State and Federal Reproductive Rights and Abortion Litigation Tracker

Last updated on

Sep 19, 2025

The Supreme Court’s Dobbs ruling, overturning Roe v. Wade, returned the decision to restrict or protect abortion to states. In many states, abortion providers and advocates are challenging state abortion bans contending that the bans violate the state constitution or another state law. The state litigation tracker presents up-to-date information on the ongoing litigation challenging state abortion policy.

In addition, since the Dobbs decision, new questions have arisen regarding the intersection of federal and state authority when it impacts access to abortion and contraception. Litigation has been brought in federal court to resolve some of these questions. The federal litigation tracker presents up-to-date information on the litigation in federal courts that involves access to contraception and abortion.

State Litigation

Federal Litigation

Litigation Involving Reproductive Health and Rights in the Federal Courts, as of February 15, 2023

Part-Time Workers Have Less Access to Employer-Based Coverage Than Full-Time Workers

Key Characteristics of the Part-Time Workforce

Authors: Aubrey Winger, Matthew Rae, and Gary Claxton

Published: Sep 19, 2025

Overview

Employer-sponsored health insurance (ESI) is the primary source of health coverage for working non-elderly adults, but adults working part time (fewer than 35 hours per week) have less access to these benefits than their full-time counterparts. Among non-elderly adults employed by public or private employers (excluding the self-employed), 18.5 million, or 14% of adult workers, work part time. This report examines the characteristics of part-time workers and their access to employer-sponsored health benefits.

Part-time workers—particularly those living in households without a full-time worker—are less likely to be offered health coverage and less likely to be enrolled in an employer plan, either through their own employer or as a dependent on someone else’s plan. Part-time workers who do not have employer coverage may be eligible for Medicaid or for subsidized coverage in the Affordable Care Act (ACA) Marketplaces. However, recent cuts in these coverage programs included in the Republican tax and spending law, as well as the potential expiration of enhanced Marketplace tax credits, will make it harder for individuals who may not have access to an affordable, job-based plan to find coverage.

Who are Part-Time Workers?

Workers cite a wide range of reasons for usually working part-time. Some of the most common include enrollment in school or a training program (30%); family or personal obligations, including childcare obligations (26%); and having a job where full-time work is less than 35 hours per week (19%). Smaller shares report working part time because they are unable to find full-time work (7%) or due to illness, health, or medical limitations (4%).

Generally, part-time workers can be broken into two categories: those working part time for economic reasons (such as inability to find work or seasonal declines in demand), and those working part time for non-economic reasons (such as medical limitations, childcare responsibilities, family or personal obligations, retirement, or jobs where full-time work is less than 35 hours per week). For this analysis, workers enrolled in school or training programs are treated as a separate category due to their large share of the part time workforce. The analysis focuses on non-elderly adult workers who usually work part time; it excludes full-time workers who happened to be working part time at the time of the survey.

On average, part-time workers are younger than full-time workers (35 years old vs. 41 years old) and are more likely to be women (66% vs. 46%). More than half (52%) of part-time workers earned a high school diploma (or equivalent) as their highest level of education. Compared to full-time workers, part-time workers are less likely to have earned a bachelor’s degree (27% vs 44%), or a postgraduate degree such as a master’s or doctorate degree (9% vs 16%).

Part Time Workers are Less Likely Than Full Time Workers to Have a Bachelors or Post Graduate Degree

Part-time workers are more likely than full-time workers to have household incomes below twice the federal poverty level (30% vs. 13%), which is about $30,120 for a single person and $62,400 for a family of four. At the same time, part-time workers are not a homogeneous group; many live in households with higher incomes. Specifically, 42% of part-time workers have household incomes above 400% of the federal poverty level (about $124,800 for a family of four), and 24% have incomes above 600% of the poverty level (about $187,200 for a family of four).

Where do Part-Time Workers Work?

About one in three part-time workers (33%) are employed in service occupations. More specifically, the most common occupations are food preparation and food service-related roles (15%), followed by office and administrative support (13%), sales (12%), transportation and material moving (9%), and education, training, and library occupations (9%). The most common jobs among part-time workers are cashier, waiter, retail salesperson, and personal care aide.

Among the major industry categories, 31% of part-time workers are employed in education, health care, or social assistance; 21% work in the arts, entertainment, recreation, or food services industry; and 17% are in wholesale and retail trade. The most common industries for part-time workers overall are restaurants and other food services; elementary and secondary schools; colleges, universities, and professional schools; hospitals (excluding facilities specifically for psychiatric and substance abuse); and supermarkets or other grocery stores.

Sixty-five percent of part-time workers live in a household with a full-time adult worker. Those living with a full-time worker are much less likely to have a household income below 200% of the federal poverty level compared to those without at least one full-time worker in their household (18% vs. 52%).

Part Time Workers Are More Likely Than Full Time Workers to Have a Family Income Less than Twice the Poverty Level

What is the Health Insurance Coverage of Part-Time Workers ?

Compared to full-time workers, part-time workers are less likely to have employer-based health coverage, either through their own workplace or as a dependent on another plan. They are also less likely to work for an employer that offers health coverage to any of their employees. If a part-time worker is working for an employer that offers coverage, they are less likely to be eligible to enroll in that coverage.

Fifty-four percent of part-time workers have employer-based health coverage, compared to 78% of full-time workers. Notably, part-time workers living in a household without a full-time worker are much less likely to have employer-based coverage (36%) than those in households with at least one full-time worker (63%). Only 19% of part-time workers have employer-based coverage from their own jobs, compared to 62% of full-time workers.

Part Time Workers Are More Likely to be Covered by Employer Insurance if They Have a Full Time Worker in the Household

Overall, part-time workers are more likely to be uninsured than their full-time counterparts (13% vs 9%). Among part-time workers, those living in a household without a full-time worker are more likely to be uninsured (17%) than those living with a full-time worker (11%). Part-time workers are also more likely to be covered by Medicaid (21%) or Direct-Purchase (12%) than full-time workers (7% and 6% respectively). Direct purchase coverage would primarily be through the ACA marketplaces and typically comes with a tax credit to subsidize the premium, scaled with income.

Part Time Workers Are Less Likely to be Covered by a Job-Based Plan, and More Likely to be Uninsured

Offers and take-up of employer-based coverage

One of the reasons part-time workers are less likely to have health coverage through their job is that they are less likely to work for employers who offer health benefits. Specifically, only 60% of part-time workers work for an employer that offers health insurance, compared to 84% for full-time workers.

Among part-time workers who do work for an employer offering health benefits, just 64% are eligible to take up the coverage. For those who work for an employer offering coverage but are not eligible to enroll:

84% do not work enough hours per week or weeks per year to qualify,
8% are contract or temporary employees,
and 5% have not worked for their employer long enough to become eligible.

Under the ACA’s shared responsibility mandate, if employers with at least 50 full-time equivalent employees do not offer minimum essential coverage to 95% of their full-time employees and their dependent children, they are taxed. However, employers are not required to offer coverage to part- time workers.

Part Time Workers Are Less Likely Than Full Time Workers to be Offered Coverage by Their Employer

Of the 60% of part-time workers that work for an employer that offers health insurance, only 64% are actually eligible for coverage at their job. Overall, 19% of part-time workers are covered by their own employer. Among those part-time employees who are eligible but do not take up coverage offered at work, 68% cite having other coverage as the reason for not enrolling, while 28% find the coverage too expensive.

Only 6 in 10 Part Time Workers Are Eligible for Coverage Offered at Their Job, Compared to Almost All Full Time Workers

Part-time workers—especially those living in households without a full-time worker—tend to have lower incomes and are less likely to be covered by a job-based health plan. Even when coverage is offered, many part-time workers cite cost as a reason for not enrolling. These workers may struggle to afford the premiums required to enroll in the plan, or the cost-sharing required by the plan when they go to use services. While, overall, those with employer-sponsored plans spend an average of 3.9% of their income on premiums and cost-sharing, the financial burden is much higher for lower-income households. Fifteen percent of workers have household incomes below 200% of the federal poverty level.

Employer-sponsored insurance remains the linchpin of coverage for non-elderly working adults, but workers with lower incomes or part-time schedules are significantly less likely to have access to this type of insurance. For part-time workers who are either ineligible for or cannot afford job-based coverage, upcoming federal policy changes may further limit their options. Changes to Medicaid and the Affordable Care Act in the Republican tax and spending package — formerly known as the “One Big Beautiful Bill”— are projected to result in 10 million more people becoming uninsured by 2034. Furthermore, if the enhanced premium tax credits that reduce the cost of ACA Marketplace coverage for many enrollees are not extended beyond 2025, an additional 4.2 million people are expected to lose coverage.

Some employers have taken steps to make coverage more accessible for low-wage workers. In 2024, 14% of firms with 200 or more employees offered a plan with reduced benefits and low premium contributions specifically designed to be affordable for low-wage workers. Additionally, some firms provide voluntary benefits to part-time workers outside of their standard health plans. These benefits may include financial assistance for hospitalization or specialized services such as telehealth. In 2024, 3% of small firms and 14% of large firms that did not offer standard coverage to part-time workers offered a voluntary benefit. Despite these efforts, access to employer-sponsored health benefits remains a significant challenge for many part-time workers.

Premium Payments if Enhanced Premium Tax Credits Expire

Authors: Justin Lo, Jared Ortaliza, Matt McGough, Emma Wager, and Cynthia Cox

Published: Sep 19, 2025

Enhanced premium tax credits (ePTCs), first introduced as part of the American Rescue Plan Act in 2021, have made ACA Marketplace coverage more affordable for the millions of enrollees that receive them. Enhanced tax credits have lowered the share of household income ACA Marketplace enrollees are expected to contribute out-of-pocket toward the premium payment for a benchmark silver plan. For those already eligible for premium subsidies, ePTCs have increased the total amount of tax credits the enrollee receives, while middle-income enrollees making above 400% of poverty ($62,600 for an individual enrolled in coverage for plan year 2026) have become newly eligible for the tax credits. The ePTCs were extended until the end of 2025 by the Inflation Reduction Act.

This data note compares how the out-of-pocket portion of premiums would differ if the ePTCs expire, or become extended, for select scenarios. (To produce your own estimate of how premium payments would differ compared to if the enhanced tax credits become unavailable, KFF provides an interactive tool where users are able to input their desired geography, income, and family size).

Premium Payments Would Increase for Subsidized Marketplace Enrollees Without Enhanced Premium Tax Credits (ePTC)

If enhanced premium tax credits expire, subsidized ACA Marketplace enrollees can expect their out-of-pocket premium payments to rise substantially. For example, a 27-year-old making $35,000 (224% of poverty) would pay $1,033 annually for a benchmark silver plan in 2026 with the ePTCs. Without the enhanced tax credits, however, they will pay $2,615 – a $1,582 (153%) increase.

With the enhanced tax credits in place, Marketplace enrollees making between 100%-150% of the federal poverty level are eligible for a fully subsidized benchmark plan. Prior to the availability of the ePTCs, enrollees making just above the poverty level were expected to contribute about 2% of their household income towards a benchmark plan. If the enhanced tax credits expire, low-income enrollees who are currently paying $0 for a benchmark plan will have to start paying for coverage again. For example, a 35-year-old couple earning $30,000 can expect to start paying $1,107 annually for a Marketplace benchmark plan.

What happens if premiums rise substantially in 2026?

There are two ways of thinking about premiums in the ACA Marketplaces. First, there is the net premium, which is what the enrollee pays out-of-pocket after taking into account their tax credit. Second, there is the gross premium, which is the amount the insurance company charges (part of which is paid by the federal government and part of which is paid by the enrollee). The expiration of the enhanced premium tax credits will affect the net premium directly (as enrollees receive less financial assistance) and it will also indirectly affect the gross premium insurers charge.

A KFF analysis of rates (gross premiums) proposed by Marketplace insurers for the 2026 plan year found that insurers are requesting a median increase of 18% in their rates. Insurers cited several reasons for these rate increases, including that they anticipate that some healthier members will leave the ACA Marketplaces once their net (or, out-of-pocket) premium payments increase if the ePTCs expire. This results in an enrollee base that is less healthy and more expensive, on average. Insurers say that rates are rising by about 4 percentage points more than they otherwise would, due to the expiration of the enhanced premium tax credit.

