When Lawrence and Penny Higgins of Fairfield, Maine, first learned in 2020 that high levels of toxic chemicals called PFAS taint their home’s well water, they wondered how their health might suffer. They had consumed the water for decades, given it to their pets and farm animals, and used it to irrigate their vegetable garden and fruit trees.

“We wanted to find out just what it’s going to do to us,” Penny Higgins said. They contacted a couple of doctors, but “we were met with a brick wall. Nobody knew anything.”

Worse still, she added, they “really didn’t want to hear about it.”

Many clinicians remain unaware of the health risks linked to PFAS, short for perfluoroalkyl and polyfluoroalkyl substances, despite rising medical and public awareness of the chemicals and their toxicity. PFAS can affect nearly every organ system and linger in bodies for decades, raising risks of cancer, immune deficiencies, and pregnancy complications.

These “forever chemicals” have been widely used since the 1950s in products including cosmetics, cookware, clothing, carpeting, food packaging, and firefighting foam. Researchers say they permeate water systems and soils nationwide, with a federal study estimating that at least 45% of U.S. tap water is contaminated. PFAS can be detected in the blood of nearly all Americans, according to the Centers for Disease Control and Prevention.

Maine was among the first states to begin extensive water and soil testing and to try to limit further public exposure to PFAS through policy action, after discovering that farms and residences — like the Higgins’ property — had been contaminated by land-spreading of wastewater sludge containing PFAS. Exposure can also be high for people living near military bases, fire training areas, landfills, or manufacturing facilities.

In regions where testing reveals PFAS hot spots, medical providers can be caught flat-footed and patients left adrift.

Rachel Criswell, a family practice doctor and environmental health researcher, is working to change that. She was completing her residency in Central Maine around the time that the Higginses and others there began discovering the extent of the contamination. Her medical training at Columbia University included more than a year in Norway researching the effects of PFAS and other chemicals on maternal and infant health.

When patients began asking about PFAS, Criswell and the state toxicologist offered primary care providers lunchtime presentations on how to respond. Since then, she has fielded frequent PFAS questions from doctors and patients throughout the state.

Even knowledgeable providers can find it challenging to stay current given rapidly evolving scientific information and few established protocols. “The work I do is exhausting and time-consuming and sometimes frustrating,” Criswell said, “but it’s exactly what I should be doing.”

Phil Brown, a Northeastern University sociology professor and a co-director of the PFAS Project Lab, said the medical community “doesn’t know a lot about occupational and environmental health,” adding that “it’s a very minimal part of the medical school curriculum” and continuing education.

Courtney Carignan, an environmental epidemiologist at Michigan State University, said learning of PFAS exposure, whether from their drinking water or occupational sources, “is a sensitive and upsetting situation for people” and “it’s helpful if their doctors can take it seriously.”

Clinical guidance concerning PFAS improved after the National Academies of Sciences, Engineering, and Medicine released a report on PFAS in 2022. It found strong evidence associating PFAS with kidney cancer, high cholesterol, reduced birth weights, and lower antibody responses to vaccines, and some evidence linking PFAS to breast and testicular cancer, ulcerative colitis, thyroid and liver dysfunction, and pregnancy-induced hypertension.

That guidance “revolutionized my practice,” Criswell said. “Instead of being this hand-wavey thing where we don’t know how to apply the research, it brought a degree of concreteness to PFAS exposure that was kind of missing before.”

The national academies affirmed what Criswell had already been recommending: Doctors should order blood tests for patients with known PFAS exposures.

Testing for PFAS in blood — and for related medical conditions if needed — can help ease patients’ anxiety.

“There isn’t a day that goes by,” Lawrence Higgins said, “that we don’t think and wonder when our bodies are going to shut down on us.”

‘Devastating but Incredibly Helpful’

After finding out in 2021 that his family was exposed to PFAS through sludge spread on their Unity, Maine, farm decades earlier, Adam Nordell discovered that “it was exceedingly difficult” to get tested. “Our family doctor had not heard of PFAS and didn’t know what the test was,” he said. A lab technician needed coaching from an outside expert to source the test. The lab analyzing the samples had a backlog that left the family waiting three months.

“The results were devastating but incredibly helpful,” Nordell said. Their blood serum levels for PFAS were at roughly the 99th percentile nationally, far higher than their well-water levels would have predicted — indicating that additional exposure was probably coming from other sources such as soil contact, dust, and food.

Blood levels of PFAS between 2 and 20 nanograms per milliliter may be problematic, the national academies reported. In highly contaminated settings, blood levels can run upward of 150 times the 20-ng/mL risk threshold.

Nordell and his family had been planning to remain on the farm and grow crops less affected by PFAS, but the test results persuaded them to leave. “Knowledge is power,” Nordell said, and having the blood data “gave us agency.”

The national academies’ guidance paved the way for more clinicians to order PFAS blood tests. The cost, typically $400 to $600, can be prohibitive if not picked up by insurance, and not all insurers cover the testing. Deductibles and copays can also limit patients’ capacity to get tested. Less costly finger-prick tests, administered at home, appear to capture some of the more commonly found PFAS as accurately as blood serum tests, Carignan and colleagues found.

Maine legislators recently passed, with overwhelming support, a bill — modeled after one in New Hampshire — that would require insurers to consider PFAS blood testing part of preventive care, but it was carried over to the next legislative session.

“In my mind, it’s a no-brainer that the PFAS blood serum test should be universally offered — at no cost to the patient,” said Nordell, who now works as a campaign manager for the nonprofit Defend Our Health. Early screening for the diseases associated with PFAS, he said, is “a humane policy that’s in the best interests of everyone involved” — patients, providers, and insurance companies.

Criswell tells colleagues in family practice that they can view elevated PFAS blood levels as a risk factor, akin to smoking. “What’s challenging as a primary care doctor is the nitty-gritty” of the testing and screening logistics, she said.

In trainings, she shares a handout summarizing the national academies’ guidance — including associated heath conditions, blood testing, clinical follow-up, and exposure reduction — to which she has added details about lab test order codes, insurance costs and coverage, and water filtration.

Criswell served on an advisory committee tasked with allocating $60 million in state funds to address PFAS contamination from past sludge-spreading in Maine. The group recommended that labs analyzing PFAS blood tests should report the results to state public health authorities.

That change, slated to take effect this summer, will allow Maine health officials to follow up with people who have high PFAS blood levels to better determine potential sources and to share information on health risks and medical screening. As with many earlier PFAS policies, Maine is among the first states to adopt this measure.

Screening for PFAS is falling short in many places nationwide, said Kyle Horton, an internist in Wilmington, North Carolina, and founder of the nonprofit On Your Side Health. She estimates that only about 1 in 100 people facing high PFAS exposure are getting adequate medical guidance.

Even in her highly contaminated community, “I’m not aware of anyone who is routinely screening or discussing PFAS mitigation with their patients,” Horton said. Knowledge of local PFAS threats, she added, “hasn’t translated over to folks managing patients differently or trying to get through to that next phase of medical monitoring.”

Patients as Advocates

In heavily affected communities — including in Michigan, Maine, and Massachusetts — patients are pushing the medical field to better understand PFAS.

More doctors are speaking out as well. Testifying before a Maine legislative committee this year in support of a bill that would limit occupational PFAS exposure, Criswell said, “We, as physicians, who are sworn to protect the health of our patients, must pay attention to the underlying causes of the illnesses we treat and stand up for policy solutions that reduce these causes.”

Even where policy changes are instituted, the physical and psychological toll of “forever chemicals” will extend far into the future. Criswell and other Maine doctors have observed chronic stress among patients.

Nordell, the former farmer, described his family’s contamination as “deeply, deeply jarring,” an ordeal that has at times left him “unmoored from a sense of security.”

To assess the mental health consequences of PFAS exposure in rural residents, Criswell and Abby Fleisch, a pediatric endocrinologist at the MaineHealth Institute for Research, teamed up on a study. In its first phase, winding up this summer, they collected blood samples and detailed lifestyle information from 147 people.

Nordell, the Higginses, and other Central Maine residents sit on an advisory board for the study, a step Criswell said was critical to ensuring that their research helps those most affected by PFAS.

“The urgency from the community is really needed,” she said. “I don’t think I would be as fired up if my patients weren’t such good advocates.”

Criswell has faced what she calls “cognitive dissonance,” caught between the deliberate pace of peer-reviewed medical research and the immediate needs of patients eager to lower their PFAS body burden. Initially she considered inviting residents to participate in a clinical trial to test therapies that are considered safe and may help reduce PFAS levels in the body, such as high-fiber diets and a drug designed to reduce cholesterol called cholestyramine. But the clinical trial process could take years.

Criswell and Fleisch are instead planning to produce a case series on PFAS blood-level changes in patients taking cholestyramine. “We can validate the research results and share those,” Criswell said, potentially helping other patients.

Alan Ducatman, an internist and occupational physician who helped design the largest PFAS cohort study to date, said providers should convey that “there is no risk-benefit analysis” for any of the current treatments, although they’re generally well known and low-risk.

“Some people want to be treated, and they should be allowed to be treated,” he said, because knowing they have high PFAS levels in their bodies “preys on them.”

