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The Brief

The most important stories for you to know today
  • What he's saying to the world at all hours

    Topline:

    President Donald Trump is now communicating with the public sometimes dozens of times a day on a social media platform that he himself created, and most Americans (and perhaps even journalists) never see most of those posts.

    How we got here: During his first presidential campaign, Trump's constant stream of seemingly unvetted tweets was a sideshow that quickly became inescapable — the boasts, insults, and lies at times hijacked news cycles. Once he was elected, they presented a new frontier in American politics: a real-time view into a president's mind.

    Why it matters: Ten years, one Twitter ejection, one Twitter return, and a move to Truth Social later, Trump's posts still make news — like when he announces a war or tries to pick a fight with the pope — but for many have become the background noise of American politics.

    Keep reading... for a picture of exactly what, in the aggregate, the president of the United States is thinking about and saying to the world at all hours.

    Stay up to date with our Politics newsletter, sent weekly.


    On March 1, the day after U.S. forces bombed Iran and began a war that's now more than nine weeks long, President Donald Trump posted 30 times on Truth Social.

    Just after midnight, he posted about the bombing campaign, including a threat to retaliate if Iran itself retaliated ("THEY BETTER NOT DO THAT").

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    But he soon had a lot more on his mind; mid-morning, he posted a video portraying Senator Mitch McConnell as the floppy, deceased Bernie from Weekend at Bernie's.

    He posted a Tiktok video praising his State of the Union — a speech he had given five days prior — then reposted that video, along with a screenshot of a post on the social media site X. Just after noon, he posted an update on the war ("we have destroyed and sunk 9 Iranian Naval Ships, some of them relatively large and important"). Mid-afternoon, he posted a string of Trump-friendly news coverage, including a New York Post article from September 2024 about how Lady Gaga's father endorsed Trump in the presidential race. Shortly thereafter, in the span of five minutes, he posted 10 times, all of them lists of screenshots of praise from X users for his State of the Union address. He later posted a video update about the war in Iran, followed by a video marked as being from an Instagram user called @truthaboutfluoride, purporting to show San Francisco as a run-down city filled with poverty.

    During his first presidential campaign, Trump's constant stream of seemingly unvetted tweets was a sideshow that quickly became inescapable — the boasts, insults, and lies at times hijacked news cycles. Once he was elected, they presented a new frontier in American politics: a real-time view into a president's mind.

    Ten years, one Twitter ejection, one Twitter return, and a move to Truth Social later, Trump's posts still make news — like when he announces a war or tries to pick a fight with the pope — but for many have become the background noise of American politics.

    The president of the United States is now communicating with the public sometimes dozens of times a day on a social media platform that he himself created, and most Americans (and perhaps even journalists) never see most of those posts. Of course, most of those posts are not individually newsworthy. But looking at them together provides a picture of exactly what, in the aggregate, the president of the United States is thinking about and saying to the world at all hours.

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    To try to grasp that, NPR analyzed the first four months of Trump's Truth Social posts this year. What emerged is a portrait of an extremely online president with scattered focus — who, even while he dealt with fallout from his policies such as war in Iran and immigration enforcement in Minneapolis, was also busy insulting his critics, posting pictures of his proposed ballroom, and continuing to insist on the lie that he won the 2020 election. The president also has unorthodox posting habits that illustrate that, even as arguably the most powerful person on earth, he remains focused on how he is seen.

    What the president is posting about

    To quantitatively analyze the president's posts, NPR compiled the president's first four months of posts, using a data scraper maintained by CNN. We then classified each post based on its topic (tariffs, the war in Iran, Greenland) and the type of post it was (sharing a news story, reposting someone else, making a threat).

    Trump posted 2,249 times in the first four months of 2026, an average of just under 19 posts per day.

    The most common topic Trump posted about – at about 14% of his posts – was 2026 elections. These posts — more than 300 of them — consist largely of either candidate endorsements or posts touting a Trump-backed candidate's win.

    However, Trump at times did not give a simple endorsement, instead adding attacks on an endorsee's opponents. For example, in endorsing Republican candidates for the Indiana state Senate, the posts became paragraph-long screeds as Trump attacked sitting senators as "RINOs" (Republicans in name only) if they voted against a Trump-backed redistricting plan.

    The next most common topics after elections were Iran (247 posts) and the economy (177). He also posted dozens of times about alleged fraud in Minnesota's safety net programs, the SAVE Act, and his belief that the justice system was weaponized against him.

