By Claudia Boyd-Barrett, Oona Zenda, KFF Health News

Lydia Romero strained to hear her husband’s feeble voice through the phone.

A week earlier, immigration agents had grabbed Julio César Peña from his front yard in Glendale, California. Now, he was in a hospital after suffering a ministroke. He was shackled to the bed by his hand and foot, he told Romero, and agents were in the room, listening to the call. He was scared he would die and wanted his wife there.

“What hospital are you at?” Romero asked.

“I can’t tell you,” he replied.

Viridiana Chabolla, Peña’s attorney, couldn’t get an answer to that question, either. Peña’s deportation officer and the medical contractor at the Adelanto ICE Processing Center refused to tell her. Exasperated, she tried calling a nearby hospital, Providence St. Mary Medical Center.

“They said even if they had a person in ICE custody under their care, they wouldn’t be able to confirm whether he’s there or not, that only ICE can give me the information,” Chabolla said. The hospital confirmed this policy to KFF Health News.

Family members and attorneys for patients hospitalized after being detained by federal immigration officials said they are facing extreme difficulty trying to locate patients, get information about their well-being, and provide them emotional and legal support. They say many hospitals refuse to provide information or allow contact with these patients. Instead, hospitals allow immigration officers to call the shots on how much — if any — contact is allowed, which can deprive patients of their constitutional right to seek legal advice and leave them vulnerable to abuse, attorneys said.

Hospitals say they are trying to protect the safety and privacy of patients, staff, and law enforcement officials, even while hospital employees in Los Angeles, Minneapolis, and Portland, Oregon, cities where Immigration and Customs Enforcement has conducted immigration raids, say it’s made their jobs difficult. Hospitals have used what are sometimes called blackout procedures, which can include registering a patient under a pseudonym, removing their name from the hospital directory, or prohibiting staff from even confirming that a patient is in the hospital.

“We’ve heard incidences of this blackout process being used at multiple hospitals across the state, and it’s very concerning,” said Shiu-Ming Cheer, the deputy director of immigrant and racial justice at the California Immigrant Policy Center, an advocacy group.

Some Democratic-led states, including California, Colorado, and Maryland, have enacted legislation that seeks to protect patients from immigration enforcement in hospitals. However, those policies do not address protections for people already in ICE custody.

More detainees hospitalized

Peña is among more than 350,000 people arrested by federal immigration authorities since President Donald Trump returned to the White House. As arrests and detentions have climbed, so too have reports of people taken to hospitals by immigration agents because of illness or injury — due to preexisting conditions or problems stemming from their arrest or detention.

ICE has faced criticism for using aggressive and deadly tactics, as well as for reports of mistreatment and inadequate medical care at its facilities. Sen. Adam Schiff, D-Calif., told reporters at a Jan. 20 news conference outside a detention center he visited in California City that he spoke to a diabetic woman held there who had not received treatment in two months.

While there are no publicly available statistics on the number of people sick or injured in ICE detention, the agency’s news releases point to 32 people who died in immigration custody in 2025. Six more have died this year.

The Department of Homeland Security, which oversees ICE, did not respond to a request for information about its policies or Peña’s case.

According to ICE’s guidelines, people in custody should be given access to a telephone, visits from family and friends, and private consultation with legal counsel. The agency can make administrative decisions, including about visitation, when a patient is in the hospital, but should defer to hospital policies on contacting next of kin when a patient is seriously ill, the guidelines state.

Asked in detail about hospital practices related to patients in immigration custody and whether there are best practices that hospitals should follow, Ben Teicher, a spokesperson for the American Hospital Association, declined to comment.

David Simon, a spokesperson for the California Hospital Association, said that “there are times when hospitals will — at the request of law enforcement — maintain confidentiality of patients’ names and other identifying characteristics.”

Although policies vary, members of the public can typically call a hospital and ask for a patient by name to find out whether they’re there, and often be transferred to the patient’s room, said William Weber, an emergency physician in Minneapolis and medical director for the Medical Justice Alliance, which advocates for the medical needs of people in law enforcement custody. Family members and others authorized by the patient can visit. And medical staff routinely call relatives to let them know a loved one is in the hospital, or to ask for information that could help with their care.

But when a patient is in law enforcement custody, hospitals frequently agree to restrict this kind of information sharing and access, Weber said. The rationale is that these measures prevent unauthorized outsiders from threatening the patient or law enforcement personnel, given that hospitals lack the security infrastructure of a prison or detention center. High-profile patients such as celebrities sometimes also request this type of protection.

Several attorneys and health care providers questioned the need for such restrictions. Immigration detention is civil, not criminal, detention. The Trump administration says it’s focused on arresting and deporting criminals, yet most of those arrested have no criminal conviction, according to data compiled by the Transactional Records Access Clearinghouse and several news outlets.

Taken outside his home

According to Peña’s wife, Romero, he has no criminal record. Peña came to the United States from Mexico in sixth grade and has an adult son in the U.S. military. The 43-year-old has terminal kidney disease and survived a heart attack in November. He has trouble walking and is partially blind, his wife said. He was detained Dec. 8 while resting outside after coming home from dialysis treatment.

Initially, Romero was able to find her husband through the ICE Online Detainee Locator System. She visited him at a temporary holding facility in downtown Los Angeles, bringing him his medicines and a sweater. She then saw he’d been moved to the Adelanto detention center. But the locator did not show where he was after he was hospitalized.

When she and other relatives drove to the detention facility to find him, they were turned away, she said. Romero received occasional calls from her husband in the hospital but said they were less than 10 minutes long and took place under ICE surveillance. She wanted to know where he was so she could be at the hospital to hold his hand, make sure he was well cared for, and encourage him to stay strong, she said.

Shackling him and preventing him from seeing his family was unfair and unnecessary, she said.

“He’s weak,” Romero said. “It’s not like he’s going to run away.”

ICE guidelines say contact and visits from family and friends should be allowed “within security and operational constraints.” Detainees have a constitutional right to speak confidentially with an attorney. Weber said immigration authorities should tell attorneys where their clients are and allow them to talk in person or use an unmonitored phone line.

Hospitals, though, fall into a gray area on enforcing these rights, since they are primarily focused on treating medical needs, Weber said. Still, he added, hospitals should ensure their policies align with the law.

Family denied access

Numerous immigration attorneys have spent weeks trying to locate clients detained by ICE, with their efforts sometimes thwarted by hospitals.

Nicolas Thompson-Lleras, a Los Angeles attorney who counsels immigrants facing deportation, said two of his clients were registered under aliases at different hospitals in Los Angeles County last year. Initially, the hospitals denied the clients were there and refused to let Thompson-Lleras meet with them, he said. Family members were also denied access, he said.

One of his clients was Bayron Rovidio Marin, a car wash worker injured during a raid in August. Immigration agents surveilled him for over a month at Harbor-UCLA Medical Center, a county-run facility, without charging him.

