risk, they wouldn’t do it. 

Rovner: True. Lauren. 

Weber: I’ve been fascinated to see [Rep.] Marjorie Taylor-Green come out and say, Wow, these are some expensive premiums. And her in general, her seeming split from some parts of the Republican Party, is fascinating to watch for many reasons. But it’s just a lot of money that these people could be staring down. I mean, there was an analyst quoted in some coverage that was, like, people will have to decide between groceries and rent. I mean, if you are paying over a thousand dollars more a month, for some of these folks, I mean, that is a significant amount of cash. So, I do feel like people vote with their pocketbooks more than they vote with anything else. But to Joanne’s point, I mean, will they attribute the blame? I’m not sure. 

Rovner: So, Politico was reporting on some possible options for a deal on those subsidies, which lawmakers are apparently talking about quietly behind closed doors, since actual negotiations are not yet happening. Two of those possibilities seem like real potential common ground. Minimum premiums — so, people who are now not paying any premiums, and the argument from some Republicans is that that’s pushing fraud, because some people, if they’re not paying premiums, don’t even know that they’re enrolled, and that the brokers are making money, which my colleague Julie Appleby has written about ad nauseum. So that seems like a possible place for compromise, to have a minimum $5-a-month premium so people would know that they have insurance. And maximum incomes for the subsidies. I know that people are floating, like, $200,000 a year or something like that. 

Then there are two possibilities that at least strike me as less likely. One of them is grandfathering the subsidies, so only people who are getting them now could continue to get them, which would be problematic at a time when the economy seems to be shedding jobs, and changing the abortion language, which I don’t even want to start with. So, I’m seeing the first two as a real possibility. The second two, not so much. I’m wondering what you guys think. 

Kenen: I mean, I’ve talked to some Republicans who claim that the current structure of the subsidies would enable families who are making $600,000, which all of us would agree is a fair amount of money. When I was told that, I went on a whole bunch of different calculators and pretended I was making $600,000. And could I actually get the subsidies? And I kept being laughed at by these calculators. I think there are probably some cases where this has happened. It’s a complicated formula where 8% of — we don’t have to get into the technicality. There may be— 

Rovner: But it is a percent of your income. You only get a subsidy if it’s more than — yeah. 

Kenen: And you’d have to have a premium that’s, like, an extraordinarily rich premium. I mean, it has to be in a really, really, really, really high number. Can this exist under current law? Several reputable Republicans have told me yes. Or conservatives — they’re not all necessarily Republicans. Conservative on this issue, at least — have said yes. I mean, if that’s the kind of thing that you want, to set an income cap, that was probably what was intended. I would take that out of the nonstarter and into the starter pile. I don’t think that’s enough, but I think that’s a reasonable discussion for both sides to have. I don’t think the intention was to subsidize people who were really not lower-middle, middle class. 

Rovner: The people who got the big tax cuts. 

Kenen: Right. They’re getting other tax cuts. I thought that was an interesting piece with some interesting options, but I’m also hearing escalating rhetoric, back to 2014 kind of rhetoric, back to repeal kind of rhetoric, that everything that you hate about the health care system is the fault of Obamacare, nothing in Obamacare works. We’ve got a really — they’re not saying “repeal,” but they’re saying reform it, and I’m hearing more and more of that. It’s just in the air now. So, and Jon Cohn had a really good piece in The Bulwark about some of the background of this. I think it could mean that this becomes a more intense tug-of-war that does not bode well for a quick resolution of the shutdown. 

I don’t think we necessarily get into a yearlong repeal fight, even if you call it reform. But I think that these demands and this rhetoric about, Well, high-risk pools worked. Well, no, they didn’t. That, This is why your insurance costs have gone up. No, there’s a whole bunch of incentives and structures and bad stuff in our health care system. It is, Obamacare fixed certain problems. Those of us, we all have employer insurance, I believe, and all of us face cost increases and frustrations and hitting our head against brick walls and delays. And things are not perfect by any means, but it’s not because of these subsidies in Obamacare. 

Rovner: And it’s not because of Obamacare. [Barack] Obama himself this week was on a podcast and said it was intended as a start, not as the be-all, end-all. I was surprised. I mean, I think one of the reasons that Republicans, I mean, this is now in their talking points about, We’re going to go after Obamacare. And [Rep.] Mike Johnson, the speaker, had kind of a rant on Monday, I mean, which sort of opened this up. And I think some of the Republicans were also talking about it on the Sunday shows. But I can’t imagine that Republicans don’t remember that the last time they had this big fight against Obamacare, Obamacare won. That was in 2017, and if anything, it’s even more popular now because there’s twice as many people on it, which was kind of the way I set up my first question. 

Kenen: Right. But the dynamic of a year’s worth of repeal votes while other things are actually functioning in government versus a fight about this when Trump holds a lot of the cards in a shutdown — it’s comparable but not the same. 

Rovner: Anna? 

Edney: Well, and I also have to wonder if an actual extended replace, or reform, whatever we’re going to call it, fight is what they want, or if this is a strategy to help blame the increases in premiums that are coming on Obamacare in general directed towards the Democrats, right?. I mean, you can see how that line could be drawn. And so if they just keep bashing Obamacare, it’s Obamacare’s fault that Obamacare’s premiums got higher, not because they didn’t vote on extending the subsidies. 

Kenen: And we’re also talking about Obamacare again. We had been talking about the Affordable Care Act. It had gone from Obamacare, which is politically toxic, to Affordable Care Act, which was sort of a subtle acknowledgment that it had bipartisan popularity among people getting benefits. And now we’re back to Obamacare, which sort of tells me, yes, we’re back into some of this endless loop of political fights about Obamacare. 

Rovner: Yeah. 

Kenen: And trying to get the Guinness Book of World Records for repeal votes on a single piece of legislation. 

Rovner: Well, meanwhile — and I said this last week and I think the week before — that even if there is a deal on the tax credits, the bigger problem for Democrats right now is that if they make a deal on spending levels for fiscal 2026, which is what this fight is actually over, the administration can simply undo it, and Congress can ratify that undoing with a simple majority of just Republican votes. This week, even Republican [Sen.] Lisa Murkowski wondered aloud why Democrats would do a deal like that. So, I’m still wondering how they get out of that box, even if they were to get some kind of a compromise on the ACA subsidies. I certainly don’t know how Democrats get out of that box. I think the Republicans don’t know how they get out of that box. 

Kenen: They don’t realize they’re both in the box. That’s one of the problems. This is a large box. 

Rovner: It’s Schrödinger’s shutdown. We will have to see how that plays itself out. In the meantime, I’m not holding my breath. Well, moving on, despite laws against it, as Anna already mentioned, the Trump administration began firing federal workers last week, and the cuts hit particularly hard at the Department of Health and Human Services and agencies like the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration. The cuts appeared both sweeping and devastating, at least at first, including the entire staff of the CDC’s news journal and lead public health source of information, the Morbidity and Mortality Weekly Report. Though by the end of the weekend, many of the firings had been rescinded. It’s not clear whether that really was a coding mistake, as was the official explanation, or an effort to continue to put federal workers, quote, air quotes here, “in trauma” as OMB [Office of Management and Budget] Director Russell Vought famously promised before he took office for the second time. Whichever, it’s not really the way to get the best work out of your workforce, right? Telling you: You’re fired. No, you’re not. Maybe you are? Go ahead, Lauren. 

Weber: I would like to go back to the story I wrote in April when a bunch of fired health workers were told to contact an employee who had died. I don’t think, based on the coding error or some of these past things, it does not seem like these layoffs are being done in any sort of organized way. It doesn’t seem like they have up-to-date records. It seems like, also, are these layoffs even legal, based on some of the litigation that’s been filed? I think there’s going to be a lot that has to shake out there. But, I mean, to be quite honest, it is very striking to see a bunch of CDC employees continue to get laid off after, again, this is an agency that got shot at with hundreds of bullets. Police officer— 

Rovner: Yeah, literally shot at. 

Weber: Literally shot at with hundreds of bullets, and a police officer died responding to that, due to a shooter who had been radicalized in part, it seems, from his father’s account, by information that was wrong about the covid vaccine. So, to see more of those employees get laid off, I mean, you just have to wonder who’s going to want to work at these places. Morale is just completely, as we understand it, terrible. But yeah, I also question if that was a coding error or what exactly was happening there, because there were a lot of priorities of folks that were seemingly let go that are allegedly Make America Healthy Again priorities, but that’s also been true for many months of policymaking, so— 

Rovner: Yeah, there’s a lot of right hand not seemingly knowing what left hand is doing in all of this, which may be the goal. I mean, I think you put your finger on it. It’s like, who would want to work at these places after what’s being done? And I think that’s the whole idea of the Russell Vought strategy of, Let’s shrink the federal government to a point where it’s so small that you can just sort of put it in a box and put it under the bed. That’s essentially where we are. Well, Lauren, as you mentioned, Wednesday afternoon, a federal district court judge ordered the administration to pause the firings. But will they actually obey that? And do we even know what offices have been most affected at this point? 

I mean, we heard a lot of things like the entire Office of Population Affairs at HHS, which runs Title X, has apparently been reduced to one person. The people who do a lot of the statistics and survey work at CDC. All these people sort of appear to have been laid off, but we’re not quite sure, and we’re not quite sure what’s going to happen from here. 

Kenen: I’m not sure if they know they’ve been laid off and rehired, because if you were laid off, you lost your access to your work email, and then if you get an email in your work email saying, Oops, you’re hired. I mean, I guess people sort of may just see if they have access again, but I’m not really sure how the actual notification of this somewhat chaotic layoff, no-layoff thing is. 