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

PITTSBURGH — Summer is a time when many of us eat at least some of our meals outdoors, which means looking for bright and delicious dishes that hold up to the rigors of car travel.

Those trips can come in the form of rolling out to a cookout or neighborhood get-together, but warm and sunny weather and kids being home from school also inspires impromptu picnics and trips to the pool, too — or maybe the beach or mountains, if you’re lucky.

No one can blame you for if you’d rather silence a growling stomach with something quick from Sheetz’s MTO menu while — say — passing through Breezewood on your way to Washington, D.C. It’s easy-in, and easy-out and still relatively affordable.

But here’s a pitch from someone who spends hours (and hours) on the road each month making weekend trips to Northern Virginia: homemade eats are almost always cheaper and healthier than ones you get from a fast food or fast-casual restaurant.

Packing a picnic basket or cooler with scratch salads, sandwiches and desserts that you can reach for whenever you get the munchies on route is also quicker for those of us who like to get where they’re going in the shortest amount of time possible.

I used to shake my head at my mother whenever she would limit my dad to just an ice cream cone for lunch or dinner when they traveled. But now that I’m a weekend road warrior myself, I think she might have been on to something.

Then again, I love to eat (a lot) as much as I like to save time and money. So planning a simple menu that can go with me wherever I decide to journey this summer might be a better idea.

The five recipes that follow make good on that plan in that all are easy to make in a short amount of time, with even limited culinary skills. And, importantly, they travel well.

Each is easy to pack and portion, relatively mess-free to eat with your hands or a plastic fork and can withstand a few hours tucked into a cooler, refrigerated bag or wicker picnic basket.

For sandwich lovers, we’ve got a meat- and veggie-packed Italian pressed sandwich that’s as fun to make as it is to eat. After assembling them, you wrap the sandwiches in plastic, place something heavy on top to flatten the bread (I used foil-wrapped bricks, but a cast-iron skillet also works) and then place them in the fridge so the flavors can melt into one another.

The result is a sandwich that’s not only more compact and portable, but one you can make well ahead and then just grab on the go.

Because people are eating more plant-based foods, we also have three vegetarian recipes that can easily be scooped while on a beach towel or in back seat of the family car. There’s a crunchy broccoli salad that’s tossed in a tangy vinaigrette instead of a more traditional mayo-based dressing; a cheesy and vegetable-forward pasta salad; and a creamy, five-ingredient hummus that brings it home with citrus.

And because no one ever said no to a homemade cookie, we also are including a recipe for cinnamon-and-sugar dusted snickerdoodles.

The chewy cookies might not scream “summer” in the same way as the chocolate soft serve on a cake cone my dad had to make do with on car trips, especially when it’s so hot outside. But they’re just as sweet, a lot less messy, and if you pace yourself to just one at a time, will last a little longer.

Some tips for flawless food transportation:

—If you’re transporting food that needs to stay cold, consider pre-chilling your cooler by filling it with an ice bath (and then draining it) before packing.

—Because coolers work best when they’re full, choose one that’s just large enough to hold your food, plus a little ice on top.

—Avoid leaks! Use sturdy containers with tight-fitting lids.

—Square and rectangle containers take up less space in a cooler or picnic basket.

—To minimize opening the cooler (and keeping food cold), pack your food in the order you will be eating it — sandwiches on the bottom, snacks on top.

—Divide food into individual portions before packing to make snacking and eating easier on the go.

—Don’t forget napkins, plastic tableware, serving spoons, a bag for trash and hand sanitizer.

Pressed Italian Sandwiches

PG tested

Who doesn’t love a big ol’ sandwich?

These filling sammies are layered with a hearty mix of Italian meats, roasted red peppers, pesto, arugula and fresh mozzarella and then pressed under a weight (I used foil-wrapped bricks) until they are flat. A homemade olive tapenade adds a fresh, briny flavor.

Easily doubled to feed a crowd, these sandwiches are best made with a loaf or mini ciabatta, but any long and wide, crusty white bread will work, too. I used salami, prosciutto and soppressata, but you can easily individualize them with mortadella, ham, coppa or any other favorite meat.

1 loaf ciabatta or other long/wide crusty white bread, cut in half lengthwise with a serrated knife

4 tablespoons pesto, homemade or jarred

4 tablespoons olive tapenade, homemade or jarred

4 ounces salami, thinly sliced

4 ounces prosciutto, thinly sliced

4 ounces spicy soppressata

8 ounces mozzarella, sliced

1/2 cup roasted red peppers from a jar, drained well and chopped

1/2 cup pepperoncini rings, drained well

2 large handfuls arugula

1 tablespoon extra virgin olive oil

1 tablespoon balsamic vinegar

Spread one side with the split ciabatta with pesto and the other with the olive tapenade.

Layer the three meats down the length of one half of ciabatta. Top the meats evenly with the roasted red peppers and pepperoncini.

Add mozzarella cheese in an even layer and season lightly with salt. Place arugula in a bowl, drizzle with the olive oil and balsamic, and season with a pinch more salt.

Place dressed arugula on top of cheese, and place the other half of ciabatta on top and press down firmly.

Wrap the loaf tightly in plastic and place on a sheet pan. Put another sheet pan upside down on top and weight it with something heavy, like a cast-iron skillet. (I used bricks wrapped in aluminum foil.)

Let the sandwich sit to press and chill overnight in the fridge. Slice crosswise into 6 even pieces and serve. To take on a picnic, wrap each sandwich in parchment, and tie with a pie of twine.

Serves 6.

— Gretchen McKay, Post-Gazette

Easy Pasta Salad

PG tested

Nothing is easier to throw together quickly (and cheaply) than a big bowl of pasta salad. Since it’s summer, this iteration is dressed up with fresh veggies that are easy to find at any market in July — cherry tomatoes, cucumbers, greens and Italian garden herbs. The fact that even picky kids will eat pasta salad — especially when it includes mozzarella — makes it even more of a winner.

If you want to pack the dish with a little extra protein, stir in a can of chickpeas (rinsed).

For pasta

3 cups uncooked tubed or curly pasta

Extra virgin olive oil

2 large handfuls of cherry tomatoes

2 Persian cucumbers

2 cups arugula or baby spinach

1 cup fresh basil leaves, torn

1/2 cup minced fresh parsley

1/2 cup chopped fresh mint leaves

4 ounces fresh mozzarella, torn into bite-sized pieces

1 ounce Parmigiano-Reggiano, grated

1/4 cup toasted pine nuts, optional

For dressing

1/4 cup extra virgin olive oil, plus more for drizzling

3 tablespoons fresh lemon juice

1 teaspoon Dijon mustard

1 small clove garlic, minced

Pinch of dried oregano

Kosher salt and freshly ground pepper, to taste

Cook pasta in a large pot of salted boiling water. When al dente, drain and toss with a little olive oil so it doesn’t stick together. Set aside to cool while you prepare vegetables.

Slice cherry tomatoes in half and cucumbers into half moons. Add to bowl with arugula or spinach, basil, parsley and mint.

Whisk together dressing ingredients in a small bowl or jar. Season to taste with salt and pepper.

Add pasta to the bowl with the veggies, add mozzarella balls and Parmigiano-Reggiano, drizzle on the dressing and toss well to combine.

Serves 6.

— Gretchen McKay, Post-Gazette

Lemon Hummus with Homemade Pita

PG tested

I never ate hummus growing up — tahini was still considered kind of exotic in the 1970s and early ’80s — but boy, do my grandkids love the thick, chickpea-based Mediterranean dip. Even 18-month-old Theo gobbles it with gusto, sometimes just with a spoon.

Hummus can be flavored with a lot of spices and add-ins, including garlic, olives and red pepper, but the spread really sings when it is brightened with citrus.

For a car trip or picnic, serve with crackers, pretzels, pita chips or apple slices. If you’re really ambitious, pair the dip with wedges of homemade pita bread.

For hummus

1 1/2 cups cooked chickpeas, drained and rinsed

1/3 cup smooth tahini

2 tablespoons extra virgin olive oil

2 tablespoons fresh lemon juice, plus more to taste

1 garlic clove

1/2 teaspoon sea salt

5 tablespoons water, or as needed to blend

Paprika, red pepper flakes, and/or fresh parsley, for garnish, optional

For pita

3/4 cup warm water

1 package active dry yeast, 2 1/4 teaspoons

1 teaspoon plus 1 tablespoon sugar, divided

3 3/4 cups bread flour, plus more for dusting

1 1/2 teaspoons sea salt

3 tablespoons extra-virgin olive oil, plus more for the bowl

3/4 cup whole-milk Greek yogurt

Prepare hummus: In a high-speed blender, place chickpeas, tahini, olive oil, lemon juice, garlic and salt.

Use the blender baton to blend until very smooth, adding water as needed to reach your desired consistency.

Refrigerate until ready to serve,

Make pita: In a medium bowl, combine water, yeast and 1 teaspoon of sugar. Let the mixture sit until it’s foamy on top, about 5 minutes.

In a large mixing bowl or stand mixer fitted with a paddle attachment, combine flour, salt and remaining tablespoon of sugar.

Add the yeast mixture, oil and yogurt, and mix to combine. Knead the dough, either in the stand mixer on medium speed or by hand on a clean work surface, adding more flour if needed, until it’s soft and slightly sticky, 7-10 minutes.

