Examining Short-Term Limited-Duration Health Plans on the Eve of ACA Marketplace Open Enrollment

Authors: Michelle Long, Emma Lee, and Sammy Cervantes
Published: Oct 15, 2025

Editorial Note: This issue brief provides an update and additions to KFF’s similar 2018 analysis on short-term limited-duration health insurance, using a revised methodology.

Issue Brief

Short-term, limited-duration (STLD) health plans have long been sold to individuals through the “non-group” (individually-purchased) private insurance market and through industry associations. STLDs were designed for individuals who experience a temporary gap in health coverage, such as someone who is between jobs. Short-term plans are often marketed as less expensive alternatives to health insurance sold on the Affordable Care Act (ACA) Marketplace. However, STLDs provide less comprehensive coverage and have fewer consumer protections than Marketplace plans. As Open Enrollment for Marketplace plans nears, recent actions taken by Congress and the Trump administration, and the potential expiration of enhanced premium tax credits, are likely to result in millions of people losing coverage or having to pay substantially higher premiums for Marketplace coverage. At the same time, the Trump administration recently announced that it would not prioritize enforcement actions for violations of Biden-era consumer protections for short-term plans, and that it intends to undertake rulemaking, which could roll back those regulations. Taken together, these changes could lead more consumers to purchase less expensive and less comprehensive coverage, such as short-term plans, instead of a more comprehensive ACA plan this Open Enrollment season.

KFF has analyzed short-term health policies sold on the websites of nine large insurers in a major city in each of the 36 states where short-term plans are available. These insurers offer 30 distinct products, with a total of approximately 200 distinct plans. For more details, see the Methods section. This brief provides an update to and expansion of a similar 2018 KFF quantitative analysis, examining premiums, cost sharing, covered benefits, and coverage limitations of these short-term policies, and comparing their features to plans sold on the ACA Marketplace.

Key Takeaways

  • Short-term plans are sold in 36 states. Five states prohibit the sale of short-term health plans, and in nine states plus the District of Columbia, short-term plans are not outright prohibited, but none are available due to more extensive state regulations.
  • Premiums for the lowest-cost short-term plans can cost two-thirds or less than the lowest-cost unsubsidized Bronze plans sold on the ACA Marketplace in the same area. However, the vast majority of Marketplace enrollees receive premium tax credits, which can effectively result in similarly priced or even cheaper Marketplace plans, all of which provide more comprehensive coverage than the highest cost short-term plan.
  • Short-term plans tend to have lower premiums because they are medically underwritten and have pre-existing condition exclusions. For example, an individual with cancer, obesity, or who is pregnant is likely to be declined. Additionally, the lowest-cost short-term plan premium for a 40-year-old woman ranges from 6% to 19% higher than the lowest-cost premium for a man. These practices are not permitted in ACA-compliant plans.
  • Short-term plan deductibles for an individual in select U.S. cities range from $500 to $25,000 compared to $0 to $9,200 for Bronze Marketplace plans. Silver and Gold plans have lower deductibles, but also higher premiums. Unlike all ACA-compliant plans, most short-term plans do not have out-of-pocket (OOP) maximums or only apply these maximums to certain OOP expenses. The maximum benefit limits for short-term plans sold in these ten cities are as low as $100,000 per policy term. ACA-compliant plans are not allowed to have annual or lifetime dollar limits.
  • Among all the short-term products we reviewed, 40% do not cover mental health services, 40% do not cover substance abuse treatment, 48% do not cover outpatient prescription drugs, and almost all exclude coverage for adult immunizations (94%) and maternity care (98%). All ACA-compliant plans must cover these services.
  • Even when short-term plans do cover these and other benefits, limitations and exclusions almost always apply that would not be permitted under ACA-compliant plans, such as separate benefit limits, limits on the number of primary care visits the plan will cover, and limits on the number of days the plan will cover inpatient hospital care.

Background

Consumer Protections

As the name suggests, short-term health plans are not required to be renewable. Whereas federal law, since 1996, has required all other individual health insurance to be guaranteed renewable at the policyholder’s option, coverage under a short-term policy terminates at the end of the contract term. Continuing coverage beyond that term requires applying for a new policy. An individual who buys a short-term policy and then becomes seriously ill will not be able to renew coverage when the policy ends.

The ACA prohibits health insurance plans sold on the non-group market from practices such as medical underwriting, pre-existing condition exclusions, and lifetime and annual limits. ACA-compliant plans are required to provide minimum coverage standards and limit out-of-pocket cost sharing ($9,200 for an individual in 2025). Since short-term plans are not regulated as individual market insurance under federal law, these market rules do not apply to short-term plans, which, by contrast, can:

  • base premiums, without limit, on health status, gender, and age;
  • require application fees or enrollment in a special association to be eligible for coverage;
  • deny coverage for people with pre-existing conditions, or exclude coverage for those conditions;
  • exclude coverage for essential health benefits, including maternity care, prescription drugs, mental health care, and preventive care, and limit coverage in other ways;
  • impose lifetime and annual dollar limits on covered services;
  • not have an out-of-pocket maximum on patient cost sharing; and
  • exclude other ACA consumer protections, such as rate review or minimum medical loss ratios.

Short-term policies are not considered “minimum essential coverage,” the term used to describe health coverage that meets the ACA requirement that individuals have health coverage, and which determines eligibility for Special Enrollment Periods. Therefore, loss of short-term coverage does not qualify an individual for a Special Enrollment Period in the ACA Marketplace, so they would have to wait until the next Open Enrollment period to enroll in an ACA Marketplace plan.

There is no current or comprehensive data on the number of consumers enrolled in an STLD. Most available estimates are a substantial undercount because they do not account for STLDs sold through associations, which is likely the majority. The most comprehensive estimate may come from a 2020 Congressional investigation, which estimated that approximately 3 million people were enrolled in a short-term plan at some point during 2019.

Federal Laws and Regulations

Today, short-term plans are typically available for one to six months, with some issuers offering coverage for up to 12 months and one offering “three-packs” of short-term policies, enabling consumers to buy up to three years of short-term coverage at a time. The duration and renewability of STLD plans have been the subject of changing federal regulations, as shown in Table 1.

Permissible Durations of Short-term Plans Under Changing Regulations, 2016-2024 (Table)

To address reports of misleading marketing and deceptive sales tactics, current federal regulations also require short-term plans to conspicuously notify consumers that short-term plans are “NOT comprehensive coverage” and to include standardized language describing STLD plans’ coverage limitations in comparison to insurance sold on HealthCare.gov.

The Trump administration’s 2018 regulation expanding the permitted duration of short-term plans was challenged in district court, with a 2019 ruling in favor of the government. The Biden administration once again imposed limits on the use of short-term plans. In August 2025, the Trump administration announced that it would no longer prioritize enforcement of Biden-era regulations on short-term plans and that it intends to undertake corresponding rulemaking. Amendments to these provisions could, again, prompt lawsuits. Meanwhile, a lawsuit challenging the 2024 regulations is working its way through the courts.

State Laws and Regulations

Short-term health plans are available in 36 states (Figure 1). Five states (CA, IL, MA, NJ, and NY) have laws prohibiting the sale of short-term health plans. In nine states plus the District of Columbia, short-term plans are not prohibited, but none are available due to more extensive state regulations that require these plans to provide more consumer protections than they do in other states (e.g., no pre-existing condition exclusions, coverage of certain benefits, shorter durations).

Availability of Short-Term Plans by State, 2025 (Choropleth map)

How Short-Term Plans Compare to Bronze-Level ACA Marketplace Plans

Premiums

Due to coverage limitations and fewer consumer protections, short-term policies, unsurprisingly, typically have lower premiums than unsubsidized Bronze plans, a trend that is similar to our 2018 analysis. (Note, however, that the methodology used for this analysis differs from that used in 2018, and some of the states we reported data for in 2018 no longer have short-term plans for sale.) Our cost analysis of approximately 200 short-term plans sold by nine major insurers in the 36 states where short-term plans are available found that many of the cheapest short-term plans for a 40-year-old non-smoker were priced at two-thirds or less of the premium for the lowest-cost ACA-compliant, unsubsidized Bronze plan in the same area (Table 2). However, premiums for the highest-price short-term plans, which typically have lower cost sharing, are higher than the highest-cost Bronze plan in four of the ten cities shown in the table for males and five of the cities for females. All Bronze plans provide more comprehensive coverage than even the highest-cost short-term plans.

The vast majority (93%) of ACA Marketplace enrollees receive a premium tax credit tied to their income, reducing both the price they pay for a Marketplace plan and the price difference between the lowest cost short-term plan and the lowest cost Bronze plan. In some cases, the lowest-cost subsidized Bronze plan is cheaper than the lowest-cost short-term plan sold in the area. For example, the cheapest Bronze plan for a 40-year-old individual living in Houston, TX, who earns $45,140 per year (the median individual income in the U.S. in 2024) and receives a premium tax credit, would be 5% less for a male and 23% less for a female than the cost for the lowest-cost short-term plan. Additionally, in nine of the ten cities in Table 2, the highest-cost subsidized Bronze plan for an individual earning $45,140 per year is lower than the highest-cost short-term plan, sometimes by hundreds of dollars. Premiums for Silver plans, with the tax credit, would be higher, but also come with lower deductibles.

ACA-compliant plans are not permitted to charge women higher premiums than men. There are no equivalent federal requirements for short-term plans, and as such, short-term plans can and do charge women more than men. Among the ten major cities shown, the lowest-cost short-term plan premium for a 40-year-old woman ranges 6% to 19% higher than the lowest-cost premium for a man. ACA-compliant plans may charge higher premiums for older consumers than younger consumers, but only within specified limits. These limits do not apply to short-term plans. For example, in Phoenix, AZ, the lowest-cost Bronze plan for a 60-year-old individual is 112% higher than for a 40-year-old, whereas the lowest-cost short-term plan costs 311% more for a 60-year-old male and 228% more for a 60-year-old female.

Premium Ranges for ACA Marketplace Bronze Plan Premiums Compared to Short-term Health Plans in Select Cities, 2025 (Table)

In addition to monthly premiums, most short-term products require one-time application fees, which typically range in price from $20 to $35. Additionally, all the national insurers require enrollment in a special association to be eligible for coverage in most states (e.g., one association serves as a source of information on consumer issues and offers its members products and services in a variety of areas); three of these insurers require enrollees to pay an extra monthly fee for the association membership, ranging from $15 to $25 per month. Taken together, these fees can turn a three-month short-term policy with a $70 monthly premium into a policy that actually costs over $100/month. Plans sold on the ACA Marketplace do not charge application fees or require association memberships.

Cost Sharing

In addition to premiums, cost sharing is another consideration when comparing the affordability of short-term plans to ACA-compliant plans. An insurer may offer several plans with variable cost-sharing structures within each product type. Cost sharing does not typically vary by the enrollee’s age or sex. A deductible is the amount an enrollee has to pay out-of-pocket in the plan year (or policy term) before insurance will begin paying for most covered services. In general, health insurance plans that have lower premiums tend to have higher deductibles and vice versa.

Among the ten major cities analyzed for this part of the analysis, deductibles for Bronze Marketplace plans range from $0 (an HMO in Milwaukee, WI) to $9,200 (most cities); in 2025, no ACA-compliant plans can have a deductible exceeding this amount (Table 3). In comparison, deductibles for short-term plans in these cities range from $500 (Houston, TX) to $25,000 (all cities), nearly three times higher than the highest deductible for a Bronze plan. Some consumers enrolled in a short-term plan with a shorter duration (such as three or four months) and a higher deductible may never meet the deductible during the policy term and may end up paying for care entirely out-of-pocket.

In the individual market, plans must have an out-of-pocket (OOP) maximum on enrollee cost sharing (including deductibles, coinsurance, and copayments) for covered services provided by an in-network provider. For the 2025 plan year, the OOP max cannot be higher than $9,200 for single coverage. If an enrollee meets the OOP maximum, the plan must pay for covered services in full (meaning no enrollee cost sharing) for the remainder of the plan year. Short-term plans, on the other hand, are not required to have an OOP maximum under federal law, and many do not, meaning there is no limit to the amount an enrollee must pay out of pocket for covered services during the policy term. When a short-term plan does have an OOP maximum, sometimes the deductible and coinsurance count toward the OOP max (not copayments, cost sharing for services with a benefit limit that has been exceeded, or facility fees). In the major cities shown, OOP maximums for a Bronze Marketplace plan range from $7,100 (Portland, OR) to $9,200 (all cities). While the lowest OOP max for a short-term plan in these cities is $2,000 (most cities), short-term plans that have no OOP maximum are available in all but one city (Portland, OR). Among short-term plans that do have an OOP maximum, OOP maximums are as high as $32,500 in most cities, approximately three and a half times higher than the highest OOP maximum for a Bronze plan.