    To the degree that his posts measure what he's thinking about, the president's social media feed suggests he is as preoccupied — or even more so — with his personal projects and vendettas than he is with pressing policy matters.

    President Trump posted about the 2020 election 71 times in the first four months of 2026, more than he posted even about tariffs (57 times — all of which we coded as a subset of posts about the economy). Those 2020 election posts all promoted the lie that via massive voter fraud or other malfeasance, Joe Biden stole that election.

    Trump posted 68 times about his various Washington, D.C., building projects, including his White House ballroom and a proposed massive arch across the Potomac near Arlington National Cemetery. That's slightly more than he posted about Venezuela, more than he posted about the SAVE Act he's promoting, and more than he posted about protesters and federal agents in Minneapolis, including federal agents killing two U.S. citizens.

    He posted more than six times as often (105) about his various legal grievances than he did about healthcare policy (17).

    Also notable are the topics that get little attention. While tariffs and the war in Iran do affect, for example, the farm economy, Trump posted just four times specifically about American farming during the first four months of the year — less than half as many times as he posted (nine times) about his anger at comedian Bill Maher.

    As for the top types of posts, the largest category – at just under one-quarter of his posts – are social media reshares. These take several formats — some are screenshots of posts from X, and others are videos reposted from other social media sites, such as TikTok.

    This emphasizes the technological differences between now and Trump's first term.

    Near the end of his first term, the videos Trump posted were largely from Fox News or other right-leaning news outlets, or they were videos produced by the White House.

    Now, there's an endless array of TikTok and Instagram videos and memes the president can repost, many of them from amateurs or generated by AI. Some have been outright offensive, as when he posted a racist video that depicted former President Obama and Michelle Obama as apes. The White House initially defended the video, with White House press secretary Karoline Leavitt telling reporters, "Please stop the fake outrage." Trump later said he hadn't seen the full video, telling reporters, "I looked at the beginning of it. It was fine." He did not apologize, and the post was later deleted.

    Other posts have promoted conspiracy theories, as with a video that baselessly proposed that Democratic Minnesota Gov. Tim Walz was involved in the 2025 killing of Minnesota Democratic State Rep. Melissa Hortman.

    Occasionally, those videos have nothing to do with current events, or even Trump, but are the kind of inane posts littering many people's Facebook feeds. Around 11 p.m. one night in February, Trump posted a TikTok video of a person's pet corgi reacting to a can of Reddi-wip. A minute later, he reposted that video along with a screenshot of a supporter's X post ("Good Night Patriot Friends!"). A minute after that, he posted a 15-second video of Bruce Lee fighting, which he similarly reposted alongside another X screenshot seconds later.

    Reposting material from X

    This posting-then-reposting pattern is one of the more notable oddities of the president's Truth Social posts. It appears to be a makeshift way of reposting things from X. The president regularly grabs, for example, a video someone else has posted on X, posts it without attribution on Truth Social, then immediately quote-posts his own post along with a screenshot of the original X post.

    Some of these reposts are about current events, but they cover many other topics as well – they include a variety of amateur-made videos praising Trump, attacking his enemies, and (incorrectly) concurring with his false claim that he in fact won the 2020 election. In recent months, Trump has reposted a video compilation of moments with his grandkids, a video about his loyalty to Michael Jackson over the years, a montage of Trump moments set to a choral arrangement of "Like a Prayer," and an apparently AI-generated video of Trump playing hockey against Canadian hockey players – and punching the bejeezus out of one of them.

    The pattern of snagging content from X highlights two important facts about Truth Social.

    One is that X appears to dwarf it in size. The Center for Campaign Innovation, a right-leaning political strategy organization, provided NPR with polling from around the 2024 election, finding that only 6% of people used Truth Social for news on even a weekly basis. That's compared to 30% who used X.

    Trump may therefore go to X to get material because there are just more users there, and especially more big names like politicians, news organizations, and MAGA influencers.

    Secondly, Truth Social's smaller size means it serves a different purpose for Trump than Twitter ever did, before Trump was kicked off of the platform after the January 6 riot. (His account was eventually reinstated.)

    "I think really the best way to understand it is this is where you get your marching orders if you're MAGA," said Eric James Wilson, a Republican strategist and executive director of the Center for Campaign Innovation. "And too, it is direct communication from him, in the way that maybe a statement, an administration policy or a press release would have to go through multiple layers of, if not revisions, certainly approvals."

