A federal judge on Wednesday permanently barred President Donald Trump’s administration from implementing most of his first executive order on elections, part of which sought to require people to show documentary proof of citizenship when they register to vote.
The ruling by U.S. District Court Judge Denise Casper in Boston effectively converts a preliminary injunction she issued a year ago, in which she temporarily blocked many of Trump’s efforts to overhaul elections, into a permanent ban.
Casper rejected the Republican administration’s argument that the lawsuit to block the changes brought by Democratic state attorneys general was premature because the rules had yet to be put in place. Instead, she agreed that the Constitution gives states and Congress the authority to regulate elections, and that Trump’s requirements violated the separation of powers.
The Constitution “does not grant the President any specific powers over elections,” wrote Casper.
Among other proposed changes, Trump’s order would have required people to provide documentary proof of citizenship when registering to vote, prevented mail ballots from being counted if they arrive after Election Day, even if they were postmarked by then, and punished states that failed to comply by withholding certain federal money.
In a statement, New York Attorney General Letitia James said she was grateful the court had blocked Trump’s “unconstitutional attempt to seize control of our elections” and would continue to defend voting rights in this year’s midterm elections.
“Generations of Americans fought tirelessly for the right to vote, and we honor their legacy by protecting that right against anyone who tries to undermine it,” said James, a Democrat.
California Attorney General Rob Bonta, whose state was the lead plaintiff in the case, said the ruling reaffirmed the constitutional principle that it s up to the states and Congress to set election rules.
“While we are proud of this result, we are clear-eyed that President Trump’s attacks on voting rights and our elections show no signs of slowing down,” Bonta, a Democrat, said in a statement. “So let me be clear: we will keep fighting back every step of the way.”
Requests for comment sent to the White House and the U.S. Department of Justice were not immediately returned.
The ruling was the latest in a series against the elections executive order Trump signed just months after taking office for his second term. The Republican president has since signed another executive order on elections that seeks to create a national voter list and limit mail balloting. That directive also faces multiple legal challenges.
Last fall, a federal judge in Washington, D.C., overseeing a separate challenge to the first election executive order by civil rights and Democratic Party-aligned groups blocked the government from taking steps to include the proof-of-citizenship requirement on the federal voter registration form. That judge later barred Trump’s defense secretary from requiring documentary proof of citizenship when military personnel register to vote or request ballots.
In an apparent nod to the difficulty of implementing a proof-of-citizen requirement by executive order, Trump is pushing legislation in the Republican-controlled Congress to create such a mandate. The SAVE America Act has passed the House but has stalled in the Senate, leading Trump to advocate for eliminating the filibuster that is blocking the legislation.
On Wednesday, he abruptly canceled the expected signing of a bipartisan housing bill, saying he would not sign legislation until Congress passes his proof of citizenship requirement for voting.
The president and many of his Republican allies have been promoting the narrative that voting by noncitizens is a major problem, when in fact it’s quite rare. The federal voter registration form already requires people to attest that they are U.S. citizens. Violating that is punishable as a felony that can lead to prison or deportation.
In another major voting case, the U.S. Supreme Court is due to issue an opinion soon on whether mail ballots must arrive by Election Day. That could immediately change the rules in 14 states that allow grace periods ranging from days to weeks if the ballots are postmarked by Election Day.
Casper, who was nominated by Democratic President Barack Obama, is the chief judge for the U.S. District Court for the District of Massachusetts.
TOKYO — The head of the U.N.’s nuclear agency said Wednesday that Iranian nuclear enrichment sites would be visited by his inspectors as part of the interim U.S.-Iran deal to reach an end to the war. An Iranian diplomat instead insisted any such visit would only come after a final deal.
The comments echoed contradictory remarks about nuclear inspections a day earlier from the U.S. and Iran. During the week since the two countries signed the deal, their leaders have repeatedly disagreed in public about what that document actually means.
International Atomic Energy Agency head Rafael Mariano Grossi on Wednesday acknowledged the “war of words” over Iran’s nuclear program. But the dueling narratives are playing out on several fronts, including Israel’s war with Iranian-backed Hezbollah militants in Lebanon and how Tehran will spend billions of dollars once unfrozen.
Through the signing of the memorandum of understanding, the U.S. and Iran agreed to a 60-day period to iron out these and other details. Until that happens — during private talks — leaders from both countries will also continue to negotiate in public, raising the risks of derailing the shaky ceasefire in the region.
The fighting between Israel and Hezbollah, a threat to the U.S.-Iran diplomacy, flared on Wednesday. Israel launched an airstrike that killed two people in southern Lebanon, the country’s state-run news agency said. It was Israel’s first airstrike on Lebanon since the latest ceasefire took effect on Saturday. There was no immediate comment from the Israeli military on the strike.
U.N.’s nuclear agency head says inspections will happen
Since Israel launched a 12-day war on Iran in 2025, the IAEA has been blocked by Tehran from visiting enrichment sites. The Islamic Republic is believed to store enough highly enriched uranium to potentially build as many as 10 nuclear weapons, should it choose. Iran maintains that its program is peaceful, though it is the only country in the world to have uranium enriched up to 60% purity without a weapons program.
Grossi’s remarks were the firmest yet from the United Nations agency, which is central to determining the status of Iran’s nuclear stockpile.
“I can understand political statements, they are part of the reality, but the fundamental thing I would like to remind you and draw your attention to is that there has been a memorandum of understanding, signed by both presidents,” he said at the tsunami-hit Fukushima Daiichi nuclear power plant.
The accord “says explicitly that the nuclear activities that are going to be carried out with regards to the nuclear material facilities will be supervised by the IAEA — in all letters,” he said.
“Obviously, to do that, we will have to inspect,” Grossi said. ”Whether this happens the day after tomorrow or in one week or in 10 days, it’s important, but not essential. This is going to happen.”
The deal calls for Iran’s uranium to be “downblended” from highly enriched levels.
Kazem Gharibabadi, an Iranian deputy foreign minister, took a swipe at Grossi after his remarks, saying Tehran didn’t meet with him while in Switzerland.
“These issues will be reviewed and decided only within the framework of a final agreement and as a result of practical action by the other side to end all sanctions and other measures.” Gharibabadi wrote on X.
He added: “You cannot advance the ‘stir up and take over’ policy with media hype.”
IAEA blocked from seeing bombed sites
The IAEA has been allowed to visit other nuclear sites in Iran since the 2025 war. But without accessing the enrichment sites, the IAEA says it can’t verify the status of Iran’s stockpile. Both Iran and the IAEA say Tehran hasn’t been enriching uranium, but nonproliferation experts worry the Islamic Republic may be moving its stockpile.
But the uneasy ceasefire already has been tested by Iran saying it closed the Strait of Hormuz again over fighting between Israel and the Iranian-backed militia Hezbollah in Lebanon.
Israel’s defense minister said Wednesday the U.S. has not demanded that Israel withdraw from Lebanon. Israeli leader Benjamin Netanyahu later declared that “as long as I am Prime Minister, we will maintain the security zone in southern Lebanon.”
