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Friday, February 21, 2025

Measles Cases Are Spreading

 Donald G. McNeil Jr. at WP:
Given how much Robert F. Kennedy Jr. has done to scare Americans away from vaccines, it seems inevitable that a runaway measles epidemic will ensue. Dozens of cases in rural West Texas might already be the start of one.

As Kennedy takes office as secretary of health and human services, the world’s most transmissible virus is challenging him to an arm-wrestling match, and it’s one that the iron-pumping health advocate cannot win. If he sticks to the nonsense he has spread for the past two decades, children will die — publicly, with their grieving parents interviewed on camera, regretting their decisions not to vaccinate.

On the other hand, if he wants to prevent the deaths, he will have to have to repudiate the skepticism that has made him famous (and wealthy) and vigorously urge Americans to be inoculated.

The signs are not good.

Adam Cancryn, Lauren Gardner and David Lim at Politico:
HHS Secretary Robert F. Kennedy Jr. is preparing to remove members of the outside committees that advise the federal government on vaccine approvals and other key public health decisions, according to two people familiar with the planning.

Kennedy plans to replace members who he perceives to have conflicts of interest, as part of a widespread effort to minimize what he’s criticized as undue industry influence over the nation’s health agencies, said one of the people, who were granted anonymity to speak freely. Kennedy has long argued that drugmakers have too much sway over the approval of their products.
The effort is likely to target the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, which plays a key role in setting vaccine policy. Kennedy and his top aides are also scrutinizing a host of other outside panels, including those that advise the Food and Drug Administration.

Kennedy has only just begun evaluating the advisory committees, one of the people cautioned, and has not decided who or how many people will be replaced, or set a firm timeline for the removals.

But should he follow through, the moves would likely generate upheaval within the Department of Health and Human Services and feed concerns across the broader public health establishment that Kennedy could undermine Americans’ trust in vaccines.

...

The fresh scrutiny comes as a meeting scheduled for next week of the CDC’s external vaccine committee was canceled, according to a person familiar with the decision. HHS spokesperson Andrew Nixon said the meeting is being “postponed to accommodate public comment in advance of the meeting.”

The federal public comment portal for the meeting — which was set to be open from Feb. 3 through Feb. 17 — was never activated, a contributing factor to the postponement. The public historically has had an opportunity to comment on the meeting agenda and request time to make oral statements.

 

Thursday, February 20, 2025

Trump v. Disability Services

According to the National Center for Education Statistics, 7.5 million children 3 to 21 years old received services under the Individuals with Disabilities Education Act in AY 2022-23.

About 980,000 of them were autistic, up from 498,000 in 2012-13.

Eric Garcia at The Independent:
Educators, researchers and employees at the Department of Education say that the Trump administration’s slashing of federal bureaucracies and workforces has significantly weakened special education enforcement and killed programs meant to help students with disabilities.

Last week, Tamara Linkow, the senior director of the American Institutes for Research’s education evaluation studies program, told The Independent that she learned that the federal government canceled funding for Charting my Path for Future Success. The program was meant to help students with disabilities learn about programs to transition to adulthood.
...

“The instructors had just started working with students,” Linkow said. “They were about a month and a half in depending upon the district, working with their students, and they had to stop overnight.”
The program was funded as part of a $45 million grant entitled “Evaluation of Transition Supports for Youth with Disabilities,” which was meant to evaluate the best programs for students with disabilities based on “strengthening students' goal setting, planning, and self-advocacy skills and helping them apply these self-determination skills to their transition objectives,” according to the grant’s website.

“This project was so powerful because it was both getting students access to services, getting school districts access to trained instructors to deliver effective services, and we were going to learn a lot about effective services as well so that we could inform the future of what schools and teachers are doing,” Karrie Shogren, a professor of special education at the University of Kansas, said.

Wednesday, February 19, 2025

RFK Jr. Makes a Fool of Senator Cassidy

Amanda Seitz at AP:
To earn the vote he needed to become the nation’s top health official, Robert F. Kennedy Jr.
made a special promise to a U.S. senator: He would not change the nation’s current vaccination schedule.

But on Tuesday, speaking for the first time to thousands of U.S. Health and Human Services agency employees, he vowed to investigate the childhood vaccine schedule that prevents measles, polio and other dangerous diseases.

