MAHA AI BS

In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.

A number of posts discussed Trump's support for the discredited notion.

 Another leading anti-vaxxer is presidential candidate Robert F. Kennedy, Jr.  He has repeatedly compared vaccine mandates to the Holocaust.  Rolling Stone and Salon retracted an RFK article linking vaccines to autism.  He is part of the "Disinformation Dozen." He helped cause a deadly 2019 measles outbreak in Samoa.

He is now Trump's Secretary of HHS.

Caitlin Gilbert, Emily Wright, Fenit Nirappil and Lauren Weber at WP:

The White House’s “Make America Healthy Again” report, which issued a dire warning about the forces responsible for Americans’ declining life expectancy, bears hallmarks of the use of artificial intelligence in its citations. That appears to have garbled citations and invented studies that underpin the report’s conclusions.

Trump administration officials have been repeatedly revising and updating the report since Thursday as news outlets, beginning with NOTUS, have highlighted the discrepancies and evidence of nonexistent research.

Department of Health and Human Services spokesman Andrew Nixon said that “minor citation and formatting errors have been corrected, but the substance of the MAHA report remains the same — a historic and transformative assessment by the federal government to understand the chronic disease epidemic afflicting our nation’s children.” .

...

• The referenced report is real. But the inclusion of "oaicite," a marker of the use of OpenAI, in the URL offers a definitive sign that artificial intelligence was used to collect research.
•  This dead URL was live as recently as 2017, according to archived versions of the site. AI experts said chatbots can produce outdated links in response to queries because they were trained using older material.

  Margaret Manto and Emily Kennard at NOTUS:

The Trump administration’s clean up of the “Make America Healthy Again” Commission’s hallmark and error-riddled report is opening new questions about how the report’s authors drew some of its sweeping conclusions about the state of Americans’ health.

At least 18 of the original report’s citations have been edited or completely swapped out for new references since NOTUS first revealed the errors Thursday morning. While some of the original report’s inconsistencies have been changed, a few of the new updated citations continue to misinterpret scientific studies.

Genetic Research

 In The Politics of Autism, I discuss various ideas about what causes the condition. Genetics plays an important role.  “I’m told that there was a 20-to-1 research ratio for genetic causes over the past 20 years,” HHS Secretary Robert F. Kennedy Jr. recently said. “I believe that was because they did not want to look at the environmental exposure because they were scared. So I don’t think we should be funding that genetic work anymore.”

Dylan Scott at Vox:

If Kennedy were serious about moving autism science forward, he would be talking more about genetics, not dismissing them. That’s because genetics is where all of the exciting drug development is currently happening.

A biotech firm called Jaguar Gene Therapy has received FDA approval to conduct the first clinical trial of a gene therapy for autism, focused on SHANK3. The treatment, developed in part by one of Buxbaum’s colleagues, is a one-time injection that would replace a mutated or missing SHANK3 gene with a functional one. The hope is that the therapy would improve speech and other symptoms among people with high-needs autism who have also been diagnosed with a rare chromosomal deletion disorder called Phelan-McDermid syndrome; many people with this condition also have Autism spectrum disorder.

The trial will begin this year with a few infant patients, 2 years old and younger, who have been diagnosed with autism. Jaguar eventually aims to test the therapy on adults over 18 with autism in the future. Patients are supposed to start enrolling this year in the trial, which is focused on first establishing the treatment’s safety; if it proves safe, another round of trials would start to rigorously evaluate its effectiveness.

“This is the stuff that three or four years ago sounded like science fiction,” Singer said. “The conversation has really changed from Is this possible? to What are the best methods to do it? And that’s based on genetics.”

Researchers at Mount Sinai have also experimented with delivering lithium to patients and seeing if it improves their SHANK3 function. Other gene therapies targeting other genes are in earlier stages of development. Some investigators are experimenting with CRISPR technology, the revolutionary new platform for gene editing, to target the problematic genes that correspond to the onset of autism.

