By GEOFF MULVIHILL, Associated Press

Seventeen Democratic officials accused President Donald Trump’s administration of unlawfully intimidating health care providers into stopping gender-affirming care for transgender youth in a lawsuit filed Friday.

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The complaint comes after a month in which at least eight major hospitals and hospital systems — all in states where the care is allowed under state law — announced they were stopping or restricting the care. The latest announcement came Thursday from UI Health in Chicago.

Trump’s administration announced in July that it was sending subpoenas to providers and focusing on investigating them for fraud. It later boasted in a news release that hospitals are halting treatments.

The Democratic officials say Trump’s policies are an attempt to impose a nationwide ban on the treatment for people under 19 — and that’s unlawful because there’s no federal statute that bans providing the care to minors. The suit was filed by attorneys general from 15 states and the District of Columbia, plus the governor of Pennsylvania, in U.S. District Court in Boston.

“The federal government is running a cruel and targeted harassment campaign against providers who offer lawful, lifesaving care to children,” New York Attorney General Letitia James said in a statement.

Trump and others who oppose the care say that it makes permanent changes that people who receive it could come to regret — and maintain that it’s being driven by questionable science.

Since 2021, 28 states with Republican-controlled legislatures have adopted policies to ban or restrict gender-affirming care for minors. In June, the U.S. Supreme Court ruled that states have a right to enforce those laws.

For families with transgender children, the state laws and medical center policy changes have sparked urgent scrambles for treatment.

FILE – Liv Y., center, holds a transgender pride flag as people gather to protest against the Trump administration and Project 2025 near the Washington State Capitol building, in in Olympia, Wash., Feb. 5, 2025. (AP Photo/Lindsey Wasson, File)

The medical centers are responding to political and legal pressure

The Center for Transyouth Health and Development at Children’s Hospital Los Angeles, the biggest public provider of gender-affirming care for children in teens in the U.S., closed in July.

At least seven other major hospitals and health systems have made similar announcements, including Children’s National in Washington D.C., UChicago Medicine and Yale New Haven Health.

Kaiser Permanente, which operates in California and several other states, said it would pause gender-affirming surgeries for those under 19 as of the end of August, but would continue hormone therapy.

Connecticut Children’s Medical Center cited “an increasingly complex and evolving landscape” for winding down care.

Other hospitals, including Penn State, had already made similar decisions since Trump returned to office in January.

Alex Sheldon, executive director of GLMA, an organization that advocates for health care equity for LGBTQ+ people, said the health systems have pulled back the services for legal reasons, not medical ones.

“Not once has a hospital said they are ending care because it is not medically sound,” Sheldon said.

FILE – President Donald Trump signs an executive order barring transgender female athletes from competing in women’s or girls’ sporting events, in the East Room of the White House, in Washington, Feb. 5, 2025. (AP Photo/Alex Brandon, File)

Trump’s administration has targeted the care in multiple ways

Trump devoted a lot of attention to transgender people in his campaign last year as part of a growing pushback from conservatives as transgender people have gained visibility and acceptance on some fronts. Trump criticized gender-affirming care, transgender women in women’s sports, and transgender women’s use of women’s facilities such as restrooms.

On his inauguration day in January, Trump signed an executive order defining the sexes as only male and female for government purposes, setting the tone for a cascade of actions that affect transgender people. About a week later, Trump called to stop using federal money, including from Medicaid, for gender-affirming care for those under 19.

About half of U.S. adults approve of Trump’s handling of transgender issues, an AP-NORC poll found. But the American Medical Association says that gender is on a spectrum, and the group opposes policies that restrict access to gender-affirming health care.

Gender-affirming care includes a range of medical and mental health services to support a person’s gender identity, including when it’s different from the sex they were assigned at birth. It includes counseling and treatment with medications that block puberty, and hormone therapy to produce physical changes, as well as surgery, which is rare for minors.

In March, a judge paused enforcement of the ban on government spending for care.

The court ruling didn’t stop other federal government action

In April, Attorney General Pam Bondi directed government investigators to focus on providers who continue to offer gender-affirming care for transgender youth. “Under my leadership, the Department of Justice will bring these practices to an end,” she wrote.