Rovner: It has been chaotic. I think that’s a good word to describe all of this. Well, one reason it was relatively easy for the administration to go after the CDC is that it doesn’t have a leader — or even a nominated leader — at the moment, after the firing of Susan Monarez in August, less than a month after her Senate confirmation vote. Another high HHS position that remains vacant is that of surgeon general, although that office at least has a nominee, Casey Means. She’s the sister of RFK [Robert F. Kennedy] Jr. top aide and MAHA associate Calley Means and more than a little bit controversial. Lauren, you did a deep dive this week into the prospective surgeon general. What’d you find? 

Weber: Yeah, my colleague Rachel Roubein and I did a deep dive into her background. And she’s, look, she’s a fascinating example, really, of MAHA today. And you could argue she really wrote the manifesto to MAHA with her book “Good Energy” that she authored with her brother, Calley Means. But basically she’s a very accomplished person in the sense that she went to Stanford undergrad; she graduated from Stanford med school; she had a very prestigious residency in ear, nose, and throat surgery; and then she resigned. She left and decided she wanted to take a different path and has become a bestselling author, a health products entrepreneur, and has also worked, as her financial disclosures have revealed, to promote a variety of products in some of her work. Financial disclosures revealed that she had received over half a million dollars over basically the last year and a half promoting a variety of different supplements, teas, elixirs, diagnostic products, and so on. 

And several of the medical and scientific experts I spoke to said that they worried that she spoke in too absolute of terms about health, and they were really concerned that as someone who would be the surgeon general that she would use that bully pulpit and speak in terms not necessarily grounded in evidence. They pointed to some of her remarks about how cancer and Alzheimer’s and fertility was within one’s power to prevent and reverse, and they felt like that language went a step too far. And looking at her history, they are concerned about what that could mean for the health of the nation if she is directing it. 

Rovner: She doesn’t even have a confirmation hearing scheduled yet, does she? Well, the Senate’s in so they could. 

Weber: She is pregnant, so I think that is playing into the timing of some of her stuff. But yes, she does not have it scheduled. Her forms seemingly were pretty delayed. And then obviously there’s other things going on. I mean, I think the CDC firing also sucked a lot of health air out of the room of what people want to deal with and spend their political capital on, I suspect. But yes, we shall see. 

Kenen: Yeah, she has to go before the [Senate] HELP [Health, Education, Labor, and Pensions] Committee, which is, Sen. [Bill] Cassidy is the chair. He is not a happy camper at the moment, from his public statements, and we do not know what the private conversations he is having at this point in time. 

Rovner: And of course, that committee will also have to pass on the new CDC nominee when there is one. 

Kenen: Yes. And the last CDC hearing, which all of us watched, I think he’s clearly concerned and displeased by lots of things going on at the federal health agencies. So, none of us are in those rooms, but they’re probably interesting conversations. 

Rovner: As I like to say, we will watch that space. Well, turning to reproductive health, The New York Times has a story this week about something that we’ve talked about before on the podcast, arguments by anti-abortion activists that abortion pill residue in wastewater might be contaminating the nation’s waterways. Notwithstanding that there is no evidence of that, the Environmental Protection [Agency], acting on a request from anti-abortion lawmakers in Congress, ordered scientists to see if they could develop methods to detect the drug in wastewater. Now, the groups that originally pushed this say they were concerned about pollution. But if such a detection method is successfully developed, abortion rights supporters worry that it could be used to trace users in particular buildings in order to enforce abortion bans. This is basically another step in this sort of, Let’s try and shut down abortion nationwide. Is it not? And Anna I see you nodding. 

Edney: Well, I mean that was my feeling when I read this really good piece that you’re talking about. And it’s a little bit lower down in the piece when they do start talking about using this to target maybe buildings or places where someone might have used an abortion drug. And I kind of was like, Yes, this is what I assumed they were trying to do, as I read this. And the reason for that is not just because I feel like there’s always a vindictive motive or something, but it’s because there are lots of drugs that are in our wastewater, and people are taking far larger amounts daily of many more things that is all going into our wastewater. So, particularly, why you would want to track that one, which is not used by millions of people for a chronic condition on a daily basis, it seems like there would be an ulterior motive. 

Rovner: And has not been shown to do any harm, even if it is showing up in trace amounts in the wastewater. Although presumably that’s what the EPA scientists were also tasked with trying to figure out. 

Kenen: I mean, it’s really hard to get rid of a drug you no longer take. I mean, pharmacies don’t want to take it back. In my neighborhood, there is a pharmacy at a supermarket that does have a take-back, which is great, but it’s always broken. If you have any drug that you want to get rid of responsibly and not have it end up — Anna’s right, I mean, there’s just a lot of stuff in our water. It’s really hard to do. And this is not the only drug that is an issue with. 

Rovner: Although if you Google it, there are a lot of places where you can actually take back drugs. 

Kenen: It’s hard. It’s limited hours, limited access, and the machines are often— 

Rovner: Yeah. Yeah. 

Kenen: I’ve been trying for a couple of them for a few months, actually. 

Rovner: You do have to actually take some steps actively to do it. Well, turning to drugs, and drug prices, there was so much other news, you might’ve missed this, but President Trump last Friday afternoon announced a deal with a second drug company to bring back manufacturing, in order to avoid tariffs. This deals with AstraZeneca, which promised to build a plant in Virginia. But Anna, is there any promise to actually bring down prices for consumers in any of this? 

Edney: Minimally, possibly. It’s a lot like the Pfizer deal, and we saw that focus largely on Medicaid, that already has extremely steep discounts that are required by law. And so how much they’d actually be slashing to offer the “most favored nations” pricing that Trump wants to the Medicaid program, it seems like that probably isn’t a huge leap, and certainly we saw that Wall Street didn’t react with any hair on fire. They’re not worried about the bottom lines of these companies when these deals come out, and they’re avoiding tariffs for three years. So, kind of net positive, seemingly. We don’t have all the details of the deal— 

Rovner: Like with the Pfizer deal where we never got all the details. 

Edney: Yeah, exactly. So, there’s some stuff that we still don’t know, but Medicaid is the main focus. Then they’ll offer, again, some of their drugs on TrumpRx. So, maybe if your insurance doesn’t cover something, or if you don’t have insurance, and you want to get a drug, that might be helpful. But most people I think are going to opt to pay their lower copay than the cost of a drug that is discounted but still full price. 

Rovner: Well, in case you’re looking for a reason why it might be a good thing to reshore some drug manufacturing, the World Health Organization this week warned of potentially poisonous cough syrup made in India. According to one of your Bloomberg colleagues, Anna, 22 children have died in the central Indian state of Madhya Pradesh — I hope I’m pronouncing that close to right. And this is far from the first time poisonous substances have been found in medications made in India, right? You’ve done a lot of reporting on this. 

Edney: Yeah, for sure, and these are really tragic stories that now seem to keep, particularly with these kind of cough medicines, keep popping up. And thankfully the FDA did put out a message saying these cough medicines in this round were not sold in the U.S., but there have been times where India has imported some of these. There were children in the Gambia that died last time — this was a few years ago. Because what’s happening is some of the drugmakers in India are supposed to be purchasing a solvent. It’s propylene glycol. Well, that solvent, that helps the medicine kind of all mix together. It can be a lot cheaper if you buy something that looks like it but is actually deadly, diethylene glycol. And so that’s what some of these companies are doing, is saving money and substituting a deadly ingredient. And so we see that this is a problem a lot of times with some of the drugmakers, and it’s happened, unfortunately, particularly in India, where the cost-cutting, the corner-cutting has actually affected people’s lives, and in this case, tragically, children. 

Rovner: Yeah. There is reason to kind of want to keep drug manufacturing where the FDA can keep an eye on it, which I know you will continue to report on. 

Edney: For sure. 

Rovner: Because that has been your specialty, I know, of late. 

Edney: Yes. 

Rovner: All right, that is this week’s news. Now we will play my Medicare open enrollment interview with Louise Norris, and then we’ll come back with our extra credits. 

I am so pleased to welcome to the podcast Louise Norris. She’s a health policy analyst at Medicareresources.org and at Healthinsurance.org and the author of some of the most helpful guides to health insurance out there — and the person who keeps track of all the changes for health reporters like me. Louise, so happy to welcome you to “What the Health?” 

Louise Norris: Thank you so much, Julie. It’s a pleasure to be here. 

Rovner: So, we’ve talked a lot these past few months about how the Affordable Care Act and its potentially skyrocketing premiums for 2026 is about to happen, but we haven’t talked as much about some of the changes to Medicare, for which open enrollment began this week. Now, most years it’s probably OK for Medicare recipients just to let whatever coverage they have kind of roll over. But that’s not the case this year, right? 

Norris: Well, I feel like it’s never the best idea to just let your coverage roll over, because there’s always plan-specific changes that people just really need to pay attention to. And even though averages might be fairly steady in terms of premiums and benefits, that doesn’t mean your plan will have a steady premium or benefits. And for 2026, we’re seeing in the Medicare Advantage and Part D —stand-alone Part D — drug plans, there are fewer plans available on average and actually a slight average decrease in premiums. But I feel like if people see that as the headline, they might be sort of lulled into complacency, of like, Oh, I just don’t need to look, when in reality there’s quite a bit of variation from one plan to another. So, although the average stand-alone Part D plan premium is actually decreasing slightly, some plans are increasing their premiums by as much as $50 a month. So, you need to really pay attention to the notice you got from your plan about what’s happening for 2026 and then comparison-shop. Comparison-shop is always in your best interest every year. 

Rovner: Right, because, I mean, people don’t realize that maybe your doctor’s been dropped from your Medicare Advantage plan or your drug has been dropped from your Part D plan. So, I mean, even if your premium doesn’t change that much, your coverage might be changing a lot, right? 

Norris: Exactly. And you don’t want to find that out when you go to the pharmacy in January to fill your prescription and then you’re locked into your Part D plan for all of 2026. It’s definitely better to know all those details at this right now during open enrollment. 

Rovner: Now there are some coverage changes that people are starting to feel from really a couple of years ago, yes? 

