The Brief

Few voters likely expected President Donald Trump in the first weeks of his administration to slash billions of dollars from the nation’s premier federal cancer research agency.

But funding cuts to the National Institutes of Health were presaged in Project 2025’s “Mandate for Leadership,” a conservative plan for governing that Trump said he knew nothing about during his campaign. Now, his administration has embraced it.

The 922-page playbook compiled by the Heritage Foundation, a conservative research group in Washington, says “the NIH monopoly on directing research should be broken” and calls for capping payments to universities and their hospitals to “help reduce federal taxpayer subsidization of leftist agendas.”

Universities, now slated to face sweeping cuts in agency grants that cover these overhead costs, say the policy will destroy ongoing and future biomedical science. A federal judge temporarily halted the cuts to medical research on Feb. 10 after they drew legal challenges from medical institutions and 22 states.

Project 2025 as prologue

The rapid-fire adoption of many of Project 2025’s objectives indicates that Trump acolytes — many of its contributors were veterans of his first term, and some have joined his second administration — have for years quietly laid the groundwork to disrupt the national health system. That runs counter to Trump’s insistence on the campaign trail, after Democrats made Project 2025 a potent attack line, that he was ignorant of the document.

“I have no idea what Project 2025 is,” Trump said Oct. 31 at a rally in Albuquerque, New Mexico, one of many times he disclaimed any knowledge of the plan. “I’ve never read it, and I never will.”

But because his administration is hewing to the Heritage Foundation-compiled playbook so closely, opposition groups and some state Democratic leaders say they’re able to act swiftly to counter Trump’s moves in court.

They’re now preparing for Trump to act on Project 2025 recommendations for some of the nation’s largest and most important health programs, including Medicaid and Medicare, and for federal health agencies.

“There has been a lot of planning on the litigation side to challenge the executive orders and other early actions from a lot of different organizations,” said Noah Bookbinder, president of Citizens for Responsibility and Ethics in Washington, a watchdog group. “Project 2025 allowed for some preparation.”

The plan, for example, calls for state flexibility to impose premiums for some beneficiaries, work requirements, and lifetime caps or time limits on Medicaid coverage for some enrollees in the program for low-income and disabled Americans, which could lead to a surge in the number of uninsured after the Biden administration vastly expanded the program’s coverage.

“These proposals don’t directly alter eligibility for Medicaid or the benefits provided, but the ultimate effect would be fewer people with health coverage,” said Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes KFF Health News, the publisher of California Healthline. “When you erect barriers to people enrolling in Medicaid, like premiums or documenting work status, you end up rationing coverage by complexity and ability to pay.”

Congressional Republicans are contemplating a budget plan that could result in hundreds of billions of dollars being trimmed from Medicaid over 10 years.

Project 2025 called for expanding access to health plans that don’t comply with the Affordable Care Act’s strongest consumer protections. That may lead to more choice and lower monthly premiums for buyers, but unwitting consumers may face potentially massive out-of-pocket costs for care the plans won’t cover.

And Project 2025 called for halting Medicaid funding to Planned Parenthood affiliates. The organization, an important health care provider for women across the country, gets roughly $700 million annually from Medicaid and other government programs, based on its 2022-23 report. Abortion made up about 4% of services the organization provided to patients, the report says.

The administration’s steps to scrub words such as “equity” from federal documents, erase transgender identifiers, and curtail international medical aid — all part of the Project 2025 wish list — have already had sweeping ramifications, hobbling access to healthcare and eviscerating international programs that aim to prevent disease and improve maternal health outcomes.

Under a memorandum issued in January, for example, Trump reinstated and expanded a ban on federal funds to global organizations that provide legal information on abortions.

Studies have found that the ban, known as the “global gag rule” or “Mexico City Policy,” has stripped millions of dollars away from foreign aid groups that didn’t abide by it. It’s also had a chilling effect: In Zambia, one group removed information in brochures on contraception, and in Turkey, some providers stopped talking with patients about menstrual regulation as a form of family planning.