Lebanese and Israeli officials are meeting this week in Washington as part of direct negotiations between the two countries, through which Lebanon hopes to reach a plan for Israeli withdrawal.
Technical-level talks between the U.S. and Iran are expected to resume early next week in Switzerland, Pakistan’s Foreign Ministry said Wednesday. Pakistan has been a key mediator.
U.S. has plan to oversee Iran’s frozen funds
The interim deal also includes a pledge to unfreeze billions in Iranian assets. U.S. President Donald Trump wants that money to go toward buying American-grown crops, but Iranian officials say they should decide how its spent.
U.S. Treasury Secretary Scott Bessent said his department would have people in Qatar to oversee what happens with the funds. He said in a CNBC interview that Iran would spend “a very large percent” of its released money on “U.S. foodstuffs and medicines.”
“We will be recycling the money back into U.S. products,” Bessent said.
Marco Rubio is in the Middle East
Secretary of State Marco Rubio traveled in the Persian Gulf for a three-nation tour, starting with a meeting in Abu Dhabi with Emirati President Mohammed bin Zayed Al Nahyan, the State Department said Wednesday.
“We’re not going to do anything that undermines the security of our allies,” Rubio later said while in Kuwait, where the Trump administration announced the limited reopening of the U.S. Embassy that was closed at the height of the Iran war.
Before leaving for Bahrain, Rubio said ongoing negotiations include the creation of “hundreds of specific areas” where Lebanon’s military could secure its territory. He called the discussions part of the process and said it’s not going to “happen overnight.”
KYIV, Ukraine — Ukrainian forces struck a major natural gas processing plant and two key satellite communications centers in their latest nighttime attacks on Russia, Ukraine’s General Staff said Wednesday.
In response, Moscow has ordered the redeployment of some air defense systems from Russian regions to the capital and to Crimea’s Kerch Bridge, a crucial link for supplying Russian troops, Ukrainian President Volodymyr Zelensky said. The bridge connects the Crimean Peninsula with the Russian mainland.
“It is important that as many Russians as possible come to understand that it is the Russian leadership’s rejection of diplomacy that is prolonging the war,” Zelensky said on X.
Zelensky has accepted an unconditional ceasefire demanded by President Donald Trump but Russian President Vladimir Putin has refused.
Ukraine says the stricken gas plant was among the world’s largest
The overnight attack hit the Orenburg Gas Processing Plant, which is part of a complex that also houses the only helium plant in Russia, the General Staff said in a statement on the Telegram messaging app. The attack set the complex on fire, it said.
Orenburg, in the southern Urals near Russia’s border with Kazakhstan, is more than 750 miles behind the front line in eastern and southern Ukraine.
The plant is one of the largest gas complexes in the world, according to the General Staff. It produces helium, used in liquid-fuel rocket engines and guidance systems, and ethane, a key component in producing solid rocket fuel and gunpowder, it added.
Overnight attacks also hit two satellite communication centers used by the Russian military, according to the General Staff.
One was the Dubna Space Communications Center near Moscow, which it described as Russia’s largest ground-based satellite communications complex, and the other was in the Vladimir region east of the capital.
It was not possible to independently verify the General Staff’s report, and Russian officials made no immediate comment.
The General Staff’s statement did not say whether the military used drones or missiles in the assault, but drones have recently been used to strike Moscow and St. Petersburg.
Ukraine keeps hammering Crimea
Ukraine has recently focused its drone and missile attacks on Crimea, aiming to cut off the vital Russian-held peninsula, and overnight drone strikes knocked out power in Sevastopol, Mikhail Razvozhayev, the city’s Moscow-installed governor, said Wednesday.
Crimea, which was illegally annexed by Russia in 2014, sits in a strategic location on the Black Sea. It has naval bases and also provides an important supply line to Moscow’s forces inside Ukraine.
Ukraine recently destroyed more than 60,000 tons of Russian ammunition when it hit a Baltic Fleet arsenal near St. Petersburg, Zelensky said.
Ukraine is trying to disrupt military supply lines in Crimea and strike the peninsula’s power grid at the height of the summer tourist season. Kyiv hopes the campaign will embarrass Putin and increase public pressure on him to end the war, according to Western analysts.
Ukraine’s Security Service said Wednesday it struck two military airfields and destroyed missile systems in Crimea.
Attacks kill at least 6 people
Two staff members of Norwegian People’s Aid were killed during a Russian attack in Ukraine, the demining organization said Wednesday, although local officials said only one person was killed.
Four other workers with the organization were injured, two of them critically, according to the head of the southern Kherson region’s military administration, Oleksandr Prokudin.
Two people were killed and two others wounded overnight in a Ukrainian drone strike on Russia’s Nizhny Novgorod region, east of Moscow, regional Gov. Gleb Nikitin said. Also, a Ukrainian drone strike killed one person overnight in Russia’s Belgorod border region bordering Ukraine, local officials said.
Ukraine’s air force, meanwhile, said Russia launched 101 long-range attack drones overnight.
Russian drones attacked the city of Balakliia in northeastern Ukraine, killing a 56-year-old woman, according to Oleh Syniehubov, head of the Kharkiv regional military administration. Also, a 57-year-old streetcar driver man died as a result of a Russian guided aerial bomb that hit the outskirts of Sumy, said Oleh Hryhorov, head of the regional military administration.
In addition, the death toll rose to four from Tuesday’s ballistic missile strike using cluster munitions on Kryvyi Rih, Zelensky’s hometown, after a 62-year-old woman died from her injuries, said Oleksandr Vilkul, the head of the city administration, said.
DALLAS — Camp Mystic filed for Chapter 11 bankruptcy reorganization on Wednesday, nearly a year after catastrophic floods killed 25 campers and two teenage counselors at the Christian camp for girls along the Guadalupe River in Texas.
Camp Mystic has been under increasing pressure since the July 4 disaster. Owners had planned to reopen the Texas Hill Country camp this summer for its 100th anniversary but reversed course in April amid outrage from victims’ families and lawmakers. Victims’ families filed lawsuits accusing the camp of failing to protect the girls as the powerful floodwaters approached.
Camp Mystic’s owner, Richard Eastland, also died in the flood.
The camp listed its debt at more than $10 million, according to the filing made in federal bankruptcy court in Houston. An attorney for Camp Mystic has not responded to an email and a phone message seeking comment.
“Bankruptcy will not stop all responsible parties from being held accountable,” Paul Yetter, a lawyer who represents multiple families of campers and counselors who died at Camp Mystic, said in a statement. “These innocent girls deserve justice.”
For decades, Camp Mystic was a summer staple and an institution for generations of families, who dropped off their girls at the sleepaway camp to ride horses, canoe, fish and attend Bible studies. Other summer camps in Kerr County, west of Austin, did not take on such devastating flooding and in some cases have reopened.
All told, the destructive flooding killed at least 136 people along a several-mile stretch of the river, raising questions about how things went so terribly wrong.
In the aftermath of the tragedy, the Eastland family spent months determined to reopen the camp this summer, pointing to enhanced safety measures that included flood warning river monitors and putting two-way radios enabled with national weather alerts in every cabin.