Norris: There are. So, there’s some basic changes like, for example, the maximum out-of-pocket cost on Part D plans, which just went into effect in 2025 under the Inflation Reduction Act, it was a $2,000 cap on out-of-pocket costs for Part D. That is indexed for inflation. So for 2026 it goes up to $2,100. So not a huge change but definitely a change people should know about. And you do still have the option to work with your plan to spread that out in equal payments across all 12 months of the year instead of having to meet it right at the beginning of the year, if you take an expensive medication. There’s this change in the maximum Part D deductible, just like there is every year. This year it’s, for 2025, it’s $590 is the maximum deductible. It’ll be $615 next year. That doesn’t mean your plan will have a $615 deductible, but it might. 

But there are also plan-specific changes that vary from one plan to another. So, for example, your Medicare Advantage plan might be adding or subtracting supplemental benefits. They might be changing the amount of your deductible or changing the amount of your inpatient hospital copay. There’s all sorts of changes that aren’t necessarily broadly applicable but that apply to your plan. And then, like you were saying, whether or not your doctor and hospital are still in the network, whether your prescription drug is still covered and covered at the same level, plans can move prescription drugs from one tier to another. So, those are all the sorts of things you really need to pay attention to now so that you can comparison-shop and see if something else might be a better option. 

Rovner: And we are seeing plans starting to sort of drop out. I mean, I know at one point there was concern that there were too many plans for people to choose from, that it was, just, it was too confusing. But now are we running the risk of having too few plans in some places? 

Norris: Well, I think the concern about too many plans is definitely valid. For a while, there were — it could definitely be overwhelming for people shopping for coverage. For both Medicare Advantage and Part D, we do have, overall, an average of a reduction in how many plans are available for next year. There are a few states where the average beneficiary will actually see more options for Medicare Advantage, but that’s rare. But the average beneficiary will have access to more Medicare Advantage plans than they did before 2022, for example. It’s just been in the last few years that it has decreased, but it still hasn’t decreased below the level that it was in 2022. So it’s still a lot. I believe it’s an average of 32 plans. And then in the Part D, for people who buy stand-alone Part D coverage, everybody has between eight and 12 plans to pick from. 

So, if your plan is ending, you obviously need to shop for new coverage. If you’re on a Medicare Advantage plan and you don’t shop for new coverage, you’ll just be automatically moved to original Medicare on Jan. 1. If you’re on a Medicare Advantage plan that’s ending, because your carrier is exiting the market or pulling out of your area and your plan can’t be renewed, you can pick any other Medicare Advantage plan that’s available in your area. But you also can do, you can switch to original Medicare, and you’ll have guaranteed issue access to Medigap, which is not normally the case. During this open enrollment period, people have guaranteed issue access to Medicare Advantage and Part D but not Medigap. So, for other folks whose Medicare Advantage plan is continuing, obviously they have the option to switch to original Medicare. But depending on how long they’ve been on their Advantage plan and what state they’re in, they do not have guaranteed issue access to Medigap. So, that is an important thing for folks to know if their plan is actually ending, is that they can make that choice if they want to. 

Rovner: We’ve seen a lot of increases in health care costs overall, and I guess that’s true for Medicare, too. I mean, why should people who aren’t on Medicare care about what happens to Medicare and what happens to the Medicare market? 

Norris: First of all, hopefully all of us will eventually be on Medicare. Almost everyone by the time they’re 65 is on Medicare. But even if you’re a long ways away from that, it is important to know how much the whole Medicare sphere, in terms of the insurance companies and the regulations, how that sort of trickles down to the rest of the commercial insurance sector. Drug price negotiation, for example, that will have a trickle-down effect into what the insurance companies in the rest of the commercial market pay for drugs. When regulations come out for Medicare, they oftentimes, the insurance companies follow suit in the private market, or states will follow suit in terms of how they regulate the private market. So, it certainly does matter for everyone, even if it’s not a direct effect. 

Rovner: So even if you’re not 65 or helping somebody who’s over 65. 

Norris: Exactly, yes, and that’s the other thing is a lot of folks who are younger are helping a parent or a grandparent navigate this, and so it really does affect most people. 

Rovner: Yeah, it is one of the autumn tasks for many people. 

Norris: Absolutely. 

Rovner: Helping Mom and Dad or Grandma and Grandpa navigate their Medicare coverage for the following year. 

Norris: And I do think, like you were saying earlier, as far as just letting it ride, obviously if you comparison-shop and you’re happy with your coverage and you’ve determined that it is still the best option, then, yes, you do not need to do anything. You just, assuming it’s still available for renewal, you just let it renew. But oftentimes I think people don’t comparison-shop, simply because the process seems overwhelming and they just figure, I’ll just keep what I have. And of course, if you’re in that situation, you might be one of the people who’s on a Part D plan that’s increasing by $50 a month next year, or you might find out in January that your doctor’s no longer in-network with your Advantage plan. 

So if you get those notices from your plan and something doesn’t make sense or you’re confused, it’s much better to reach out to someone who can help you, whether it’s a family member or friend, asking them for help, or call 1-800-MEDICARE. Call the Medicare SHIP in your state. Every state has a State Health Insurance Assistance Program that’s staffed with people who can answer your questions. Contact a Medicare broker in your area. Just asking questions and finding out the answers is a much better approach than just assuming things will work out if you just let your plan renew. 

Rovner: I’ll put a link to your site also. 

Norris: Yeah, Medicareresources.org. We do have an open enrollment guide where we list all of the changes that are happening for 2026, the broad changes, and we’ll continue to update that. For example, we don’t yet have the Medicare Part B premiums for 2026, so as those numbers come out, we’ll update that guide with everything people need to know. 

Rovner: Louise Norris, thank you so much. 

Norris: Absolutely. Thank you so much for having me, Julie. 

Rovner: OK, we’re back. It’s time for our extra-credit segment. That’s where we each recognize the story we read this week we think you should read, too. Don’t worry if you miss it. We will put the links in our show notes on your phone or other mobile device. Joanne, why don’t you go first this week? 

Kenen: The piece I have this week is from Mother Jones, and it’s about Florida Surgeon General Dr. Joseph Ladapo. And the headline is “From Medicine to Mysticism: The Radicalization of Florida’s Top Doc,” by Kiera Butler and Julianne McShane. It’s a phenomenal read. He has stellar credentials — Harvard, Stanford. He was an academic medicine MPH [master of public health]. He’s public health and medicine. He had this stellar traditional career. He was widely respected. And now he is this leading voice. He’s trying to get rid of the vaccine mandates, childhood vaccine mandates, to the whole state of Florida. He has questioned all sorts of established public health practices. He is out there. And we’ve sort of all wondered: How do people get to this point? 

And this story talks about his wife and her mysticism, and their guru healer, who walks on their thighs to the point that it’s painful. And they emerge from this foot-walking thigh-walking thing, and his mystical experiences with this whole different take on the human experience and the role of health. I cannot begin to capture it. And here it is. It is a long, detailed, and fascinating read on his wife, who he met on an airplane, and her beliefs in, we bring certain things on ourselves because of who we are and who are the ancestors that we carry. She sees auras and visions, and this is their current belief system. And it is not compatible with what most of us think of as science-based public health. Really good read. Really, really good read. 

Rovner: Definitely MAHA to the max. Anna. 

Edney: Mine was a guest essay in The New York Times, “The Drug That Took Away More Than Her Appetite,” [by Maia Szalavitz]. And I thought it was a really great look at how some of these obesity medications, the GLP-1s like Ozempic and others, can be used to treat addiction. And so it follows this woman who was addicted to different kinds of drugs at different times. And she lost her children and all sorts of horrible things and had tried over and over again to stop using, and then has been in this program that uses a version of these GLP-1s at a lower level — they don’t necessarily want you also losing weight — but to treat addiction, and just how it’s kind of been the only thing that’s worked for her. It stops the cravings, kind of as you think it might do for people with obesity as well. 

I thought we don’t see this as much, and the companies that make these drugs aren’t extremely focused on this. So I thought the article did a good job of saying why this could be really important, and looking at the fact that right now it requires federal funding of research to keep the promise alive, and hope that at some point some pharmaceutical company will be more willing to pick it up. 

Rovner: Right now, there’s a lot more money to be made in the obesity side of this. But yeah, it’s a really interesting story. Lauren. 

Weber: I actually highlighted work from Rachana Pradhan and Samantha Liss from KFF Health News. The article’s titled “Senators Press Deloitte, Other Contractors on Errors in Medicaid Eligibility Systems.” It’s impact from their great reporting, which I think we talked about on this podcast earlier in the year, about how — talk about waste, fraud, and abuse — that there’s some questionable issues with how Deloitte manages Medicaid systems and how money’s being wasted through them. And the senators, it looks like, read KFF Health News’ reporting and have sent some letters about it. So, great work by the team over there, and eye-opening for sure to see, on some of the dollars, Medicaid, that are not going to patients. 

Rovner: Journalism impact. My extra credit this week is a really thoughtful story from our fellow podcast panelist Alice Miranda Olstein at Politico. It’s called “RFK Jr.’s Got Advice for Pregnant Women. There’s Limited Data to Support It.” It’s about a topic that I have been covering for more than three decades — the difficulties of including women, particularly women of childbearing age, in clinical trials of drugs. As Alice outlined so well, the problem isn’t just ethical — an unborn fetus obviously can’t give informed consent to be part of an experiment — but it’s also a question of liability. Drugmakers are afraid of getting sued for bad pregnancy outcomes, and with good reason. That’s why it’s so hard to know what is and isn’t safe to take during pregnancy and what might cause birth defects or miscarriages. And despite the secretary’s promise to, quote, “do the science,” it is not that easy. It’s a really, really good read. 

OK, that is this week’s show. Thanks this week to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. If you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me still on X, @jrovner, or on Bluesky, @julierovner. Where are you folks these days? Joanne? 

Kenen: I’m either on Bluesky, @joannekenen, or on LinkedIn. 

