By Henry Larweh, Rachana Pradhan, Rae Ellen Bichell, KFF Health News

The Trump administration’s cuts to Centers for Disease Control and Prevention funding for state and local health departments had vastly uneven effects depending on the political leanings of a state, according to a KFF Health News analysis. Democratic-led states and select blue-leaning cities fought back in court and saw money for public health efforts restored — while GOP-led states sustained big losses.

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The Department of Health and Human Services in late March canceled nearly 700 Centers for Disease Control and Prevention grants nationwide — together worth about $11 billion. Awarded during the COVID-19 pandemic, they supported efforts to vaccinate people, reduce health disparities among demographic groups, upgrade antiquated systems for detecting infectious disease outbreaks, and hire community health workers.

Initially, grant cancellations hit blue and red states roughly evenly. Four of the five jurisdictions with the largest number of terminated grants were led by Democrats: California, the District of Columbia, Illinois, and Massachusetts.

But after attorneys general and governors from about two dozen blue states sued in federal court and won an injunction, the balance flipped. Of the five states with the most canceled grants, four are led by Republicans: Texas, Georgia, Oklahoma, and Ohio.

In blue states, nearly 80% of the CDC grant cuts have been restored, compared with fewer than 5% in red states, according to the KFF Health News analysis. Grant amounts reported in an HHS database known as the Tracking Accountability in Government Grants System, or TAGGS, often don’t match what states confirmed. Instead, this analysis focused on the number of grants.

The divide is an example of the polarization that permeates health care issues, in which access to safety-net health programs, abortion rights, and the ability of public health officials to respond to disease threats diverge significantly depending on the political party in power.

In an emailed statement, HHS spokesperson Andrew Nixon said the agency “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 money in question wasn’t spent solely on COVID-related activities, public health experts say; it was also used to bolster public health infrastructure and help contain many types of viruses and diseases, including 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,” said Susan Kansagra, chief medical officer of the Association of State and Territorial Health Officials.

The Trump cutbacks came as the U.S. recorded its largest measles outbreak in over three decades and 266 pediatric deaths during the most recent flu season — the highest reported outside of a pandemic since 2004. Public health departments canceled vaccine clinics, laid off staff, and put contracts on hold, health officials said in interviews.

After its funding cuts were blocked in court, California retained every grant the Trump administration attempted to claw back, while Texas remains the state with the most grants terminated, with at least 30. As the CDC slashed grants in Texas, its measles outbreak spread across the U.S. and Mexico, sickening at least 4,500 people and killing at least 16.

Colorado, which joined the lawsuit, had 11 grant terminations at first, but then 10 were retained. Meanwhile, its neighboring states that didn’t sue — Wyoming, Utah, Kansas, Nebraska, and Oklahoma — collectively lost 55 grants, with none retained.

In Jackson, Ohio, a half-dozen community health workers came to work one day in March to find the Trump administration had canceled their grant five months early, leaving the Jackson County Health Department half a million dollars short — and them without 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 said.

At one point, he said, the funding helped 11 Appalachian Ohio counties. Now it supports one.

Marsha Radabaugh, one employee who was reassigned, has scaled back her community health efforts: She’d been helping serve hot meals to homeless people and realized that many clients couldn’t read or write, so she brought forms for services such as Medicaid and the Supplemental Nutrition Assistance Program to their encampment in a local 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 said. As a counselor, she’d also remind people “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 community health worker program, said people like Radabaugh “were basically a walking human 411,” offering aid to those in need.

Radabaugh also partnered with a food bank to deliver meals to homebound residents.

Aston said the abrupt way they lost the funds — which meant the county unexpectedly had to pay unemployment for more people — could have ruined the health district financially. Canceling funding midcycle, he said, “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 in the U.S. and abroad.

Federal CDC funding accounts for more than half of state and local health department budgets, according to KFF, a health information nonprofit that includes KFF Health News. States that President Donald Trump won in the 2024 election received a higher share of the $15 billion the cCDC allocated in fiscal 2023 than those that Democrat Kamala Harris won, according to KFF.

The Trump administration’s nationwide CDC grant terminations reflect this. More than half were in states that Trump won in 2024, totaling at least 370 terminations before the court action, according to KFF Health News’ analysis.

