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Category: Health

Under Robert F. Kennedy Jr., America’s health department is in the business of promoting Kennedy

As health and human services secretary, Robert F. Kennedy Jr. wields one of the louder megaphones the federal government has. Yet he insists he doesn’t want to impose his opinions on Americans.

“I don’t think people should be taking medical advice from me,” Kennedy told a Democratic congressman in May.

Kennedy once expressed different views — for example, about the need to proselytize about exercise. As he said on a podcast, he wants to use the “bully pulpit” to “obliterate the delicacy” with which Americans discuss fitness and explain that “suffering” is virtuous.

“We need to establish an ethic that you’re not a good parent unless your kids are doing some kind of physical activity,” Kennedy told the podcaster in September 2024.

RFK Jr.’s pointless dismantling of the nation’s public health system places us all at risk | Editorial

The Department of Health and Human Services is tasked with communicating information to protect and improve the health and well-being of every American. It provides reminders about vaccinations and screenings; alerts about which food is unsafe; and useful, everyday tips about subjects such as sunscreen and, yes, exercise.

Under Kennedy’s watch, though, HHS has compromised once-fruitful campaigns promoting immunizations and other preventive health measures. On Instagram, the agency often emphasizes Kennedy’s personal causes, his pet projects, or even the secretary himself. Former agency employees say communications have a more political edge, with “Make America Healthy Again” frequently featured in news releases.

Interviews with over 20 former and current agency employees provide a look inside a health department where personality and politics steer what is said to the public. KFF Health News granted many of these people anonymity because they fear retribution.

One sign of change is what is no longer, or soon will not be, amplified — for instance, acclaimed anti-smoking campaigns making a dent in one of Kennedy’s priorities, chronic disease.

Another sign is what gets commemorated. On the official HHS Instagram account this year, out were posts saluting Juneteenth and Father’s Day. In, under Kennedy, were posts marking President Donald Trump’s birthday and Hulk Hogan’s death.

Commenting on such changes, HHS spokesperson Andrew Nixon said in an email that “DEI is gone, thanks to the Trump administration.”

Some elected officials are pointedly not promoting Kennedy as a source of healthcare information. Regarding the secretary’s announcement citing unproven links between Tylenol and autism, Senate Majority Leader John Thune (R., S.D.) told MSNBC (now called MS NOW) that, “if I were a woman, I’d be talking to my doctor and not taking, you know, advice from RFK or any other government bureaucrat, for that matter.” (Thune’s office did not respond to a request for comment.)

At least four polls since January show trust in Kennedy as a medical adviser is low. In one poll, from the Economist and YouGov, barely over a quarter of respondents said they trusted Kennedy “a lot” or “somewhat.”

The department’s online messaging looks “a lot more like propaganda than it does public health,” said Kevin Griffis, who worked in communications at the CDC under President Joe Biden and left the agency in March.

Transition to a new administration

The new administration inaugurated dramatic changes. Upon arrival, political appointees froze the health agency’s outside communications on a broader scale than in previous changeovers, halting everything from routine webpage updates to meetings with grant recipients. The pause created logistical snafus: For example, one CDC employee described being forced to cancel, and later rebook, advertising campaigns — at greater cost to taxpayers.

Even before the gag order was lifted in the spring, the tone and direction of HHS’ public communications had shifted.

According to data shared by iSpot.tv, a market research firm that tracks television advertising, at least four HHS ads about vaccines ended within two weeks of Trump’s inauguration.

“Flu campaigns were halted” during a season in which a record number of children died from influenza, Deb Houry, who had resigned as the CDC’s chief medical officer, said in a Sept. 17 congressional hearing.

Instead of urging people to get vaccinated, HHS officials contemplated more-ambivalent messaging, said Griffis, then the CDC’s director of communications. According to Griffis, other former agency employees, and communications reviewed by KFF Health News, Nixon contemplated a campaign that would put more emphasis on vaccine risks. It would “be promoting, quote-unquote, ‘informed choice,’” Griffis said.

Philadelphia scientists will receive more than $6 million in funding from RFK Jr.’s new autism research center

Nixon called the claim “categorically false.” Still, the department continues to push anti-vaccine messaging. In November, the CDC updated a web page to assert the false claim that vaccines may cause autism.

Messaging related to tobacco control has been pulled back, according to Brian King, an executive at the Campaign for Tobacco-Free Kids, as well as multiple current and former CDC employees. Layoffs, administrative leaves, and funding turmoil have drained offices at the CDC and the Food and Drug Administration focused on educating people about the risks of smoking and vaping, King said.

Four current and former CDC employees told KFF Health News that “Tips From Former Smokers,” a campaign credited with helping approximately a million people quit smoking, is in danger. Ordinarily, a contract for the next year’s campaign would have been signed by now. But, as of Nov. 21, there was no contractor, the current and former employees said.

Nixon did not respond to a question from KFF Health News regarding plans for the program.

“We’re currently in an apocalypse for national tobacco education campaigns in this country,” King said.

Kennedy’s HHS has a different focus for its education campaigns, including the “Take Back Your Health” campaign, for which the department solicited contractors this year to produce “viral” and “edgy” content to urge Americans to exercise.

An earlier version of the campaign’s solicitation asked for partners to boost wearables, such as gadgets that track steps or glucose levels — reflecting a Kennedy push for every American to be wearing such a device within four years.

The source of funds for the exercise campaign? In the spring, leadership of multiple agencies discussed using funding for the CDC’s Tips From Former Smokers campaign, employees from those agencies said. By the fall, the smoking program had not spent all its funds, the current and former CDC employees said.

Nixon did not respond to questions about the source of funding for the exercise campaign.

Food fight

At the FDA, former employees said they noticed new types of political interference as Trump officials took the reins, sometimes making subtle tweaks to public communications, sometimes changing wholesale what messages went out. The interventions into messaging — what was said, but also what went unsaid — proved problematic, they said.

Early this year, multiple employees told KFF Health News, Nixon gave agency employees a quick deadline to gather a list of all policy initiatives underway on infant formula. That was then branded “Operation Stork Speed,” as if it were a new push by a new administration.

Marianna Naum, a former acting director of external communications and consumer education at the FDA, said she supports parts of the Trump administration’s agenda. But she said she disagreed with how it handled Operation Stork Speed. “It felt like they were trying to put out information so they can say: ‘Look at the great work. Look how fast we did it,’” she said.

Nixon called the account “false” without elaborating. KFF Health News spoke with three other employees with the same recollections of the origins of Operation Stork Speed.

“Things that didn’t fit within their agenda, they were downplayed,” Naum said.

For example, she said, Trump political appointees resisted a proposed news release noting agency approval of cell-cultured pork — that is, pork grown in a lab. Similar products have raised the ire of ranchers and farmers working in typically GOP-friendly industries. States such as Florida have banned lab-grown meat.

The agency ultimately issued the news release. But a review of the agency’s archives showed it has not put out news releases about two later approvals of cell-cultured meat.

Wide-ranging layoffs have also hit the FDA’s food office hard, leaving fewer people to make sure news gets distributed properly and promptly. Former employees say notices about recalled foods are not circulated as widely as they used to be, meaning fewer eyeballs on alerts about contaminated ice cream, peaches, and the like.

Nixon did not respond to questions about changes in food recalls. Overall, Nixon answered nine of 53 questions posed by KFF Health News.

Pushing politics

Televised HHS public service campaigns earned nearly 7.3 billion fewer impressions in the first half of 2025 vs. the same period in 2022, according to iSpot data, with the drop being concentrated in pro-vaccine messaging. Other types of ads, such as those covering substance use and mental health, also fell. Data from the marketing intelligence firm Sensor Tower shows similar drops in HHS ad spending online.

With many of the longtime professionals laid off and new political appointees in place atop the hierarchy, a new communications strategy — bearing the hallmarks of Kennedy’s personality — is being built, said the current and former HHS employees, plus public health officials interviewed by KFF Health News.

Whereas in 2024, the agency would mostly post public health resources such as the 988 suicide hotline on its Instagram page, its feed in 2025 features more of the health secretary himself. Through the end of August, according to a KFF Health News review, 77 of its 101 posts featured Kennedy — often fishing, biking, or doing pull-ups, as well as pitching his policies.

By contrast, only 146 of the agency’s 754 posts last year, or about 20%, featured Xavier Becerra, Kennedy’s predecessor.

In 2024, on Instagram, the agency promoted Medicare and individual insurance open enrollment; in 2025, the agency has not.

In 2024, the agency’s Instagram feed included some politicking as Biden ran for reelection, but the posts were less frequent and often indirect — for instance, touting a policy enacted under Biden’s signature legislation, the Inflation Reduction Act, but without mentioning the name of the bill or its connection to the president.