All short-term plans have a total dollar limit that they will pay for covered care during the term of the plan, or sometimes over the enrollee’s lifetime. The maximum benefit limits among the ten are as low as $100,000 per policy term. This means that if the plan spends $100,000 on covered services for an enrollee, the plan will not pay for any more covered services the enrollee receives during the policy term. This amount is lower than in 2018, when the lowest coverage limit was $250,000. ACA-compliant plans are prohibited from imposing dollar limits on how much they will pay for covered services during the plan year (unless those services are not part of the ACA’s essential health benefits).

Cost-Sharing Ranges for ACA Marketplace Bronze Plans Compared to Short-term Health Plans in Select Cities, 2025 (Table)

Covered Benefits

All plans sold on the ACA-Marketplace must cover these 10 essential health benefits: hospitalization, ambulatory services, emergency services, maternity and newborn care, mental health and substance abuse treatment, prescription drugs, laboratory services, pediatric services, rehabilitative and habilitative services and devices, and preventive care (many of these preventive services must also be covered without cost sharing). In contrast, there are no federal requirements for short-term plans to cover the essential health benefits, though many short-term plans provide at least some level of coverage for some of these benefits, and some states have their own coverage requirements for certain services.

This part of the analysis examines specific benefits covered by 30 distinct short-term products from nine major insurers in the 36 states where short-term plans are available. This information is based on shopping tools and plan documents available on the insurers’ websites, including state variations when provided. Table 4 shows the percentage of short-term products by major city that cover at least some services in five benefit categories: mental health services, substance use services, prescription drugs, adult immunizations, and maternity services. Note that short-term plans that cover these benefit categories often apply limits and exclusions on these services, which are not reflected in this table, but are discussed in more detail below.

Of the short-term products reviewed, just 60% cover mental health services, 60% cover services for substance abuse treatment, 52% cover prescription drugs, 6% cover adult immunizations, and just 2% cover maternity care. In two states (AK and MD), mental health services are not covered by any short-term product, and in six other states, fewer than half cover them. There are no short-term products in Maryland that cover substance use treatment, and in six other states, fewer than half cover treatment. Two states (MD and SD) do not have any short-term products that cover prescription drugs, and in three other states, fewer than half cover them. Ten states have no short-term products that cover adult immunizations. Only two states (MT and NH) have products that cover maternity services. See the Methods section for how we defined a product as covering these benefits.

Percentage of Short-Term Health Insurance Products Covering Select Benefits, by Major City, 2025 (Table)

Benefit Limitations

Even when short-term plans do cover these benefits, limitations and exclusions almost always apply that would not be permitted under ACA plans. For example, thirteen of the fourteen products that cover prescription drugs apply a maximum dollar limit on the benefit, all ranging from $1,000 to $5,000 per policy term, except for one product with a $10,000 pharmacy benefit limit. Some short-term plans that cover prescription drugs also limit the types of drugs they will cover. For example, they may not cover contraceptives or may only cover them if the primary purpose they are being prescribed for is not to prevent pregnancy. Additionally, many products that cover prescription drugs do not cover specialty drugs, and some only cover “maintenance” medications for certain chronic conditions. Short-term products that cover mental health and substance abuse treatment impose significant limits on the benefits. Examples of coverage limitations for these benefit categories include a $50 maximum benefit for outpatient visits, a 31-day maximum for inpatient care, and a benefit limit of $3,000 per policy term. Additionally, short-term products that cover treatment for substance use disorders usually do not cover illnesses or injuries resulting from being under the influence of alcohol, illegal substances, or controlled substances unless they were prescribed to that individual.

Short-term products have several other limitations on covered benefits. For example, while nearly all advertise coverage for preventive care, most services require cost sharing or dollar limits that would not be permitted in ACA-compliant plans. Other common examples of per policy term limitations and additional costs include coverage of only one office, coverage of no more than three emergency room visits, an additional $750 deductible for inpatient care, and a $15,000 benefit limit for all covered outpatient care.

All of the short-term products reviewed exclude coverage for pre-existing health conditions, and most have waiting periods for at least some services, rendering coverage of certain covered benefits less meaningful than they may seem at first glance. For example, nearly eight in ten products advertise coverage for cancer treatment, but anyone who has been diagnosed with cancer before enrolling would be denied coverage when they apply. Even if there had been no cancer diagnosis before enrolling in the plan, if the enrollee is first diagnosed with cancer while enrolled in the short-term plan, the plan could deny coverage for treatment if the symptoms should have caused an “ordinarily prudent person” to seek medical care, or the plan could terminate coverage altogether. Additionally, for many cancers, a course of treatment would take much longer than short-term coverage would last. By contrast, ACA-compliant health plans are prohibited from having pre-existing condition exclusions or dropping coverage if the enrollee gets sick. Other common health conditions that are typically considered “declinable” by short-term plans include having a history of ulcers or Crohn’s disease, diabetes, depression, heart disease, and obesity; recent pregnancy is also considered a pre-existing health condition by short-term plans.

Looking Forward

With the ACA enhanced premium tax credits slated to expire at the end of this year and new federal policies on the horizon that are expected to result in millions of people losing coverage, more individuals may consider purchasing less expensive and less comprehensive coverage, such as short-term health plans. Without federal enforcement of Biden-era consumer protections, short-term health plans already are available for longer durations, and while all short-term products we reviewed do include the consumer warning currently required, insurers could opt to exclude or modify it in future plan years. Consumers, who, as mentioned above, have been the target of aggressive and, at times, misleading marketing of short-term plans, could end up enrolled in plans that cover less than they thought and leave them on the hook for higher out-of-pocket costs than are permitted under Marketplace plans. Relatedly, the Trump administration has already taken action to expand access to catastrophic plans sold on the Marketplace, beginning with the coming Open Enrollment period. Although these plans must meet all the requirements of metal-level Marketplace plans (described above), they have much higher cost sharing.

Additionally, to the extent that healthy individuals opt for short-term plans instead of ACA-compliant plans, this adverse selection could contribute to instability in the non-group market and raise the cost of comprehensive coverage, particularly for those who are not eligible for premium tax credits. Furthermore, short-term plans are just one loosely regulated alternative to ACA plans. Other types of coverage that consumers could be steered to by marketers and insurers include fixed indemnity plans, cancer-only plans, hospital-only plans, and other types of supplemental coverage.

If the Trump administration issues regulations rolling back the 2024 regulations limiting the duration of short-term plans and requiring a standardized consumer warning on these products, which it aims to do by the end of 2026, additional lawsuits are likely. Unlike previous litigation, however, legal challenges to new regulations would not face the same standard of judicial review that upheld the 2018 Trump regulations.

Considering the significant attention focused on issues like high drug prices, the opioid epidemic, and mental health, it is notable that short-term plans often exclude or severely limit coverage for mental health, substance use, and prescription drugs. Because short-term plans provide less comprehensive coverage and fewer consumer protections than ACA-compliant plans, people who buy short-term policies in order to reduce their monthly premiums risk that if they do need medical care, they could be left with significant medical bills.

KFF acknowledges Karen Pollitz for her contributions to this analysis, including insights into the data and feedback on the draft.

Methods

In the summer and fall of 2025, we analyzed publicly-available information published on the websites of nine insurers: Allstate, United, Pivot, Everest, Select Health, Moda Health, BCBS of ID, BCBS of SC, and Medical Mutual. We believe these insurers are the primary sellers of short-term plans in the U.S, representing a wide breadth of short-term plans and products in the 36 states where short-term plans are sold. The number of insurers in each state ranges from one in Alaska, Maryland, New Hampshire, and North Dakota, to five in Ohio, South Carolina, and Texas. We used the online shopping tool for each insurer to identify the plans available in one major city of each of the 36 states and reviewed both the information in the search results and accompanying plan documents. One issuer sells a short-term product in some states that is guaranteed issue. For an equivalent comparison across all other insurers and products, this analysis does not include that product.

Each short-term product has a unique name and set of benefits and often offers multiple plans with different cost-sharing structures. The insurers in this analysis offer 30 distinct products (representing a total of approximately 200 unique plans), ranging from one product in Maryland to 23 in Ohio. The same product is often sold in multiple states, occasionally with variations in benefits by state. While we made every effort to account for state-level variations in this analysis, we only present information made available in insurers’ published plan documents and online shopping tools, which may be incomplete or may not reflect every specific state requirement, as some insurers may not make full coverage details available until after the plan has been purchased.

Premiums presented are for a 40-year-old non-smoker. Since premiums vary by gender for short-term plans, they are presented for males and females. Since ACA-compliant plans cannot base premiums on gender, only one set of premiums is presented.

For the analysis of covered benefits, products that only cover treatment for “organic” mental health conditions are not considered to cover mental health for this analysis. Products that only cover treatment for alcohol disorders are not considered to cover substance use. Products that only cover prescription drugs when administered in an inpatient setting, or that only provide a prescription drug discount card, are not considered to cover prescription drugs. A few products do not specify whether adult immunizations are covered. In these instances, we do not consider them to be covered. All products cover complications of pregnancy. Only products that also cover pregnancy care and childbirth are considered to cover maternity care.

Poll Finding

KFF/The Washington Post Survey of Parents: Polling Insights on the MAHA Movement

Published: Oct 15, 2025

Findings

At the start of his second term, President Donald Trump established the Make America Healthy Again (MAHA) Commission, chaired by Health and Human Services Secretary Robert F. Kennedy Jr., to examine the rise in chronic childhood conditions and develop federal strategies to address them. Recent MAHA Commission reports have covered issues including diet and exercise, the dangers of social media and excessive screen time, the impact of highly-processed foods, and use of prescription medications and vaccines. Findings from the KFF/Washington Post Survey of Parents shed light on the issues that parents see as top concerns for their children’s wellbeing and the attitudes and behaviors of parents who identify with the MAHA movement.

Key Takeaways

  • About four in ten (38%) parents identify as supporters of the MAHA movement, a coalition that includes between three in ten and four in ten parents across gender, age, race, and ethnicity. Alignment with the movement among parents is highly correlated with political identification, as about six in ten Republican parents (62%), rising to eight in ten MAGA Republican parents (81%), identify with the President’s health movement, compared to about one in six (17%) Democratic parents. One third of independent parents (34%) identify with the movement.
  • Many MAHA-supporting parents echo vaccine skepticism that has been amplified by HHS Secretary Kennedy. Nearly six in ten (56%) MAHA parents say they trust Kennedy to provide reliable information about vaccines, more than twice the share of non-MAHA-supporting parents who say the same (23%). While few MAHA parents say they are “anti-vaccine” (9%), a majority say they are “in the middle” when it comes to vaccines (55%), and their attitudes reflect this mix of views and behaviors. Most MAHA parents say they have kept their children up to date with recommended vaccines (75%), but at least four in ten say the CDC recommends too many vaccines for children (42%) and they are not confident in U.S. health agencies to ensure vaccine safety and effectiveness (58%).
  • There is broad agreement across parents on some of the biggest issues facing children’s health in the U.S. today, with large shares of both MAHA-supporting parents and non-MAHA parents saying the use of social media (78% and 74% respectively) and mental health challenges (68% and 69%) are either the biggest or a major threat to children’s health. Majorities of both groups also cite highly processed foods (78% and 62%) and obesity (69% and 61%) as major threats to children’s health, though the shares are somewhat larger for MAHA parents compared to non-MAHA parents. Attitudes diverge on some other issues, with larger shares of MAHA parents than non-MAHA parents citing over-prescribing of medications (61% vs. 43%), neurodevelopmental disorders (48% vs. 38%), and fluoride in water supplies (33% vs. 25%) as at least major threats to children’s health. Parents who do not support the MAHA movement are more likely than MAHA parents to cite gun violence (68% among non-MAHA parents vs. 50% among MAHA parents), pollution (56% vs. 48%), difficulty affording enough food (50% vs. 41%), and infectious diseases (45% vs. 36%) as the biggest or major threats to children’s health in the U.S. today.
  • The MAHA Commission’s policy goals related to regulating food in the U.S. have broad support, though parents are split on the question of whether to deregulate the sale of raw milk. At least eight in ten parents support increasing government regulations on dyes and chemical additives in food (85%), on highly processed food (82%), and on added sugars in food (80%). While MAHA-supporting parents are more likely than non-MAHA parents to support each of these regulation proposals, at least three in four, regardless of MAHA support, support these policy goals. About half (47%) of parents support deregulating the sale of unpasteurized milk, including much larger shares of MAHA (63%) than non-MAHA (36%) supporting parents.

Who Are MAHA Parents?