    Leavitt told NPR in a statement that Truth Social is "the most powerful and popular social media platform in the world because it serves as President Trump's authentic voice."

    One restriction has kept Trump from simply posting on X when he wants a bigger audience – according to details about a licensing agreement in a 2023 SEC filing, he is "generally obligated to make any social media post on TruthSocial and may not make the same post on another social media site for 6 hours." This gives the site "limited time to benefit from" his postings.

    NPR emailed Truth Social's press team to check if this agreement is still in effect, but the email bounced back.

    It's not entirely clear how many of the posts on the president's Truth Social account come directly from him. Leavitt also told NPR that some posts are made by staffers.

    "President Trump posts at all hours because he is constantly working, but sometimes these posts are also published by staff who are simply catching up on the many articles and reading materials President Trump approves the day prior," she said in another statement.

    It's not just news articles that the White House says Trump isn't personally posting; after backlash to the racist video depicting the Obamas the White House also said a staffer "erroneously" posted the video.

    Old news

    One of the most telling indicators of what's on Trump's mind can be found in the news articles he posts — more than 1 in 5 of the president's social media posts in the first four months of this year were news articles, op-eds, and videos. Those news pieces almost uniformly praise the president or promote administration-friendly storylines, including persecuting his perceived enemies.

    On March 29, in a span of six minutes, his account posted 10 news pieces about criminal referrals against New York Attorney General Letitia James, who prosecuted Trump in a civil business fraud case.

    A substantial number of the news stories Trump's account posts are not current. At least 1 in 4 of the news stories posted were more than 10 days old at the time he posted them (the dates of some TV news clips could not be easily verified).

    In some cases, such as the article about Lady Gaga's father, the news pieces were months old. At other times, he posted several older articles in rapid succession about the same event. On March 16, Trump posted three January articles in a row about the crowd at the College Football National Championship game cheering for him.

    Leavitt told NPR in a statement: "The President is extraordinarily well read, and he likes to share stories or content that he finds interesting on his account."

    The problem with bluster

    In the first four months of the year, President Trump made 98 posts we classified as "announcements" — which we defined as the president purporting to give the public new information.

    These covered a range of topics — there was the video announcing the U.S. had bombed Iran. There was the announcement of a new DHS secretary nominee — Markwayne Mullin. There were announcements about disaster aid to states affected by a massive winter storm. There were notifications of upcoming interviews or press conferences. Not all of these announcement posts turned out to be accurate, however, as with an April 17 post declaring the Strait of Hormuz to be "COMPLETELY OPEN AND READY FOR BUSINESS AND FULL PASSAGE."

    He also made 29 posts we classified as "threats." These range from the specific ("If Canada makes a deal with China, it will immediately be hit with a 100% Tariff") to the vague ("I wonder what would happen if we 'finished off' what's left of the Iranian Terror State"). The president hasn't followed through on all of these threats with concrete action.

    Altogether, that's 127 of Trump's most newsmaking posts — around one per day. Those posts have introduced an unprecedented unpredictability into presidential policymaking. His tariff policy posts, for example, have created widespread uncertainty in the business world.

    This can make life in a Trump White House particularly difficult, especially in the realm of foreign policy. John Bolton, who served as National Security Advisor in Trump's first term, tells a story about Trump's chaotic posts.

    "My deputy was there when [Trump] was shown — this is in 2019 — overhead pictures of a failed Iranian missile launch," Bolton says. "And he said to the intelligence briefer, can I keep this picture? And she said, 'Well, yes, but it's very sensitive, Mr. President.' He said, 'Okay.' And about 20 minutes after they left, he tweeted the picture out with some of the markings still on the picture."

    As NPR later reported, the photo was revealed to be classified. Experts told NPR that tweeting the picture potentially helped America's adversaries, including Iran and Russia, because it revealed U.S. satellite capabilities.

    Since his time in the first Trump administration, Bolton has been willing to sharply criticize the president. In October, the Trump Department of Justice obtained indictments against Bolton on 18 charges alleging that he unlawfully retained and transmitted classified documents. Bolton pleaded not guilty.

    Bolton sees Trump tweeting the picture as part of a larger pattern: to attempt maximum bluster and in the process reveal more than he intends to. Trump's recent posts about the war in Iran are another example.

    "The very ferocity of his tweets or the outrage you can hear just tell the Iranians 'If we just stay, if we just be patient a little while longer, he's just going to flip right out entirely, and he wants out. So we're going to drag it out and get every concession we can from him,'" Bolton said. "I don't understand why he can't see that."