Transfer the dough to an oiled bowl, cover with a towel or plastic wrap, and let rise until it’s doubled in size, about 2 hours.

Preheat the oven to 500 degrees and line two baking sheets with parchment paper.

Turn the dough out onto a clean work surface and divide it into 12 equal balls. Cover and let rise an additional 20 minutes.

Roll the balls out into circles that are 1/4 – to 1/2 -inch thick. Place onto the baking sheets an inch apart, then bake, one sheet at a time, until they’re puffy and lightly browned on top.

Bake about 8 minutes, rotating the pan after the 5-minute mark if one side of the sheet is puffing up more than the other. Transfer pitas to a wire rack to cool.

— loveandlemons.com

Broccoli, Cheese and Apple Salad

PG tested

Broccoli salad is crisp, refreshing and full of flavor. This no-cook, crunchy version is gluten- and nut-free, and if you’re avoiding dairy, the cheese is optional.

Tossed in a tangy vinaigrette instead of a calorie-laden mayonnaise-based dressing, this is a salad you won’t feel guilty eating. Chopped apple and dried cherries add a touch of sweetness.

For salad

1 pound broccoli florets (from 1 1/2 pounds broccoli stalks), thinly sliced and then roughly chopped

1/2 cup finely chopped red onion

1/2 cup grated sharp cheddar cheese, optional

1/3 cup dried cranberries or dried tart cherries, chopped

1 tart apple, peeled, seeded and chopped

For dressing

1/3 cup extra-virgin olive oil

2 tablespoons apple cider vinegar

1 tablespoon Dijon mustard

1 tablespoon honey

1 medium clove garlic, pressed or minced

1/4 teaspoon fine sea salt

To a large bowl, add chopped broccoli, onion, cheese, cranberries and apples. Set aside.

In a 1-cup liquid measuring cup or small bowl, combine the dressing ingredients (olive oil, vinegar, mustard, honey, garlic and salt). Whisk until the mixture is well blended.

Pour the dressing over the salad and stir until all of the broccoli is lightly coated. I highly recommend letting the salad marinate for at least 20 minutes, or even overnight in the refrigerator.

Divide the salad into individual bowls and serve. Leftovers will keep well for 3-4 days in the fridge, covered.

Serves 8.

— adapted from cookiesandkate.com

Brown Sugar Snickerdoodles

PG tested

A cookie that travels well is one that won’t melt, stacks up neatly in a container and won’t make a mess when you’re eating it. For me, that’s a snickerdoodle with its signature crystalline coat of cinnamon-sugar.

This easy recipe is made with a mix of brown and white sugar, and is heavy on the cinnamon in the topping.

The cookies will spread as they bake, so be sure to place the dough balls 3 inches apart on a parchment paper-covered cookie sheet. I refrigerated the dough for about an hour before baking (it’s soft) and used a cookie scoop for even portioning. I also doubled the recipe because, why not?

If you like a crisper cookie (snickerdoodles are typically chewy in the middle, with crisp edges) let them linger a few minutes longer in the oven.

4 tablespoons unsalted butter

1/3 cup light brown sugar

1/3 cup white granulated sugar

1/4 teaspoon kosher salt

1 large egg

1 cup all-purpose flour

1 tablespoon cornstarch

1/4 teaspoon baking soda

For the cinnamon-sugar mixture

1/4 cup sugar

1 1/2 tablespoons ground cinnamon

Preheat your oven to 350 degrees.

In the bowl of a stand mixer with a paddle attachment, or with a hand mixer, beat the butter until it’s soft, smooth and light.

Scrape down the bowl, add the sugars to the beaten butter, and mix until they are fully incorporated and lighter in color.

Beat in salt followed by the egg. Mix until the batter looks uniform.

In a medium bowl, sift together flour, cornstarch and baking soda. In three additions, beat this slowly into the butter-egg mixture until you see a few dry streaks remaining. Switch to a stiff spatula and gently mix the cookie dough until no more dry flour remains.

Thoroughly whisk together the cinnamon-sugar mixture. Form balls of dough with a medium-sized cookie scoop or a tablespoon measure and plop them in cinnamon-sugar, swirling to coat.

On a parchment-lined cookie sheet, place the dough balls 3 inches apart. Flatten the dough slightly (to about 1/2 – to 3/4 -inch thick) using the bottom of a glass, and sprinkle a little more cinnamon sugar over the flattened surface.

Put into the preheated oven. Bake for 7 minutes, rotate the pan, and bake for another 5-7 minutes (12-14 minutes total), until the edges of the cookies look golden and the tops are crackled but still pale.

Cool on the baking sheet and eat as soon as possible. Snickerdoodles will keep in an airtight container, at room temperature for 3 days.

Makes 12 cookies.

— simplyrecipes.com

©2025 PG Publishing Co. Visit at post-gazette.com. Distributed by Tribune Content Agency, LLC.

SHREVEPORT, La. — When Robert Smith met his future girlfriend in 2010, he wanted to take things slowly. For Smith, no relationship had been easy in the years since he was diagnosed with the human immunodeficiency virus, or HIV. People often became afraid when they learned his status, even running away when he coughed.

The couple waited months to have sex until Smith felt he could share his medical status. To prepare her, Smith said, he took his girlfriend to his job in HIV prevention at the Philadelphia Center, a northwestern Louisiana nonprofit that offers resources to people with HIV, which also provided him housing at the time.

Finally, he revealed the news: Smith was diagnosed with HIV in 1994 and started taking daily antiviral pills in 2006. The virus could no longer be detected in his blood, and he couldn’t transmit it to a sexual partner.

Smith said his girlfriend seemed comfortable knowing his status. When it came to sex, there was no hesitation, he said. But a couple of years later, when Smith wanted to break up, he said, her tone shifted.

“She was like, ‘If you try to leave me, I’m gonna put you in jail,’” recalled Smith, now 68. “At the time, I really didn’t know the sincerity of it.”

After they broke up, she reported him to the police, accusing him of violating a little-known law in Louisiana — a felony called “intentional exposure to HIV.” He disputed the allegations, but in 2013 accepted a plea deal to spend six months in prison on the charge. He had a few months left on parole from a past conviction on different charges, and Smith thought this option would let him move past the relationship faster. He didn’t realize the conviction would also land him on the state’s sex offender registry.

For nearly two decades, Smith had dealt with the stigma associated with having HIV; the registry added another layer of exclusion, severely restricting where he could live and work to avoid minors. Not many people want to hire a sex offender, he said. Smith has been told by the local sheriff’s office he’s not allowed to do simple things, like go to a public park or a high school football game, since the conviction.

“I’ve been undetectable for 15 years, but that law still punishes us,” Smith said.

Louisiana is one of 30 states with criminal penalties related to exposing or transmitting HIV. Most of the laws were passed in the 1980s during the emergence of the AIDS epidemic. Since then, several states have amended their laws to make them less punitive or repealed them outright, including Maryland and North Dakota this year.

But Louisiana’s law remains among the harshest. The state is one of five that may require people such as Smith to register as a sex offender if convicted, a label that can follow them for over a decade. And state lawmakers considered a bill to expand the law to apply to other sexually transmitted infections, then failed to pass it before the session ended.

Meanwhile, people with HIV also face the threat that federal funding cuts will affect their access to treatment, along with prevention efforts, supportive services, and outreach. Such strategies have proved to slow the HIV/AIDS epidemic, unlike the laws’ punitive approach.

The tax and domestic policy law previously known as the “One Big Beautiful Bill” will likely affect HIV-positive people enrolled in Medicaid by reducing federal support for Medicaid and restricting eligibility. About 40% of adults under 65 with HIV rely on Medicaid.

The Trump administration proposed in its fiscal 2026 budget request to eliminate HIV prevention programs at the Centers for Disease Control and Prevention and to cancel a grant that helps fund housing for people with HIV. The Ryan White HIV/AIDS program, the largest federal fund dedicated to supporting HIV-positive people, also faces cuts. The program serves more than half of the people in the U.S. diagnosed with HIV, including in Louisiana, according to KFF, a health information nonprofit that includes KFF Health News.

Public health officials maintain that state laws criminalizing HIV exposure hurt efforts to end the HIV epidemic. Epidemiologists and other experts on AIDS agree that the enforcement of such laws is often shaped by fear, not science. For example, in many states that criminalize HIV exposure, people living with HIV can face heightened criminal penalties for actions that can’t transmit the virus, such as spitting on someone. The laws further stigmatize and deter people from getting tested and treatment, undermining response to the epidemic, experts say.

At least 4,400 people in 14 states have been arrested under these laws, though data is limited and the actual number is likely higher, and the arrests aren’t decreasing, according to analyses by UCLA’s Williams Institute.

“ Some people think it’s an issue that’s gone away, and that simply isn’t the case,” said Nathan Cisneros, a researcher at the Williams Institute.

In Louisiana, a 2022 Williams Institute analysis found at least 147 allegations reported to law enforcement under the state’s HIV law from 2011 to mid-2022. Black people made up nearly three-quarters of the people convicted and placed on the sex offender registry. Most were Black men, like Smith. At the time of the analysis, Black people made up about two-thirds of HIV diagnoses in the state.