In November, the Los Angeles County Board of Supervisors voted to curb the use of blackout policies for patients under civil immigration custody at county-run hospitals. In a statement, Arun Patel, the chief patient safety and clinical risk management officer for the Los Angeles County Department of Health Services, said the policies are designed to reduce safety risks for patients, doctors, nurses, and custody officers.

“In some situations, there may be concerns about threats to the patient, attempts to interfere with medical care, unauthorized visitors, or the introduction of contraband,” Patel said. “Our goal is not to restrict care but to allow care to happen safely and without disruption.”

Leaving patients vulnerable

Thompson-Lleras said he’s concerned that hospitals are cooperating with federal immigration authorities at the expense of patients and their families and leaving patients vulnerable to abuse.

“It allows people to be treated suboptimally,” Thompson-Lleras said. “It allows people to be treated on abbreviated timelines, without supervision, without family intervention or advocacy. These people are alone, disoriented, being interrogated, at least in Bayron’s case, under pain and influence of medication.”

Such incidents are alarming to hospital workers. In Los Angeles, two health care professionals who asked not to be identified by KFF Health News, out of concern for their livelihoods, said that ICE and hospital administrators, at public and private hospitals, frequently block staff from contacting family members for people in custody, even to find out about their health conditions or what medications they’re on. That violates medical ethics, they said.

Blackout procedures are another concern.

“They help facilitate, whether intentionally or not, the disappearance of patients,” said one worker, a physician for the county’s Department of Health Services and part of a coalition of concerned health workers from across the region.

At Legacy Emanuel Medical Center in Portland, nurses publicly expressed outrage over what they saw as hospital cooperation with ICE and the flouting of patient rights. Legacy Health has sent a cease and desist letter to the nurses’ union, accusing it of making “false or misleading statements.”

“I was really disgusted,” said Blaire Glennon, a nurse who quit her job at the hospital in December. She said numerous patients were brought to the hospital by ICE with serious injuries they sustained while being detained. “I felt like Legacy was doing massive human rights violations.”

Handcuffed while unconscious

Two days before Christmas, Chabolla, Peña’s attorney, received a call from ICE with the answer she and Romero had been waiting for. Peña was at Victor Valley Global Medical Center, about 10 miles from Adelanto, and about to be released.

Excited, Romero and her family made the two-hour-plus drive from Glendale to the hospital to take him home.

When they got there, they found Peña intubated and unconscious, his arm and leg still handcuffed to the hospital bed. He’d had a severe seizure on Dec. 20, but no one had told his family or legal team, his attorney said.

Tim Lineberger, a spokesperson for Victor Valley Global Medical Center’s parent company, KPC Health, said he could not comment on specific patient cases, because of privacy protections. He said the hospital’s policies on patient information disclosure comply with state and federal law.

Peña was finally cleared to go home on Jan. 5. No court date has been set, and his family is filing a petition to adjust his legal status based on his son’s military service. For now, he still faces deportation proceedings.

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

Ever since Larry Wilkewitz retired more than 20 years ago from a wood products company, he’s had a commercial Medicare Advantage plan from the insurer Humana.

But two years ago, he heard about Peak Health, a new Advantage plan started by the West Virginia University Health System, where his doctors practice. It was cheaper and offered more personal attention, plus extras such as an allowance for over-the-counter pharmacy items. Those benefits are more important than ever, he said, as he’s treated for cancer.

“I decided to give it a shot,” said Wilkewitz, 79. “If I didn’t like it, I could go back to Humana or whatever after a year.”

He’s sticking with Peak Health. Members of Medicare Advantage plans, a privately run alternative to the government’s Medicare program, can change plans through the end of March.

Now entering its third year, Peak Health has tripled its enrollment since last year, to “north of 10,000,” said Amos Ross, its president. It expanded from 20 counties to 49, he said, and moved into parts of western Pennsylvania for the first time.

Although hospital-owned plans are only a sliver of the Medicare Advantage market, their enrollment continues to grow, reflecting the overall increase in Advantage members. Of the 62.8 million Medicare beneficiaries eligible to join Advantage plans, 54% signed up last year, according to KFF, the health information nonprofit that includes KFF Health News. While the number of Advantage plans owned by hospital systems is relatively stable, Mass General Brigham in Boston and others are expanding their service areas and types of plan offerings.

Health systems have dabbled in the insurance business for years, but it’s not for everyone. MedStar Health, serving the greater Washington, D.C., area, said it closed its Medicare Advantage plan at the end of 2018, citing financial losses.

“It’s a ton of work,” said Ross, who spent more than a decade in the commercial health insurance industry.

Like any other health insurer, hospitals entering the business need a back-office infrastructure to enroll patients, sign up providers, fill prescriptions, process claims, hire staff, and — most importantly — assure state regulators they have a reserve of money to pay claims. Once they get a state insurance license, they need approval from the federal Centers for Medicare & Medicaid Services to sell Medicare Advantage policies. Some systems affiliate with or create an insurance subsidiary, and others do most of the job themselves.

Kaiser Permanente, the nation’s largest nonprofit health system by revenue, started an experimental Medicare plan in 1981 and now has nearly 2 million people enrolled in dozens of Advantage plans in eight states and the District of Columbia. The Justice Department announced Jan. 14 that KP had agreed to pay $556 million to settle accusations that its Advantage plans fraudulently billed the government for about $1 billion over a nine-year period.

Last year, UCLA Health introduced two Medicare Advantage plans in Los Angeles County, the most populous county in the United States. Other new hospital-owned plans have cropped up in less profitable rural areas.

“These are communities that have been very hard for insurers to move into,” said Molly Smith, group vice president for public policy at the American Hospital Association.

But Advantage plans offered by hospitals have a familiar, trusted name. They don’t have to move into town, because their owners — the hospitals — never left.

Bad Breakups

Medicare Advantage plans usually restrict their members to a network of doctors, hospitals, and other clinicians that have contracts with the plans to serve them. But if hospitals and plans can’t agree to renew those contracts, or when disputes flare up — often spurred by payment delays, denials, or burdensome prior authorization rules — the health care providers can drop out.

These breakups, plus planned terminations and service area cuts, forced more than 3.7 million Medicare Advantage enrollees to make a tough choice last year: find new insurance for 2026 that their doctors accept or, if possible, keep their plan but find new doctors.

About 1 million of these stranded patients had coverage from UnitedHealthcare, the country’s largest health insurer. In a July earnings update for financial analysts, chief financial officer John Rex blamed the company’s retreat on hospitals, where “most encounters are intensifying in services and costing more.”

The turbulence in the commercial insurance market has upset patients as well as their providers. Sometimes contract disputes have been fought out in the open, with anxious patients in the middle receiving warnings from each side blaming the other for the imminent end to coverage.

When Fred Neary, 88, learned his doctors in the Baylor Scott & White Health system in central and northern Texas would be leaving his Medicare Advantage plan, he was afraid the same thing could happen again if he joined a plan from another commercial insurer. Then he discovered that the 53-hospital system had its own Medicare Advantage plan. He enrolled in 2025 and is keeping the plan this year.

