One year into its creation, a $50 billion federal program aimed at improving rural healthcare lacks transparency, which could make it difficult to protect against fraud, identify successful projects, and ensure the program delivers on its promise to transform the system.

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In the thick of his competitive reelection race in Michigan, Republican Rep. Tom Barrett joined Health and Human Services Secretary Robert F. Kennedy Jr. at a sprawling 400-acre apple orchard, farm, and winery. They touted Trump administration efforts to improve the American diet, including the removal of some artificial dyes from processed foods.

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Summer may be approaching its end, but the health policy stories that have marked the season continue. In Washington and across the country, public health officials are still struggling with outbreaks of vaccine-preventable diseases such as measles, while states and health systems are preparing for the impact of major federal funding cuts to their Medicaid programs.

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MILLVILLE, Pa. — In an open field, arrows whizzed through the humid June air and struck their targets. Campers and counselors cheered.

It was archery hour at Camp Cranium. Operations director Drew Meyer watched, a few tears escaping from behind his dark sunglasses.

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BAKERSFIELD, Calif. — Carlos A. grew up in a family on Medicaid, which made healthcare an afterthought since the public insurance is free for low-income enrollees. But when he received a raise two years ago, he found himself earning too much to qualify for the safety net program. And when he browsed Covered California plans, he found that marketplace prices were still too steep for his comfort.

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In recent years, concerns about access to maternity care in rural areas have grown as hundreds of rural hospitals have closed their obstetrics units. In 2023, approximately half of rural hospitals offered obstetrics services, and almost half of rural counties did not have a hospital offering obstetrics services. A lack of access to maternity care can lead to negative health outcomes, such as low birthweight and premature births, and increased maternal mortality.

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In January, Jeff La Marca got a prescription for the popular weight loss drug Zepbound. But he couldn’t afford the $750 monthly price tag.

Then Medicare launched an 18-month pilot program that offers GLP-1 medications to some enrollees for only $50 a month. La Marca thought he might finally be able to afford the drug.

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As measles cases rise across the U.S., children’s routine vaccination rates continue to decline while exemptions from school vaccination requirements, particularly non-medical exemptions, have increased. These trends began during the COVID-19 pandemic and have continued (Figure 1), signaling a shift in attitudes toward childhood vaccinations.

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Key Points

• The Constitution gives authority to state and local governments, not the federal government, to set school vaccine requirements and currently all 50 states and DC currently require certain vaccines for school attendance. All jurisdictions require MMR, DTaP, polio, and varicella vaccination for school-age children, while requirements for several other vaccines vary by state. All states allow for exemptions to these requirements.

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Heidi Overton, a physician and White House domestic policy adviser, is President Donald Trump’s choice to be the next head of the Food and Drug Administration. Overton, an abortion opponent and supporter of Trump’s proposed changes to the childhood vaccine schedule, has made enemies while working on health policy from the White House and could face some tough questioning from senators.

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