If enhanced premium tax credits expire, enrollees with incomes between the poverty level and four times the poverty level will continue to be eligible for financial assistance – they will just receive a smaller tax credit than they currently do. As shown in the examples above, these enrollees will pay significantly more for their monthly premium, but they will still pay a certain percent of their income for the benchmark silver plan. In other words, the increase in their monthly premium will primarily be a result of a smaller tax credit — the amount subsidized enrollees pay is largely shielded from increases in the amount insurance companies charge.

However, if enhanced premium tax credits expire, people with incomes over four times the poverty level will no longer be eligible for any financial assistance. Because their monthly payments will no longer be tied to a certain percentage of their income, these enrollees will not only lose financial assistance but will also be exposed to any increase in underlying gross premiums. With the enhanced tax credits, middle-income enrollees making above 400% of poverty currently have their out-of-pocket premium payments for a benchmark plan capped at 8.5% of their income. However, if the ePTCs are not renewed, these enrollees will experience a “double whammy” – losing their eligibility for Marketplace premium tax credits and facing the annual increases in the cost of a Marketplace plan.

Enrollees Making Above 400% of Poverty Will Lose All Financial Assistance Without Enhanced Premium Tax Credits

On average, a 55-year-old couple making $85,000 is currently receiving $13,567 in premium tax credits annually, covering 65% of the total cost of a benchmark plan. If the ePTCs expire, this couple would lose financial assistance and pay the full annual cost of $20,792, assuming premiums stay the same. However, if the gross premium grows at a rate of 18% into 2026, the 55-year-old couple can expect their net (out-of-pocket) premium payments to more than triple if ePTCs expire, increasing by $17,310 (240%), from $7,225 to $24,535 annually for the same plan.

How do Trump Administration Regulations Affect Premium Payments?

The maximum household required contribution for a benchmark ACA Marketplace plan is indexed annually to adjust for growth in premiums relative to income. Since the introduction of enhanced premium tax credits, new (and more generous) required contribution levels for premiums were implemented without annual adjustment.

As the ePTCs are set to expire, the IRS has released the required contributions for 2026. The Trump administration introduced changes in the calculation of required contribution through the Marketplace Integrity and Affordability rule earlier this year. Compared to the indexing methodology in place previously, the maximum out-of-pocket contribution for benchmark premiums for those that receive premium tax credits has increased as a share of income.

Prior estimates indicated that in 2024, out-of-pocket premium payments among subsidized enrollees would have been over 75% higher without the enhanced tax credits. Enrollees could expect to pay even more in 2026, on average, due to annual increases in the average costs of premium and IRS changes to the contribution requirements.

Methods

Premium data for 2025 is used in table 1 as rates for 2026 have not yet been finalized. Premium data for 2025 were obtained from Centers for Medicare and Medicaid Services (CMS), insurer rate filings, and information directly received or collected by KFF researchers from state exchanges or insurance departments. To isolate the effect on premiums without enhanced tax credits in table 1, the maximum required contribution was calculated using the federal poverty threshold for 2025, comparing the applicable percentage under the IRA to what is expected for 2026. In figure 1, the 2025 scenario reports values using required contribution and poverty guidelines in place for plan year 2025. An additional 18% increase is applied in the 2026 (without enhanced tax credit) scenario to model annual increases in premiums.

Dave A. Chokshi Joins KFF Board of Trustees

Published: Sep 18, 2025

San Francisco – KFF announced today that Dr. Dave Ashok Chokshi, a practicing physician and health leader, has joined KFF’s Board of Trustees.

Dr. Chokshi is a physician at Bellevue Hospital as well as Sternberg Family Professor of Leadership at the City College of New York. From 2020 to 2022, he served as the 43^rd Health Commissioner of New York City, where he led the city’s response to the COVID-19 pandemic, including its historic campaign to vaccinate over six million New Yorkers.

“Dr. Chokshi is a tremendous addition to KFF and our board as we confront new and unprecedented challenges in health policy and public health,” said Dr. Drew Altman, KFF’s President and CEO.

“There could not be a more vital moment for the work of KFF,” said Dr. Chokshi. “I have long admired KFF’s focus on how policy affects people, and its unwavering pursuit of truth through data, research, and journalism. I am honored to join the Board and excited to contribute to this essential mission.”

Dr. Chokshi also serves as chair of the Common Health Coalition, a nonpartisan, not-for-profit organization dedicated to strengthening partnership across healthcare and public health. He is also co-chair of the Health and Political Economy Project.

Dr. Chokshi’s prior experience includes appointment as the inaugural Chief Population Health Officer at NYC Health + Hospitals (H+H), the largest public healthcare system in the nation, where he also served as CEO of the H+H Accountable Care Organization. Dr. Chokshi has practiced primary care internal medicine at Bellevue Hospital since 2014, and his current clinical practice focuses on people experiencing homelessness.

In addition to KFF, he is currently a board member for Community Solutions, Rock Health, and Yuvo Health.

KFF’s Board of Trustees is chaired by former U.S. Senator Olympia Snowe and its 13 members have deep backgrounds in public service, academia, nonprofit organizations, health care, and the media.
Board members serve up to two five-year terms. Additional information about KFF’s board can be found here.

Contact

Chris Lee

clee@kff.org

Key Global Health Positions and Officials in the U.S. Government

Published: Sep 18, 2025

This tracker is updated periodically and currently reflects major positions known to be filled or likely to be retained thus far in the second Trump administration (other key roles will be added as filled). Some of the officials noted in this tracker may be on administrative leave and not performing the duties of their roles under direction from the Trump administration.

Position	Official
WHITE HOUSE/EXECUTIVE OFFICE OF THE PRESIDENT
National Security Advisor/Assistant to the President for National Security Affairs, National Security Council (NSC)	Marco Rubio
Director, Office of National AIDS Policy (ONAP)	Vacant
Director, Office of Management and Budget (OMB)	Russ Vought
U.S. Trade Representative, Office of the United States Trade Representative (USTR)	Jamieson Greer
Director, Office of Science and Technology Policy (OSTP)	Michael Kratsios
Director, Office of Pandemic Preparedness and Response Policy (OPPR)	Vacant
DEPARTMENT OF STATE
Secretary of State	Marco Rubio
Permanent U.S. Representative to the United Nations, U.S. Mission to the United Nations	Mike Waltz (Designate) Dorothy Shea
Senior Official, Under Secretary for Foreign Assistance, Humanitarian Affairs and Religious Freedom	Jeremy Lewin
Senior Bureau Official and Acting Global AIDS Coordinator, Bureau of Global Health Security and Diplomacy	Jeffrey Graham
Principal Deputy Coordinator for PEPFAR, Bureau of Global Health Security and Diplomacy	Rebecca Bunnell
Senior Advisor for Global Health Security and Diplomacy, Bureau of Global Health Security and Diplomacy	Brad Smith
Senior Bureau Official, Bureau of Democracy, Human Rights, and Labor	Jacob McGee
Senior Bureau Official, Bureau of Population, Refugees, and Migration	Spencer Chretien
Principal Deputy Director, Office of Global Women’s Issues	Katrina Fotovat
Senior Bureau Official, Bureau of International Organization Affairs	McCoy Pitt
Assistant Secretary of State for Oceans and International Environmental and Scientific Affairs (OES)	John Thompson
DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
Secretary	Robert F. Kennedy Jr.
Assistant Secretary for Global Affairs, Office of Global Affairs (OGA)	Vacant
Assistant Secretary for Health	Dorothy Fink
Surgeon General	Casey Means (Designate)
Principal Deputy Assistant Secretary for Preparedness and Response, Office of the Assistant Secretary for Preparedness and Response (ASPR)	John Knox
Director, Center for the Biomedical Advanced Research and Development Authority (BARDA), ASPR	Gary Disbrow
HHS/CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
Director	Jim O’Neill
Director, Office of Readiness and Response	Henry Walke
Director, Washington Office	Jeff Reczek
Director, Global Health Center (GHC)	Paige Alexandra Armstrong
Director, Division of Global Health Protection, GHC	Benjamin Park
Director, Division of Global HIV and TB, GHC	Hank Tomlinson
Director, Global Immunization Division, GHC	John Vertefeuille
Director, Division of Parasitic Diseases and Malaria, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)	Simon Agolory
Director, Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD)	Vivien Dugan
HHS/NATIONAL INSTITUTES OF HEALTH (NIH)
Director	Jay Bhattacharya
Director, National Institute of Allergy and Infectious Diseases (NIAID)	Jeffrey Taubenberger
Director, Office of Global Research, NIAID	Joyelle Dominique
Director, Division of AIDS, NIAID	Carl Dieffenbach
Director, Division of Microbiology and Infectious Diseases (DMID), NIAID	John Beigel
Director, Vaccine Research Center, NIAID	Ted Pierson
Director, Office of AIDS Research (OAR); NIH Associate Director for AIDS Research	Geri Donenberg
Director, Fogarty International Center (FIC); NIH Associate Director for International Research	Peter Kilmarx
Director, Center for Global Health, Office of the Director, National Cancer Institute	Satish Gopal
Director, Office of Global Health, Office of the Director, National Institute of Child Health and Human Development	Vesna Kutlesic
Director, Center for Global Mental Health Research, National Institute of Mental Health	Leonardo Cubillos
HHS/FOOD & DRUG ADMINISTRATION (FDA)
Commissioner	Marty Makary
Deputy Commissioner for Policy, Legislation, and International Affairs	Grace Graham
Associate Commissioner for Global Policy and Strategy	Mark Abdoo
HHS/HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)
Administrator	Thomas Engels
Associate Administrator, Bureau of HIV/AIDS	Heather Hauck
Director, Office of Global Health, Office of Special Health Initiatives	Melissa Ryan Kemburu
DEPARTMENT OF DEFENSE (DoD)
Secretary	Pete Hegseth
Assistant Secretary of Defense for Health Affairs, Personnel and Readiness (P&R)	Keith Bass (Designate) Steve Ferrara
Commander, Naval Medical Research Command (NMRC)	Eric Welsh
Director, DoD HIV/AIDS Prevention Program (DHAPP)	Brad Hale
Commander, Walter Reed Army Institute of Research (WRAIR)	Brianna Perata
Director, U.S. Military HIV Research Program (MHRP)	Julie Ake
Chief, Armed Forces Health Surveillance Division (AFHSD)	Richard Langton
Chief, Global Emerging Infections Surveillance (GEIS), AFHSD	Vacant
OTHER AGENCIES AND DEPARTMENTS
Peace Corps*: Director	Paul Shea
Council of the Inspectors General on Integrity and Efficiency*: Chair, Pandemic Response Accountability Committee	Michael Horowitz
Council of the Inspectors General on Integrity and Efficiency*: Executive Director, Pandemic Response Accountability Committee	Kenneth Dieffenbach
Department of Agriculture (USDA): Secretary	Brooke Rollins
Environmental Protection Agency (EPA)*: Assistant Administrator for International and Tribal Affairs	Vacant
Department of Homeland Security (DHS): Chief Medical Officer	Dev Jani
Notes: Acting officials in italics. Officials who the White House has signaled it intends to nominate or who are formally awaiting Senate confirmation are noted as “Designate.” tbd means to be determined. As of September 5, 2025. Also see NIH/FIC, Global Health Initiatives at NIH, available at: https://www.fic.nih.gov/Global/Global-Health-NIH/Pages/institute-center-ics-global-health.aspx.

What Could the Health-Related Provisions in the Reconciliation Law Mean for Older Adults?

Authors: Tricia Neuman, Alice Burns, Justin Lo, Juliette Cubanski, and Matthew Rae

Published: Sep 17, 2025

Editorial Note: This brief was updated on September 17, 2025 to reflect language in the final bill enacted July 4, 2025.

On July 4, President Trump signed into law the budget reconciliation bill, previously known as “One Big Beautiful Bill Act.” The law includes several policy changes that could have significant implications for the health and health coverage of older Americans ages 50 and older, including those who are covered by Medicare.