Project 2025 called on the next president to reinstate the gag rule, saying it “should be drafted broadly to apply to all foreign assistance.”

Trump also signed an executive order rolling back transgender rights by banning federal funds for transition-related care for people under age 19. An order he signed also directed the federal government to recognize only two sexes, male and female, and use the term “sex” instead of “gender.”

The Project 2025 document calls for deleting the term “gender identity” from federal rules, regulations, and grants and for unwinding policies and procedures that its authors say are used to advance a “radical redefinition of sex.” In addition, it states that Department of Health and Human Services programs should “protect children’s minds and bodies.”

“Radical actors inside and outside government are promoting harmful identity politics that replaces biological sex with subjective notions of ‘gender identity,’” the Project 2025 road map reads.

Data disappears

As a result of Trump’s order on gender identity, health researchers say, the Centers for Disease Control and Prevention took down online information about transgender health and removed data on LGBTQ+ health. A federal judge on Feb. 11 ordered that much of the information be restored; the administration complied but added notices to some webpages labeling them “extremely inaccurate” and claiming they don’t “reflect biological reality.”

The CDC also delayed the release of information and findings on bird flu in the agency’s Morbidity and Mortality Weekly Report. Federal workers have said they were told to retract papers that contain words such as “nonbinary” or “transgender.” And some hospitals suspended gender-affirming care such as hormone therapy and puberty blockers for youths.

Advocacy groups say the orders discriminate and pose barriers to medically necessary care, and transgender children and their families have filed a number of court challenges.

Lawyers, advocates, and researchers say implementation of many of Project 2025’s health policy goals poses a threat.

“The playbook presents an antiscience, antidata, and antimedicine agenda,” according to a piece last year by Boston University researchers in JAMA.

The Project 2025 blueprint sets out goals to curb access to medication abortion, restructure public health agencies, and weaken protections against sex-based discrimination. It would have seniors enroll by default in Medicare Advantage plans run by commercial insurers, in essence privatizing the health program for older Americans. And it calls for eliminating coverage requirements for Affordable Care Act plans that people buy without federal subsidies, which, insurance experts say, risks leaving people underinsured.

“It’s the agenda of the Trump administration,” said Robert Weissman, a co-president of Public Citizen, a progressive consumer rights advocacy group. “It’s to minimize access to care under the guise of strict work requirements in Medicaid, privatizing Medicare and rolling back consumer protections and subsidies in the Affordable Care Act.”

The White House didn’t respond to a message seeking comment. Conservatives have said implementation of the project’s proposals would curb waste and fraud in federal health programs and free health systems from the clutches of a radical “woke” agenda.

“Americans are tired of their government being used against them,” Paul Dans, a lawyer and former director of Project 2025, said last year in a statement. “The administrative state is, at best, completely out of touch with the American people and, at worst, is weaponized against them.”

Dans did not return messages seeking comment for this article.

The Heritage Foundation has sought to separate itself and Project 2025 from Trump’s executive orders and other initiatives on health.

“This isn’t about our recommendations in Project 2025 — something we’ve been doing for more than 40 years. This is about President Trump delivering on his promises to make America safer, stronger and better than ever before, and he and his team deserve the credit,” Ellen Keenan, a spokesperson for Heritage, said in a statement.

Versions of the document have been produced roughly every four years since the 1980s and have influenced other GOP presidents. Former President Ronald Reagan adopted about two-thirds of the recommendations from an earlier Heritage guide, the group says.

In some instances, the Trump administration hasn’t just followed Project 2025’s proposals but has gone beyond them.

The document called on the next president to scale back and “deradicalize” the U.S. Agency for International Development, an independent federal agency that provides foreign aid and assistance, including for many international health programs. The administration hasn’t just scaled back USAID. Trump adviser Elon Musk bragged on his social media platform, X, that his Department of Government Efficiency fed the agency “into the wood chipper,” physically closing its offices and putting nearly all its staff on administrative leave while ending funding for its programs and disseminating misinformation about them.