“ We see over and over that Black people are disproportionately affected by the HIV epidemic and disproportionately affected by policing and incarceration in the United States,” Cisneros said.

Nationally, other marginalized groups such as women, sex workers, the queer community, or people who overlap across more than one group are also disproportionately arrested and prosecuted under similar criminalization laws, Cisneros said.

Ensnared in the System

Louisiana’s law hinges on the requirement that if a person knows they have HIV, they must disclose their HIV status and receive consent before exposing someone to the virus.

Louisiana District Attorneys Association Executive Director Zach Daniels said these cases don’t come up often and can be difficult to prosecute. Daniels said the intimate nature of the cases can lead to little evidence in support of either side, especially if the accuser doesn’t contract HIV.

When it comes to talking about one’s sex life, Daniels said, “there are often no other witnesses, besides the two participants.”

Louisiana’s law is written so that “intentional exposure” can occur through “any means or contact.” That includes sex and needle-sharing, practices known to transmit the virus. But the language of the law is so broad that actions known not to transmit the virus — like biting or scratching — could be included, said Dietz, the statewide coordinator for the Louisiana Coalition on Criminalization and Health, an advocacy network founded by people living with HIV that has opposed the law.

The broad nature of the law creates opportunities for abuse, as the threat of being reported under the law can be used as a coercive tool in relationships, said Dietz, who goes by one name and uses they/them pronouns. Such threats, Dietz said, have kept people in abusive relationships and loomed over child custody battles. Dietz said they’ ve supported people accused of exposing their children to HIV in ways that are not medically possible.

“ ‘Any means or contact’ could be just merely being around your kids,” they said.

The prosecutors’ organization still supports the law as a recourse for emergency responders who, in rare instances, come into contact with blood or syringes containing the virus. In one recent high-profile case in New Orleans, the law was used against a local DJ accused of knowingly transmitting HIV to several women without informing them of his status or using a condom.

The person accused of violating the law, not the accuser, must prove their case — that they disclosed their HIV status beforehand. Without a signed affidavit or tape recording, courts can end up basing their decisions on conflicting testimonies with little supporting evidence.

That’s what Smith alleged happened to him.

After his relationship ended, he said, he remembered being called into a meeting with his parole officer where a detective waited for him, asking about his former relationship and whether his girlfriend had known about his HIV status.

Smith said yes. But that’s not what she had told police.

Verite News could not find a working phone number for Smith’s former girlfriend but corroborated the story with the incident’s police report. His attorney at the time, a public defender named Carlos Prudhomme, said he didn’t remember much about the case, and court documents are sealed because it was a sex offense.

In court, it was her word against his. So when he was offered six months in prison instead of the 10-year maximum, he switched his plea from not guilty to guilty. But he said he didn’t know his new conviction would require him to register as a sex offender once he got out — worsening the stigma.

“When people see ‘sex offender,’ the first thing that comes to their mind is rape, child molester, predator,” Smith said. “This law puts me in a category that I don’t care to be in.”

He has tried to make the most of it, despite the expense of paying fees each year to reregister. After being rejected from jobs, he started a catering business and built a loyal clientele. But he said he’s still stuck living in a poorly maintained apartment complex primarily inhabited by sex offenders.

“I understand their strategy for creating this law to prevent the spread, but it’s not helping. It’s hurting; it’s hindering. It’s destroying people’s lives instead of helping people’s lives, especially the HIV community,” he said. “They don’t care about us.”

The Case for Reform

Since 2014, there has been a nationwide effort to update or repeal state laws that criminalize HIV nondisclosure, exposure, or transmission. A dozen states have changed their laws to align more closely with modern science, and four have gotten rid of them completely in hopes of reducing stigma and improving public health outcomes, according to the Center for HIV Law and Policy.

Sean McCormick, an attorney with the center, said these changes are influenced partly by a growing body of evidence showing the laws’ negative consequences.

McCormick said the laws offer a “clear disincentive” for people to get tested for HIV. If they don’t know their status, there’s no criminal liability for transmission or exposure.

A 2024 survey by Centers for Disease Control and Prevention and DLH Corp. researchers found that after California updated its HIV criminalization law in 2018, respondents were more likely to get tested. Meanwhile, survey respondents in Nevada, which still had a more punitive law on the books, were less likely to get tested.

There’s no one-size-fits-all solution, McCormick said. His center works with HIV-positive people across the country to determine what legislative changes would work best in their states.

Texas was the first to repeal its HIV law in 1994.

“As a person living with HIV in Texas, I’m deeply appreciative that we don’t have an HIV-specific statute that puts a target on my back,” said Michael Elizabeth, the public health policy director for the Equality Federation.

But Elizabeth points out that Texans living with HIV still face steeper penalties under general felony laws for charges such as aggravated assault or aggravated sexual assault after state courts in Texas equated the bodily fluids of a person with HIV with a “deadly weapon.”

Louisiana activists have pushed lawmakers in the state to amend the law in three ways: removing the sex offender registration requirement, requiring transmission to have occurred, and requiring clear intent to transmit the virus.

“Our strategy, as opposed to repeal, is to create a law that actually addresses the kind of boogeyman that they ostensibly created the law for: the person who successfully, maliciously, intentionally transmits HIV,” said Dietz with the Louisiana Coalition on Criminalization and Health.

In 2018, a bill to narrow the statute was amended in ways that expanded the law. For example, the updated law no longer had any definition of which actions “expose” someone to HIV.

In 2023, state lawmakers created a task force that recommended updating Louisiana’s law to align with the latest public health guidelines, limit the potential for unintended consequences, and give previously convicted people a way to clear their record.

Lawmakers in the state House pushed forward a bill this year to criminalize other sexually transmitted infections, including hepatitis B and the herpes simplex virus. That bill died in the Senate, but it spurred the creation of another legislative task force with a nearly identical mission to that of the first.

“ This state has no idea how closely we just dodged a bullet,” Dietz said.

In the meantime, the Louisiana coalition is helping Smith petition the state to take his name off the sex offender registry. Louisiana law allows people to petition to have their names removed from the registry after 10 years without any new sex crime convictions. Smith expects his case to be approved by the end of the year.

Despite the difficulty of the past 12 years, he said, he’s grateful for the chance to be free from the registry’s restrictions.

“It’s like a breath of fresh air,” Smith said. “I can do stuff that I wanted to do that I couldn’t. Like, go to a football game. Simple stuff like that, I’m going to be ready to do.”

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

Every time Ashton Alexander sees an ad for Georgia Pathways to Coverage, it feels like a “kick in the face.”

Alexander tried signing up for Pathways, the state’s limited Medicaid expansion, multiple times and got denied each time, he said, even though he met the qualifying terms because he’s a full-time student.

Georgia is one of 10 states that haven’t expanded Medicaid health coverage to a broader pool of low-income adults. Instead, it offers coverage to those who can prove they’re working or completing 80 hours a month of other qualifying activities, like going to school or volunteering. And it is the only state currently doing so.

“Why is this marketing out here?” said the 20-year-old, who lives in Conyers, east of Atlanta. “It’s truly not accessible.”

Each denial used the same boilerplate language, Alexander said, and his calls to caseworkers were not returned. State offices couldn’t connect him with caseworkers assigned to him from the same state agency. And when he requested contact information for a supervisor to appeal his denial, he said, the number rang to a fax machine.

“It’s impenetrable,” Alexander said. “I’ve literally tried everything, and there’s no way.”

Millions of Americans trying to access Medicaid benefits could soon find themselves navigating similar byzantine state systems and work rules. Legislation signed into law by President Donald Trump on July 4 allocates $200 million to help states that expanded Medicaid create systems by the end of next year to verify whether some enrollees are meeting the requirements.

Conservative lawmakers have long argued that public benefits should go only to those actively working to get off of government assistance. But the nation’s only Medicaid work requirement program shows they can be costly for states to run, frustrating for enrollees to navigate, and disruptive to other public benefit systems. Georgia’s budget for marketing is nearly as much as it has spent on health benefits. Meanwhile, most enrollees under age 65 are already working or have a barrier that prevents them from doing so.

What Georgia shows is “just how costly setting up these administrative systems of red tape can be,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families.

Over the past two years, KFF Health News has documented the issues riddling Georgia’s Pathways program, launched in July 2023. More than 100,000 Georgians have applied to the program through March. Just over 8,000 were enrolled at the end of June, though about 300,000 would be eligible if the state fully expanded Medicaid under the terms of the Affordable Care Act.

The program has cost more than $100 million, with only $26 million spent on health benefits and more than $20 million allocated to marketing contracts, according to a KFF Health News analysis of state reports.

“That was truly a pretty shocking waste of taxpayer dollars,” Alker said.

The Government Accountability Office is investigating the costs of the program after a group of Democratic senators — including both members of the Georgia delegation — asked the government watchdog to look into the program. Findings are expected this fall.

A state report to the federal government from March said Georgia couldn’t effectively determine if applicants meet the qualifying activities criteria. The report also said the state hadn’t suspended anyone for failing to work, a key philosophical pillar of the program. Meanwhile, as of March, more than 5,000 people were waiting to have their eligibility verified for Pathways.