“Nothing is going to be off limits,” Kennedy said, adding that pesticides, food additives, microplastics, antidepressants and the electromagnetic waves emitted by cellphones and microwaves also would be studied.

Kennedy’s remarks, which circulated on social media, were delivered during a welcome ceremony for the new health secretary at the agency’s headquarters in Washington as a measles outbreak among mostly unvaccinated people raged in West Texas. The event was held after a weekend of mass firings of thousands of HHS employees. More dismissals are expected.

In his comments Tuesday, Kennedy promised that a new “Make America Healthy Again” commission would investigate vaccines, pesticides and antidepressants to see if they have contributed to a rise in chronic illnesses such as diabetes and obesity that have plagued the American public. The commission was formed last week in an executive order by Donald Trump immediately after Kennedy was sworn in as the president’s new health secretary.

That directive said the commission will be made up of cabinet members and other officials from the administration and will develop a strategy around children’s health within the next six months. Kennedy said it will investigate issues, including childhood vaccinations, that “were formally taboo or insufficiently scrutinized.”

While Kennedy did not directly call for changes to the vaccination schedule on Tuesday, his plan to investigate it raises questions about his commitment to Republican Sen. Bill Cassidy, a Louisiana physician who harbored deep misgivings over the health secretary’s anti-vaccine advocacy. Cassidy ultimately voted to send Kennedy’s nomination to the Senate floor after he said Kennedy gave him assurances that he would not alter the federal vaccine schedule.

Tuesday, February 18, 2025

Trump Wants to Scrap the Department of Education

In The Politics of Autism, I write about social servicesspecial education and the Individuals with Disabilities Education Act

Katy Neas, CEO of The Arc of the United States.,writes at Newsweek:
The Department of Education does far more than provide support to state departments of education. It funds high-quality training for special education teachers, drives innovation in how we educate students with disabilities, supports parents, and enforces disability rights laws. It also ensures that when students with disabilities are not able to access appropriate special education services, families have a way to fight back. In fact, the largest category of complaints filed with the Department of Education are from parents of students with disabilities who believe their children are being denied the education they need and deserve. In many cases, the Department of Education works directly with school districts to resolve these issues and improve services.

What does this work mean for children with disabilities? Consider Whitman, an 11-year-old with autism and apraxia who is nonspeaking and uses an augmentative communication device to communicate. The support he receives through special education has been life-changing—not just for him, but for his entire family. At first, he was placed in a school where all the children had disabilities. He struggled until the school started a program that helped Whitman learn alongside his non-disabled peers. Now, he is not only excelling academically but recently performed in two school musicals—something his family never imagined possible.

Decades ago, the United States decided that having a disability or living in a certain state should not determine whether a child receives a quality education. That promise is now under attack. Dismantling the Department of Education wouldn't just turn back the clock—it would create chaos and deepen inequality. It would mean fewer trained teachers, weaker enforcement of disability rights, and more children slipping through the cracks.

Monday, February 17, 2025

Attack on 504

In The Politics of Autism, I discuss the civil rights of people with autism and other disabilities

Anni Layne Rodgers at ADDitude:

Texas v. Becerra is a lawsuit filed by 17 states against the United States government that could effectively end 504 Plans for millions of students across the country.

The lawsuit was filed in late 2024 by Texas Attorney General Ken Paxton against the Biden administration, which changed Section 504 of the Rehabilitation Act to include gender dysphoria as a protected disability. Notably, the lawsuit also argues that “Section 504 is unconstitutional.” The lawsuit says that “Section 504 is coercive, untethered to the federal interest in disability, and unfairly retroactive” and it asks for “permanent injunctive relief” that would block enforcement of Section 504.

From the complaint:

 238. Because the Act attaches its requirements universally—to all federal spending—it forces an impossible choice on the States, all of which must decide between implementing the Rehabilitation Act and accepting any amount of federal money. When spending “conditions take the form of threats to terminate other significant independent grants,” they “are properly viewed as a means of pressuring the State to accept policy changes.” Sebelius, 547 U.S. at 580. Section 504’s universal scope renders it an unconstitutionally coercive condition on federal spending. 239. Because Section 504 is coercive, untethered to the federal interest in disability, and unfairly retroactive, the Rehabilitation Act is not constitutional under the spending clause. 240. The constitutional violation posed by invalid spending legislation can be remedied by injunctive relief that precludes relevant federal officials from withdrawing funds for incompliance. Sebelius, 567 U.S. at 588.