In May, the Department of Health and Human Services issued a report discouraging medical interventions for transgender youth and instead focusing solely on talk therapy. The report questions adolescents’ capacity to consent to life-changing treatments that could result in future infertility. The administration has not said who wrote the report, which has been deeply criticized by LGBTQ+ advocates.

In June, a Justice Department memo called for prioritizing civil investigations of those who provide the treatment.

In July, Justice Department announced it had sent more than 20 subpoenas to doctors and clinics involved in gender-affirming care for youth, saying they were part of investigations of health care fraud, false statements and other possible wrongdoing.

And in a statement last week, the White House celebrated decisions to end gender-affirming care, which it called a “barbaric, pseudoscientific practice”

Families worry about accessing care

Kristen Salvatore’s 15-year-old child started hormone therapy late last year at Penn State Health. Salvatore said in an interview with The Associated Press before the lawsuit was announced that it was a major factor in reduced signs of anxiety and depression. Last month, the family received official notice from the health system that it would no longer offer the hormones for patients under 19 after July 31, though talk therapy can continue.

Salvatore has been struggling to find a place that’s not hours away from their Mechanicsburg, Pennsylvania, home that would provide the hormones and accept Medicaid coverage.

“I’m walking around blind with no guidance, and whatever breadcrumbs I was given are to a dead-end alleyway,” she said.

The family has enough testosterone stockpiled to last until January. But if they can’t find a new provider by then, Salvatore’s child could risk detransitioning, she said.

By TOM MURPHY and NICKY FORSTER, Associated Press

Delayed treatments, canceled doctor visits, skipped prescriptions. Losing insurance is bad for your health.

The Congressional Budget Office forecasts that the U.S. uninsured population will grow by 10 million in 2034, due to the tax and spending bill signed into law by President Donald Trump.

And, thanks to a natural experiment nearly two decades ago, researchers can forecast what that will mean for patient care. Among the problems they predict will develop as a direct result of these people losing coverage:

— About 2.5 million people may no longer have a personal doctor.

— About 1.6 million patients will take on medical debt.

— The lack of care may cause nearly 22,000 deaths annually.

“There’s really no questioning the basic reality that you can’t take health care away from 10 million people without causing many preventable deaths,” said Dr. Adam Gaffney, lead researcher on a team that explored the new law’s impact.

Here’s a deeper look at the research and challenges that could develop.

How the law may affect coverage

It will become harder for many people to enroll in Medicaid or individual insurance plans and then stay covered. Medicaid is a state and federally funded program that covers care for people with low incomes.

States will have to verify every six months whether someone remains eligible for Medicaid. That could cause coverage lapses for people with incomes that fluctuate or for those who move and miss renewal paperwork.

Many also are expected to lose coverage as states require Medicaid recipients to work, volunteer or go to school unless exempted.

Enrollment in Medicaid has swelled in recent years. Republicans are cutting back in part to help fund tax breaks and pay for other priorities like border security. They also say they are trying to root out waste and fraud by rightsizing Medicaid for the population it was initially designed to serve — mainly pregnant women, the disabled and children.

People covered through the Affordable Care Act’s individual insurance marketplaces also will see shorter enrollment windows and no more automatic renewals.

About the research

Gaffney, of Harvard Medical School, and other researchers looked to past studies to measure how many people would experience detrimental effects, like going without prescriptions, from the upcoming changes. Gaffney updated the published analysis, which was originally based on the House version of the bill, at the AP’s request.

One study in particular was critical for their work: In 2008, Oregon offered a rare opportunity to compare groups of people enrolled in Medicaid with those who were not.

After a four-year period of frozen enrollment due to budget limitations, the state determined it could enroll 10,000 more people in Medicaid. It used a lottery system to make the selection amid high demand.

That gave researchers a chance to follow people who got coverage and those who did not, similar to how scientists testing a new drug might compare patients taking it to those given a placebo.

“This is a gold standard research design because it replicates a randomized-controlled trial,” said Christine Eibner, a senior economist at RAND Corp. who was not involved in the study.

Applying results from that study and other research to the recent CBO estimate allowed Gaffney and other researchers to estimate specific effects of losing coverage.