The Columbus, Ohio, health department had received $6.2 million in CDC grants, but roughly half of it — $3 million — disappeared with the Trump cuts. The city laid off 11 people who worked on investigating infectious disease outbreaks in such places as schools and nursing homes, Columbus Health Commissioner Mysheika Roberts said.

She also said the city had planned to buy a new electronic health record system for easier access to patients’ hospital records — which could improve disease detection and provide better treatment for those infected — but that was put on ice.

“We’ve never had a grant midcycle just get pulled from us for no reason,” Roberts said. “This sense of uncertainty is stressful.”

Columbus did not receive its money directly from the CDC. Rather, the state gave the city some funds it received from the federal government. Ohio, led by Republican Gov. Mike DeWine and a Republican attorney general, did not sue to block the funding cuts.

Columbus sued the federal government in April to keep its money, along with other Democratic-led municipalities in Republican-governed states: Harris County, Texas, home to Houston; the Metropolitan Government of Nashville and Davidson County in Tennessee; and Kansas City, Missouri. A federal judge in June blocked those cuts.

As of mid-August, Columbus was awaiting the funds. Roberts said the city won’t rehire staff because the federal funding was expected to end in December.

Joe Grogan, a senior scholar at the University of Southern California’s Schaeffer Institute and former director of the White House Domestic Policy Council in Trump’s first term, said state and local agencies “are not entitled” to the federal money, which was awarded “to deal with an emergency” that has ended.

“We were throwing money out the door the last five years,” Grogan said of the federal government. “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 email that the $250 million in grants lost had helped with, among other things, upgrading the disease reporting system and boosting public health laboratory testing.

Some of the canceled HHS funding wasn’t slated to end for years, including four grants to strengthen public health in Indian Country, a grant to a Minnesota nonprofit focused on reducing substance use disorders, and a few to universities about occupational safety, HIV, tuberculosis, and more.

Brent Ewig, chief policy and government relations officer for the Association of Immunization Managers, said the cuts were “the predictable result of ‘boom, bust, panic, neglect’ funding” for public health.

The association represents 64 state, local, and territorial immunization programs, which Ewig said will be less prepared to respond to disease outbreaks, including measles.

“The system is blinking red,” Ewig said.

Methodology

KFF Health News’ analysis of Centers for Disease Control and Prevention grants sought to answer four questions: 1) How many grants have been terminated in the U.S. under the Trump administration since March? 2) Which states saw the most grants cut? 3) What were the grants for? and 4) Did the grant terminations affect blue, red, and purple states differently? This follows a similar analysis by KFF Health News for an article on nationwide NIH grant terminations.

Our primary data source was a Department of Health and Human Services website showing grant terminations. We compared an initial list of grant terminations from April 3 with one from July 11 to determine how many grants had been restored. The USAspending.gov database helped us track grants by state.

To classify states politically, we followed the same steps from our April coverage of National Institutes of Health grant terminations. States were “blue” if Democrats had complete control of the state government or if the majority of voters favored Democratic presidential candidates in the last three elections (2016, 2020, 2024). “Red” states were classified similarly with respect to the Republican Party. “Purple” states had politically split state governments and/or were generally considered to be presidential election battleground states. The result was 25 red states, 17 blue states, and eight purple states. The District of Columbia was classified as blue using similar methods.

This analysis does not account for potential grant reinstatements in local jurisdictions where the funds were awarded indirectly rather than directly from the CDC; it accounts only for the recipients’ location, and excludes grants terminated from Compacts of Free Association states and other foreign entities that received grants directly from the CDC. At least 40 CDC grants were terminated that were meant for global health efforts or assisting public health activities in other nations following the Trump administration’s order for the CDC to withdraw support for the World Health Organization.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By FATIMA HUSSEIN, Associated Press

WASHINGTON (AP) — Golf caddies, blackjack dealers and house painters are among the jobs covered under the Trump administration’s preliminary list of occupations not required to pay income tax on their tips under Republicans’ new tax cuts and spending bill.

A bit more unexpected? Podcasters and social media influencers will also be excluded from forking over a portion of their tips, according to the list released Tuesday by the Treasury Department.

The provision in the law signed by President Donald Trump in July eliminates federal income taxes on tips for people working in jobs that have traditionally received them. It’s temporary and runs from 2025 until 2028. It applies to people who make less than $160,000 in 2025.

The Yale Budget Lab estimates that there were roughly 4 million workers in tipped occupations in 2023, which amounts to roughly 2.5% of all jobs.