The reconciliation law as enacted includes an estimated $911 billion in federal Medicaid spending cuts over the next 10 years, including several provisions expected to increase costs or eliminate coverage for Medicaid beneficiaries. Collectively, these provisions could affect the 22 million people ages 50 and older with coverage under the Medicaid program by reducing the number of people with Medicaid and reducing access to health and long-term care services for people who remain enrolled in the program. The reconciliation bill also includes changes that are expected to reduce the number of people with ACA Marketplace coverage, including among individuals between the ages of 50 and 64.

According to KFF’s Health Tracking Poll conducted in July of 2025 less than half (42%) of older adults have a favorable view of the just-passed tax and budget law, including 39% of people ages 50-64 and 44% of adults ages 65 and older, with far stronger support among older adults who are Republicans (83%) than those who are independents (25%) or Democrats (3%). (See Figure 1 below).

Opinions About the GOP's So-Called "One Big Beautiful Bill" Recently Signed Into Law Are Highly Partisan Among Older Adults

Below are seven health-related provisions to watch as provisions of the 2025 budget reconciliation law are implemented.

1. New Medicaid Work Requirements. The largest source of federal Medicaid spending cuts will come from new work requirements that will be imposed on the Medicaid expansion population. The Congressional Budget Office (CBO) estimates that the work requirements would reduce Medicaid spending by $326 billion and cause nearly 5 million people to become uninsured.

The new law requires adults ages 50-64 to meet new work and reporting requirements if they are enrolled through the ACA expansion. Most Medicaid enrollees ages 50-64 are working or could be exempt from the work requirements because of a disability or caregiving responsibility, but they will still need to comply with reporting requirements, putting them at risk of risk losing Medicaid coverage. According to a new KFF analysis, fewer than half of adults ages 50-64 would meet the work requirements through either employment or school, compared with 72% of adults ages 19-27 and 66% of adults ages 27-49.

2. Changes to ACA Marketplaces. An estimated 5.5 million adults ages 55 to 64 get health insurance from ACA Marketplaces in 2025. The law makes changes to the ACA Marketplaces that will increase the number of people who are uninsured, including older people ages 50-64. Combined with the Trump administration Marketplace integrity rules, the law will shorten the open enrollment period, impose new documentation and pre-enrollment verification of eligibility requirements, and make other changes that would affect enrollment. Overall, the outcome will be loss of health insurance coverage for as many as 3 million people by 2034, including older adults.

Further, because the law does not extend enhanced ACA premium tax credits for Marketplace coverage that are set to expire at the end of 2025, an additional 4.2 million people (including older adults) are estimated to lose coverage by 2034. Without enhanced premium tax credits, Marketplace enrollees with incomes over four times poverty will lose subsidy eligibility and those with incomes between 100% and 400% of poverty will receive a smaller tax credit.

Over half of individual market enrollees with incomes above four-times the poverty threshold are between the ages of 50 and 64, which means that older adults will be disproportionately affected if the premium tax credits are not extended beyond this year. Furthermore, the loss of premium tax credits for those over 400% of poverty means that group will bear the full cost of any premium increases on top of the loss of financial assistance. Premiums are expected to increase by about 18% in 2026.

Health insurance premiums are higher for people in their 50s and early 60s than for younger adults choosing the same plan in the same area. If the enhanced premium tax credits expire, Marketplace enrollees currently receiving a subsidy could face higher costs to enroll, particularly if their incomes are about or above 400% of poverty. For example, according to the KFF calculator, a 59-year-old single widow living in Jackson, Missouri earning $63,000 (just above 400% of the poverty level) would pay $5,355 for her silver Marketplace plan in 2026 if Congress acts to extend the enhanced premium tax credits before the end of this year. But if Congress does not extend the enhanced premium tax credits, she could pay more than twice the amount—$14,213 in premiums a year—or 22.9% of her income for the same health insurance policy. It’s not hard to see why she and others like her might give up their Marketplace plans, given the cost relative to their income.

3. Placing a Moratorium on Implementation of the Medicare Savings Program and Medicaid Eligibility and Enrollment Rules. Older adults are also at risk of losing coverage due to provisions in the law that impose a moratorium on implementation of most provisions in two Biden-era rules that were intended to streamline the enrollment process for Medicaid, especially for older adults and people with disabilities. The fourth largest source of federal reductions in Medicaid spending stems from these two provisions, which are collectively estimated to reduce federal Medicaid spending by $122 billion.

Both rules aimed to reduce barriers to enrolling in and maintaining Medicaid coverage. They were expected to disproportionately affect enrollment among older adults and people with disabilities because they included specific requirements related to streamlining Medicaid enrollment among Medicare beneficiaries, and to facilitating smoother enrollment for people who are eligible for Medicaid because they have a disability, are ages 65 and older, or use long-term care.

Earlier CBO analysis showed that delaying implementation of these rules would mean that 1.3 million fewer Medicare beneficiaries would also have Medicaid coverage in 2034. That number may be lower under the law as enacted based on the Senate’s changes to the legislation, because CBO’s estimates of the savings associated with the provisions decreased from $167 billion prior to those changes to $122 billion for the law as enacted. A separate KFF analysis shows that the loss of these Medicaid benefits would result in a someone with an income of $967 per month paying $185 per month in Medicare premiums, or about 20% of income, without accounting for other non-trivial out-of-pocket costs, including Medicare cost-sharing requirements and the loss of Medicaid benefits.

4. Reducing Spending for Long-Term Care Services.The reconciliation law could also reduce federal funds for nursing facilities and would likely lead to reductions in spending for other long-term care services. The law will reduce federal Medicaid spending by $23 billion over 10 years by prohibiting implementation of a Biden Administration rule on nursing facility staffing. The rule had aimed to help address long-standing concerns about inadequate staffing and the quality of care, but the law locks into place a federal judge’s ruling to overturn key elements of the rule.

The reconciliation law could also reduce Medicaid funds available to nursing facilities through a moratorium on provider taxes (in place for nursing facilities in 46 states) and new limits on some payments to nursing facilities (known as state-directed payments). Savings from provisions affecting provider taxes and state-directed payments account for $340 billion in reduced federal Medicaid spending over 10 years, although they would also affect hospitals and other providers. KFF estimates that at least 29 states would have to reduce existing state-directed payments to hospitals or nursing facilities under the enacted legislation.

If experience from the past is a guide, substantial cuts to federal Medicaid spending could lead to reduced spending on home care, which includes long-term care provided in people’s homes and the community (and is sometimes referred to as home- and community-based services or HCBS). During the last major reduction in federal spending, all states reduced spending on home care by serving fewer people (40 states) or by benefits or cutting payment rates (for long-term care providers) (47 states). As a significant source of Medicaid spending comprised of optional services for which there are already waiting lists, home care may be especially vulnerable.

5. Ending Medicare Eligibility for Previously Eligible People with Lawful Immigrant Status. Under current law, undocumented immigrants are not eligible for Medicare. Medicare coverage is restricted to people who are citizens or permanent legal residents. The 2025 budget reconciliation law prevents defined groups of individuals who are lawfully present in the U.S. from becoming eligible for Medicare benefits and terminates Medicare coverage for currently eligible beneficiaries who are not U.S. citizens, green card holders, certain Cuban-Haitian entrants, and people residing under the Compacts of Free Association no less than 18 months from enactment. Individuals affected by this provision and their employers would continue to be required to pay Medicare payroll taxes. This is the first time that Congress has eliminated Medicare coverage from previously eligible legally residing individuals. According to CBO, the provision will save $5.1 billion over 10 years, and result in 0.1 million Medicare beneficiaries losing their Medicare coverage as of 2034.

6. Adding Work Requirements and Cutting Federal Spending for Supplemental Nutritional Assistance Program (SNAP). The reconciliation law reduces federal spending for SNAP by about $186 billion. Reductions of this magnitude, coupled with work requirements, are likely to affect the health of older adults, particularly given the strong ties between health and nutrition. As noted above, work requirements, even with exemptions, pose administrative hurdles for older adults that put them at risk for losing SNAP benefits. An estimated 9.2 million Medicare beneficiaries received SNAP benefits to help cover the costs of food and groceries in 2022, according to a KFF analysis. The SNAP work requirements may particularly exacerbate financial challenges for older Medicaid enrollees ages 50 and older who are two and a half times more likely to experience food insecurity than other older adults not enrolled in Medicaid (28% compared to 10%).

7. Modifying the Medicare Drug Price Negotiation Program to Delay or Exempt Certain High-Spending Drugs from Negotiation. Under the Medicare Drug Price Negotiation Program, the federal government is required to negotiate with drug companies for the price of some high-spending drugs that have been on the market for several years without competition, with the goal of lowering Medicare drug spending and helping to reduce out-of-pocket costs for people with Medicare. The law that created the negotiation program exempted drugs from negotiation if they were designated and approved for only one rare disease or condition (known as orphan drugs).

The reconciliation law exempts orphan drugs from Medicare drug price negotiation if they are approved for two or more rare diseases or conditions, not just a single rare disease. It also delays the timeframe for Medicare price negotiations for orphan drugs that are subsequently approved for non-orphan indications. These changes have the effect of delaying the negotiating process for some drugs, while exempting others from negotiations altogether, which is projected to diminish savings to Medicare from the negotiation program.

The changes are expected to have an immediate impact on which drugs are selected for Medicare price negotiation in 2026, including, for example, likely delaying the selection of the cancer drug Keytruda by a year. In 2023, Medicare and the 70,000 beneficiaries who used Keytruda spent a total of $5.6 billion on this drug alone, with annual out-of-pocket liability averaging around $15,000. By exempting or delaying price negotiation for Keytruda and other orphan drugs, the reconciliation law is likely to lead to higher out-of-pocket costs for beneficiaries who take these drugs relative to what they would have paid if a lower, Medicare-negotiated price was available.

This work was supported in part by the John A. Hartford Foundation. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

Which PEPFAR Investments Drive HIV Outcomes? Informing PEPFAR Transition and Scale-Down

Authors: Collins Gaba, Moaven Razavi, Jennifer Kates, and Allyala Nandakumar

Published: Sep 17, 2025

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Overview

As PEPFAR faces increased pressure to transition and scale down, understanding which of its investments most effectively drive HIV outcomes can help inform future directions. This analysis examines PEPFAR spending and HIV viral suppression rates in 22 countries from 2018–2023, looking at spending in three areas: (1) core-services; (2) targeted/stand-alone programs; and (3) non-service delivery/institutional strengthening. Overall, it finds that targeted program spending, which accounts for the smallest share of PEPFAR spending, was associated with the biggest improvement in viral suppression, followed by spending on core-services. Further, targeted programs appear to be most important for “last-mile” gains (in countries closer to sustained epidemic control) while core-services appear to be most important in countries where HIV outcomes remain below optimal levels and are lower income. By contrast, spending on non-service delivery was negatively associated with viral suppression, suggesting diminishing returns at this point in PEPFAR’s trajectory. These findings provide new information about how future PEPFAR investments could best be tailored to support transition while maintaining HIV outcomes. Additional research on the relationship between specific activities within each spending category and HIV outcomes could further aid these efforts. Finally, it is important to note that despite the strength of the analytic model, it is possible that other factors may be contributing to the results.