“It was very important to me that I would never have to worry about switching over to another plan because they would not accept my Baylor Scott & White doctors,” he said.

Eugene Rich, a senior fellow at Mathematica, a health policy research group, said hospital systems’ Medicare Advantage plans offer “a lot of stability for patients.”

“You’re not suddenly going to discover that your primary care physician or your cardiologist are no longer in the plan,” he said.

A Health Affairs study that Rich co-authored in July found that enrollment in Advantage plans owned by hospital systems grew faster than traditional Medicare enrollment for the first time in 2023, though not as rapidly as the overall rise in sign-ups for all Advantage plans.

The massive UCLA Health system introduced its two Medicare Advantage plans in Los Angeles County in January 2025, even though patients already had a list of more than 70 Advantage plans to choose from. Before rolling out the plan, the University of California Board of Regents discussed its merits at a November 2024 meeting. The meeting minutes offer rare insight into a conversation that private hospital systems would usually hold behind closed doors.

“As increasing numbers of Medicare-enrolled patients turn to new Medicare Advantage plans, UC Health’s experience with these new plans has not been good, either for patients or providers,” the minutes read, summarizing comments by David Rubin, executive vice president of UC Health.

The minutes also describe comments from Jonathon Arrington, CFO of UCLA Health. “Over the years, in order to care for Medicare Advantage patients, UCLA has entered numerous contracts with other payers, and these contracts have generally not worked out well,” the minutes read. “Every two or three years, UCLA has found itself terminating a contract and signing a new one. Patients have remained loyal to UCLA, some going through three iterations of cancelled contracts in order to remain with UCLA Health.”

Costs to Taxpayers

CMS pays Advantage plans a monthly fixed amount to care for each enrollee based on the member’s health condition and location. In 2024, the federal government paid Advantage plans an estimated $494 billion to care for patients, according to the Medicare Payment Advisory Commission, which monitors the program for Congress.

The commission said this month that it projects insurers in 2026 will be paid 14%, or about $76 billion, more than it would have cost government-run Medicare to care for similar patients.

Many Democratic lawmakers have criticized overpayments to Medicare Advantage insurers, though the program has bipartisan congressional support because of its increasing popularity with Medicare beneficiaries, who are often attracted by dental care and other coverage unavailable through traditional Medicare.

Whenever Congress threatens cuts, insurers claim these generous federal payments are essential to keep Medicare Advantage plans afloat. UCLA Health’s Advantage plans will need at least 15,000 members to be financially sustainable, according to the meeting minutes. CMS data indicates that 7,337 patients signed up in 2025.

A study published in JAMA Surgery in August compared patients in commercial Medicare Advantage who had major surgery with those covered by Medicare Advantage plans owned by their hospital. The latter group had fewer complications, said co-author Thomas Tsai, an associate professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health.

Smith, of the American Hospital Association, isn’t surprised. When insurers and hospitals are not on opposite sides, she said, care delivery can be smoother. “There’s more flexibility to manage premium dollars to cover services that maybe wouldn’t otherwise be covered,” Smith said.

But Tsai warns seniors that hospital-owned Medicare Advantage plans operate under the same rules as those run by commercial health insurance companies. He said patients should consider whether the extra benefits of Advantage plans “are worth the trade-off of potentially narrow provider networks and more utilization management than they would get from traditional Medicare.”

In Texas, Neary hopes the closer relationship between his doctors and his insurance plan means there’s less of a chance that bills for his medical care will be kicked back.

“I don’t think I would run into a situation where they would not provide coverage if one of their own doctors recommended something,” he said.

©2026 Kaiser Health News. Visit khn.org. Distributed by Tribune Content Agency, LLC. ©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

That means helping their people, they say, and specifically tackling high rates of diabetes and obesity that affect their tribal nation and many other Indigenous communities.

It also means restoring their land and the river that has been intrinsically linked with their people for millennia.

“We are Native people tied to the resources and rhythms of the Eel River,” Parker said. “Our health is connected to the river.”

Now, the tribal nation is confronting the Trump administration over the river’s future and fighting some of its regional allies to reclaim water rights that have been overlooked for a century.

The struggle is taking place as the entity with a dominant stake in the river for generations, Pacific Gas & Electric Co., seeks to give up in Lake and Mendocino counties its network of Eel River dams and a linked hydropower plant. The move has triggered a federal review that has pitted the tribes, together with environmental groups in favor of dam removal, against farming interests, reservoir supporters and the Trump administration, which has taken a dim view of dam demolition.

The tribes never had much of a say when those dams went up starting 118 years ago, but they have been heavily involved in talks in recent years geared to planning for the future of the Eel River. Due to a century-old diversion that links the Eel River to the Russian River in the south — and to farms and about 100,000 residents who rely on the upper Russian for drinking and irrigation supplies — those talks have drawn in a host of sometimes competing interests, including counties and farm and fishery groups with a wider scope of interest across the North Coast.

Our “water rights were completely ignored,” Parker said of his ancestors. “The Round Valley Indian Tribes were very much in survival mode when the dams were built and the diversions began.

“It started in 1905 when W.W. Van Arsdale posted a note along a tree saying he had a right to appropriate more than 100,000 acre-feet of Eel River water to put into the Russian River basin,” Parker said. “That’s how it all started.”

PG&E has informed federal officials it wants to decommission Scott and Cape Horn dams and give up the aging, associated hydropower plant, offline since 2021, that has helped get Eel River water through Mendocino County’s Potter Valley into the Russian River basin.

In 2022, the power company applied to surrender its operating license to the Federal Energy Regulation Commission, which oversees the nation’s hydropower projects. The utility giant followed through with formal plans to FERC in June 2025.

Historically, FERC has had the final say and has not stood in the way of dam removal, though Congress and the White House have.

Years from now, the tribes and their allies hope their efforts will lead to the nation’s next big dam removal project, freeing the headwaters of California’s third longest river to revive its beleaguered salmon and steelhead trout runs — and the culture and economy of the Round Valley Indian Tribes, said John Bezdek, an attorney for the seven-tribe nation.

“The fishery declined with the significant diversions of water into the watershed,” Bezdek said. “It was a source of subsistence and culture. This is a fishing tribe. That was taken away from them.”

Farming interests and others in the region, however, are against dam removal, pointing to downstream ripples for irrigators and drinking water customers, the loss of reservoir water for aerial fire suppression and the blow to the hundreds of Lake County residents and visitors around the largest of those reservoirs, Lake Pillsbury, a destination for boaters and hunters.

They secured a powerful ally late last year in the Trump administration, which raised its objections to dam regulators in a Dec. 19 letter from Agriculture Secretary Brooke Rollins. She warned that “if this plan goes through as proposed, it will devastate hundreds of family farms and wipe out more than a century of agricultural tradition in Potter Valley. Without it, crops fail, businesses close and rural communities crumble.”

Rollins also said that her department would work with the Department of the Interior to bring “real solutions” for water security to the North Coast.