The administration was required to publish a list of qualifying occupations within 90 days of the bill’s signing. The full list of occupations is located on the Treasury Department website.

They are broken down into eight categories, including beverage and food service; entertainment and events; hospitality and guest services; home services; personal services; personal appearance and wellness; recreation and instruction; and transportation and delivery.

Among other jobs exempted from tax on tips are sommeliers, cocktail waiters, pastry chefs, cake bakers, bingo workers, club dancers, DJs, clowns, streamers, online video creators, ushers, maids, gardeners, electricians, house cleaners, tow truck drivers, wedding planners, personal care aides, tutors, au pairs, massage therapists, yoga instructors, cobblers, skydiving pilots, ski instructors, parking garage attendants, delivery drivers and movers.

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A report from the Budget Lab shows that the effects of the law would be small, given that tipped workers tend to be lower income. More than 37% of tipped workers, or over one third, earned income low enough that they faced no federal income tax in 2022.

“The larger and far more uncertain effect would stem from behavioral changes incentivized by the bill, such as substitution into tipped employment and tipped income, which would increase the bill’s overall cost,” states the report, which was written by Ernie Tedeschi, the director of economics at the Budget Lab.

Congressional budget analysts project the “No Tax on Tips” provision would increase the deficit by $40 billion through 2028. The nonpartisan Joint Committee on Taxation estimated in June that the tips deduction will cost $32 billion over 10 years.

Only tips reported to the employer and noted on a worker’s W-2, their end-of-year tax summary, will qualify. Payroll taxes, which pay for Social Security and Medicare, would still be collected along with state and local taxes.

Polling shows Americans have panned the big bill. Half U.S. adults expect the new tax law will help the rich, according to the poll from The Associated Press-NORC Center for Public Affairs Research. Most — about 6 in 10 — think it will do more to hurt than help low-income people.

By Tim Henderson, Stateline.org

Virginia and New Jersey may be among the states most affected by the hiring slowdown that enraged President Donald Trump when it appeared in an Aug. 1 jobs report showing the United States had 258,000 fewer jobs than initially reported in May and June.

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Such revisions to earlier reports are based on more up-to-date payroll data and are routine. But the scale in this case was shocking — showing the smallest monthly job gains since pandemic-era December 2020 and the largest jobs revision, outside recessions, since 1968.

In response, Trump declared the numbers were wrong, fired the Bureau of Labor Statistics chief, and offered as a replacement E.J. Antoni, a loyalist who has proposed suspending the jobs report. Trump falsely said in a Truth Social post that the revised jobs numbers were “RIGGED in order to make the Republicans, and ME, look bad.”

Beyond those attention-grabbing actions, though, the numbers demonstrate the real effects of Trump’s work slashing the federal government.

A Stateline analysis of the data shows how several states, especially Virginia and New Jersey, shed jobs in the second quarter of this year, which includes May and June.

In Virginia, there were job losses blamed on canceled federal contracts in Northern Virginia as part of cuts made by Elon Musk’s Department of Government Efficiency, known as DOGE. Meanwhile, a slow housing market shuttered a plywood factory in the southern part of the state, and DOGE efforts canceled flooding control contracts on the coast.

Jay Ford, Virginia policy manager at the Chesapeake Bay Foundation, told a state legislative committee in June that $50 million in contracts were slashed in the Hampton Roads area near the coast, causing a spike in unemployment claims.

That included $20 million to address flooding in Hampton, where almost a quarter of homes are in flood zones, and $24 million to repair a Portsmouth dam that could fail in a major storm, he said.

“This is work that you desperately needed,” Ford said at the committee hearing. “There was a real focus on certain buzzwords like ‘climate’ or ‘resilience,’ and I think people conflated some of these projects as somehow unnecessary.”

For instance, the American Institutes for Research announced 233 layoffs in Virginia in May and 50 in Maryland since the beginning of the year. The not-for-profit organization’s projects include working with school districts to solve achievement gaps and absenteeism, creating AI-driven workforce training, and addressing health care issues such as improving kidney disease care while reducing Medicare costs and strengthening access to health care by keeping rural hospitals open.

“The changes occurring in the federal government have brought significant challenges for many federal contractors, including AIR,” said Dana Tofig, the company’s spokesperson.