By the spring, Camp Mystic’s attorney said it was ready to reopen for business for nearly 900 campers.
But assurances of safety did not convince victims’ families and some Texas lawmakers. State regulators found nearly two dozen deficiencies in the emergency operations plan submitted by the owners, including in proposals for flood warning evacuations and safety training.
The decision not to reopen followed weeks of testimony in court hearings and legislative investigations that laid bare the camp’s lack of detailed planning for a flood emergency and its reliance on poorly trained staff.
Families of the victims packed the hearings, some wearing “Heaven’s 27” pins with photographs of their daughters. They listened to the details of missed flood warning signs, the descriptions of the flood and the decision to leave the girls in their cabins until it was too late. Testimony included video of the raging floodwaters as a girl repeatedly screamed “help!” somewhere in the distance.
Before halting the reopening plans, Camp Mystic invited journalists and lawmakers to review safety improvements at the camp and promised that no camp activities would take place in the low-lying area that was devastated by the flood. The Eastland family also stressed that hundreds of families wanted to return.
JDEIDAT MARJAYOUN, Lebanon — Looking out from a friend’s balcony, Milia el-Cheikh struggled to find her own home in the ruins of her now-deserted village, its entrances strung with barbed wire.
Her village of Dibbine is one of several Shiite-majority communities across southern Lebanon destroyed by Israeli forces battling the Iran-backed Shiite Hezbollah. Israel has occupied vast areas and fighting has raged through declared ceasefires. The latest truce — part of the interim peace deal between the United States and Iran — has largely held.
El-Cheikh, one of the few Christians from Dibbine, found shelter in another village but regularly visits Jdeidat Marjayoun, a mostly Christian village next to her hometown, to have coffee with a friend from church. Before the war, it was a comforting ritual. Now it takes place against a backdrop of loss and fear.
“I don’t know anything about my house,” she said. “Nothing is more agonizing than not being able to get to your home.”
Jdeidat Marjayoun is one of a string of towns and villages visited by the Associated Press on the blurry edge of the Israeli-occupied zone of southern Lebanon. The military has pushed out the mostly Shiite population, believing they harbor Hezbollah, and many towns have been demolished.
Residents of neighboring Christian, Sunni and Druze communities have been allowed to stay, but the conflict has transformed their lives. Their homes have been struck, road closures have isolated them from the rest of Lebanon, and nighttime raids by Israeli troops have terrified residents.
Israeli warnings against hosting Hezbollah fighters have effectively barred them from taking in displaced Shiites, driving a wedge between longtime neighbors and stoking political and sectarian tensions.
Lebanon is a linchpin for the Iran deal
The latest conflict began when Hezbollah fired rockets into Israel days after Israel and the U.S. launched their war on Iran on Feb. 28. Israel invaded Lebanon and has expanded its zone of control up to seven miles deep in places.
As troops advanced, Israel warned people to leave large areas of southern Lebanon, and in April published a list of 53 towns and villages — mostly Shiite — where residents are barred from returning. On Thursday, it added eight more predominantly Shiite villages.
Israel says its troops will remain in southern Lebanon for self-defense. It says Hezbollah was deeply entrenched and has released videos purporting to show tunnels and other military infrastructure in residential areas.
Iran says any wider truce must include Lebanon and that Israel must withdraw, while Hezbollah says it will resist occupation. Lebanon’s government has also called on Israel to withdraw.
They live in the Israeli military’s shadow
Mixed villages and towns on the edge of the security zone, spread over hills and valleys among orchards and olive groves, stand within sight of their devastated neighbors. Residents have vowed to stay.
The Shiite town of Khiam — now an empty white swath of flattened buildings controlled by Israel — can be seen from the Christian village of Qlayaa.
Qlayaa’s residents are effectively barred from reaching their olive groves in the valley between. “Now another season is lost,” said Hanna Daher, Qlayaa’s mayor.
A priest in Qlayaa was killed by shelling as he inspected an earlier strike, and a father and his two children were killed in a drone strike while driving to Qlayaa. Israel says it only targets militants.
In Jdeidat Marjayoun, a house was bombed on suspicion that militants were using it. Rockets — believed to be from Hezbollah — damaged a church’s dome. In other places, solar panels, power transmitters and water stations have been hit.
El-Cheikh fled Dibbine with her neighbors in early March after Israel warned people to leave. In late May, following weeks of fighting, Israeli forces raided Dibbine before withdrawing in early June.
As the fighting raged, el-Cheikh’s friend, Lolitta Costantine, huddled with her husband in their home in Jdeidat Marjayoun, and at one point stayed with neighbors. Cracks caused by explosions run down the walls of her home. Windows were shattered and doors knocked loose. She keeps shrapnel as a reminder of the ordeal.
“We didn’t know where the danger was coming from,” Costantine said.
Tensions rise as the displaced are turned away
Shiites seeking shelter from the fighting have been turned away by those who fear Israeli strikes or eviction, aggravating tensions that have been mostly dormant since Lebanon’s 1975-1990 civil war.
When a Qlayaa resident hosted a friend from a Shiite village in his orchard, his house was bombed, said Daher, the mayor. Other residents have asked Shiites seeking refuge to leave.
“We told them, we don’t want problems for you or for us,” Daher said.
Israel has warned Jdeidat Marjayoun’s municipality not to allow in people displaced from neighboring villages, saying it could put the town at risk or force it to be evacuated, the municipality said on social media.
“We were forced to ask some to leave the town,” said the parish priest, Father Philip Habib Okla. “It caused many disagreements and tension,” he added. “We are counting on faith to remain united.”
The Israeli military said it has warned people in parts of southern Lebanon not to allow Hezbollah to use their villages. It said Hezbollah operates in civilian areas, endangering residents.
During Israel’s 1982-2000 occupation of southern Lebanon, the area was a bastion of the South Lebanon Army, a mostly Christian militia working with the Israeli military. When Israel withdrew, some of them fled to Israel while others faced trial in Lebanon, where they were widely seen as collaborators.
Some residents worry they will be unfairly painted with that brush for staying in their homes. Few are willing to speak of the tensions openly, fearing retaliation by Israel or Hezbollah.
At a church visited by AP, a man shouted in exasperation that everyone had become suspicious of each other, even among Christians. He blamed Hezbollah for dragging Lebanon into the war, saying it had made a serious mistake.
‘It is like the West Bank here’
Late one night in March, Israeli forces surrounded a building in the mostly Sunni village of Halta. They burst in and arrested Chadi Abdel-Al, who screamed “my heart” as he was being beaten and dragged into a van, according to his mother, Ayesha al-Qaderi, who lives in the same building.
In the commotion, a 15-year-old relative, Mohammad Abdel-Al, ran through the dark in his pajamas toward the house, his grandfather, Hatem, said. The Israeli soldiers shot him dead. A neighbor, who was out on his balcony, was wounded.
The Israeli military said it had detained the commander of a local militant group and that its forces had opened fire at two individuals who it said had approached in a suspicious manner.