    Pundits have theorized that with his threatening posts about Iran, President Trump is practicing the "madman theory" of foreign relations. H.R. Haldeman, who served as chief of staff to President Nixon wrote that Nixon's strategy was to make the U.S.S.R. and the government in North Vietnam think that the fervently anticommunist president was willing to go to even extreme lengths, such as dropping a nuclear bomb, to end the Vietnam War.

    "Nixon had credibility. He was strongly anti-communist," Bolton said, adding that communist adversaries might have thought, "Good God, that guy is crazy enough that he would drop a nuclear weapon."

    "Just being generically crazy does not give you an advantage," Bolton added.

    A president's id on display

    To some degree, the president's posting can be seen as an extension of his communications strategy of simply communicating a lot. Trump regularly does lengthy press gaggles in the Oval Office, and he also has the unprecedented habit of fielding calls directly from reporters who have his phone number.

    However, with posts, unlike interviews, the president is not having a conversation. Rather than being prompted by a reporter, the president in his posts seemingly reveals what is on his mind at any given time. On April 2, the day he announced that Pam Bondi would be leaving her post as attorney general, President Trump was also thinking about Bruce Springsteen. He insulted the singer in two posts shared at 7:58 a.m. and 9:21 p.m. that day.

    Indeed, the president's insults and tirades have become so commonplace that they at times don't get much notice. Some of these posts go on at length. On April 9, he wrote a more than 2,700-character post that insulted a series of right-wing commentators but also veered into the topics of Iran, election results, media outlets he dislikes, and his approval rating.

    This kind of naked fury from the president of the United States toward his perceived opponents ("NUT JOBS," "TROUBLEMAKERS," "low IQs," "nasty") might once have made headlines.

    In 2026, it's a Thursday.

    (
    Truth Social
    /
    Screenshot by NPR
    )

    NPR also analyzed the length of Trump's posts this year through the end of April. He wrote 93 posts of 1,500 characters or more in that time period, accounting for around 4% of all his posts. About half of those are endorsements, in which the president praises his chosen candidates and at times rails against the opponent ("DEFEAT Third Rate Congressman Thomas Massie, a Weak and Pathetic RINO"). Many of these endorsements appear to be variations on boilerplate language as Trump endorses a string of candidates in a short timeframe.

    The rest of these long posts are anything but boilerplate – they are often attacks ("Pope Leo is WEAK ON CRIME") and occasionally announcements ("I am nominating Kevin Warsh to be the CHAIRMAN OF THE BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM").

    Trump had more of those ultra-long posts in April than in any other month. And if you take out endorsements, it's even more stark. In April, Trump posted 22 extra-long posts about things other than endorsements — slamming Supreme Court justices, repeatedly promoting his ballroom, and railing against particular media outlets. That's twice as many such posts, or more, as he had in any other month.

    To the degree, then, that the length of his posts correlates to Trump's anger, or perhaps enthusiasm, April was a particularly enthusiastic month for the president.

    The president's Truth Social account primarily gets wide attention when the president either makes an announcement or writes something particularly coarse or offensive.

    That was the case on Easter morning this year, at around 8:00 a.m., when President Trump threatened Iran.

    "Tuesday will be Power Plant Day, and Bridge Day, all wrapped up in one, in Iran. There will be nothing like it!!! Open the F*****' Strait, you crazy bastards, or you'll be living in Hell - JUST WATCH! Praise be to Allah," he wrote.

    A threat of massive violence — and potentially war crimes — along with an obscenity and a tongue-in-cheek praise to Allah, all on one of Christianity's holiest days, together were stunning choices for a president whose core supporters are white evangelical Christians.

    In a recent NPR focus group of Georgia swing voters — people who voted for Joe Biden in 2020 and Trump in 2024 — no one reacted positively to that post. Participants were identified by their first names as a condition of their participation. One voter named Joe said that posts like that one inspire fear.

    "It's not presidential. They're supposed to be doing diplomatic negotiations. You know, he's the agent of chaos when it comes to this kind of thing. It just – it scares me," he said. "He's a loose cannon, in my opinion, when it comes to this kind of stuff."

    Brent Jones contributed to this report.