“By taking coverage away, we are putting patients in a terrible position,” said Gaffney, a former president of Physicians for a National Health Program.

Care could grow complicated

Amanda Schlesier went four days without her cancer treatment Calquence this spring and wound up in a local emergency room, delirious with pain.

The leukemia patient worries about what might happen if she stops treatment again for a longer stretch because she’s lost Medicaid.

“God forbid I forget to fill out a page of documentation, and suddenly I lose access to my medication or my doctors or any of the treatment that I’ve been going through,” the 33-year-old Farmington Hills, Michigan, resident said.

People can still receive care when they don’t have coverage, but important steps often are delayed, said Dr. Gwen Nichols, chief medical officer of The Leukemia & Lymphoma Society.

Patients may be able to visit a doctor, but they would have to line up coverage or help before they can receive expensive chemotherapy. Diagnosis also may be delayed. Meanwhile, the patient’s cancer continues to grow.

“It’s a ticking time bomb,” Nichols said.

Preventive care may lapse

The first thing patients often ditch when they lose coverage are screenings designed to catch health problems before they become serious, said Dr. Jen Brull, president of the American Academy of Family Physicians.

That could mean patients skip tests for high cholesterol, which can contribute to heart disease, or colonoscopies that detect cancer. Researchers forecast that a half million fewer women will have gotten a mammogram within the past year by 2034.

When patients struggle financially and lose coverage, they focus on things like keeping a place to live and food on their table, said Brull, a Fort Collins, Colorado, physician.

“Seeing a doctor because you don’t want to get sick feels like a much lower priority,” Brull said.

Financial pressure can build

Patients start taking financial hits at all ends of care when they lose coverage.

They may have to pay up front or start a payment plan before they receive care, said Erin Bradshaw, an executive vice president with the nonprofit Patient Advocate Foundation, which helps people with medical bills.

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Anyone with an outstanding balance will have to pay it before the next appointment.

Financial assistance may be available, but patients don’t always know about it. Getting help also may take time and require the submission of tax returns, pay stubs or some validation that the patient no longer has coverage.

Bradshaw said letters stating that a patient has lost Medicaid sometimes arrive a couple months after the fact. That can contribute to treatment delays or missed medication doses.

Some patients also try to avoid financial stress by skipping care. Schlesier said she delayed seeing a doctor when she first felt symptoms of her cancer returning because she had no coverage at the time.

Staying on medications

If prescriptions are too expensive, patients may simply not get them or split the doses to stretch the medicine.

For Thomas Harper, it’s a question of priorities.

“Sometimes you have to make a choice, how well do you want to eat this week versus taking your medicine,” he said.

The West Monroe, Louisiana, truck driver has around $300 a month in prescriptions as he deals with diabetes and recovers from non-Hodgkin lymphoma, a type of blood cancer.

Harper, 57, recently returned to work. That meant he lost Medicaid, which covered more of his prescription costs. He’s balancing buying his meds with shopping for healthy food that keeps his blood sugar in check and builds his immune system.

“I’ll survive, but I know there’s people out there that cannot survive without Medicaid,” he said.

AP video journalist Laura Bargfeld contributed to this report.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

By DEE-ANN DURBIN and ANNE D’INNOCENZIO, AP Business Writers

American businesses and consumers woke up Friday to find the contours of President Donald Trump’s foreign trade agenda taking shape but without much more clarity on how import taxes on goods from dozens of countries would affect them.

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Late Thursday, Trump ordered new tariff rates for 66 countries, the European Union, Taiwan and the Falkland Islands. Among them: a 40% tariff on imports from Laos, a 39% tariff on goods from Switzerland and a 30% tariff on South African products.

Other trade partners, such as Cambodia, had the tax rates on their exports to the U.S. reduced from levels the president had threatened to impose. Trump postponed the start date for all of the tariffs from Friday until Aug. 7.

Wendong Zhang, an associate professor in the Dyson School of Applied Economics and Management at Cornell University, said U.S. consumers may be feeling some relief with the tariff rates announced, since many were lower than Trump initially threatened. Indonesia’s rate was 19%, for example, down from the 32% Trump announced last spring.

But tariffs are a tax, and U.S. consumers are likely to foot at least part of that bill.