The Round Valley tribes responded Jan. 14 in a letter to those two agencies, spotlighting a familiar slight: Rollins’ failure to acknowledge or even mention the tribes’ “senior water and fishing rights, much less our culture, our economy and our way of life.”

“We are reminding the departments … that the discussions going back to DC have been one sided and that we have been left out of the conversation,” Parker said in an interview with The Press Democrat.

Tribes to DC: Respect local solution

Just as dam removal opponents, including Lake County itself, are lobbying the administration to intervene and block federal sign-off on PG&E’s plans, the tribes and their allies are asking Washington, D.C., to allow a locally brokered water pact to proceed.

Known as the two-basin solution, it solidified a 30-year framework under which diversions from the Eel River to the Russian River would continue after dam removal, at least in periods of high flows, and only if there’s enough water in the Eel to support its salmon and steelhead runs. The pact supporters, including many local governments and water providers, agreed to construct a new diversion facility to support those operations, and to return water rights to Round Valley Indian Tribes who, as the first people in the area, have seniority rights to Eel River flows.

Hailed by supporters as historic when it was finalized in early 2025, the deal sought to rectify wrongs that disadvantaged tribes and harmed Eel River fisheries, signatories said.

“Our tribal members work and live in the broader regional community and despite the historic injustice to our tribal community, an ‘all or nothing approach’ is simply not realistic,” Parker wrote to the secretaries.

Parker and Russ said it was better to come together with partners and collaborate on a solution.

“We decided at the time we could spend the next 20 years arguing about what’s right and what’s wrong,” Russ said. “We decided collectively to focus on our commonalities so that maybe our kids and grandkids wouldn’t be fighting this war. We started to figure out what would be beneficial for everyone.”

But the deal has many staunch opponents, and few more visible these days than Cloverdale Vice Mayor Todd Lands, who has made his opposition to the pact and to dam removal a central part of his campaign for a seat on the Sonoma County Board of Supervisors. In January, he accompanied Secretary Rollins at an American Farm Bureau Federation conference in Anaheim, speaking out against the two-basin solution and appealing to the Trump administration to intervene.

“The two-basin solution does not guarantee water,” Lands told The Press Democrat. He fears the change from year-round to seasonal diversions will not be enough to fill Lake Mendocino, which helps sustain dry-season flows in the upper Russian River, the main source of drinking water for communities stretching from Ukiah to Healdsburg.

“This will cause drought conditions, not allow cities to replenish their water systems for fire and public use, and cause disease in the (Russian) river basin,” Lands said. “People will have to decide between showers and laundry and will not be able to have their own gardens as a food source.”

He also echoed shared concerns among dam removal opponents that the Round Valley Indian Tribes would cease all diversions “if the goals of the water supply and fish in the Eel River are not met.”

Those fears were inflamed in December when a California-based attorney for the Round Valley Indian Tribes told a group of Potter Valley farmers that diversions would one day end — comments that were caught on video and circulated widely.

In an interview with The Press Democrat, Bezdek, the tribal attorney based in Washington, D.C., sought to clarify that statement.

“Obviously if the fishery doesn’t recover, that will be a problem for us,” he said. “But we believe the best science is available and it says that we can do this.”

Parker and Russ elaborated.

“We believe everything is integrated,” Russ said. “The other side is saying we are putting fish before people. But we need healthy fish for a healthy balance for people. We are trying to create a healthy ecosystem for healthy people.”

Critical resource over millennia

The Round Valley coalition, made up of the Yuki, Pit River, Little Lake, Pomo, Nomlacki, Concow and Wailacki tribes, trace their ancestry in the area to “the beginning of time,” Bezdek said.

The Eel River and its tributaries served as the center of Indigenous culture, religion and trade.

“Our elders used to tell us stories about seeing so many fish that you could walk on their backs,” Bezek said. “Now, when we fish, we barely see a fish. Our ecosystem has just been decimated.”

As they told Rollins and Interior Secretary Doug Burgum in their Jan. 14 letter, the tribal nation seeks to bring back the health of the river and their community.

“If the river is not healthy, the community is not healthy,” Russ said.

Sonoma County Supervisor David Rabbitt, who has close ties to the region’s farming industry, has heard the concerns of those opposed to dam removal, including their fears the tribe will end all diversions.

He isn’t buying that claim.

“There’s no automatic termination and no single entity can end diversions,” Rabbitt said. “The whole thing is a collaborative effort.”

Rabbitt, who read the Round Valley Indian Tribes’ letter, said he supported their effort “to set the record straight” and “establish a position within all the noise that’s going on. That’s vitally important.”

At the same time, he understood people’s fears and reservations.

“I will admit, I’m not a huge fan of taking down dams, but ultimately it isn’t my decision,” he said. “But then it’s ‘OK, what happens if you’re on your soapbox in the corner, it comes down and there’s no agreement for diversion? Then what?’

“We have to move forward.”

Rabbit is board president of the entity created by the pact outlining a post-dam future, the Eel-Russian Project Authority. Its aim for fish, he said, is “making sure both runs” — the Eel’s and the Russian’s — “are healthy. Our goal is to keep the diversion active and to do it in a responsible, collaborative way.”

Parker said collaboration is key and he shared his hope the Trump administration will work with the tribes and Eel-Russian Project Authority.

A spokesperson for the Department of Agriculture said it had received the tribes’ letter and “looks forward to formally responding to President Parker on this important topic.” The Department of the Interior declined to comment.

Bezdek said both secretaries have reached back out to him and are trying to coordinate dates to discuss a way forward.

“We were here before Sonoma County and Mendocino County and we will be here after they are gone,” Parker said. “PG&E’s decision to decommission the project is a once-in-a-lifetime opportunity to bring fairness. We know we won’t be adequately compensated, but the two-basin solution is the first step to heal those wounds and remedy this historical wrong.”

Possible risk of autism in children. Dormant cancer cells awakening. Accelerating aging of the brain.

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

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

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

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

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

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

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

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

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

COVID’s Growing Reach

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

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

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

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

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

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

Epidemiologists point to some specific, emerging challenges.

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

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

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

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

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

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

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

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

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

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

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

Following the Findings

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

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

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

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

Al-Alay agreed.

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

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

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

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

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

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

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

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

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

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

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

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

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

Buses will be stationary, open to the public and available free of charge from 5-9 a.m. and 7-11 p.m. both days.

In Macomb County, buses will be at Macomb Mall, 32233 Gratiot Avenue, Roseville.

In Oakland County, buses will be at the Pontiac Phoenix Center, 47251 Woodward Avenue, Pontiac.

In Wayne County, buses will be at Southland Center, 23000 Eureka Road, Taylor and Fairlane Mall, 18900 Michigan Avenue, Dearborn.

“No one should have to endure dangerous cold without a place to warm up,” said Tiffany J. Gunter, SMART General Manager and chief executive officer in a news release. “We’re using our resources to help protect our community during these extreme temperatures.

— Macomb Daily staff 

“Don’t give me narcotics.”