    Copyright 2026 NPR

  • Work to begin Monday
    A peeling chemical tank is seen next to two other intact tanks at the GKN aerospace facility in Garden grove. An RV can be seen on the right hand side peeking into the picture. An even larger tank is behind the two other tanks.
    The chemical tank at the GKN Garden Grove aerospace facility.

    Topline:

    On Monday clean up begins for two tanks of neutralized methyl methacrylate at the center of last month’s chemical incident in Garden Grove.

    The backstory: About 50,000 Orange County residents were evacuated for several days after one of the tanks overheated on May 21, generating fears of an explosion or a leak through the Memorial Day weekend.

    What's next: The cleanup will be done in phases. This phase wraps Thursday, July 2.

    Go deeper: FBI executes search warrant at site of Garden Grove chemical meltdown scare

    A hazardous materials team will begin working Monday to remove neutralized methyl methacrylate from two of three tanks at the GKN aerospace facility in Garden Grove.

    Some 50,000 Orange County residents were evacuated for several days last month after one of the tanks overheated on May 21, causing fears of an explosion or a leak through the Memorial Day weekend.

    The clean-up will be done in phases, until Thursday, “with multiple layers of safety protocols and oversight measures in place,” according to a press release from the Orange County Health Care Agency.

    Garden Grove chemical cleanup

    Updates on the cleanup activities will be posted publicly here, including air monitoring data.

    Containers that support temperature control and secure transportation will be used in the operation.

    Cleanup was initially scheduled to begin June 4, but was postponed after officials said "needed resources" were unavailable.

    Orange County District Attorney Todd Spitzer launched an investigation into the incident last month. The FBI and Environmental Protection Agency also seized evidence at the facility earlier this month.

    Methyl methacrylate produces a fruit-like odor, Orange County Health Care Agency said residents may notice the scent during the operation. The agency said levels will remain below thresholds that could pose health risks.

    Officials say environmental protection will be in place throughout the week. Air will be continuously monitored through both mobile and fixed equipment at the fence line of the facility and in the community. Air and odor monitoring based on wind conditions will also be done. Work will occur only during the daylight hours until Thursday.

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  • Budget cuts limit education access
    a number of men in blue shirts sit at desks with papers and books in front of them, many of them holding pencils
    Incarcerated people study to take the G.E.D. exam at San Quentin State Prison on July 26, 2023.

    Topline:

    California prisons are limiting access to programs for incarcerated people as the system manages it overtime budget. The state spends about $18 billion a year on corrections.

    Why now: The rollback began earlier this month and will end June 30, according to documents obtained by CalMatters. Corrections spokesperson Terri Hardy described the limitations as a “cost-saving measure.” The department’s overall budget has remained about flat since 2022 around $18 billion a year despite recent cuts that include five prison closures.

    The backstory: Lawmakers at budget hearings earlier this year pressed Corrections Secretary Jeff Macomber to tighten spending as the department asked for additional $91 million in ongoing funding to cover unbudgeted personnel costs. The department last month also proposed an additional $100 million in workers compensation.

    Read on ... for more on how these cuts will affect programs in the prisons.

    The California Department of Corrections and Rehabilitation is restricting access to rehabilitative programming for incarcerated people as it clamps down on overtime spending before the end of its financial year.

    Hundreds of rehabilitative programs operate throughout California prisons, including restorative justice, violence prevention, higher education, creative arts expression and entrepreneurial training.

    The rollback began earlier this month and will end June 30, according to documents obtained by CalMatters. Corrections spokesperson Terri Hardy described the limitations as a “cost-saving measure.” The department did not respond to a detailed list of questions, including which prisons and programs have been affected.

    The department’s overall budget has remained about flat since 2022, around $18 billion a year despite recent cuts that include five prison closures.

    Lawmakers at budget hearings earlier this year pressed Corrections Secretary Jeff Macomber to tighten spending as the department asked for additional $91 million in ongoing funding to cover unbudgeted personnel costs. The department last month also proposed an additional $100 million in workers compensation.

    The California Correctional Peace Officers Association, the union that represents state prison guards, did not respond to CalMatters’ requests for an interview.

    Tony Tafoya, who’s been incarcerated since 2012, said he’s never seen anything like this happen before. Tafoya said the scale-back has had the biggest impact on college classes. He’s currently enrolled in Mount Tamalpais College at San Quentin but said his math class has missed out on 12 days of instruction.

    “I feel like I’m falling behind,” he said. “There’s a lot of healing that comes from going to school. It provides humanity. It makes me feel like I’m actually seen as a person. I feel like that’s what’s being missed out on.”

