Henry Larweh and Rachana Pradhan and Rae Ellen Bichell
The Trump administration’s cuts to Centers for Disease Control and Prevention funding for state and native well being departments had vastly uneven results relying on the political leanings of a state, in response to a KFF Health News evaluation. Democratic-led states and choose blue-leaning cities fought again in court docket and noticed cash for public well being efforts restored — whereas GOP-led states sustained massive losses.
The Department of Health and Human Services in late March canceled practically 700 Centers for Disease Control and Prevention grants nationwide — collectively value about $11 billion. Awarded throughout the covid-19 pandemic, they supported efforts to vaccinate individuals, scale back well being disparities amongst demographic teams, improve antiquated methods for detecting infectious illness outbreaks, and rent group well being staff.
Initially, grant cancellations hit blue and pink states roughly evenly. Four of the 5 jurisdictions with the most important variety of terminated grants have been led by Democrats: California, the District of Columbia, Illinois, and Massachusetts.
But after attorneys basic and governors from about two dozen blue states sued in federal court docket and gained an injunction, the steadiness flipped. Of the 5 states with essentially the most canceled grants, 4 are led by Republicans: Texas, Georgia, Oklahoma, and Ohio.
In blue states, practically 80% of the CDC grant cuts have been restored, in contrast with fewer than 5% in pink states, in response to the KFF Health News evaluation. Grant quantities reported in an HHS database generally known as the Tracking Accountability in Government Grants System, or TAGGS, typically don’t match what states confirmed. Instead, this evaluation targeted on the variety of grants.
The divide is an instance of the polarization that permeates well being care points, by which entry to safety-net well being packages, abortion rights, and the flexibility of public well being officers to reply to illness threats diverge considerably relying on the political social gathering in energy.
In an emailed assertion, HHS spokesperson Andrew Nixon mentioned the company “is committed to protecting the health of every American, regardless of politics or geography. These funds were provided in response to the COVID pandemic, which is long over. We will continue working with states to strengthen public health infrastructure and ensure communities have the tools they need to respond to outbreaks and keep people safe.”
The cash in query wasn’t spent solely on covid-related actions, public well being specialists say; it was additionally used to bolster public well being infrastructure and assist include many forms of viruses and illnesses, together with the flu, measles, and RSV, or respiratory syncytial virus.
“It really supported infrastructure across the board, particularly in how states respond to public health threats,” mentioned Susan Kansagra, chief medical officer of the Association of State and Territorial Health Officials.
The Trump cutbacks got here because the U.S. recorded its largest measles outbreak in over three many years and 266 pediatric deaths throughout the newest flu season — the highest reported exterior of a pandemic since 2004. Public well being departments canceled vaccine clinics, laid off workers, and put contracts on maintain, well being officers mentioned in interviews.
After its funding cuts have been blocked in court docket, California retained each grant the Trump administration tried to claw again, whereas Texas stays the state with essentially the most grants terminated, with at the very least 30. As the CDC slashed grants in Texas, its measles outbreak unfold throughout the U.S. and Mexico, sickening at the very least 4,500 individuals and killing at the very least 16.
Colorado, which joined the lawsuit, had 11 grant terminations at first, however then 10 have been retained. Meanwhile, its neighboring states that did not sue — Wyoming, Utah, Kansas, Nebraska, and Oklahoma — collectively misplaced 55 grants, with none retained.
In Jackson, Ohio, a half-dozen group well being staff got here to work sooner or later in March to seek out the Trump administration had canceled their grant 5 months early, leaving the Jackson County Health Department half one million {dollars} quick — and them with out jobs.
“I had to lay off three employees in a single day, and I haven’t had to do that before. We don’t have those people doing outreach in Jackson County anymore,” Health Commissioner Kevin Aston mentioned.
At one level, he mentioned, the funding helped 11 Appalachian Ohio counties. Now it helps one.
Marsha Radabaugh, one worker who was reassigned, has scaled again her group well being efforts: She’d been serving to serve sizzling meals to homeless individuals and realized that many purchasers couldn’t learn or write, so she introduced kinds for companies corresponding to Medicaid and the Supplemental Nutrition Assistance Program to their encampment in an area park and helped fill them out.
“We would find them rehab places. We’d get out hygiene kits, blankets, tents, zero-degree sleeping bags, things like that,” she mentioned. As a counselor, she’d additionally remind individuals “that they’re cared for, that they’re worthy of being a human — because, a lot of the time, they’re not treated that way.”
Sasha Johnson, who led the group well being employee program, mentioned individuals like Radabaugh “were basically a walking human 411,” providing help to these in want.
Radabaugh additionally partnered with a meals financial institution to ship meals to homebound residents.
Aston mentioned the abrupt manner they misplaced the funds — which meant the county unexpectedly needed to pay unemployment for extra individuals — might have ruined the well being district financially. Canceling funding midcycle, he mentioned, “was really scary.”