In a separate incident, Israeli troops detained three farmers from Halta during a raid on a nearby village.
They are among at least eight people detained by Israeli troops since March, according to Lebanese media. The Israeli military says they were suspected of involvement in militant activities and plots against its troops.
“We still don’t know why they kidnapped them. Maybe to instill fear in the village and to send a message that they see everyone,” said Issa Abdel-Al, the community’s leader.
“It has become like the West Bank here,” he added, referring to the occupied Palestinian territory.
Al-Qaderi, who has heard nothing about her son since he was spirited away, said: “I just want to know his fate.”
NEW YORK — Three Democrats who made criticism of Israel central to their political identities swept to victory in House primary races in New York City on Tuesday, signaling a new era of skepticism in their party toward the Jewish state and its actions.
The striking results reflected a fast-moving shift in liberal politics. Democratic voters are now more likely to be critical of Israel and its government than they are to be supportive, according to several recent polls, a monumental change in American sentiment.
And while many Democratic officials remain supportive of Israel, next year’s class of congressional Democrats is on track to be more wary about the United States’ relationship with Israel than at any other moment since the Jewish state was established after World War II.
The primary triumphs in deep-blue districts of Brad Lander, Claire Valdez, and Darializa Avila Chevalier came after each was endorsed by Mayor Zohran Mamdani of New York, whose advocacy for the Palestinian cause has been integral to his rapid political rise. At a rally for the candidates last week, he called the nation’s leading pro-Israel organization part of a group of “monsters” that he said were too powerful in American politics.
At Avila Chevalier’s victory party Tuesday night in Harlem, supporters chanted “free Palestine” while she pushed her campaign’s “babies, not bombs” slogan. She suggested in her victory speech that her win represented a shift in how Democrats in New York would operate.
“Today, we make it clear: The politics of the past ends today,” she said.
Super political action committees allied with the American Israel Public Affairs Committee, the pro-Israel group, have spent huge amounts of money on this year’s midterm elections to try to turn the tide in voter opinion. The organization has had some victories, saying in a statement Tuesday night that 180 Democrats and Republicans it had endorsed had advanced to the November election. The group congratulated a Maryland House candidate its allied super PAC spent millions backing and said this would “ensure this seat remains represented by pro-Israel leadership.”
But despite those successes, AIPAC has largely been on the defensive.
Polls show that support for Israel among Democrats has sharply and steadily eroded since the Hamas-led terrorist attacks on Oct. 7, 2023, and Israel’s subsequent destruction of most of the Gaza Strip. A New York Times/Siena survey this spring found that 60% of Democratic supporters said they were more sympathetic to Palestinians than Israelis, compared with 15% who were more supportive of Israel.
“You’re seeing more and more Democrats making it clear that we should provide no U.S. taxpayer support to the government of Israel,” Sen. Chris Van Hollen (D., Md.) said in an interview Tuesday. Next year, he added, “I hope we will see a Congress that doesn’t provide reflexive unconditional support to the government of Israel.”
Perhaps the most significant of the New York races pitted Rep. Dan Goldman, a two-term Democrat from Brooklyn, against Lander, the former New York City comptroller, who staked his campaign on opposing Goldman for being insufficiently critical of Israel.
The race between the two men, Jews who both describe themselves as liberal Zionists, symbolized how Democratic voters, especially younger ones, have shifted away from support for Israel.
But perhaps the most outspoken anti-Israel Democratic candidate who won in New York City, Avila Chevalier, defeated Rep. Adriano Espaillat, who has been a steadfast supporter of Israel in his decade in Congress. Avila Chevalier spoke often of having lived in the West Bank and attended a rally on Oct. 8, 2023, that was widely criticized for featuring speakers who appeared to justify the attacks a day earlier.
Like Lander and Valdez, Avila Chevalier is now the Democratic nominee in a solidly blue House district and is a heavy favorite to wind up in Congress come January.
New York Mayor Zohran Mamdani (left) congratulates Brad Lander after his victory in the Democratic primary election for the seat held by Rep. Daniel Goldman (D., N.Y.) in Brooklyn on Tuesday night.
The fights in New York became increasingly nasty in the final days of the campaign. A local coffee shop chain wrote on social media that Goldman, who is critical of Israel’s government but has opposed banning aid to the country, was not welcome because it did not serve “genocide enablers.”
Pitched midterm battles over Israel
The main super PAC tied to AIPAC, the United Democracy Project, has spent more than $25 million so far this year, in addition to at least $5 million it has funneled to create new super PACs.
That sum may be just a fraction of what is to come. The group started the year with more than $96 million, making it one of the best-funded PACs in the country.
Its most prominent spending battles so far have been in New Jersey and Illinois. But Israel also became a driving issue in several House primaries in California.
The results have been mixed. In the Chicago suburbs, Daniel Biss, the mayor of Evanston, Ill., won a House primary after explicitly attacking AIPAC. The group spent $7 million in the race, mostly aimed at defeating Biss, who is Jewish. But in the final days of the primary, when it became clearer that a candidate even more critical of Israel than Biss could win, the super PAC dialed back its attacks on him.
In New Jersey, the AIPAC-tied super PAC targeted Tom Malinowski, a popular former member of Congress who supported more restrictions on aid to Israel. But in an embarrassing turn for AIPAC, Analilia Mejia, a progressive organizer who was loudly critical of Israel, beat him in the special election and then won a later primary.
AIPAC has won victories, too. Two of its preferred candidates in Illinois won crowded primaries, even as another anti-AIPAC Democrat won in a Chicago district.
Democratic congressional candidate Claire Valdez speaks during a June 18 rally in Brooklyn ahead of New York’s primary election.
In Washington, defending Israel has fallen out of favor among many congressional Democrats, with a large majority of senators who caucus with the party voting this year to block some U.S. arms sales to Israel.
“Do I think the Overton window on Israel has shifted more in the last six months than my entire career?” said Amy Rutkin, the longtime chief of staff to Rep. Jerry Nadler of New York, the longest-serving Jewish Democrat in the House, who is retiring. “It surely, absolutely has.”
The shift is part of a generational change after the retirements of longtime Democratic leaders such as former House Speaker Nancy Pelosi of California and Rep. Steny Hoyer of Maryland, the longest-serving Democrat in the House, both of whom are stalwart supporters of Israel. Rep. Hakeem Jeffries of New York, the minority leader, is also a backer of Israel.
But among Democratic voters, support for Israel has crumbled. And even House Democrats who are broadly supportive of Israel are highly critical of Benjamin Netanyahu, the country’s prime minister. Few enthusiastically support the right-wing Israeli government, and many are openly counting down until elections there, which are scheduled for October.
Shifting winds in New York
The Democratic shift on Israel has been particularly notable in New York, home to the country’s largest Jewish population and a mayor who has frequently focused on the plight of Palestinians.
“The monsters that we are up against, they take many different forms,” Mamdani said at a recent rally for his endorsed candidates, before adding that AIPAC believed “the only thing more frightening than democracy being allowed to run its course is an end to genocide and Netanyahu’s wars.”