    Programs at Pleasant Valley State Prison in Coalinga have also been interrupted, including a civic education pilot program. The program, run by the organization Initiate Justice, includes just over a dozen incarcerated people who helped draft legislation to improve social emotional learning in the K-12 school system. Assembly Bill 1851, authored by Democratic Assemblymember Mike Gipson from Gardena, is sailing through the Legislature and scheduled for an upcoming education committee hearing Wednesday.

    Antoinette Ratcliffe, executive director of Initiate Justice, said the group “thrives off of active and live discussion, off of meaningful exploration.” The severing of that connection disrupts the learning experience and practical application of the programming, she said.

    “We have made it a goal across the Legislature to make rehabilitative programming a priority, so to continue to see disruptions like this feels counter to what we agreed upon as a state,” she said. “It feels like a let down.”

    Other advocates have echoed those sentiments. Danica Rodarmel, a criminal justice reform lobbyist, said any disruption in people’s ability to access programming impacts their mental health and well being. The completion of a program or certificate, she said, is often a determining factor in people’s ability to be granted parole.

    “Limiting people’s ability to engage in pro-social activities is contradictory to the goals of maintaining safe prisons both for the people who are incarcerated but also for the people who work there,” she said.

  • Would those most at risk trust potential vaccine?
    a person in an american flag t-shirt holds up a piece of paper with red targets printed on it and which has been shot full of holes
    Matthew Mealer holds up his targets at the Busch Shooting Range in Weldon Spring, Mo., in May. Mealer said he's generally skeptical of new vaccines but might consider one for Lyme disease if it proves safe and effective.
    Topline:
    Pharmaceutical companies Pfizer and Valneva announced this spring that they plan to seek regulatory approval for a vaccine to protect against Lyme disease. But it's unclear whether this latest stab at a Lyme disease vaccine will get a warmer reception if it's approved, especially in the post-COVID era of vaccine skepticism.

    Why it matters: About 476,000 people in the U.S. may be diagnosed and treated for Lyme disease each year, the CDC says. Left untreated, Lyme disease can cause a variety of symptoms, from fevers, chills and headaches to arthritis, shooting pains and inflammation of the brain and spinal cord.

    Read on ... to see what rural hunters in Missouri think about the possibility of a vaccine and for their stories of how the disease has affected them personally.

    It's tick season, possibly the worst in a decade.

    More and more Americans are being exposed to these parasites as climate change expands the range where they can survive. That means more people are also exposed to the bevy of health conditions they can cause, such as Rocky Mountain spotted fever, the alpha-gal-triggered red meat allergy and, most common of all, Lyme disease.

    For Lyme disease, there may be some additional protection on the horizon. Pharmaceutical companies Pfizer and Valneva announced this spring that they plan to seek regulatory approval for a vaccine to protect against Lyme disease. A previous vaccine for Lyme became available in the late 1990s but was pulled only three years later due to lawsuits, public fear of side effects and a lack of interest.

    It's unclear whether this latest stab at a Lyme disease vaccine will get a warmer reception if it's approved, especially in the post-COVID era of vaccine skepticism.

    For a sense of how it might go over with rural populations at high risk of Lyme, KFF Health News spoke with a group of hunters.

    Few people spend more time in the woods exposed to ticks. At the same time, as a collective, hunters  skew conservative, rural and male, according to a survey from the Theodore Roosevelt Conservation Partnership. And these are identities associated with increased hesitancy about or resistance to vaccines, according to Ashley Kirzinger, associate director for Public Opinion and Survey Research at KFF, a health information nonprofit that includes KFF Health News.

    Targets for ticks

    Left untreated, Lyme can cause a variety of symptoms, from fevers, chills and headaches to arthritis, shooting pains and inflammation of the brain and spinal cord, according to the Centers for Disease Control and Prevention.

    About 476,000 people in the U.S. may be diagnosed and treated for Lyme disease each year, the CDC says. That's at least in part because the range of places where cases have been reported has "expanded significantly" since 1995.

    So would hunters get the Lyme vaccine if it became available?

    "Given my proclivity for the outdoors, absolutely," said Jess Manganelli, one of seven hunters (and one hiker) who spoke with KFF Health News on a recent Saturday at the Busch Shooting Range in Weldon Spring, Mo., just outside of St. Louis.