In 2025, sloganeering is a frequent feature of the agency’s Kennedy-era Instagram. Through the end of August, “Make America Healthy Again” or variants of the catchphrase featured in at least 48% of posts.

Amid the layoffs, the agency made a notable addition to its team. It hired a state legislative spokesperson as a “rapid response” coordinator, a role that employees from previous administrations could not recall previously existing at HHS.

“Like other Trump administration agencies, HHS is continuously rebutting fake news for the benefit of the public,” Nixon said when asked about the role.

On the day Houry and Susan Monarez, the CDC leader ousted in late August, testified before senators about Kennedy’s leadership, the agency’s X feed posted clips belittling the former officials. The department also derisively rebuts unfavorable news coverage.

“It’s very interesting to watch the memeification of the United States and critical global health infrastructure,” said McKenzie Wilson, an HHS spokesperson under Biden. “The entire purpose of this agency is to inform the public about safety, emergencies as they happen.”

‘Clear, powerful messages from Bobby’

Kennedy’s Make Our Children Healthy Again report, released in September, proposes public awareness campaigns on subjects such as illegal vaping and fluoride levels in water, while reassuring Americans that the regulatory system for pesticides is “robust.”

Those priorities reflect — and are amplified by — cadres of activists outside government. Since the summer, HHS officials have appeared on Zoom calls with aligned advocacy groups, trying to drum up support for Kennedy’s agenda.

On one call — on which, according to host Tony Lyons, activists “representing over 250 million followers on social media” were registered — famous names such as motivational speaker Tony Robbins gave pep talks about how to influence elected officials and the public.

“Each week, you’re gonna get clear, powerful messages from Bobby, from HHS, from their team,” Robbins said. “And your mission is to amplify it, to make it your own, to speak from your soul, to be bold, to be relentless, to be loving, to be loud, you know, because this is how we make the change.”

The communications strategy captivates the public, but it also confuses it.

Anne Zink, formerly the chief medical officer for Alaska, said she thought Kennedy’s messaging was some of the catchiest of any HHS director.

But, she said, in her work as an emergency physician, she has seen the consequences of his health department’s policies on her puzzled patients. Some question vaccines. Children show up with gastrointestinal symptoms Zink says she suspects are related to raw milk consumption.

“I increasingly see people say, ‘I just don’t know what to trust, because I just hear all sorts of things out there,’” she said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

December 4, 2025
David E. Loder, longtime attorney, multifaceted board member, and education advocate, has died at 71

David E. Loder, 71, of Flourtown, longtime attorney at Duane Morris LLP, multifaceted trustee and board member, education advocate, mentor, and volunteer, died Thursday, Oct. 23, of complications from lymphoma and scleroderma at his home.

A graduate of Germantown Friends School and what is now the University of Pennsylvania’s Carey Law School, Mr. Loder spent 43 years, from 1982 to his retirement in 2024, as an associate, partner, and chair of the health law group at the Duane Morris law firm. He became partner in 1989 and helped the health law practice gain national recognition for its success.

Mr. Loder and his team represented the Hospital and Healthsystem Association of Pennsylvania, the Pennsylvania Trauma Systems Foundation, and other medical providers in all kinds of consequential litigation. In 2006, he helped local hospitals win a multimillion-dollar settlement with an insurance company. In 2010, he supervised a case that successfully revived a state abatement program that alleviated medical malpractice costs for physicians and hospitals.

In a tribute, former colleagues at the Pennsylvania Trauma Systems Foundation praised “his ability to see both the legal complexities and the human dimensions of every situation.”

Mr. Loder stands with Blanka Zizka , the Wilma Theater’s artistic director, at an event in 2018.

He was adept in vendor contract law, board governance, policy development, and human relations issues. He took special interest in doctor-patient relations and told the Daily News in 2016: “While it is critical that the healthcare provider convey necessary and accurate information to patients concerning their health condition, it is also important to remain sensitive to the patient’s interest and willingness to hear such information.”

Matthew A. Taylor, chair and chief executive officer at Duane Morris, said in a tribute: “He was one of the nation’s most respected healthcare lawyers.”

Mr. Loder also represented the Philadelphia Zoo, homeowners fighting increased property assessments, participants in gestational-carrier programs, and other clients. “He was a shrewd judge of character,” said his son Kyle. “He was thoughtful and strategic. He became a confidant and adviser to many of his clients.”

John Soroko, chair emeritus at Duane Morris, said in a tribute: “Dave had a unique ability to turn friends into clients. But, even more importantly, to turn clients into friends.”

This photo of Mr. Loder (right) representing the Philadelphia Zoo appeared in The Inquirer in 1989.

Away from the law firm, Mr. Loder was chair of the board for the Wilma Theater and served on boards at Germantown Friends, the old University of the Sciences, the World Affairs Council of Philadelphia, and other groups. He was a trustee at the Dolfinger-McMahon Foundation and the Christian R. and Mary F. Lindback Foundation, and represented the Lindback regularly at its annual distinguished educators awards ceremony.

“There’s a firm belief in the importance of excellence in education in the public schools,” he told The Inquirer at the 2016 Lindback ceremony. In 2017, he said: “All of us need to recognize that the Philadelphia public schools are serving an incredibly important function.” In 2018, he said: “People need to know that there are some exceptional educators in Philadelphia public schools.”

He mentored many other lawyers and volunteered to help students in need. In online tributes, friends noted his “kind advice,” “voice of reason and compassion,” and “sense of humor, keen intellect, love of sports, and limitless knowledge on so many topics.”

In 1998, he was featured in an Inquirer story about the challenges parents face when dealing with young children stuck inside during the cold winter months. He said: “I find that if you can get the kids down by 6 p.m. and have a glass of wine in front of the fireplace, it gets you through.”

Mr. Loder enjoyed sports and the outdoors.

His family said in a tribute: “He took life seriously but never too seriously, and his warmth, humor, guidance, and generosity will be remembered.”

David Edwin Loder was born April 22, 1954, in Yalesville, Conn. His father, noted theologian Theodore Loder, moved the family to West Mount Airy when Mr. Loder was a boy, and he graduated from Germantown Friends in 1972.

He starred in football, basketball, and baseball in high school, and went on to play basketball and earn a bachelor’s degree in political science at Wesleyan University in Connecticut in 1977. He worked briefly after college as a high school history teacher, served an independent study fellowship in Poland, earned his law degree at Penn in 1981, and studied international law at the London School of Economics and Political Science.

He married Nadya Shmavonian, and they had sons Marek and Kyle, and a daughter, Julya, and lived in Philadelphia and Flourtown. After a divorce, he married Jennifer Ventresca and welcomed her children into the family.

Mr. Loder liked hiking in New York’s Adirondack Mountains and relaxing at his getaway home on Long Beach Island.

Mr. Loder enjoyed tennis, squash, and golf at the Philadelphia Cricket Club. He liked hiking in New York’s Adirondack Mountains and relaxing at his getaway home on Long Beach Island, N.J.

He doted on his family and Labrador, and played cards every month for years with an eclectic group of old friends.

Survivors give advice about mourning their loved ones, as told to The Inquirer’s obit writer

“David embodied the values of faith, service, and integrity,” his family said. His son Kyle said: “He was magnetic, gracious, thoughtful, and curious. He was easy to talk to.”

In addition to his wife, children, and former wife, Mr. Loder is survived by a granddaughter, a sister, two brothers, and other relatives.

Mr. Loder “was magnetic, gracious, thoughtful and curious,” his son Kyle said.

A memorial service and celebration of his life were held earlier.

Donations in his name may be made to the Penn Medicine Scleroderma Center, Attn: Amanda Hills, 3535 Market St., Suite 750, Philadelphia, Pa. 19104.

December 4, 2025
Seeking answers on autism: A CHOP expert debunks the top 5 myths | Expert Opinion

Several parents asked for my opinion when the Food and Drug Administration recently announced a warning label on acetaminophen for its alleged link to autism, and when the agency supported the use of leucovorin as an autism treatment despite a lack of scientific evidence. And I am sure I will get questions about the Centers for Disease Control and Prevention’s new claim on its website that the link between vaccines and autism cannot be “ruled out.”

As a developmental and behavioral pediatrician who cares for many children on the autism spectrum, I love to talk with families about what they’re hearing.

Families with children on the spectrum can feel whiplashed by online “influencers” hawking different theories, products, and alternative treatments. These families want to do everything they can to support their children, and so they seek out information everywhere they can find it.

Families look for alternatives because many of our current treatments are not effective for all children, and even those that work well can require intensive effort from teachers, therapists, and caregivers. As a clinician, I try to share the available evidence with families so they can make informed decisions.

Hype for particular treatments and theories about autism’s rise are not new. But when the highest officials in government shout about autism from the rooftops and the internet is awash in “information” untethered from scientific proof, it is more important than ever for clinicians and public health officials to approach parents with compassion, honesty, and evidence.