About four in ten (38%) parents say they are supporters of the MAHA movement, with support strongly tied to political identification. About six in ten (62%) Republican parents identify with the movement, rising to eight in ten (81%) among Republicans who support the Make America Great Again (MAGA) movement. About one-third (34%) of independent parents and one in six (17%) Democratic parents support the MAHA movement.

Larger shares of parents without a college degree (41%) than with a college degree (33%) support the MAHA movement, a difference that persists even when controlling for partisanship, MAGA identity, and other demographics.

About four in ten White parents (43%) say they support the MAHA movement compared to about three in ten Hispanic parents (32%) and Black parents (30%). While much media attention has been paid to so-called MAHA moms, a group of social media influencers who amplify the MAHA movement’s stance on food additives, this poll finds similar shares of mothers and fathers say they support MAHA, as do similar shares of parents across age groups.

About Four in Ten Parents Support the MAHA Movement, Including Eight in Ten MAGA Republican Parents (Bar Chart)

Trusted Information Sources for MAHA Parents

There are wide divisions when it comes to trust in some sources of vaccine information for MAHA and non-MAHA parents. Pediatricians continue to be the most trusted source of information about vaccines for parents, with about eight in ten (81%) MAHA-supporting parents and about nine in ten (88%) non-MAHA parents saying they trust their child’s pediatrician “a great deal” or “a fair amount.”

Aside from pediatricians, majorities of MAHA parents say they trust their friends and family (58%), HHS Secretary Kennedy (56%), and their local public health departments (56%) for vaccine information, making these the top sources of vaccine information for these parents after pediatricians. About half of MAHA parents report trusting the CDC (51%) or FDA (47%) for information on vaccines. One-third or fewer MAHA parents say they trust their child’s school or daycare (37%), pharmaceutical companies (22%), or health and wellness influencers (14%) “a great deal” or “a fair amount” when it comes to reliable information about vaccines.

MAHA Supporting Parents Are More Than Twice as Likely as Non-MAHA Parents to Trust Kennedy on Vaccines (Split Bars)

Vaccine Views Among MAHA-Supporting Parents

In a section titled “The Overmedicalization of Our Kids,” the White House’s MAHA report released earlier this year states that while vaccines protect children from infectious diseases, there has not been enough research into the risks of vaccines. Vaccine skepticism is a core component of the MAHA platform.

As with parents overall, MAHA and non-MAHA parents overwhelmingly value long-standing childhood vaccines but are more divided when it comes to the COVID-19 and flu vaccines for children. About nine in ten MAHA and non-MAHA parents see the measles, mumps, and rubella (MMR) (86% and 93% respectively) and polio (85% and 91%) vaccines as important for children in their communities, including majorities who say each of these are “very important.”

MAHA parents, however, are much less likely to say the COVID-19 or flu vaccines are important for children in their communities. Parents who do not support the MAHA movement are nearly twice as likely as MAHA parents to say it is “very” or “somewhat” important for children in their community to be vaccinated for COVID-19 (52% vs. 28%) and 20 percentage points more likely to say it is important for children to be vaccinated for the flu (64% vs. 44%).

Split bar chart showing percent who say it is very or somewhat important for children in their community to be vaccinated against specific diseases. Results shown by total parents and MAHA support.

While most MAHA and non-MAHA parents report confidence in the safety of MMR and polio vaccines, MAHA parents are less likely to be “very” confident. These parents are even less confident in the safety of flu and COVID-19 vaccines for children. About three in four MAHA parents (78%) and nearly nine in ten non-MAHA-supporting parents (88%) are confident in the safety of MMR vaccines, though MAHA parents are less likely than non-MAHA parents to be “very confident” (44% vs. 60%). Similarly, about eight in ten (79%) MAHA parents and nine in ten (88%) non-MAHA parents are confident in the safety of polio vaccines, with fewer MAHA parents being “very confident” (43% vs. 60%).

When it comes to the safety of COVID-19 vaccines for children, just one in four MAHA-supporting parents are “very” (9%) or “somewhat” (16%) confident, compared to about half (54%) of non-MAHA parents. In fact, about half (53%) of MAHA parents say they are “not at all” confident in the safety of COVID-19 vaccines for children. MAHA parents are divided in their confidence in the flu vaccines for children, with about half (54%) saying they are confident. About seven in ten (72%) parents who do not support the MAHA movement are confident in the safety of the flu vaccines.

Most MAHA Parents Express Confidence in Childhood Vaccine Safety, but Fewer Than Half Are Very Confident (Stacked Bars)

Parents who support the MAHA movement are more likely than parents who do not support MAHA to hold vaccine skeptical views explored in this survey, though few (9%) would call themselves anti-vaccine. About six in ten (58%) MAHA parents say they are not confident in the CDC and FDA to ensure the safety and effectiveness of vaccines approved for use in the U.S., compared to about half (47%) of non-MAHA parents.

About half (51%) of MAHA-supporting parents say children are healthier when their vaccines are spaced out and they do not get multiple shots in one visit, while about half (47%) correctly say there is no strong evidence for this. Parents who are not supporters of the MAHA movement are more likely to correctly indicate that there is no evidence for spacing vaccines (63%), while one-third (35%) say children are healthier when vaccines are spaced out.

About four in ten MAHA-supporting parents (42%) say the CDC recommends “too many” childhood vaccines, more than twice the share of non-MAHA parents who say the same (17%).

As with parents overall, a majority of MAHA-supporting parents report keeping their children up to date on childhood vaccinations aside from COVID-19 and flu (75%). However, one in four MAHA-supporting parents (24%) report skipping or delaying at least one childhood vaccine for their kids, more than twice the share of non-MAHA-supporting parents who report the same (11%).

Vaccine Attitudes Differ Between MAHA and Non-MAHA Supporting Parents (Split Bars)

Make America Healthy Again and Vaccine Myths

HHS Secretary Kennedy has amplified claims about vaccines that have been rejected by scientists and public health officials, adding to the confusion surrounding their safety. While small shares of parents believe these claims are true, most MAHA parents do not reject them as false, and many express uncertainty.

Though the overall shares are small, MAHA parents are more likely than non-MAHA parents to say it is true that chronic diseases are likely rising because of an increase in the number of vaccines children get (21% vs. 8%), that MMR vaccines can cause autism in children (15% vs. 6%), that the measles vaccine causes the same illness it is supposed to prevent (11% vs. 6%), and that vitamin A is an effective treatment for measles (9% vs. 4%).

About half of MAHA parents say they “do not know enough to say” whether it is true that the measles vaccine causes the illness it is meant to prevent, or that chronic diseases are likely rising because of an increase in the number of vaccines children get, two claims alluded to in the MAHA Commission report. Fewer than four in ten MAHA parents correctly say either of these claims are false (38% and 31% respectively), while a majority of non-MAHA parents identify these as false (57% and 55%).

When it comes to the false claim that MMR vaccines can cause autism in children, nearly six in ten (59%) MAHA parents say they “do not know enough to say” whether it is true, and about one in four (26%) say it is false. Non-MAHA-supporting parents are about twice as likely to correctly indicate that this claim is false (53%). There has been extensive scientific research disproving the link between autism and vaccines.

Stacked bar chart showing percent who say specific false claims about vaccines and diseases are true, they don't know enough to say, or are false.

Views of Autism Research

While there has been extensive scientific research disproving the link between autism and vaccines, there is a lack of consensus on the exact causes for the rise in autism rates in the U.S. The White House MAHA Commission is tasked with studying the root causes of autism.

Many (44%) parents overall say there has been “too little” research into the causes of autism spectrum disorder generally. One in four parents say there has been “about the right amount” of research, and a similar share (28%) say they are not sure. Few (3%) parents say there has been too much research into the topic.

When asked more specifically about the amount of research done into whether there is a link between vaccines and autism spectrum disorder, one-third say there has been “too little” research into this, and similar shares say there has been “about the right amount” (29%) or they are not sure (30%). Few (7%) parents say there has been “too much” research into whether there is a link.

Stacked bar chart showing percent who say they has been too much, too little, or about the right amount, or are unsure, of scientific research into specific topics regarding autism spectrum disorder.

Parents who support the MAHA movement, and Republican parents (including MAGA Republican parents) are more likely than their counterparts to say there has been “too little” research into the causes of autism or whether there is a link between autism and vaccines. In fact, MAHA-supporting parents are twice as likely as non-MAHA parents to say there has been too little research into the connection between autism and vaccines (48% vs. 24%).

While about six in ten parents of children diagnosed with autism spectrum disorder say there has been “too little” research into the causes of autism spectrum disorder generally (61%), fewer – about one-third (35%) – say there has been too little research into whether there is a link between vaccines and autism spectrum disorder. About six in ten parents who have skipped or delayed vaccines for their children say there has been too little research into the causes of ASD (60%) or whether there is a link between vaccines and ASD (57%).

Split bar chart showing percent who say there has been too little scientific research into specific topics related to autism spectrum disorder. Results shown by total parents, parents by vaccine choice, parents with and without a child with autism spectrum disorder, party identification, and MAGA support.

What Do Parents See As the Biggest Threats to Children’s Health in the U.S.?

Social media use, mental health challenges, and issues related to diet and exercise are top issues parents view as serious threats to children’s health in the U.S. At least six in ten parents overall say social media use (75%), highly processed foods (68%), mental health challenges such as chronic anxiety or depression (68%), obesity (64%), gun violence (61%), and lack of physical activity (60%) are either the “biggest” or a “major” threat to children’s health in the U.S. today. About half of parents say pollution, poor air quality, and environmental toxins (53%), over-prescribing medications (50%), and difficulty affording food (46%) are at least major threats to children’s health, while about four in ten cite neurodevelopmental disorders (42%) and infectious diseases (41%) as threats. Fewer (28%) see fluoride in local water supplies as the biggest or a major threat to children’s health.

Social Media Use, Mental Health Challenges, and Highly Processed Food Rank Among the Biggest Threats Parents See for Children (Stacked Bars)

Despite partisan and demographic differences in who identifies with the MAHA movement, there are some similarities in what parents see as the biggest threats to children’s health. Social media and mental health challenges rank high for both MAHA and non-MAHA-supporting parents when it comes to assessing threats to children’s health, with about three-fourths of MAHA-supporting parents (78%) and non-MAHA-supporting parents (74%) citing social media, and about seven in ten of each group citing mental health challenges.

For issues related to nutrition and exercise, majorities of parents in both groups identify these as threats to children’s health, but MAHA parents are more likely to emphasize their level of threat. MAHA parents are more likely than parents who do not support the movement to say highly processed foods (78% among MAHA parents vs. 62% among non-MAHA parents), obesity (69% vs. 61%), and lack of physical activity (66% vs. 57%) are threats to children’s health. MAHA parents are also more likely to cite over-prescribing medications (61% vs. 43%), neurodevelopmental disorders (48% vs. 38%), and fluoride in water supplies (33% vs. 25%) as the biggest or major threats to children’s health today.

Parents who do not support the MAHA movement, largely comprised of Democratic and independent parents, are more likely to cite gun violence (68% among non-MAHA parents vs. 50% among MAHA parents), pollution (56% vs. 48%), difficulty affording enough food (50% vs. 41%), and infectious diseases (45% vs. 36%) as the biggest or major threats to children’s health in the U.S. today.

Highly Processed Foods, Use of Social Media, are Among The Biggest Threats MAHA Parents See for Children Today; Non-MAHA Parents Also Cite Gun Violence (Range Plot)

Support for Regulating Food Additives

In the past year, Robert F. Kennedy Jr. has called for stricter regulations on the U.S. food supply, requesting the removal of synthetic dyes and ultra-processed foods, citing their negative impact on children’s health. These policy proposals are popular, with at least eight in ten parents saying they “strongly” or “somewhat” support increasing government regulations on dyes and chemical additives in food (85%), on highly processed food (82%), and on added sugars in food (80%). About one in five or fewer parents oppose each of these proposals.

Parents are more divided when it comes to removing government restrictions on the sale of unpasteurized or raw milk, with half (47%) in support and another half (52%) opposed.

Most Parents Support Increasing Government Regulations on Food Additives, Highly Processed Foods, and Sugar (Stacked Bars)

About three quarters or more of Democratic parents, independent parents, Republican parents, MAHA-supporting, and non-MAHA-supporting parents support increasing government regulation on food additives, highly processed foods, and sugar. Partisans are divided on the question of raw milk de-regulation, as six in ten Republican (60%) and MAHA-supporting (63%) parents support removal of restrictions on raw milk, while majorities of non-MAHA supporters and Democrats are in opposition. For decades, the FDA has prohibited the interstate sale of raw milk, citing serious health risks posed by the consumption of unpasteurized milk. While Secretary Kennedy has previously accused the FDA of unfairly suppressing the consumption of raw milk, the MAHA Commission report released this year did not include references to raw milk or proposed changes to existing regulations.