Sunday, February 16, 2025

A.J.T. v. Osseo Area Schools

In The Politics of Autism, I write about social servicesspecial education and the Individuals with Disabilities Education Act

 Julia Metraux at Mother Jones:
Minnesota teenager Ava T. lives with seizures that predominate in the morning, preventing her from attending school safely before noon. When her suburban Minneapolis school district refused to update her individualized education plan—a disability accommodation guaranteed by federal law—to allow at-home evening instruction to compensate, Ava and her parents sued in 2021.

A district court sided with Ava and her family—her last name is withheld—ruling in 2022 that the school district had violated her rights under the Individuals with Disabilities Education Act. But separate complaints say that the district had breached Section 504 of the Rehabilitation Act and the Americans with Disabilities Act, which include extensive disability rights provisions. In five of the 13 federal circuit courts, including the Eighth Circuit, which covers Minnesota, families suing schools under Section 504 and the ADA have to prove “bad faith or gross misjudgment,” a standard the Eighth Circuit said Ava’s case did not meet—despite acknowledging that the family “may have established a genuine dispute about whether the district was negligent or even deliberately indifferent.”

The Supreme Court agreed to hear Ava’s case, A.J.T. v. Osseo Area Schools, in January. Its ruling will decide whether that tougher standard—bad faith is notoriously hard to prove—applies nationwide under Section 504 and the ADA when suing schools. A ruling against Ava and her family could be a major setback for student disability rights enforcement and an equally major boon for the Trump administration’s plan to gut the Department of Education at the expense of disabled kids

Saturday, February 15, 2025

MAHA Commission

On Thursday, Trump signed an executive order establishing a "Make America Healthy Again Commission,"  which RFK Jr. will chair. Among other things, it will investigate the causes of autism.  We can expect that the commission will employ junk science to support the lies that Trump and Kennedy have repeated.

Emily Kennard at NOTUS:
Republicans in Congress want to spend taxpayer money to research the repeatedly debunked link between vaccines and autism — all as they continue to cheer on the Trump administration’s cuts to what they consider excessive spending.

So far in his presidency, Donald Trump has aggressively talked up government efficiency, giving Elon Musk and his Department of Government Efficiency aides unprecedented power to review, and cut, federal spending wherever they see fit — including medical research funding. But lawmakers who told NOTUS they’d support more research into whether vaccines cause autism didn’t see it as wasteful or redundant.
...
Republicans largely told NOTUS they shared the same concerns as Trump, who has repeatedly said he wants his administration to look into this disproven link. Just last week, Trump pointed again to the increase in autism diagnoses in children.

 ...

The relationship between autism and vaccines has been studied — and repeatedly debunked. Many peer-reviewed studies and analyses spanning decades have refuted that vaccines can cause autism. Meanwhile, the 1998 study that first tried to causatively link the measles, mumps and rubella vaccine to autism was retracted 12 years later, after the study’s author was found to have altered medical records to support his conclusions.

From the Autistic Self Advocacy Network:

Under the leadership of Trump, who has publicly claimed that he believes in the debunked claim that vaccines cause autism, and Robert F. Kennedy Jr, who has founded an anti-vaccine group, claimed that no vaccine has been proven safe and effective, that the recommended vaccine schedule for children is dangerous, and that “autism does come from vaccines,” ASAN is deeply concerned about the call for increased causation research. Trump claimed in December that he would direct the HHS to investigate a connection between vaccines and autism, which has already been proven to be nonexistent. The executive order also directs the Make America Healthy Again commission to look into the “potential over-utilization of medication, certain food ingredients, certain chemicals, and certain other exposures pose to children.” While some of these things may indeed be connected to or cause other disabilities, such as lead poisoning and fetal alcohol syndrome, they do not cause autism. We also ask the president, why, if he is concerned about the link between toxic chemicals exposure for American children, he, in his first term, rolled back many regulations aimed at reducing toxic emissions and, in his second, has cut programs enforcing restrictions on toxic emissions, and pledged to further roll-back regulation aimed at eliminating and decreasing pollutants.