Emmalee Hortin, a doula, recalled one of her clients delivering that message to hospital staff. Doctors were operating on the woman to clear tissue after a miscarriage.

But despite her patient’s pleas, clinicians still administered fentanyl via IV to manage pain, Hortin said. Her client had substance use disorder and had been working toward recovery.

“She was really, really upset,” Hortin said. “She actually was really worried about returning to use, and so was her husband.”

Hortin is a doula trained in supporting pregnant and postpartum moms with substance use disorder — a role in increasing demand amid the nation’s concurrent crises of maternal mortality and addiction.

In recent years, more states, including Colorado and Utah, have passed laws to include Medicaid coverage for doula care. Some clinics are incorporating peer recovery doulas and other providers are offering training to bolster the workforce.

Many doulas who specialize in helping moms with substance use disorder are recovering from addiction themselves, or have helped loved ones with addiction. Hortin, a mother of three and stepmom to three others, is nine years into her recovery. Drawing on her own experience of isolation and addiction, she’s able to relate to struggling moms. She works at One Health, a Montana community health center that trains doulas from across the state in peer recovery.

In the case of the woman who asked not to be given fentanyl, Hortin recalled, hospital staff asked for her help to “defuse” her client’s emotions. “I was like, ‘Well, my job is not to defuse emotions, if you weren’t listening to my patient,’” she said. “When a patient in recovery, or that is working towards recovery, asks specifically for no fentanyl — that’s one of her triggers — you need to respect that.

“We had to do a lot of breakdown work and debriefing through the emotions,” Hortin said. “She felt like she couldn’t trust the hospital.”

Mental health conditions and substance use are leading underlying causes of maternal death, according to the federal Centers for Disease Control and Prevention.

Those conditions can arise, or worsen, during pregnancy. Without treatment, it can be an especially vulnerable time for people with addiction and those who are trying to get sober, said recovery doula Britt Westmoreland, program coordinator for the University of Colorado’s recovery coach doula program.

Peer recovery doulas can advocate for patients in labor settings as well as support them when they face stressors or crave illicit substances during pregnancy or postpartum. Being in recovery themselves also helps foster trust and more open communication.

“It’s a lot easier for us to build rapport with people because there’s not a power differential or that systemic mistrust,” said Westmoreland, who is in long-term recovery and, like Hortin, knows the stigma and difficulties firsthand.

Stigma and bias

Stigma and bias around substance use disorder, mental health conditions and pregnancy can cause shame that prevents moms from reaching out for help or opening up about their struggle, doulas and doctors say. Those issues are exacerbated for Black and Indigenous women, who are disproportionately drug tested in hospitals during labor and disproportionately likely to be investigated by child welfare agencies, research has shown.

Native women can feel they’re treated differently in hospitals, said Julianne Denny, who is Cree, Ojibway and Mikmaq. Denny refers to her role as an Indigenous “birth worker,” as she supports women through cultural practices as well as through doula care. She trained at One Health and earned an addiction studies degree at Stone Child College.

It’s her job “to remind [moms] of their humanity and that they can gain control over their addictions and they can keep their babies,” she said. “That’s the endgame — is that their baby is safe and they’re safe, and we want our moms to grow with our babies, and our babies to grow with our moms.

“A big part of our work is working through the tough parts with moms to get them through to a successful pregnancy where they’re proud of themselves and they feel empowered.”

Hortin helps recovering moms up to three years postpartum. Working with clinicians, she helps create a personalized care plan for each family.

“No matter what these parents are struggling or facing, that’s not all they are,” said Hortin. “When we keep people held to our stigma and our bias, why would they want to change when no one’s willing to trust that they can?”

Policies to expand coverage

One day last week, 34 pregnant and postpartum patients with substance use disorder were on the schedule at the University of Utah’s Substance Use & Pregnancy—Recovery, Addiction, and Dependence (SUPeRAD) Clinic, where Dr. Marcela Smid is the medical director.

This week, more than 50 patients are on the schedule in a three-day period. Smid said her clinic gets patients from rural areas in Wyoming, Idaho and eastern Nevada.

States are slowly expanding coverage for doulas. Utah passed a law last year to start the process toward Medicaid coverage of doula care. Federal officials approved Utah’s plan, effective April 1, to allow certified doulas to be reimbursed via Medicaid.

“Now that we will be able to be paid through Medicaid, a lot of doulas will be able to feel this work is sustainable for them,” said Aleece Weaver, founder of the Utah Doula Access Project. She currently does doula work pro bono with Smid’s clinic.

Smid said the majority of the clinic’s patients are on Medicaid, which is the largest payer for behavioral health care nationwide. Most of her patients can’t afford to pay for doula care out of pocket, and because the state policy hasn’t gone into effect yet, doulas care for her patients pro bono.

Colorado also recently expanded its Medicaid coverage to include doulas, and Montana passed a law last year establishing doula licensures, a first step toward coverage.

Beyond coverage, access is also an issue — especially in rural communities where health care providers, including mental and maternal health clinicians, are scarce. Smid travels monthly to Wyoming, where most residents don’t have easy access to maternal-fetal medicine specialists, she said.

States included goals of expanding behavioral and maternal health care access in their bids for federal dollars under the new five-year Rural Health Transformation Program.

For example, in its application, Montana said it would use the money to train a variety of health care providers and community-based professionals, including peer support specialists, in maternal health and crisis intervention.

Mental health conditions contributed to about 70% of Montana’s maternal deaths between 2020 and 2022 — with substance use contributing to more than 40% of those women’s deaths.

“It’s really just providing support to people that are already feeling hopeless. It’s about giving them the tiniest bit of hope and walking through it,” said One Health recovery doula Lanita Hoskinson. “All these families, they need somebody, especially in these frontier rural areas — they have nobody.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

©2026 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

NEW YORK (AP) — The Trump administration on Thursday launched TrumpRx, a website it says will help patients buy prescription drugs directly at a discounted rate at a time when health care and the cost of living are growing concerns for Americans.

“You’re going to save a fortune,” President Donald Trump said at the site’s unveiling. “And this is also so good for overall health care.”

The government-hosted website is not a platform for buying medications. Instead, it’s set up as a facilitator, pointing Americans to drugmakers’ direct-to-consumer websites, where they can make purchases. It also provides coupons to use at pharmacies. The site launches with over 40 medications, including weight-loss drugs such as Ozempic and Wegovy.

The site is part of a larger effort by the Trump administration to show it’s tacking the challenges of high costs. Affordability has emerged as a political vulnerability for Trump and his Republican allies going into November’s midterm elections, as Americans remain concerned about the cost of housing, groceries, utilities and other staples of middle-class identity.

Trump stressed that the lower prices were made possible by his pressuring of pharmaceutical companies on prices, saying he demanded that they charge the same costs in the U.S. as in other nations. He said prescription drug costs will increase in foreign countries as a result.

“We’re tired of subsidizing the world,” Trump said at the event on the White House campus that lasted roughly 20 minutes.