Many Jewish leaders and groups criticized the remarks, arguing that they echoed antisemitic tropes at a time of increased hate crimes targeting Jews.
One of the candidates the mayor backed, Avila Chevalier, defeated Espaillat, the chair of the Congressional Hispanic Caucus. He was the only candidate in New York who was explicitly backed by AIPAC’s super PAC, which transferred money to a separate group that supported him.
In the 10th Congressional District, which includes lower Manhattan and a large area of Brooklyn and is one of the most Jewish districts in the country, Goldman frequently argued that a focus on foreign policy was misplaced given voters’ domestic priorities. Those arguments fell flat: He lost badly, trailing late Tuesday by more than 30 percentage points.
Several Jewish Democrats who are most likely heading to the House, including Lander and Biss, have taken a more antagonistic tone toward the current Israeli government. But whether they will take radically different approaches to policy remains to be seen.
AIPAC as a litmus test
For decades, AIPAC was the leading voice of a bipartisan congressional consensus on the importance of the U.S.-Israel alliance. Now, many Democrats in contested primaries want nothing to do with it.
The organization has become a symbol of dark money, alongside organizations backing the cryptocurrency and artificial intelligence industries. And all three interest groups are spending money on many of the same races.
None of the advertisements paid for by the AIPAC super PAC even mention Israel, focusing instead on top-polling issues in each area.
In Maryland, the super PAC spent more than $5 million to back Adrian Boafo, a state legislator, in the primary to replace Hoyer. The ads focused on Boafo’s biography and his accomplishments in Annapolis. Cryptocurrency interests spent an additional $3.4 million to back Boafo, according to AdImpact, a media tracking firm. He ended up finishing well ahead of a crowded Democratic field.
The next Democratic primaries to revolve around Israel will come in August, when Minnesota, Michigan and other states are holding competitive intraparty contests.
At a Democratic primary debate for Senate last week in Minnesota, Lt. Gov. Peggy Flanagan declared that “I don’t take AIPAC money because my values don’t align with AIPAC.” Her opponent, Rep. Angie Craig, who has been endorsed by AIPAC in the past, replied that she had taken “not one penny” from the group and called for Netanyahu to lose his reelection bid in October.
The most divisive race, however, will be in Michigan, which has large Jewish and Muslim populations.
The Democratic Senate primary there includes Rep. Haley Stevens, a staunch backer of Israel, and Abdul El-Sayed, a progressive public health official who has called Israel’s actions a genocide and opposes any military aid to the country. A third candidate, State Sen. Mallory McMorrow, has tried to take a middle path on Israel, but is struggling in the polls.
NAIROBI, Kenya — Reported Ebola cases have surged above 1,000 in the Democratic Republic of Congo, and health experts are warning this could be one of the worst outbreaks, rivaling the largest on record, which killed 11,365 people in West Africa from 2014 to 2016.
On Wednesday, French officials announced the country’s first case of Ebola from this outbreak — a doctor who had traveled to Congo on a humanitarian mission. The doctor was being treated at a special medical facility and was reported to be in stable condition, according to a statement from the French Health Ministry.
With more than 250 confirmed deaths in Africa, the World Health Organization said Tuesday that the current outbreak, first reported in May, has the largest number of confirmed cases during the first month of any Ebola outbreak in Africa.
There have been 17 outbreaks since the discovery of the virus in 1976, involving three strains. The current strain, Bundibugyo, has been seen only twice before, in 2007 in Uganda and in 2017 in Congo. There is no specific treatment or vaccine for it.
“None of those previous outbreaks had the magnitude of the volume of cases and geographical spread that we are seeing today,” said Manuel Albela, an epidemiologist with Doctors Without Borders who is working with the Ebola response team.
“And even that comparison — again, one month into the declaration of the outbreak — it falls short, because we have never seen almost 900 confirmed cases just after one month of the declaration of the outbreak,” Albela said. “Going back to the comparison with the outbreak in West Africa, it’s a very similar situation because we don’t have a specific treatment for this specific virus.”
Diagnosing Bundibugyo is complicated, because there is no specific test kit for the rare strain and this is one reason the strain initially spread fast without detection.
Red Cross workers prepare to bury Vanisa Anifa, a 6-month-old orphaned girl who died of Ebola, at the Bigo Cemetery, in Bunia, Congo, on Friday.
The virus is now present in at least three eastern provinces in Congo. Ituri province, the epicenter, has recorded 954 confirmed cases, with 91 more in North Kivu province and three in South Kivu province, according to government data released Sunday, with 267 people reported dead.
In neighboring Uganda, 20 infections and two deaths have been reported.
Misinformation and distrust about the virus have complicated the response, leading many infected people to refuse treatment.
Health workers have been attacked during contact tracing and when relatives are denied access to the infected bodies of their loved ones.
On Friday, in the Mambangu neighborhood of Beni, angry residents attacked workers who went to disinfect the home of someone who died of Ebola, according to said Serge Kambale, 39, a doctor who spoke to the Washington Post by phone from the city.
During the incident, two workers were injured when the locals started throwing stones at them. Fabrice Kavono, a witness, said that the crowd attacked the health workers and accused them of fabricating the disease for material gain.
“It is the second time Ebola is in Beni, but they say it’s in Bunia and Mongbwalu only and that they are making it up here to make money,” Kavono said.
Another witness told the Post that people with relatives in Mongbwalu, the mining town in Ituri province at the center of the outbreak, were fleeing in droves to relatives in parts of North and South Kivu — spreading the virus as they traveled.
Onesphore Bangenza, the leader of the Ebola Response Team in Bunia for Mercy Corps, a nonprofit group, said that burials in which relatives insisted on washing bodies of loved ones and touching them were still happening, and that residents were not adhering to distancing guidelines.
“We have motor taxis transporting more than three people,” Bangenza said. “There are people who do not want to be tested. The scale of the outbreak could be larger.”
In May, 30 people who had exhibited Ebola-like symptoms died at a displacement camp in Kigonze that hosts families fleeing conflict in the region, Reuters reported.
Two aid workers confirmed that 13 deaths had been reported at the camp within 48 hours and that more 30 total deaths were expected.
“The constant movement and overcrowding of refugees in camps is causing fear that this virus could spread even more and the scale of the outbreak may grow” Bangenza said, adding that conditions in the camps were abysmal. “No water, no latrines,” he said. “The hygiene condition is very, very bad.”
New Ebola cases have been reported in cities such as Beni where an ISIS-affiliated rebel group, the Allied Democratic Forces, has waged attacks, prompting families to flee their homes.
At a local hospital in Beni, a patient admitted with malaria asked to be discharged early because he feared that others at the hospital would have Ebola and infect him, he told the Post. While he was in the hospital, the ADF attacked an area near the hospital, killing seven people.
“First, I was afraid that because I exhibited malaria symptoms, which are similar to Ebola, I would be assimilated with people with Ebola,” the patient said, speaking on the condition of anonymity to discuss private health matters. “In the small hospital, there is no clear follow-up, so anything can happen. Then, the attack scared me more.”