Introduction

The Trump administration’s foreign aid review and related actions have resulted in significant changes to PEPFAR, the U.S. global HIV/AIDS program. These actions have included reductions in PEPFAR programming and steps to accelerate the scale-down of the program at a more rapid pace. Although PEPFAR had been working to develop transition plans, Congress and other stakeholders had been increasingly encouraging the program to develop more ambitious timelines for transitioning responsibility to countries. Still, how such planning is pursued, including which services are transitioned and when, can affect HIV outcomes and the sustainability of the HIV response. To help inform current discussions, this analysis examines the relationship between bilateral PEPFAR spending and HIV viral suppression rates in 22 PEPFAR countries between 2018 and 2023. The outcome measure – the share of people with HIV on treatment who are virally suppressed (to undetectable levels) – is used because viral suppression supports individual health and those who are virally suppressed cannot transmit HIV to their partner. The analysis looks at the association between viral suppression by country and year and PEPFAR spending in three areas (also see Table 1):

(1) core-services (e.g., commodities, supplies, health care work force);

(2) targeted/stand-alone programs (e.g., for key and vulnerable populations, including the DREAMS program and services for orphans and vulnerable children, and community-based testing); and

(3) non-service delivery/institutional strengthening (e.g., technical assistance, training, data collection)

It further stratifies countries into lower and higher achievement groups (based on a composite measure of the share of people with HIV who know their status, the share who know their status and are on treatment, and the share on treatment who are virally suppressed) and lower and higher income groups (based on GDP per capita) to better understand where different types of investments may be most needed. The first stratification reflects countries’ current performance and potential to improve HIV outcomes, while the second highlights their financial capacity to sustain HIV efforts independently. Importantly, findings here represent PEPFAR’s 2018-2023 period and may not reflect the relationship between investments and HIV outcomes earlier on in the program. They also may not be directly applicable to the current period, given the pause in activities and terminations of many PEPFAR projects as part of the administration’s foreign aid review. Still, they can serve to provide an indication of where future investments could promote stronger outcomes.

Findings

The share of people with HIV on treatment who were virally suppressed increased in all but two countries over the period. Viral suppression went up, on average, by 8 percentage points and increased in 20 of the 22 countries between 2018 and 2023. Increases ranged between 2 and 23 percentage points, depending on the country. Decreases occurred in Ethiopia (-1 percentage point) and the Dominican Republic (-6). See Appendix Table.
Across the 22 countries analyzed, bilateral PEPFAR spending averaged $3.7 billion per year, during the 2018 to 2023 period. Spending fluctuated somewhat and was highest in 2019 and lowest in 2020. It was $275 million lower in 2023 compared to 2018 and spending declined in 14 of the 22 countries. See Figure 1.
Spending on non-service delivery accounted for the largest category of PEPFAR spending, followed by core-services and then targeted programs. Spending on non-service delivery averaged $1.76 billion per year in the 22 countries and accounted for 47% of spending over the period. Core-services averaged $1.40 billion per year (38%). Targeted programs accounted for the smallest share of spending (15%), averaging $560.7 million per year. See Figure 2.
Declines in spending between 2018 and 2023 were driven entirely by non-service delivery. Non-service delivery spending declined by $714 million overall and fell in 19 of the 22 countries. By contrast, spending on core-services and targeted programs increased between the two periods (by $250.3 million and $188.8 million, respectively) and in most countries (17 and 19, respectively). See Appendix Table.
The results of the model indicate that despite accounting for just 15% of PEPFAR spending, targeted programs were associated with the greatest improvement in viral suppression. Between 2018 and 2023, viral suppression increased by 0.11 percentage points, on average, for every $1 million spent on targeted programs. This translates into a one percentage point increase in viral suppression for every $9.3 million spent in a country.
This association was strongest in countries closer to epidemic control, suggesting their importance for “last mile” gains. Targeted spending was associated with twice the gain in viral suppression (a 0.21 percentage point increase) in the high achieving country group (those closer to sustained epidemic control), compared to .011 percentage points for all countries. There was no significant association in the lower achieving country group. Significant improvement was found in both lower (0.19) and higher (0.17) income country groups. These findings suggest that targeted investments may be most important for “last mile” gains (those needed to fully reach and sustain epidemic control), regardless of country income. See Table 2.
Core-services spending was also associated with improvement in viral suppression, although of a lesser magnitude. Overall, core-services spending was associated with a .05 percentage point increase in viral suppression, on average, for every $1 million spent. This translates into a 1 percentage point increase in viral suppression for every $20 million spent in a country.
In addition, spending on core-services was only associated with viral suppression improvement in lower achieving and lower income country groups. Viral suppression increased in both lower achieving (0.08) and lower income (0.09) country groups. There was no significant association in higher achieving and higher income countries. This suggests that core-services investments yield the biggest returns in countries still needing to make more progress towards sustained epidemic control and those more likely to be in need of external financial assistance.
By contrast, spending on non-service delivery, the largest category of spending, was associated with a reduction in viral suppression. Every $1 million spent on non-service delivery was associated with a .06 percentage point decrease in viral suppression. This was true regardless of country progress toward epidemic control or income. This finding suggests that spending in this area, which likely contributed to scale-up earlier on in PEPFAR’s evolution, may now have diminishing returns when it comes to HIV outcomes. While some spending on non-service delivery (such as for surveillance and other monitoring efforts) may aid in transitioning PEPFAR programming to country governments, this analysis suggests that reductions can be made without sacrificing program outcomes.

Implications

These findings support prior analyses that point to the importance of tailoring transition efforts to country-specific factors, including epidemiology and income. Approaches that are responsive to these factors are likely to be more effective than uniform strategies. More specifically, the findings suggest that targeted, stand-alone investments – those focused on specific populations – are associated with the strongest improvement in viral suppression, particularly for “last mile” gains, those needed to fully reach and sustain epidemic control. For example, spending an additional $9.3 million on targeted programs is predicted to increase the share of people with HIV on treatment who are virally suppressed by one percentage point; spending $100 million would increase viral suppression by 11 percentage points. On the other hand, a $100 million cut would decrease viral suppression by the same magnitude. Targeted programs, which represent a relatively small share of PEPFAR spending, are also those least likely to be assumed by country governments, highlighting the potential ongoing role for PEPFAR in this area. Core-services investments were associated with somewhat smaller improvements, and these were concentrated in lower-income countries and those further away from sustained epidemic control. By contrast, non-core investments appear to have diminishing returns at this point in PEPFAR’s trajectory. This suggests opportunities to adjust spending in this area, while recognizing that some non-core activities, such as monitoring and support for transition processes, may still be useful in the near term.

There are some limitations to these findings. The results reflect average effects across countries and do not capture within-country variation. Additional country-level analyses could provide a more nuanced approach to transition, as could further disaggregation of activities within each spending category to provide a more complete picture of the specific types of investments most closely associated with improvements in HIV outcomes. It is also the case that PEPFAR investments in all three categories are not necessarily independent of one another. For example, the success of targeted program investments is also likely predicated on delivery of core services, particularly commodities for HIV treatment and prevention. In addition, despite the strength of the analytic model, which included controls for country income and health service coverage (a proxy for the strength of a health system strength), it is possible that other factors may be contributing to the results. It is also possible that these findings may not be directly applicable to the current PEPFAR environment given the pause in activities and terminations of many PEPFAR projects as part of the foreign aid review. Despite these limitations, the findings contribute to the evidence base on how different types of PEPFAR spending align with progress toward epidemic control and may help inform decisions about future allocation, including potential re-allocations, and transition planning.

Methods

We obtained data on bilateral PEPFAR expenditures by country over the 2018-2023 time period from PEPFAR’s program expenditure database which includes data for 33 operating units (26 countries and 7 regions). We excluded four countries (Cameroon, India, South Sudan and Vietnam) due to poor data availability across HIV outcome indicators and excluded the 7 regions. Our final dataset included 22 countries (Angola, Botswana, Burundi, Côte d’Ivoire, DRC, Dominican Republic, Eswatini, Ethiopia, Haiti, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Ukraine, Zambia, and Zimbabwe) containing 132 country/year observations over the period.

Spending was divided into three, broad categories (see Table 1 for further details):
(1) core-services (e.g., commodities, supplies, health care work force);
(2) targeted/stand-alone programs (e.g., for key and vulnerable populations, including the DREAMS program and services for orphans and vulnerable children, and community-based testing); and
(3) non-service delivery/institutional strengthening (e.g., technical assistance, training, data collection)

Our main outcome of interest was the share of people living with HIV who were on HIV treatment and were virally suppressed. These data were obtained from UNAIDS. While this was the dependent variable we modeled, we used other HIV outcome data from UNAIDS to generate composite scores to allow us to create country strata based on progress toward sustained epidemic control for further analysis. The composite scores included the share of people living with HIV who were aware of their HIV status, the share on treatment, and the share virally suppressed. The score was generated by giving equal weight to each of the three outcomes and was based solely on data from the latest year, 2023. Countries below the median were assigned to the lower achievement stratum, while countries above the median were assigned to the higher achievement stratum. We also divided countries into two strata based on income, using GDP per capita (current international $) for the most recent year, 2023. Countries below the median were categorized as lower-income and those above the median as higher-income. For observations with a few missing outcome values, the missing data were generated using linear interpolation.

We ran five models with PEPFAR financial data expressed in USD millions and the dependent variable expressed as a percentage. Model 1 included all 22 countries over the 2018-2023 period (for a total of 132 observations). Models 2 and 3 divided countries into two strata based on composite scores of the three HIV outcomes (resulting in 11 countries in each stratum, each with 66 observations). Models 4 and 5 divided countries into the two economic group strata based on GDP per capita. Our models included controls for GDP per capita, PPP (current international $) and the WHO Service Coverage Index, which measures coverage of essential health services and serves as a proxy for health system strength, for the median year (2021).

To analyze the panel data, we tested both fixed and random effects models. Fixed effects models control for all time-invariant differences between countries. Random effects models control for unobserved heterogeneity. The Hausman test was used to determine that the random effects model was the preferred specification for the data.

Estimated Percentage Point Change in Viral Suppression by PEPFAR Spending Category, 2018-2023 (standard errors in parentheses)

Estimate Additional Spending Needed to Raise Viral Suppression by 1 Percentage Point (in USD millions)

PEPFAR Spending by Category, 2018-2023 (in USD billions)

Share of PEPFAR Spending by Category, 2018-2023

Appendix


Appendix Table # 1
PEPFAR Spending by Category and Percent Virally Suppressed, 2018 and 2023
Country	Targeted	Core	Non-Core	Total	Targeted	Core	Non-Core	Total	% Virally Suppressed
	2018				2023				2018	2023
Angola	$3,841,633	$478,898	$8,471,700	$12,792,231	$438,279	$0	$3,765,634	$4,203,913	55.0	78.0
Botswana	$9,188,688	$12,759,114	$24,870,282	$46,818,084	$17,646,565	$5,389,744	$22,789,597	$45,825,907	97.0	99.0
Burundi	$1,801,767	$1,874,579	$11,335,090	$15,011,436	$3,600,810	$6,158,745	$10,631,531	$20,391,086	87.3	89.0
Cote d’Ivoire	$17,303,080	$22,024,735	$71,241,076	$110,568,891	$26,935,252	$28,148,513	$28,998,007	$84,081,772	77.0	88.0
DRC	$10,523,645	$15,373,773	$29,605,903	$55,503,321	$9,611,968	$45,223,754	$31,965,084	$86,800,805	73.3	89.0
Dominican Republic	$3,656,850	$786,187	$5,196,748	$9,639,785	$4,501,686	$4,829,020	$9,829,188	$19,159,894	93.0	87.0
Eswatini	$11,172,727	$11,275,208	$33,105,932	$55,553,867	$17,866,238	$14,758,439	$28,178,327	$60,803,004	93.0	99.0
Ethiopia	$19,499,477	$17,495,821	$103,477,386	$140,472,684	$20,097,637	$19,334,925	$44,500,139	$83,932,701	90.0	89.0
Haiti	$14,181,119	$34,372,263	$51,749,891	$100,303,273	$14,611,550	$30,106,447	$43,048,408	$87,766,405	77.0	85.0
Kenya	$56,591,156	$146,132,514	$234,030,849	$436,754,519	$63,807,040	$120,456,513	$112,541,769	$296,805,321	90.0	97.0
Lesotho	$10,462,376	$20,843,626	$31,703,237	$63,009,239	$14,050,868	$21,140,546	$26,020,807	$61,212,221	93.0	99.0
Malawi	$14,321,280	$23,050,062	$84,731,219	$122,102,561	$31,084,406	$52,502,078	$68,613,196	$152,199,680	89.0	95.0
Mozambique	$32,009,703	$103,055,070	$240,274,822	$375,339,595	$39,102,228	$149,534,500	$166,514,020	$355,150,748	76.1	90.0
Namibia	$5,860,629	$10,539,001	$40,584,784	$56,984,415	$19,372,076	$15,965,548	$31,591,075	$66,928,699	82.4	99.0
Nigeria	$47,420,855	$136,018,210	$171,857,733	$355,296,799	$67,789,733	$158,063,694	$122,508,397	$348,361,824	82.9	96.0
Rwanda	$8,942,243	$42,042,538	$16,625,175	$67,609,956	$13,038,878	$25,660,903	$17,576,226	$56,276,007	92.0	99.0
South Africa	$53,379,111	$142,389,246	$257,463,135	$453,231,491	$85,711,833	$178,734,528	$124,817,074	$389,263,436	88.0	91.0
Tanzania	$64,427,213	$88,685,437	$266,269,079	$419,381,729	$60,038,096	$155,506,898	$200,291,101	$415,836,095	80.0	97.0
Uganda	$42,291,465	$144,480,428	$211,712,274	$398,484,167	$49,130,305	$147,510,953	$152,084,226	$348,725,484	88.0	94.0
Ukraine	$3,968,162	$9,741,849	$18,967,369	$32,677,380	$8,752,342	$12,800,280	$14,803,193	$36,355,815	93.0	98.0
Zambia	$31,912,365	$160,009,043	$177,411,909	$369,333,318	$53,606,148	$174,679,809	$133,148,050	$361,434,007	89.2	97.0
Zimbabwe	$21,706,311	$43,324,946	$73,841,291	$138,872,548	$52,470,392	$70,552,100	$56,255,761	$179,278,253	84.0	96.0
Notes: PEPFAR spending represents bilateral spending only. Viral suppression is percent of people with HIV on antiretroviral treatment who are virally suppressed. Sources: PEPFAR’s program expenditure database; UNAIDS 2024 HIV estimates.