But the administration risks waning public support if it adopts the project’s goals to upend U.S. healthcare and health policy. Almost 60% of voters said they felt negatively about Project 2025 in a September poll by NBC News.

“Project 2025 was never a thought exercise; it was always a blueprint,” said Ally Boguhn, a spokesperson for Reproductive Freedom for All, an abortion rights group. “We’re only a few weeks into his presidency, and it’s setting the groundwork for even more.”

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

A second case of measles has been confirmed in Los Angeles County.

L.A. County Department of Public Health officials announced on Saturday the virus was detected in an international traveler who arrived at the Tom Bradley International Terminal — or Terminal B — at LAX on Monday, Jan. 26, through Gate 201A on Viva Aerobus Flight 518.

Public Health said anyone at Terminal B from 10:45 p.m. on Jan. 26 to 1 a.m. on Jan. 27 may have been exposed.

The traveler also spent a day in Disneyland Park and California Adventure Park in Anaheim on Jan. 28 from 12:30 to 10 p.m. On Jan. 30, they visited a Dunkin’ Donuts in Woodland Hills from 3 to 4:45 p.m.

Health officials say people who visited the above locations during those time periods may also be at risk of developing measles.

Symptoms typically appear one to three weeks after exposure.

Public Health recommends these individuals check if they are already protected against measles and advise getting a measles, mumps and rubella vaccine if they aren't.

Symptoms include a fever above 101 degrees; cough; runny nose; red, watery eyes; and a rash that typically starts on the face.

• For those exposed at LAX, the last day to monitor for symptoms is Feb. 16.
• For those exposed at Disneyland Park and California Adventure Park, the last day to monitor for symptoms is Feb. 18.
• For those exposed at Dunkin’ Donuts, the last day to monitor for symptoms is Feb. 20.

Saturday's announcement comes one day after L.A. County public health officials confirmed the first case of measles in the county. More information about that case here.

Orange County has reported two other measles cases this year, one in a young adult who recently traveled internationally and the second in an unvaccinated toddler who had no known exposure to the virus.

Transmission, prevention and more

Measles spreads easily through the air and can stay on surfaces for many hours. Those infected can spread the virus before showing symptoms, which can take weeks to appear.

So far, 588 measles cases of measles have been reported in the U.S. this year, the highest number of cases in a January since the U.S. eliminated measles in 2000. Most of these cases are linked to outbreaks in South Carolina, Arizona and Utah.

The L.A. County Department of Public Health is encouraging Angelenos to check their immunization status for the measles, mumps and rubella vaccine to determine if they’re protected against the virus.

If symptoms develop, contact a health care provider via phone as soon as possible. L.A. Public Health advises people not to go physically into a health care facility before notifying them of measles symptoms.

The measles outbreak in South Carolina is showing little sign of slowing down. The state has confirmed 847 cases since the first case was reported in October, making the outbreak bigger than the one in Texas, which started just over a year ago.

Dr. Linda Bell, South Carolina's state epidemiologist, points out that in Texas, measles cases grew over the course of seven months, while in South Carolina it has taken just 16 weeks to surpass the Texas case count.

"This is a milestone that we have reached in a relatively short period of time, very unfortunately," she said at a press briefing Wednesday. "And it's just disconcerting to consider what our final trajectory will look like for measles in South Carolina."

The state on Friday reported 58 new cases since Tuesday.

This latest outbreak, as well as the speed at which it is spreading, is another test of the United States' ability to contain measles. It comes as the Trump administration has taken multiple steps to undermine overall confidence in vaccines.

And it is happening as the U.S. is already in danger of losing its status as a country that has eliminated measles. That's a technical designation. It's given to countries that have gone a year without a continuous chain of transmission. For the U.S., the clock started in January 2025 with the Texas outbreak.

Who makes the call?

Measles elimination status is granted — and taken away — by a special verification commission set up by the Pan American Health Organization (PAHO). It reviews extensive evidence to determine whether the outbreaks in the U.S. are all part of a continuous chain of transmission that began with the outbreak in Texas in January 2025. Gathering the necessary epidemiological data, genomic analyses and surveillance reports takes time.