Bipartisan Majorities of Parents Support Increasing Regulations on Food, Parents Are Split on De-Regulating Raw Milk Sales (Split Bars)

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.

GroupN (unweighted)M.O.S.E.
Total parents2,716± 2 percentage points
   
Support for Make America Healthy Again (MAHA) movement  
MAHA-supporting parents977± 3 percentage points
Not MAHA-supporting parents1,679± 3 percentage points
   
Party ID  
Democratic parents801± 4 percentage points
Independent/Other party parents1,077± 3 percentage points
Republican parents780± 4 percentage points
MAGA Republican parents498± 5 percentage points
   
Parents by vaccine choice  
Skipped or delayed any childhood vaccines436± 5 percentage points
Kept kids up to date on all childhood vaccines2,264± 2 percentage points

Medicare Beneficiaries Have 32 Medicare Advantage Prescription Drug Plans Available, on Average, for 2026

The average number of private plans has declined slightly but remains above the number available in 2022 and prior years

Authors: Jeannie Fuglesten Biniek, Meredith Freed, Anthony Damico, and Tricia Neuman
Published: Oct 14, 2025

In anticipation of the Medicare annual open enrollment period, which runs from October 15 to December 7, the Centers for Medicare and Medicaid Services (CMS) recently released information about Medicare Advantage plans for the coming year. News articles following the release of plan information report that Medicare Advantage insurers are scaling back their offerings in response to changes in federal payments and because unexpected increases in the use of health services have led to rising costs and falling profits.

KFF’s analysis of plan offerings shows that Medicare beneficiaries will have the option of 32 Medicare Advantage prescription drug (MA-PD) plans in 2026, two fewer than the 34 options available in 2025 (excluding employer plans and special needs plans). The number of MA-PD options has grown steadily since 2010, peaking in 2024 when the average Medicare beneficiary had 36 options. Despite the decline in offerings over the last two years, the number of options available for 2026 will be higher than the number available in 2022 (31) and every year before (Figure 1).

The Number of Medicare Advantage Plans Available to the Average Medicare Beneficiary is Slightly Lower than the Past Few Years, But More Than Every Year Prior to 2023 (Stacked Bars)

Across all Medicare Advantage plans for individual enrollment, including those with and without prescription drug coverage, the average Medicare beneficiary has the option to choose among 39 plans in 2026, compared to 42 options in 2025. Similar to the trend for MA-PDs, the total number of Medicare Advantage plans available to the average beneficiary is higher than the average number of plans available in 2022 (38), and each year since 2010. While Medicare Advantage plans are required to cover all Medicare Part A and Part B benefits, plans decide whether to include Part D prescription drug coverage as part of the benefit package. Enrollees may pay a separate premium for Part D coverage, or plans can use the rebate portion of their payment from the federal government to cover these costs. Most Medicare Advantage enrollees are in plans that include prescription drug coverage.

The number of Medicare Advantage plans with prescription drug coverage available to the average beneficiary varies across states, as does the change in the number of plans compared to 2025 (Figure 2). In 35 states, DC and Puerto Rico, the average beneficiary has a choice of fewer plans on average in 2026 than in 2025. The states with the largest drop in the number of plans available were New Hampshire (13 fewer plans) and Minnesota (11 fewer plans). In Minnesota, UCare, the second largest Medicare Advantage insurer in the state, exited the market altogether, while UnitedHealthcare and Humana decreased their offerings, especially in more rural counties with lower enrollment. However, in 6 states (AL, HI, KS, MO, UT, and WV), the average beneficiary has access to more plans in 2026 than in 2025, on average. In the remaining 8 states, the number of plans available to the average beneficiary stayed the same. This includes Alaska, which had no plans available in 2026, as in 2025 (Alaska has historically had few or no Medicare Advantage plans available for general enrollment). Connecticut is not included in this calculation because of differences in how counties are reported across CMS enrollment and plan files.

The Average Beneficiary Has More or Fewer Medicare Advantage Plans Available to Choose from in 2026 Depending on the State They Live In (Choropleth map)

While the average Medicare beneficiary will have more than 30 Medicare Advantage plans with prescription drug coverage to choose from, in certain states the number of options is substantially lower. Medicare beneficiaries will have fewer than 5 options, on average, in four states: Alaska (0), South Dakota (4), Wyoming (3), and Vermont (1). Within states, the number of plans also varies across counties (data not included). Historically, fewer Medicare Advantage plans have been offered in the most rural areas, and a larger share of Medicare beneficiaries in the most rural areas get Medicare coverage from traditional Medicare.   

The modest decrease in the average of Medicare Advantage plans means that some Medicare beneficiaries will find that their current coverage is no longer an option for next year. In most cases, these beneficiaries live in counties where they will continue to have dozens of other Medicare Advantage plan options available for 2026, as well as traditional Medicare. Some beneficiaries in plans that have exited the market will have the option to enroll in a plan offered by the same insurer, and in many cases, enrollees will be moved into a new plan offered by the same insurer automatically if the contract includes another plan of the same type (i.e., HMO or PPO) in the same county. Others will have to make an active choice about their Medicare coverage if they wish to enroll in another Medicare Advantage plan, or will be automatically covered by traditional Medicare.

Every year, Medicare Advantage plans change in ways that could be important to enrollees, including the scope and generosity of extra benefits, cost sharing for Medicare-covered benefits, rules for using covered services (such as referral requirements and prior authorization), drug formularies, and provider networks. Despite these changes, most Medicare beneficiaries report that they do not compare coverage options on an annual basis. Further, prior Medicare focus groups indicate that Medicare enrollees are often overwhelmed by the number of Medicare Advantage choices and have difficulty sorting through all plan options. With more than 30 Medicare Advantage plans with prescription drug coverage available in 2026, on average, understanding how plans differ, and why it may matter, may remain a challenge.

 

The Trump Administration Executive Order on Gender Continues to Reverberate

Author: Lindsey Dawson
Published: Oct 14, 2025

Much has been written about the Trump Administration’s early effort to suppress data collection, presentation, and research related to LGBTQ – and particularly transgender – people’s health. A day one executive order (and subsequent HHS guidance and an OPM memorandum) on “gender ideology” laid out the administration’s approach to sex and gender, defining sex as an immutable binary biological classification and removing recognition of gender identity. While they have each been challenged in court, together, these and other policies have underpinned the removal of a range of websites, cancellation of federal grants, and led to changes to federal survey instruments, including those related to health and well-being, actions that continue to be expanded upon.

Earlier this year, court orders required the restoration of certain webpages, datasets, and resources needed to provide medical care (and in a separate case, the government agreed to restoration of pages), yet data collection related to LGBTQ people remains limited and removal of information reportedly continues. 1 In at least some cases where it was required to restore websites, the administration plainly states it is doing so only because of its legal obligation. By way of example, a Centers for Disease Control and Prevention (CDC) page on transgender people and HIV now includes a banner stating that it has been restored per court order and that “any information on this page promoting gender ideology,” including reference to transgender people “does not reflect biological reality and therefore the Administration and this Department rejects it.” Additionally, new reporting found that more pages relating to sexual health, LGBTQ people, and other topics have been removed from the CDC site, as recently as September. These actions stand to limit understanding of LGBTQ people’s experiences and challenge the ability of stakeholders to shape responsive policy.

Also in September, the CDC updated its “about” page to include a new set of agency priorities, with a section on “gender ideology and protecting children.”  This section references the HHS guidance and states that it is an agency “priority to recognize that a person’s sex as either male or female is unchangeable and determined by objective biology, and to ensure CDC programs accurately reflect science, including the biological reality of sex.” Removing acknowledgment of transgender people from agency materials has implications for public health messaging and services related to the population’s health needs, posing challenges for a community that has elevated health risks, including for some communicable diseases, like HIV. This could lead to gaps in individual, community, and scientific knowledge and, depending on what is removed, the ability to monitor, and ultimately, respond to outbreaks or health disparities. This priority shift could also negatively influence the LGBTQ community’s trust in the agency – which has historically been important when CDC has responded to certain events, like the mpox outbreak of 2022, necessitating community collaboration. Further, if CDC, aligns funding opportunities with this priority area, it could jeopardize CDC grants going to those working to engage gender diverse communities, thereby limiting service provision. Tailoring public health approaches to communities experiencing high unmet needs or not otherwise being reached is a basic public health approach and requires acknowledging their existence and approaching needs in culturally competent ways.

Additionally, recent CDC clinical guidelines, used to inform providers about the evidence and clinical recommendations related to public health interventions, omit mention of transgender people, seemingly reflecting administrative priorities. A new twice-yearly injectable pre-exposure-prophylaxis or PrEP (HIV prevention) drug, lenacapavir, was approved in June and holds significant promise in helping to bend the curve on the HIV epidemic by addressing adherence and clinical capacity issues. However, the clinical recommendations from the CDC do not reference transgender or non-binary people, who, because they experience HIV at disproportionate rates, were specifically included in “PURPOSE 2”, one of the clinical trials that led to the drug’s FDA approval. The PURPOSE 2 trial assessed lenacapavir’s efficacy in cisgender men, transgender men and women, and non-binary people. The trials found that lenacapavir was 96%-100% effective at preventing HIV transmission and the final drug label issued by the FDA specifies that “there were no clinically significant differences in the pharmacokinetics of lenacapavir based on…gender identity”, among other variables. This marks a departure from CDC’s 2021 PrEP guideline, released prior to approval of the new drug, which included a section on PrEP and transgender people. It also represents a departure from the approach taken by the World Health Organization (WHO) in their lenacapavir guidelines, which identified gender diverse people as a key population and discusses prescribing lenacapavir to those also taking gender affirming hormone therapy. While providers may look elsewhere for detailed information (such as to the WHO or the trial data), the exclusion could impact willingness to prescribe among those less experienced with PrEP or in working with transgender patients. In addition, given that an earlier PrEP drug (emtricitabine/tenofovir alafenamide), was not approved for people engaged in “receptive vaginal sex because the effectiveness in this population has not been evaluated,” providers may be especially cautious about reviewing sex and gender based indications for new PrEP drugs. Indeed, this earlier exclusion is a key reason that led to the more inclusive – of both cisgender women and gender diverse people – trial design and ultimate broad approval of lenacapavir. This follows the removal of detailed information on proving antiretrovirals to transgender people for HIV treatment from the HHS treatment guidelines, an action that took place sometime between March and April 2025.   

As with other changes, the exclusion of transgender people from treatment and prevention recommendations likely reflects and is consistent with the administration’s stance on sex and gender with the Executive Order directing agencies to “remove all statements, policies, regulations, forms, communications, or other internal and external messages that promote or otherwise inculcate gender ideology.”   

Looking across these actions, barriers to providing complete treatment and prevention information could impact individual health (HIV is a life-long chronic condition when treated, and a deadly one when untreated), as well as public health if ongoing HIV transmission continues. It also has implications for private and public budgets with the estimated lifetime cost of HIV treatment per person in the United States now over $1 million.

  1. The Court in this case vacated the OPM Memo and the HHS Guidance, remanding them to the agencies. However, the remedy was limited to website and data restoration and “vacatur does not require the HHS defendants to undo every action taken pursuant to the OPM Memo or HHS Guidance” and the court “will not prevent the defendants from heading back to the drawing board and attempting to craft a lawful policy with similar objectives.” Other cases challenge the gender Executive Order itself. ↩︎

Designating English as the Official Language of the United States Could Impact Millions with Limited English Proficiency

Published: Oct 10, 2025

Introduction

On March 1, 2025, President Trump signed Executive Order (EO) 14224 designating English as the official language of the United States. This marks the first time in the country’s history that the U.S. has declared an official language at the federal level. Although the Order does not by itself trigger changes in services provided by agencies or organizations receiving federal funding, the policy represents a departure from previous administrations’ policies around language access for individuals with limited English proficiency (LEP). The federal government defines people with LEP as those who do not speak English as their primary language and who have a limited ability to read, write, speak, or understand English (also described as speaking English “less than very well”).

An accompanying official fact sheet released by the Trump administration outlines how EO 14224 will affect agencies and their services, including review of all services currently offered in languages other than English and phasing out of non-essential services. Prior guidance for agencies serving people with LEP has been suspended.

The Order will likely result in more limited availability of language access services for people with LEP.  Language and interpretation services are important for ensuring access to health coverage, care, and for improving health outcomes. Loss of services may further exacerbate disparities in health and health care, as people with LEP are disproportionately more likely to be Hispanic, Asian, immigrants, and to have lower incomes. Further, the new EO could also create challenges and confusion for health care and other service providers, who remain subject to other laws and regulations that still require provision of language access services.