“Prices are still going up, they just won’t go up as much as in the worst-case scenario,” Zhang said.

Companies are dealing with tariffs in various ways. Many automakers appear to be swallowing tariff costs for now. But the world’s largest eyewear maker, EssilorLuxottica, said it raised U.S. prices due to tariffs. The maker of Ray-Bans grinds lenses and sunglasses in Mexico, Thailand and China and exports premium frames from Italy.

Here’s what we know about the tariffs and what their impact will be on U.S. consumers:

How we got here

President Donald Trump unveiled sweeping import taxes on goods coming into the U.S. from nearly every country in April. He said the tariffs were meant to boost domestic manufacturing and restore fairness to global trade.

A week later, Trump announced a 90-day pause on the tariffs but did leave in place a 10% tax on most imports. In early July, Trump began sending letters to dozens of countries saying higher tariffs would go into effect Aug. 1 unless they reached trade deals.

The administration announced new rates for dozens of countries on Thursday but delayed their implementation until Aug. 7.

In the meantime, Trump announced a 35% tariff on imports from Canada would take effect Friday. But Trump delayed action on Mexico and China while negotiations continue.

Other duties not specific to countries also remained in place Friday, like a 50% tariff on imported aluminum and steel announced in June.

What tariffs are in place already

The Trump administration has reached deals with the European Union, Japan and South Korea that put 15% tariffs in place. A deal with the Philippines puts 19% tariffs in place while a deal with Vietnam imposes a 20% levy. On Wednesday, Trump announced a 25% tariff on goods from India and a 50% tariff on goods from Brazil.

Tariffs are already impacting prices

The U.S. Commerce Department said Thursday that prices rose 2.6% in June, up from an annual pace of 2.4% in May and higher than the Federal Reserve’s goal of 2%. Many goods that are heavily imported saw price increases, including furniture, appliances and computers.

Zhang, the Cornell economist, said U.S. consumers could see higher prices in the coming months for appliances and other products that contain a large amount of steel and aluminum. Toys, kitchenware, electronics and home goods could also see price spikes.

But Zhang said a 15% tariff doesn’t mean prices will immediately rise by 15%. Companies were aware of the tariff deadlines and have been trying to stockpile goods and take other measures to mitigate the impacts.

Some Americans will see benefits

Zhang noted that Trump’s trade deals often contain specific provisions designed to boost U.S. exports. The agreement with the European Union, for example, calls for European companies to purchase $750 billion worth of natural gas, oil and nuclear fuel from the U.S. over three years.

Zhang said semiconductor firms and military contractors could also see bumps in trade.

Some U.S. farmers could also see a potential upside, Zhang said. As part of its trade deal, Vietnam agreed to purchase $2 billion in U.S. agricultural products over three years, including corn, wheat and soybeans, according to the International Trade Council.

But Zhang cautioned that agricultural agreements tend to be short-lived. Over the longer term, the uncertainty over tariffs could cause countries like China to back away from U.S. agricultural markets and look for other partners, Zhang said.

Food and drink prices will climb

The tariffs will almost certainly result in higher food prices, according to an analysis released this week by the nonpartisan Tax Foundation. The U.S. simply doesn’t make enough of some products, like bananas or coffee, to satisfy demand. Fish, beer and liquor are also likely to see price hikes, the foundation said.

Conagra Brands, the maker of Hunt’s canned tomatoes, Reddi-wip and other brands, said in July that tariffs – particularly the 50% tax on imported aluminum and steel — will add $200 million annually to its costs. The company said it’s shifting some of its suppliers but also expects to raise prices.

Ben Aneff, managing partner at Tribeca Wine Merchants and president of the U.S. Wine Trade Alliance, said that beginning Friday shoppers will see prices rise 20% to 25% at his store and others because of tariffs and the declining value of the dollar.

“Nobody can afford to eat the tariff. It gets passed on,” Aneff said.

Aneff said shoppers haven’t felt the impact from higher duties until now because distributors and retailers accelerated shipments from France and other European countries earlier in the year. But with the tariff rate bumping to 15%, Aneff expects European wine prices to jump 30% in September.