But these scientists fear that their work could be slowed by Kennedy’s insistence on hunting for environmental toxins, if federal dollars are instead shifted into his new project. They are already trying to subsist amid deep budget cuts across the many funding streams that support the institutions where they work.

MAHA Fakery

 In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.

A number of posts discussed Trump's support for the discredited notion.

 Another leading anti-vaxxer is presidential candidate Robert F. Kennedy, Jr.  He has repeatedly compared vaccine mandates to the Holocaust.  Rolling Stone and Salon retracted an RFK article linking vaccines to autism.  He is part of the "Disinformation Dozen." He helped cause a deadly 2019 measles outbreak in Samoa.

He is now Trump's Secretary of HHS.

Emily Kennard and Margaret Manto at NOTUS:

Health Secretary Robert F. Kennedy Jr. says his “Make America Healthy Again” Commission report harnesses “gold-standard” science, citing more than 500 studies and other sources to back up its claims. Those citations, though, are rife with errors, from broken links to misstated conclusions.

Seven of the cited sources don’t appear to exist at all.

Epidemiologist Katherine Keyes is listed in the MAHA report as the first author of a study on anxiety in adolescents. When NOTUS reached out to her this week, she was surprised to hear of the citation. She does study mental health and substance use, she said. But she didn’t write the paper listed.

“The paper cited is not a real paper that I or my colleagues were involved with,” Keyes told NOTUS via email. “We’ve certainly done research on this topic, but did not publish a paper in JAMA Pediatrics on this topic with that co-author group, or with that title.”

It’s not clear that anyone wrote the study cited in the MAHA report. The citation refers to a study titled, “Changes in mental health and substance abuse among US adolescents during the COVID-19 pandemic,” along with a nonfunctional link to the study’s digital object identifier. While the citation claims that the study appeared in the 12th issue of the 176th edition of the journal JAMA Pediatrics, that issue didn’t include a study with that title.

As the Trump administration cuts research funding for federal health agencies and academic institutions and rejects the scientific consensus on issues like vFromaccines and gender-affirming care, the issues with its much-heralded MAHA report could indicate lessening concern for scientific accuracy at the highest levels of the federal government.

From ASAN:

The Autistic Self Advocacy Network condemns the release of the Make America Healthy Again (MAHA) Commission’s most recent report. The Commission was created to try and lower the rate of “autism and other chronic health conditions” in the United States. Lowering the rate of autism is not possible given that autism is a hereditary developmental disability.

Much of what the report talks about is not actually a problem. It presumes that a condition getting diagnosed more often, or more people getting care for it, must mean that the condition is getting more common or getting worse. The truth is that in many cases there have been improvements to the accessibility of health care, as well as improved criteria for diagnosis. For example, the increased prevalence of autism diagnosis is thanks to better access to screening and improved understanding of autism, especially for people of color, women, and LGBTQI+ autistics. Doing a better job of identifying a condition and helping more people get supports for it is a good thing, not proof of an “epidemic.” ASAN remains committed to debunking disinformation and scare tactics from the MAHA Commission.

 

 

 

Early Diagnosis and Medicaid

In The Politics of Autism, I discuss evaluation and diagnosis.

Lindly, O. J., Abate, D., Fuchu, P. L., Kuhn, J. L., Mudnal Bharath, P. S., Asantewaa, S. M., Feinberg, E., & Broder-Fingert, S. (2025). The impact of state policy on early autism diagnosis: A qualitative investigation. Autism, 0(0). https://doi.org/10.1177/13623613251336813

Lay abstract:

In the United States, when children on the spectrum are diagnosed before age three, it can help them get the services they need to thrive. There are many differences between states as far as how many children are diagnosed with autism and the average age when they are diagnosed. Some work suggests these differences may be due to state polices, which include the laws and processes governments and organizations follow. Little research has tried to understand the similarities and differences between state policies related to autism diagnosis. Because of this, our study looked at how state policies impact the timing of autism diagnosis in the United States. We interviewed 57 experts in five states and nationally from 2021 to 2023. Four key themes were identified including (1) developmental monitoring often leads to screening, but there is much variation in and across states; (2) family, community, and healthcare factors shape pathways to autism diagnosis in states; (3) early intervention and education programs play a role in autism diagnosis; and (4) systematic differences in access to diagnosis services persist for certain groups of children and families such as those with limited English-speaking abilities. This study’s findings point to certain state and federal policy changes or enhancements to reduce the age of autism diagnosis and ameliorate persistent disparities in autism diagnosis.