Other recent layoffs in Virginia: 442 workers at Northern Virginia’s Mitre, which manages federally funded defense research centers and faced $28 million in canceled federal contracts; and 554 workers at a shuttered plywood factory in Southern Virginia.

“Housing affordability challenges and a 30-year low in existing home sales are impacting our plywood business, as many of our plywood products are used in repair and remodel projects, which often occur when homes change ownership,” Georgia-Pacific said in a May news release.

Stateline looked at two state jobs surveys for the second quarter that sometimes have quite different results: the so-called payroll survey of businesses that the Bureau of Labor Statistics uses for its monthly report, which has yet to be revised at the state level, and the BLS Local Area Unemployment Statistics program, which estimates job changes based on monthly household surveys.

The LAUS estimates are often called the “household” survey because they rely mostly on surveys of households, asking how many people are employed. They include jobs the payroll survey can’t get, such as contract and agricultural jobs, and capture jobs where people live rather than states where employers are located.

In a state like Virginia with a high number of federal employees and contract workers, lost jobs may show up sooner in the household survey since many federal jobs are not reflected on state-level payrolls if they are done by subcontractors, if the agency or contractor is based in another state, or if DOGE cuts allowed people to stop work but stay on the payroll until September. Those people might report being unemployed in the household survey but wouldn’t show up in other surveys until October.

The household survey shows about the same number of slowing job gains as the revised national payroll report, so it may be a window into the trends, many caused by Trump administration cuts in government, health care and foreign aid, and also by slowing sales in stores and housing markets.

Both surveys rely on small samples and are often revised later, said Charles Gascon, an economist and research officer at the Federal Reserve Bank of St. Louis. The more definitive Quarterly Census of Employment and Wages, set for release Dec. 3 for the second quarter, will show state patterns more conclusively, he said.

The household surveys show Virginia with the largest job losses in the country for the second quarter, down about 43,000, and job losses every month since February. Before that, the state gained jobs every month since the height of pandemic job losses in April 2020.

New Jersey, which had the most job losses — 15,400 — in the separate second-quarter payroll survey, has suffered layoffs in retail stores hit by a slowdown in consumer spending, increased shoplifting and, among drugstores, lawsuits for their role in the opioid epidemic.

Walmart announced 481 layoffs at its Hoboken, New Jersey, corporate office, and Rite Aid drugstores laid off 1,122 amid Chapter 11 bankruptcy affected by opioid crisis lawsuits that also hit Walmart and other pharmacy chains. Pharma firms Bristol Myers Squibb and Novartis also have announced hundreds of layoffs in New Jersey, citing patent expirations on popular drugs.

Wobbly state finances

Rising unemployment combined with weak revenue growth suggests “economic fragility” for state finances, said Lucy Dadayan, a principal research associate for the Urban-Brookings Tax Policy Center who tracks state tax revenue.

Nationally, unemployment was at 4.2% in July, the same as July 2024 but up from recent lows of 3.4% in April 2023, with the largest increases in Mississippi, Virginia and Oregon.

Unemployment has dropped the most compared with July 2024 in Indiana, Illinois, New York and West Virginia.

The states with the highest unemployment rates in July were California (5.5%), Nevada (5.4%) and Michigan (5.3%), while the lowest were in South Dakota (1.9%), North Dakota (2.5%) and Vermont (2.6%).

“I think the dramatic May and June jobs revision signals economic fragility. State-level warning signs suggest the impacts will show gradually,” Dadayan said. “And of course states are facing fiscal challenges caused by One Big Beautiful Bill Act tax and spending decisions.”

State finances are a mixed picture, with income tax collections rising because of a strong stock market and sales tax growth weak as consumers retreat on spending, Dadayan said.

In Virginia, the economically distressed area around Emporia will suffer aftershocks from the plywood plant closing, said Del. Otto Wachsmann, a Republican who represents the area in the state House of Delegates. The area is already reeling from the indefinite closure of a nearby Boar’s Head lunch meat plant that employed 600 people after a listeria outbreak there last year.

The community, part of the southern “Wood Basket” region, has a large logging industry that will now struggle to find new markets farther away with higher costs for trucking, Wachsmann said. “We’re working hard to find new industries to come here.”

Layoff rates in April, as calculated by the online human resources platform Techr, showed New Jersey, Vermont and Virginia with the highest rates.