This issue brief provides an overview of EO 14224 and its potential implications for multilingual resources, including data on the shares of individuals with LEP across different socioeconomic characteristics based on KFF analysis of 2023 American Community Survey (ACS) data.

Prior Language Access Policies

Prior laws and guidance have established requirements for language access and protection for people with LEP. Title VI of the Civil Rights Act of 1964 and Section 1557 of the Affordable Care Act (ACA) prohibit discrimination based on national origin, including discrimination based on the ability to speak English. Previously, the Department of Justice (DOJ) took the stance that Title VI of the Civil Rights Act prohibited discrimination against people with LEP, recognizing that a lack of language access represented discrimination based on national origin. In 2000, President Clinton issued EO 13166, which required all federal agencies to ensure meaningful access to services for people with LEP and established that failing to provide adequate services would be considered discrimination based on national origin. EO 14224, signed by President Trump, revokes EO 13166 and any policy guidance documents issued under it, and requires the Attorney General to provide updated guidance.

Section 1557 of the Affordable Care Act strengthened language access protections by prohibiting discrimination in health programs and other services that receive federal financial assistance. Section 1557 requires covered entities, including hospitals, clinics, insurers, and state Medicaid programs, to provide meaningful access for individuals with LEP. While Section 1557’s protections took effect when the ACA was enacted in 2010, much of its reach has been determined by implementation guidance issued across different presidential administrations. Under the Biden administration regulations issued in 2024, entities that operate health programs or activities and receive federal financial assistance must take reasonable steps to provide meaningful access to individuals with LEP who are eligible to be served or likely to be directly affected by the program or activity. The regulation specifies requirements regarding how the services must be provided, including that they be free of charge, accurate, and timely; outlines standards for interpretation and translation services; and identifies requirements for entities to provide notice of the availability of services. Section 1557 remains in effect despite the Executive Order, meaning that health care entities will continue to be required to provide language access services, even as federal agencies may scale back their language access resources.

Changes in Language Access Under the Trump Administration

EO 14224, issued by President Trump in March 2025, declares English as the official language of the U.S. and revokes prior orders requiring federal agencies to provide meaningful access to services for individuals with LEP. The Order also instructs the Attorney General to rescind all policy guidance stemming from EO 13166. As a result, in April 2025, the DOJ rescinded its 2022 LEP guidance, which directed agencies to assess and enhance their language access policies, and published a new memorandum providing implementation guidance related to the EO. The DOJ also removed LEP.gov, a website that provided resources to federal agencies and other entities receiving federal funding for developing language access plans.

Patients are still entitled to interpreter services under Title VI through qualified bilingual staff or interpreter services at no additional cost. Historically, providers have often aligned their services with the Department of Health and Human Services (HSS) outlined National Standards for Culturally Linguistically Appropriate Services (CLAS), a set of 15 voluntary guidelines designed to advance language access and cultural competence in healthcare. These standards include informing individuals of language assistance availability, ensuring the competence of individuals providing translation services, and providing written translation of key documents such as health consent and education documents. While the CLAS standards are not a binding federal regulation and therefore cannot be revoked by EO 14224, their adoption and implementation may decline as changes to federal language access policies reduce oversight, investment, and incentives for compliance.

The new memorandum recommends that federal agencies scale back the provision of language services, minimizing non-essential multilingual services, and recommends that agencies consider offering services exclusively in English. However, it does not require agency heads to amend, remove, or otherwise stop the production of documents, products, or other services prepared or offered in languages other than English. Despite these ongoing requirements, the new guidance signals that the DOJ will no longer treat a lack of multilingual services as discrimination, and that agencies are no longer required to implement wide-scale language access plans.

The EO and accompanying DOJ guidance apply only to federal government agencies and do not change existing language access requirements under laws like Title VI of the Civil Rights Act or Section 1557 of the ACA. Executive Orders cannot overturn existing statutes and regulations that go through formal revisions and public notice and comment processes. Title VI and Section 1557, which were issued by HHS, outline compliance measures that cannot unilaterally be changed by Executive Order. Entities that receive federal funding including state and local health departments, hospitals, insurance companies, clinics, and other health care providers remain legally obligated to provide meaningful language access under these laws. Under Section 1557 regulations, forms such as informed consent documents, intake forms, and discharge instructions are still required to be translated for individuals with LEP. Moreover, several states, including, New York, California, Hawaii, Maryland, and the District of Columbia, have state-level language access laws that remain in effect. However, the reduction in federal oversight, and granting agencies the ability to decide how and when to offer services in languages other than English, including at HHS and the DOJ, may create uncertainty about implementation and compliance practices, and reduce the availability of federal resources for providing language access services. Enforcement is also likely to shift since the DOJ has narrowed its interpretation of Title VI, indicating that it will no longer pursue enforcement based on disparate impact claims related to language access, instead, it will now focus on cases involving intentional discrimination. This change in enforcement could impact accountability measures and ultimately weaken protections for individuals with LEP.

Who is Likely to Be Affected by Reductions in Language Access Services?

Over 27 million people in the U.S. have LEP and may be affected by decreased access to language access services, with disproportionate impacts on Asian and Hispanic people, immigrants, and people with lower incomes. Data from the 2023 ACS show that 9% of the population ages 5 and older, or 27.3 million individuals, have LEP (defined as speaking a language other than English at home and speaking English less than very well). Asian (30%) and Hispanic people (29%), immigrants (47%), and those with incomes under $40,000 per year (13%) are disproportionately more likely to have LEP than the overall population (Figure 1). Decreased access to language assistance services comes at a time when immigrants are facing other barriers to accessing health care and other services, including increased immigration-related fears and more limited eligibility for health care coverage and other services.

Hispanic and Asian People, Immigrants, and Those With Lower Incomes are More Likely to Have Limited English Proficiency (Bar Chart)

Decreased access to language assistance services would have greater effects in some states, since there are wide variations in the shares of people with LEP across states (Figure 2). The share of people ages 5 and older with LEP ranges from less than 1% in West Virginia to 18% in California. New York (14%), New Jersey (14%), Texas (13%), and Florida (13%) also have relatively high shares of individuals with LEP, likely reflecting larger numbers of immigrants residing in those states.

The Shares of People with Limited English Proficiency Vary Across States (Choropleth map)

Language access services have important implications for health and health care. People with LEP face challenges and barriers to accessing high-quality health care. Language barriers between providers and patients can reduce the quality of care and increase the risk of adverse outcomes or medical errors. Studies have found that a lack of language assistance often delays patients’ access to timely care, leading to poor chronic disease management and resulting in worse health outcomes. Despite existing language access requirements, KFF survey data find that around half (48%) of adults with LEP have encountered at least one language barrier in a health care setting within the past three years, such as difficulty filling out forms for a health care provider (34%), communicating with office staff at a doctor’s office or clinic (33%), understanding instructions given by a doctor or health care provider (30%), filling a prescription or understanding how to use it (27%), or scheduling a medical appointment (25%) (Figure 3). Among adults with LEP, one in five reported experiencing at least one of several negative experiences with a health care provider in the past three years, including a provider ignoring a direct request or question (11%), assuming something about them without asking (8%), suggesting they were personally to blame for a health problem (8%), or refusing to prescribe needed pain medication they thought they needed (8%).

About a Half of Adults With Limited English Proficiency Say They Have Faced Language Barriers When Seeking Health Care (Bar Chart)

Reductions in requirements for federal agencies to provide language access services may create new challenges for health care and other service providers. If federal agencies reduce language access guidance and requirements, providers will have fewer translated materials to rely on, such as consent documents and health education materials. This can also create inconsistencies in the quality and accuracy of materials across the health care landscape. Community health centers (CHCs) and other safety net providers may be disproportionately impacted by the reduced availability of federal language access resources as they are disproportionately likely to serve individuals with LEP and those with lower incomes. Federal cuts have already eliminated funding for community workers who help people who speak other languages navigate and sign up for health insurance coverage. Moreover, given differences between the new guidance and other laws that remain in place, providers may have questions or confusion about when translation services are required, compliance risks, and how comprehensive services must be.

Poll Finding

KFF/The Washington Post Survey of Parents

Published: Oct 10, 2025

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.

Other KFF reports from the survey:

Polling Insights on the MAHA Movement

Exposure to and Trust in Children’s Health-Related Information Online

Explore The Washington Post’s journalism:

Poll shows who supports RFK Jr.’s ‘Make America Healthy Again’ movement, Oct. 15, 2025

In an age of vaccine skepticism, parents trust pediatricians most, Oct. 10, 2025

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.
  • Pediatricians remain the most trusted source of vaccine information for parents. Though, as past KFF polls have found of the public as a whole, parents are divided along partisan lines in their trust of vaccine information from government agencies like their local public health department, the U.S. Centers for Disease Control and Prevention (CDC), and the U.S. Food and Drug Administration (FDA), with Democratic parents much more likely than Republican parents to trust these sources. Parents who have skipped or delayed childhood vaccines also list pediatricians as their most trusted source of vaccine information, with their friends and family, and HHS Secretary Kennedy ranking second and third. One-third or fewer of these parents report trusting their local health department, CDC, or FDA “a lot” or “a little.”

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.”

Stacked bar chart showing percent who say it is very important, somewhat important, not too important, or not at all important for children in their community to be vaccinated against specific diseases.

 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.

Split bar chart showing percent who say it is very or somewhat important for children in their community to be vaccinated against specific diseases. Results shown by total parents, party identification, and MAGA and non-MAGA Republicans.

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.”

Stacked bar chart showing percent who say they are very confident, somewhat confident, not too confident, or not at all confident that vaccines for specific diseases are safe for children.

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.

Split bar chart showing percent who say they are very or somewhat confident that vaccines for specific diseases are safe for children. Results shown by total parents, party identification, and MAGA and non-MAGA Republicans.

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.

Split bar chart showing percent who say they are very or somewhat confident that vaccines for specific diseases are safe for children. Results shown by total parents, age, and race and ethnicity.

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%).

Split bar chart showing percent who say vaccines go through not enough, the right amount, or too much safety testing, or who say they are not sure. Results shown by total parents, age, party identification, and MAGA and non-MAGA Republicans.

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.

Split bar chart showing percent who say the CDC recommends too many, about the right amount, or not enough vaccines, or who say they are not sure. Results shown by total parents, age, party identification, and MAGA and non-MAGA Republicans.

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.

Mirrored bar chart showing percent who say either of the two statements come closer to their view. Results shown by total parents, party identification, MAGA support, and race and ethnicity.

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%).

Split bar chart showing percent who say they consider themselves pro-vaccine, somewhere in the middle, or anti-vaccine. Results shown by total parents, age, party identification, MAGA support, and race and ethnicity.

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%).

Stacked bar chart showing percent who say they have delayed or skipped some vaccines for their children or that they have kept their children up to date. Results shown by total parents, party identification, MAGA support, age, race and ethnicity, among very religious White parents, and among parents who currently homeschool a child.

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.

Stacked bar chart showing percent who say they have delayed or skipped some vaccines for their children or that they have kept children up to date. Results shown by total parents and by self-identified vaccine attitudes.

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.

Split bar chart showing percent who have skipped or delayed specific vaccines for their children.

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.

Stacked bar chart showing percent who say specific reasons were a major reason, minor reason, or not a reason for skipping or delaying vaccines for their children.

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.

Stacked bar chart showing percent who say their child's health care provider was supportive or not supportive of their decision, or that they did not discuss it with a provider.

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.

Bar chart showing percent who say they have ever tried to change their child's health care provider or sought alternative medical care. Results shown by total parents and parents by vaccine choice.

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.

Split bar chart showing percent who say they have ever felt unfairly pressured by specific agencies and people. Results shown by total parents and parents by vaccine choice.

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.

Mirrored bar chart showing percent who say either of the two claims comes closest to their view. Results shown by total parents, party identification, and support for MAGA.

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.

Split bar chart showing percent who say they have applied for a vaccine exemption for their child, and whether that was for medical, religious, or other personal reasons. Results shown by total parents and parents who skipped or delayed vaccines.

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.

Stacked bar chart showing percent who say their child has already gotten the HPV vaccine, or that they definitely will, probably will, probably will not, or definitely will not get them vaccinated, or are not sure. Results shown by total parents, party identification, and parents by vaccine choice.

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.

Stacked bar chart showing percent who say they will definitely, probably, probably not, or definitely not get their child vaccinated against HPV, or are not sure. Results shown by total parents, age, party identification, and parents by vaccine choice.

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 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 diseases 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.