Congo has been besieged by years of conflict especially in the mineral-rich eastern regions of the country, which boast the world’s largest deposits of coltan and cobalt, used to manufacture electronics.
Cycles of violence have also weakened health systems in the region.
Just last week, protests broke out in Kinshasa, Congo’s capital, after people learned of a proposal to change the constitution to allow an extension of term limits, which would allow President Félix Tshisekedi to stay beyond his current term, which was supposed to be his last.
The Rwanda-affiliated M23 rebel group was working with health teams after two cases of Ebola were discovered in Goma, a city that M23 controls, the group’s deputy spokesperson, Oscar Balinda, told The Post. M23 controls large swaths of territory in eastern DRC.
The United States has sent $375 million in aid, so far, to contain this latest Ebola outbreak, Trump said during a recent Group of Seven meeting in France.
Experts say more must be done contain the outbreak.
“One of the key factors to try to control an outbreak of Ebola is to decentralize as much as possible the testing capacity, so that the tests can be done in the places where the cases are,” said Abela, the epidemiologist. “And I think that this, little by little, is happening. But, as usual, we want things to happen yesterday.”
Abela also said that contact-tracing is crucial but not enough is being done. “At the moment, I think there are 70 percent of the contacts being followed up when the target is normally 95 percent, according to the DRC authorities.”
In his battle to clean the murky waters of the Lincoln Memorial Reflecting Pool, President Donald Trump has tried draining, painting, hydrogen peroxide, and what the Interior Department describes as “high-tech nanobubble ozone technology.” But he has seemingly overlooked two of the most important factors that experts say are driving unsightly — and sometimes dangerous — profusions of algae: pollution and climate change.
Algae thrive in warm, still waters, causing populations to explode as global temperatures rise, said environmental engineer Steve Chapra, an emeritus professor at Tufts University.
Meanwhile, rampant human development has increased the amount of fertilizer and sewage produced by farms and cities, and severe storms intensified by the warmer atmosphere are causing more of these pollutants to run off into local waterways — providing algae with the nutrients they need to grow.
In a 2017 study, Chapra and his colleagues projected that climate change would cause a more than fivefold increase in the number of days when U.S. water bodies are affected by harmful algal blooms.
Short-term measures like those Trump has pursued may temporarily reduce algae populations in some water bodies, Chapra said. But unless they grapple with warming and nutrient pollution, any efforts to address these blooms in the Reflecting Pool and elsewhere are doomed to fail in the long run.
The consequences could be profound, because the problems presented by blooms go far beyond aesthetics, he added. They can disrupt aquatic food chains, deplete oxygen in water bodies and even produce deadly toxins.
“It’s probably the biggest water quality problem in the world,” Chapra said. “The Reflecting Pool is the canary in the coal mine.”
A spokesperson for the Interior Department did not respond to questions about whether the department had considered nutrient pollution or water temperature in planning the pool’s refurbishment. In an email, the agency reiterated that the National Park Service is using hydrogen peroxide and ozone nanobubbles, which break up algae by damaging their cells.
The Reflecting Pool has been beset by algae blooms, as seen Monday.
The root causes of blooms
Algal blooms have long thrived in the Reflecting Pool, thanks to stagnant, shallow water enriched by pollution and warmed by sweltering D.C. summers.
Since 2012, the pool has been filled from the Tidal Basin, which in turn is fed by the Potomac River. Both water bodies contain excessive amounts of nitrogen and phosphorous — the nutrients most loved by algae — and are designated as “impaired” by the Environmental Protection Agency, meaning they don’t meet basic water quality standards for swimming, fishing, and supporting aquatic life.
Trump said his $14 million renovation this spring would clean the pool’s algae-clouded waters by sealing leaks and painting the bottom “American flag blue.”
But the refurbishment didn’t address the pollution that is the root cause of algal growth, said Hans Paerl, an aquatic ecologist at University of North Carolina at Chapel Hill. The pool was refilled on June 4 using the same nutrient-rich Tidal Basin water as before.
The spate of warm, sunny days that followed — June so far has been about 2 degrees Fahrenheit hotter than normal, according to the National Weather Service — provided ideal conditions for the photosynthetic creatures to multiply. Those high temperatures may have been exacerbated by the pool’s new dark blue coating, which absorbs more heat than its previous gray finish, Chapra said.
Within days, satellite data showed that the Reflecting Pool contained more algae than at any recorded point in June for at least five years.
The bloom that turned the pool green shortly after it was refilled was likely caused by a single-celled organism called cyanobacteria, Paerl said. Pictures of the pool showed a characteristic bright green scum coating the surface of the water.
Cyanobacteria blooms are the most dangerous, Paerl said, because they produce toxic compounds that can cause rashes, vomiting, and neurological problems in people who touch or ingest them.
After the Interior Department treated the pool with hydrogen peroxide, which breaks down cyanobacteria’s cell membrane and disrupts photosynthesis, the cyanobacteria bloom seemed to wane.
But the water’s sickly green sheen remains. Aquatic ecologist Rosalina Christova, a George Mason University researcher who acquired a sample from the Reflecting Pool on June 15, found that the water had been colonized by a genus of multicellular green algae called Desmodesmus. In an email, she called the population “very dense.”
The green algae are more resistant to the effects of hydrogen peroxide, and they were likely able to capitalize on the nutrients released from the disintegrating bodies of the slain cyanobacteria, Paerl said.
“This created a niche for another player, so to speak,” he said. “Nutrients keep cycling through there and feed whatever blooms.”
A growing global threat
Though the administration’s concerns about algae in the Reflecting Pool are in part cosmetic, the proliferation of blooms in waterways across the planet pose a significant — and growing — threat, said Joaquim Goes, a biogeochemist at Columbia University.
By studying satellite images of the ocean, he found that microalgae scums — caused by the same tiny organisms as those afflicting the Reflecting Pool — have expanded at a rate of 1% per year since 2003. The phenomenon has disrupted food chains and created oxygenless “dead zones” where fish can’t survive.
“It is spreading like wildfire all over the world,” Goes said. “And there is no question that temperature is playing a role.”
Blooms are also increasing in freshwater bodies that supply people’s drinking water, research shows.
A 2022 EPA assessment found that 49% of U.S. lakes showed excess amounts of chlorophyll a, the photosynthetic compound that indicates presence of cyanobacteria and green algae. Detections of microcystins, a class of toxin produced by cyanobacteria, increased by almost 30 percentage points since the previous assessment was conducted five years earlier.
Massive cyanobacteria blooms have poisoned important fisheries, such as in Lake Erie. They can imperil important ecosystems, like the Everglades below Florida’s Lake Okeechobee. They have been linked to the deaths of dogs, cattle and, in rare cases, humans.
Even green algae, which do not produce toxins, can clog filtration systems and disrupt drinking water supplies. When they die, the decomposition of their bodies depletes oxygen in the surrounding water, killing other aquatic life.
