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Halfway through Medicaid purge, enrollment is down about 10 million

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Halfway through Medicaid purge, enrollment is down about 10 million

Halfway through what will be the biggest purge of Medicaid beneficiaries in a one-year span, enrollment in the government-run health insurance program is on track to return to roughly pre-pandemic levels.

Medicaid, which covers low-income and disabled people, and the related Children’s Health Insurance Program grew to a record 94 million enrollees as a result of a rule that prohibited states from terminating coverage during the nation’s public health emergency.

But since last April, states have removed more than 16 million people from the programs in a process known as the “unwinding,” according to KFF estimates compiled from state-level data.

While many beneficiaries no longer qualify because their incomes rose, millions of people have been dropped from the rolls for procedural reasons like failing to respond to notices or return paperwork. But at the same time, millions have been reenrolled or signed up for the first time.

The net result: Enrollment has fallen by about 9.5 million people from the record high reached last April, according to KFF. That puts Medicaid and CHIP enrollment on track to look, by the end of the unwinding later this year, a lot like it did at the start of the coronavirus pandemic: about 71 million people.

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“What we are seeing is not dissimilar to what we saw before the pandemic — it is just happening on a bigger scale and more quickly,” said Larry Levitt, executive vice president for health policy at KFF.

Enrollment churn has long been a feature of Medicaid. Before the pandemic, about 1 million to 1.5 million people nationwide fell off the Medicaid rolls each month — including many who still qualified but failed to renew their coverage, Levitt said.

During the unwinding, many people have been disenrolled in a shorter time. In some ways — and in some states — it’s been worse than expected.

The Biden administration predicted about 15 million people would lose coverage under Medicaid or CHIP during the unwinding period, nearly half due to procedural issues. Both predictions have proved low. Based on data reported so far, disenrollments are likely to exceed 17 million, according to KFF — 70% due to procedural reasons.

But about two-thirds of the 48 million beneficiaries who have had their eligibility reviewed so far got their coverage renewed. About one-third lost it.

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The federal government has given most states 12 months to complete their unwinding, starting with the first disenrollments between last April and October.

Timothy McBride, a health economist at Washington University in St. Louis, said the nation’s historically low unemployment rate means people who lose Medicaid coverage are more likely to find job-based coverage or be better able to afford plans on Obamacare marketplaces. “That is one reason why the drop in Medicaid is not a lot worse,” he said.

There are big differences between states. Oregon, for example, has disenrolled just 12% of its beneficiaries. Seventy-five percent have been renewed, according to KFF. The rest are pending.

At the other end of the spectrum, Oklahoma has dumped 43% of its beneficiaries in the unwinding, renewing coverage for just 34%. About 24% are pending.

States have varying eligibility rules, and some make it easier to stay enrolled. For instance, Oregon allows children to stay on Medicaid until age 6 without having to reapply. All other enrollees get up to two years of coverage regardless of changes in income.

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Jennifer Harris, senior health policy advocate for Alabama Arise, an advocacy group, said her state’s Medicaid agency and other nonprofit organizations communicated well to enrollees about the need to reapply for coverage and that the state also hired more people to handle the surge. About 29% of beneficiaries in Alabama who’ve had eligibility reviews were disenrolled for procedural reasons, KFF found.

“Things are even keel in Alabama,” she said, noting that about 66% of enrollees have been renewed.

State officials have told the legislature that about a quarter of people disenrolled during the unwinding were reenrolled within 90 days, she said.

One of a handful of states that have refused to expand Medicaid under the Affordable Care Act, Alabama had about 920,000 enrollees in Medicaid and CHIP in January 2020. That number rose to about 1.2 million in April 2023.

More than halfway into the unwinding, the state is on track for enrollment to return to pre-pandemic levels, Harris said.

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Joan Alker, executive director of the Georgetown University Center for Children and Families, said she remains worried the drop in Medicaid enrollment among children is steeper than typical. That’s particularly bothersome because children usually qualify for Medicaid at higher household income levels than their parents or other adults.

During the unwinding 3.8 million children have lost Medicaid coverage, according to the center’s latest data. “Many more kids are falling off now than prior to the pandemic,” Alker said.

And when they’re dropped, many families struggle to get them back on, she said. “The whole system is backlogged and the ability of people to get back on in a timely fashion is more limited,” she said.