    Of the eight, Manganelli, who had been hunting turkeys the weekend before, was the most positive about the vaccine. Six others said they would consider it but would want more information about its safety and effectiveness, as well as their risk for contracting the disease.

    But Manganelli was the only one who believed she may have previously contracted Lyme disease, although she was never formally diagnosed with it. Two years ago, she experienced muscle weakness, tiredness, fatigue, swelling and headaches after a tick bite, but when she went to urgent care, she was told they didn't test for Lyme.

    Nearly all the hunters knew someone who had had Lyme disease — an old roommate, a family member, friends, a former student. Lyme can be difficult to diagnose and to treat and is often misdiagnosed at first. Many of the hunters witnessed their acquaintances navigating those challenges and struggling with sometimes debilitating symptoms.

    An illness with lingering effects

    That familiarity among the hunters in Missouri was unsurprising to author and conservationist Steven Rinella, host of the hunting show MeatEater.

    "I'm a turkey hunter. In talking about turkey hunting, you talk about ticks as much as you talk about turkeys," Rinella said. "Just the nature of turkey hunting puts you into exposure. You're sitting for long periods of time, trying to use vegetation for concealment."

    In fact, both Rinella and his older son contracted Lyme disease 13 years ago during a bluegill fishing trip in the Hudson Valley in New York. His son developed Bell's palsy, a sudden paralysis on one side of the face, but recovered quickly after a course of oral antibiotics. Steven Rinella's symptoms, on the other hand, lingered for months, leaving him unable to walk down stairs without a handrail or to ride a bike. He ended up receiving intravenous antibiotic treatments for a month.

    "I thought my life had changed," Rinella said, "but I recovered, as far as I know."

    That experience is one reason Rinella said he would absolutely consider getting a Lyme vaccine if it proved safe and provided considerable protection against the disease. Unlike with some other diseases, prior infection does not provide permanent immunity, so a person who has had Lyme could still benefit from a vaccine.

    Knowledge of similar challenges influenced the thinking of the hunters in Missouri as well.

    Jeremy Hollingshead said he may be less inclined to take a vaccine owing to his former roommate's experience with Lyme disease, which is not to say the experience was pleasant. In fact, Hollingshead said he thinks his old pal is still dealing with lingering effects of it 10 years later. But Hollingshead has spent his whole life in the woods, and of hundreds of people he knows who have done the same, he knows of only one of them contracting Lyme.

    "I know it was a bad outcome for him," Hollingshead said, but he thinks the odds of getting Lyme himself seem pretty slim.

    Meanwhile, Julian Barnes said seeing a relative struggle with Lyme makes him more open to a potential vaccine. It took a long time for doctors to come to that diagnosis, and finding a good treatment has been equally difficult.

    "I would say I am vaccine-hesitant, generally speaking," Barnes said. "But Lyme, I've seen the way it affects people in my life. ... I would definitely have to really understand the vaccine, how it works."

    An unclear path for a new vaccine

    The new, four-dose vaccine candidate technically missed one of the bars set out in trials because not enough participants contracted Lyme. Still, the companies say it's about 75% effective in reducing cases, and they plan to submit it to regulators for approval. A Pfizer spokesperson said there were no updates on their regulatory efforts when contacted by KFF Health News in June.

    Health and Human Services Secretary Robert F. Kennedy Jr. was a noted anti-vaccine activist before taking over as head the agency that oversees vaccine approvals, and he's remade it in ways that have prompted some vaccine makers to pull back on development.

    But he's also been an advocate on Lyme disease. In May, he announced an initiative to combat Lyme disease. And during his Senate confirmation hearings, he said his family had been deeply affected by Lyme disease and that nobody would work harder than he would to find a vaccine or treatment.

    If the vaccine is ultimately approved by the FDA, an endorsement from Kennedy would go a long way, according to KFF's Kirzinger, particularly among supporters of his Make America Healthy Again movement, who tend to be more vaccine-skeptical.

    "They trust him as much as they trust their own doctors to tell them what to do with their health and for health information," Kirzinger said. "If he comes out as a strong proponent of this vaccine and says, 'Look what my administration did, and we made this available,' I would imagine there would be less vaccine resistance among that group."

    Only one of the hunters who spoke with KFF Health News said they definitely would not be interested in a Lyme vaccine if it became available.

    "I kind of hand it off to God and the body he gave me. I'm pretty durable," JP Cummings said. But even though he's not interested in it for himself, he's curious to see what his fellow hunters do as more information comes out.