We are deeply concerned at the Trump administration’s commitment to further research thoroughly debunked myths about autism and his disregard for established science and research. We are also deeply concerned about the potential damage caused by President Trump and Secretary Kennedy using official channels and government agencies to promote false “cures” and “treatments” for autism, as well as other disabilities. This will not only decrease American confidence in public health agencies, but also cause real harms, such as the decrease in childhood vaccination in the United States since the beginning of the pandemic and the death of 83 people in Samoa, both attributable to anti-vaccine advocacy and specifically now-Secretary Kennedy. Autism causation research is dangerous, ignores decades of science and research, and ignores the autistic community, which has been insistent that we do not need or want a cure for autism, and that we will fight for the civil rights and services and supports needed for us to fully participate in all aspects of society.

Friday, February 14, 2025

A Very Bad Day for Americans with Disabilities

According to the National Center for Education Statistics, 7.5 million children 3 to 21 years old received services under the Individuals with Disabilities Education Act in AY 2022-23.

About 980,000 of them were autistic, up from 498,000 in 2012-13.

The Senate confirmed RFK Jr. as HHS Secretary.

The Senate Health, Education, Labor and Pensions Committee held a confirmation hearing for Linda McMahon to be Secretary of Education.  She wants to obey Trump's command to dismantle the department. When she testified that HHS could take over the administration of IDEA, Senator Maggie Hassan pointed out: "I just want to be clear: you're going to put special education in the hands of Robert F. Kennedy, Jr."  

See this clip at about 3:25:

Erica Meltzer and Kalyn Belsha at The hechinger Report:

McMahon said multiple times that parents of children with disabilities should not worry about federal funding being cut for the Individuals with Disabilities Education Act, though she said it was possible that the U.S. Department of Health and Human Services would administer the money instead of the Education Department.

But it appeared that McMahon had limited knowledge of the rights outlined in IDEA, the landmark civil rights law that protects students with disabilities. And she said it was possible that civil rights enforcement — a large portion of which is related to complaints about children with disabilities not getting the services to which they’re entitled — would move to the U.S. Department of Justice.

Dismantling the education department by moving key functions to other departments is a tenet of Project 2025, the playbook the conservative Heritage Foundation developed for a second Trump administration. Most of these functions are mandated in federal law, and moving them would require congressional approval.

McMahon struggled to articulate the goals of IDEA beyond saying students would be taken care of and get the assistance and technology they need.

“There is a reason that the Department of Education and IDEA exist, and it is because educating kids with disabilities can be really hard and it takes the national commitment to get it done,” Hassan, the New Hampshire senator, said. “That’s why so many people are so concerned about this proposal to eliminate the department. Because they think kids will once again be shoved aside, and especially kids with disabilities.”


Thursday, February 13, 2025

Trump's Threat to Students with Disabilities

According to the National Center for Education Statistics, 7.5 million children 3 to 21 years old received services under the Individuals with Disabilities Education Act in AY 2022-23.

About 980,000 of them were autistic, up from 498,000 in 2012-13.


Jessica Winter at The New Yorker:
Dan Stewart, the managing attorney for education and employment at the National Disability Rights Network, a legal-advocacy group, told me that, through these executive orders, “this Administration is engaging with education at the micro level as well as the macro level. It’s looking at curriculum, which is traditionally in the power of the local schools and the state, at the same time that it’s looking at different ways of moving public dollars out of the system.”

...

“The vast majority of I.D.E.A. rights only apply to public-school students,” Jessica Levin, who is litigation director at the nonprofit Education Law Center, told me. I.D.E.A. mandates certification requirements for special-education teachers and shields students from being punished for manifestations of their disability. It also enshrines parents’ rights to be involved in developing their children’s education plans and to argue for more or different services, which can range from speech-language or occupational therapy to assistive technology. “These rights are all lost when a student goes to a private school,” Levin said.