Clothing and shoe prices are already creeping up

Ninety-seven percent of clothing and shoes sold in the U.S. are imported, primarily from Asia, according to the American Apparel & Footwear Association said. China leads the pack, but companies have been shifting more of their sourcing to Vietnam, Indonesia and India.

And prices are already on the rise. Steve Lamar, president and CEO of of the trade group, declined to estimate price increases because he said the situation continues to be in flux. He also said shoppers will see higher costs from tariffs play out in other ways starting this fall. Companies may drop products because they’re too expensive or reduce promotions, he said.

Matt Priest, president and CEO of the Footwear Distributors and Retailers of America, estimates prices for shoes are starting to go up for the back-to-school shopping season. He estimates price increases in the 5% to 10% range.

Lululemon said in June that price increases will be modest and apply to a small portion of its assortment, while Ralph Lauren said it would be hiking prices for this fall and next spring to offset tariffs.

Bjorn Gulden, CEO of Germany-based Athletic wear giant Adidas, told investors Wednesday that the company is reviewing different price increases for products for the U.S. but no decision has been made.

“Tariffs (are) nothing else than a cost,” he said. “And regardless of what people are saying, you can’t just throw a cost away. It’s there.”

Car prices hold steady — so far

Some automakers have already raised prices to counteract tariffs. Luxury sports car maker Ferrari said Thursday it was waiting for more details of Trump’s trade deal with the European Union before scaling back a 10% surcharge it put in place in April on most vehicles in the U.S.

But for the most part, automakers haven’t been raising prices as they wait for details of the trade deals. Kelley Blue Book, which monitors car pricing, said the average U.S. new car cost $48,907 in June, which was up just $108 from May.

But that could change. General Motors said last week that the impact of the tariffs could get more pronounced in the third quarter of this year. GM has estimated that the tariffs will cost it $4 billion to $5 billion this year.

AP Business Writer Colleen Barry reported from Milan.

By ERIKA KINETZ and AARON KESSLER

ROME (AP) — Hard-right commentators, politicians and activists in Europe have uncovered a secret to expanding their influence: engaging with Elon Musk.

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Take the German politician from a party whose own domestic intelligence agency has designated as extremist. Her daily audience on X surged from 230,000 to 2.2 million on days Musk interacted with her posts. She went on to lead her party to its best-ever electoral showing.

Or the anti-immigration activist in Britain, who was banned from Twitter and sentenced to 18 months in prison for contempt of court. Since Musk let him back on the platform in late 2023, he’s mentioned, reposted or replied to the billionaire more than 120 times on X — and gained nearly a million followers.

Even a little-known social-media influencer turned politician from Cyprus has benefited from the Musk effect. Before winning a surprise seat in the European Parliament, where he’s advocated for Musk, the influencer seemed to have one ambition: to hug the world’s richest man. He got his hug — and political endorsements. On days Musk has interacted with his account on X, the man’s audience exploded from just over 300,000 to nearly 10 million views.

In this combination of 2023 photos, a worker removes parts of a sign on the Twitter headquarters building in San Francisco, on July 24, right; and workers install lighting on an “X” sign atop the downtown San Francisco building that housed what was previously known as Twitter, rebranded “X” by new owner Elon Musk, on July 28. (AP Photos/Godofredo A. Vásquez, Noah Berger)

Elon Musk may have tumbled from political grace in Washington — he stepped down as an adviser to President Donald Trump in May and has since traded insults with the president — but as he works to build his own political party, his power on X his power remains unchecked.

Musk’s influence on the platform he bought for $44 billion has made him a kingmaker at home and abroad. Among those he has chosen to cultivate are hard-right politicians and insurgent influencers across Europe, according to an Associated Press analysis of public data. His dominance, which has real-world financial and political impacts, is fueling concerns in Europe about foreign meddling — not from Russia or China this time, but from the United States.

“Every alarm bell needs to ring,” said Christel Schaldemose, a vice president of the European Parliament who works on electoral interference and digital regulation. “We need to make sure that power is not unbalanced.”

In seeking to quantify Musk’s effect on European politics, The Associated Press analyzed more than 20,000 posts over a three-year period from 11 far-right European figures across six countries who frequently promote a hard-right political or social agenda and had significant interactions with Elon Musk since he purchased Twitter. Tens of thousands of posts by Musk on Twitter, now known as X, were also collected.