The National Office for Harmful Algal Blooms, funded by the National Oceanic and Atmospheric Administration, estimates that phenomenon causes an average $50 million in damage to the U.S. economy each year. Individual severe events can cause even greater harm: An unprecedented “red tide” cost roughly $2.7 billion in decreased tourism revenue when it forced the closure of beaches across southern Florida in 2018.
Lasting solutions
Theories about the persistence of the Reflecting Pool algae abound.
The Interior Department has blamed residual organisms that remained in supply lines after the renovation. Some have speculated that the recent blooms are a product of liberal “sabotage.”
The Trump administration has said it plans to drain the pool again to address algae growth and paint that is peeling from its bottom.
But those measures are unlikely to prevent algae from reemerging, said environmental engineer Victor Bierman, a retired water quality consultant and former EPA scientist.
As summer heat continues to ramp up, he worries the green algae could be replaced by cyanobacteria, which have no predators and readily outcompete other microbes at high temperatures.
“You can get rid of an existing bloom, but if you don’t change the underlying conditions … you’re going to grow more algae,” Bierman said.
Officials could stymie growth by increasing the flow of water through the pool, but that would disrupt the still surface needed for it to be reflective, he added. A better option would be installing an enhanced filtration system that removes nutrients from the Tidal Basin water before it is pumped into the pool.
Ultimately, said Chapra, algae blooms will continue to plague the Reflecting Pool and countless other water bodies until people address the human-made problems of nutrient runoff and climate change.
“If you don’t follow the science, then you think it’s magic or espionage, and it’s not,” Chapra said. “This is basic biology.”
It was the 10th time the Senate has tried to stop the war, and the outcome, on a vote of 50-48, was a stunning turnaround from past efforts. While the resolution is largely symbolic, and does not carry the full force of law, it reflects the growing concerns from a number of Republican lawmakers in both the House and Senate over both the war and the deal Trump struck with Iran to end it. The House approved the resolution earlier this month.
Trump responded angrily Tuesday night on his Truth Social platform, calling the vote “poorly timed and meaningless” and saying it “provided aid and comfort” to Iran.
Senate Democratic Leader Chuck Schumer of New York said, “Time after time, the vast majority of Senate Republicans sided with Trump and his war instead of the American people.”
Schumer said Americans have paid the price for “Trump’s historic blunder in Iran. It’ll go down in the history books as one of the worst foreign policy forays America has ever made.”
In the past, as many as four GOP senators have voted for the war powers resolutions, and they did so Tuesday — Republicans Lisa Murkowski of Alaska, Susan Collins of Maine, Rand Paul of Kentucky and Bill Cassidy of Louisiana. One Democrat, Sen. John Fetterman of Pennsylvania, voted against.
Trump bashed the four Republicans as losers, saying, “These senators have made my job more difficult.”
On this vote, the absence of two Republicans, including Sen. Mitch McConnell of Kentucky, who was admitted to the hospital recently for an undisclosed matter, left the GOP without a full majority to halt the effort. Sen. Dave McCormick, R-Pa., also missed the vote.
Trump to meet senators as Republicans balk at Iran deal
Trump himself is headed to the Capitol on Wednesday to meet with GOP senators after Vice President JD Vance was overseas working to negotiate with Iran to end its nuclear ambitions — which had been among the stated rationales for the war.
The president is not pleased with the Republicans who have been critical of the deal he struck with Iran, according to one GOP senator granted anonymity to discuss the private dynamics.
The terms of the Iran deal are spelled out in a memorandum of understanding that Trump signed last week, starting a 60-day clock for the sides to reach a broader agreement over ending Iran’s nuclear program.
But Republicans have particularly objected to the $300 billion fund to help Iran rebuild, which is far greater than the $1.7 billion then-President Barack Obama refunded the country under his administration’s 2015 Iran deal.
“I believe President Trump is getting very poor advice on Iran,” Sen. Ted Cruz, R-Texas, said last week on his podcast after the deal was made public.
Democrats have repeatedly forced Iran votes
Over and again, Democrats have been forcing votes on the Iran war, almost since the U.S. and Israel launched missile strikes on Iran on Feb. 28.
Nearly each week they’re in session, the Senate Democrats have put forward war powers resolutions, but they have failed to amass the majority needed for passage in the narrowly split chamber, where Trump’s Republican Party holds the majority. Trump would almost certainly veto any measure that passed.
While the House- and Senate-passed resolution does not go to the president for his signature, passage stands as a powerful, if symbolic, statement from Congress and a rebuke of the administration’s military actions.
Sen. Tim Kaine, the Democrat from Virginia who has led his party’s efforts, said the pause in warfighting, as Trump’s team works to shore up a fragile ceasefire, provides the perfect time for Congress to step back and assess “what should the next chapter be.”
Hegseth seeks $80 billion from Congress for the Iran war
Defense Secretary Pete Hegseth is on Capitol Hill this week, seeking roughly $80 billion in supplemental funding to shore up defense supplies in the aftermath of the Iran war, which is drawing scrutiny when many Americans are reeling from high gas prices and costs of living.
The Pentagon early on had estimated the war cost $11.3 billion during its first week, and senators said experts put the overall price tag of Operation Epic Fury higher, at some $100 billion.
The Defense Department’s funding request is part of a broader beef-up of military money the White House wants as part of its budget request this year.
House Democratic Leader Hakeem Jeffries said Tuesday, “We should not spend another dime of taxpayer dollars on Operation Epic Failure.”
The Trump administration is seeking $1.5 trillion in defense funding this year — a nearly 50% increase — including $350 billion that it wants in a so-called budget reconciliation package. Johnson and GOP leaders are working to pass that package on their own, over the objections of Democrats, much the way they approved Trump’s big tax cuts bill last year.
The 2025 tax cuts package also included a sizable increase for the military.
Bill Curry, 65, raises cattle on the same land in rural Oklahoma once owned by his father and generations before him. Each quarter, for several years, he has made the 2½-hour drive to Oklahoma City for an epidural in his spine to treat his back pain.
But this year, because of a new Medicare program, Curry has traveled a little more often.
In February, during one trip, he was told unexpectedly that he needed preapproval for the procedure. Then he went again a month or so later to get the injection, for a total of 10 hours on the road. His clinic wanted him to come in a third time, which they had never asked of him before. That appointment was “just to fill out a piece of paper to tell them how you feel again,” Curry said, so he hasn’t gone.
In January, Oklahoma became one of six states to begin a pilot program testing the use of pre-approvals in traditional Medicare, the federal health insurance program for people 65 and older or with disabilities. Medicare had previously eschewed the practice — also known as prior authorization — which requires patients or someone on their medical team to seek insurance approval before proceeding with certain procedures, tests, and prescriptions.
Epidurals like Curry’s are among 13 medical services subject to the new program because the Trump administration says they’re prone to fraud or misuse. Powered by artificial intelligence, the program — called the Wasteful and Inappropriate Service Reduction Model, or WISeR — is intended to save the federal government money and protect patients from potentially unsafe or unneeded care.