Rovner: Anna? 

Edney: Bluesky or X, @annaedney. 

Rovner: Lauren. 

Weber: I’m on X or Bluesky, @LaurenWeberHP. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

DARPA officials didn’t return a message seeking comment.

Federal Messaging

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

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

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

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

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

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

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

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

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

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

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

Widespread Misinformation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Green burials are gaining popularity as an affordable, eco-friendly alternative to traditional funerals. They avoid toxic embalming chemicals, steel caskets, and concrete vaults, letting a body naturally decompose. Methods range from the elaborate — like “human composting” and water cremation — to a simple pine box.

“The New Old Age” columnist Paula Span appeared on WAMU’s Oct. 8 “Health Hub” to talk about the environmental and economic motivations behind these alternatives to conventional burials.

Jackson Sinnenberg 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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At the largest hospital, as much as 5 feet of water could reach the emergency room. At the children’s hospital, the river could rise to cut off all exits. And at another hospital in the city center, more than 10 feet of flooding could besiege the facility on three sides. 

These are some findings of a new KFF Health News investigation that examined nationwide hospital flood risk using data provided by Fathom, a company considered a leader in flood simulation. The investigation identified 171 hospitals, totaling nearly 30,000 patient beds from coast to coast, that face the greatest risk of significant or dangerous flooding. 

The investigation found heightened flood risks at large trauma centers, small rural hospitals, children’s hospitals, and long-term care facilities that serve older and disabled patients. While coastal flooding threatens many hospitals in low-lying states like Florida and Texas, many inland hospitals are at risk from overflowing rivers and streams, particularly in Appalachia. Even in the sun-soaked cities and arid expanses of the American West, storms have the potential to flood some hospitals with several feet of pooling water, according to Fathom’s data. 

“The reality is that flood risk is everywhere. It is the most pervasive of perils,” said Oliver Wing, the chief scientific officer at Fathom, who reviewed the findings. “Just because you’ve never experienced an extreme doesn’t mean you never will.”

The KFF Health News investigation is among the first to analyze nationwide hospital flood risk in an era of warming climate and worsening storms. It comes as the administration of President Donald Trump has slashed federal agencies that forecast and respond to extreme weather, dismantled Federal Emergency Management Agency programs designed to protect hospitals and other important buildings, and generally dismissed the threat of climate change, which the president recently referred to as “the greatest con job ever perpetrated on the world.” 

Even a small amount of flooding could shut down an unprepared hospital, often by interrupting its power supply, which is needed for life-sustaining equipment such as ventilators and heart monitors. 

Charleston Area Medical Center, a health system that runs most of the hospitals in Charleston, stated that it is aware of its flood risk and has taken steps to prepare, like acquiring a deployable floodwall. 

Many other hospitals could be unaware of their flood risk. Of the 171 hospitals with significant flood risk identified by KFF Health News, one-third are in areas outside flood hazard zones mapped by FEMA. 

“This is highly concerning,” said Caleb Dresser, who studies climate change and is both an emergency room doctor and a Harvard University assistant professor. “If you don’t have the information to know you’re at risk, then how can you triage that problem?”

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Watts knew other missileers with similar cancers. But the connection really hit home later that same January day, when the results of a blood test revealed that Watts himself had chronic lymphocytic leukemia, a type of non-Hodgkin lymphoma.

“I don’t know if it was ironic or serendipitous or what the right word is, but there it was,” Watts said.

Within the community of U.S. service members who staff nuclear missile silos scattered across the Northern Rockies and Great Plains, suspicions had long been brewing that their workplaces were unsafe. Just months after Watts was diagnosed in 2022, Lt. Col. Danny Sebeck, a former Air Force missileer who had transferred to the U.S. Space Force, wrote a brief on a potential cancer cluster among people who served at Minuteman III launch control centers on Malmstrom Air Force Base in Montana.

Sebeck identified 36 former workers who served primarily from 1993 to 2011 and had been diagnosed with cancer, including himself. Of those, 11 had non-Hodgkin lymphoma; three had died. The Air Force responded swiftly to Sebeck’s findings, launching a massive investigation into cancer cases and the environment at three intercontinental ballistic missile bases and a California launch facility. The goal is to complete the research by the end of 2025.

The service has released portions of the studies as they conclude, holding online town halls and briefings to highlight its findings. But while former missileers say they are heartened by the rapid response, they remain concerned that the research, which crosses decades and includes thousands of ICBM personnel and administrative workers, may address too large a population or use statistical analyses that won’t show a connection between their illnesses and their military service.

They need that tie to expedite benefits from the Department of Veterans Affairs.

Historically, the Department of Defense has been slow to recognize potential environmental diseases. Veterans sickened by exposure to Agent Orange in Vietnam, Marines who drank contaminated water at Camp Lejeune, North Carolina, and service members who lived and worked near burn pits in Iraq and Afghanistan fought for years to have their illnesses acknowledged as related to military service.

In the case of the missileers, the Air Force already had studied potential contamination and cancer at Malmstrom in 2001 and 2005. That research concluded that launch control centers were “safe and healthy working environments.” But with Sebeck’s presentation and the decision to pursue further investigation, Air Force Global Strike Command — the unit responsible for managing nuclear missile silos and aircraft-based nuclear weapons — said the earlier studies may not have included a large enough sampling of medical records to be comprehensive.

Sebeck, who serves as co-director of the Torchlight Initiative, an advocacy group that supports ICBM personnel and their families, told congressional Democrats on April 8 that the Defense Department has not accurately tracked exposures to the community, making it difficult for veterans to prove a link and obtain VA health care and disability compensation.

“I had to go to a VA person and pull some papers,” Sebeck said, referring to the government system for recording service members’ environmental risks. “It says that I visited Poland once. It doesn’t mention that I pulled 148 alerts in a launch control center with polychlorinated biphenyls and with this contaminated air and water.”

PCBs — And the Missileers Exposed to Them

PCBs are synthetic chemicals once used in industry, including missile control electrical components such as display screens, keyboards, and circuit breakers. They have been banned for manufacture since 1979, deemed toxic and a likely carcinogen by the Environmental Protection Agency.

The Air Force’s Missile Community Cancer Study compares 14 types of common cancers in the general U.S. population and the missile community and also studies the environments at Malmstrom Air Force Base in Montana, F.E. Warren Air Force Base in Wyoming, Minot Air Force Base in North Dakota, and Vandenberg Space Force Base in California to determine whether they may have contributed to the risk of developing cancer.

The Malmstrom, Warren, and Minot bases together field 400 Minuteman III missiles, the land-based leg of the U.S. nuclear triad, which also includes submarine- and aircraft-launched nuclear weapons. The missiles are housed in silos spread across parts of Montana, North Dakota, Wyoming, Colorado, and Nebraska, staffed around the clock by missileers operating from underground, bunkerlike launch control centers.

So far, the Air Force investigation has found no “statistically elevated” deaths from cancer in the missile community compared with the general population, and it found that the death rates for four types of common cancers — non-Hodgkin lymphoma, lung, colon and rectum, and prostate cancer — were significantly lower in missileers than in the general population.

Non-Hodgkin lymphoma accounted for roughly 5.8% of all cancer deaths among people who worked in launch control centers from January 1979 to December 2020.

Early results, derived from Defense Department medical records, found elevated rates of breast and prostate cancers in the missile community, but a later analysis incorporating additional data did not support those findings. The studies also did not find increased rates of non-Hodgkin lymphoma. Air Force officials noted during a June 4 online town hall, however, that these assessments are based on roughly half the data the service expects to review for its final epidemiological reports and cautioned against drawing conclusions given the limitations.

The final incidence report will include federal and state data, including information from civilian cancer registries, and delve into subgroups and exposures, which may “provide deeper insights into the complex relationship” between serving in the missile community and cancer risk, wrote Air Force Col. Richard Speakman in a September 2024 memo on the initial epidemiology results.

Gen. Thomas Bussiere, commander of Air Force Global Strike Command, said during the June town hall that only the final results will determine whether the missile community’s cancer rates are higher than the general population’s.

Some lawmakers share the concern of missileers about the Air Force study. Following the release of a University of North Carolina review of Torchlight Initiative data that showed higher rates of non-Hodgkin lymphoma — at younger ages — among Malmstrom missileers, Rep. Don Bacon (R-Neb.) introduced an amendment to a defense policy bill calling for the National Academies of Sciences, Engineering, and Medicine to review health and safety conditions in the facilities.

“Let’s make sure that we have some outside experts working with the Air Force studying cancer rates with our ICBM missions,” Bacon posted July 30 on the social platform X. “We want to ensure credibility and that whatever results come out, we’ve done total due diligence.”

Regarding additional studies on the working environments at the installations and a possible relationship between exposures and cancer risk, Speakman, who commands the Air Force School of Aerospace Medicine, said Malmstrom had two types of PCBs that the other two missile wing bases did not.

He added that benzene, found in cigarette smoke, vehicle exhaust, and gasoline fumes, was the largest contributor to cancer risk in reviews of the bases.

The assessment concluded that health risks to missileers is “low, but it’s not zero,” Speakman said. He said it would be appropriate to monitor the health of launch control workers.

Next Steps

Watts, whose story has been highlighted by the Torchlight Initiative, has asked the Defense Department’s inspector general to investigate — the watchdog agency referred his request to Global Strike Command — and is closely watching the Air Force research. He said the bulk of the cancer cases reported to Torchlight occurred in the 2000s, when ICBM personnel still used technology that contained PCBs, burned classified material such as treated paper and plastic coding devices indoors, and possibly were exposed to contaminated water.

“I open the door and there’s guys standing there in pressurized suits with sampling equipment,” Watts recalled. “They said, ‘We’re here to check for contaminated water.’ I look at my crew commander, and we’re standing there in cotton uniforms. I said, ‘Do you see anything wrong with this?’”

