New at Unbreaking
THE BIG NEWS this week is a new war with Iran. At Unbreaking, we don’t cover foreign affairs—not because they’re not important, but because it’s not our lane. But we do remember how the Iraq War that began in 2003 was used by the then-administration to curtail civil liberties at home. We remain focused on how the current administration is attacking rights and critical services needed for our survival and thriving, and will be watching carefully to see how the war comes home.
Below, some grounding understanding on many of the issues we’re tracking so far, and the things we’re paying attention to in the week ahead.
Medicaid
Medicaid is the primary funder of both long-term care and in-home care in the US, and it pays for 4 out of 10 births. More than 90% of Medicaid enrollees under 65 either work, or are not working because they attend school, serve as full-time caregivers, or are disabled. Medicaid is also very popular among Americans of all stripes: more than 80% of Americans want Congress to maintain or increase current levels of Medicaid spending.
But that’s not what Congress is currently doing. The GOP budget bill now with the Senate is threatening to push 7.8 million people out of healthcare coverage through deep cuts to Medicaid funding. Among the mechanisms of the cuts are increased “work requirements” which are really paperwork requirements: burdensome, red-tape laden processes that require Medicaid enrollees to regularly document time spent at work or other alternatives, like school attendance or taking care of a child or disabled person.
The bill also has cuts that target both documented and undocumented immigrant children and families, including refugees, people granted asylum, and other lawful residents. Our Medicaid explainer has the details, including next steps in passing the bill.
Transgender Healthcare
Over 1.6 million people in the United States over the age of 13 identify as transgender, which means that they do not identify with the sex assigned to them at birth. Every major medical and mental health association in the US recognizes the medical necessity of providing gender-affirming care, which can include mental health care, medical care, and social services.
Congress is attempting to block gender affirming care both for people who depend on Medicaid and for those who use Affordable Care Act marketplace plans. The Senate version of the GOP budget bill contains a ban on federal Medicaid funding for gender-affirming care for trans people of all ages. At the same time, a new proposed rule would prohibit states from mandating that gender-affirming care be considered an “essential benefit”—meaning that ACA marketplace plans would no longer legally have to cover it.
These efforts are just part of the multi-pronged attack on trans healthcare; we’re tracking many others in our Transgender Healthcare explainer, as well as the communities mobilizing to protect these critical services.
Medical Research Funding
Medical research is the scientific effort dedicated to expanding our understanding of health and disease. For decades, the US National Institutes of Health has been the largest public funder of medical research in the world, responsible for over 80% of the world’s grant investment in biomedical research. That’s at risk now, with thousands of grants canceled and delayed, amounting to lost research funding of more than $5 billion.
Some of the grant terminations are blatantly ideological: a result of DOGE-directed screening and searches for flagged keywords like “women,” “trans,” “nonbinary,” “diversity,” or “COVID.” Last week, a federal judge ordered the NIH to restore grants that were cut based on gender ideology, diversity, equity and inclusion. The judge called the terminations illegal, saying, “I’ve sat on this bench now for 40 years. I’ve never seen government racial discrimination like this.”
Our current assessment of medical research funding in the US is that it is critically endangered, with many research efforts at risk even if funding comes back (and it’s unlikely that all of the funding will come back). Read the full assessment on our explainer.
Equality at Work
The Trump administration’s attempt to cast lawful diversity, equity, and inclusion (DEI) practices as “illegal DEI” is the administration’s most obvious line of attack on anti-discrimination practices. But another vector, and one operating at a much larger scale, is the parallel effort to hollow out the federal workforce through a combination of layoffs, elimination of services, and targeting of Black, LGBTQ+, and female workers.
At least a quarter million federal workers and contractors have lost their jobs since January through a chaotic process that’s seen some workers fired, rehired, then fired again. Some agencies have been so crippled by the job cuts that they are now scrambling to rehire workers, but it’s unclear how many workers will be willing or able to come back. Many of the terminations have been complicated by judicial orders, and last week a judge in one case confirmed that additional reductions in force are prohibited by injunction.
We have more in our equality at work explainer, including how the attack on the federal workforce amounts to an attack on equality in all workplaces.
Food Safety
Food safety is the set of practices that ensure that our food doesn’t make us sick or kill us. But since February, the Trump administration has fired food safety workers across the federal government in a series of mass layoffs, with potentially dangerous consequences, including: fewer food inspections, reduced quality control for food safety tests, less support for food safety teams responding to outbreaks, and a reduced ability to keep foreign outbreaks from spreading to the US.
As with cuts to other parts of the federal government, these layoffs have occurred with little transparency and a lot of chaos. Earlier this month, FDA commissioner Martin Makary sent an email to employees stating that the agency may conduct further cuts to “eliminate duplicative services.” At the same time, the HHS reversed a number of firings of employees they had previously claimed were inessential, including a team at the CDC handling food safety matters. Our explainer has the full story, including the many ways that everyone in the US is now more vulnerable to illness.
Up next
We’re anticipating another substantial update to the Medicaid and Trans Healthcare pages this week, as the Senate parliamentarian begins to rule on what’s acceptable within the budget reconciliation process. We’ve begun work on pages related to the US immigration system, due process, and targeted repression, as well as researching issues around data safety and security, with dozens of other pages in the hopper. Over the next few weeks, we’ll roll out some lighter-weight page types and other features to help get more of our work into public view faster.
If this sounds like something you could use, please come look; all of our content is available under a Creative Commons license, so you can use and adapt it to your needs—just give Unbreaking a shout out when you do. And if you’d like to help document what’s happening, we’d love to hear from you.