Stacked bar chart showing percent who say specific false claims about vaccines and diseases are true, they don't know enough to say, or are false.

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.

Split bar chart showing percent who say specific false claims about vaccines and diseases are true. Results shown by total parents, parents by vaccine choice, party identification, and support for MAGA.

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.  

Stacked bar chart showing percent who say the false claim that MMR vaccines can cause autism in children is true, they don't know enough to say, or it's false. Results shown by parents of children who have and have not been diagnosed with autism spectrum disorder.

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%).

Stacked bar chart showing percent who say they have a lot, some, a little, or no confidence at all in federal government health agencies to act in specific ways.

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.

Split bar chart showing percent who say they have a lot or some confidence in federal government health agencies to act in specific ways. Results shown by total parents, age, party identification, and MAGA support.

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.

Stacked bar chart showing percent who say they have heard a lot, some, a little, or nothing at all about recent changes made by the Secretary of Health and Human Services. Results shown by total parents, party identification, MAGA support, and educational attainment.

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.

Split bar chart showing percent who say changes made by RFK Jr. will make childhood vaccines safer, less safe, there will be no difference, or they are not sure. Results shown by total parents, party identification, and MAGA support.

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%).

Split bar chart showing percent who say changes made by RFK Jr. will make it easier, more difficult, or there will be no difference when it comes to parents accessing vaccines for children, or they are unsure. Results shown by total parents, party identification, and MAGA support.

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%).

Split bar chart showing percent who say changes made by RFK Jr. will increase influence, decrease influence, or there will be no difference when it comes to the influence of pharmaceutical companies in U.S. vaccine policy, or they are not sure. Results shown by total parents, party identification, and MAGA support.

Trust in Sources of Vaccine Information

Consistent with prior KFF polling, pediatricians are the most trusted source of vaccine information among parents, with more than eight in ten (85%) saying they trust their child’s pediatrician a “great deal” or “fair amount” to provide reliable information about vaccines. Smaller majorities express trust in government sources of vaccine information, including their local public health department (64%), the CDC (59%), and the FDA (55%). Over half (56%) of parents say they trust their friends and family for reliable vaccine information, while nearly half (46%) trust their child’s school or daycare.

Fewer parents say they trust HHS Secretary Kennedy (36%) or pharmaceutical companies (31%) as sources of vaccine information. Trust in health and wellness influencers for reliable vaccine information is the lowest among these sources, with about one in seven (14%) parents expressing trust, including just 2% who say they trust health influencers “a great deal.”

Aside from pediatricians, who garner “a great deal” of trust from four in ten (43%) parents overall, other sources for vaccine information garner “a great deal” of trust from 15% of parents or fewer.

Stacked bar chart showing percent who say they trust specific people and institutions a great deal, a fair amount, not much, or not at all to provide reliable information about vaccines.

There are wide partisan divisions when it comes to trust in some sources of vaccine information. While large majorities across partisans trust their children’s pediatrician at least a “fair amount” for vaccine information, trust is higher among Democratic parents (93%) than Republican (85%) or independent parents (82%). Notably, about four in ten independent (39%) and Republican parents (37%) say they trust their child’s pediatrician a “great deal” for vaccine information compared to about six in ten Democratic parents (62%).

Democratic parents are more likely than both independent and Republican parents to express at least a “fair amount” of trust in government health agencies, including their local public health department, the CDC, and the FDA, as well as their children’s school or day care. Conversely, just over half of Republican parents (54%) and one-third of independent parents say they trust HHS Secretary Kennedy to provide reliable vaccine information compared to about one in five Democratic parents (18%). Fewer than one in five parents across partisans say they trust health and wellness influencers as sources of vaccine information.

Split bar chart showing percent who say they trust specific people and institutions a great deal or a fair amount to provide reliable information about vaccines. Results shown by party identification.

Pediatricians continue to be the most trusted source of information about vaccines for parents, regardless of their vaccine choices. About two-thirds (64%) of parents who report skipping or delaying at least one childhood vaccine for their children and nine in ten of those who have kept their kids up to date say they trust their child’s pediatrician “a great deal” or “a fair amount.”

Aside from pediatricians, parents who have made different vaccine choices for their children report trusting different sources for information. About half of parents who have skipped or delayed vaccines say they trust their friends and family (55%) and HHS Secretary Kennedy (47%) for vaccine information, making these the top two sources of vaccine information for these parents after pediatricians. One-third or fewer parents who have skipped or delayed childhood vaccines trust their local health department, FDA, and CDC, sources which are trusted by majorities of parents who report keeping their children up to date on vaccines.

Split bar chart showing percent who say they trust specific people and institutions a great deal or a fair amount to provide reliable information about vaccines. Results shown by parents who have skipped or delayed vaccines for their children, and parents who have kept kids' vaccines up to date.

Despite trusting a variety of information sources, few parents report difficulty understanding the vaccine schedule for their children and why they should get them vaccinated. Overall, about eight in ten parents say it is either “very” or “somewhat easy” to understand why their children should get vaccines in general (84%), when their children should get certain vaccines (83%), and which vaccines their children should get (81%). However, half or fewer parents say it is “very easy” to understand each of these, including why they should be vaccinated (52%), when they should be vaccinated (44%), and which vaccines they should get (44%).

Stacked bar chart showing percent who say it is very easy, somewhat easy, somewhat difficult, or very difficult, for themselves to understand specific aspects of getting vaccines.

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 parents2,716± 2 percentage points
Texas parents276± 7 percentage points
Florida parents136± 9 percentage points
   
Party ID  
Democratic parents                                                                                           801± 4 percentage points
Independent/Other party parents1,077± 3 percentage points
Republican parents780± 4 percentage points
MAGA Republican parents498± 5 percentage points
   
Parents by vaccine choice  
Skipped or delayed any childhood vaccines436± 5 percentage points
Kept kids up to date on all childhood vaccines2,264± 2 percentage points

 

 

How Much do People with Employer Plans Spend Out-of-Pocket on Cost-Sharing?

Authors: Lynne Cotter, Kaitlyn Vu, and Matthew Rae
Published: Oct 9, 2025

Over the past decade, cost-sharing (the out-of-pocket portion of household health spending) has grown faster than both workers’ wages and general inflation for those with employer coverage. In recent years, that growth has reached a rate more similar to inflation. Since 2003, average out-of-pocket costs have increased by 37%. In 2023, a majority (66%) of people with employer coverage spent more than $100 on out-of-pocket costs.

This chart collection examines trends in employee spending on deductibles, copayments, and coinsurance from 2012 to 2023, using a sample of health benefit claims for individuals under 65 from the Merative™ MarketScan® Commercial Database.

The full analysis and other data on health costs are available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

From Margins to Mainstream: How Amplification May Be Giving Misinformation New Reach

Authors: Hagere Yilma and Joel Luther
Published: Oct 9, 2025

Health communicators face the persistent challenge of balancing correcting misinformation with the risk of amplifying claims that audiences might not have noticed otherwise. As KFF’s President and CEO, Drew Altman noted in a previous column, reporters and communicators “likely [have] no choice when [politicians] spread false information but to cover it and correct the lies in the process, but there are choices to be made about how it’s done.” This tension was recently illustrated when President Donald Trump briefly shared, and later deleted, an AI-generated video on Truth Social that falsely alleged “medbeds,” a fake technology featured in a long-standing conspiracy theory, could cure all diseases and reverse aging. Although the video was deleted and widely debunked by mainstream media, like ABC, CNN, MSNBC, and Forbes, coverage and discussion briefly amplified the claim, exposing new audiences and sustaining its circulation. In this example, most of the coverage and online posts criticized or shared background on the claim, but coverage and attention intended to correct or criticize misinformation to an audience that was previously unaware of it can extend the claim’s reach and persistence.

Amplifying Misinformation Can Increase its Reach and Persistence

Several mechanisms contribute to amplification risks when reporting on or criticizing a claim:

  • Engagement-driven dissemination: Content that provokes a reaction, whether agreement or criticism, generates engagement like clicks, comments, likes, and shares. Social media algorithms are designed to detect this potential for attention and amplify it further. This allows posts that criticize or mock false claims to travel just as far, or farther, than posts promoting them. A similar pattern occurs in  news media, as coverage that elicits reactions like fear, disgust, and surprise is more likely to be shared across networks.
  • Repetition and familiarity: Repeated exposure to a false claim, whether through multiple news stories or recurring social media posts, increases the perception of plausibility (the “illusory truth effect”). Some studies have even shown that neither fact-checking nor media literacy interventions can fully mitigate the effects of exposure to repeated misinformation.
  • Extended lifespan: Any reporting, corrective or not, keeps a claim in public view longer than if it were ignored, allowing it to resurface and influence perceptions over time.

Exposure to Misinformation Can Erode Trust

Misinformation spreads more easily during periods of uncertainty and low institutional trust. In these contexts, even when a specific claim is debunked, narratives like medbeds can persist because they reinforce doubts about official institutions and align with their ideology. These dynamics occur in a landscape of fractured trust. KFF’s Tracking Poll on Health Information and Trust finds that many Republicans report more trust in health information from President Trump than from the CDC, FDA, or their local health department. In this environment, even unsubstantiated claims can have indirect effects. Exposure to these claims and corrections can erode trust in health authorities and government by reinforcing skepticism, even without belief in the specific conspiracy. So, people may reject the literal claim that medbeds exist but accept the broader idea that powerful institutions hide cures or they may have difficulty believing true information in the future.

Proactive and Strategic Communication

While reporting on misinformation too early can have unintended effects, leaving it unchecked can also leave information voids. Reporting on misinformation requires balancing transparency with amplification risks. Focusing on verified facts, limiting repetition of false claims, and avoiding sensationalizing or mocking narratives can reduce unintended spread. Research and practice offer additional strategies:

  • Build Audience Resilience through Proactive Prebunking: Prebunking exposes audiences to fact-based information and explains how misinformation spreads before false claims appear. It strengthens resistance, fills knowledge gaps, emphasizes accurate facts without repeating false claims, and highlights manipulative tactics. Prebunking is especially useful for low- or medium-risk narratives and can complement later debunking if a claim gains traction.
  • Debunk Strategically: If there is reason to believe that misinformation has reached the large swaths of Americans who are unsure about health information, or “the muddled middle”, debunking may be necessary. The Public Health Communication Collaborative suggests beginning with a clear fact, providing context on the misinformation and tactics used, and ending with a reinforcing fact. This helps audiences retain accurate information while limiting amplification of the false claim.
  • Build Trust to Make Corrections Stick: Misinformation persists partly because of underlying distrust. Strengthening community relationships, amplifying trusted messengers, and communicating consistently reduces the appeal of conspiracies more effectively than corrections alone.

Misinformation is not just about what is said, but how it spreads. By anticipating false narratives, using prebunking and debunking strategically, reporting responsibly, and prioritizing trust-building, communicators can limit the reach of false claims while supporting informed, resilient audiences.

Impacts of Recent Federal and State Actions on Natural Disaster Preparedness and Response on Health

Published: Oct 9, 2025

Introduction

What used to be rare extreme weather events have increased in both intensity and frequency due to climate change. August 29, 2025 marked the 20th anniversary of Hurricane Katrina’s landfall in the Gulf Coast region of the U.S. Hurricane Katrina was one of the deadliest storms to hit the continental U.S., resulting in the deaths of nearly 2,000 people and the displacement of over one million. Since Katrina, major hurricanes such as RitaSandyHarveyMaria, and Helene, have resulted in massive loss of life and billions of dollars of damage. In January 2025, Los Angeles County experienced one of the deadliest wildfires in California’s history, killing over 30 people and injuring many more. In early May 2025, tornadoes in Kentucky, Missouri, and Virginia killed at least 25 people. In early July 2025, communities in Texas, New Mexico, and North Carolina experienced deadly flash floods, with over 100 people dying in the Texas floods. This brief provides an overview of who is impacted by health risks of natural disasters and recent federal and state actions related to disaster preparedness and response.

Reflecting underlying structural inequities, low-income communities, people of color, and other historically underserved groups are at increased risk of being affected by a natural disaster. In addition to the immediate hazards created by extreme weather events, their impacts can extend to miles away and years into the future. Natural disasters also have significant economic impacts. It is estimated that if left unaddressed, climate change related natural disasters could cost the U.S. economy approximately $14.5 trillion over the next fifty years.