HHS Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist and promoter of vaccine misinformation, has called the CDC a “cesspool of corruption.” At HHS, he has taken steps to undermine vaccination within the U.S. and overseas.
Federal CDC funding accounts for more than half of state and native well being division budgets, in response to KFF, a well being info nonprofit that features KFF Health News. States that President Donald Trump gained within the 2024 election obtained a better share of the $15 billion the CDC allocated in fiscal 2023 than those who Democrat Kamala Harris gained, in response to KFF.
The Trump administration’s nationwide CDC grant terminations replicate this. More than half have been in states that Trump gained in 2024, totaling at the very least 370 terminations earlier than the court docket motion, in response to KFF Health News’ evaluation.
The Columbus, Ohio, well being division had obtained $6.2 million in CDC grants, however roughly half of it — $3 million — disappeared with the Trump cuts. The metropolis laid off 11 individuals who labored on investigating infectious illness outbreaks in such locations as colleges and nursing properties, Columbus Health Commissioner Mysheika Roberts mentioned.
She additionally mentioned the town had deliberate to purchase a brand new digital well being file system for simpler entry to sufferers’ hospital information — which might enhance illness detection and supply higher therapy for these contaminated — however that was placed on ice.
“We’ve never had a grant midcycle just get pulled from us for no reason,” Roberts mentioned. “This sense of uncertainty is stressful.”
Columbus didn’t obtain its cash straight from the CDC. Rather, the state gave the town some funds it obtained from the federal authorities. Ohio, led by Republican Gov. Mike DeWine and a Republican lawyer basic, didn’t sue to dam the funding cuts.
Columbus sued the federal government in April to maintain its cash, together with different Democratic-led municipalities in Republican-governed states: Harris County, Texas, house to Houston; the Metropolitan Government of Nashville and Davidson County in Tennessee; and Kansas City, Missouri. A federal choose in June blocked these cuts.
As of mid-August, Columbus was awaiting the funds. Roberts mentioned the town gained’t rehire workers as a result of the federal funding was anticipated to finish in December.
Joe Grogan, a senior scholar on the University of Southern California’s Schaeffer Institute and former director of the White House Domestic Policy Council in Trump’s first time period, mentioned state and native companies “are not entitled” to the federal cash, which was awarded “to deal with an emergency” that has ended.
“We were throwing money out the door the last five years,” Grogan mentioned of the federal authorities. “I don’t understand why there would ever be a controversy in unspent covid money coming back.”
Ken Gordon, Ohio Department of Health spokesperson, wrote in an electronic mail that the $250 million in grants misplaced had helped with, amongst different issues, upgrading the illness reporting system and boosting public well being laboratory testing.
Some of the canceled HHS funding wasn’t slated to finish for years, together with 4 grants to strengthen public well being in Indian Country, a grant to a Minnesota nonprofit targeted on decreasing substance use issues, and some to universities about occupational security, HIV, tuberculosis, and extra.
Brent Ewig, chief coverage and authorities relations officer for the Association of Immunization Managers, mentioned the cuts have been “the predictable result of ‘boom, bust, panic, neglect’ funding” for public well being.
The affiliation represents 64 state, native, and territorial immunization packages, which Ewig mentioned might be much less ready to reply to illness outbreaks, together with measles.
“The system is blinking red,” Ewig mentioned.
Methodology
KFF Health News’ evaluation of Centers for Disease Control and Prevention grants sought to reply 4 questions: 1) How many grants have been terminated within the U.S. underneath the Trump administration since March? 2) Which states noticed essentially the most grants minimize? 3) What have been the grants for? and 4) Did the grant terminations have an effect on blue, pink, and purple states in a different way? This follows the same evaluation by KFF Health News for an article on nationwide NIH grant terminations.
Our main information supply was a Department of Health and Human Services web site displaying grant terminations. We in contrast an preliminary record of grant terminations from April 3 with one from July 11 to find out what number of grants had been restored. The USAspending.gov database helped us monitor grants by state.
To classify states politically, we adopted the identical steps from our April coverage of National Institutes of Health grant terminations. States have been “blue” if Democrats had full management of the state authorities or if nearly all of voters favored Democratic presidential candidates within the final three elections (2016, 2020, 2024). “Red” states have been labeled equally with respect to the Republican Party. “Purple” states had politically break up state governments and/or have been typically thought-about to be presidential election battleground states. The end result was 25 pink states, 17 blue states, and eight purple states. The District of Columbia was labeled as blue utilizing comparable strategies.
This evaluation doesn’t account for potential grant reinstatements in native jurisdictions the place the funds have been awarded not directly slightly than straight from the CDC; it accounts just for the recipients’ location, and excludes grants terminated from Compacts of Free Association states and different overseas entities that obtained grants straight from the CDC. At least 40 CDC grants have been terminated that have been meant for world well being efforts or aiding public well being actions in different nations following the Trump administration’s order for the CDC to withdraw help for the World Health Organization.