The president first teased TrumpRx in September while announcing the first of his more than 15 deals with pharmaceutical companies to lower drug prices to match the lowest price offered in other developed nations. He said in December the website would provide “massive discounts to all consumers” — though it’s unclear whether the prices available on drugmakers’ websites will routinely be any lower than what many consumers could get through their insurance coverage.

The website’s Thursday release came after it faced multiple delays, for reasons the administration hasn’t publicly shared. Last fall, Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, told Trump the site would share prices for consumers before the end of the year. An expected launch in late January was also pushed back.

The president has spent the past several months seeking to spotlight his efforts to lower drug prices for Americans. He’s done that through deals with major pharmaceutical companies, including some of the biggest drugmakers like Pfizer, Eli Lilly and Merck, which have agreed to lower prices of their Medicaid drugs to so-called “most favored nations” pricing. As part of the deals, many of the companies’ new drugs are also to be launched at discounted rates for consumer markets through TrumpRx.

Many of the details of Trump’s deals with manufacturers remain unclear, and drug prices for patients in the U.S. can depend on many factors, including the competition a treatment faces and insurance coverage. Most people have coverage through work, the individual insurance market or government programs like Medicaid and Medicare, which shield them from much of the cost.

Trump’s administration also has negotiated lower prices for several prescription drugs for Medicare enrollees, through a direct negotiation program created by a 2022 law.

Eating enough protein is important for good health, Denver-area dieticians said, but people who want to increase their intake need to make sure they choose quality foods and don’t crowd out healthy carbohydrates and fats.

Data from the U.S. Department of Agriculture showed that, as of 2020, the average American already ate enough protein to meet the new recommendations.

The most recent edition of the federal nutrition guidelines, released in early January, raised the recommended floor for protein consumption, setting a range from 50% higher to double the previous recommendation.

U.S. Health and Human Services Secretary Robert F. Kennedy Jr. also unveiled a flipped food pyramid, with beef and full-fat dairy among the foods to emphasize at the top. Federal recommendations had ditched the pyramid about 15 years ago for a model plate divided between produce, protein and whole grains.

The previous protein guideline was a bare minimum to avoid malnutrition, so raising that was probably the right call, said Jessica Crandall, a registered dietitian nutritionist who works at HCA HealthOne Rose.

Generally, Crandall recommends 60 to 80 grams of protein each day for women and 80 to 100 grams for men. For comparison, a three-ounce serving of ground beef has 22 grams, a skinless chicken breast has 18 grams and 6 ounces of Greek yogurt has 15 to 17 grams, according to Washington University in St. Louis.

But the right amount for any individual will depend on their body weight, age, level of physical activity and health, with some conditions requiring more protein and others demanding restrictions, Crandall said.

The International Food Information Council’s 2024 Food and Health survey found about 71% of Americans were specifically trying to eat protein, up from 59% in 2022. About one in five said they specifically follow a “high protein” diet, making it more popular than calorie counting, low-carb or Mediterranean food plans.

People who work in nutrition have known about protein’s importance to the muscles and immune system for quite some time, but public perception of it has changed significantly in recent years, said Kelly Elliot, a registered dietitian nutritionist at Saint Joseph Hospital.

“It’s interesting how marketing sways the public and how the public sways marketing,” she said.

While protein shakes and bars have been staples among the gym-going set for some time, other food brands are getting in on the game.

Snickers and Pop Tarts unveiled higher-protein options, and Thomas’ bagels added a line about protein content to the front of the packaging for their existing products. Starbucks and Dunkin’ Donuts recently debuted drinks enhanced with whey protein, and Chipotle’s menu now promotes a “protein cup” of chicken and a chicken taco, designed to offer a similar mix of protein, fat and carbs to a protein bar, said Stephanie Perdue, Chipotle’s interim chief marketing officer.

“We’ve seen growing demand for protein-forward choices across more occasions, especially snack-sized portions at accessible prices,” she said in a statement. “We’ll carry this focus throughout 2026, with our culinary team driving protein-led innovation informed by customer behavior and emerging trends across our restaurants and digital channels.”

As more people get the message that they need to increase their protein intake — despite the fact that most Americans already eat enough — food companies have responded by adding protein in unexpected places, including pretzels, chips and even bottled water, said William Hallman, a psychologist at Rutgers University who studies how people think about food.

Emphasizing protein creates a “health halo” around products that makes people think they’re a better option, even if the manufacturer had to increase sugar and fat to mask the taste of protein powder, he said.

“Consumers think it’s healthier for them, and that’s the problem,” he said.

Brands highlight the positive aspects of their food, but that doesn’t mean that every high-protein product is a good choice, Elliot said. Consumers need to consider other factors such as sugar and saturated fat content, and whether the ingredients list includes a string of additives, she said.

The new nutrition guidelines also warned the public to avoid added sugars and ultra-processed foods, while maintaining the existing advice to limit saturated fat for heart disease prevention.

“Some of these protein bars, many of them are glorified candy bars,” she said.

The new nutrition guidelines may encourage products to continue jumping on the protein bandwagon, but in the long run, food companies will have to consider whether the costs of fortifying their products are worthwhile in an increasingly crowded marketplace, Hallman said.

“At some point, people are going to figure out they’re getting plenty of protein,” he said.

Most people will be able to meet their needs as long as they have a good source of protein at each meal, alongside fruits, vegetables and whole grains, Crandall said. While most people think of meat when discussing protein, other options with less saturated fat include eggs, dairy foods, seafood, nuts, seeds and beans, she said.

“Protein is one piece of the puzzle,” she said.

For most people, eating more protein than they need isn’t likely to cause a problem, though it can exacerbate kidney or liver disease. The concern is that they’ll forgo foods that are low in protein but high in fiber or vitamins and minerals that also contribute to good health, Crandall said.

“Sometimes when we hyper-focus on one area… we miss out on those other nutrients,” she said.

When Rachel Marshall was growing up in Virginia, her parents kept a magnet on the refrigerator from a national homeschooling advocacy group, with a phone number to call if local school officials tried to interfere with their decision to educate their children at home.

“You tell [the organization] the state’s after you, and they will come in with their lawyers and defend your right to homeschool and do what you want with your kids,” said Marshall, now a licensed counselor in Utah. “The state should be hands-off, that was their goal.”

Marshall wishes the state had been more hands-on. When she was a child, she said, her education and her safety were at the mercy of her parents, who struggled with mental illness and addiction.

“It was an ugly situation,” Marshall told Stateline. “But I think had there been some sort of regulation, some expectations from the state, I would not have been exposed to that as much.”

As homeschool enrollment has risen in recent years, so have concerns about oversight.

Recent high-profile child abuse deaths in several states have led to renewed calls from lawmakers for stronger regulations. They warn that some abusers claim they are homeschooling their kids when they pull them out of school, but really want to hide their crimes from teachers and other so-called mandatory reporters in public schools. Mandatory reporters are legally obligated to speak up about abuse if they suspect it.

But the push has inflamed a broader debate over parental rights and galvanized hundreds of homeschool groups to rally at statehouses around the country.