But even if PAHO determines that the outbreaks are separate, the U.S. could still lose its elimination status if it fails to prove that it can interrupt the spread of measles quickly and consistently, says Dr. Demetre Daskalakis, an infectious disease specialist and former top official with the Centers for Disease Control and Prevention (CDC). And so far, he says, the U.S. is failing on this front.

"We do not have the capability to actually control measles, whether or not this is demonstrated through continuous measles transmission for 12 months," Daskalakis said in a press briefing this month. "So I'm going to say that elimination is already lost."

PAHO has said it plans to review the United States' measles elimination status this spring.

"Health freedom"

When asked whether the potential loss of measles elimination status was significant during a press call this month, Dr. Ralph Abraham, the principal deputy director of the CDC, said, "Not really."

Abraham said losing elimination status would not impact how the administration tackles measles. He said the administration supports the measles vaccine, but "You know, the president, Secretary [Kennedy], we talk all the time about religious freedom, health freedom, personal freedom. And I think we have to respect those communities that choose to go a somewhat of a different route."

But infectious disease experts and epidemiologists say the choice not to vaccinate is what's driving these outbreaks. Daskalakis says the resurgence of measles is being fueled by misinformation that undermines trust in vaccines.

And public health experts say losing elimination status is more than just symbolic. "I think it's really a comment on the state of the public health system," says Caitlin Rivers, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health. "We maintained elimination for 25 years. And so now, to be facing its loss, it really points to the cycle of panic and neglect, where I think that we have forgotten what it's like to face widespread measles."

And as measles cases rise, that will lead to more hospitalizations, more deaths and a greater toll on the public health system as a whole, says Dr. William Moss of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health. He points to estimates suggesting that the average cost for a measles outbreak is $43,000 per case, with costs escalating to well over $1 million total for outbreaks of 50 cases or more. And fighting measles also takes resources away from other public health priorities.

Elimination vs. eradication

In 2000, PAHO declared measles eliminated from the U.S. because there had been no continuous domestic spread for more than 12 months. But the virus is still endemic in many parts of the world, and every year, there are U.S. cases brought in from abroad. So the virus has not been eradicated. 

Compare that with the smallpox virus, which has not been reported anywhere in the world since the World Health Organization declared it eradicated in 1980. 

Across state lines

Similar to Texas, the vast majority of cases in South Carolina have been in children and teens who are unvaccinated, leading to quarantines in about two dozen schools. Clemson University and Anderson University also have recently reported cases. And the virus has crossed state lines. North Carolina has confirmed several cases linked to the South Carolina outbreak. Across the country in Washington state, officials in Snohomish County told NPR they've linked six measles cases in unvaccinated children there to a family visiting from South Carolina.

Dr. Anna-Kathryn Burch, a pediatric infectious disease specialist with Prisma Health in Columbia, S.C., says it breaks her heart to see her state have such a large outbreak.

"I'm from here, born and raised — this is my state. And I think that we are going to see those numbers continue to grow over the next several months," she says.

Measles is dangerous. Here's how to protect yourself.

Measles is one of the most contagious diseases on Earth — more than Ebola, smallpox or just about any other infectious disease.

A person infected with measles can be contagious from four days before the telltale measles rash appears, until four days after. So the person could be spreading measles before they know they're infected. And when they cough, sneeze, talk or even just breathe, they emit infectious particles that can linger in the air for up to two hours, long after the infected person has left the room. On average, one infected person can go on to sicken up to 18 other unvaccinated people.

The best way to protect yourself is vaccination. The measles, mumps and rubella vaccine is very safe, and two doses is 97% effective — which means 97% of people will develop lifelong immunity against the disease. When vaccination rates are high in a community — 95% or more is considered ideal — that helps prevent measles outbreaks because there aren't enough vulnerable people for the virus to keep spreading. In Spartanburg County, S.C., the schoolwide vaccination rate for required immunizations is 90%.