From the article:

Many participants noted that children with Medicaid often have a more challenging time obtaining autism evaluation due to low reimbursement rates and limited providers who will accept Medicaid coverage for autism evaluation across the five states. These challenges with Medicaid coverage and access to autism diagnostic services were attributed to longer wait times for poor and rural families, thereby perpetuating inequity in early autism diagnosis. According to one participant:

We have [. . .] approximately 50, that I know of, professionals that can diagnose autism. Or actively do. Out of that 50, there’s probably five, that I know, who are quality, qualified autism experts that accept AHCCCS [Arizona Health Care Cost Containment System, Medicaid] payments for those evaluations. So, if you don’t have private insurance or you can’t afford a private evaluation, you are . . . sent to Phoenix Children’s Hospital. And their wait list is . . . 12 to 18 months. (Participant 33, Arizona)

Participants additionally explained that when an autism evaluation does not yield a diagnosis, parents may be forced to pay out of pocket for the evaluation because their insurance plan will not cover the cost. Nevertheless, participants explained how some healthcare organizations have determined ways to ensure that children with Medicaid receive an autism diagnosis. For example, several participants described that some academic medical centers could pursue supplemental payment for low Medicaid reimbursement rates through state programs such as early and periodic screening, diagnostic, and treatment (EPSDT). Some participants elaborated that Medicaid coverage may be a greater barrier to early diagnosis in states where the Medicaid program does not accept autism as a qualifying diagnosis (regardless of income) for eligibility.

Adult Autism Prevalence

In The Politics of Autism, I discuss the uncertainty surrounding estimates of autism prevalence.

Nidhi Subbaraman at WSJ:

Overall, the rate of autism in people 18 or older more than doubled between 2011 and 2019, from 4.2 per 1,000 to 9.5 per 1,000, according to an analysis of Medicaid data published in the journal JAMA Psychiatry in 2023.

Researchers saw the most rapid growth in adults between the ages of 26 and 34, according to a study, published in the journal JAMA Network Open in 2024, that analyzed U.S. health records and insurance claims for more than nine million individuals a year from 2011 to 2022. That group’s rate of autism increased from 0.7 per 1,000 people in 2011 to 3.7 per 1,000 in 2022.

Some of this growth comes from autistic children aging into adulthood.

For adults seeking evaluations for the first time, scientists attribute the rise to a variety of factors.

Social media has increased awareness of autism. Autism has shed the stigma it used to hold. The definition of the condition has expanded over time to include a broader range of behaviors. And some parents who have children diagnosed with autism then recognize their own challenges and seek out evaluations, said Michelle Gorenstein-Holtzman, a clinical psychologist who works with adults at the NewYork-Presbyterian/Weill Cornell Medical Center and the Center for Autism and the Developing Brain.

Three years ago, before she joined, the center did one adult autism evaluation a month. Now Gorenstein-Holtzman does two a week.

Measles Count: 1,046

 In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.  HHS Secretary RFK Jr. is an infamous superspreader of the vaccine lie.

Mary Kekatos and Dr. Karen Tachi Udoh at ABC:

Measles cases have reached 1,046 as the virus continues spreading across the United States, according to data updated Friday from the Centers for Disease Control and Prevention (CDC).

Cases have been confirmed in 30 states including Alaska, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, Virginia and Washington.

Infectious disease experts have previously said the U.S. is likely on track to surpass the 2019 total of 1,274 cases, which were confirmed over the course of a year. This year's total also marks the second highest case count in 25 years, CDC data shows.