Launch control operators no longer burn code tapes indoors and the Air Force has made improvements to air circulation in the centers. Sebeck wants Congress to consider including missileers and others sickened by exposure to base contamination in the PACT Act, landmark legislation that mandates health care and benefits for veterans sickened by burn pits and other pollutants.

“It’s documented that there is a large cancer cluster in Montana, probably also in Wyoming. People act surprised, but all they have to do is go to the oncology office in Denver. I can find my missileer buddies there. We are sitting in the same chairs getting chemotherapy,” Sebeck said.

Air Force Global Strike Command spokesperson Maj. Lauren Linscott said in response to Sebeck’s remarks that the unit understands the impact of cancer on its personnel and is committed to supporting them.

“While current findings are preliminary and no conclusions can yet be drawn, we are dedicated to a rigorous, peer-reviewed, data-driven process to better understand potential health risks because the safety of our airmen is our top priority,” Linscott said.

Bills introduced in the House and Senate would address the situation. In addition to Bacon’s amendment, the Senate version of an annual defense policy bill would require a “deep cleaning” of launch control centers every five years until the sites are decommissioned as a new ICBM, the Sentinel, replaces the Minuteman IIIs.

The Air Force aims to release its final epidemiological report by the end of the year.

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At this decades-old psychiatric hospital on the edge of the Tennessee River, an intense storm could submerge the building in 11 feet of water, cutting off all roads around the facility, according to a sophisticated computer simulation of flood risk.

Aurora, a young woman who was committed to Peninsula as a teenager, said the hospital sits so close to the river that it felt like a moat keeping her and dozens of other patients inside. KFF Health News agreed not to publish her full name because she shared private medical history.

“My first feeling is doom,” Aurora said as she watched the simulation of the river rising around the hospital. “These are probably some of the most vulnerable people.”

Covenant Health, which runs Peninsula Hospital, said in a statement it has a “proactive and thorough approach to emergency planning” but declined to provide details or answer questions.

Peninsula is one of about 170 American hospitals, totaling nearly 30,000 patient beds from coast to coast, that face the greatest risk of significant or dangerous flooding, according to a months-long KFF Health News investigation based on data provided by Fathom, a company considered a leader in flood simulation. At many of these hospitals, flooding from heavy storms has the potential to jeopardize patient care, block access to emergency rooms, and force evacuations. Sometimes there is no other hospital nearby.

Much of this risk to hospitals is not captured by flood maps issued by the Federal Emergency Management Agency, which have served as the nation’s de facto tool for flood estimation for half a century, despite being incomplete and sometimes decades out of date. As FEMA’s maps have become divorced from the reality of a changing climate, private companies like Fathom have filled the gap with simulations of future floods. But many of their predictions are behind a paywall, leaving the public mostly reliant on free, significantly limited government maps.

“This is highly concerning,” said Caleb Dresser, who studies climate change and is both an emergency room doctor and a Harvard University assistant professor. “If you don’t have the information to know you’re at risk, then how can you triage that problem?”

The deadliest hospital flooding in modern American history occurred 20 years ago during Hurricane Katrina, when the bodies of 45 people were recovered from New Orleans’ Memorial Medical Center, including some patients whom investigators suspected were euthanized. More flooding deaths were narrowly avoided one year ago when helicopters rescued dozens of people as Hurricane Helene engulfed Unicoi County Hospital in Erwin, Tennessee.

Rebecca Harrison, a paramedic, called her children from the Unicoi roof to say goodbye.

“I was scared to death, thinking, ‘This is it,’” Harrison told CBS News, which interviewed Unicoi survivors as part of KFF Health News’ investigation. “Alarms were going off. People were screaming. It was chaos.”

The investigation — among the first to analyze nationwide hospital flood risk in an era of warming climate and worsening storms — comes as the administration of President Donald Trump has slashed federal agencies that forecast and respond to extreme weather and also dismantled FEMA programs designed to protect hospitals and other important buildings from floods.

When asked to comment, FEMA said flooding is a common, costly, and “under appreciated” disaster but made no statement specific to hospitals. Spokesperson Daniel Llargués defended the administration’s changes to FEMA by reissuing an August statement that dismissed criticism as coming from “bureaucrats who presided over decades of inefficiency.”

Alice Hill, an Obama administration climate risk expert, said the Trump administration’s dismissal of climate change and worsening floods would waste billions of dollars and endanger lives.

In 2015, Hill led the creation of the Federal Flood Risk Management Standard, which required that hospitals and other essential structures be elevated or incorporate extra flood protections to qualify for federal funding.

FEMA stopped enforcing the standard in March.

“People will die as a result of some of the choices being made today,” Hill said. “We will be less prepared than we are now. And we already were, in my estimation, poorly prepared.”

‘Flood Risk Is Everywhere’

The KFF Health News investigation identified more than 170 hospitals facing a flood risk by comparing the locations of more than 7,000 facilities to peer-reviewed flood hazard mapping provided by Fathom, a United Kingdom company that simulates flooding in spaces as small as 10 meters using laser-precision elevation measurements from the U.S. Geological Survey.

Hospitals were determined to have a significant risk if Fathom’s 100-year flood data predicted that a foot or more of water could reach a considerable portion of their buildings, excluding parking garages, or cut off road access to the hospital. A 100-year flood is an intense weather event that has roughly a 1% chance of occurring in any given year but can happen more often.

The investigation found heightened flood risks at large trauma centers, small rural hospitals, children’s hospitals, and long-term care facilities that serve older and disabled patients. At least 21 are critical access hospitals, with the next-closest hospital 25 miles away, on average.

Flooding threatens dozens of hospitals in coastal areas, including in Florida, Louisiana, Texas, and New York. Farther inland, flooding of rivers or creeks could envelop other hospitals, particularly in Appalachia and the Midwest. Even in the sun-soaked cities and arid expanses of the American West, storms have the potential to surround some hospitals with several feet of pooling water, according to Fathom’s data.

These findings are likely an undercount of hospitals at risk because the investigation overlooked pockets of potential flooding at some hospitals. It excluded facilities like stand-alone ERs, outpatient clinics, and nursing homes.

“The reality is that flood risk is everywhere. It is the most pervasive of perils,” said Oliver Wing, the chief scientific officer at Fathom, who reviewed the findings. “Just because you’ve never experienced an extreme doesn’t mean you never will.”

Dresser, the ER doctor, said even a small amount of flooding can shut down an unprepared hospital, often by interrupting its power supply, which is needed for life-sustaining equipment like ventilators and heart monitors. He said the most vulnerable hospitals would likely be in rural areas.

“A lot of rural hospitals are now closing their pediatric units, closing their psychiatry units,” Dresser said. “In a financially stressed situation, it can be hard to prioritize long-term threats, even if they are, for some institutions, potentially existential.”

Urban hospitals can face dangerous flooding, too. Fathom’s data predicts 5 to 15 feet of water around neighboring hospitals — Kadlec Regional Medical Center and Lourdes Behavioral Health — that straddle a tiny creek in Richland, Washington.

By Fathom’s estimate, a 100-year flood could cause the nearby Columbia River to spill over a levee that protects Richland, then loosely follow the creek to the hospitals. Some of the deepest flooding is estimated around Lourdes, which was built on land the U.S. Army Corps of Engineers set aside in 1961 as a “ponding and drainage easement.”

At the time, this land was supposed to be capable of storing enough water to fill at least 40 Olympic-size swimming pools, according to military documents obtained through the Freedom of Information Act. A mental health facility has occupied this spot since the 1970s.

Both Kadlec and Lourdes said in statements that they have disaster plans but did not answer questions about flooding. Tina Baumgardner, a Lourdes spokesperson, said government flood maps show the hospital is not in a 100-year flood plain.

This is not uncommon. Of the more than 170 hospitals with significant flood risk identified by KFF Health News, one-third are located in areas that FEMA has not designated as flood hazard zones.

Sometimes the difference is stark. For example, at Ochsner Choctaw General in Alabama — the only hospital for 30 miles in any direction — FEMA maps suggest a 100-year flood would overflow a nearby creek but spare the hospital. Fathom’s data predicts the same event would flood most of the hospital with 1 to 2 feet of water, including the ER and the helicopter pad.

Ochsner Health did not answer questions about flooding preparations at Choctaw General.

FEMA flood maps were launched in the ’60s as part of the National Flood Insurance Program to determine where insurance is required and building codes should include flood-proofing. According to a FEMA statement, the maps show only a “snapshot in time” and are not intended to predict where flooding will or won’t happen.

FEMA spokesperson Geoff Harbaugh said the agency intends to modernize its maps through the Future of Flood Risk Data initiative, which will enable the agency to “better project flood risk” and give Americans “the information they need to protect their lives and property.”

The program was launched by the first Trump administration in 2019 but has since received sparse public updates. Harbaugh declined to provide a detailed update or timeline for the program.

Chad Berginnis, executive director of the Association of State Floodplain Managers, said it is unknown whether FEMA is still trying to upgrade its maps under Trump, as the agency has cut off communications with outside flooding experts.

“There has been not a single bit of loosening of what I’m calling the FEMA cone of silence,” Berginnis said. “I’ve never seen anything like it.”

Floods are expected to worsen as a warming climate fuels stronger storms, drenching areas that are already flood-prone and bringing a new level of flooding to areas once considered lower risk.

The National Oceanic and Atmospheric Administration has said that 2024 was the warmest year on record — more than 2 degrees Fahrenheit higher than the 20th-century average. Scientists across the globe have estimated that each degree of global warming correlates to a 4% increase in the intensity of extreme rainfall.

“Warmer air can hold more moisture, so this leads us to experience heavier downpours,” said Kelly Van Baalen, a sea level rise expert at the nonprofit Climate Central. “A 100-year flood today could be a 10-year flood tomorrow.”

Intensifying storms raise concerns about Peninsula Hospital, which has operated for decades mere feet from the Tennessee River but has no known history of flooding.