Vaccination rates have been dropping in the United States. Nationwide, 92.5% of kindergartners had received the measles vaccine in the 2024-2025 school year, according to the CDC. In many communities across the country, those figures are much lower, creating the conditions needed for measles outbreaks to spread. Experts say all that's needed is one spark to ignite it.
Copyright 2026 NPR

ABOARD AIR FORCE ONE — President Donald Trump said Saturday that he has instructed Homeland Security Secretary Kristi Noem not to intervene in protests occurring in cities led by Democrats unless local authorities ask for federal help amid mounting criticism of his administration's immigration crackdown.

On his social media site, Trump posted that "under no circumstances are we going to participate in various poorly run Democrat Cities with regard to their Protests and/or Riots unless, and until, they ask us for help."

He provided no further details on how his order would affect operations by U.S. Immigration and Customs Enforcement and DHS personnel, or other federal agencies, but added: "We will, however, guard, and very powerfully so, any and all Federal Buildings that are being attacked by these highly paid Lunatics, Agitators, and Insurrectionists."

Trump said that in addition to his instructions to Noem he had directed "ICE and/or Border Patrol to be very forceful in this protection of Federal Government Property."

Later Saturday night, Trump said to reporters as he flew to Florida for the weekend that he felt Democratic cities are "always complaining."

"If they want help, they have to ask for it. Because if we go in, all they do is complain," Trump said.

He predicted that those cities would need help, but said if the leaders of those cities seek it from the federal government, "They have to say, 'Please.'"

The Trump administration has already deployed the National Guard, or federal law enforcement officials, in a number of Democratic areas, including Washington, Los Angeles, Chicago and Portland, Oregon. But Saturday's order comes as opposition to such tactics has grown, particularly in Minnesota's Twin Cities region.

Trump said Saturday night that protesters who "do anything bad" to immigration officers and other federal law enforcement, "will have to suffer" and "will get taken care of in at least an equal way."

"You see it, the way they treat our people. And I said, you're allowed, if somebody does that, you can do something back. You're not going to stand there and take it if somebody spits in your face," Trump said.

Minnesota Attorney General Keith Ellison and the mayors of Minneapolis and St. Paul have challenged a federal immigration enforcement surge in those cities, arguing that DHS is violating constitutional protections.

A federal judge says she won't halt enforcement operations as the lawsuit proceeds. State and local officials had sought a quick order to halt the enforcement action or limit its scope. Justice Department lawyers have called the lawsuit "legally frivolous."

The state, particularly Minneapolis, has been on edge after federal officers fatally shot two people in the city: Renee Good on Jan. 7 and Alex Pretti on Jan. 24. Thousands of people have taken to the streets to protest the federal action in Minnesota and across the country.

Trump's border czar, Tom Homan, has suggested the administration could reduce the number of immigration enforcement officers in Minnesota — but only if state and local officials cooperate. Trump sent Homan to Minneapolis following the killings of Good and Pretti, seeming to signal a willingness to ease tensions in Minnesota.

The president on Saturday night said he intended to speak to Homan and Noem on Sunday and he seemed to endorse the idea of immigration agents wearing body cameras or having their interactions filmed.

Trump was asked by a reporter if he thought it was a good thing having lots of cameras capturing incidents with law enforcement.

"I think it would help law enforcement but I'd have to talk to them," Trump said.

He went on and added: "That works both ways. But overall, I think it's 80% in favor of law enforcement."
Copyright 2026 NPR

Facing federal funding cuts that could strip health coverage from hundreds of thousands of Angelenos, clinic leaders, union members and patients gathered in Inglewood last Wednesday to boost a stop-gap proposal they want to put in front of voters: a county sales tax to stave off service cuts and keep more sick people from seeking primary care in emergency rooms.

A newly formed coalition, Restore Healthcare for Angelenos, is asking the Los Angeles County Board of Supervisors to place a five-year, half-cent sales tax measure on the June ballot in Los Angeles County.