At Children’s Hospital of Philadelphia (CHOP), Pediatric Health Chat is tracking medical myths and rumors, including those about autism. Based on that data and conversations with parents, here are the top five things I wish my families knew:

1. Autism is not an epidemic

While it is true the number of children with autism spectrum disorder continues to rise across all sociodemographic groups, there is no evidence a single environmental toxin or other factor is the cause. In fact, the strongest studies show that most of the rise in autism over the past 20 years is due to increased recognition of the condition that has meant earlier, incorrect diagnoses can be set aside; and the fact that more characteristics and behaviors are known to be signs of autism. So, while autism diagnoses are rising, there is no evidence of an epidemic — autism is growing, but it’s not a sudden outbreak like COVID .

2. Vaccines do not cause autism

The myth that vaccines cause autism originated in a British study back in the 1990s on just 12 children that was so fraudulent, the journal that published it wound up retracting it. Some people continue to insist that because autism has continued to increase — and new vaccines have been developed — there must be some kind of a link. But just because two things occur at the same time does not mean that one causes the other. (A classic example is that both ice cream purchases and drownings increase in the summer, but no one is claiming that ice cream causes drowning!)

As CHOP’s Vaccine Education Center lays out, there have been numerous, well done studies that have not found a link between vaccines and autism. Vaccines save lives, and the evidence in favor of vaccine safety with respect to autism is overwhelming. I encourage all of my patients’ families to vaccinate their children. I am proud to say that I vaccinate my own children following recommended schedules — to protect them from preventable infections.

3. Acetaminophen does not cause autism

While a few small studies have found an association between prenatal acetaminophen use and autism, the largest and strongest studies have found no association. Studies that do not include factors like why the pregnant person is taking acetaminophen or whether siblings are on the autism spectrum may inaccurately conclude that acetaminophen is a cause when it is not. The truth is that high fevers during pregnancy are known to be dangerous, and acetaminophen, the active ingredient in Tylenol, is the safest medication we have for treating fever. I would have no hesitation recommending acetaminophen during pregnancy as needed.

4. Leucovorin is not a proven treatment for autism

Last spring, a news story appeared about a child who became more verbal after taking leucovorin (also known as folinic acid, a medication that is used for cancer patients undergoing chemotherapy). Since that time, requests from families in the autism community to begin leucovorin have skyrocketed. Yet the evidence for leucovorin’s effectiveness is incredibly limited. For example, children in placebo groups — those that didn’t get any leucovorin — showed similar gains as those that got it. Some families dropped out of the trials because their children became more aggressive while receiving leucovorin. We need larger, well designed, randomized control trials before I would feel comfortable recommending leucovorin to my patients.

5. So-called facilitated communication does not help children with autism

Several decades ago, facilitated communication (in which a facilitator touches a patient to “help them spell” on a keyboard or letter board) was thoroughly debunked by studies proving the facilitator was guiding responses, not helping the person to truly communicate their own thoughts.

Yet facilitated communication (FC) has made a comeback in the form of other “therapies” like supported typing and through the “Telepathy Tapes” podcast. However, these are just FC by another name and are also unsupported by evidence.

On the other hand, augmentative or alternative communication, through which individuals themselves use alternative strategies or “talker” devices to express themselves (instead of having a facilitator physically help them), is strongly supported by evidence. While I understand why families want to give their children every opportunity to express themselves, I strongly urge them to go with the methods that are proven to help them achieve their goals.

Most troubling to me is that woven through all these myths and misinformation is the implicit belief that individuals with autism lack value, or that they cannot lead happy, successful lives. While some individuals on the autism spectrum struggle to live independently and may have some challenging behaviors, all these people are worthy of dignity and respect. Continuing to find ways to best support people with autism and their families, to allow them to reach their highest potential, needs to be the focus.

Editor’s note: Pediatric Health Chat is an online initiative at Children’s Hospital of Philadelphia taking aim at the latest myths and misconceptions about children’s health. Kate E. Wallis, MD, MPH, is a developmental behavioral pediatrician with the Division of Developmental and Behavioral Pediatrics at Children’s Hospital of Philadelphia.

December 4, 2025
Drugs took both her sons and her leg. Now, Kelly Wyatt is committed to staying sober.

Kelly Wyatt winced as a nurse unwrapped layers of gauze from her left leg, exposing the massive wound beneath.

Yellow and red and gray, weeping plasma and agonizingly painful at the slightest touch, it covered almost the entirety of the end of her leg — the site of the amputation she had undergone four years before.

Emergency room doctors at the time had warned her that if the drugs she was using didn’t kill her, her wounds would.

Now Wyatt is 14 months into recovery from an addiction to fentanyl, a potent synthetic opioid, and xylazine, an animal tranquilizer never approved for human use. The emergence of xylazine, known as “tranq” on the streets, early in the decade marked the beginning of a dangerous new era for Philadelphians addicted to illicit opioids.

Tranq users developed skin lesions that became gaping wounds, though exactly how is still unclear. As the medical establishment scrambled to respond, amputations more than doubled among people addicted to opioids between 2019 and 2022.

Wyatt, 52, is among hundreds of Philadelphians facing lifelong medical needs from tranq, as the latest wave of the area’s drug crisis has seen a rapidly evolving succession of veterinary and industrial chemicals compound the dangers of the powerful opioids being sold on the streets.

Some have become regular patients in burn units and wound care clinics at area hospitals, among the only places capable of treating severe tranq injuries.

As part of its ongoing coverage of the area’s drug crisis, The Inquirer followed Wyatt for more than a year as she went through early recovery and worked with doctors to heal her wound.

Kelly Wyatt receives treatment at Jefferson Einstein Philadelphia Hospital’s Center for Wound Healing in Philadelphia in November.

Wyatt initially shrugged when the small sores had emerged on her legs, only to watch them grow into massive abscesses, resulting in an amputation below her knee. Her ongoing tranq use prevented the wound on her left leg from healing properly. Even after recent months of sobriety and careful treatment, doctors are still warning her that they may have to amputate more of her leg.

But Wyatt’s tranq wounds go still deeper.

Over the last several years, both of her sons had spiraled into addiction. By January, both of them were dead.

A family photo of Dakota Wyatt, left, and Tyler, right.

Spiraling into addiction

Several members of Wyatt’s family have struggled with addiction.

Wyatt experimented with drugs as a teenager, but was sober during her kids’ early childhoods. She didn’t drink alcohol, let alone seek out illicit drugs, after giving birth to her eldest son, Dakota, at 18. She raised two sons and a daughter in a neighborhood near Pennypack Park.

Her days had a familiar rhythm: packing lunches, picking the kids up from school, watching them play together at the local park. In her spare time, she dabbled in mixed-media art, designing the window displays at the downtown restaurant where she worked for years. One Philadelphia Flower Show-themed display had a working waterfall.

Her youngest, Tyler, was a happy child, grinning wide in every school picture and sharing inside jokes and a love for music with his brother. Dakota, more sensitive, had struggled with anxiety from an early age; Wyatt remembers him asking her at bedtime what the family would do if their house burned down in the night. But he could always make her laugh, and she and the boys would sing along to the same music in the car: ’90s alt-rock, Johnny Cash, the local hip-hop station.

In 1999, she divorced their father. A few years later, at 28, she took her first Percocet pill, an opioid painkiller approved for medical use that is widely abused as a street drug. She had just started working at a bar, and the long hours were wearing on her.

With the pills, “I could get more cleaning done, I could push my body more,” she said. “And it snowballed.”

She was not aware when her sons began using drugs themselves in their teenage years. “I didn’t know for a long, long time,” she said.

Afterward, Wyatt tried to help them seek treatment, even while her own drug use increased, she said.

But a series of traumatic life events resulted in all falling deeper into addiction together.

Wyatt’s ex-husband died following long-standing health issues, including diabetes.

Then Dakota, who drove a Zamboni at a local ice rink, was injured in an accident at work — losing the tips of his fingers while cleaning the machine. He had been using more opioids to deal with the pain.

Wyatt began buying drugs with him in Kensington, at the vast open-air drug market that is the epicenter of Philadelphia’s opioid crisis. “It was normalizing — I’m his mom and I’m with him in that crazy environment. I’m sure it made him feel like it was OK. And I regret that,” Wyatt said.

“I regret a lot of stuff. But that was the beginning.”

Kelly Wyatt leaves her wound care appointment at Jefferson Einstein Philadelphia Hospital’s Center for Wound Healing in November.

Tranq warning signs

It was the mid-2010s, and the drugs on the street were changing. The stronger synthetic opioid fentanyl was just emerging; dealers chanted “fetty-fetty-fetty” on the corners to draw in customers.

And then Wyatt began hearing talk of “tranq” getting mixed into the drug supply.