Peninsula spokesperson Josh Cox said the river is overseen by the Tennessee Valley Authority, which uses dams to manage water levels and generate electricity. Estimates provided by the TVA suggest the dams could keep Peninsula dry even in a 500-year flood.

Fathom, however, said its flood simulation accounts for the dams and stressed that a large enough storm could drop more rain than even the TVA could control. These predictions are echoed by another flood modeling firm, First Street, which also says an intense storm could cause more than 10 feet of flooding in the area around Peninsula.

“It’s a hospital right on the banks of a major American river,” said Wing, the Fathom scientist. “It just isn’t conceivable that such a location is risk-free.”

Jack Goodwin, 75, a retired TVA employee who has lived next to Peninsula for three decades, said he was confident the dams could protect the area. But after reviewing Fathom’s predictions, Goodwin began to research flood insurance.

“Water can rise quickly and suddenly, and the destruction is tremendous,” he said. “Just because we’ve never seen it here doesn’t mean we won’t see it.”

‘All the Elements of a Real Disaster’

One year ago, as Hurricane Helene carved a deadly path across Southern Appalachia, Angel Mitchell was visiting her ailing mother at Unicoi County Hospital in the tiny town of Erwin, Tennessee.

Swollen by Helene, the nearby Nolichucky River spilled over its banks and around the hospital, which was built in a flood plain. Staff tried to bar the doors, Mitchell said, but the water got in, trapping her and others inside. The lights went out. People fled to the roof, where the roar of rushing water nearly drowned out the approach of rescue helicopters, Mitchell said.

Ultimately, 70 people from the hospital, including Mitchell and her mother, were airlifted to safety on Sept. 27, 2024. The hospital remains closed, and the company that owns it, Ballad Health, has said its reopening is uncertain.

“Why allow something — especially a hospital — to be built in an area like that?” Mitchell told CBS News. “People have to rely on these areas to get medical help, and they’re dangerous.”

Beyond Unicoi, KFF Health News identified 39 inland hospitals — including 16 in Appalachia — that Fathom predicts could flood when nearby rivers, creeks, or drainage canals overspill their banks, even in storms far less intense than Helene.

For example, in the Cumberland Mountains of southwestern Virginia, a 100-year flood is projected to cause Slate Creek to engulf Buchanan General Hospital in more than 5 feet of water.

Near the Great Lakes in Erie, Pennsylvania, LECOM Medical Center and Behavioral Health Pavilion could become flooded by a small drainage creek that is less than 50 feet from the front door of the ER.

Neither Buchanan nor LECOM responded to questions about flooding or preparations.

And in West Virginia’s capital of Charleston, where about 50,000 people live at the junction of two rivers in a wide and flat valley, a single storm could potentially flood five of the city’s six hospitals at once, along with schools, churches, fire departments, and other facilities.

“I hate to say it,” said Behrang Bidadian, a flood plain manager at the West Virginia GIS Technical Center, “but it has all the elements of a real disaster.”

At the largest hospital in Charleston, CAMC Memorial Hospital, Fathom predicts that the Kanawha River could bring as much as 5 feet of flooding to the ER. Across town, the Elk River could surround CAMC Women and Children’s Hospital, cutting off all exits.

And in the center of the city, where the overflowing rivers are predicted to merge, Thomas Orthopedic Hospital could be besieged by more than 10 feet of water on three sides.

WVU Medicine, which owns Thomas Orthopedic Hospital, did not respond to requests for comment.

CAMC spokesperson Dale Witte said the hospital system is aware of its flood risk and has prepared by elevating electrical infrastructure and acquiring flood-proofing equipment, like a deployable floodwall. CAMC also regularly revises and drills its disaster plans, Witte said, although he added that hospitals there have never been tested by a real flood.

Shanen Wright, 48, a lifelong Charleston resident who lives near CAMC Memorial, said many in the city have little worry about flooding in the face of more immediate problems, like the opioid epidemic and the decline of manufacturing and mining.

Tugboats and coal barges sail past his neighborhood as if they were cars on his street.

“It’s not to say it’s not a possibility,” he said. “I’m sure the people in Asheville and the people in Texas, where the floods took so many lives, they probably didn’t see it coming either.”

‘The Water Is Coming’

Despite wide scientific consensus that climate change fuels more dangerous weather, the Trump administration has taken the position that concerns about global warming are overblown. In a speech to the United Nations in September, Trump called climate change “the greatest con job ever perpetrated on the world.”

The Trump administration has made deep staff and funding cuts to FEMA, NOAA, and the National Weather Service. At FEMA, the cuts prompted 191 current and former employees to publish a letter in August warning that the agency is being dismantled from within.

Daniel Swain, a University of California climate scientist, said the administration’s rejection of climate change has left the nation less prepared for extreme weather, now and in the future.

“It’s akin to enforcing malpractice scientifically,” Swain said. “Imagine making a medical decision where you are not allowed to look at 20% of the patient’s vital signs or test results.”

Under Trump, FEMA has also taken actions critics say will leave the nation more vulnerable to flooding, specifically:

• FEMA disbanded the Technical Mapping Advisory Council, which had repeatedly pushed the agency to modernize its flood maps to estimate future risk and account for the impacts of climate change.
• FEMA canceled its Building Resilient Infrastructure and Communities program, which provided grants to help communities and vital buildings, including hospitals, protect themselves from floods and other natural disasters.
• And after stopping enforcement early this year, FEMA intends to rescind the Federal Flood Risk Management Standard, which was designed to harden buildings against future floods and save tax dollars in the long run.

Berginnis, of the Association of State Floodplain Managers, said the administration’s unwillingness to prepare for climate change and worsening storms would result in a dangerous and costly cycle of flooding, rebuilding, and flooding again.

“The president is saying we are closed for business when it comes to hazard mitigation,” Berginnis said. “It bugs me to no end that we have to have reminders — like people dying — to show us why it’s important to make these investments.”

FEMA did not answer specific questions about these decisions. In the statement to KFF Health News, spokesperson Llargués touted the administration’s response to flooding in Texas and New Mexico and said FEMA had provided billions of dollars to help people and communities recover and rebuild. He did not mention any FEMA funding for protecting against future floods.

Few hospitals understand this threat more than the former Coney Island Hospital in New York City, which has suffered catastrophic flooding before and has prepared for it to come again.

Superstorm Sandy in 2012 forced the hospital to evacuate hundreds of patients. When the water receded, fish and a sea turtle were found in the building.

Eleven years later, the facility reopened as Ruth Bader Ginsburg Hospital, transformed by a FEMA-funded $923 million reconstruction project that added a 4-foot floodwall and elevated patient care areas and utility infrastructure above the first floor.

It is now likely one of the most flood-proofed hospitals in the nation.

But, so far, no storm has tested the facility.

Svetlana Lipyanskaya, CEO of NYC Health+Hospitals/South Brooklyn Health, which includes the rebuilt hospital, said the question of flooding is “not an if but a when.”

“I hope it doesn’t happen in my lifetime,” she said, “but frankly, I’d be surprised. The water is coming.”

Methodology

After Hurricane Helene made landfall a year ago, a raging river flooded a rural hospital in eastern Tennessee. Patients and employees were rescued from the rooftop. Floods have hit hospitals from New York to Nebraska to Texas in recent years. We wanted to determine how many other U.S. hospitals face similar peril. Ultimately, we found more than 170 hospitals at risk.

For this analysis, we used data from Fathom, a United Kingdom-based company that specializes in flood-risk modeling across the globe. To assess the United States’ vulnerability, Fathom uses sophisticated computer simulations and detailed terrain data covering the country. It accounts for environmental factors such as climate change, soil conditions, and many rivers and creeks not mapped by other sources. Fathom’s modeling has been peer-reviewed and used by insurance companies, the World Bank, the Nature Conservancy, and government agencies in Florida, Texas, and elsewhere. The Iowa Flood Center has validated Fathom’s U.S. data.

Through a data use agreement, Fathom shared its U.S. mapping data that predicts areas with at least a 1% chance of flooding in any given year. Fathom’s data estimates the effects of three main types of flooding: coastal, fluvial (from overflowing rivers, lakes, or streams), and pluvial (rainfall that the ground can’t absorb). The data also accounts for dams, reservoirs, and other structures that defend against floods.

To identify at-risk hospitals, we used a publicly available Department of Homeland Security database containing the GPS coordinates of more than 7,000 short-term acute, critical access, rehab, and psychiatric hospitals — basically any hospital with inpatient services. (DHS under the Trump administration has discontinued public access to the database, so data for hospitals and other infrastructure is no longer widely available.)

Using GPS coordinates as the centerpoint, we created a circle with a 150-yard radius around each hospital, which in most cases captured the building plus nearby grounds and access roads. We then mapped Fathom’s flood-risk data to see where it overlapped with these circles. We started by looking for hospitals where at least 20% of the circle’s area had a predicted flood depth of at least 1 foot. That gave us an initial list of more than 320 hospitals across the U.S.

From there, we visually inspected those hospitals using mapping software and Google Maps, both satellite and street view. We trimmed our list to only the hospitals where a considerable portion of the building or all access roads were predicted to have at least a foot of flooding.

If two hospitals were mapped to the same building — for instance, a small rehab facility within a large hospital — we counted only one hospital. We also excluded hospitals recently converted to nursing homes or for other uses.

We ended up with a list of 171 hospitals across the U.S. That is most likely an undercount. Some hospitals could still face significant impact from flooding that is not deep enough or widespread enough to fit our methodology. Our analysis also does not account for how flooding farther from a hospital could affect employees or patients. And it does not assess what steps hospitals may have already taken to prepare for severe weather events.

We also ran a spatial analysis comparing Fathom’s data with flood hazard maps from the Federal Emergency Management Agency, which in many cases are incomplete or haven’t been updated in years. We found that about a third of hospitals identified as flood risks by Fathom’s data did not overlap at all with FEMA’s 100- or 500-year hazard areas.