The Pathways program has strained Georgia’s eligibility system for other public benefits, such as food stamps and cash assistance.

In April, the state applied to the federal government to renew Pathways. In its application, officials scaled back key elements, such as the requirement that enrollees document work every month. Critics of the program also say the red tape doesn’t help enrollees find jobs.

“Georgia’s experience shows that administrative complexity is the primary outcome, not job readiness,” said Natalie Crawford, executive director of Georgia First, which advocates for fiscal responsibility and access to affordable health care.

Despite the struggles, Garrison Douglas, a spokesperson for Georgia’s Republican governor, Brian Kemp, defended the program. “Georgia Pathways is doing what it was designed to do: provide free healthcare coverage to low-income, able-bodied Georgians who are willing to engage in one of our many qualifying activities,” he said in an emailed statement.

New federal requirements in the tax and spending legislation mean that the 40 states (plus Washington, D.C.) that expanded Medicaid will need to prepare technology to process the documentation some Medicaid recipients will now have to regularly file.

The federal law includes exemptions for people with disabilities, in addiction treatment, or caring for kids under 14, among others.

The Trump administration said other states won’t face a bumpy rollout like Georgia’s.

“We are fully confident that technology already exists that could enable all parties involved to implement work and community engagement requirements,” said Mehmet Oz, head of the Centers for Medicare & Medicaid Services, in an emailed statement.

In a written public comment on Georgia’s application to extend the program, Yvonne Taylor of Austell detailed the difficulties she faced trying to enroll.

She said she tried to sign up several times but that her application was not accepted. “Not once, not twice, but 3 times. With no response from customer service,” she wrote in February. “So now I am without coverage.”

Victoria Helmly of Marietta wrote in a January comment that she and her family members take care of their dad, but the state law doesn’t exempt caregivers of older adults.

“Georgia should recognize their sacrifices by supporting them with health insurance,” she wrote. “Let’s simplify this system and in the end, save money and lives.”

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

Congress set aside $50 billion for rural hospitals and medical providers to allay fears over the billions more in historic cuts to federal health care spending that President Donald Trump signed into law on Independence Day.

But is that bandage big enough to save struggling rural hospitals?

“I have more questions than I have answers,” said Alan Morgan, CEO of the National Rural Health Association, a nonprofit policy group. “No one has those answers yet.”

Morgan noted that the new money for rural health, to be spent over five years, is far less than the $155 billion in rural Medicaid spending cuts over 10 years, as estimated by KFF, a nonprofit health policy and research group.

Experts, hospital leaders and lawmakers on both sides of the aisle fear that Trump’s signature legislation will particularly gut rural hospitals and clinics, which see an outsize share of patients who are insured through Medicaid, the federal-state public health insurance for people with low incomes. The new law slashes more than $1 trillion from Medicaid over the next 10 years to help pay for tax cuts that disproportionately benefit the wealthy.

The $50 billion addition was an effort by Republican leaders in Congress to win the votes of colleagues within their party who initially balked at supporting such steep cuts to Medicaid and other health services.

In the U.S. Senate, the rural program helped secure the vote of Alaska moderate Republican Sen. Lisa Murkowski, who expressed concern about the law’s impact on health care in her state. About 1 in 3 Alaskans are insured through Medicaid.

Jared Kosin, the president and CEO of the Alaska Hospital & Healthcare Association, said he’s deeply frustrated with the new law’s gutting of Medicaid funding, which he thinks will wreak lasting damage on Alaskans. And Republicans sidestepped potential solutions by just throwing money into a program, he said.

“It’s frustrating in the public realm when decisions like this are made fast and, frankly, carelessly,” he said.

“The consequences are going to fall on us, not them.”

More than half of the law’s cuts to funding in rural areas are concentrated in 12 states with large rural populations that expanded Medicaid under the Affordable Care Act to cover more people, according to KFF: Illinois, Kentucky, Louisiana, Michigan, Minnesota, Missouri, New York, North Carolina, Ohio, Oklahoma, Pennsylvania and Virginia.

Some GOP lawmakers in Congress have heralded the $50 billion rural program as a health care victory. But it’s still unclear which hospitals, clinics and other providers would receive money and how much.

How it works

The Rural Health Transformation Program will dole out $10 billion annually from fiscal years 2026 through 2030.

States must apply for their funding by the end of this year, submitting a detailed plan on how it would be used.

The law outlines some ways that states can use the money, according to an analysis of the legislation from the Bipartisan Policy Center:

• Making payments to rural hospitals to help them maintain essential services such as emergency room care or labor and delivery.
• Recruiting and training rural doctors, nurses and other health workers.
• Bolstering emergency medical services such as ambulances and EMTs.
• Using new technologies, including telehealth.
• Providing opioid use disorder treatment and mental health services.
• Improving preventive care and chronic disease management.

Half of the $10 billion each year will be distributed evenly across states that have applied for it. The other half can be distributed by the administrator of the federal Centers for Medicare & Medicaid Services — currently Dr. Mehmet Oz — at his discretion, based on a state’s rural population and rural health facilities.

Although the program doesn’t replace the amount states are likely to lose, Morgan said it’s still an opportunity to rethink how rural health care is funded. He’d like to see states given flexibility in how they’re able to use the funds, and he hopes they focus on keeping rural communities healthy through preventive care while still helping hospitals keep their doors open.

“If done correctly, it could really change the future course for rural America,” Morgan said. “That is such a tough ask, though.”

Hardest hit

Kentucky could take the biggest hit from the new law’s reduction in rural Medicaid funding, losing an estimated$12 billion over 10 years, according to a KFF analysis.

The state’s Medicaid department is still waiting for additional federal guidance to understand how the state’s program will be affected, Kendra Steele, spokesperson with the Kentucky Cabinet for Health and Family Services, told Stateline in a statement.

“Over 1.4 million Kentuckians rely on Medicaid — including half of all children in our state, seniors and more vulnerable populations — and the passage of legislation on the federal level will have serious impacts for those individuals, rural health care and hospitals and local economies,” she wrote.

Even with the new program, states across the country will have to reevaluate their budgets in light of the cuts, said Hemi Tewarson, executive director at the National Academy for State Health Policy, a nonpartisan group that supports states in developing health care policies.

“Every region is slightly different and there’s not a one-size-fits-all approach,” she said. “Hospital ownership varies [as well as] the types of services that are critical for the community where they’re located. They have to think about new ways to provide those services in a context with fewer resources.”

About 44% of rural hospitals are operating in the red, according to a KFF analysis of Rand Hospital Data, a higher share than the 35% of hospitals in urban areas.

‘Rural at heart’

Prior to the bill’s passage, Oz attempted to reassure U.S. House Republicans that their districts could get money from the program even if they weren’t specifically rural, Politico reported earlier this month.

Pennsylvania Republican U.S. Rep. Rob Bresnahan said money would begin flowing to his district as early as the beginning of next year, telling the Wilkes-Barre Times Leader earlier this month that he met with Trump, Oz and others to secure pledges that hospitals in his district could access the fund. He represents the northeastern corner of Pennsylvania, which includes suburban and rural areas, as well as the cities of Scranton and Wilkes-Barre.

Though the legislation includes guidelines on which facilities or areas qualify as “rural,” Morgan, of the National Rural Health Association, expects a mad dash from lawmakers and providers to claim rural status in order to get a piece of the funding.

“That’s going to be a huge issue — defining who’s rural,” Morgan said. “We’re all rural at heart when it comes to money.”

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

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

Summer heat often makes baking less than desirable, so if you’re going to heat up the kitchen to make dessert, you gotta make it worth every bead of sweat that collects on your forehead.

These berry crumb bars are worth it and then some.

Built on a forgiving shortbread-like crust (it’s supposed to be crumbly) and topped with gooey seasonal fruit, they offer all the great taste of a summer pie but are so much easier to make since you don’t have to bother with mixing and rolling out dough.

How easy is this recipe? While a food processor or KitchenAid mixer will certainly speed things along, all you really need to cut in the butter that helps create the crumbly bottom layer is a fork or pastry cutter and some good old-fashioned elbow grease.

I used a mix of blueberries and strawberries because the two fruits have such complementary flavors and are always easy to find, often on sale. Also, two contrasting colors are always more visually appealing in a dessert than one.

If you’re worried about the butter and sugar content, at least know this: Both fruits are fairly low-cal and packed with vitamin C and other nutrients. Also, blueberries are famous for their high antioxidant content.

Be sure to allow the bars to cool completely on a wire rack before slicing into squares or they will crumble. The original recipe finished the bars with a simple lemon glaze, but I served them without.