That was around the time that Dakota developed wounds on his arm, open sores that would not close. Wyatt found small wounds on her arms and legs — “like melon-ball scoops.”

One day, she saw a flier, handed out by health authorities in Kensington, warning that tranq can cause skin lesions.

“All of a sudden,” she recalled, “things made sense.”

But her addiction was so severe that she was afraid to stop using the fentanyl-tranq mix now prevalent in the illicit drug market. She fixated on avoiding xylazine’s severe withdrawal symptoms — chills, sweating, anxiety, and agitation — which don’t respond to traditional opioid withdrawal medications. She worried about seeking treatment with no guarantee of relief.

By the time Wyatt was admitted to a hospital in 2021, she was hallucinating from sepsis, a severe complication from an infection that can lead to organ failure, shock, and death.

When she woke up eight days later, a doctor told her she was at risk of having one leg amputated, and maybe both. “Please let me keep as much of my leg as possible,” she recalls begging a doctor who wanted to remove her entire leg.

Kelly Wyatt receives treatment for a serious xylazine wound at the site of her amputation at Jefferson Einstein Philadelphia Hospital’s Center for Wound Healing in November.

“The doctor thought I should get the whole leg cut off. The other thing I could do was amputate below the knee, and then get tons of operations for the infection,” she said.

Her oldest son’s tranq wounds had also worsened. Dakota had wounds on his legs and an arm, which was eventually amputated later that year. He also suffered a heart infection linked to his drug use, and needed a valve replacement.

After a month in the hospital, he came home and continued using drugs.

He developed new lesions. Maggots ate at his rotting skin. Wyatt cleaned the bugs out of his wounds.

Wyatt tried bargaining with her son, promising they could get addiction treatment together. She offered to get him enough drugs that he wouldn’t enter withdrawal while waiting for care at the hospital. Sometimes, he managed to stay at the hospital for a few hours, but never longer.

“He was too embarrassed to go anywhere, he was too afraid to get clean, and he was too afraid to be sick. He told us he would rather die than go through withdrawal again,” she said. “A couple times, he asked me if I wanted to just shoot up and lay down and die with him.”

“‘I want to live,’” she recalls telling him, “‘and I don’t want to live without you.’”

Kelly Wyatt waits for treatment for a serious wound on her leg at Jefferson Einstein Philadelphia Hospital’s Center for Wound Healing in November.

Loss and recovery

One night in January 2024, Dakota was having trouble breathing and seemed to be hallucinating, speaking nonsense. He asked Wyatt to call an ambulance to the house.

Dakota died before the family reached the hospital. His cause of death was listed as drug intoxication.

Wyatt believes ongoing health issues from his wounds hastened his death. Her grief intensified her own drug use, leading to more xylazine wounds. The wound that had opened near her amputation grew worse.

A month after Dakota’s death, she entered drug treatment. After three months, she relapsed and overdosed on cocaine and fentanyl. Her first thought after waking up was to use again, but instead she chose rehab.

“I didn’t want to die,” Wyatt said. “I didn’t want to be in pain anymore.”

She arrived at the Behavioral Wellness Center at Girard in July 2024, hoping to enter outpatient rehab.

Instead, physicians recommended their inpatient clinic that could also treat her wounds, one of the few such facilities in Philadelphia.

In August 2024, Kelly Wyatt attended a wound care appointment as part of her inpatient care at Girard Behavioral Health, one of a few addiction rehabs in the city that can treat xylazine wounds.

Wyatt was living there and undergoing treatment a month later, in August 2024, when she wheeled her motorized wheelchair into a clinic room and took deep breaths as nurses carefully peeled back layers of moisturized gauze on her left leg, cleaning the wound.

Still in the shaky early months of recovery, and needing to remain in inpatient rehab, she remained worried about Tyler, who was still using drugs.

“He was the primary caretaker of his brother. They would be in their room, getting high together. And now he’s just in that room by himself, day in and day out,” she said in an interview that summer.

“I kept saying, ‘I think I should go home to him.’ And everybody kept saying to me, ‘You have to work on yourself first. He’ll be fine,’” she later recalled.

“And then he wasn’t fine.”

Kelly Wyatt and her partner Randy Stewart at the headquarters of Resources for Human Development, which runs the skilled nursing and inpatient addiction treatment center where Wyatt sought treatment this winter.

A mother’s guilt

Wyatt was still in rehab in January 2025 when her partner, Randy Stewart, called. He hadn’t seen Tyler in hours and thought he might have left the family’s house.

Wyatt called several hospitals and then asked Randy to check the bathroom in the back of the house.

He found Tyler on the floor.

“I just thought, God, please no,” Wyatt said. “Not again. You can’t do this to me again.”

Tyler’s cause of death was also listed as “drug intoxication.”

He died at 27, a year and 10 days after his brother.

Wyatt is still wracked by guilt. Guilt that she used drugs with her sons. That she used drugs at all. That she wasn’t there when either of her boys died. That her daughter, who does not use drugs, stopped speaking to her. Sometimes, she dreams about her children and wakes up screaming.

As she continues treatment, Wyatt said, she hopes her story will help other families struggling with addiction, especially the realities of tranq use.

“Sometimes I’m embarrassed to talk about it. But I feel like I have to,” she said. “Because people need to know. If one person sees this and gets some medical care, gets any kind of help, I would be happy.”

Heidi Hunt, a wound care-certified registered nurse, cleans the wound on Kelly Wyatt’s leg at Jefferson Einstein Philadelphia Hospital’s Center for Wound Healing in November.

Treating tranq’s wounds

For Wyatt, maintaining her recovery from addiction and caring for her wounds are full-time occupations that sometimes are in conflict.

Methadone, the opioid addiction treatment drug that has helped Wyatt curb cravings for more than a year, can be dispensed only at special clinics.

Wyatt’s clinic journey meant three hours a day on a bus where she couldn’t keep her leg elevated. The wound worsened until she was able to switch to a closer methadone clinic.

Wyatt relies on Stewart to help her move around her home, where the only bathroom that she can access is the one where Tyler died.

“Cleaning, taking care of me, changing my wound dressings, talking about my sons — he calms me down. It’s been a lot, and he’s really done a lot,” she said.

Kelly Wyatt and her partner Randy Stewart in July.

Once a week, Wyatt travels to Jefferson Einstein Philadelphia Hospital’s Center for Wound Healing for wound care.

At a recent appointment, nurse practitioner Danielle Curran scraped away infected skin, measured the wounds, cleaned and re-bandaged her lesion.

In between office visits, nurses also go to her home to clean and re-bandage her wound twice weekly. Several times this year, Wyatt has undergone debridement surgery to remove more damaged skin under anesthesia.

If the treatments manage to shrink her wound, Curran said, Wyatt could try a skin graft and eventually receive a prosthetic leg that could help her get around more easily.

Curran has treated about 20 xylazine patients at the clinic over the last few years. About 10, including Wyatt, are still getting regular care. Others have relapsed and returned to the streets. Several have died of overdoses.

She is relieved that, as Philadelphia’s opioid crisis continues to evolve, tranq is becoming less prevalent. But it has been replaced in street drugs by another animal tranquilizer, medetomidine, which does not appear to cause flesh wounds but, rather, agonizing withdrawal symptoms. Skin lesions among opioid users have decreased in the last year.

Yet Curran still insists on seeing patients like Wyatt with xylazine wounds weekly, trying to help them through their injuries and hopefully their recovery, too. “I like to be another person holding them accountable, to stay on the path. We try to give them that support.”

Sometimes, that support means simply reminding Wyatt how far she has come in the four years since the amputation, and now 14 months of sobriety.

At a recent appointment, after carefully scraping dead skin away from Wyatt’s leg with a small curette, Curran walked through her next steps: A disinfecting gel to keep bacteria out of the wound. A course of antibiotics to avoid infection. Another debridement surgery, in a few weeks.

“As a rule of thumb,” Curran told a reporter, “it’s very hard to give timelines for wound care, because of all the things that could possibly go wrong. A wound this size, though? It could take years.”

Wyatt began to cry. “It’s already been four years,” she said.

Curran turned to her. “You’ve made so much progress,” she said gently. “Give yourself time.”

Kelly Wyatt enters the wound care clinic at Girard Behavioral Health in August 2024.

Editor’s note: This story has been updated to clarify the name of the Jefferson Health clinic where Kelly Wyatt received wound care.

December 4, 2025
Making friends as an adult is hard. Here’s the secret.

On a recent Thursday evening in downtown Washington, I took a deep breath and walked into a bar. I joined a couple dozen other women who were milling around making small talk and ordering drinks, waiting for the more formal portion of the evening to begin.

I was there to make friends.

When I first moved to D.C. at age 23, I immediately met lots of new people who were in the same boat. Many of my fellow interns were new to the city, and we were all game for adventures. These days I still have close friends, but many of us have busy jobs and young children. Some have moved away. It can be hard to even schedule a phone call to catch up.