Collins Gaba, Moaven Razavi, and Allyala Nandakumar are with Boston University. Jen Kates is with KFF. The authors would like to acknowledge assistance provided by William Crown and Deborah Stenoien from Boston University.

Global COVID-19 Tracker

Published: Sep 16, 2025

Editorial Note: The Policy Actions tracker will no longer be updated as the data source has ceased tracking government responses to COVID-19. For more information, please visit the Oxford Covid-19 Government Response Tracker.

Section:

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Cases and Deaths

This tracker provides the cumulative number of confirmed COVID-19 cases and deaths, as well as the rate of daily COVID-19 cases and deaths by country, income, region, and globally. It will be updated weekly, as new data are released. As of March 7, 2023, all data on COVID-19 cases and deaths are drawn from the World Health Organization’s (WHO) Coronavirus (COVID-19) Dashboard. Prior to March 7, 2023, this tracker relied on data provided by the Johns Hopkins University (JHU) Coronavirus Resource Center’s COVID-19 Map, which ended on March 10, 2023. Please see the Methods tab for more detailed information on data sources and notes. To prevent slow load times, the tracker only contains data from the last 200 days. However, the full data set can be downloaded from our GitHub page. While the tracker provides the most recent data available, there is a two-week lag in the data reporting.

Note: The data in this tool were corrected on March 18, 2024, to clarify that they represent new cases and deaths over a full week rather than the average per day over a seven-day period.

Policy Actions

Editorial Note

The Policy Actions tracker will no longer be updated as the data source has ceased tracking government responses to COVID-19. For more information, please visit the Oxford Covid-19 Government Response Tracker.

This tracker contains information on policy measures currently in place to address the COVID-19 pandemic. Policy categories currently being tracked include social distancing & closure measures, economic measures, and health systems measures. Policies are tracked at the country-, income-, and region-level. Please see the Methods tab for more detailed information on data sources and notes.

As countries continue to implement policies to prevent the transmission of SARS-CoV-2, the virus that causes COVID-19, these tables and charts show which social distancing and closure measures are currently in place by country.

Economic Measures

The COVID-19 pandemic has placed an unprecedented strain on country economies. These tables and charts show which economic-related measures, namely income support and debt relief, are currently in place by country.

Health Systems Measures

The COVID-19 pandemic continues to strain and disrupt global health systems. These tables and charts show which health systems measures are currently in place by country.

Methods

Cases and Deaths

SOURCES

As of March 7, 2023, all data on COVID-19 cases and deaths are drawn from the World Health Organization’s (WHO) Coronavirus (COVID-19) Dashboard. Prior to March 7, 2023, this tracker relied on data provided by the Johns Hopkins University (JHU) Coronavirus Resource Center’s COVID-19 Map, which ends on March 10, 2023. Population data are obtained from the United Nations World Population Prospects using 2021 total population estimates. Income-level classifications are obtained from the latest World Bank Country and Lending Groups. Regional classifications are obtained from the World Health Organization.

Policy Actions

NOTES

Policy actions data include the measure that was in place for each indicator at the country-level as of the end of 2022. Policy actions data will no longer be updated as the data source has ceased tracking government responses to COVID-19. For more information, please visit the Oxford Covid-19 Government Response Tracker.

Social Distancing and Closure Measures

Under ‘Stay At Home Requirements’, exceptions for leaving the house may include anything from being able to leave for daily exercise, grocery shopping, and essential trips, to only being allowed to leave once a week, or one person may leave at a time, etc. Under ‘Workplace Closing’, partial closing includes instances in which a country recommends closing the workplace (or working from home); businesses are open but with significant COVID-19-related operational adjustments; or when workplaces require closing for only some, but not all, sectors or categories of workers. Under ‘School Closing’, partial closing includes instances in which a country has recommended school closures; all schools are open but with significant COVID-19-related operational adjustments; or some schools, but not all, are closed; full closing includes schools that are in session but operating virtually. Under ‘Restrictions On Gatherings’, partial restrictions include restrictions on gatherings of more than 10 people; full restrictions include restrictions on gatherings of 10 people or less. Under ‘International Travel Controls’, partial restrictions include screening and quarantine requirements for those entering the country. Values for ‘Cancel Public Events’ were not recodified.

Economic Measures

Under ‘Income Support’, narrow support includes instances in which a country’s government is replacing less than 50% of lost salary (or if a flat sum, it is less than 50% median salary); broad support includes instances in which a country’s government is replacing 50% or more of lost salary (or if a flat sum, it is greater than 50% median salary). Under ‘Debt/Contract Relief’, narrow support includes instances in which a country’s government is providing narrow relief, such as relief specific to one kind of contract.

Health Systems Measures

Under ‘Vaccine Eligibility’, partial availability includes availability for some or all of the following groups: key workers, non-elderly clinically vulnerable groups, and elderly groups, or for select broad groups/ages. Under ‘Facial Coverings’, recommend/partial requirement includes instances in which a country’s government recommends wearing facial coverings, requires facial coverings in some situations, and requires facial coverings when social distancing is not possible.

SOURCES

Data on and descriptions of government measures related to COVID-19 provided by the Oxford Covid-19 Government Response Tracker (OxCGRT). For more detailed information on their data collection and methodology, please see their codebook and interpretation guide.

News Release

New KFF-Washington Post Survey Explores Parents’ Trust In, and Confusion About, Childhood Vaccines as the Trump Administration Revamps Federal Policies

Most Parents Remain Confident in Routine Childhood Vaccines and Support School Mandates, But Are Less Certain About Seasonal Flu and COVID Vaccines; 1 in 4 MAGA Republicans Say They Have Delayed or Skipped a Child’s Vaccine

Published: Sep 15, 2025

A new KFF-Washington Post partnership survey of parents explores their experiences with and views about vaccines for their children, including a look into how they make decisions related to vaccines and where they are uncertain or confused about their safety.

The poll comes as the Trump administration’s Health and Human Services Secretary Robert F. Kennedy Jr. continues to question the childhood vaccine schedule and to raise doubts about vaccine safety and effectiveness. Based on interviews with more than 2,700 parents, including more than 1,000 parents with children under age 6 who have had to make decisions about vaccines in the post-COVID era, the survey’s findings will be featured in a series of Washington Post stories and KFF reports analyzing the survey data.

The survey reveals large majorities of parents view long-standing childhood vaccines such as the ones to prevent measles, mumps, and rubella (MMR) and polio as safe and important, but are less confident in seasonal vaccines for flu and especially COVID-19.

While most parents say they keep their children up to date on recommended childhood vaccines, about one in six (16%) say that they have delayed or skipped at least one vaccine for their children (other than those for flu and COVID-19). Those most likely to report delaying or skipping vaccines include Republican parents (22%), especially those who identify with President Trump’s “Make America Great Again” movement (25%), parents under age 35 (19%), and those who homeschool their child (46%).

Among parents who delayed or skipped some vaccines for their children, the most common reasons include concerns about side effects, a lack of trust in vaccine safety, and a belief that not all recommend vaccines are necessary.

This is the 37^th survey in the KFF-Post partnership dating back to 1995 that combines survey research with in-depth journalism. The Post today published its overview of the results, while KFF published a report breaking down the data. The Post plans to publish additional stories drawing on the survey results.

Key themes from the survey include:

Most favor school vaccine requirements. A large majority (81%) of parents say that public schools should require students to get the measles and polio vaccines, with exceptions for medical and religious reasons. Among all parents, 8% say that they had requested an exemption to vaccine requirements so a child could attend school or daycare.

Many are uncertain about false claims. When asked about several false claims about vaccines and measles, relatively few parents believe the untrue statements, but larger shares are uncertain what to believe. One example: While relatively few (9%) parents believe the false claim that the MMR vaccine can cause autism in children, nearly half (48%) say they don’t know enough to say.

Views of parents with children diagnosed with autism spectrum disorder. Parents of children with autism spectrum disorder are somewhat more likely than other parents to believe the false claim that vaccines cause autism (16% vs. 9%).

Confidence in federal health agencies is shaky. Fewer than one in six (14%) parents say they have “a lot” of confidence in government health agencies like the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration to ensure the safety and effectiveness of vaccines, while half say they have only a little confidence (29%) or none at all (22%). Confidence is even lower in the agencies’ abilities to make decisions based on science rather than the views of agency officials or to act independently without interference from outside interests. A quarter (26%) of parents overall say that the CDC recommends too many vaccines.

Many parents are unsure about impact of federal vaccine policy changes. Few parents (11%) say they’ve heard “a lot” about Secretary Kennedy’s changes to federal vaccine policy. When asked about the changes’ impact, most say either that they don’t know or that the changes won’t make of a difference on safety, access, and industry influence.

The survey also examines parents’ views of the safety testing for vaccines, the number of recommended vaccines, and experiences with the human papillomavirus (HPV) vaccine.

METHODOLOGY INFO:

The KFF/Washington Post Survey of Parents includes interviews with a nationally representative sample of 2,716 parents or legal guardians of children under age 18 in the U.S. The survey was conducted between July 18-August 4, 2025, online, in English and Spanish, using the Ipsos KnowledgePanel. The margin of sampling error including the design effect for total sample of parents is plus or minus 2 percentage points. For results based on other subgroups, the margin of sampling error may be higher.

Contact

Craig Palosky

CraigP@kff.org

Poll Finding

KFF/The Washington Post Survey of Parents

Authors: Audrey Kearney, Alex Montero, Isabelle Valdes, Liz Hamel, and Ashley Kirzinger

Published: Sep 15, 2025

News Release: New KFF-Washington Post Survey Explores Parents’ Trust In, and Confusion About, Childhood Vaccines as the Trump Administration Revamps Federal Policies

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Overview

The Survey of Parents is the 37th in a collaborative reporting series between KFF and The Washington Post, dating back to 1995, that combines survey research with in-depth journalism. Based on interviews with more than 2,700 parents, including more than 1,000 parents with children under age 6 who have had to make decisions about vaccines in the post-COVID era, this survey explores parents’ experiences with and views about vaccines for their children.

As HHS Secretary Robert F. Kennedy Jr. questions the federal childhood vaccine schedule, debates over safety, access, and trust in public health guidance are front and center, leaving many parents confused about some of the most important decisions they’ll make for their children’s health. This poll offers a snapshot of how parents view childhood and routine vaccines, and the decisions they’re making for their children. These findings highlight where parents agree on the importance of long-standing vaccines, and where some attitudes have started to diverge in the wake of the COVID-19 pandemic.