Autism and Medicaid

The Politics of Autism includes an extensive discussion of insurance and Medicaid services for adults with intellectual and developmental disabilities.  The House has voted to make it harder to get Medicaid.

From the Policy Impact Project at Drexel:

1.In 2020, nearly 1.6 million autistic people were enrolled in Medicaid services nationwide. Approximately one-third had a co-occurring intellectual disability. 

2.About 57% of autistic people qualify for Medicaid based on their disability. 

3.More autistic Medicaid enrollees are children versus adults. Over 65% were under the age of 18 years. 

4.Autistic people who use Medicaid live in rural areas as well as urban. Nearly 16% live in large or small rural towns. 

5.Only about 21% of autistic people, or roughly 332,000 people, have spots in Medicaid Home and Community BasedServices (HCBS) waivers in their state, also known as 1915c waivers. 

"Artificially Induced"

In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.

A number of posts discussed Trump's support for the discredited notion.

Alex Gangitano at The Hill:

President Trump said Thursday that autism must not occur naturally, citing figures inflating the spike in autism and suggesting the administration’s Make America Healthy Again (MAHA) Commission could provide answers.

“When you hear 10,000, it was 1 in 10,000, and now it’s 1 in 31 for autism, I think that’s just a terrible thing. It has to be something on the outside, has to be artificially induced, has to be,” Trump said at a MAHA Commission event. “And we will not allow our public health system to be captured by the very industries it’s supposed to oversee. So we’re demanding the answers, the public is demanding the answers and that’s why we’re here.”

...

At the event, the president was sitting beside Health and Human Services Secretary Robert F. Kennedy Jr., who is a prominent vaccine skeptic and has also shared his debunked theories about a link between autism and vaccines.

Ahead of Kennedy’s confirmation vote in the Senate, Trump also shared figures questioning the autism rate.

“20 years ago, Autism in children was 1 in 10,000. NOW IT’S 1 in 34. WOW! Something’s really wrong. We need BOBBY!!! Thank You! DJT,” Trump wrote on Truth Social at the time.

He has similarly brought up autism rates during Cabinet meetings while touting Kennedy’s work, and in December, he said he thinks there are “problems with vaccines” and has suggested his administration would investigate a debunked link between the two.

RFK Fudges Autism Study Timeline

 In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.

A number of posts discussed Trump's support for the discredited notion.

 Another leading anti-vaxxer is presidential candidate Robert F. Kennedy, Jr.  He has repeatedly compared vaccine mandates to the Holocaust.  Rolling Stone and Salon retracted an RFK article linking vaccines to autism.  He is part of the "Disinformation Dozen." He helped cause a deadly 2019 measles outbreak in Samoa.

He is now Trump's secretary of HHS.

Sarah Owermohle, CNN:

The federal government may have partial answers on the purported causes of autism by this fall, but not the full picture, as Health and Human Services Secretary Robert F. Kennedy Jr. promised in April.

Kennedy sat down with CNN’s Kaitlan Collins on Thursday shortly after a White House event to release the Make America Healthy Again Commission’s first report, which argued that ultaprocessed foods, environmental toxins and overmedication are driving a rise in childhood chronic illnesses.

The commission’s next report, spelling out strategies to combat chronic diseases across health, agricultural and environmental agencies, will be released this August, Kennedy said.

But his self-declared deadline to distill the drivers of autism by September — as Kennedy announced in an April Cabinet meeting — is slipping.

“We’ll have some of the information [by September]. To get the most solid information, it will probably take us another six months,” Kennedy said Thursday. By the end of those additional six months, or roughly March, “I expect we will know the answers of the etiology of autism,” he said.

Autism researchers and scientists have questioned the likelihood of delivering definitive conclusions on the drivers of autism in such a short timeframe, considering the years of research that is often undertaken in this area.

That research has already identified likely factors leading to autism, including genetics and prenatal exposures.

Public Education Defense Fund

In The Politics of Autism, I discuss the civil rights of people with autism and other disabilities. 