Project 2025 proposes rolling federal Title I and special-education funding into block grants, which states can administer without extensive federal oversight. “The states would no longer have a check on how they are complying with I.D.E.A. or other federal laws,” Stewart said. The likely scenario for kids with special needs, he went on, is “fewer teachers, fewer funds, delayed funds, and less certainty.” Of course, according to the school-choice movement, parents who are dissatisfied with their child’s cash-strapped public school should have the opportunity to choose a private one in a thriving educational marketplace. In reality, Levin said, “private schools are legally allowed to not accept students with disabilities or serve them appropriately, and so you end up with a higher concentration of higher-needs students in schools that now have fewer resources.”
...
Public and private schools alike, Stewart told me, are incentivized to view students with disabilities as “a drain on their resources.” Underfunded districts in red, blue, and purple states routinely fail these students, whether they are illegally capping the percentage of children who can receive services or willfully keeping parents in the dark about their constitutional rights. I.D.E.A. is perhaps a law too aptly named, as its protections often seem more theoretical than concrete.
...
Trump and Musk’s public statements are instructive here. In 2023, Musk fired a longtime employee of his who has muscular dystrophy and then ridiculed him on Twitter, falsely claiming that he “did no actual work.” (Musk later apologized and indicated that the employee could remain at Twitter; he did not.) As for Trump, according to a memoir written by his nephew, the disability advocate Fred Trump III, the President once commented that some disabled people “should just die,” and said, of Fred’s own son, who is nonverbal and uses a wheelchair owing to a rare genetic disorder, “Maybe you should just let him die.”

Wednesday, February 12, 2025

Measles Rising

In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread   Examples include measlesCOVID, flu, and polio.

He is now Trump's nominee to head HHS.  Now that he has the support of Senator Bill Cassidy, he is likely to win confirmation.

And children will die of vaccine-preventable diseases.

Measles cases are rising in the U.S. with infections confirmed in at least five states so far this year.

Cases have been reported in Alaska, Georgia, New York City, Rhode Island and Texas, mostly among individuals not vaccinated for measles, according to the Centers for Disease Control and Prevention (CDC).

In western Texas, an outbreak has grown to at least 24 cases according to an update published Tuesday from the Texas Department of State Health Services (DSHS).

All of the cases are in unvaccinated people who live in Gaines County, which borders New Mexico, and at least nine of the patients have been hospitalized. Two cases are in adults aged 18 and older, while the remaining cases are among children and adolescents.

"Due to the highly contagious nature of this disease, additional cases are likely to occur in Gaines County and the surrounding communities," DSHS said on its website.

Vaccine exemptions among children in Gaines County -- the epicenter of the outbreak -- have grown dramatically in the past few years. Roughly 7.5% of kindergarteners had parents or guardians who filed for an exemption for at least one vaccine in 2013. Ten years later, that number rose to more than 17.5% -- one of the highest in all of Texas, according to state health data.

Individual schools saw similar jumps. At Loop ISD, located in the county, 13.08% of students between kindergarten and 12th grade received a conscientious exemption from at least one vaccine during the 2018-19 school year, During the 2023-24 school year, that figure rose to more than 47.95%, according to DSHS data.

Meanwhile, the Georgia Department of Public Health recently confirmed two additional cases of measles in metro Atlanta among unvaccinated family members of a case confirmed earlier this year in January.

Heath officials have been urging parents to vaccinate children who have not received the measles, mumps, rubella (MMR) shot yet. The CDC recommends that children get two doses with the first dose at 12 to 15 months old and the second dose between ages 4 and 6. One dose is 93% effective and two doses are 97% effective.

Zach Holbrooks, executive director of the South Plains Public Health District, told ABC News on Tuesday that the district's clinic in Seminole will be offering MMR vaccines through Thursday.

The cases mirror those seen across the country. The CDC says 14 cases have been confirmed nationwide so far, which does not include the updated cases in Texas or Georgia. Every single case is among someone who is unvaccinated or whose status is unknown.

Vaccination rates have been lagging in the U.S. About 93% of kindergarteners received select routine childhood vaccines, including the MMR vaccine, for the 2022-23 school year, according to a November 2023 CDC report
.

Tuesday, February 11, 2025

ASAN v. RFK and McMahon

 In The Politics of Autism, I discuss the issue's role in campaign politics.   In the 2016 campaign, a number of posts discussed Trump's bad record on disability issues more generally.   As his words and actions have shown, he despises Americans with disabilities  He told his nephew Fred that severely disabled people -- such as Fred's son -- should "just die."

From the Autistic Self Advocacy Network:

Call your Senators NOW and tell them to vote NO on RFK Jr. for Secretary of the Department of Health and Human Services (HHS) and vote NO on McMahon for Secretary of Education.