Amanda Goodall, a workforce analyst who calls herself “The Job Chick” on social media, said the layoffs reflect restructuring in major corporations as well as federal cutbacks. She wrote about the layoff rates in a recent post.

“These are not statistical flukes. They reflect real corporate moves, in New Jersey and Virginia especially,” Goodall wrote in an emailed statement to Stateline. “The bigger issue is that nobody on the ground cares what the unemployment rate says if they can’t find an interview for a job they’re qualified for. State layoff figures are giving us an early read.”

California and Texas

California and Texas saw the biggest jobs gains in both surveys in the second quarter.

Texas added 42,700 jobs in the payroll survey, with the largest increase coming in the category of private educational services, 14,400 jobs, as the state approved a plan for school vouchers to start next year, according to a statement to Stateline from the Texas Workforce Commission.

California added 25,300 jobs. But the household survey showed an increase of almost 111,000 jobs, the highest in the country.

A Public Policy Institute of California blog post in July called the state’s labor market “at best, in a hold-steady pattern this year,” citing the state’s stubbornly elevated unemployment rate of 5.4% but also its jobs improvement over last year.

“A hold-steady pattern is a welcome change from a year ago,” said the post, written by Sarah Bohn, a senior fellow at the institute.

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By CURT ANDERSON, Associated Press

ST. PETERSBURG, Fla. (AP) — Florida will work to phase out all childhood vaccine mandates in the state, building on the effort by Republican Gov. Ron DeSantis to curb vaccine requirements and other health mandates during the COVID-19 pandemic.

DeSantis also announced on Wednesday the creation of a state-level “Make America Healthy Again” commission modeled after similar initiatives pushed at the federal level by Health and Human Services Secretary Robert F. Kennedy Jr.

On the vaccines, state Surgeon General Dr. Joseph Ladapo cast current requirements in schools and elsewhere as an “immoral” intrusion on people’s rights bordering on “slavery,” and hampers parents’ ability to make health decisions for their children.

“People have a right to make their own decisions, informed decisions,” said Ladapo, who has frequently clashed with the medical establishment, at a news conference in Valrico, Florida, in the Tampa area. “They don’t have the right to tell you what to put in your body. Take it away from them.”

The state Health Department, Ladapo said, can scrap its own rules for some vaccine mandates, but others would require action by the Florida Legislature. He did not specify any particular vaccines but repeated several times the effort would end “all of them. Every last one of them.”

Florida would be the first state to eliminate so many vaccine mandates, Ladapo added.

Democratic state Rep. Anna Eskamani, who is running for Orlando mayor, said in a social media post that scrapping vaccines “is reckless and dangerous” and could cause outbreaks of preventable disease.

“This is a public health disaster in the making for the Sunshine State,” she said on the social platform X.

Meanwhile, the Democratic governors of Washington, Oregon and California announced Wednesday that they created an alliance to safeguard health policies, contending that the administration of President Donald Trump is politicizing public health decisions.

The partnership plans to coordinate health guidelines by aligning immunization plans based on recommendations from respected national medical organizations, according to a joint statement from Gov. Bob Ferguson of Washington, Gov. Tina Kotek of Oregon and Gov. Gavin Newsom of California.

In Florida, vaccine mandates for child day care facilities and public schools include shots for measles, chickenpox, hepatitis B, Diphtheria-tetanus-acellular pertussis (DTaP), polio and other diseases, according to the state Health Department’s website.

Under DeSantis, Florida resisted imposing COVID vaccines on schoolchildren, requiring “passports” for places that draw crowds, school closures and mandates that workers get the shots to keep their jobs.

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“I don’t think there’s another state that’s done as much as Florida. We want to stay ahead of the curve,” the governor said.

The state “MAHA” commission would look into such things as allowing informed consent in medical matters, promoting safe and nutritious food, boosting parental rights regarding medical decisions about their children, and eliminating “medical orthodoxy that is not supported by the data,” DeSantis said. The commission will be chaired by Lt. Gov. Jay Collins and Florida first lady Casey DeSantis.

“We’re getting government out of the way, getting government out of your lives,” Collins said.

The commission’s work will help inform a large “medical freedom package” to be introduced in the Legislature next session, which would address the vaccine mandates required by state law and make permanent the recent state COVID decisions relaxing restrictions, DeSantis said.

“There will be a broad package,” the governor said.