I find myself craving the easy friendships of my early 20s. Could I find that again?

The meetup I was attending was organized by RealRoots, one of a number of startups aimed at making us less lonely. Even before the pandemic, Americans were spending less time with friends. By 2023, the U.S. surgeon general warned we were in a loneliness epidemic and that the health risks of isolation were akin to smoking.

The good news is there’s now less stigma in admitting you want to make friends, especially since the pandemic, RealRoots CEO and co-founder Dorothy Li told me.

“We were all lonely together for two years,” she said, and many of us have begun rebuilding social lives at the same time.

I consulted experts about how to both make new friends and reconnect with old ones. Here’s what I learned.

Be vulnerable

I went into the RealRoots event with a healthy dose of skepticism. I was told that I would be matched with a curated group of women based on my responses to a personality quiz and an interview with an artificial intelligence assistant named Lisa who detected my “social vibe.” (I was “grounded, thoughtful, and warm” — thanks, Lisa!)

“I totally get it,” Li said when I told her about my doubts. “Human connection needs to be in real life.” But the planning and logistics of matching people who are similar and finding times on their calendars? That, she said, “can be done seamlessly by AI.”

The women at my meetup included a former professional ballroom dancer, a nurse who loves her work with dementia patients, and an aid worker about to leave for a work trip to Sudan.

Everyone had different reasons for being there. One woman worked from home and felt isolated, especially since becoming pregnant. Another wanted to push out of her comfort zone and meet new people. A third said she had social anxiety and felt this took the pressure off.

After mingling, moderators led us through a series of questions, which started like corporate icebreakers (what are your hobbies?) but got progressively more personal (what’s something you’re good at?), finally building to the last question: What’s something you’re struggling with right now?

I searched my mind for something that wouldn’t feel too revealing. These were basically strangers, after all. But then someone talked about her fertility issues. Another was going through a difficult divorce. Another had a serious illness. I quietly reassessed. When it was my turn, I no longer felt the need to hold back. I talked about my insecurities as a mom. I felt myself starting to cry as I explained my fears about how my anxiety would affect my daughter. I was met with so much empathy.

When I told Li I felt close to all the women by the end of the night, she told me that’s the point.

“When you start talking about the things that are actually on your mind, everyone can relate,” Li said.

Vulnerability invites vulnerability. This rule also applies when trying to deepen friendships.

For journalist Billy Baker, after getting married, having kids and relocating to the suburbs, he realized that many of his high school and college friends couldn’t be part of his daily life anymore. He set out to build a community where he lived, and the first step was to reach out to people he felt a connection to, and to tell them that. It was intentional and a little scary, but worth it, he said.

“Vulnerability for me was always rewarded,” said Baker, author of the book We Need to Hang Out: A Memoir of Making Friends.

Do things you want to do anyway

When Baker was working on his book about friendship, he was trying to nail down exactly what draws us to other people. He found that a shared interest or activity worked particularly well as a first step. For instance, he would often run into a guy at the gym, so he started asking him to meet up there to work out together.

“Pickleball has changed senior friendship,” he said. “Is it pickleball they love or is it having this activity that they enjoy, and finding others who also enjoy it and then they’re off for coffee?”

Baker says if you choose something you want to do anyway, you’ll probably meet people with a shared interest, and even if you don’t you’ll still have a good time.

Put friendship on the to-do list — near the top

Baker learned that he couldn’t just assume friendships would happen to him — he needed to take initiative.

“We were never taught to prioritize friendship,” Baker said. For him, this journey began when his editor asked him to write about how many men let friendships lapse in middle age. Even though Baker had always been social, he realized he had been prioritizing his work and family and neglecting to make time for friends.

“The gift I gave myself is to put friendship on the to-do list every day alongside eating well, taking care of my family, taking out the trash, all those things,” Baker said. “It needs to be a part of our daily life if you really are going to reap the benefits.”

Baker’s solution was to take inspiration from a group of men in his town with a tradition called “Wednesday nights” — a weekly promise of getting together. Baker created his own version of it, and said it was awkward at first. But eventually, genuine connections formed.

At the end of my conversation with Baker, he gave me a challenge: Was there anyone I could think of who I wanted to be closer to?

I thought of a colleague I have been casual friends with for a few years. I always delighted in running into her in the hallways or at parties, but we had never gotten together just us. Baker encouraged me to ask her to hang out.

I felt a familiar creeping fear as I reached out to her — what if she was too busy, or didn’t feel the same friendship vibe I did? What if we did hang out and had nothing to say?

I asked her, my colleague Rachel Kurzius, to get lunch on a Sunday. We chatted for two hours that felt like 20 minutes. We bonded over talking about books and our kids and the surprising number of things we had in common, and it really feels like the start of a friendship. Similar to Baker, I was rewarded by vulnerability.

If you’re contemplating taking the first step, just do it. The odds are stacked in your favor.

“We like people who like us,” Baker said. So make the first move.

After my RealRoots meetup, I declined to join RealRoots’ six week series — like a kickball league, there was a cost, and it didn’t fit into the budget this month — but I was still grateful for the opportunity to meet people. A few days later, I ran into one of the women from the group at a workout class, and we greeted each other like old friends.

December 4, 2025
What to know about the hepatitis B vaccine schedule debate

The nation’s top vaccine advisory panel is expected to debate whether to delay the first dose of the hepatitis B shot on Thursday.

The immunization, developed in Philadelphia and long recommended for all U.S. infants at birth, protects against a disease that can do permanent damage to the liver, and for which there is no cure.

The shot is widely considered safe and effective, but who should receive it, and when, has come under scrutiny by President Donald Trump’s administration.

The Advisory Committee on Immunization Practices (ACIP), an independent panel of experts reconstituted this past summer to include several vaccine skeptics, had tabled a vote on this topic in September. It is now scheduled to spend Thursday discussing the vaccine, according to a draft agenda of the group’s two-day December meeting.

Vaccine experts and patient advocates have previously advocated against delaying the birth dose, citing concerns that unvaccinated children could be at risk of contracting the highly contagious virus.

Here’s what to know about the vaccine.

The hepatitis B vaccine, a ‘Philadelphia story,’ is being scrutinized.

It’s recommended for all newborns at birth.

Starting in 1991, the first dose of the hepatitis B vaccine has been universally recommended for all newborns within 24 hours of birth. Rates of infection among children and teens have since dropped by 99%.

Prior to the universal birth dose recommendation, about half of infections in children were acquired from mothers infected with the virus, the Centers for Disease Control and Prevention found.

The virus spreads through contact with blood and other body fluids.

The virus can be transmitted from mother to baby, as well as through a variety of household sources, such as personal items like toothbrushes and razors that become contaminated with blood.

The virus cannot be spread through casual contact such as hugging, touching, or sharing utensils, but it can be spread through open wounds.

The disease is incurable.

Hepatitis B is the most common chronic viral infection in the world. Over time, the disease can cause cirrhosis or severe scarring of the liver, liver failure, and liver cancer.

Patients can take antiviral treatments to help control the virus, but there is no cure.

The panel has previously considered delaying the birth dose until one month of age.

ACIP previously debated delaying the first dose of the vaccine until one month of age for most babies.

Some members had suggested the dose for newborns should instead be given only to the populations most at risk.

The ACIP considered recommending doctors vaccinate only those newborns whose mothers test positive for the virus, and having the other babies wait a month for their first dose.

Trump separately stated in a news conference, without citing scientific evidence, that he thinks newborns should no longer universally receive the shot and children should wait until age 12. Experts criticized Trump for incorrectly suggesting that hepatitis B is only transmitted sexually.

Experts are concerned about a potential change to the guidelines.

Leading medical societies and infectious-disease experts say there is no scientific evidence for changing the current guidelines.

Experts worry that delaying the vaccine could affect its ability to prevent transmission of the virus from mother to baby. “If you wait longer than 24 hours, then the vaccine doesn’t work as well,” Chari Cohen, president of the Hepatitis B Foundation, told The Inquirer in an interview earlier this fall.

Even if the ACIP were to recommend vaccinating only babies whose mothers have the virus, some cases could be missed. Universal testing for the virus has been recommended since the 1990s, but 15% to 16% of women still do not get tested.

Such a policy also would not account for other exposures. Su Wang, a New Jersey physician who treats patients with hepatitis B and herself has the disease, told The Inquirer earlier this year that she likely caught hepatitis B as a child living with her grandparents. Her parents tested negative. “There are a lot of exposures that we aren’t testing for,” she said.

The vaccine is a Philadelphia success story.

The hepatitis B virus was first discovered by Baruch Blumberg, a scientist at Fox Chase Cancer Center, in 1967.

He went on to win a Nobel Prize for that work, and later cocreated and developed the vaccine, which continues to be manufactured in and around the region.