Explore The Washington Post’s journalism:

Why 1 in 6 U.S. parents say they skipped or delayed their kids’ vaccines, Sept. 15, 2025

RFK Jr. drives a wedge between red and blue states on vaccines, Sept. 4, 2025

Key Findings

Large majorities of parents have positive views of long-standing childhood vaccinations for measles, mumps, and rubella (MMR) and polio, saying these vaccines are important for children in their community to get (90% and 88%, respectively) and that they are confident they are safe for children (84% and 85%). About eight in ten parents support current state laws, saying students should be required to be vaccinated against measles and polio to attend public schools with some exceptions (81%). These views are consistent across partisan lines, with large majorities of parents who identify as Democrats, independents, and Republicans viewing MMR and polio vaccines as safe and important for children to get and supporting policies that require these vaccines in public schools.
Views on seasonal vaccines for flu and especially COVID-19 are more divided, with much smaller shares of parents expressing confidence that these vaccines are safe for children (65% for flu and 43% for COVID-19) and saying they are important for children in their community to get (56% and 43%, respectively). Parents’ views on COVID-19 and flu vaccines divide along partisan lines, with Democratic parents much more likely than Republican parents to hold positive views of both. Republican parents who support the Make America Great Again (MAGA) movement express the most skeptical attitudes towards vaccines for children, particularly when it comes to confidence in the safety of COVID-19 (14%) and flu (48%) vaccines.
In addition to partisan divisions, parents under age 35 express greater concern about vaccine safety compared with parents ages 35 and over, perhaps an indication of shifting attitudes with younger generations of parents. For example, four in ten (39%) younger parents say vaccines do not go through enough safety testing before being recommended for children compared with about one-third (35%) of parents ages 35 to 49 and one quarter (26%) of parents ages 50 and older.
While a large majority of parents report keeping their children up to date on vaccinations, one in six (16%) parents say they have ever skipped or delayed at least one childhood vaccine other than flu or COVID-19 immunizations. About one in five Republican parents (22%), rising to one in four MAGA Republicans (25%), report skipping or delaying any childhood vaccines, higher than the share of Democratic (8%) parents who report this. Younger parents are also somewhat more likely to report skipping or delaying vaccines than older parents, regardless of the age of their children; 19% of parents under age 35 say they have skipped or delayed at least one childhood vaccine compared with 12% of those age 50 and over. Most parents who skip or delay vaccines cite side effects and safety as their top reasons, while few cite reasons related to a child’s health condition or access to health care.
Before his confirmation and in his role as HHS Secretary, Robert F. Kennedy Jr. has amplified claims about vaccines that have been rejected by scientists and public health officials. He has suggested, without evidence, that the number of recommended childhood vaccines has led to a rise in chronic disease in the U.S., that MMR vaccines can cause autism, and that the measles vaccine causes the illness it prevents. More recently, Kennedy has promoted Vitamin A as an effective treatment for measles. Asked about each of these claims, many parents are uncertain what to believe. While about one in ten or fewer parents say each claim is true and between a quarter and half say each is false, substantial shares – between four in ten and two-thirds – say they don’t know enough to say. On the widely circulated claim that MMR vaccines can cause autism in children, 9% of parents believe this to be true, rising to 16% among parents who have a child with autism spectrum disorder.
Six in ten parents have heard little to nothing about HHS Secretary Kennedy’s recent changes that could impact vaccine policies in the U.S., while just one in ten (11%) have heard “a lot” and one-quarter (27%) have heard “some” about these changes. Awareness is higher among older parents, Democratic parents, and parents with a college degree. When asked how they expect these changes to impact vaccine policy in the U.S., parents are divided, and many are not sure whether they will have an impact on access to vaccines, safety, or the influence of pharmaceutical companies. Democratic parents are considerably more likely than Republican parents to say these changes will make access more difficult (52% vs. 7%) and will make childhood vaccines less safe (40% vs. 5%). Republican parents are more likely than Democrats to say Kennedy’s changes will decrease pharmaceutical companies’ influence on vaccine policy (32% vs. 11%) but most parents across groups expect no changes or say they’re not sure.

Parents’ Views of Vaccine Safety and Importance

Parents overwhelmingly value long-standing childhood vaccines but are more divided when it comes to the COVID-19 and flu vaccines for children. Across parties, large majorities of parents see the measles, mumps, and rubella (MMR) and polio vaccines as important for children in their communities and are confident in their safety, but opinions on flu vaccines and especially COVID-19 vaccines are more mixed and sharply divided along partisan lines.

About nine in ten parents say it is important for children in their community to receive vaccines for MMR (90%) and polio (88%), including about seven in ten who say each is “very important” (70% and 68% respectively). A smaller share, but still a majority (56%) of parents say it is important for children in their community to be vaccinated against the flu, while fewer than half (43%) say the same about COVID-19, including one in five who say it is “very important.”

Nine in Ten Parents Say It Is Important for Children To Be Vaccinated Against MMR and Polio, Fewer Say the Same About the Flu and COVID-19

While large majorities of parents regardless of partisanship agree that the MMR and polio vaccines are important for children to get, parents are divided along partisan lines when assessing the importance of COVID-19 and flu shots for children in their community. Democratic parents are more than three times as likely as Republican parents to say it is “very” or “somewhat” important for children in their community to be vaccinated for COVID-19 (68% vs. 21%) and twice as likely to say it is important for children to be vaccinated for the flu (78% vs. 38%). About four in ten independent parents (43%) say the COVID-19 vaccine is important for children, and just over half (55%) say the same of the flu vaccine.

Republican parents are not a monolith, as those who support the Make America Great Again (MAGA) movement are between 9 and 16 percentage points less likely than non-MAGA Republican parents to say each of these vaccines are important for children to receive. Even still, a majority of MAGA Republican parents and non-MAGA Republican parents alike say it is important for children in their community to receive MMR and polio vaccines.

Majorities of Parents Across Partisans Say It Is Important for Children To Be Vaccinated for MMR, Polio; Partisans Are Divided on Flu, COVID-19 Vaccines

Mirroring parents’ opinions on the importance of childhood and annual vaccines, large majorities of parents express confidence in the safety of childhood vaccines for polio and MMR, while views on the safety of flu and COVID-19 vaccines are more divided.

Just over eight in ten parents say they are either “very” or “somewhat confident” that polio vaccines (85%) and MMR vaccines (84%) are safe for children, including about half who say they are “very confident” (53% and 54% respectively). A smaller majority of parents express confidence in the safety of flu vaccines (65%), including about one-third who are “very confident” (34%). About four in ten (43%) parents are confident in the safety of COVID-19 vaccines for children, including one in five who are “very confident.”

Large Majorities of Parents Are Confident MMR and Polio Vaccines Are Safe for Kids, While Fewer Say the Same About Flu and COVID-19

While majorities of parents across partisanship say they are confident in the safety of polio and MMR vaccines for children, confidence in the safety of annual flu and COVID-19 vaccines for children differs.

At least eight in ten parents across partisanship say they are least “somewhat” confident in the safety of MMR and polio vaccines for children. About eight in ten (82%) Democratic parents say they are confident in the safety of flu vaccines for children, larger than the share of Republican (55%) or independent (64%) parents who say the same. Partisans are more deeply divided on confidence in the COVID-19 vaccine. Seven in ten Democratic parents say they are confident in the safety of COVID-19 vaccines for children, more than three times the share of Republicans who say the same (70% vs. 22%). About four in ten (43%) independent parents say they are confident in the safety of the COVID-19 vaccine for children.

The public overall and parents in the U.S. have been divided along partisan lines when it comes to the COVID-19 vaccine since it became available in 2021, when Republican adults were particularly hesitant to get themselves or their children vaccinated, past KFF polling finds.

The division when it comes to the flu vaccine, however, is more prominent now since the pandemic, and may be linked to concerns about vaccines generally. While the newly reformed Advisory Committee on Immunization Practices (ACIP) under HHS Secretary Kennedy has reaffirmed the existing recommendation that anyone ages 6 months and older should receive an annual flu vaccine, the panel recommended against vaccines containing a preservative called thimerosal, which has been falsely linked to autism. This recommendation comes despite scientific evidence that these vaccines are safe. Vaccines containing thimerosal comprised less than 6% of the U.S. influenza vaccine supply in 2024.

Parents Are Divided Along Party Lines on Confidence in Flu, COVID-19 Shot Safety for Children; Large Majorities Are Confident in MMR, Polio Vaccine Safety

Black parents and parents under age 35 are less likely than other groups to say they are confident in the safety of some vaccines. For example, just over half (55%) of Black parents say they are confident the flu vaccines are safe for children compared to about two-thirds of White parents (64%) and seven in ten (69%) Hispanic parents. While majorities across racial and ethnic groups express confidence in the safety of MMR and polio vaccines, Black parents are at least 10 percentage points less likely than White parents and Hispanic parents to express confidence in the safety of each of these vaccines.

Parents under age 35 are also less likely than older parents – particularly those ages 50 and older – to say they are either “very” or “somewhat confident” that routine vaccines are safe for children. The widest gap between younger and older parents is on confidence in the safety of COVID-19 vaccines for children, with just under four in ten (38%) parents under age 35 expressing confidence compared to about half (51%) of parents ages 50 and older.

Fewer Younger Parents and Black Parents Are Confident in the Safety of Some Vaccines for Children

Parents’ Views of Vaccine Safety Testing, Schedule, and Spacing

In his role as HHS Secretary, Robert F. Kennedy Jr. has called into question the safety of vaccines, arguing that they do not go through enough safety testing, including placebo testing. The American Academy of Pediatrics (AAP) released a statement ensuring that childhood vaccines are “carefully studied, including with placebos” to ensure safety and effectiveness before they are available to the public. This poll shows that parents are divided over the question of whether vaccines go through enough safety testing before being recommended for children, with many being unsure what to believe.

About four in ten (41%) parents say vaccines go through “the right amount” of safety testing in the U.S. before being recommended for children by federal health agencies, while about one-third (35%) say vaccines do not go through enough safety testing. An additional one in five parents express uncertainty, saying they are not sure whether vaccines are adequately safety tested. Very few parents overall (3%) say vaccines go through “too much” safety testing before being recommended for children.

Just as they differ on their confidence in safety, partisans differ on whether they think there is enough safety testing of vaccines, with about half (48%) of Republican parents saying there is not enough safety testing of vaccines before they are recommended for children, more than twice the share of Democratic (20%) parents who say the same. Republican parents are not a monolith, as those who say they support the Make America Great Again (MAGA) movement are more likely than Republicans who do not to say there is not enough testing (57% vs. 32%).

Views on the adequacy of safety testing for childhood vaccines also differ by age, with about four in ten (39%) parents under age 35 and about one-third (35%) of those ages 35 to 49 saying there is not enough safety testing compared to fewer parents ages 50 and older (26%).

Many Parents Are Unsure Whether Vaccines for Kids Go Through Enough Safety Testing; Younger and MAGA Republican Parents More Likely To Say They Do Not

Earlier this summer, Secretary Kennedy took a step towards changing vaccine policy in the U.S. by firing the President Biden-appointed ACIP and rebuilding it with the goal to review the current vaccine schedule for children. Secretary Kennedy himself and some of the members of the new committee have raised doubts about the current number of vaccines in the schedule, questioning whether the interactions between vaccines are safe for children. However, clinical studies have shown the current vaccine schedule and getting multiple doses when age appropriate to be safe.

About half (52%) of parents say the CDC currently recommends “about the right amount” of childhood vaccines, while a quarter say the CDC recommends “too many” childhood vaccines (26%). One in six parents say they are not sure (16%), and 5% say the CDC does not recommend enough vaccines for children. A larger share of Republican parents (41%) than Democratic (9%) or independent (26%) parents say the CDC recommends “too many” vaccines, rising to about half (49%) of MAGA Republicans.

A Quarter of Parents, Including About Half of MAGA Republicans, Say the CDC Recommends Too Many Childhood Vaccines

The CDC’s current childhood immunization schedule is based on how children’s immune systems respond to vaccines at particular ages as well as their likelihood of exposure to different diseases. The CDC advises that parents follow the timing of the immunization schedule, and there is no evidence that delaying or spacing out shots for children offers better protection or reduces serious effects. Parents, however, are divided on the question of whether childhood vaccines should be spaced out, with most (57%) correctly saying there is no strong evidence that spacing out vaccines or avoiding multiple shots in one visit is healthier for children, while four in ten (41%) incorrectly say that children are healthier when their vaccines are spaced out and they don’t get multiple shots in one visit.