The AP used the records, obtained from data provider Bright Data, to analyze how Musk’s account interacted with the European influencers, and vice versa, and the extent to which Musk’s engagement boosted their reach.

These case studies are not meant to be representative of a broad universe; rather, they showcase the ways in which Musk’s engagement can have an impact on local influencers who share his views.

Due to limitations on data collection, the dataset is not a complete record of all posts made by these accounts. Even so, it captured at least 920 instances in which one of the European accounts tagged, replied or otherwise attempted to interact with Musk’s account, and at nearly 190 instances where Musk’s own posts interacted with the Europeans.

The AP also analyzed records of daily follower counts, using data from Social Blade, to measure any growth in the European accounts’ audience that occurred in the wake of Musk’s online interactions. This kind of analysis is no longer possible. In March, Social Blade removed X from its analytics, saying that X had increased its data access fees to prohibitive levels, making the platform harder to research.

Among those included in AP’s analysis are several people who have run into legal trouble in their own countries. An anti-immigrant agitator in the U.K., for example, was sentenced in October to 18 months in prison for violating a court order blocking him from making libelous allegations against a Syrian refugee. A German politician was convicted last year of knowingly using a Nazi slogan in a speech. An Italian vice premier was acquitted in December of illegally detaining 100 migrants aboard a humanitarian rescue ship.

FILE – Elon Musk speaks at the Conservative Political Action Conference, CPAC, at the Gaylord National Resort & Convention Center, Thursday, Feb. 20, 2025, in Oxon Hill, Md. (AP Photo/Jose Luis Magana, File)

Others examined by AP were an influencer known as the “shieldmaiden of the far-right;” a German activist dubbed the “anti-Greta Thunberg” now living in what amounts to political exile in Washington, D.C.; and two politicians who have advocated for the interests of Musk’s companies as those firms seek to expand in Europe.

AP’s analysis shows how Musk is helping unite nationalists across borders in common cause to halt migration, overturn progressive policies and promote an absolutist vision of free speech. While his efforts have sparked backlash in some countries, Musk’s promotion of a growing alliance of hard-right parties and individuals has helped rattle the foundation of a transatlantic bond that has guided U.S. and European relations for over eight decades.

Engagement from Musk does not guarantee a surge in followers or page views. But AP found it can have a huge impact, especially on up-and-coming influencers. One account that began with around 120,000 followers when Musk took over Twitter in October 2022 topped 1.2 million by January of this year. Seven other European accounts saw six-figure increases in their follower counts over the same period.

Most of the 11 accounts examined saw triple-digit percentage increases in their followers. Even some that grew more steadily on their own before Musk interacted with them saw their follower counts rise sharply after he began engaging with their posts. Similarly, on days Musk interacted with a post, its account saw its views soar — in most cases, accruing two to four times as many views, with a few seeing boosts 30 or 40 times their normal daily viewership.

Musk is not the only factor influencing the growth of these accounts, of course, but their rising fortunes are a measure of how the platform has evolved under his leadership. When Musk acquired X, he pledged to turn it into a haven for free speech, declaring himself a “free speech absolutist.” AP’s analysis adds to growing evidence that instead of serving as a neutral forum for free speech, X amplifies Musk’s speech.

This shift has given him sweeping power to direct people’s attention.

“There’s an extreme asymmetry in the way Musk is able to leverage and shape the platform,” said Timothy Graham, an associate professor in digital media at the Queensland University of Technology in Brisbane, Australia, who has studied data anomalies on X. “There’s an unequivocal sense when you go onto the site that you’re entering Musk’s kingdom.”

FILE – President Donald Trump, right, speaks during a news conference with Elon Musk in the Oval Office of the White House, Friday, May 30, 2025, in Washington. (AP Photo/Evan Vucci, File)

Musk’s megaphone: Bigger than Trump and Taylor Swift

Since he acquired Twitter in 2022, Musk has come to dominate the platform. His followers have more than doubled, to more than 220 million — growth so tremendous that it easily outpaced the other Top 10 accounts. Not even Taylor Swift has been able to keep up.