Fathom provided guidance and feedback as we developed our analysis.

CBS News correspondent David Schechter, photojournalist Chance Horner, and producer Aparna Zalani 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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For days, Laura was just a tropical storm, wet and disorganized. But the Gulf of Mexico was warm — much warmer than average. Local officials worried the temperatures could supercharge the storm as it spun toward the Louisiana coast. So, just as Laura approached the open Gulf, two days before it would make landfall 30 miles south of Stonebridge, Guidry made the call to evacuate.

“I don’t think anybody anticipated it to be as strong as it was,” she said.

Residents were sent to a partner facility about four hours north. Those with the most serious medical conditions were taken by ambulance. Others packed into vans. They avoided the highways, taking backroads for most of the drive. In the time it took to settle into the other facility, Laura rapidly strengthened into a Category 4 hurricane. It eventually became one of the strongest hurricanes to make landfall in the U.S. in the last century. It also tied for the fastest rate of intensification, with wind speeds increasing by 65 mph in just 24 hours.

A hotter Gulf and wetter climate create more opportunity for hurricanes to intensify much faster with less notice to call for evacuations, as also seen in more recent storms like Hurricanes Ida and Helene. It’s still hard to predict how much or how fast a storm will strengthen, despite recent advances in forecasting.

Representatives of southern Louisiana communities have pressed the state to overhaul its infrastructure by turning highway shoulders into temporary travel lanes to make it easier for residents to leave as the window for evacuation shortens. But the state’s underfunded Department of Transportation and Development has balked at the multibillion-dollar price tag.

The process of evacuating can be dangerous, especially for people living in medical facilities, older adults, or those dealing with chronic health issues. That’s why planning and timing are critical, said Guidry and other medical professionals. Gridlocks, bottlenecks, and vehicle breakdowns can result in injury, even death. In 2005, nearly 100 people died in the evacuation of Houston ahead of Hurricane Rita, which also rapidly intensified, largely due to a fatal combination of gridlock and extreme heat.

In 2022, the Louisiana State Legislature created a task force to study the state’s contraflow plan after lengthy evacuation times ahead of Hurricane Ida the year before. When the state enacts contraflow, all travel lanes on main evacuation routes lead out of southeastern Louisiana, allowing more people to leave in a short time frame. It was once the state’s go-to strategy for last-minute mass evacuations, though it isn’t always possible to implement. To launch the state’s current contraflow plan, several triggers must be met at least 72 hours before a storm’s landfall.

“If you go back the last three years, the storms have been pretty serious. Quickly intensifying, shifting direction, and lasting longer,” said Louisiana Rep. Matt Willard (D-New Orleans), who authored the resolution. “So we really do need to take our contraflow processes and evacuation processes seriously and start looking at what they look like over the next decade.”

As hurricanes intensify faster, the state’s existing contraflow plan has grown less feasible. Contraflow is also labor-intensive and can make it harder to stage resources to respond in the aftermath of a storm, so state officials have moved away from the evacuation strategy.

The task force delivered several recommendations, from shortening the time needed to initiate contraflow to repairing evacuation routes closed due to safety. The task force also introduced a strategy used in Texas and Florida: widening existing highways so the shoulders can be used as additional travel lanes to relieve congestion, known as “evaculanes” or “emergency shoulder use.”

The state Department of Transportation and Development declined to pursue any of the recommendations. Instead, state agency spokesperson Rodney Mallett said, officials have focused on encouraging residents not to rely on strategies like contraflow, which is meant to be used rarely as a last resort.

Contraflow requires immense coordination among state and local agencies as well as Mississippi officials. The state has implemented contraflow twice: to evacuate 1.2 million residents ahead of Hurricane Katrina in 2005 and then for a mass evacuation of 2 million residents ahead of Hurricane Gustav in 2008. It was also partially implemented for evacuations ahead of Hurricane Ivan in 2004.

Although contraflow requires less lead time in other states, Louisiana officials say a shorter time frame isn’t possible.

The current 72-hour plan includes 22 hours for transportation staff to prepare the roads and change thousands of signals to switch directions. For Katrina, the state completed preparations for contraflow within six hours, allowing officials to open all lanes for 25 hours before the weather deteriorated.

An Alternative Evacuation Strategy

Louisiana isn’t the only state hesitant to rely on contraflow. Florida, the only state hit by more hurricanes than Louisiana and Texas, has never implemented its contraflow plan. Instead, in 2016, it implemented its plan for emergency shoulder use.

“We were looking for something that was more efficient for us to do that took less resources,” such as law enforcement staff, said Rudy Powell, the Florida Department of Transportation’s chief engineer of operations.

Contraflow is also less safe to operate at night, while emergency shoulders can run continuously without blocking out-of-state resources from entering areas ahead of the storm, such as groceries and other supplies. Depending on which highways need more capacity, Powell said, the emergency use of shoulders takes two to four hours to implement.

“This is our go-to strategy for hurricane evacuation traffic,” Powell said. “The times we implemented it, it’s made a big difference in volume and speed. The whole idea is to keep traffic flowing.”

But the Louisiana transportation department said the strategy would be too expensive.

Unlike Florida, Louisiana hasn’t historically constructed shoulders wide enough to be safely used as temporary travel lanes. The standard for highway and bridge construction in Florida has long required the state to build shoulders at least 10 feet wide. In Louisiana, shoulders must be at least 8 feet wide to accommodate traffic.  They also have to be structurally secure. Louisiana roads and bridges are narrower, such as the shoulders on the Interstate 10 bridge over the Bonnet Carré Spillway.

In 2024, the transportation department estimated that reconstructing the shoulders along I-10, I-59, and I-55 and their bridges would cost at least $1 billion, not including other structures that would need to be rebuilt to accommodate the new shoulder width. Most of that money would go toward widening the bridges, which would cost up to $28 million per mile.

Shawn Wilson led the Department of Transportation under Gov. John Bel Edwards from 2016 until Wilson resigned in early 2023 for an unsuccessful run for governor. He said the agency had begun taking steps toward rehabilitating the state’s inconsistent shoulder construction before he left, even incorporating wider shoulders on new bridges along I-12.

But any road improvements, Wilson said, are weighed against the cheaper cost to simply maintain state highways as they are. Louisiana ranks among the lowest in transportation spending, and the state’s spending on highways has fallen since 2007. A decades-old fuel tax is the only consistent source of revenue, but it hasn’t been enough even to maintain the state’s aging infrastructure. And the lack of funding has led to a $19 billion backlog in road projects, said Steven Procopio, president of the Public Affairs Research Council of Louisiana. In 2023, the state and federal fuel tax combined raised $600 million in revenue for the agency. Special capital projects typically rely on state surplus dollars, Procopio said.

He noted the state’s 20-cent-per-gallon fuel tax has been the same since 1990 and much of the revenue goes toward paying off old debt, not new projects.

“Inflation is just eating up the spending power of these dollars,” he said.

When To Leave

Debra Campbell said it took her 14 hours to make the 200-mile drive to Lake Charles when she evacuated New Orleans the day before Hurricane Katrina made landfall. It was the same day then-Mayor Ray Nagin finally called for a mandatory evacuation of the city. (Nagin later admitted he could have issued the order earlier.)

“It was hectic,” Campbell said. “It took so many hours for our people to get to safety. But we got out.”

Campbell made it through the slow-moving traffic unscathed, but she said others were plagued with stressors like running out of gas or threats of violence from other frustrated motorists.

While more than 1 million people made it out of southeastern Louisiana, tens of thousands remained behind. Many couldn’t leave. Some didn’t have a car, while others couldn’t afford the gas needed to evacuate or a multiday hotel stay while waiting to return.

Campbell chaired the state’s Contraflow Task Force and leads A Community Voice-Louisiana, a nonprofit that advocates on behalf of low- to moderate-income families in the state. For years, Campbell has advocated for state and local officials to find more ways to get people out of New Orleans and the surrounding parishes, especially people who can’t afford the cost of evacuation.

“The people don’t have the resources to evacuate as it is, so they’re not going to make a move until the very last minute,” she said.

One University of Florida study found that insecure access to transportation can play a key role when making evacuation decisions, including whether residents can receive medical services. Low-income, car-less, and senior residents face an increased health risk throughout a hurricane as a result.

In lieu of infrastructure changes, state transportation officials want residents to leave as early as possible. People who are especially vulnerable to health issues while on the road should prepare their medications, monitor their blood pressure, stay hydrated, and ensure they’re able to stay cool while traveling.

The stress of traveling can exacerbate health conditions, on top of the anxiety that weighs many Louisianians down during hurricane season, said DePaul Community Health Centers pharmacy director Raymond Strong. “For all diseases, whether it’s asthma, hypertension, cancer, or HIV, stress makes it worse,” he said. Planning ahead, he said, can help manage the amount of stress patients feel.

Campbell and others advocating for the state to start planning for more rapidly intensifying storms agree that leaving early is important for safety. But Campbell isn’t convinced it’s realistic, especially for working-class residents.

“People’s finances don’t always allow them to leave early. They have to be pushed to move,” she said, adding that without a mandatory evacuation order, businesses stay open and some people try to stay and work as long as possible. “That’s why we need [the state] to open up all the lanes.”

Although the state isn’t looking to make big changes to its evacuation plans, Campbell said, there has been progress with New Orleans officials. Public buses provided to evacuate residents from the city to shelters could soon be more easily accessible. The city is also considering another task force recommendation: installing a siren system to help alert residents during tornadoes and other hazards.

Campbell said she hopes city and state officials continue to think of more ways to help people leave before major hurricanes hit.

“We have to offer them as much as we can,” she said. “The task force needed to meet with the people who could make a difference, but now we need to see it implemented.”

This article was produced in collaboration with Verite 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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As Hokit walked the path, he carried a handmade tool made of plastic pipes taped together to hold a large rectangle of white flannel cloth.