While prior administrations have taken steps to bolster the nation’s efforts to prepare for and respond to natural disasters, the Trump administration has recently taken actions that may reverse some of these efforts. Weakened federal protections may deepen existing disparities, leaving communities that already face disproportionate climate risks with fewer safeguards against natural disasters. The elimination of key offices, programs, and data tools may also make it more difficult to assess and mitigate the health risks associated with natural disasters. As climate change-related disasters worsen, the federal government’s shrinking of emergency and disaster preparedness support to state and local governments may leave millions of people vulnerable and unable to recover from natural disasters. As of October 2025, more than two dozen local jurisdictions sued the federal government over the withholding of more than $350 million in emergency and disaster funds unless they complied with immigration enforcement efforts and federal policies against diversity, equity, and inclusion conditions. The lawsuit follows a recent decision by a federal judge blocking the Trump administration’s efforts to freeze federal emergency preparedness funds for states that opposed the administration’s mass deportation efforts. Some states have taken actions to prepare for and respond to natural disasters, however variation in state-level actions may leave some areas and communities at increased risk.

Who is at Increased Risk for Negative Health Impacts Due to Natural Disasters?

Many of the same factors that contribute to health inequities leave some communities at higher risk of being affected by a natural disasterLow income communities and communities of color are often on the front lines of natural disasters and climate change. Due to historical residential segregation, including redlining, people of color are more likely to live in neighborhoods that have worse infrastructure, increasing their risk of harm and limiting their ability to prepare or safely shelter-in-place. Rural communities face challenges responding to natural disasters, ranging from physical isolation, high poverty rates, to limited access to health care as well as limited financial capacity. Barriers such as language access and immigration-related fears may prevent immigrants from receiving timely warnings or recovery assistance and financial challenges make it harder for low income families to evacuate, with surveys showing that costs often run into the thousands of dollars. Further, there are gaps in federal disaster management and response efforts. Recovery efforts are not always distributed equitably, with research finding wealthier and White communities more likely to benefit than communities of color. For example, during the 2025 L.A. County wildfires, fewer fire trucks were deployed to west Altadena, a historically Black neighborhood that experienced the greatest loss of life.

Natural disasters have immediate negative impacts on health and can limit access to health care and basic necessities. In addition to immediate loss of life and injury, damage to infrastructure caused by storms can also compromise emergency response efforts, limit access to basic needs, and disrupt access to health care and needed medications. These disruptions can be particularly severe for people who rely on continuous medical treatments or who live in communities with limited health care capacity. For example, immediately after Hurricane Maria, residents in Puerto Rico reported difficulties in accessing basic needs, including health care, water, food, gas and money. Those with chronic conditions such as asthma, diabetes and kidney disease had trouble managing their conditions due to power outages that impacted dialysis centers and their ability to refrigerate their medicines. A KFF Health News investigation found that at least 170 hospitals in the U.S. are at risk of severe flooding, potentially jeopardizing access to care and endangering the lives of hospital workers and people reliant on hospital care during flooding disasters. The cumulative effects of these challenges can widen existing health disparities, leaving some groups at greater risk of adverse outcomes during and after natural disasters.

Impacts of natural disasters can extend beyond the immediately affected area to people miles away. For example, in 2023, smoke from wildfires in Canada caused air pollution that affected more than 60 million people in the U.S. During that time, U.S. emergency room visits for asthma increased by nearly 20%. Research also shows that wildfire smoke accounts for significant amounts of particulate matter, worsening air pollution and creating persistent and chronic health risks. Communities of color are particularly susceptible to the adverse impacts of wildfires and wildfire smoke exposure due to their higher rates of underlying conditions including higher rates of asthma among American Indian and Alaska Native and Black people compared to White people.

Natural disasters can also affect communities years after their immediate impacts. For example, research shows that years after hurricanes have occurred, excess mortality persists, with Black people experiencing higher cumulative excess deaths than their White counterparts. One year after Hurricane Katrina, about one third (32%) of New Orleans residents reported that their lives remained “very disrupted” or “somewhat disrupted” by the storm, with this share rising to about six in ten (59%) of African American residents in Orleans Parish compared to about three in ten (29%) of White residents. Ten years after the storm, KFF survey data also showed that New Orleans residents who lived in the area during Katrina still reported lingering stress and problems with their mental health due to the hurricane.

Prior administrations took steps to strengthen the nation’s capacity to prepare for and respond to natural disasters. These efforts focused on building federal infrastructure, improving coordination, and investing in hazard mitigation. For example, after Hurricane Katrina, President George W. Bush signed the Post-Katrina Emergency Management Reform Act of 2006 to overhaul the Federal Emergency Management Agency (FEMA), which included creating regional offices and stronger protections for people with disabilities and those with limited English proficiency. Later, the Obama administration expanded flexibility for states and Tribes in using recovery funds and allowed Tribes to make disaster declarations independently. The Preparing the United States for the Impacts of Climate Change Executive Order directed federal agencies to integrate climate preparedness into operations and planning. During its first term, the Trump administration established a national fund for pre-disaster mitigation, giving states more reliable access to resources for strengthening infrastructure. Together, these actions enhanced the federal framework for disaster preparedness, improved coordination, and increased protections for disproportionately affected populations.

The Biden administration took additional steps to prepare for, respond to, and address the impacts of climate change, natural disasters, and emergency and rescue services on health. The passage of the Infrastructure Investment and Jobs Act in 2021 and the Inflation Reduction Act in 2022 dedicated significant funds to disaster mitigation and resilience, including increasing the resilience of infrastructure and investing in more resilient energy grids to reduce power outages during extreme weather events. The National Climate Resilience Framework launched a whole-of-government climate resilience strategy, which directed agencies to integrate climate risk into planning and strengthening building standards to withstand disasters. Through the Building Resilience Infrastructure and Communities (BRIC) program and the Hazard Mitigation Assistance (HMA) Grant, FEMA awarded billions of dollars for pre-disaster mitigation and resiliency projects, with an emphasis on projects in underserved communities. By mid-2024, more than 20 federal agencies released climate adaptation plans that aligned with the National Climate Resilience Framework, which emphasized environmental justice and Tribal engagement.

On the first day of its second term, the Trump administration began implementing policies and regulations that cut funding and reversed efforts to mitigate the impacts of natural disasters and extreme weather events on health. In March 2025, the administration announced the cancelation of grants worth $1.7 billion aimed at preparing communities for extreme weather events as well as improving their air and water quality. In April 2025, FEMA suspended the BRIC and HMA programs, both of which funded flood control, wildfire mitigation, and infrastructure resilience projects. FEMA also reduced staff and training capacity by 20%, limiting the agency’s ability to coordinate disaster response and recovery. In addition to significant workforce cuts, the National Oceanic and Atmospheric Administration (NOAA) faces significant budget cuts that are expected to hinder severe weather forecasting and early warning systems that are key for preparing for natural disasters and extreme weather events. NOAA is one of the few reliable sources that people can access when determining how and when to respond to a natural disaster; cuts to its programs may contribute to increases in loss of life. Further, the Trump administration stopped updating the Billion-Dollar Weather and Climate Disasters database, which documented the economic cost of natural disasters. The loss of this source of data will leave researchers, policymakers, and other actors with less reliable information to determine the impacts of natural disasters and plan for future events.

Beyond the changes at FEMA, the administration has pursued broader policy shifts that affect disaster preparedness and health. The administration has made major cutbacks to the Environmental Protection Agency’s (EPA) climate and resilience programs, including reduced enforcement of clean air and water standards that help protect communities during and after extreme weather events. In July 2025, the EPA finalized its proposal to rescind the 2009 Endangerment Finding under the Clean Air Act, which found that greenhouse gas emissions endangered public health and welfare and implemented greenhouse gas emissions standards for vehicles and other sectors. If this finding is eliminated, the EPA could no longer limit emissions from cars or power plants. The administration also eliminated the U.S. Global Change Research Program and fired the scientists who worked on the National Climate Assessment, a report that outlined the dangers of climate change and global warming, which the government used to help prepare for extreme weather events. The administration also eliminated or restructured federal environmental justice and diversity, equity, and inclusion initiatives, scaling back efforts designed to identify and address disproportionate environmental burdens on low income communities and communities of color. Areas like the Southeast U.S. are particularly vulnerable to the impacts of these changes as they are often affected by severe tropical storms and have high concentrations of low income communities and communities of color who due to underlying factors are less able to prepare for and recover from natural disasters. These actions reduce the agency’s ability to monitor risks, provide data to communities, and enforce protections in areas most likely to experience climate-related harm.

The Trump administration has also taken actions that block or weaken state level climate measures, including responses to natural disasters. Through the Executive Order, “Protecting American Energy From State Overreach,” the federal government directed the Department of Justice to challenge state and local climate resilience policies, including building codes and emission standards that support disaster preparedness. By targeting these measures, the order weakens safeguards that protect buildings against natural disasters and cuts emission standards that lower the production of greenhouse gas emissions that cause extreme weather events and mitigate toxin exposures during natural disasters. Further, the Trump administration’s efforts to limit the role of the federal government in state disaster response and management efforts will have significant effects for states that do not have the fiscal capacity or resources to adequately prepare for and recover from natural disasters. In 2019, of the 31 states that received federal disaster response and recovery resources, only five states would have had enough disaster-specific relief funds to cover the costs of disasters in 2019 without the support of the federal government.

Reflecting the increase in frequency and intensity of extreme weather and other natural disasters and the resultant economic losses associated with these events, several states have passed recent legislation focused on disaster preparedness and recovery. Most state policies emphasize centralized planning, identifying at-risk communities, developing mitigation strategies, and building infrastructure and community resilience. For example, New Jersey and South Carolina enacted bills that require all land-use agreements to include resiliency clauses or climate change-related hazard vulnerability assessments that take into account the impacts of natural disasters on local communities and built infrastructure. In Colorado, SB222-206 established the Office of Climate Preparedness to coordinate disaster recovery and develop a statewide climate roadmap, integrating climate adaptation, mitigation, and resilience strategies to support long-term environmental and community health efforts. The bill also created the Disaster Resilience Rebuilding Program to provide financial support for rebuilding homes, businesses, and infrastructure after disasters, as well as encouraging sustainable rebuilding projects that promote high-efficiency and sustainable reconstruction efforts.

Some states have integrated actions into their disaster response policies to help identify and reach historically marginalized populations who are often left behind during disaster preparedness and recovery efforts due to social and economic inequities. For example, Washington’s Greenhouse Gas Emissions-Cap and Invest Program encourages the use of an environmental justice assessment to ensure that funds and programs provide benefits to and reduce disparities faced by overburdened communities−“communities that have historically borne the disproportionate impacts of environmental burdens and now bear the disproportionate negative impacts of climate change.” As part of HB 1237, Colorado directed funds to study how to improve language access in their warning systems by hiring multilingual staff and translating materials into languages other than English. They are also developing best practices for engaging with communities in other languages. Hawaii established a recovery fund for Native Hawaiian people who are at the frontline of climate change and experiencing loss from natural disasters. While Hawaii has dedicated funds to support Native Hawaiian people, the Lahaina fire from 2023 highlighted the hurdles survivors faced in accessing and utilizing recovery funds. Challenges in accessing funds, inability to pay rent and mortgages, and difficulty rebuilding have forced many Native Hawaiian survivors to move out of West Maui. For survivors who stayed, substantial increases in housing costs and recent changes to FEMA may jeopardize their ability to stay on their ancestral land long-term. Research shows that two years after the fire, survivors continue to report worsened mental and physical health and about four in ten (41%) adults still live in temporary housing.

VOLUME 32

Debunked Autism Claims Resurface After Press Conference, And Supreme Court to Hear Cases on Conversion Therapy and School Vaccine Mandates


Summary

This volume analyzes the resurgence of false narratives about autism rates in Cuba and among Amish people in the U.S. following recent statements by President Trump. It also examines health-related cases before the Supreme Court this term, including challenges to state bans of conversion therapy for LGBTQ+ people and on school vaccine mandates. Lastly, it highlights research showing the limitations of AI chatbots as primary sources of health information.


Recent Developments

False Claims About Autism Rates in Cuba and in Amish Communities Resurface After Press Conference on Tylenol

What’s Happening?

At a September 22 press conference announcing HHS actions related to acetaminophen, the main ingredient in Tylenol, President Donald Trump revived misleading claims about the prevalence of autism in certain populations, including in Cuba and in Amish communities in the U.S. President Trump cited the two groups as examples of people who “don’t take vaccines and don’t take any pills” and “have essentially no autism,” implying an association between vaccines and medications and autism.

Why It Matters
  • Political amplification of these long-debunked claims may bring them to new audiences, particularly if health communicators have stopped actively countering these claims.
  • Renewed circulation of the claim that vaccines cause autism may influence parents’ vaccination decisions and contribute to vaccine hesitancy, despite extensive research showing no causal relationship.
  • Attempts to link common medications or vaccines to autism may contribute to stigma and reinforce the idea that autism, which has a largely genetic basis, is a preventable condition.
What Are People Saying?