From the National Center for Youth Law:

Millions of students are now vulnerable to unchecked discrimination within their schools as a direct result of the Trump Administration's dismantling of the U.S. Department of Education's Office for Civil Rights (OCR). Today, the National Center for Youth Law (NCYL) launched a new initiative that aims to stand up for these students where the federal government has let them down.

The Public Education Defense Fund (PEDF) is a bold new enterprise that aims to fill the enforcement void caused by the dismantling of the Department of Education and ensure that civil rights in education remain real — not just an empty promise.NCYL launches this initiative during the 71st anniversary of the U.S. Supreme Court's landmark Brown v. Board of Education decision, which outlawed racial segregation in public schools. The Brown decision, delivered May 17, 1954, stands as a milestone moment in the history of the U.S. education system — and is an especially poignant reminder of both the progress toward equal opportunity that is attainable in our democracy and what is at stake today.

"Seven decades after Brown v. Board of Education affirmed that every child deserves equal access to education, we're once again called to defend that promise," said Johnathan Smith, Chief of Staff & General Counsel at NCYL. "The Trump administration's assault on civil rights enforcement is a direct betrayal of that promise made 71 years ago, and also a betrayal of students and families across the country. Every student deserves safety, dignity, and opportunity. We refuse to let this administration drag us backward."

PEDF will build on NCYL's already expansive work in protecting students' civil rights and equity in education. Specifically through PEDF, NCYL will:

• Ensure students and families still have protections if federal systems fail them;
• Build momentum for civil rights enforcement even in a hostile federal environment; and
• Create a scalable, nimble, and community-centered legal infrastructure that can intervene directly and support long-term systemic change.

“At a time when civil rights protections for students are under unprecedented attack, preserving those rights is not negotiable — it’s vital," Smith added. "We can't stand by while the federal government abandons its responsibility to uphold the basic rights of children and young people in this country.”

In addition to launching PEDF, NCYL also announced today that it is accepting applications for the first cohort of PEDF Fellows. The fellowship provides short-term placements to support civil rights infrastructure and protect vulnerable students. The application period will remain open through June 30.

Visit here to support PEDF, and/or to learn more about the fellowship program.

###

The National Center for Youth Law centers youth through research, community collaboration, impact litigation, and policy advocacy that fundamentally transform our nation's approach to education, health, immigration, foster care, and youth justice. Our vision is a world in which every child thrives and has a full and fair opportunity to achieve the future they envision for themselves.

The Threat to Special Education

In The Politics of Autism, I write about social services, special education, and the Individuals with Disabilities Education Act (IDEA). 

According to the National Center for Education Statistics, 7.5 million children 3 to 21 years old received services under the Individuals with Disabilities Education Act in AY 2022-23.

About 980,000 of them were autistic, up from 498,000 in 2012-13.

The Trump administration is halving the staff of the Department of Education.

The Trumpist Project 2025 would gut IDEA, wiping out protections for all those students.

During the campaign, Trump tried to deny any connection to Project 2025, but named Project 2025 collaborator Russell Vought as director of the Office of Management and Budget. Watch out when he issues the full Trump budget.

 Mark Lieberman at Education Week:

Half a century after the federal government passed a monumental law protecting the rights of students with disabilities, the Trump administration has upended special education on multiple fronts: slashing grant funding; terminating research contracts; decimating federal staffing; and threatening further disruption.

Earlier this month, the latest shock came as the White House proposed merging separate funding streams for special education into a single “consolidated” grant program. Without going into detail, the proposal also emphasized that parents would “remain empowered to direct these funds,” and that the Education Department would withhold funding from “states and districts who flout parental rights.”

...

Congress allocated level funding for IDEA in the budget resolution it passed in March for the current fiscal year, which school districts should start receiving July 1.

Beyond that, it remains to be seen how lawmakers will respond to the Trump administration’s proposal for a “Special Education Simplified Funding Program,” in which all the annual dollars Congress allocates for IDEA go out to states in a single bundle.

The White House’s “skinny” budget document—for the federal money schools would receive starting in July 2026—describes the changes as “limiting the federal role in education by reducing the number of programs at ED, the number of staff needed to administer them, and the administrative burden on States so more dollars go to students instead of bureaucrats.”