He poked fun at this “sophisticated” device, but the scientific survey was quite serious: He was sweeping the cloth over the shrubs and grass, hoping that “questing” ticks would latch on.

Along the summer trail, ticks dangle from blades of grass, sticking their legs out and waiting for a passing mammal.

“We got one,” Hokit said.

“So that came off of this sedge grass right here,” he said. “Simply pick them off with our fingers. We’ve got a vial that we pop them in.”

Any captured ticks would go back to Hokit’s lab in Helena for identification. Most of them would probably be identified as Rocky Mountain wood ticks.

But Hokit also wanted to find out whether new species are making their way into the state.

As human-driven climate change makes winters shorter, ticks are spending less time hibernating and have more active months when they can hitch rides on animals and people. Sometimes the ticks carry themselves — and diseases — to new parts of the country.

Hokit found deer ticks for the first time in northeastern Montana earlier this year. Deer ticks are infamous for transmitting Lyme disease and can infect people with other pathogens.

Knowing a new species like the deer tick has arrived in Montana or other states is important for doctors.

Neil Ku is an infectious disease specialist at the Billings Clinic in eastern Montana. He said most patients don’t come in right after they get bitten by a tick. They usually show up later, when they start feeling sick from a tick-borne illness.

“Fever, some chills, they may just feel bad, similar to many infections we may encounter throughout the year,” he said.

It’s rare that patients connect a tick bite to those symptoms, and even more rare that they capture and keep the tick that bit them. Sorting out whether someone might have a tick-borne illness can be complicated.

Knowing what kinds of ticks are in the region will help doctors know that they might start encountering patients infected with new diseases after a tick bite, Ku said.

That’s partially why the state is on the hunt for new tick species.

“The more we know about what’s in Montana, the better we can inform our physicians, the better care you can receive,” said Devon Cozart, a zoonotic illness and vector-borne disease epidemiologist with the Montana Department of Public Health and Human Services.

Cozart collects and tests the ticks from field surveys in Montana to see whether they are carrying any pathogens.

Whether a tick can get a human sick depends on the species, but the kind of mammal it feeds on also plays a role.

“Usually it’s a rodent that might be carrying, for example, Rocky Mountain spotted fever,” she said. “So, the tick will feed on that rodent, then will get the pathogen as well.”

Because the prevalence of a particular disease can vary in mammal populations, ticks in one part of the state could be more or less likely to get you sick. That’s also important information for medical providers, Cozart said.

This kind of surveillance and testing isn’t happening in every county or state. A 2023 survey of nearly 500 health departments throughout the country found that roughly a quarter do some kind of tick surveillance.

Not all surveillance efforts are equal, said Chelsea Gridley-Smith, director of environmental health at the National Association of City and County Health Officials.

Field surveys can be expensive. For numerous local and state health departments, tick surveillance relies on a less expensive, more passive approach: Concerned patients, veterinarians, and doctors must collect and send in ticks for identification.

“It does provide a little information about what ticks are actually interacting with people and animals, but it doesn’t get into the weeds of how common ticks are in that area and how often do those ticks carry pathogens,” Gridley-Smith said.

She said more health departments want to start tick surveillance, but getting funding is hard — and might get harder as federal public health grants from agencies like the Centers for Disease Control and Prevention dry up.

Montana receives about $60,000 from a federal grant annually, but the bulk of that funding goes toward mosquito surveillance, which is more intensive and costly. What’s left funds trips into the field to look for ticks.

Hokit said he doesn’t have enough funding for his small team to survey everywhere he would like to in a state as large as Montana. That means he’s unable to monitor emerging populations of deer ticks as closely as he would like.

He found those new deer ticks in two Montana counties, but he doesn’t have enough data to determine whether they have begun reproducing there, establishing a local population.

In the meantime, Hokit uses data on climate and vegetation to make predictions about where deer ticks might thrive in the state. He has his eye on particular areas of western Montana, like the Flathead Valley.

He said that will help him and his team narrow down where to look next so they can let the public know when deer ticks — and the diseases they can carry — arrive.

This article is part of a partnership with NPR and Montana Public Radio

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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Mientras caminaba por el sendero, Hokit cargaba una herramienta hecha a mano con tubos de plástico pegados entre sí que sostenían un enorme rectángulo de franela blanca.

Se burlaba de lo “sofisticado” de su dispositivo, pero el estudio científico era muy serio: pasaba la tela por encima de los arbustos y la hierba, con la esperanza de que las garrapatas se agarraran a ella.

Durante el verano, estas garrapatas cuelgan de las hojas, estirando sus patas mientras esperan que pase un mamífero.

“Tenemos una”, dijo Hokit.

“Esta salió de este arbusto”, explicó. “Al resto simplemente las recogemos con los dedos. Tenemos un frasquito donde las guardamos”.

Las garrapatas capturadas irán al laboratorio de Hokit en Helena, la capital del estado, para ser identificadas. La mayoría probablemente será clasificada como “garrapatas de la madera” de las Montañas Rocosas.

Pero Hokit también quería saber si han llegado nuevas especies al estado.

El cambio climático provocado por los humanos ha acortado los inviernos, lo que hace que las garrapatas pasen menos tiempo en hibernación y tengan más meses de actividad para engancharse a animales y personas. A veces, las garrapatas se trasladan —junto con las enfermedades que acarrean— a nuevas regiones del país.

Este año, Hokit encontró por primera vez garrapatas del ciervo (o garrapatas de patas negras) en el noreste de Montana. Esta especie es conocida por transmitir la enfermedad de Lyme, y también puede infectar a las personas con otros patógenos.

Saber que una nueva especie como la garrapata del ciervo ha llegado a Montana y a otros estados es muy importante para los médicos.

Neil Ku, especialista en enfermedades infecciosas en Billings Clinic, en el este de Montana, explicó que la mayoría de los pacientes no van al médico justo después de haber sido picados por una garrapata.

Por lo general, buscan atención más tarde, cuando ya se sienten enfermos por una enfermedad transmitida por estos parásitos.

“Fiebre, escalofríos, simplemente se sienten mal, como sucede con muchas infecciones que pueden presentarse a lo largo del año”, señaló.

Es poco común que las personas relacionen esos síntomas con una picadura de garrapata, y aún más raro que conserven la garrapata que los picó. Por eso, identificar si alguien tiene una enfermedad transmitida por garrapatas puede ser complicado.

Conocer qué tipos de garrapatas hay en una región ayuda a los médicos a identificar enfermedades nuevas relacionadas con estas picaduras, dijo Ku.

Esa es una de las razones por las que el estado busca nuevas especies de garrapatas.

“Cuanto más sepamos sobre lo que hay en Montana, mejor podremos informar a los médicos y mejor atención podrán brindar”, afirnó Devon Cozart, epidemióloga del Departamento de Salud Pública y Servicios Humanos de Montana, especializada en enfermedades zoonóticas transmitidas por vectores (infecciones que se propagan de animales a humanos a través de garrapatas o mosquitos que pican a un animal infectado y luego a una persona).

Cozart recolecta y analiza las garrapatas obtenidas en los estudios de campo en Montana para detectar si portan algún patógeno.

La capacidad de una garrapata para enfermar a una persona depende de la especie, pero también influye el tipo de mamífero del que se alimenta.

“Por lo general es un roedor que puede portar, por ejemplo, la fiebre maculosa de las Montañas Rocosas”, explicó. “Entonces la garrapata se alimenta de ese roedor y adquiere el patógeno”.

Como la presencia de una enfermedad puede variar según la población de mamíferos, las garrapatas en una parte del estado pueden representar más, o menos, riesgo para las personas. Esta también es información relevante para los profesionales de salud, agregó Cozart.

Este tipo de vigilancia y análisis no se hace en todos los condados ni en todos los estados. Una encuesta de 2023, realizada a casi 500 departamentos de salud en el país, halló que apenas una cuarta parte lleva a cabo algún tipo de monitoreo de garrapatas.

No todas las tareas de vigilancia son iguales, dijo Chelsea Gridley-Smith, directora de salud ambiental en la Asociación Nacional de Funcionarios de Salud de Ciudades y Condados.

Los estudios de campo pueden ser costosos. Por eso, muchos departamentos de salud estatales y locales dependen de un enfoque más económico y pasivo: pacientes preocupados, veterinarios y médicos deben recolectar y enviar las garrapatas para su identificación.

“Eso da un poco de información sobre qué garrapatas están en contacto con personas y animales, pero no permite conocer lo comunes que son en determinada zona ni con qué frecuencia portan patógenos”, explicó Gridley-Smith.

Agregó que más departamentos de salud quieren empezar a vigilar a las garrapatas, pero conseguir financiamiento es difícil. Y podría volverse aún más complicado si se reducen los fondos federales para salud pública, como los que otorgan los Centros para el Control y Prevención de Enfermedades (CDC).

Montana recibe unos $60.000 al año a través de una subvención federal, pero la mayor parte de ese dinero se destina a la vigilancia de mosquitos, que es más intensiva y costosa. Lo que queda se utiliza para realizar salidas en busca de garrapatas.

Hokit comentó que no cuenta con suficiente financiamiento para que su pequeño equipo pueda hacer estudios en todo el estado, que es muy extenso. Eso significa que no puede monitorear de cerca las poblaciones emergentes de garrapatas del ciervo como quisiera.

Encontró estas nuevas garrapatas en dos condados de Montana, pero no tiene suficientes datos para determinar si ya están reproduciéndose allí y formando una población local.

Mientras tanto, Hokit usa datos sobre el clima y la vegetación para predecir en qué zonas del estado podrían prosperar estas garrapatas. Está observando áreas específicas del oeste de Montana, como Flathead Valley.

Dijo que eso ayudará a su equipo a enfocar la búsqueda y a informar al público cuando lleguen las garrapatas del vciervo y las enfermedades que pueden transmitir.

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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