The Hepatitis B Foundation is also locally based, in Doylestown.

December 3, 2025
Even a 15-minute walk may help boost your longevity

Walking for at least 10 or 15 minutes at a time might do more for your health and longevity than spreading your steps out into shorter walks throughout the day, a large-scale study suggests.

The study, published in October, looked at the effects of how people gather their steps each day, as well as how many steps they take and the associations that these patterns of daily activity might have with risks for heart disease and premature death.

The data showed that middle-aged and older people in the study who grouped some of their steps into walks lasting 15 continuous minutes or more were about half as likely to develop heart disease in the near term as those who rarely walked for that long at one time. The people taking longer walks were also less likely to die during the yearslong study from any cause.

“With physical activity, we know that the more the better,” said Emmanuel Stamatakis, a professor of physical activity, lifestyle and population health at the University of Sydney in Australia and lead author of the study. “But we haven’t had a very good understanding of the role of the pattern” of that activity.

The study builds on earlier research, including from Stamatakis’s lab, exploring how to intensify the health benefits of even a little physical activity. But it also raises questions about whether it’s possible to overthink the simple walk.

Most of us aren’t moving enough

“This study is about identifying ways to maximize what people get out of their walking,” Stamatakis said.

Walking may be the most common physical activity for almost everyone. But many of us do little of it. Current physical activity guidelines recommend 150 minutes a week of moderate activity, which would include brisk walking.

But “75 to 80% of people are insufficiently active,” Stamatakis said, meaning they don’t meet those guidelines. Quite a few rarely exercise at all.

It should be possible, though, to make even the briefest amounts of movement better for us, Stamatakis and his colleagues have speculated. In past studies, they have shown that picking up the pace of brief daily activities, such as housework, is associated with lower risks for heart disease and early death. The extra intensity seemed to make everyday chores and actions more potent for people’s health.

But not everyone can or wishes to up the vigor of their vacuuming. Were there other ways to get more health bang from just being in motion, Stamatakis and his colleagues wondered? What about if people’s activities simply lasted a little longer?

15-minute walks are best

To find out, the scientists drew records for 33,560 men and women, most of them in their 60s, from the UK Biobank, a massive databank of British health records. All Biobank participants provide extensive medical information when they join, and many wear an activity tracker for a week.

The scientists looked for participants who said they don’t formally exercise and whose activity trackers showed they typically accumulated fewer than 8,000 steps a day, most of them far fewer. They also had to be free of diagnosed heart disease.

Using activity tracker data, the scientists divided people into groups, based on whether their longest daily walk lasted five or fewer minutes, 10 minutes, or 15 minutes or more. They also checked death and hospital records for up to about a decade after people wore the trackers. Then the researchers cross-referenced to see who seemed to have had the longest and healthiest lives.

The results were consistent and clear. The men and women who’d walked for 15 continuous minutes or more had the lowest risks of heart attacks and other cardiovascular problems and were more likely than the other groups to still be alive. Similarly, those walking for 10 uninterrupted minutes tended to live longer and with less heart disease than those whose longest walk lasted only five minutes.

These effects held true even if people were taking about the same number of total steps each day.

Why? It’s likely that the longer walking bouts “meaningfully activated” and altered people’s cardiovascular and metabolic systems in ways the briefer walks couldn’t, the researchers speculate in the study.

“This is a very insightful and important epidemiological paper that sheds further light into the importance of being physically active,” said Darren Warburton, an exercise scientist at the University of British Columbia, who has studied the health effects of physical activity. He wasn’t involved in the new study.

Any activity is better than none

But the study shows association, not cause and effect, so it can’t prove longer walks necessarily lead to better health outcomes. People who walk longer might also be more interested in healthy eating and other good habits that influence their longevity as much as — or more than — their stepping behavior.

The effects were most pronounced, too, in people walking the least. The people who took fewer than 5,000 steps most days but grouped some of those steps into longer 10- or 15-minute walks showed relatively larger reductions in their risks for heart disease and early death than people taking closer to 8,000 steps a day who likewise strolled for a quarter hour. In other words, if people rarely walked but sometimes walked longer, they got more out of those longer walks than people who generally walked more.

So, the true lesson of the study could be, just walk more. But if you can’t or really want to amplify the potential benefits of your daily steps, walk a bit longer sometimes.

That’s a message the study’s authors embrace. “We have a lot of data from other studies showing that any amount of physical activity is good,” said I-Min Lee, a professor of epidemiology at the Harvard T.H. Chan School of Public Health and a study co-author. So, sure, “if you have a choice and are able to, try to walk for more than 10 minutes at a time,” she said. “But the total amount of activity is what matters more than the pattern in which it’s accumulated.”

December 3, 2025
How Affordable Care Act premiums are estimated to rise across the region
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How Affordable Care Act premiums are estimated to rise across the region

If tax credits expire, how much your premiums go up will depend on where you live, how old you are, and what you earn.

By

Jasen Lo

Published Dec 3, 2025

If you pay for your doctor visits with an Affordable Care Act health plan – Pennie in Pennsylvania., Get Covered NJ in New Jersey, or Healthcare.gov in Delaware – the cost of your premium might be about to go way up. Experts say costs could rise fivefold unless lawmakers move to review or replace tax credits – that ensure no one pays more than 8.5% of their income on premiums – before they expire at the end of the year.

Without these tax credits, people on ACA health plans will need to pay for a greater share of the premium themselves. This was a central issue in the recent standoff between congressional Republicans and Democrats that led to the longest ever U.S. government shutdown.

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The shutdown ended after eight senators broke ranks with the Democrats and voted on compromise legislation to reopen the government. Senate Majority Leader John Thune of South Dakota pledged to hold a vote in December on the ACA subsidies. Congress would need to approve extending tax credits.

If they’re not extended, here is how much premiums could increase across the region, according to estimates by KFF, an independent source for health policy research, polling, and journalism:

For an average 27-year-old from

AdamsAlleghenyArmstrongBeaverBedfordBerksBlairBradfordBucksButlerCambriaCameronCarbonCentreChesterClarionClearfieldClintonColumbiaCrawfordCumberlandDauphinDelawareElkErieFayetteForestFranklinFultonGreeneHuntingdonIndianaJeffersonJuniataLackawannaLancasterLawrenceLebanonLehighLuzerneLycomingMcKeanMercerMifflinMonroeMontgomeryMontourNorthamptonNorthumberlandPerryPhiladelphiaPikePotterSchuylkillSnyderSomersetSullivanSusquehannaTiogaUnionVenangoWarrenWashingtonWayneWestmorelandWyomingYorkAtlanticBergenBurlingtonCamdenCape MayCumberlandEssexGloucesterHudsonHunterdonMercerMiddlesexMonmouthMorrisOceanPassaicSalemSomersetSussexUnionWarrenKentNew CastleSussex

, making $35,000 a year, insurance premiums could go from costing 27_35k_yesEPTC to 27_35k_noEPTC, an increase of 27_35k_diffEPTC.

The expiration of tax credits could mean the end of free insurance for the lowest earners, according to KFF’s estimates. For example, a 27-year-old from

AdamsAlleghenyArmstrongBeaverBedfordBerksBlairBradfordBucksButlerCambriaCameronCarbonCentreChesterClarionClearfieldClintonColumbiaCrawfordCumberlandDauphinDelawareElkErieFayetteForestFranklinFultonGreeneHuntingdonIndianaJeffersonJuniataLackawannaLancasterLawrenceLebanonLehighLuzerneLycomingMcKeanMercerMifflinMonroeMontgomeryMontourNorthamptonNorthumberlandPerryPhiladelphiaPikePotterSchuylkillSnyderSomersetSullivanSusquehannaTiogaUnionVenangoWarrenWashingtonWayneWestmorelandWyomingYorkAtlanticBergenBurlingtonCamdenCape MayCumberlandEssexGloucesterHudsonHunterdonMercerMiddlesexMonmouthMorrisOceanPassaicSalemSomersetSussexUnionWarrenKentNew CastleSussex

making $22,000 a year will have to pay 27_22k_noEPTC if these tax credits expire.

This can be a meaningful amount for someone making less than $2,000 a month. Especially as those in lower income brackets are more likely to forgo health insurance to steer limited financial resources to other household expenses, according to KFF surveys.

Enshrined into the original ACA are coverage subsidies for those who earn less than $62,600. As a result, anyone who makes below that threshold would be impacted similarly.

ACA calculates this value at 4 times the poverty rate, which is currently at $15,650.