But some experts see the brief and vaguely worded proposal as an invitation for Congress to let states circumvent IDEA regulations, relax costly oversight of programs for students with disabilities, and direct greater shares of federal funding for parents to spend on private educational options outside the taxpayer-funded public school system.

Condensing IDEA funding streams into a single grant would risk shortchanging services and programs that would get overlooked if not for the federal spotlight, said Myrna Mandlawitz, policy and legislative consultant for the Council of Administrators of Special Education.

Some IDEA grants go to states and schools by way of formulas, while others have a competitive application process. IDEA Part C funds for infants and toddlers with disabilities, meanwhile, typically flow to agencies other than local districts.

Vitamin D

 In The Politics of Autism, I discuss various ideas about what causes the condition. Contrary to the lies of Trump and RFK Jr., vaccines do not cause autism.

So what does?  Genetics, for sure.

The literature has identified dozens of potential causes and correlates.

Convergent evidence linking neonatal vitamin D status and risk of neurodevelopmental disorders: a Danish case-cohort study Horsdal, Henriette Thisted et al. The Lancet Psychiatry, Volume 12, Issue 6, 410 - 420 Summary:

Background
There is growing evidence linking neonatal vitamin D deficiency to an increased risk of schizophrenia, ADHD, and autism spectrum disorder (ASD). The aim of this study was to examine the association between two vitamin D biomarkers (25 hydroxyvitamin D [25(OH)D] and vitamin D-binding protein [DBP], and their related genetic correlates) and the risk of six mental disorders.

 

Methods
We used a population-based, case-cohort sample of all individuals born in Denmark between 1981 and 2005. Using Danish health registers with follow-up to Dec 31, 2012, we identified individuals diagnosed with major depressive disorder, bipolar disorder, schizophrenia, ADHD, ASD, and anorexia nervosa based on ICD-10 criteria. Additionally, a random subcohort from the general population was selected. Based on neonatal dried blood spots, we measured concentrations of 25(OH)D and DBP. Our primary analyses were based on hazard ratios (HR) with 95% CI and absolute risks for the six mental disorders according to measured concentrations of 25(OH)D and DBP. As secondary analyses, we examined the association between genetic predictors of 25(OH)D and DBP, and the six mental disorders, and Mendelian randomisation analyses based on published summary statistics for 25(OH)D, DBP, and the six mental disorders. People with lived experience contributed to the development of the guiding hypothesis.

Findings
We used the total population from the iPSYCH2012 design (n=88 764), which included individuals who developed the six mental disorders, major depressive disorder (n=24 240), bipolar disorder (n=1928), schizophrenia (n=3540), ADHD (n=18 726), ASD (n=16 146), anorexia nervosa (n=3643), and the randomly sampled subcohort (n=30 000). Among those who met a range of inclusion criteria (eg, measured 25[OH]D, DBP or genotype, and predominantly European ancestry), we measured 25(OH)D or DBP in 71 793 individuals (38 118 [53·1%] male and 33 675 [46·9%] female); 65 952 had 25(OH)D and 66 797 the DBP measurements. Significant inverse relationships were found between 25(OH)D and schizophrenia (HR 0·82, 95% CI 0·78–0·86), ASD (HR 0·93, 95% CI 0·90–0·96), and ADHD (HR 0·89, 95% CI 0·86–0·92). A significant inverse relationship was found between DBP and schizophrenia (HR 0·84, 95% CI 0·80–0·88). Based on polygenic risk scores, higher concentrations of 25(OH)D (adjusted for DBP) were significantly associated with a reduced risk of both ASD and schizophrenia. Analyses based on Mendelian randomisation provided support for a causal association between both lower 25(OH)D and DBP concentrations and an increased risk of ADHD.

Interpretation
Convergent evidence finds that neonatal vitamin D status is associated with an altered risk of mental disorders. Our study supports the hypothesis that optimising neonatal vitamin D status might reduce the incidence of a range of neurodevelopmental disorders.