“The ballot measure that we are proposing is an urgent and necessary step to stop the damage, to protect access to life-saving care,” said Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County, one of the organizations in the coalition. “The stakes right now could not be higher.”

As the federal spending plan, H.R. 1, starts to take effect, Medi-Cal cuts and eligibility changes will affect millions of Californians. The state estimates it could lose tens of billions of dollars a year in federal funding.

According to the coalition, their proposal would raise about $1 billion annually for health care in Los Angeles County. The revenue would help create a local coverage program that would pay for primary and emergency care as well as behavioral health needs for people who fall off their Medi-Cal insurance and have no other coverage options, according to the coalition. When people are uninsured, uncompensated care at clinics and hospitals grow, threatening the availability of services for everyone, coalition leaders say.

The coalition is working with Supervisor Holly Mitchell, whose office on Wednesday presented the motion to the county — an initial step before public debate. The board is expected to vote next month; the deadline for placing a board-sponsored measure on the June ballot is March 6.

“I do not take lightly asking fellow residents to consider imposing a ½ percent retail tax,” Mitchell said in an emailed statement. “This option is on the table because what’s at stake are safety net services unraveling for millions of residents — which would come at an even greater cost for the largest county in the nation.”

She added that if the measure passed it would sunset on Oct. 1, 2031 and would be subject to public oversight and audits. “This is a last resort option for the times we’re facing and for voters to make the final call on,” Mitchell said.

If the board of supervisors does not approve the measure for a June vote, the coalition will gather signatures toward qualifying the initiative for the November ballot, said Jim Mangia, CEO of St. John’s Community Health, another coalition member.

Efforts to shore up health care access for poor Californians aren’t unique to Los Angeles. Pressure is building for state and county leaders to find new revenue streams to make up at least in part for the federal losses. In a legislative hearing Tuesday, health providers and advocates also urged state lawmakers to seek creative funding solutions.

Last November, voters in Santa Clara County approved a tax similar to the one proposed in Los Angeles County. Santa Clara’s Measure A will raise the local sales tax by five-eights of a cent for five years. The county projects that it will provide $330 million annually for local hospitals and clinics.

Both local proposals are separate from the push led by SEIU-United Healthcare Workers West for a one-time 5% tax on the wealth of the state’s approximately 200 billionaires, which would generate an estimated $100 billion to fund  medical care and other social services at the state level. Gov. Gavin Newsom opposes the initiative, arguing that such a tax would drive wealthy people — who pay a significant portion of the state’s income taxes — from the state. That measure has not yet qualified for the November ballot.

Local and state tax proposals could seemingly compete for the attention of voters, since both are responses to the issue of federal funding cuts. And in L.A., voters may have to consider a number of other tax measures this election year from a city hotel tax in June to a sales tax to support the Los Angeles Fire Department in November.

Mangia sees the tax initiatives to fund health care as complementary. He said the state tax on billionaires would help restore some of federal cuts to Medi-Cal at the state level, while the L.A County measure would help shore up the local safety net.

“We’re doing this to make sure that no matter what happens federally, statewide, residents of L.A. County will have access to health care,” Mangia said.

Among the most prominent changes and cuts made in Trump’s major budget reconciliation law are a new requirement for enrollees to log 80 hours per month of school, work or volunteering starting in 2027; a rule that requires people to renew coverage every six months rather than annually; restrictions on taxes that the state places on insurers to help pay for the Medi-Cal program; and a reduction in how much the feds will pay for the emergency care of non-citizens.

State health officials estimate 2 million Californians could lose their Medi-Cal coverage over the next several years.

Under its own growing budget pressures, the state has also rolled back coverage for certain groups. Starting earlier this month state health officials froze Medi-Cal enrollment for undocumented people — the state foots most of the cost for this group because with the exception of emergency care, federal dollars cannot be used to cover individuals who are in the country illegally. This summer the state will also cut non-emergency dental care for undocumented adults already enrolled in the program.