KFF’s monitoring of the social media platform X found that, as of September 29, mentions of autism among Cuban and Amish populations identified in our search rose nearly 1400% over the last 30 days when compared to the previous 30-day period, increasing from almost 12,000 to approximately 160,000 posts, reposts, and comments. Many of the most-engaged-with posts sought to refute the claims, but some influential accounts, including a radio host and founder of InfoWars who has more than 4 million followers, amplified them to large audiences.

Where Do These Claims Come From?

These narratives have appeared cyclically for many years, often tied to broader messaging opposed to vaccination. The claims rely on and perpetuate assertions that vaccines are associated with autism, but decades of research has shown there is no association between autism and vaccines.

What Does The Evidence Say?
  • Many Amish children do receive vaccines, with a 2017 study of an Amish community in Ohio showing that 98% of parents surveyed had accepted at least some vaccines for their children. A 2011 survey found similar patterns, with 85% of Amish parents reporting that all or some of their children had received at least one immunization.
  • While some research has suggested rates of autism among Amish children are lower than the prevalence in the general population, the topic has not been extensively studied. The lower rate may be a result of underdiagnosis, with cultural differences including different utilization of healthcare and different educational environments potentially leading to underreporting. Similarly, lower reported rates of autism in Cuba may result from lack of diagnostic resources. The World Health Organization (WHO) has said that the prevalence of autism in many low- and middle-income countries is unknown.

Polling Insights: A recent KFF/Washington Post Survey of Parents found that though few parents say it is true that MMR vaccines can cause autism in children (9%), many express uncertainty, with about half (48%) saying they do not know enough to say.

Belief in the false claim that MMR vaccines can cause autism is correlated with the medical decisions parents are making for their children. Notably, parents who say they skipped or delayed recommended vaccines for their children are more than four times as likely as those who have kept their children up to date to say it is true that MMR vaccines can cause autism in children (27% v. 6%).

Stacked bar chart showing percent who say the false claim that MMR vaccines can cause autism in children is true, they don't know enough to say, or it's false. Results shown by parents of children who have and have not been diagnosed with autism spectrum disorder.

Supreme Court Case Challenges State Bans on Conversion Therapy

What’s Happening?

The Supreme Court began hearing cases this week for its new term, with oral arguments taking place on Tuesday in Chiles v. Salazar, a case that addresses whether state bans on conversion therapy for minors violate Constitutional free speech protections. Conversion therapy refers to practices that attempt to change or suppress an LGBTQ person’s sexual orientation or gender to conform to heterosexual or cisgender identities.

Why This Matters
  • The case focuses on free speech protections, but discussions around conversion therapy bans and the case inaccurately portray conversion therapy as an effective way to change an individual’s gender identity or sexual orientation through intervention, contradicting established medical consensus. Such claims discount the known risks of conversion therapy, including higher rates of depression, suicidality, and substance abuse.  If the Court overturns Colorado’s ban of conversion therapy for minors, the decision could be used to legitimize these false claims in support of conversion therapy.
  • In 2023, the KFF/Washington Post Survey of Trans Adults found that 11% of trans adults said as a child or teenager they attended conversion or reparative therapy that tried to change their sexual orientation or gender identity. A ruling upholding the ban would reaffirm states’ ability to regulate conversion therapy based on its documented harms. 23 states and DC have banned conversion therapy for minors, but a ruling overturning these bans could limit states’ ability to regulate these practices.
What Are People Saying?
  • The Supreme Court case has brought attention to conversion therapy in online discussions. In 2025, “conversion therapy” was mentioned an average of about 1,015 times per day in posts, reposts, and comments across X, Reddit, and Bluesky. But on the day the Supreme Court announced that it would review the case, the number of mentions jumped to 8,586, followed by 9,571 the next day. This was the biggest spike of the year, showing how the case announcement pulled the topic into broader public conversation. Although smaller in size, additional spikes in conversation about conversion therapy occurred around key case developments, with mentions more than tripling compared to the daily average on August 6, around the time when oral arguments were scheduled. The increases in conversation closely track with court milestones, suggesting that coverage of the case directly fuels discussion and potentially creates moments for false claims to spread.
  • While many of the most-engaged-with posts, especially earlier in the year, condemned conversion therapy, the visibility of the case has contributed to an increase in false claims about conversion therapy. Posts throughout September incorrectly claimed that bans “criminalize helping confused youth” or leave youth with gender dysphoria without resources.
  • Overall, the volume of online conversation about conversion therapy is still limited compared to discourse around other LGBTQ issues. But as attention towards conversion therapy increases, false narratives that claim banning it removes support for youth with gender dysphoria or that ignore generally agreed upon harms have gained visibility. In one high-engagement post, for example, a parent of a child with gender dysphoria said that Colorado’s ban restricted what counselors could discuss during therapy sessions, misleadingly asserting that this led to worse mental health and harmed “vulnerable kids.” These types of posts frame the bans as limiting access to care rather than restricting harmful practices, which may resonate with audiences unfamiliar with the medical consensus that conversion therapy causes psychological harm. KFF is monitoring whether the start of oral arguments prompts new or resurfacing narratives, as similar patterns emerged when the Court previously heard cases involving gender-affirming care.
  • Some of the legal arguments presented in the case create opportunities for misleading narratives to gain credibility. The respondent’s brief addresses these misconceptions by noting that the petitioners claim, without substantial evidence, that “restrictions like Colorado’s” have left “detransitioners . . . with no counseling support whatsoever in much of the United States.” The brief also highlights that the petitioners rely on an unverified Reddit post to suggest that patients struggling with gender identity will have difficulty accessing mental health care.
  • While the petitioners in the case do not primarily focus on gender-affirming care in their initial request for review by the court or in their brief, they do suggest that conversion practices might play a role as an alternative to gender-affirming care. Some amicus briefs filed in support of the petitioner echo this sentiment, with a few using inflammatory language around this care. Such narratives erroneously conflate gender-affirming care debates with the issue before the court in this case and suggest conversion therapy is a substitute for gender-affirming care, distracting from the evidence around the harms associated with conversion efforts.
What Does The Evidence Say?
  • Conversion therapy is not supported by evidence and research shows attempts to change sexual orientation or gender identity are associated with adverse mental health outcomes. There is no credible evidence that such practices can change sexual orientation or gender identity, and 28 medical and mental health associations have signed onto a joint statement opposing conversion practices. Some, including the AAP and American Psychological Association (APA), have provided independent statements opposing the practice.

Challenge to School Vaccine Mandates Focuses on Use of Fetal Cell Lines

What’s Happening?
  • During its October term, the Supreme Court will weigh whether to grant an emergency injunction in We the Patriots USA, Inc. v. Ventura Unified School District, a case involving a California mother who argues that the state’s school vaccine mandate, requiring her son to get vaccinated to attend school, infringes on her religious freedom because some vaccines were developed or tested using fetal cell lines originally derived from abortions performed decades ago. The woman claims that vaccinating her son with products connected to abortion would violate her Christian faith, regardless of when the abortion occurred.
  • The case has drawn attention as false claims circulate on social media that vaccines contain fetal tissue or “debris,” despite no such material being present in final vaccine products.
Why This Matters
  • While the current case focuses on the historical use of these cell lines in vaccine development, a factual element of how some vaccines were developed, the increased attention on the topic may also increase exposure to pre-existing false claims that current vaccines contain fetal tissue or “debris” in their final products.
  • Despite major religious authorities, including the Catholic Church, concluding that using vaccines developed with these cell lines is morally acceptable, the case provides an opportunity for the false claim that fetal tissue is present in current vaccines to spread and may influence vaccination decisions by parents who have a religious objection to abortion. Even though no fetal material is present in final vaccine products, this misconception may contribute to increased vaccine hesitancy and declining public confidence in vaccines, particularly among parents with religious objections or limited understanding of the difference between historical cell line use and the vaccines they receive.
How Is The Narrative Spreading?
  • Influential figures, including health authorities like HHS Secretary Robert F. Kennedy Jr., have previously misrepresented the historical use of fetal cell lines in vaccine development, claiming that fetal tissue or fetal “debris” is present in final vaccine products.
  • On average, 168 posts, reposts, or comments on X mentioned fetal cell lines or tissue in vaccine-related content identified in KFF’s search each day in September. This number rose to nearly 2,000 on September 21 following Fox News coverage of the emergency petition, illustrating how the narrative can expand when amplified through high-profile media attention.
  • Even before the case gained prominence, false claims about fetal tissue being present in vaccines were circulating online. Days before the emergency petition was filed on September 11, one account with nearly 2 million followers listed “fetal tissue” among a list of vaccine ingredients, implying that parents would not choose to vaccinate their children if they knew vaccines contained such tissue. Many of the comments on the post signaled agreement, with several criticizing what they called pharmaceutical greed or corruption.
Where Did This Confusion Come From?
  • Fetal cell lines are laboratory-grown cells used in vaccine research and production because they provide a controlled environment needed to create vaccines. These cell lines were originally established from elective abortions performed decades ago, but the cells used today are many generations removed from the original tissue, and no further abortions are performed or necessary for vaccine development.
  • Some vaccines, including the rubella component of the MMR vaccine, the chickenpox vaccine, and the hepatitis A vaccine were developed using these lines.
What Does The Evidence Say?

No fetal tissue or “debris” is present in final vaccine products. The manufacturing process involves growing viruses in fetal cell lines, then purifying the vaccines to remove any cellular material, leaving only the viral components needed for immunity.

Polling Insights: KFF’s latest Tracking Poll on Health Information and Trust finds that seven in ten parents oppose their state removing public school vaccine requirements, while three in ten support removing these vaccine requirements. Support differs sharply across partisans, with about half (48%) of Republican and Republican-leaning independent parents saying they support removing public school vaccine requirements in their state compared to far fewer Democratic and Democratic-leaning parents (13%).

Split bar chart showing shares that support versus oppose states recommending vaccines that are not recommended by federal health agencies.

The survey also found that just over half (56%) of parents say getting children vaccinated is “part of parent’s responsibility to protect the health of others,” while just under half (44%) instead say it is a “parent’s personal choice.” Most Republican and Republican-leaning parents say that getting children vaccinated is a parent’s personal choice (62%), while most Democratic and Democratic-leaning parents say it’s a responsibility to protect others (74%).

Mirrored bar charts showing the views of percent of adults in different demographics.

AI & Emerging Technology

Study Finds AI Chatbots Provide Low-Quality Information on Fibromyalgia

What Did Researchers Find?
  • A recent study published in Archives of Rheumatology evaluated how six major artificial intelligence (AI) chatbots, including ChatGPT, Gemini, and Copilot, responded to the 10 most commonly searched questions about fibromyalgia, a chronic condition that causes widespread pain. Researchers rated each of the responses on content quality, accuracy, readability, and alignment with evidence-based guidelines, like those from the American College of Rheumatology. The quality of the responses was rated using a standardized system designed to evaluate the quality of health information based on structure, accuracy, and how well responses aligned with evidence-based guidelines, with scores expressed as a percentage.
  • Even the best-performing chatbot (Gemini) provided “low-quality” information, scoring 40.5 out of 100, while the worst (ChatGPT 3.5) was rated “very low-quality,” scoring 20.6. The study identified moderate levels of factual inaccuracies, unsupported claims, or omissions of important information across all of the chatbots. All of the chatbots produced responses at university reading levels, potentially making the information inaccessible to many patients.
Why This Matters In This Context
  • Patients with fibromyalgia report high levels of stigma and skepticism from healthcare providers, and the condition has been historically dismissed by some as a psychosomatic disorder. As a result, these patients may be more likely to turn to online sources like AI chatbots for information.
  • The study’s authors concluded that even when the chatbots provided generally accurate facts, the quality, understandability, and actionability of the responses were insufficient to help patients.
What Are The Broader Implications?
  • The findings align with research on the usefulness of AI chatbots for other chronic conditions, including colorectal and renal cancers, which have shown inconsistent quality and low readability. As more people turn to AI chatbots for health information, the risks of false information and the gap between accessibility and readability may create risks for patient safety.
  • The study’s authors emphasize the need for clinician involvement in developing and validating AI tools to ensure alignment with evidence-based standards, and recommend chatbots as supplementary tools rather than primary sources of health information.

About The Health Information and Trust Initiative: the Health Information and Trust Initiative is a KFF program aimed at tracking health misinformation in the U.S., analyzing its impact on the American people, and mobilizing media to address the problem. Our goal is to be of service to everyone working on health misinformation, strengthen efforts to counter misinformation, and build trust. 


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Support for the Health Information and Trust initiative is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed do not necessarily reflect the views of RWJF and KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities. The data shared in the Monitor is sourced through media monitoring research conducted by KFF.