Yet early reviews from Oklahoma and the other pilot states — Arizona, New Jersey, Ohio, Texas, and Washington — suggest WISeR’s rollout has not been smooth. Patients, doctors, and other healthcare professionals who spoke with KFF Health News say the effort has created confusion, errors, long wait times, and stress. Some described the rollout as “horrendous” and say people enrolled in Medicare in the pilot states are now getting ensnared in the same red tape as those with private insurance.
One key concern is that it all happened too hastily. WISeR was announced in June 2025 and launched in mid-January.
That was “quicker than normal” for the federal government, said Todd Baker, who recently stepped down as CEO of the Ohio State Medical Association. Doctors “just sort of had to figure it out,” added Jeb Shepard, director of policy at the Washington State Medical Association.
Government contractors have also acknowledged the rapid pace. “We’ve had an aggressive rollout from the time of being notified to going live,” said Jeremy Friese, CEO of Humata Health, the vendor for Oklahoma. Tech executives servicing other states have said they were still adding features to their products in the spring.
Abe Sutton, director of the Center for Medicare and Medicaid Innovation, which is administering the program, didn’t comment on the rollout schedule. But he said in a statement that the goal of these reforms is to ensure that prior authorization is efficient, fast, and streamlined.
“The model aims to reduce inappropriate care without delaying appropriate care,” he said.
Mehmet Oz, the leader of the Centers for Medicare & Medicaid Services, told NewsNation in December that they were “rolling out some prior authorization on abused practices.”
“The purpose of these is not to deny care,” Oz continued. “It’s to make sure you get the care you need and deserve, not the care some unscrupulous doctor wants to use on you.”
Medicare has struggled in recent years with suspected fraud associated with particular services. The Department of Health and Human Services’ inspector general warned in September that the program’s spending on skin substitutes, for example, had surged nearly 700% over two years, raising “major concerns about fraud, waste, and abuse.” Skin substitutes are among the 13 therapies currently subject to review under WISeR.
The program also imposes prior authorization requirements for kyphoplasty, a surgery for spinal fractures, which a report by the Medicare Payment Advisory Commission flagged as overused.
Sutton acknowledged, however, that “the percentage of providers committing waste, fraud, and abuse is small.”
Consumers and clinicians largely detest prior authorization. Even as federal health officials test the process for Medicare, the Trump administration is trying to scale it back for those with private insurance. According to a KFF poll conducted in January, 69% of insured adults consider prior authorization a burden for care.
Through WISeR, doctors and their staff log in to online portals to submit medical records that justify the procedures. Using artificial intelligence, the systems quickly approve applications that meet the program’s criteria, Friese, Humata’s chief executive, told KFF Health News. He said there is an “immediate yes” in 88% of cases for which clinical data supports an approval.
CMS has touted the process as one in which decisions are returned within 72 hours. After that, clinicians receive a “universal tracking number,” which allows them to schedule the procedure and get paid. In practice, however, participants say the process is anything but easy.
The University of Washington’s medical system alone had nearly 100 patients waiting earlier this year for epidural injections due to WISeR-related delays, according to an April report from the office of U.S. Sen. Maria Cantwell (D-Wash.) that drew on hospital association data. “Now, patients are subject to delays or denials which did not exist prior to the WISeR Model,” the report said.
FILE – Sen. Maria Cantwell, D-Wash., speaks on Capitol Hill in February. (AP Photo/Tom Brenner, File)
Curry, the Oklahoma cattle farmer, said he might go to Kansas for future treatments to avoid the approval process. Dorota Gribbin, a New Jersey-based physical medicine and rehabilitation physician, said that by the time authorization came for one of her patients who needed a back pain procedure, the patient had gone to the hospital for more expensive care.
Jennifer Valle, a precertification and insurance supervisor at Clinical Radiology of Oklahoma, said when it comes to kyphoplasties, there has been a lot of “nitpicking” from reviewers. Other times, information her practice provides to CMS gets overlooked, she said, and reviewers ask for imaging that’s already in the file.
Claims with no problems are supposed to be paid within 15 days, said James Webb, a musculoskeletal radiologist in Tulsa, Okla., who has also been frustrated by the prior approval and reimbursement process for kyphoplasties. “Six- to eight-week delays is what we’ve been seeing,” he said.
“It’s been horrendous,” said Jerry Sobel, a Phoenix-area pain management doctor. “Right from the beginning, there seemed to be no organization.” Sobel said that as of May, he hadn’t gotten paid by Medicare for nine epidurals.
“We continuously monitor operations and work closely with stakeholders to address questions and improve the provider experience,” said Sundar Subramanian, the CEO of Zyter, which has the contract for Arizona.
During an April webinar, another Zyter executive acknowledged a large backlog in payments stretching to January. Those backlogs “are currently being resolved,” Medicare’s Sutton said, without providing further detail.
When asked about other issues — including what doctors suspect are AI-driven errors — Medicare’s Sutton said the agency appreciates “feedback on provider experience.” It will be used “to help providers better understand WISeR processes,” he said.
Although CMS vendors say humans make the final decisions on approvals, doctors and their staffs believe artificial intelligence is playing a large role in the process and that denials are sometimes the result of AI hallucinations that garble or make up information.
One Arizona doctor, who wasn’t authorized by his practice to speak, recalled a denial saying his patient wasn’t eligible for procedures in the thoracic region, or midback. The patient needed an injection to the neck. Webb, the Oklahoma radiologist, documented four times that a patient lacked numbness, and yet his WISeR application was still denied, citing numbness, which, in the reviewer’s interpretation, would rule out the spinal surgery procedure.
Friese, Humata’s CEO, said he hasn’t heard about any AI hallucinations.
The process is also raising government costs. With more rejections, more appeals are being filed with Medicare’s administrative contractors. The government pays the contractors to handle the appeals, and Medicare’s Sutton acknowledged that the agency has “accounted for potential changes in the volume of Medicare appeals because of the WISeR program and its associated costs.”
Eighty-four percent of commercial insurers already use AI tools, according to a survey released in 2025 by the National Association of Insurance Commissioners, though they have consistently said AI isn’t used to deny prior authorization requests.
Its use in Medicare risks introducing friction and frustration into the program — and piling costs onto its beneficiaries. Prior authorization saves money for insurers partly by making patients pay a price in wait times and inconvenience, said Miranda Yaver, a University of Pittsburgh health policy researcher studying the technique.
“People will end up getting ensnared in a lot of red tape, having to be on hold, and getting rerouted,” she said. She often wonders whether prior authorization simply shifts costs to patients and doctors, rather than saving them.
Some doctors involved in Medicare’s prior authorization experiment believe it will inevitably expand beyond a few services officials in Washington consider fraud-prone.
“Everybody knows that if this pilot project works, it will be prior auth for basically all procedures,” said Mary Clarke, a family practice physician in Stillwater, Okla. “If they can show that they can save money, then that’s going to be extrapolated and rolled out to other procedures and multiple other things in other states.”
When asked whether CMS is considering expansion of its prior authorization pilot, Sutton said in his statement that there are “currently no changes” considered for the list of services subject to the WISeR program, “but CMS continues to assess whether any changes are warranted.”
KFF Health News Southern correspondent Lauren Sausser contributed to this report.
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.