Half of Republican parents and four in ten (42%) independent parents incorrectly say children are healthier when their vaccines are spaced out compared to about three in ten (28%) Democrats. About half (47%) of Black parents and about four in ten Hispanic (42%) and White (39%) parents hold this misconception.

About Four in Ten Parents Incorrectly Say Children Are Healthier When They Space Out Vaccines and Don't Get Multiple Shots at the Same Time

How Parents Identify Themselves When It Comes to Vaccine Views

While many parents express at least some level of concern or uncertainty about vaccine safety, very few (6%) say they consider themselves “anti-vaccine.” Similar shares of parents identify as either “pro-vaccine” (48%) or “somewhere in the middle” (45%). Six in ten Republican parents (57%), including six in ten MAGA Republicans and about half (52%) non-MAGA Republicans, say they are “somewhere in the middle” when it comes to vaccine attitudes. Most (70%) Democratic parents say they are “pro-vaccine.” White parents are more likely to be “pro-vaccine” than Black or Hispanic parents (51% v. 34% v. 43% respectively), while larger shares of Black parents (51%) and Hispanic parents (50%) say they are “somewhere in the middle.”

While anti-vaccine parents express vaccine skeptic views on other questions, and pro-vaccine parents are generally accepting and confident in vaccines, parents who identify as “somewhere in the middle” hold mixed views. For example, few “pro-vaccine” parents (17%) say childhood vaccines do not go through enough safety testing compared to much larger shares of parents who consider themselves anti-vaccine (64%) or somewhere in the middle (51%).

Across Groups, Few Parents Identify As Anti-Vaccine, With Most Saying They Are Pro-Vaccine or Somewhere in the Middle

Skipping and Delaying Childhood Vaccines: Which Parents Do It and Why?

As large shares of parents express positive attitudes towards childhood vaccines, most parents also report keeping their children up to date on childhood vaccines (83%). However, about one in six (16%) parents say they have ever skipped or delayed at least one childhood vaccine for any of their children (excluding seasonal vaccines like flu and COVID-19). Like vaccine attitudes, parents’ decisions about vaccination also differ along partisan lines. Republican parents are nearly three times as likely to report skipping vaccinations for their children compared to parents who are Democrats (22% vs. 8%). This partisan gap in parents’ reports of keeping children’s vaccinations up to date is consistent with trends KFF polls have found since the COVID-19 pandemic led to deepening partisan divides in vaccine attitudes among all adults.

Similar to differences seen in some vaccine attitudes, younger parents are more likely than older parents to report skipping or delaying childhood vaccines. About one in five (19%) parents under age 35 report skipping or delaying vaccines for their children, regardless of the age of their child. This is larger than the shares of parents ages 35 to 49 (16%) or parents ages 50 and older (12%) who say the same.

Among White parents, religious beliefs play a role in childhood vaccine decisions. About one in five (19%) White parents overall report skipping or delaying vaccines for their children, rising to about one-third (36%) of White parents who describe themselves as “very religious.” Parents who homeschool their children are nearly four times as likely to report skipping or delaying vaccines compared to parents who have never homeschooled (46% vs. 12%).

Most Parents Report Keeping Children Up to Date on Vaccines; One in Five Young Parents, Republican Parents Report Skipping or Delaying Childhood Vaccines

About three quarters (73%) of the 6% of parents who describe themselves as “anti-vaccine” say they have skipped or delayed vaccines for their children. The vast majority (95%) of “pro-vaccine” parents have kept their children up to date with recommended vaccines. While most parents who describe themselves as “somewhere in the middle” on vaccines have kept their children up to date (78%), about one in five (22%) of these parents say they have ever skipped or delayed a childhood vaccine for their kids.

Three Quarters of Anti-Vaccine Parents Have Skipped or Delayed Vaccines for Their Kids, As Have One in Five Parents Who Are "Somewhere in the Middle" on Vaccines

When asked which specific childhood vaccines they have skipped or delayed, similar shares of parents report skipping or delaying the MMR vaccine (4% skipped, 5% delayed), DTaP (4% skipped and 5% delayed), hepatitis B (5% skipped and 4% delayed), chickenpox (4% skipped and 4% delayed), and polio (3% skipped and 4% delayed) vaccines. While just 6% of parents say they have skipped or delayed all the vaccines asked about in this poll, one in ten (10%) say they have skipped or delayed at least 2 childhood vaccines for their children, and 8% have skipped or delayed at least three. Overall, 8% of parents report delaying at least one of these vaccines, while 7% report forgoing at least one vaccine entirely.

Similar Shares of Parents Report Skipping or Delaying Different Childhood Vaccines

Parents’ reasons for skipping or delaying vaccines for their own children mirror many of the general concerns and uncertainty expressed by parents overall. About two-thirds (67%) of parents who skipped or delayed vaccines for their child say concerns about side effects were a “major reason” for their decision. About half of these parents say not trusting that vaccines are safe (53%) or not thinking all the recommended vaccines are necessary (51%) are major reasons they skipped or delayed their child’s vaccines.

About four in ten (42%) parents who skipped or delayed vaccines for their child say not wanting their child to get multiple shots at once was the major reason, followed by about one-third (34%) who say they skipped or delayed vaccines because they can keep their child healthy in other ways without vaccines. About one in ten parents who skipped or delayed vaccines say the major reason was that their child is afraid of needles (10%) or their doctor did not recommend vaccination (9%).

Few vaccine-skipping parents cite access reasons, such as not having time or not being able to get an appointment (9%) or that the cost was too high (5%). One in eight (13%) parents say a major reason they skipped or delayed vaccines for their child was that their child has a health condition, while one in eight (13%) say this was a minor reason and nearly three in four (72%) parents who skipped vaccines say a medical condition was not a reason for skipping vaccines for their child.

Half or More Parents Who Skipped or Delayed Vaccines for Their Children Cite Side Effects, Safety Concerns, or Claim Not All Vaccines Were Necessary

Half of parents who delayed or skipped vaccines for their children say their child’s health care provider was supportive of their decision (49%), while one in five say their doctor was not supportive (23%) and about one in four (27%) say they did not discuss the decision with a health care provider. Similar shares of parents across age groups and with children in different age cohorts say their doctor was supportive of their decision to delay or skip vaccines.

Half of Parents Who Skipped Vaccines For their Children Say Their Child's Doctor Was Supportive of the Decision; About One Quarter Did Not Consult a Doctor

Some parents may be self-selecting pediatricians who align with their vaccine views. One in four parents who have skipped or delayed vaccines for their children say they have ever changed or tried to change their child’s provider due to the provider’s views on vaccines. Few (3%) parents who keep their children up to date on vaccines say the same.

One in Four Parents Who Skipped or Delayed Vaccines for Their Kids Say They Tried To Change Pediatricians Due to Provider’s Vaccine Views

Few parents report feeling pressured by peers or doctors to vaccinate their children, though those who have skipped or delayed vaccines are more likely to report feeling pressure. About one in four (23%) parents overall say they have felt unfairly pressured by government health agencies to vaccinate their children, rising to about half (49%) among parents who have skipped or delayed vaccines. Smaller shares say they have felt pressure from a health care provider (16% overall, 44% among parents who skipped or delayed vaccines), their child’s school or daycare (14% overall, 32% among parents who skipped or delayed vaccines), friends or family (10% overall, 24% among parents who skipped or delayed vaccines), or other parents (10% overall, 26% among parents who skipped or delayed vaccines). Few parents who report keeping their children up to date on vaccines report feeling pressure from these sources.

At Least Four in Ten Parents Who Skipped or Delayed Vaccines Say They Felt Unfairly Pressured by a Doctor, Gov. Health Agency to Vaccinate Their Kids

The Role of Schools

At this time, all 50 states and D.C. have state laws that require children starting school to be vaccinated against MMR and polio at the federally recommended ages, though Florida has announced that the state will end all vaccine mandates, including for school children. While there is no federal law regarding childhood vaccinations, recommendations about school requirements are issued by the CDC’s Advisory Committee on Immunization Practices (ACIP). Each state has its own laws determining school vaccination requirements, including policies for exemptions. While all states allow for medical exemptions from school vaccine requirements, some states additionally allow for religious or other personal-belief exemptions.

Overall, parents largely support these policies, with about eight in ten (81%) parents saying public schools should require vaccines for measles and polio with some exceptions, while about one in five (18%) say public schools should not require measles and polio vaccines for any students. While Republican parents and independents are each more likely than Democrats to say public schools should not require these vaccines, majorities across these groups nonetheless support such requirements.

Most Parents Support Public School Vaccine Requirements for Measles and Polio, While About One in Five Say Public Schools Should Not Require These Vaccines

Eight percent of parents overall, including about one in four (27%) of those who have skipped or delayed vaccines, say they have applied for an exemption so their child could attend school or daycare without receiving required vaccines. The most common type of exemption is for personal reasons, reported by 4% of parents overall and one in five parents who have skipped or delayed any vaccinations for their children. Religious reasons for exemption are cited by 4% of parents overall, and one in six (16%) parents who have skipped or delayed vaccinations for their children. Medical exemptions are least common, reported by 3% of parents overall and one in ten (11%) parents who have skipped vaccines for their children.

About two-thirds (64%) of parents who applied say their exemption was approved, while 36% say it was denied. Among all parents, 5% say they applied for an exemption, and it was granted and 3% say they applied and were denied. In a policy statement, the American Academy of Pediatrics (AAP) “advocates for the elimination of nonmedical exemption from immunizations” citing their role in increasing the risk of measles and other vaccine preventable disease outbreaks.

One in Ten Parents Who Have Skipped or Delayed Vaccines Say They Have Applied for a Medical Exemption for Their Child To Attend School Without Vaccinations

One in five parents of children ages 6-17, including four in ten (42%) of those who have skipped or delayed vaccinations, say they have homeschooled their child for reasons other than the COVID-19 school shutdowns. Consistent with previous polling on homeschooling by The Washington Post, vaccine requirements do not appear to be the main motivation for homeschooling for most parents. Three in ten homeschool parents say school vaccine requirements were a major (14%) or minor (16%) reason for homeschooling their child, while seven in ten (69%) say school vaccine policies were not a reason. One in five parents who currently or previously homeschooled their children say they applied for a school vaccine exemption at some point.

Parents’ Views of the HPV Vaccine

Introduced in 2006, vaccines for human papillomavirus (HPV) prevention have been the source of some controversy. HPV is a sexually transmitted infection (STI) that can cause cervical cancer and other cancers. The HPV vaccines available in the U.S. have been clinically proven to be safe and effective at preventing HPV-related infections and cancers. Children can be vaccinated for HPV as young as 9 in some states, though the CDC recommends routine vaccination against HPV between ages 11 and 15. While health experts broadly recommend the vaccine for adolescents and children before an exposure to HPV, its connection to STIs has fueled debate over whether it should be given to children. About two-thirds of parents (64%) say they have heard “a lot” (22%) or “some” (41%) of the vaccine that prevents HPV, including similar shares of parents of girls and boys.

About six in ten (62%) parents of children ages 9 and older say their child has already received the HPV vaccine, or they probably or definitely will get it. This rises to about seven in ten (69%) among parents who have kept all their children up to date on other childhood vaccines. As with vaccine uptake for other childhood vaccines, Democratic parents (76%) are more likely to say their child will get or has gotten vaccinated against HPV, though half (51%) of Republican parents of eligible children say the same. About six in ten (62%) independent parents say they have gotten their child vaccinated against HPV or plan to do so. Similar shares of parents of boys and girls say they have gotten or will get their older children vaccinated.