Indian Prime Minister Narendra Modi, whose followers grew by 21 million — or 25% — from October 2022 through January, clocked a distant second. Donald Trump’s followers grew by 14%, or around 12 million, while Taylor Swift mustered a mere 3% growth, or 3 million new followers.

None of the other Top 10 accounts have shown such consistent follower growth, month after month, AP found. The result is a further concentration of power for the world’s richest man, who now commands the most popular account on a social media platform used by hundreds of millions of people around the world.

Given the opacity of the algorithms that power X, it’s hard to determine with certainty what array of factors might be driving such unusual — and unusually consistent — growth in Musk’s account. But researchers who have analyzed data patterns on X argue that the platform’s algorithm has, at times, been altered to amplify Musk’s voice.

How X promotes content is a growing point of contention in Europe. In January, the European Union expanded its investigation of X to assess how the platform pushes content to users and why some material goes viral. In February, French prosecutors opened a separate investigation into X over allegations that Musk changed the platform’s algorithms to promote biased content.

Musk’s public attacks on left-leaning politicians, support for hard-right policies and loose handling of facts have prompted rebukes from British Prime Minister Keir Starmer, former German Chancellor Olaf Scholz, French President Emmanuel Macron, Spanish Prime Minister Pedro Sanchez, Italian President Sergio Mattarella, and Norwegian Prime Minister Jonas Gahr Støre.

X did not respond to requests for comment.

Musk is X’s kingmaker

Musk’s dominance creates a strong incentive for people seeking to increase their clout — or their revenues, through the platform’s monetization options — to exploit these network effects and try to get Musk to engage with their content.

“People know that he’s gearing everything towards him,” said Graham, the digital media scholar in Australia. “They’re doing everything they can to get close to this person because he is the moneymaker.”

Germany’s Alternative for Germany (AfD) party, for example, has benefited from the Musk effect. AfD coleader Alice Weidel helped lead the party, which advocates for nationalist and anti-immigrant policies, to second place in German parliamentary elections in February.

When Musk interacted with her account in the run-up to those elections, the average number of daily views she got rose from about 230,000 to 2.2 million.

Germany’s domestic intelligence agency in May classified Weidel’s party as a right-wing extremist organization, which would subject the AfD to greater surveillance. The party, which maintains that it’s a victim of politically motivated defamation, promptly filed a lawsuit against the move, which Musk, along with top U.S. officials blasted as an attack on free speech. The designation has been suspended pending judicial review.

The AfD denies any association with Germany’s Nazi past — though, in a chat with Musk livestreamed on X in January, Weidel falsely described Hitler as a “communist, socialist guy.”

The chat has gotten 16 million views. Musk also appeared at AfD rallies and endorsed the party in a German newspaper.

AfD officials did not respond to requests for comment.

Naomi Seibt, a German climate skeptic, pinged Musk nearly 600 times between October 2022 and Jan. 2025. Musk finally engaged in June 2024, when he asked her to explain why the AfD is so controversial in Germany.

Since then, Musk has replied to, quoted or tagged Seibt more than 50 times, and her followers have grown by more than 320,000 since Musk took over the platform. On days Musk interacted with Seibt, her posts, on average, got 2.6 times as many views.

“I didn’t intentionally ‘invade’ Elon’s algorithm,” Seibt told AP. “Obviously Elon has a lot of influence and can help share a message even with those who are usually glued to the legacy media, particularly in Germany.”

Seibt said she’s now living in the United States because she fears political persecution in Europe. “Washington DC is the political heart of America and thus also the safest place for me to be,” she said. “I fear the German state wants me locked up.”

Musk has also boosted the influence of political insurgents in the U.K. Days before British national elections last July, Musk took to X to ask Nigel Farage, the leader of the populist Reform U.K. party: “Why does the media keep calling you far-right? What are your policies?”

Farage replied eagerly: “Because we believe in family, country and strong borders. Call me!”

Such interactions from Musk helped Farage more than triple his daily audience. Farage did not reply to requests for comment.

In Spain, Rubén Pulido, a columnist for a newspaper published by the populist Vox party’s think tank, hit the jackpot in August, when Musk responded to two posts in which he argued that rescue boats operated by nongovernmental organizations effectively help smugglers move migrants to Europe. Pulido’s visibility soared. On days Musk engaged with him, his account got nearly 300,000 views — roughly three times more than usual.