RFK Jr. has said things about autism and public health that are not true. These things make him a terrible choice for Secretary of HHS. He is against vaccines which save lives. He questions whether HIV causes AIDS. He wants to use more quack autism “treatments” that could hurt people. He has also suggested putting people who take psychiatric medication in labor camps. These dangerous views should stop him from getting the role. We are upset about his nomination as self-advocates, professionals in health policy, and people who want the government to protect our health and trust science. If RFK Jr. becomes Secretary of HHS, our country’s health will suffer. But there is still time to stop him — call TODAY!

Linda McMahon is Trump’s nominee for the Department of Education, and she shares Trump’s agenda of exclusion and discrimination. The Department of Education works to ensure that every child has access to an inclusive education and to protect students from discrimination. Already, this administration has stopped ongoing civil rights enforcement for students, threatened to defund or even prosecute teachers who teach racial equity or support LGBTQ+ students, and is even planning to dismantle the Department of Education itself. Tell your Senators to vote NO on McMahon!

Next, meet with your Representative and Senators and tell them to OPPOSE cuts to Medicaid! Many disabled people in the US rely on Medicaid for life-saving care and services, but some people in Congress think the government should spend less on Medicaid. If funding is cut, people across the country will lose the services we need to survive. There is no way to cut Medicaid that won’t hurt disabled people who rely on it. We need to tell Congress: no cuts to Medicaid! Learn how to set up and get ready for your meeting here. Can’t set up a meeting but want to speak out for Medicaid? Call your members of Congress — we’ve even got a guide to help you feel prepared! Our elected officials work for us, so make your voice heard!

Sunday, February 9, 2025

RFK's "Commitments" to Cassidy

In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread   Examples include measlesCOVID, flu, and polio.

He is now Trump's nominee to head HHS.  Now that he has the support of Senator Bill Cassidy, he is likely to win confirmation.

And children will die of vaccine-preventable diseases.


He will have even less influence after Kennedy is installed at the health department, said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania.

“While I appreciate what Cassidy is trying to accomplish, his capacity to act once the confirmation goes through is limited,” Jamieson said. “Do I expect he will do everything he can? Yes. Do I think it’s going to be productive with Robert Kennedy given everything we know about him with respect to vaccination? No.”

Dr. Georges Benjamin, executive director of the American Public Health Assn., was also pessimistic about Cassidy’s prospects for making sure Kennedy upholds his side of the bargain. He recalled that Sen. Susan Collins (R-Maine) said she had received assurances from Neil Gorsuch and Brett Kavanaugh that they wouldn’t overturn Roe vs. Wade if they were elevated to the Supreme Court.

“You see how that worked out,” Benjamin said.

...

Should Kennedy or anyone else at the Department of Health and Human Services take steps that undermine support for vaccines, Cassidy could flex his authority as the HELP Committee chairman and make good on his threat to call an oversight hearing.

Kennedy and other Trumpists won't care.  In any oversight hearing, pro-Trump senators will just parrot the party line. 


Saturday, February 8, 2025

HCBS Is In Danger


Julia Metraux at Mother Jones:
Advocates are worried about the fate of HCBS, which would be relatively easy for states to abandon under the new administration—and which helps millions of people stay out of hospitals, nursing homes, and group homes, which McLelland says frequently deliver “lower-quality care, often at a higher cost.”

The GOP has put forth several proposals promoting Medicaid per-capita spending, which would change current spending practices by limiting funds through a formula that doesn’t take into consideration the needs of disabled people. Nicole Jorwic, Caring Across Generations‘ chief of advocacy and campaigns, said that what such changes “would ultimately do is cut the amount of money that the federal government is sending to states per person…just on the consumer price index.”

Changes to Medicaid per-capita spending, Jorwic says, “means waiting lists would grow” and that “the types of services being offered are going to narrow” as funding is reduced or withdrawn. Given that federal Medicaid funds already make up, on average, one-third of state budgets, Jorwic believes that state governments coughing up the extra cost “is never going to happen.” She notes that health funding is a popular target even in blue states like Maryland, where a $3 billion state funding shortfall has put hundreds of millions of dollars in funding for its human services department funds—where Medicaid is housed—on the chopping block.

Another attack on Medicaid incorporated into Project 2025 has involved lifetime caps on the support of people on Medicaid—caps that many disabled people may hit at a young age. “A state will have to take up the rest of that spending,” said Ives-Rublee, “or they will reduce the coverage of an individual, either by saying we won’t cover these services or by saying we won’t cover you at all.”