The expiring tax credits were added later to ensure that nobody pays more than 8.5% of their income in premiums. In

AdamsAlleghenyArmstrongBeaverBedfordBerksBlairBradfordBucksButlerCambriaCameronCarbonCentreChesterClarionClearfieldClintonColumbiaCrawfordCumberlandDauphinDelawareElkErieFayetteForestFranklinFultonGreeneHuntingdonIndianaJeffersonJuniataLackawannaLancasterLawrenceLebanonLehighLuzerneLycomingMcKeanMercerMifflinMonroeMontgomeryMontourNorthamptonNorthumberlandPerryPhiladelphiaPikePotterSchuylkillSnyderSomersetSullivanSusquehannaTiogaUnionVenangoWarrenWashingtonWayneWestmorelandWyomingYorkAtlanticBergenBurlingtonCamdenCape MayCumberlandEssexGloucesterHudsonHunterdonMercerMiddlesexMonmouthMorrisOceanPassaicSalemSomersetSussexUnionWarrenKentNew CastleSussex

, a 27-year-old making $65,000 could pay a premium of 27_65k_noEPTC, while a 60-year-old in the same income bracket could pay 60_65k_noEPTC. Older people in higher income brackets, who are generally charged more since they are generally less healthy than younger people, are set to see large premium increases.

The impact will be greatest in some rural parts of Pennsylvania. For example, in Fulton County, 60-year-olds making $65,000 could pay an estimated 60_65k_diffEPTC more a month, an almost five times increase from existing premiums.

Lisa Davis, director at Pennsylvania Office of Rural Health, explained that generally, “in rural communities, there’s often very little competition” between providers and rural populations “are generally older, poorer, and have more chronic health conditions.”

New Jersey could see larger price increases than Philadelphia and the collar counties. In Camden County, for instance, 60-year-olds making $65,000 could pay almost 60_65k_diffEPTC more a month.

Premium estimates are uniform across New Jersey because the state does not have rates that vary by region, as seen in Pennsylvania.

See what price increases look like for those across Pennsylvania, New Jersey, and Delaware. Select your county:

AdamsAlleghenyArmstrongBeaverBedfordBerksBlairBradfordBucksButlerCambriaCameronCarbonCentreChesterClarionClearfieldClintonColumbiaCrawfordCumberlandDauphinDelawareElkErieFayetteForestFranklinFultonGreeneHuntingdonIndianaJeffersonJuniataLackawannaLancasterLawrenceLebanonLehighLuzerneLycomingMcKeanMercerMifflinMonroeMontgomeryMontourNorthamptonNorthumberlandPerryPhiladelphiaPikePotterSchuylkillSnyderSomersetSullivanSusquehannaTiogaUnionVenangoWarrenWashingtonWayneWestmorelandWyomingYorkAtlanticBergenBurlingtonCamdenCape MayCumberlandEssexGloucesterHudsonHunterdonMercerMiddlesexMonmouthMorrisOceanPassaicSalemSomersetSussexUnionWarrenKentNew CastleSussex

As a result of these changes, the Congressional Budget Office estimates that 4.2 million Americans will choose to drop their coverage. Pennie administrators estimate about 150,000 of the 500,000 people who bought plans this year will drop out because they find the plans unaffordable.

“Individuals who are least likely to be able to afford these premium increases will not be enrolled. Of course, people want to have health insurance, whether or not they can afford it is a different conversation. It’s a tough, challenging situation,” Davis said.

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In addition to tax credits shrinking, premium prices are rising. Rates requested by insurers for 2026 reflected the expectation that only the sickest (and most expensive to cover) individuals will continue to prioritize buying health insurance, Pennsylvania Insurance Commissioner Michael Humphreys said during a call with reporters in September. If this happened, there would be fewer healthier people to share the cost, resulting in higher premiums for those who stay enrolled.

Already, many uninsured people cite the high cost of insurance as the main reason they lack coverage. Sixty-three percent of uninsured adults ages 18-64 said that they were uninsured because the cost of coverage was too high in a 2024 KFF survey.

The impact of this is that those without insurance coverage are more likely to delay or forgo care because of costs, which could lead to worse healthcare outcomes for the individual.

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Devon Trolley, Executive Director of Pennie expressed, although it is still early in this year’s open enrollment, the uncertainty could already be having an impact. “So far this year, Pennie is seeing 16-18% less new enrollees and a lot more people drop enrollment compared to prior years” said Trolley.

“When people call in, they are making the connection between congressional debate around healthcare subsidies and rising premiums on the consumer side.”

The focus remains on D.C., where lawmakers will determine whether the existing tax credits are extended. President Donald Trump said last week that “some kind of an extension may be necessary” but didn’t go into specifics.

Davis said “Pennie extended the enrollment deadline through to the end of January, but we’re running out of time.”

story continues after advertisement

Methodology

Every year, KFF collects premium information from a variety of sources, such as contacting the state insurance regulator in Pennsylvania. From these data, KFF identifies the benchmark silver plan (typically the second-lowest cost silver plan) by county.

Premiums are calculated based on the age and location of the individuals. KFF then calculates the premium tax credits based on family size and income, using the applicable percentage tables produced by the IRS.

You can use KFF’s calculator tool to find out how much you or your family would pay in premiums with and without the ACA's Enhanced Premium Tax Credits.

Staff Contributors

Design, data analysis, and reporting: Jasen Lo

Development: Jasen Lo and Garland Fordice

Data: KFF

Editing: Sam Morris

Copy Editing: Brian Leighton
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December 3, 2025
RFK Jr.’s vaccine advisers plan biggest change yet to childhood schedule

Federal vaccine advisers selected by Health Secretary Robert F. Kennedy Jr. are planning to vote on ending the practice of vaccinating all newborns for hepatitis B and to examine whether shots on the childhood immunization schedule are behind the rise of allergies and autoimmune disorders, the newly appointed chair of the group told the Washington Post.

Kirk Milhoan, a pediatric cardiologist and critic of coronavirus vaccination who recently took over as chair of the influential vaccine panel, said members meeting Thursday and Friday are broadly scrutinizing vaccines recommended for children. The wide-ranging discussions on the timing of vaccines and ingredients could signal major changes to how children in the United States are vaccinated, marking the latest flash point in an accelerating reshaping of immunization policy under Kennedy.

For decades, the childhood and adolescent immunization schedule has called for administering vaccines at set milestones. But Kennedy, the founder of an anti-vaccine group, has long linked the rise of chronic disease, autism, and food allergies in the U.S. to what he calls the “exploding vaccine schedule” — claims that have been rebutted by medical associations and extensive research into the safety of shots.

The members of the Advisory Committee on Immunization Practices are preparing to make their most significant change to the childhood vaccine schedule yet since Kennedy purged the panel and replaced members with experts who have largely been critical of public health vaccination practices.

The new members plan to vote Thursday on scrapping the recommendation to give babies a dose of hepatitis B vaccine within 24 hours of birth if their mothers test negative for the virus. Instead, the panel is weighing a delay in that first dose byan interval that is “still being finalized,” Milhoan said. Vaccine advisers pushed back a vote on hepatitis B vaccine recommendations at their September meeting following disagreement.

The birth dose has been credited for a 99% drop in infections in children and teens since the 1991 recommendation from the Centers for Disease Control and Prevention and the American Academy of Pediatrics, according to a 2023 study in the official journal of the U.S. Surgeon General.

Critics of the birth dose, including Kennedy, say that it is unnecessary to vaccinate all children for the virus when the vast majority are not at risk for infection.

Clinicians say the birth dose acts as a safety net to give infants immediate protection if they acquire the infection from mothers whose infection status is unknown, incorrectly documented or whose test results are delayed.

ACIP makes recommendations to the CDC director on how approved vaccines should be used. CDC directors have almost always adopted the committee’s recommendations, which compel insurers to pay for vaccines and have traditionally guided pediatricians and medical organizations.

The committee also plans to begin public discussions on its effort to review the childhood immunization schedule and the cumulative health effects of the dozens of shots children receive.

“We’re looking at what may be causing some of the long-term changes we’re seeing in population data in children, specifically things such as asthma and eczema and other autoimmune diseases,” Milhoan said in an interview Monday.

“What we’re trying to do is figure out if there are factors within vaccines,” he said, such as their ingredients or unintended substances contaminating them during manufacturing.

Milhoan said the panel is focusing on the use of aluminum as an adjuvant, an ingredient added to vaccines to help the body produce an immune response strong enough to protect the person from the disease.

Aluminum salts are in more than a dozen routinely recommended vaccines such as hepatitis A, hepatitis B, diphtheria-tetanus-containing vaccines, Haemophilus influenzae type B, HPV, and meningococcal B and pneumococcal vaccines. Adjuvants are essential because without them, the vaccine might not be able to trigger adequate immune responses.

Aluminum salts have been used safely in vaccines for more than 70 years, according to the CDC. Aluminum-adjuvant-containing vaccines have only uncommonly been associated with severe local reactions, according to the Food and Drug Administration, which tests vaccines containing adjuvants extensively in clinical trials before they are licensed. The agency notes that the most common source of exposure to aluminum is food and drinking water.