When Musk didn’t interact with Pulido’s account, the results were just as clear. In January, he again inveighed against migrant rescues and sought to get Musk’s attention.

“Hi @elonmusk! Speak up,” he urged.

Three weeks later, he tweeted: “Perhaps @elonmusk might find this interesting.”

That post garnered just 5,128 views.

Pulido did not respond to requests for comment.

While Musk helped boost the accounts of such fringe parties and rising influencers, his interactions did not provide as stark a benefit to more established politicians, AP found. That was true for both Italian Prime Minister Giorgia Meloni, whose ruling Brothers of Italy party has neo-fascist roots, and Dutch politician Geert Wilders, an anti-Islamic firebrand who has been called the Dutch Donald Trump.

What happens on X doesn’t always stay on X

Musk’s interactions online have spilled into political endorsements, policy advocacy — and money.

X helps users monetize their accounts, through ad revenue sharing and paid subscription programs as well as direct fundraising links. That means a surge in attention on X can bring a surge in revenue.

Tommy Robinson, a British anti-immigration agitator who was released from prison in May, after serving a reduced sentence of seven months for contempt of court, has a link to his fundraising page on his X profile. Interactions from Musk more than doubled Robinson’s daily views, from around 380,000 to nearly 850,000. Robinson — whose real name is Stephen Yaxley-Lennon — could not be reached for comment

Radio Genoa, an account reportedly investigated by Italian authorities last year for allegedly spreading hate speech about migrants, used X to publicize a call for a GoFundMe campaign to raise money for legal defense. Radio Genoa has pinged Musk dozens of times over the last three years, and for good reason: On days Musk engaged with him, the views on his account doubled. Radio Genoa’s followers surged from less than 200,000 before Musk’s engagement to over 1.2 million. Radio Genoa could not be reached for comment.

Eva Vlaardingerbroek — a conservative Dutch political commentator dubbed the “shieldmaiden of the far-right” whose account Musk has engaged with three dozen times — uses X to solicit tips and has creator status, which allows her to charge subscription fees. So does Seibt, the German activist — though she told AP her earnings from X aren’t enough to sustain herself. Vlaardingerbroek did not respond to requests for comment.

Musk has also advocated for Matteo Salvini, vice premier of Italy and the leader of the hard-right, anti-migrant League party. On X, Musk’s interactions boosted Salvini’s daily visibility more than fourfold. Offline, Salvini has urged Italy to move ahead with controversial contracts for Starlink and pushed back against EU efforts to regulate content on X.

Before Fidias Panayiotou — a 25-year-old social media influencer from Cyprus with no political experience — won a surprise seat as an independent in the European Parliament last year, he spent weeks camped outside Twitter and Space X headquarters in a highly publicized quest to hug the world’s richest man. In January 2023, his wish came true. Their embrace went viral.

Soon, Musk was interacting with Panayiotou’s posts on a variety of subjects, expanding his typical audience on X by more than 3,000%.

Since taking his seat, Panayiotou — whose positions often also reflect the views of Cyprus’ traditional leftist establishment — has praised X on the floor of the European Parliament, pushed back against regulations that impact the platform, and credited Musk with sparking his call to fire 80% of EU bureaucrats.

Musk, evidently, was pleased. “Vote for Fidias,” he posted on X, an endorsement that was viewed more than 11.5 million times. “He is smart, super high energy and genuinely cares about you!”

In July, after AP asked for comment, Panayiotou posted a video to dispel any impression that he was Musk’s puppet. “I don’t have any relationship with Elon Musk,” he said. “We haven’t spoken at all since we hugged, neither through messages, nor by phone, and I’ve never invited him anywhere.”

He said that Musk, unprompted, began reposting his content after he was elected to the European Parliament.

“I don’t think it’s a danger to democracy honestly that Elon Musk supports me,” Panayiotou explained in another video. “I think this is the beauty of democracy.”

Kessler reported from Washington. Menelaos Hadjicostis in Nicosia and Suman Naishadham in Madrid contributed to this report.

Contact AP’s global investigative team at Investigative@ap.org or https://www.ap.org/tips/