The big question, Levitt said, is how many of the millions of people dropped from Medicaid are now uninsured.

The only state to survey those disenrolled — Utah — discovered about 30% were uninsured. Many of the rest found employer health coverage or signed up for subsidized coverage through the Affordable Care Act marketplace.

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What’s happened nationwide remains unclear.

KFF Health News, formerly known as Kaiser Health News, is a national newsroom that produces in-depth journalism about health issues.

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EPA touts crackdown on smuggled pesticides in L.A. visit

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EPA touts crackdown on smuggled pesticides in L.A. visit

The U.S. Environmental Protection Agency is ramping up its enforcement of illegal pesticides smuggled through the ports of Long Beach and Los Angeles, officials said during a visit to L.A. on Thursday.

Since President Trump began his second term in January 2025, EPA has blocked more than 2.4 million pounds of illegal pesticides from entering the country, said Lee Zeldin, the agency’s administrator. Much of it comes from China, but some comes from Mexico and, on the East Coast, from Africa.

“We’re very alarmed by any chemical that anyone would seek to bring into this country that our own government hasn’t had the opportunity to vet, to research to fully understand,” Zeldin said. “That’s why it’s so important that these products get stopped at the border.”

The announcement came just hours after the Supreme Court handed a major victory to the makers of the weedkiller Roundup, shielding it from thousands of lawsuits from states alleging the company failed to warn people the product could cause cancer.

Speaking from a U.S. Customs and Border Protection warehouse in Carson, Zeldin pointed to a white bottle with a yellow label reading “SNIPER” — an illegal pesticide product commonly imported from abroad and sold online — that was recently intercepted at the Port of L.A. complex. Sniper contains dichlorvos, or DDVP, a highly toxic insecticide that is not registered or approved for use in the U.S. It is known to cause neurological problems, convulsions and comas, with children particularly at risk.

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Illegal pesticides are cause for concern in California, where they are often associated with illegal cannabis operations. Last year, Siskiyou County declared a local emergency in response to the “escalating threat” posed by illegal pesticides, often fumigants, in illicit cannabis operations.

“These chemicals, when burned, create thick, poisonous smoke that presents serious risks to public health, the environment, waterways, and first responder safety,” the county said.

A 2024 Los Angeles Times investigation found that contraband Chinese pesticides used on cannabis farms is a growing problem in the state.

Customs and Border Protection seized containers of an illegal pesticide from China that were packed with legitimate items.

(Myung J. Chun/Los Angeles Times)

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Much of the illegal product comes through the ports of L.A. and Long Beach, which together handle more than 30% of the nation’s container traffic, officials said. EPA works closely with Border Patrol officials, who flag suspicious cargo containers at the port for further inspection.

CBP spokesman Jaime Ruiz said the agency is using artificial intelligence tools to help scan incoming cargo manifests for potentially illegal items. Thousands of containers are flagged for inspection each year, although that number also includes drugs, counterfeit goods and other contraband in addition to pesticides, he said. He could not immediately say what percentage were illegal pesticides.

Illegal pesticides have at times been found in California agriculture and the California Department of Pesticide Regulation has taken enforcement action against violators. The DPR operates one of the nation’s largest pesticide residue testing programs, analyzing some 3,500 produce samples each year from wholesale and retail stores and other outlets. The state produces about half of the nation’s fruits and vegetables.

Jeff Hall, assistant administrator of EPA’s Office of Enforcement and Compliance, said the issue should be bipartisan.

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“We cannot allow foreign actors to profit by sending toxic and poisonous products into the United States and poisoning American communities,” he said. “This is a message that we should all be able to agree on, especially for pesticides.”

However, the agency’s visit to L.A. arrived at a fractured moment for U.S. pesticide regulation and for the Trump-aligned Make America Healthy Again movement.

On Thursday, the Supreme Court ruled 7-2 in favor of Bayer’s Monsanto, the maker of the powerful weedkiller Roundup, shielding it from thousands of state lawsuits that allege the company failed to warn people the product could cause cancer.

Roundup contains glyphosate, which was classified by the World Health Organization as “probably carcinogenic” in 2015. But the Supreme Court found that the company can’t be sued in state courts because federal agencies — including the EPA — have determined that it’s not likely to cause cancer in humans when used as directed. The EPA has repeatedly approved a label for the product without a cancer warning.