Lemon Strawberry Crumb Bars

Serves 16; PG tested

INGREDIENTS

3 cups all-purpose flour, spooned and leveled

1 teaspoon baking powder

1/2 teaspoon salt

1 cup unsalted butter, very cold and cubed

1 large egg

1 large egg yolk

1 cup packed light or dark brown sugar

2 teaspoons pure vanilla extract

2 cups chopped strawberries

2 cups blueberries

1/3 cup granulated sugar

1 1/2 tablespoons cornstarch

1 teaspoon lemon zest

For optional glaze

1 cup confectioners’ sugar, sifted

2 tablespoons fresh lemon juice (about 1 lemon)

DIRECTIONS

1. Preheat oven to 350 degrees. Line the bottom and sides of a 9-by-13-inch baking pan with parchment paper, leaving an overhang on the sides to lift the finished bars out. (This makes cutting easier!) Set aside.
2. Make the crumble mixture for the crust and topping: Whisk flour, baking powder and salt together in a large bowl.
3. Add cubed butter and using a pastry cutter or two forks, cut in the butter until all the flour is coated and resembles pea-sized crumbles. (I whisked the ingredients together in a food processor.)
4. Whisk egg, egg yolk, brown sugar and vanilla together in a small bowl. Pour over the flour/butter mixture and gently mix together until the mixture resembles moist, crumbly sand.
5. Use your hands if needed — the mixture comes together easier with your hands than a spoon.
6. You will have about 6 cups of the crust/crumble mixture. Set 2 cups aside.
7. Pour the remaining crumble mixture into the prepared pan and flatten down with your hands or a flat spatula to form an even crust. It will be a little crumbly — that’s OK. Set aside.
8. Make filling: In large bowl, mix strawberries, blueberries, granulated sugar, cornstarch and lemon zest together. Spoon evenly over crust.
9. Crumble the remaining butter/flour mixture on top and gently press down so it’s snug on the strawberry layer.
10. Bake for 45-50 minutes or until the top is lightly browned and the strawberry filling is bubbling on the sides. (My bars took about 55 minutes.)
11. Remove from the oven and place the pan on a wire rack. Allow to cool completely.
12. If adding a glaze, whisk the glaze ingredients together and drizzle on top of the bars (or you can drizzle on individual squares).
13. Lift the cooled bars out using the overhang on the sides. Cut into squares.
14. Cover and store leftover bars (with or without icing) at room temperature for up to 2 days, in the refrigerator for up to 1 week and in freezer for up to 3 months (arrange in even layers between sheets of parchment). To serve frozen bars, thaw overnight in the refrigerator, then bring to room temperature before serving.

Adapted from sallysbakingaddiction.com

©2025 PG Publishing Co. Visit at post-gazette.com. Distributed by Tribune Content Agency, LLC.

ALBANY, Ga. — Belinda McLoyd has been thinking about peanut butter.

McLoyd, 64, receives a small monthly payment through the federal Supplemental Nutrition Assistance Program, previously known as food stamps.

“They don’t give you that much to work with,” she said. To fit her tight budget, she eats ramen noodles — high on sodium and low on nutrition — multiple times a week.

If she had more money, said McLoyd, who has been diagnosed with multiple sclerosis and heart problems, she’d buy more grapes, melons, chuck roast, ground turkey, cabbage, and turnip greens. That’s what she did when lawmakers nearly doubled her SNAP benefit during the pandemic.

But now that a GOP-led Congress has approved $186 billion in cuts to the food assistance program through 2034, McLoyd, who worked in retail until she retired in 2016, isn’t sure how she will be able to eat any healthy food if her benefits get reduced again.

McLoyd said her only hope for healthy eating might be to resort to peanut butter, which she heard “has everything” in it.

“I get whatever I can get,” said McLoyd, who uses a walker to get around her senior community in southwestern Georgia. “I try to eat healthy, but some things I can’t, because I don’t have enough money to take care of that.”

The second Trump administration has said that healthy eating is a priority. It released a “Make America Healthy Again” report citing poor diet as a cause of childhood illnesses and chronic diseases. And it’s allowing states — including Arkansas, Idaho, and Utah — to limit purchases of unhealthy food with federal SNAP benefits for the first time in the history of the century-old anti-hunger program.

President Donald Trump also signed a tax and spending law on July 4 that will shift costs to states and make it harder for people to qualify for SNAP by expanding existing work requirements. The bill cuts about 20% of SNAP’s budget, the deepest cut the program has faced. About 40 million people now receive SNAP payments, but 3 million of them will lose their nutrition assistance completely, and millions more will see their benefits reduced, according to an analysis of an earlier version of the bill by the nonpartisan Congressional Budget Office.

Researchers say SNAP cuts run counter to efforts to help people prevent chronic illness through healthy food.

“People are going to have to rely on cheaper food, which we know is more likely to be processed, less healthy,” said Kate Bauer, an associate professor of nutritional sciences at the University of Michigan School of Public Health.

“It’s, ‘Oh, we care about health — but for the rich people,’” she said.

About 47 million people lived in households with limited or uncertain access to food in 2023, according to the U.S. Department of Agriculture. The agency’s research shows that people living in food-insecure households are more likely to develop hypertension, arthritis, diabetes, asthma, and chronic obstructive pulmonary disease.

The Trump administration counters that the funding cuts would not harm people who receive benefits.

“This is total fearmongering,” said White House spokesperson Anna Kelly in an email. “The bill will ultimately strengthen SNAP for those who need it by implementing cost-sharing measures with states and commonsense work requirements.”

McLoyd and other residents in Georgia’s Dougherty County, where Albany is located, already face steep barriers to accessing healthy food, from tight budgets and high rates of poverty to a lack of grocery stores and transportation, said Tiffany Terrell, who founded A Better Way Grocers in 2017 to bring fresh food to people who can’t travel to a grocery store.

More than a third of residents receive SNAP benefits in the rural, majority-Black county that W.E.B. Du Bois described as “the heart of the Black Belt” and a place “of curiously mingled hope and pain,” where people struggled to get ahead in a land of former cotton plantations, in his 1903 book, “The Souls of Black Folk.”

Terrell said that a healthier diet could mitigate many of the illnesses she sees in her community. In 2017, she replaced school bus seats with shelves stocked with fruits, vegetables, meats, and eggs and drove her mobile grocery store around to senior communities, public housing developments, and rural areas.

But cuts to food assistance will devastate the region, setting back efforts to help residents boost their diet with fruits, vegetables, and other nutritious food and tackle chronic disease, she said.

Terrell saw how SNAP recipients like McLoyd ate healthier when food assistance rose during the pandemic. They got eggs, instead of ramen noodles, and fresh meat and produce, instead of canned sausages.

Starting in 2020, SNAP recipients received extra pandemic assistance, which corresponded to a 9% decrease in people saying there was sometimes or often not enough food to eat, according to the Institute for Policy Research at Northwestern University. Once those payments ended in 2023, more families had trouble purchasing enough food, according to a study published in Health Affairs in October. Non-Hispanic Black families, in particular, saw an increase in anxiety, the study found.

“We know that even short periods of food insecurity for kids can really significantly harm their long-term health and cognitive development,” said Katie Bergh, a senior policy analyst on the food assistance team at the Center on Budget Policy and Priorities. Cuts to SNAP “will put a healthy diet even farther out of reach for these families.”

The Trump administration said it’s boosting healthy eating for low-income Americans through restrictions on what they can buy with SNAP benefits. It has begun approving state requests to limit the purchase of soda and candy with SNAP benefits.

“Thank you to the governors of Indiana, Arkansas, Idaho, Utah, Iowa, and Nebraska for their bold leadership and unwavering commitment to Make America Healthy Again,” said Health and Human Services Secretary Robert F. Kennedy Jr. in a press release about the requests. “I call on every governor in the nation to submit a SNAP waiver to eliminate sugary drinks — taxpayer dollars should never bankroll products that fuel the chronic disease epidemic.”

Although states have asked for such restrictions in the past, previous administrations, including the first Trump administration, never approved them.

Research shows that programs encouraging people to buy healthy food are more effective than regulating what they can buy. Such limits increase stigma on families that receive benefits, are burdensome to retailers, and often difficult to implement, researchers say.

“People make incredibly tough choices to survive,” said Gina Plata-Nino, the deputy director of SNAP at the Food Research & Action Center, a nonprofit advocacy group, and a former senior policy adviser in the Biden administration.

“It’s not about soda and candy,” she said. “It’s about access.”

Terrell said she is unsure how people will survive if their food benefits are further trimmed.

“What are we thinking people are going to do?” said Terrell of A Better Way Grocers, who also opened a bustling community market last year that sells fresh juices, smoothies, and wellness shots in downtown Albany. “We’ll have people choosing between food and bills.”

That’s true for Stephen Harrison, 22, whose monthly SNAP benefit supports him, along with his parents and younger brother. During the pandemic, he used the extra assistance to buy strawberries and grapes, but now he comes into A Better Way Grocers to buy an orange when he can.

Harrison, who is studying culinary arts at Albany Technical College, said his family budgets carefully to afford meals like pork chops with cornbread and collard greens, but he said that, if his benefits are cut, the family will have to resort to cheaper foods.

“I’d buy hot dogs,” he said with a shrug.

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

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

Elliott Hinkle experienced depression and suicidal thoughts even before entering the foster care system in Casper, Wyoming, at age 15.

At the time, Hinkle, who is transgender, struggled with their sexual identity and gender issues, and their difficulties continued in foster care. They felt like they had no one to confide in — not their foster parents, not church leaders, not their caseworker.

“To my knowledge, I don’t remember ever taking a suicide screening,” Hinkle said. “No one ever said: ‘Are you having thoughts of taking your life? Do you feel hopeless?’”

With their psychological and behavioral health needs left unaddressed, Hinkle’s depression and suicidal thoughts worsened.