Six in Ten Parents of Children Ages 9 and Older Say Their Child Has Already Gotten or Will Get Vaccinated Against HPV

Among parents of children under age 9 who are not yet eligible for HPV vaccination, about six in ten say they will definitely (29%) or probably (29%) get their child vaccinated against HPV, while one in five say they probably (9%) or definitely (10%) will not vaccinate their child. One in five (22%) are not sure. Larger shares of Democratic parents (79%) and parents who have not skipped any childhood vaccines for their children (66%) say they will probably or definitely get their children vaccinated against HPV when they are eligible, compared with about four in ten (42%) Republican parents and one in five (19%) of those who have skipped or delayed childhood vaccines.

Six in Ten Parents of Young Children Say They Will Probably or Definitely Get Them Vaccinated Against HPV When They Are Eligible; One in Five Are Not Sure

In Their Own Words: Why do you think you will not get your child vaccinated against HPV?

In a follow up question, parents who said they “probably” or “definitely” would not get their child vaccinated against HPV told us why that is. Many offered responses related to concerns about the HPV vaccine being associated with unsafe sexual behavior and did not see a need to give that to their children, as well as anecdotes of side effects.

“Risks outweigh the benefits. This is a disease caused by a virus you get due to unwise behavior.” – Republican parent of a teenage boy and girl, age 51, Wisconsin

“They should not be engaging in sexual activity until marriage, and they explicitly understand the risks without the vaccine, and of course, the sinful nature.” – Independent parent of a pre-teen girl, age 34, Pennsylvania

“[I] know someone who had a vaccine injury from the vaccine and because it is a newer vaccine unsure of effectiveness and risk of long-term complications.” – Republican parent of a teenage girl, age 38, Louisiana

“Children should not be having a sexual relationship and being exposed to disease.” – Republican parent of a teenage boy, age 54, Pennsylvania

“I have personally known multiple people with severely adverse health effects directly caused by that vaccine. It also sends a message to our children that we expect them to be sexually immoral. It appears to have been more of a money grab than an actually useful vaccine.” – Independent parent of a teenage boy, age 43, Florida

“I’ve seen mixed information about the vaccine not just from parents. I would like to do further research about the potential adverse effects and benefits before making a decision.” – Democratic parent of pre-teen girls, age 41, Texas

Belief in False and Misleading Claims About Measles and Vaccines

Before his confirmation and in his role as HHS Secretary, Robert F. Kennedy Jr. has amplified claims about vaccines that have been rejected by scientists and public health officials. Along with firing and reassembling the ACIP, Kennedy has said he will investigate the childhood vaccination schedule, suggesting without evidence that the number of recommended childhood vaccines has led to a rise in chronic disease in the U.S. Kennedy has also repeated false claims that vaccines, including MMR, can cause autism and that the measles vaccine causes the illness it prevents. More recently, Kennedy has promoted Vitamin A as an effective treatment for measles, despite public health experts’ warning that supplements cannot substitute for vaccination.

Relatively few parents think false or misleading claims about vaccines and measles are true, but many are uncertain, with at least four in ten saying they do not know enough to say. At the same time, the share who say these false claims are true is higher among Republican parents, particularly those who identify as supporters of the Make America Great Again (MAGA) movement.

Overall, few parents say they think it is true that chronic diseases are rising because of an increase in the number of vaccines children get (13%), that MMR vaccines can cause autism in children (9%), that the measles vaccine causes the same illness it is supposed to prevent (8%), or that vitamin A is an effective treatment for measles (6%). For each of claim related to vaccines, between four in ten and half say they are false, including that the measles vaccines cause the same illness they are supposed to prevent (49%), that chronic disease are likely rising due to an increase in the number of childhood vaccines (45%), or that MMR vaccines can cause autism in children (42%). Assessing the false claim that Vitamin A is an effective treatment for measles, about one in four correctly say it is false (27%), while two-thirds (66%) say they do not know enough to say.

Few Adults Say They Think False Statements About Vaccines and Measles are True, But At Least Four In Ten Express Uncertainty

Republican parents are about twice as likely as Democratic parents to believe that chronic diseases are rising because of an increase in the number of vaccines children get (18% v. 7%) and that the MMR vaccines can cause autism in children (13% v. 5%). Belief in each of the three claims related to vaccines and measles is higher among parents who are MAGA Republicans compared to non-MAGA Republicans; nonetheless, most MAGA supporters either express uncertainty or say these claims are false.

Parents who say they skipped or delayed recommended vaccines for their children are far more likely than those who have kept their children up to date to believe these myths.

MAGA Republican Parents and Parents Who Have Skipped or Delayed Children's Vaccines Are More Likely To Believe False Claims About Vaccines

The claim linking MMR vaccines to autism is one that has a long history, and previous KFF polling has found many parents are uncertain about the facts around autism and vaccines. The poll finds that parents who say their child has been diagnosed with autism spectrum disorder are more likely than those whose children have not to say it is true that MMR vaccines can cause autism in children (16% v. 9%). About one-third (37%) of parents of children diagnosed with autism say they do not know enough to answer.

About Half of Parents of Kids Diagnosed With Autism Correctly Say it is False That MMR Vaccines Cause Autism, Nearly Four in Ten Are Unsure

Confidence in Federal Health Agencies and Changes to Vaccine Policy

Amid criticism of federal health agencies, Robert F. Kennedy Jr. was appointed HHS Secretary, and said his priority was to strengthen the agencies’ independence and base decisions on scientific evidence. Six months into his term as Secretary, parents’ confidence in federal health agencies to carry out some of their core functions is mixed.

About half (49%) of parents say they have “a lot” or “some confidence” in government health agencies like the CDC and FDA to ensure the safety and effectiveness of vaccines. Fewer than half express confidence in these agencies to make decisions based on science rather than the views of agency officials (40%) or to act independently without interference from outside interests (35%).

Half or Fewer Parents Are Confident in Federal Health Agencies To Ensure Vaccine Safety, Follow Science, or Act Independently

Republican parents are less likely than Democratic parents to express confidence in government health agencies to ensure the safety and effectiveness of vaccines (41% v. 60%), make decisions based on science rather than the views of agency officials (35% v. 48%), or to act independently without outside interference (30% v. 40%).

Even among parents who are ostensibly among the current administration’s most ardent supporters (Republicans who say they support the MAGA movement), fewer than half express at least some confidence in federal government health agencies to ensure the safety and effectiveness of vaccines, make decisions based on science, or act independently.

Parents under age 50, who are more likely to express vaccine-skeptical attitudes and to report skipping or delaying vaccines for their children, are less likely than older parents to express confidence in government health agencies to ensure vaccine safety and effectiveness and to act independently without outside interests.

Confidence in Federal Health Agencies to Ensure Vaccine Safety is Lower Among Younger Parents, MAGA Republican Parents

Since his appointment as Secretary of Health and Human Services, Robert F. Kennedy Jr. has made several changes to U.S. vaccine policy, including replacing the ACIP, removing COVID-19 vaccine recommendations for healthy children, and cancelling funding for mRNA vaccine research. This survey, fielded late July to early August 2025, finds that fewer than half of parents have heard about these changes.

About four in ten (38%) parents have heard “a lot” (11%) or “some” (27%) about recent changes Kennedy has made that could affect vaccine policies in the U.S., while about one in four (27%) have heard “a little” and one-third (34%) have heard “nothing at all.” Parents with a college degree (49%) and Democrats (49%) are more likely than their counterparts to say they have heard at least “some” about these recent changes.

A Majority of Parents Have Heard Little or Nothing About Kennedy's Changes That Could Impact Vaccine Policy in the U.S.

When it comes to expectations of the impact of these changes, parents are split along party lines. One in six parents (16%) say the changes made by Kennedy will make childhood vaccines safer, about one in five (18%) say the changes will make childhood vaccines less safe, and an additional one in five say these changes will not make a difference (22%). The largest share of parents, more than four in ten (44%), say they are not sure how these changes will impact safety.

Partisans are split, with about three in ten (29%) Republican parents, rising to nearly four in ten (38%) MAGA Republicans, saying these changes will make childhood vaccines safer, compared to 4% of Democratic parents. Four in ten Democratic parents and 5% of Republican parents say the changes will make vaccines less safe. About one in five parents across partisans say the changes will not make a difference, and at least one-third say they are not sure.

Parents Are Divided Over Whether Kennedy's Changes Will Make Childhood Vaccines Safer or Less Safe; Four in Ten Are Not Sure

Fewer than one in ten (8%) parents say that changes made by Kennedy will make it easier for parents to access vaccines for their children, about one in four (24%) say these changes will make it more difficult, and about one in four say it will not make a difference (23%). The largest share (44%) say they are not sure.

Again, partisans are split, with half of Democratic parents (52%) saying Kennedy’s changes will make it more difficult to access vaccines. Most Republican parents say Kennedy’s changes will not make a difference in access to childhood vaccines (33%) or that they are not sure (46%).

About Half of Democrats Say Kennedy’s Changes Will Make Vaccine Access Difficult; Most Republicans See No Impact or Are Unsure

Secretary Kennedy has promised radical transparency and a decrease in the pharmaceutical industry’s influence on U.S. vaccine policy, yet about half (51%) of parents are unsure whether Kennedy’s policies will achieve this decreased influence. One in five (20%) say Kennedy’s changes will decrease pharmaceutical company influence in U.S. vaccine policy, about one in ten (11%) say they will increase influence, and one in six (17%) parents say it won’t make a difference.

Half of Republicans (47%) and Democrats (50%) say they are not sure if Kennedy’s changes will increase or decrease pharmaceutical company influence in U.S. vaccine policy. One-third (32%) of Republicans expect the changes to decrease pharmaceutical company influence, while one in five Democrats say it will either increase (18%), or will not make a difference (20%).

Half of Parents Are Unsure How Kennedy's Changes Will Impact Pharmaceutical Influence in U.S. Vaccine Policy; Republicans More Likely to Say it Will Decrease

Methodology

This KFF/The Washington Post Survey of Parents was designed and analyzed by public opinion researchers at KFF and The Washington Post. The survey was designed to reach a representative sample of parents or legal guardians of children under the age of 18 in the U.S. The survey was conducted July 18 – August 4, 2025, online among a nationally representative sample of 2,716 parents using the Ipsos KnowledgePanel in English (n=2519) and in Spanish (n=197). KnowledgePanel is a nationally representative probability-based panel where panel members are recruited randomly through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Groups (MSG) through the U.S. Postal Service’s Computerized Delivery Sequence (CDS). Invitations were sent to panel members by email followed by up to two reminder emails.

All completes were reviewed to ensure respondents were giving the survey adequate attention. Three cases were removed from the data that failed internal quality checks. Most KnowledgePanel respondents received a financial incentive equaling about $1 for their participation in this survey with some harder-to-reach groups receiving about $5 for their participation.

The survey also includes an oversample of parents of children 5 years old and younger (n=1,092) in order to reach a higher rate of responses from parents who are currently making decisions around their child’s vaccines. The full sample was weighted to match the sample’s demographics to the national U.S. parent population using data from the Census Bureau’s 2023 American Community Survey. Weighting parameters included gender, age, education, race/ethnicity, region, metro status, and language proficiency within the Hispanic sample. The sample was also weighted to the total parent population on political party identification using the 2025 KFF Benchmarking Survey. An additional adjustment was conducted in order to provide estimates from parents living in Texas (n=276) using the 2023 ACS as well as the 2023-2024 Pew Religious Landscape Survey. Both weights take into account differences in the probability of selection, including adjustment for the sample design, within household probability of selection, and the design of the panel-recruitment procedure.

The margin of sampling error including the design effect for the total sample is plus or minus 2 percentage points and plus or minus 3 percentage points for the parents of children under the age of 6. The full Texas sample has a margin of sampling error of plus or minus 7 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available on request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF and The Washington Post are charter members of the Transparency Initiative of the American Association for Public Opinion Research.

M.O.S.E.	N (unweighted)	M.O.S.E.
Total parents	2,716	± 2 percentage points
Texas parents	276	± 7 percentage points
Florida parents	136	± 9 percentage points

Party ID
Democratic parents	801	± 4 percentage points
Independent/Other party parents	1,077	± 3 percentage points
Republican parents	780	± 4 percentage points
MAGA Republican parents	498	± 5 percentage points

Parents by vaccine choice
Skipped or delayed any childhood vaccines	436	± 5 percentage points
Kept kids up to date on all childhood vaccines	2,264	± 2 percentage points

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