“When people are exposed to pesticides, they deserve honest warnings about the risks,” said Bill Jordan, former deputy director of EPA’s Office of Pesticide Programs, in a statement. “The Court’s decision leaves families, workers, and communities with fewer tools to protect themselves and to recover damages when they are injured by a pesticide.”

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Drug overdoses in L.A County drop for third straight year. Here’s why

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Drug overdoses in L.A County drop for third straight year. Here’s why

For the third year in a row, accidental drug-related overdose and poisoning deaths have dropped in Los Angeles County, a decline officials attribute to ongoing investments in prevention and harm reduction resources countywide.

There were 2,298 accidental drug overdose and poisoning deaths in 2025, down 6%, a relatively small drop from 2,438 the prior year but an overall substantial reduction from the all-time high of 3,220 deaths countywide in 2022, according to a recent report from the Los Angeles County Department of Public Health.

Drug overdoses continue to be the leading cause of accidental deaths countywide — surpassing the deaths due to vehicle crashes and firearms in 2017 combined — with methamphetamine and fentanyl most often involved in the overdoses.

The problem reached a historic high in 2022 when fentanyl surpassed methamphetamine as the most common drug listed as a cause of overdose deaths. At the time, the number of overdoses in general had increased across the board.

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However, these accidental deaths have been on a downward trend, with a nearly 30% overall decrease in drug-related overdoses from 2022 to 2025. Fentanyl-related deaths dropped by 40% and methamphetamine-related deaths declined by 25% in that period.

Officials said in the report that the numbers are more modest compared with 2024, when accidental overdose deaths plunged overall by 22%, which they said “demonstrates sustained progress in the County’s efforts to address the overdose crisis.”

“Three consecutive years of fewer overdose deaths in LA County is proof that sustained investments in prevention, harm reduction, treatment, and recovery services saves lives,” Barbara Ferrer, director of the Los Angeles County Department of Public Health, said in a statement.

Ferrer credited the continued reduction to outreach workers and community partners who “are working every day to connect people to treatment, distribute lifesaving naloxone and meet people where they are without judgment.”

The department continues to invest in a coordinated spectrum of community-based overdose prevention efforts that include the Fentanyl Frontline — a multimedia campaign focused on the widespread distribution of naloxone — and ByLAforLA.org, a community-powered platform that connects residents to lifesaving services with an aim to reduce stigma.

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The health department report also found:

  • Los Angeles County overdose deaths declined across most age groups in 2025 but deaths among adults 65 and older increased by 14%.
  • Although older adults accounted for only 11% of all overdose deaths, this increase contrasts with the broader downward trend observed across other age groups, according to the report.
  • Those aged 40 to 64 remained the most affected group, accounting for 53% of overdose deaths last year.
  • Communities with 30% of residents living below the federal poverty level had a higher rate of drug overdose deaths than areas with less than 10% of families living below the federal poverty level.
  • By race, Black residents continued to experience the highest overdose death rates in 2025.
  • By gender, a persistent disparity remains, with men accounting for most overdose deaths, nearly 1,800 compared with more than 500 deaths among women.

Nationwide, opioid overdose deaths have been on the decline since mid-2023, driven largely by decreases in fentanyl-related deaths, but the numbers remain above pre-pandemic levels, according to a recent report by KFF, a national health policy organization.

KFF said multiple policy actions have contributed to the decline, including efforts to expand access to treatment as well as overdose-reversal drugs and public awareness campaigns. At the federal level, there have been some efforts to mitigate the crisis including improving fentanyl detection at ports and borders.

“Despite progress, a range of more recent federal policy actions may affect future trends, including federal budget cuts, federal staffing reductions, and cuts to federal grants that support state and local programs; reduced Medicaid and Marketplace coverage; and a shift toward a more enforcement-focused approach, including the designation of illicit fentanyl as a ‘Weapon of Mass Destruction,’” according to the report.

Los Angeles County residents can access assistance for substance-use services 24 hours a day, seven days a week by calling (800) 854-7771, select Option 2 after the language prompt.

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Health concerns mount as Boyle Heights warehouse fire stretches into a week

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Health concerns mount as Boyle Heights warehouse fire stretches into a week

Tens of thousands of people in southeast Los Angeles County have been engulfed in a dense cloud of smoke for nearly a week as a fire continues to tear through a massive refrigerated warehouse in Boyle Heights. Toxic air has covered the San Gabriel Valley and beyond at times, as the fire continues to burn and the wind shifts the pall in different directions.