“Do I stay in the closet and feel terrible and want to end my life?” Hinkle said. “Or do I come out and lose all my supports, which also feels dangerous?”

Children in foster care are significantly more likely to have mental health issues, researchers say. They attempt or complete suicide at rates three to four times that of youths in the general population, according to several studies.

LGBTQ+ people in foster care, like Hinkle, are at an even higher risk of having suicidal thoughts.

Yet despite the concentration of young people at risk of serious mental illness and suicide, proactive efforts to screen foster children and get them the treatment they need have been widely absent from the system. And now, efforts underway to provide widespread screening, diagnosis, and treatment are threatened by sweeping funding cuts the Trump administration is using to reshape health care programs nationwide.

In June, federal officials announced they would shut down a suicide hotline serving LGBTQ+ youths as part of those cuts.

Children in foster care use a disproportionate amount of Medicaid-funded mental health services. Meanwhile, President Donald Trump’s massive budget package, passed this month by Congress, contains substantial shifts in Medicaid funding and policies that are projected to drastically reduce services in many states.

“I think anybody who cares about kids’ well-being and mental health is concerned about the possibility of reduced Medicaid funding,” said Cynthia Ewell Foster, a child psychologist and clinical associate professor in the University of Michigan psychiatry department. “The most vulnerable children, including those in foster care, are already having trouble getting the services they need.”

A lack of federal standards and other system-level issues create barriers to psychological and behavioral care in the child welfare system, said Colleen Katz, a professor at Hunter College’s Silberman School of Social Work in New York.

“When you’re talking about anyone getting screened for suicide ideation upon entrance into the system, it’s inconsistent at best,” she said.

Katz said all children entering foster care should have a brief, standardized suicide screening embedded into their initial medical assessment. And more screenings need to be conducted throughout a foster care stay, she said, because youths getting ready to transition out of the system are also vulnerable.

Hinkle, now 31, said the summer before they aged out of the system was “one of the darkest periods, because I was coming to terms with the church not wanting me to be gay and I was about to lose stable housing and whatever foster care support there was.”

Katz studied transition-age youths in foster care in California, which has the highest numbers of placements in foster care nationwide. According to her analysis, 42% of study participants had thoughts of taking their life and 24% had attempted suicide, and she expects findings would be similar in other states.

Katz also examined suicide screening tools and found many that already exist could work and be easily administered by trained child welfare workers or alternative frontline service providers, or embedded in existing mental health services.

Still, the quality of services varies by state and locality and can hinder attempts to curb suicides.

Julie Collins, vice president of practice excellence at the Child Welfare League of America, which advocates for improvements to the child welfare system, said the gap in suicide prevention in foster care mirrors the overall nationwide void of behavioral health services for children and adolescents. “The preparation of people coming into the field isn’t what it needs to be,” Collins said of the lack of training for caseworkers.

Ewell Foster is trying to change that.

She worked with the state of Michigan to redefine and update the competencies required to earn an undergraduate certificate in child welfare in the state. Eighteen colleges and universities that offer certificate programs in child welfare in Michigan now teach about suicide prevention.

“It’s something the workforce has asked for,” Ewell Foster said. “They need real clear guidance on what to do when they are worried about someone.”

So far, Ewell Foster’s effort to change the wider system has not run into any roadblocks. Her work with Michigan’s child welfare agency is still being funded under a grant administered by the Substance Abuse and Mental Health Services Administration.

Agency spokesperson Danielle Bennett said such grants will continue for up to three years.

However, the future of the federal agency has been in question for months. The Trump administration has laid off hundreds of its employees and has proposed folding its functions into another agency.

Some states have made changes to address the foster care gaps on their own, but often it has taken legal action to spark changes in suicide prevention efforts.

In Kansas, officials made several changes after the state settled the McIntyre v. Howard class action lawsuit in 2021 on behalf of foster children who the suit alleged were subjected to inadequate access to mental health resources and moved from home to home frequently.

The state increased salaries for social workers in the child welfare system and reduced their caseloads, among other things.

Other states, including Texas, have implemented similar changes after facing lawsuits.

Still, experts caution that the changes taking place in foster care systems are not enough to steer outcomes.

Lily Brown, an assistant professor of psychology and director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania Perelman School of Medicine, said moving the needle in suicide prevention will require implementing a universal risk assessment for children in state care.

Brown recently sought a grant to fund and implement free, universal suicide risk screening in foster care throughout Pennsylvania. She had several counties agree to the project, but not enough to support her application — the study wouldn’t have had enough participants to work statistically, she said.

Without such studies, foster care systems nationwide can’t meet the needs of children, she said.

April Miller, 27, entered the system in Minnesota at age 3. As a Native American, she is part of a group that is overrepresented in foster care.

“The child welfare system as a whole neglected me,” said Miller, who said she endured several traumatic events in her early life, including witnessing a murder.

“I did a lot of self-harm and had thoughts of suicide but didn’t have access to means, which is why I am still alive,” she said.

Today, Miller is a social worker and suicide prevention coordinator in Bemidji, Minnesota.

Similarly, Hinkle’s experience in the system made them driven to change the trajectory of other young people.

Hinkle provides training, consultation, and policy development services at Unicorn Solutions in Oregon in support of youths and young adults affected by systems such as child welfare, with a particular focus on the LGBTQ+ community.

They said they are committed to making sure that sexual identity and gender topics are not avoided in the system.

“I think every young person should feel loved and cared for,” Hinkle said.

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

When my husband and I refinanced our mortgage in 2009, we felt confident we were making the right move. Since both of us had exceptional credit, we knew we could reduce our mortgage rate by one percentage point or more, as is considered de rigueur when refinancing. A no-brainer, right?

In retrospect, I wonder. We should have considered other factors beyond the rate, ranging from the overall cost of refinancing to its impact on our home equity stake. And we should’ve made some comparisons among lenders, instead of rushing off to our current bank.

Here are seven missteps I made when refinancing my mortgage in 2009 — and what I would do differently today.

1. Focusing only on the interest rate

I have to admit: I was laser-focused on the fact that we could lower our mortgage rate by 1.25% and shave almost $300 off our monthly mortgage payment. That felt like a huge win, and in some ways, it was.

What I didn’t consider was the real cost of refinancing. I didn’t fully grasp the importance of the APR (annual percentage rate). The APR reflects the total cost of the loan: not just the interest rate, but lender fees, points and other closing costs. Your APR can be as much as a full point higher than the quoted interest rate.

Lesson learned: The APR is inevitably higher than the interest rate and is the real number you should compare when evaluating offers. If I could do it over, I would run the numbers through a mortgage refinance calculator to understand the total cost of the refinance, including how much interest we would pay over time and closing costs, not just the monthly savings.

2. Not paying closing costs upfront

Refinancing isn’t free: Like a primary mortgage, it comes with closing costs — various fees associated with applying for, administrating and underwriting the loan that you pay upfront — unless you roll them into the mortgage instead. A no-closing-cost refinance, which lets you do that, sounded great at the time. Between the appraisal, title insurance, lender fees, and everything else, these costs added up, and I didn’t want to pay a big sum out-of-pocket. Plus, adding these expenses into the loan just felt easier.

What I failed to grasp: When you roll over closing costs, the lender adds them to the principal of the new mortgage — and the amount interest is charged on. That results in a larger loan balance, higher monthly payments and more interest paid overall over the life of the loan.

Lesson learned: It’s been more than 15 years since we refinanced. I know by now we’ve recouped the cost of the loan. But at the time, we didn’t crunch the numbers in a mortgage refinance break-even calculator to weigh our options. If I were refinancing now, I would be more interested in paying off the mortgage sooner rather than realizing the immediate savings.

3. Not negotiating fees

While some are non-negotiable, many refinancing fees aren’t set in stone — they’re at the lender’s discretion. That means the lender can lower or even waive these charges, including big ones like the origination fee. Lenders may also offer discounts for automatic payments or paperless statements, to stay competitive and win your business.

In our case, we simply accepted the terms the lender offered as-is, without asking any questions. We don’t know for sure if they would’ve changed anything, but — if you don’t ask, you don’t get.

Lesson learned: Negotiation might not wipe away every fee, but even trimming a few hundred dollars can make a difference. Comparing refinance offers from various lenders puts you in a much better position to get the best deal.

Which brings me to my next mistake…

4. Not shopping around

Refinancing is like buying anything else: You better shop around, as the song says. We made the mistake of refinancing with our mortgage lender without even considering any other institution, mainly because it was easier. I didn’t compare rates, fees, customer reviews or loan terms across companies. I was just happy we were approved and ready to move forward.

Refinance rates and terms vary from banks, credit unions and online lenders. Even if you’ve been a loyal customer, your current lender might not have the best deal.

Lesson learned: Get quotes from at least three to five mortgage refinance lenders and compare their overall costs. Even a small difference in the rate, like 0.25%, can lead to significant savings over time.

5. Ignoring the impact on home equity

The most important consideration in refinancing is how much home equity you have. It can eat into your homeownership stake, especially if you borrow against portion of your home’s value with a cash-out refinance.

If you recall, 2009 was a precarious time for the U.S. economy, near the official tail end of the Great Recession. To say home values were dropping would be an understatement. Between December 2006 and December 2009, home prices fell 20% on average, according to the Federal Reserve Bank of Philadelphia.