Public health and medical experts have raised alarms that the panel is moving toward recommending that only vaccines without aluminum adjuvants be used, a move that health and industry experts have said would be expensive and difficult on a practical level and could lead to shots being pulled from the market. Milhoan said the panel is not calling for the removal of aluminum from vaccines.

“We’re not saying that at all,” he said. “We’re just starting to have the discussion.”

The FDA generally has the responsibility to direct manufacturers to remove ingredients from vaccines. Some high-level FDA officials think that it would be infeasible to take aluminum adjuvants out of vaccines and that it cannot be done on any practical timeline, according to a senior federal health official who spoke on the condition of anonymity to be candid.

Vaccine industry officials said that removing aluminum adjuvants from vaccines would cost billions of dollars and that finding a replacement would take years, according to people involved in the drug industry who spoke on the condition of anonymity to avoid publicly antagonizing the administration. The costs and technical complexities of doing so are enormous, one of the people said.

The two-day ACIP meeting this week follows intense upheaval in the federal vaccination system.

The committee has come under intense criticism from public health groups who accused the new members of botching and misstating science to further an agenda to undermine vaccines.

Sean O’Leary, who chairs the infectious-diseases committee of the American Academy of Pediatrics, said revisions to the childhood immunization schedule by the newly reformulated ACIP “should not be trusted.”

“Any changes they do make could be devastating to children’s health and public health as a whole,” O’Leary said in a briefing with reporters.

Andrew Nixon, a spokesman for the Department of Health and Human Services, said in a statement that the vaccine panel “remains committed to evidence based decision making, and will carefully consider all data before any recommendation is made.”

HHS announced Monday that Milhoan would be chair because his predecessor Martin Kulldorff, a Swedish biostatistician and prominent critic of the public health response to COVID, is joining the health agency in a staff role.

Milhoan is affiliated with an organization that promoted ivermectin as a coronavirus treatment despite trials finding it is not effective, and in March, he called for mRNA vaccines to be halted.

Former CDC director Susan Monarez said she was fired in August after refusing to rubber-stamp recommendations from the reformulated committee, and several top CDC officials resigned in protest.

Last week, the CDC revised its website to contradict its longtime guidance that vaccines don’t cause autism. Kennedy told the New York Times he personally directed the change.

On Friday, the nation’s top vaccine regulator, Vinay Prasad, announced plans to impose a more stringent approach to approving vaccines, including the annual flu shot, citing his team’s conclusion — without detailing the underlying evidence — that coronavirus vaccines had contributed to the deaths of at least 10 children.

With the exception of the vote on hepatitis B vaccine, the federal vaccine advisers have not scheduled any other votes on the childhood vaccine schedule this week. According to the draft agenda, there are no presentations about vaccine effectiveness, access, equity or practical consequences of disrupting well-established schedules, which were always included before panel membership changed.

Milhoan said vaccine benefits are well known and have been extensively discussed.

“Not enough attention is being paid to risk,” he said.

December 2, 2025
The Foundation for Delaware County’s Family Village aims to close health gaps in Delaware County

Tonya Robertson was working one of her three jobs at a charter school in Chester when she broke down crying to a colleague: She was homeless, living in a domestic violence shelter with three children, and pregnant with twins.

Her co-workers suggested she talk to the school’s counselor, who gave her a stack of applications to apply for federally funded food support, at-home prenatal nurse visits, and maternal health resources, all coordinated through The Foundation for Delaware County.

The nonprofit has for almost a decade provided access to safety net programs such as Women, Infants, and Children, the nutrition program known as WIC; Healthy Start; and the Supplemental Nutrition Assistance Program (SNAP), the food program for low-income families. It also offers a menu of other support services for families, such as a program that provides at-home prenatal visits, housing assistance, legal aid, doulas, mental health resources for new mothers, and a fathers’ support group.

“They had so many resources — things I was scared to open up my mouth about, things I didn’t want to say I needed,” said Robertson, 39, of Marcus Hook.

She said she wishes she’d known about the organization sooner, during the years she struggled to raise her three older children as a single mother.

Now the foundation is rebranding its offerings as the Family Village, in an effort to raise awareness about the nonprofit’s full range of services. Foundation leaders said that in the past, people may have connected with the organization for a specific resource, such as WIC or SNAP, without learning about other programs they could benefit from. The idea of the Family Village is to make the foundation’s services more cohesive, wrapping around those in need.

The initiative has been years in the making, but is especially timely after the county’s largest health provider, Crozer Health, closed earlier this year when its for-profit owner filed for bankruptcy. The health system had long been an anchor for Chester and the surrounding communities, providing critical access to maternity, pediatric, and mental health services.

Here’s Delaware County’s plan for addressing emergency response shortages following Crozer’s closure

“Children don’t come with instructions. We all need a helping hand at some point,” said Joanne Craig, the foundation’s chief impact officer. “We have this great continuum of resources for families, but from the outside looking in, it wasn’t always easy to see and understand.”

An ambulance drove by the entrance to Crozer-Chester Medical Center, in Upland. This hospital closed earlier this year.

Filling gaps in Delaware County

The Foundation for Delaware County was formed in 2016, when the nonprofit Crozer-Keystone Health System was sold to Prospect Medical Holdings. When for-profit companies acquire nonprofit health systems, Pennsylvania law requires the nonprofit assets be set aside in an independent charity. Crozer’s nonprofit assets became the Foundation for Delaware County.

The foundation’s overarching mission is to support the health and welfare of Delaware County residents by coordinating government safety-net programs and creating its own offerings to help families in need. The foundation also provides millions of dollars in grants to nonprofits and charities to support public health, housing, and youth development.

With $53.9 million in net assets as of October, the foundation is the largest philanthropic organization in Delaware County, serving some 8,000 people a year.

Many of the foundation’s most used programs, such as Healthy Start, a federally funded prenatal and early childhood initiative, began before the foundation was spun out of Crozer, in response to the high infant mortality rate in Chester.

Other programs — such as one that provides cribs and safe-sleep education, and a support group for new fathers — were created in response to needs raised by families the foundation was already working with.

“We found ourselves filling gaps,” Craig said.

When Prospect said it would close the remaining Crozer hospitals, The Foundation for Delaware County was pressured by the case’s bankruptcy judge to take on part of the company’s debt to keep the hospital open until a new operator was found. The foundation shelled out $20 million to extend operations temporarily and later contributed $3 million to help former patients obtain their medical records.

The foundation’s new Family Village initiative can’t close all the gaps Crozer’s closure left — the area lost its largest emergency department and maternity ward, the only 24-7 mental health crisis center, and critical pediatric care.

ChristianaCare won an auction to take over five former Crozer outpatient locations in Broomall, Media, Glen Mills, and Havertown, and has plans to open two new micro hospitals in Aston and Springfield.

Delaware County in August selected Belmont Behavioral Health to establish a new crisis response center and expand mental health services.

But Craig said she hopes the foundation’s new approach will help families better access resources that remain available — and that they may not have known about.

Help without judgment

Before connecting with the foundation, Robertson was skeptical of organizations and programs that offered help.

Her grandfather, for instance, berated her for enrolling in SNAP and the at-home nurse program, warning her that she could end up losing her children, if coordinators decided her home and parenting weren’t good enough.

“I’m so scared to let someone in, let them come in my house and see that my house is not up to par, see that I’m struggling with this, or that I can’t feed them,” Robertson said.

“If I can’t feed them, they’re going to take my kids, and I’m going to go to jail,” she added.

Research has found that these fears are often justified, with social service workers deeming parents of color unfit at higher rates than white parents, and equating poverty with neglect.

Healthcare workers, social workers, and teachers are among so-called mandated reporters, who are required to report to Child Protective Services any suspicion of abuse. Only a fraction of reports are substantiated after being investigated, but they stoke fear and can dissuade families from seeking help.

But Robertson was working three jobs and still couldn’t feed her family, so she filled out the forms the school counselor had given her.

Her first prenatal visits through the Nurse-Family Partnership were at the domestic violence shelter where she was living.

Robertson was proud when she was able to afford to move her family into an apartment in Chester. But her nurse told her the gaping hole in the ceiling and mold growing in the corners were unsafe. She connected Robertson with the foundation’s Housing Opportunities Program for Equity, which helps people secure safe housing and navigate problems with landlords.

After her twins were born, the foundation’s Moving Beyond Depression program helped Robertson work through postpartum depression, which may have otherwise affected her ability to work and care for her children.

Two years later, Robertson said she still faces challenges. The recent government shutdown cut off the family’s food stamps, making for tough budgeting decisions earlier this month.

But now she knows where to turn for help, if the load ever becomes too heavy again.

Editor’s note: This story was updated with additional information on the foundation’s mission.

December 2, 2025

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