    "Hunters care about the wildlife; hunters care about health," Cummings said. "They love the wildlife, they love their deer, and they love their fellow hunters."

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF.

  • Steep price increase likely to blame
    The federal government released data on how many people dropped coverage in the 29 states that use the HealthCare.gov marketplace for ACA insurance.

    Topline:

    Five million fewer people are currently enrolled in ACA marketplace plans compared to the record high reached last year. More than 1 million fewer people picked a plan for 2026, and then 4 million more either disenrolled or failed to pay their premiums and, therefore, dropped coverage.

    Why now: Prices in the market skyrocketed after President Donald Trump and Republicans in Congress failed to extend extra financial help for enrollees last year. The Department of Health and Human Services published a report about the data on its website Friday.

    What's next: People dropping their coverage tend to be healthier people. If too many healthy people drop out of the markets, there's a danger that the markets could enter a "death spiral."

    Read on ... for more on the latest insurance market trends.

    Far more people than previously known have dropped Affordable Care Act health insurance for 2026, according to data released Friday.

    Five million fewer people are currently enrolled in ACA marketplace plans compared to the record high reached last year. More than 1 million fewer people picked a plan for 2026, and then 4 million more either disenrolled or failed to pay their premiums and, therefore, dropped coverage.

    Prices in the market skyrocketed after President Donald Trump and Republicans in Congress failed to extend extra financial help for enrollees last year. The Department of Health and Human Services published a report about the data on its website Friday.

    The report says 19.2 million people are currently enrolled in ACA insurance now.

    At its high, 24.2 million people were in the ACA marketplace in 2025, according to government figures.

    The steep drop in enrollment reflects what insurers, administrators and other health policy experts expected earlier this year. After initial sign ups were lower than last year, they predicted the picture would get worse as time went on and people found they could not afford to pay their premiums.

    "The main takeaway is that enrollment is down 13% from last year," explains Cynthia Cox, director of KFF's Program on the ACA. "While the Trump administration attributes this drop in enrollment to their attempts to address fraud, this coverage loss happened at the same time millions of people faced double- or even triple-digit increases in their premium payments with the expiration of enhanced tax credits."

    The idea that the growth in enrollment was due to massive fraud is a theory advanced by the Paragon Health Institute, a conservative think tank influential in the Trump administration.

    Many health policy experts are skeptical. They say the increase in enrollment during the pandemic is not suspicious. It was a predictable consequence of Congress's investment of billions of federal dollars in making premiums more affordable — the enhanced premium tax credits.

    "The marketplace doubled in size during the period when there were enhanced subsidies because the coverage was much more affordable and much more appealing to people," Cox says.

    This year's drop in enrollment is also predictable, given that premium costs doubled, on average, from 2025 to 2026. The costs went up after Republican lawmakers let the enhanced premium tax credits expire; Democrats shut down the government in October 2025 trying to negotiate an extension of the credits that would have kept prices low.

    "When their costs went up, many of them dropped their coverage," Cox says.

    She adds that while fraud is a real problem in the ACA marketplaces, as it is in all insurance markets, she thinks it does not account for all of the drop in enrollment.

    Stacey Pogue, senior research fellow at the Georgetown Center on Health Insurance Reforms, agrees.

    "I don't see data that point to that conclusion that a 5 million-person drop can be explained by allegations of fraud," she says. "There's lots of evidence pointing to people making decisions based on what they can pay each month."

    The higher health insurance costs are tough for consumers in an economy still plagued by overall inflation. As congress let the prices go up, people made tough decisions about family budgets, where to work, whom to marry and more.

    It's also a problem for insurance companies, several of which have announced they will not be participating in ACA markets next year, including Cigna.

    "If there are fewer customers, then that makes the market less appealing to insurance companies," Cox says.

    That's especially true because the people dropping their coverage tend to be healthier people. If too many healthy people drop out of the markets, there's a danger that the markets could enter a "death spiral."

    Cox says she's not worried about a death spiral at this point.

    "I think there are still enough people buying ACA marketplace coverage and that's going to keep these markets working," she says. "At this point, we don't see any parts of the country that are at risk of having no insurance company. If that were to happen, that would be what a death spiral might look like."

    Even so, the premiums for these plans are on track to keep rising, which could continue to pummel consumers navigating high health care costs. Enrollment in the marketplaces may continue to shrink too. According to a recent analysis from Pogue at Georgetown, early insurance rate filings for 2027 show that rates will be going up again next year.