In every state, parents or guardians can withdraw their children from public or private school to be homeschooled. States allow this even if the caregiver has been the subject of a substantiated child welfare investigation, according to the Coalition for Responsible Home Education, an advocacy group. Nearly every state allows parents to withdraw children in the middle of an active investigation, and most states don’t prevent people convicted of crimes against children from homeschooling their kids.

Lawmakers in states such as Connecticut, Illinois and West Virginia have attempted to pass additional reporting requirements to guard against child abuse in homeschool settings.

They’re running up against parents’ rights groups and homeschooling advocates who argue that such regulations treat all homeschooling parents as potential criminals and aren’t necessary because many children in such situations are already on the radar of social service agencies. They say the additional requirements don’t address problems inside child protection agencies that allow such abuse to go unaddressed.

“When bad things happen, people feel compelled to do something, whether it makes a difference or not,” said Connecticut state Rep. Anne Dauphinais, a Republican who opposes homeschool regulation. “It’s often overreach of government, just because [lawmakers] want to feel good about doing something.”

In West Virginia, Democratic state Del. Shawn Fluharty said in an interview that he’d lost track of how many times he’s tried to get a bill passed that would prevent a parent from pulling a child out of public school to homeschool if social services is investigating the parent for possible child abuse or neglect. According to Stateline’s sister publication, West Virginia Watch, this year will mark the seventh year he’s tried.

Fluharty calls his bill “Raylee’s Law,” after an 8-year-old girl who died from severe abuse and neglect in 2018. Before her death, her abusers had pulled her out of public school after teachers and school administrators began noticing signs of abuse.

“At this point, I’m just pissed off,” Fluharty told Stateline. “We’ve had at least two other circumstances very similar to Raylee’s situation since I’ve been pushing this legislation.”

Fluharty said he’s considering revising the law’s name to also memorialize Kyneddi Miller, a West Virginia 14-year-old who starved to death in 2024. Her mother had pulled her from public school in 2021 to homeschool her.

The bill passed the House twice in recent years, with bipartisan support, but died in a Senate committee each time. It faces opposition from homeschooling advocates in the legislature, he said, as well as lobbying efforts from national homeschool groups.

“It’s not a complex situation,” said Fluharty. “It’s a glaring loophole that needs to be closed. The longer it stays open, the more vulnerable children are in West Virginia.”

Homeschool explosion

Before the COVID-19 pandemic, homeschool participation hovered around 2-3% of K-12 students. It exploded during the pandemic to a high of 11% of families, as learning outside of traditional schools became normalized. Now about 6% of school-age children in the United States are homeschooled, according to the most recent data from the U.S. Census Bureau.

But interest is on the rise. In recent years, the 30 states that publicly report homeschool participation have seen those numbers grow. More than a third of those states recorded their highest homeschool enrollment ever in the 2024-2025 school year, even exceeding pandemic-era peaks, according to a study published in November.

Homeschooling has increasingly been framed as a political and cultural choice, particularly in conservative circles where it’s promoted as a way to exercise control over children’s education amid anger over how schools address racial equity, gender identity and sexuality, school violence and vaccine requirements. Homeschool supporters praise its flexibility and safety. Others warn that minimal regulation can leave some children isolated from the visibility and protections built into public school systems.

The issue doesn’t always fall neatly along party lines. In Georgia, the 2018 deaths of two siblings prompted a Republican-sponsored bill that prohibits caregivers from withdrawing a child from school for the purpose of evading detection of child abuse and neglect. It became law in 2019.

In Hawaii, Republican state Sen. Kurt Fevella filed a resolution in 2024 calling for the state to conduct a wellness visit for any child removed from school to be homeschooled. He was motivated by the deaths of two unrelated children in Hawaii who had been taken out of school for homeschooling. It died in committee.

Last year, Rachel Marshall gave testimony before Utah legislators who were considering a controversial bill that would remove part of a 2023 law requiring parents to attest they’ve never been convicted of child abuse before they’re allowed to homeschool their children.

Marshall opposed the bill, worried the state was erasing one more safeguard protecting the small subset of homeschooled children who are at risk of abuse or neglect. But as she sat listening to the homeschooling parents speaking in favor of it, their words sounded familiar.

“I could hear the fear and rage that someone would take away your rights,” she said. “But I think if you are being investigated by [child protective services], you should not be allowed to withdraw your children from daily mandated reporters like schoolteachers.”

The bill’s chief sponsor, Republican state Rep. Nicholeen Peck, said her goal was to remove a portion of state homeschooling law that was ineffective, had created confusion for school districts, and unfairly stigmatized homeschooling families.

The Utah legislature passed the bill and it was signed into law last spring.

Statehouse rallies

Studies are mixed on whether children who are homeschooled are more likely to be victims of abuse.

A 2022 survey of homeschooled and conventionally schooled adults found homeschooled children aren’t necessarily more likely to report experiencing abuse or neglect.

But among abuse victims, isolation from mandated reporters — like school teachers — is a common thread. A 2014 study found that nearly half of child torture victims had been pulled from school to be homeschooled to evade suspicions of abuse. Withdrawal from school to homeschool under suspicious circumstances is a red flag for abuse and is associated with higher risk factors for abuse, according to a report from the Coalition for Responsible Home Education.

More than 1 in 5 children withdrawn from school for homeschooling in Connecticut lived in families with at least one substantiated report from the state’s child services agency, according to a report released last year from Connecticut’s Office of the Child Advocate. The office based its findings on a sample of more than 700 children aged 7-11 who were withdrawn from school for homeschooling between July 2021 and June 2024.

For homeschooling families who’ve been providing their children with a high-quality education without oversight, “I can understand why they might feel they don’t need to be regulated,” said Christina Ghio, Connecticut’s child advocate.

“But as a state, we have an obligation to all children,” she told Stateline. “We know there are children whose parents say they’re homeschooling who are not. The challenge is, there’s one set of rules that has to apply to everybody.”

Her office’s report recommended state lawmakers create requirements for annual assessments of homeschoolers.

The report was issued in the wake of a high-profile abuse case: A Connecticut man was rescued in February 2025 after authorities say he’d been held captive and abused for two decades. His stepmother had pulled him from public school in fourth grade after school officials contacted authorities with concerns he was being abused.

But when lawmakers gathered for hearings on homeschooling regulation last May, after Ghio’s report, more than 2,000 people, most of them homeschool families, flooded the state’s Legislative Office Building to protest, according to the CT Mirror.

In Illinois, Democratic lawmakers introduced a sweeping homeschool regulation bill last year that, among other things, would have banned those convicted of sexual abuse crimes from homeschooling. It was prompted by an investigation from Capitol News Illinois and ProPublica into the state’s nearly nonexistent homeschool regulation.

But while the bill cleared its committee, hundreds of homeschool families and supporters packed the Illinois State Capitol to oppose it. It never made it to a full vote in the House.

Despite pushback, Connecticut House Speaker Matt Ritter, a Democrat, has signaled his interest in revisiting some kind of oversight during this legislative session.