People have reason to be concerned about their loved ones breathing in the plume, experts say.

“There’s no safe level of exposure to particle pollution,” said Will Barrett, assistant vice president for nationwide clean air policy at the American Lung Assn.

Soot can be deadly. The charred microscopic particles can travel deep into a person’s lungs and bloodstream, causing swelling and triggering heart attacks and strokes.

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People aren’t just being exposed for hours. They’ve been exposed for days in Boyle Heights, unincorporated East Los Angeles, Maywood, Montebello and Bell, according to the South Coast Air Quality Management District.

“There are some pollutants where just breathing in a little bit of it can cause some serious issues for people,” said Dr. Afif El-Hasan, a pediatrician with Kaiser Permanente. He said he’s most concerned about particles, carbon monoxide, volatile organic compounds and chemical gases from incinerated insulation, plastics and paint in the smoke.

“Those chemicals can cause irritation in the lungs, they can cause long-term lung damage, and sometimes they can even cause cancer,” he said. “I also worry about children, because children breathe in more air per volume of their body than adults do and they tend to be more active.”

“People also need to remember that even if you are healthy, these chemicals are going to put you at risk. It’s not just people who are vulnerable, anyone is in danger.”

The fact that the smoke continues to billow into the sky for a sixth day matters, said Jill Johnston, associate professor of environmental and occupational health at UC Irvine. “The longer the exposure time, the more dose you’re getting, or the more potential chemicals that you’re inhaling. So you’re gonna be increasing a potential risk,” she said.

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Pregnant women and their babies in utero are known to be vulnerable to smoke from wildfires, she said. But less is known about city fires. “We see increased risk of low birth weight and preterm birth connected to exposure to wildfire smoke. This isn’t exactly the same composition of smoke, but would anticipate … there could be potentially similar risk.”

A fire like this can leave people with no good choices. They can stay home with an air filter if they have one. But homes need “fresh” air, and a fire can make getting that impossible.

For that reason, some people believe that the official response to the gravity of the fire at Lineage Logistics has been inadequate. Jane Williams, executive director of California Communities Against Toxics, is among several activists who criticized the Los Angeles Fire Department and city officials who appeared to downplay health risks from prolonged smoke, and ultimately decided against evacuating these areas. They think many more people should have been evacuated.

“They always under-warn, they under-evacuate, they bring people back too fast,” Williams said. “I get that there’s a societal desire to return to normalcy.”

Local officials have opened a pair of shelters to house residents who want to temporarily relocate. The Los Angeles Unified School District also canceled summer programming for schools in the smoke-affected communities.

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But “there is nothing in the air that is so dangerous that we have to do evacuations or even shelter in place,” LAFD Chief Jaime Moore said. Asked at a recent news conference whether the air was dangerous, Mayor Karen Bass said, “not to the extent that required a mandatory evacuation.”

Yet Williams pointed to the burning chemical-laden insulation foam inside the building, which could release several other highly toxic gases, including hydrogen cyanide, an asphyxiating gas, and isocyanates, chemical vapors that can cause serious lung damage.

“It’s about what you value and who you value,” Williams said. “If you value truth, you cannot sit there in front of a burning building and say the air is safe.”

A Fire Department spokesperson declined to comment when asked why the department considered a shelter-in-place order more appropriate than issuing an evacuation. It’s not clear that evacuation would have been purely a city responsibility. Lineage Logistics sits along the city boundary, with unincorporated Los Angeles County and other cities nearby.

mark! Lopez, a community organizer with East Yard Communities for Environmental Justice, also said the recently lifted shelter-in-place orders were not enough to protect residents from the heavy smoke and potential chemical releases. Residents, he said, have complained about smoke seeping into homes through cracks in doorways and windows, giving them sore throats and breathing problems.

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Lopez said many of the smoke-affected communities have long suffered from poor air quality from decades of heavy polluting industrial facilities, highway traffic and rail yards. He said the public statements from Fire Department and elected officials that cast doubt on the risks from smoke were unacceptable.

“This is what happens when the Fire Department says there’s not a threat to human health. … The LAFD, they aren’t public health experts.”

Times staff writer David Zahniser contributed to this report.

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