At one point, like millions of homeowners, we were actually underwater on our mortgage, meaning we owed more than the home was worth. And rolling in closing costs didn’t help the situation either. By increasing our overall mortgage balance, we chipped away at the homeownership stake we had built (your home equity equals your home’s value minus the mortgage — the amount of the home you own outright).

Lesson learned: Since then, we have recouped the equity we lost and more. But some homeowners aren’t so lucky. ATTOM Data Solutions reports that more than 5 million properties were still “seriously underwater” in 2019, a full decade after the housing crisis ended. (“Seriously underwater” mortgages are classified as those at least 25% higher than the homes’ estimated market value.) Always consider how much a refinance will impact your equity. If home values fall, or you plan to sell before prices recover, refinancing can do more harm than good.

6. Not buying points

Knowing that we didn’t plan to move, we probably should have taken a longer-term view when we refinanced. At the time, we chose not to buy points to lower our interest rate, as we didn’t want to spend extra upfront.

Points will typically cost you 1% of the loan amount, which in turn lowers your interest rate by about 0.25 percentage points. While that may not sound like a big difference, over the life of a loan, it can really add up. Let’s say you are refinancing your $300,000 mortgage to a 30-year fixed loan at 7% interest. Here’s how the savings might break down:

Without buying points, a mortgage with a 7% interest rate will cost you $418,527 over the life of the loan.

Buying one point for $3,000 lowers the interest rate to 6.75%, and you will pay $400,486 over the life of the loan.

Buying two points for $6,000 lowers the interest rate to 6.5%, and you will pay $382,634 over the life of the loan.

In other words, paying $6,000 now can save you $35,893 in interest costs.

Lesson learned: Buying points doesn’t make sense for everyone, as it will extend your break-even point on the refi. But if you’re planning to stay put for the long haul, it’s worth doing the math. Fifteen years after the refinance, it’s clear we’ve paid far more in interest than we would have if we’d made that investment. What felt like saving money ended up being a costly mistake.

7. Overlooking term options

When we refinanced, we went from a 30-year loan, which we’d already been paying for five years, into a brand-new 30-year mortgage. In hindsight, we missed a big opportunity.

By refinancing into another 30-year mortgage, we basically reset the clock, effectively extending our mortgage and stretching our debt to 35 years. That means we’ll end up paying more in interest over the long run, even with the lower rate. What I didn’t realize was that refinancing into a 15- or 20-year loan could have dramatically reduced what we paid over time, even if the monthly payment was a bit higher.

Lesson learned: Refinancing doesn’t just have to be about lowering your monthly payments. It’s also a chance to shorten your loan term and potentially save a lot in interest.

The moral to my mortgage mistakes story

Do I regret refinancing our mortgage? No, but if I could rewind the clock, I would approach the process more cautiously. I would’ve run the numbers more carefully, thought harder about the long-term trade-offs and asked more questions upfront about APR and how our home equity might be affected. I would’ve taken a closer look at the costs we rolled into the loan, tried to negotiate fees, and considered whether buying points really made sense for us.

I also didn’t explore whether other refi options, like a shorter-term loan might have been a better fit or realize how important it is to shop around for the best lender.

Lesson learned: The refinancing process isn’t just about snagging a lower rate. Sometimes it pays to think long-term, even when the short-term savings are tempting.

©2025 Bankrate.com. Distributed by Tribune Content Agency, LLC.

There’s never a dull moment in the U.S. market as automakers hustle to divine consumer trends, navigate federal regulations, juggle tariff-driven plant production, and dodge activist Molotov cocktails.

The first six months of 2025 saw robust sales on track for an annual 16.3 million in unit sales as gas prices dropped and tariffs rose. America’s love affair with trucks and SUVs continued with sales making up 82% of the light vehicle market. Just 10 years ago, cars made up 43% of the market. This year? Just 18%.

General Motors Co. brands led the herd with 17.6% of the market, followed by Japanese behemoth Toyota Motor Corp. at 15.2% and Ford Motor Co. with 13.6%, according to Autodata figures. The General gobbled a point-and-a-half of market share while its two closest rivals also gained.

On other other hand, compared to 2015, Stellantis NV (then Fiat Chrysler Automobiles) declined to 7.4% from 12.3% and Nissan fell to 6% from 8.7%, stumbling while a company named Tesla Inc. (despite losses the last 12 months) came out of nowhere to reach a 3.3% share versus 0.1% a decade ago.

Enough macro, let’s talk micro. Dig deeper and the numbers reveal a raft of rivalries and rages. What are the best-sellers? Are EVs still the bee’s knees? Is Wrangler tying up Bronco?

The Detroit News sifted the numbers.

Best-sellers. The Ford F-Series and Chevy Silverado continue to slug it out in the marquee pickup duel. F-Series was King of Sales (again) with 412,848 units sold over Silverado’s 284,038. Throw in Chevy’s premium sibling GMC Sierra, however, and the GM twins are tops with 453,220 units combined.

A year ago, three non-pickup SUVs were climbing their way to the 400,000-plus sales summit: Toyota RAV4 (248,295), Tesla Model Y (198,030), and Honda CR-V (196,204). This year, RAV4 (239,451) and CR-V (212,561) are on pace again, but Model Y has hit a pothole with just 150,171 in sales — a victim of the slow rollout of its remade 2025 model and an often violent, anti-Tesla campaign aimed at Trump ally and brand CEO, Elon Musk.

EVs. Tesla Model 3 took up some of the slack, registering a 38% sales jump (to 101,323 units) with its re-worked sedan. So popular is the Model 3 that it not only was the hands-down best-selling luxury sedan (out-selling its closest competitor and segment icon, the BMW 3-series, 7:1), but it outsold every mainstream compact sedan except for the Honda Civic and Toyota Corolla.

Alas, for government regulators targeting 60% EV adoption by 2030, Model 3 sales were an anomaly as the electric market flat-lined at 7.4% share of the market, according to Cox Automotive, despite an expanded menu of offerings.

“The consumer tolerance level for EVs is about 7-8% of the market with all the federal incentives in place,” said ISeeCars.com senior analyst Karl Brauer in an interview. “And as those incentives go away over the next year, we expect to see EV sales continue to slide.”

Despite losing 6% market share in 2025, Tesla still dominated EV sales with 44.7% of the pie. Winners so far are the Chevy Equinox EV, which vaulted to third place in the EV beauty contest in its first stage appearance — its 27,749 sales eclipsing the best sales year of Chevy’s previous entry-level EV, the Bolt, by over 4,000 units.

Equinox EV’s sales paled next to its internal-combustion-engine-powered stablemate, the redesigned Equinox, which surged nearly 50% with 157,638 units sold.

Amidst the EV stall, Honda Motor’s first two battery-mobiles — the Honda Prologue and Acura ZDX — shared GM’s Ultium platform and combined to sell 26,652 units. That’s more than the combined 22,053 units sold by their peer, mid-size GM products built on the same platform: the Chevy Blazer EV and Cadillac Lyriq.

Muscle cars. The Mustang vs. Challenger vs. Camaro war ended as Stellantis and GM exited the segment — for now — to focus capital on EVs. Only Mustang is still standing.

Yet, the pony car icon didn’t profit from its rivals’ demise, losing 14% of sales year-over-year to 23,551 units from 27,444.

“Muscle cars are a discretionary purchase, and their sales decline is evidence of consumer concern about the broader economy,” said analyst Brauer. “These cars also have dedicated buyer groups like pickup trucks. Challenger people are not going to buy a Mustang.”

Not even EV muscle-inspired customers. After ditching its Challenger and Charger V-8 models under regulatory duress, Dodge debuted an earth-pawing, all-electric Charger EV coupe that sold just 4,299 units — well below the 21,217 sold by the Challenger ICE coupe as it rode into the sunset this time last year.

Jeep v. Bronco. At the heart of SUV-mania is the battle for off-road supremacy between the Jeep Wrangler and Ford Bronco. Wrangler continued to lead the horse race with 85,624 sales (11% gain over ‘25), but Bronc is coming fast.

Revived in 2021 after a 25-year hiatus from the market, Bronco surged past the Toyota 4Runner with 72,063 sold — a 43.7% gain and within striking distance of King Wrangler.

“Wrangler has the advantage of consistent, decades-long production and a loyal fan base,” said Brauer. “Ford has a huge, built-in audience from its trucks, but Bronco’s growth suggests it is pulling in a lot of non-Ford loyalists as well.”

Bronco’s halo appeared to help sales of its more affordable junior sibling, the Bronco Sport, which doesn’t share Big Brother’s ladder frame but is still plenty tough. Its 72,438 units tallied a 21.7% gain over a year ago.

Sedan sunset. In 2015, six of the Top Ten best-selling U.S. vehicles were sedans, led by the Toyota Camry. This year, only Camry made the Top 10.

Forty brands vied for U.S. market attention a decade ago. This year that number is 48 as new players like Ineos, Polestar and Rivian test the waters. The next six months’ tariffs and EV welfare pullback will test them as well.

©2025 www.detroitnews.com. Visit at detroitnews.com. Distributed by Tribune Content Agency, LLC.