“I don’t think this is a fight about homeschooling,” he said during a public Q&A in January, citing cases like the highly publicized death of 11-year-old Jacqueline “Mimi” Torres-Garcia.

In October, the girl’s remains were found on an abandoned property in Connecticut. The family had prior history with the state’s social services, but her mother emailed school officials in July 2024 to tell them she planned to homeschool her daughter. Authorities say that less than two months later, the girl was dead. An autopsy confirmed her death was caused by abuse and starvation.

Dauphinais, the Connecticut Republican, told Stateline she doesn’t believe any of the proposed homeschool requirements she’s heard from her Democratic colleagues would have saved children like Mimi Torres-Garcia.

“If you want to abuse your child, you’re going to abuse your child and you are never going to show up for any kind of annual evaluation,” she said. “They will game the system. We’re not talking about the 99.9% of homeschoolers doing it genuinely. We’re talking about people doing evil things.”

Ritter said families that have been investigated by child protective services or law enforcement need more follow-up. But he was candid about the long road that regulation might face: “That might get really ugly, Republican versus Democrat. I think it depends on how it gets drafted.”

National advocacy

In Utah, some of the speakers supporting removing reporting requirements from state law included representatives from the same organization that was on Marshall’s family’s refrigerator magnet: the Home School Legal Defense Association.

It’s one of the most visible homeschooling organizations in statehouses around the nation, fighting homeschool regulation of all kinds.

The group argues that the intent behind such regulation is good, but misplaced, and that such regulations unfairly burden homeschooling families without meaningfully overhauling the systems — like social services agencies — that are tasked with protecting kids from abuse.

Homeschool families struggle with “being treated as though they were being lumped in with felons, being lumped in with kidnappers, being lumped in with people who had harmed their children,” said Peter Kamakawiwoole, an attorney with the Home School Legal Defense Association, during a Utah House committee hearing last January.

Also tracking such legislation are groups like the Coalition for Responsible Home Education, which was founded by former homeschoolers and advocates for oversight and accountability in homeschooling. The group drafted a model bill it calls the Make Homeschool Safe Act that proposes certain state reporting requirements for homeschooling families. The Home School Legal Defense Association opposes it.

Fluharty, the West Virginia lawmaker, said that when he’s accused of “going after homeschoolers,” he encourages them to read the bill. He believes the national homeschooling lobbyists are lying to families about what his legislation really does.

The goal of such regulation isn’t to take away homeschoolers’ rights, said Marshall. It’s not even necessarily for the kids whose cases wind up in front of child protective services. Instead, she said, it’s for the kids that no one can see.

“These kids are invisible,” she said. “Homeschooling is inherently isolating. Other kids are going to school and have teachers in their lives, a bus driver in their life.”

But for homeschooled kids, “If you are being abused or your education is being neglected, your parents aren’t telling others that. Nobody knows. It feels like the state doesn’t care.”

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

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Cortisol, what is known as the stress hormone, is the talk of the internet.

Wellness influencers warn about the various symptoms of chronically high cortisol: waking up at 3 a.m., swollen “cortisol face” and accumulating belly fat. And many offer diet and exercise routines that they claim will help.

But do you really need supplements and advice from influencers to control your cortisol? Doctors say it’s very unlikely.

Don’t be so quick to label this hormone as a villain, they say. And if you suspect something is off, talk to a professional.

Here’s what to know.

Cortisol keeps you alive and disorders are relatively rare

Cortisol is a hormone and you need it to survive. It comes from the adrenal glands, located above the kidneys, and is one of many hormones at play in times of stress. It can influence inflammation, the immune system, metabolism, blood pressure and many other bodily functions.

Cortisol is incredibly attuned to your body and environment. It fluctuates throughout the day, rising in the morning when you wake up and falling at night before you go to sleep. It also rises when you’re sick or in other times of stress, doctors say.

“Our cortisol level is regulated by the minute,” said Dr. Roberto Salvatori, a Johns Hopkins University endocrinologist. “It is very sensitive.”

It’s rare that people have a disorder where cortisol on its own is the cause. If a person’s cortisol level is chronically low, doctors would diagnose them with adrenal insufficiency. This includes an autoimmune condition called Addison’s disease, in which the immune system attacks the adrenal gland.

People with Cushing’s syndrome have cortisol levels that are too high. Among its causes are tumors, which are usually benign, in the adrenal or pituitary glands. It is treated with medication, surgery or both.

Talk to your doctor before ordering a cortisol test

The symptoms of either high or low cortisol are wide-ranging and can overlap with signs of other health issues.

Adrenal insufficiency can manifest as fatigue, unintentional weight loss, low blood pressure and loss of appetite. Cushing’s syndrome comes with weight gain, high blood pressure, brittle bones, weight gain around the face and belly, abnormal hair growth in women, sleep issues and more.

Diagnoses take time, multiple tests and an understanding of a patient’s overall health, doctors said. Cortisol can be measured through the patient’s saliva, blood or urine.

“There’s a lot of nuance to interpreting cortisol and that’s what makes me a little bit nervous about patients getting cortisol testing for themselves without having some kind of physician oversight,” said Dr. Katie Guttenberg, an endocrinologist at UTHealth Houston.

A one-off cortisol blood test won’t provide useful information for most people, she said, and could lead to unnecessary stress and medical follow-ups. For example, women who are on birth control will have falsely high cortisol blood results, because of how the medicine works in the body.

Be cautious of supplements that claim to lower cortisol

Endocrinologists say there are no proven over-the-counter treatments for high or low cortisol, despite claims that supplements like ashwagandha and magnesium are helpful in “lowering cortisol.”

Beyond Cushing’s syndrome, chronically high cortisol is a concern, said Dr. James Findling, an endocrinologist with the Medical College of Wisconsin, but more research into treatments is needed.

He worries about people taking unregulated supplements when it’s not always clear what’s in them.

“They’re not innocuous,” Findling warned.

Even in patients who have Cushing’s syndrome, the medications have to be carefully dosed, Salvatori said, because an overcorrection could drive cortisol levels too low and cause other health issues.

Managing stress is good for you, regardless of cortisol

Salvatori notes there is a condition called “pseudo Cushing’s syndrome,” which is often milder but causes some of the same physical effects despite the patient not having a tumor. It can be caused by alcoholism and other chronic issues.

It is generally treated by addressing the underlying cause, doctors said, like getting the patient to stop drinking.

Endocrinologists are learning new potential benefits for treating high cortisol, said Findling, who studies the condition. For example, it could potentially help diabetics who are on multiple drugs better control their blood sugar.

The doctors also acknowledged that stress is highly subjective and Cushing’s syndrome patients can go unheard and undiagnosed.

But their advice for the vast majority of people: Talk to a doctor if you are concerned.

For healthy people, rather than focusing in on one elusive hormone, the doctors recommended going back to the basics of stress management: Eat well, get enough sleep, move your body or go to therapy.

“Nothing new about any of that,” Findling said.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.