Funding
The Danish National Research Foundation.

Health Care Costs for Children with Disabilities

The Politics of Autism includes an extensive discussion of insurance and Medicaid services for adults with intellectual and developmental disabilities.

Houtrow AJ, Shearer CS, McKernan G, Kuhlthau K, Agrawal R. Health Care Cost Concerns and Hardships for Families of Children With Disabilities. JAMA Netw Open. 2025;8(4):e257826. doi:10.1001/jamanetworkopen.2025.7826

Introduction

Families of children with disabilities report more health care–related financial problems than families of children without disabilities.1 Their families are also more likely to report inadequate insurance coverage.2,3 We used the National Health Interview Survey (NHIS) to quantify the hardships of health care costs to families of children with disabilities in terms of difficulty paying their child’s medical bills, concerns about paying their child’s health care bills, and their child’s care delayed or forgone due to cost.

Methods

Data from the 2019-2022 NHIS for children aged 5 to 17 years were pooled for these analyses (eAppendix in Supplement 1). The NHIS is a nationally representative cross-sectional survey of the noninstitutionalized US population conducted by the National Center for Health Statistics.4 Information about the household’s sample child was collected via computer-assisted personal interview with a parent or guardian knowledgeable about the child’s health and disabilities, if present.5 Statistical analysis was performed from December 2024 to February 2025. Prevalence estimates and 95% CIs were calculated with survey weights applied. The χ2 test was applied to determine within-group prevalence differences, and the Cramer V was calculated for effect size estimates. The main outcome was the presence of health care–related financial hardship measured by caregiver report of difficulty paying the child’s medical bills, concerns about paying the child’s medical bills, delayed or forgone medical care due to cost and/or delayed or forgone prescriptions due to cost. Outcome estimates were adjusted for sociodemographic factors with missing data deleted. All P values were from 2-sided tests, and results were deemed statistically significant at P < .05. All analyses were conducted using R software, version 4.4.1. This secondary analysis falls under the exempt category for the University of Pittsburgh institutional review board because the data are publicly available. The study follows the AAPOR reporting guideline for survey studies.

 Results

Among the 22 670 children aged 5 to 17 years in the analytic sample representing 53 586 children annually, the overall prevalence of disability among children aged 5 to 17 years was 17.4% (95% CI, 16.7%-18.1%) (Table 1). The most commonly reported disabilities were emotional or behavioral (10.8% [95% CI, 10.2%-11.3%]). Disability prevalence varied across sociodemographic characteristics, with generally weak associations (Table 1). Children with disabilities were more likely to have public insurance (adjusted odds ratio [AOR], 1.42 [95% CI, 1.26-1.60]) or a combination of private and public insurance (AOR, 2.79 [95% CI, 2.10-3.71]) than their peers without disabilities (Table 2). Families of children with disabilities were almost twice as likely to experience any of 6 financial hardships than families of children without disabilities (22.3% [95% CI, 22.3%-20.7%] vs 12.6% [95% CI, 12.0%-13.3%]; AOR, 1.91 [95% CI, 1.70-2.14]). Families of children with disabilities had more difficulty paying medical bills (AOR, 1.97, 95% CI 1.76-2.21) and were more likely to be very worried about medical expenses (AOR, 1.35 [95% CI, 1.18-1.55]). These families also experienced higher rates of delayed and forgone care due to cost compared with families of children without disabilities.

Discussion

This study contributes to the existing literature by identifying that while insurance coverage is higher among children with disabilities, their families had higher adjusted odds for all of the financial hardships evaluated, compared with families of children without disabilities. This finding suggests that insurance is inadequate for disabled children. A key component of adequate insurance is the lack out-of-pocket expenses or having out-of-pocket expenses that were usually or always reasonable, such as for copays and coinsurance for diagnostic tests, visits, services, and treatments.3 Proposed cuts to the federal contribution to Medicaid6 would likely exacerbate the financial distress of these families. These data demonstrate a need to structure health insurance policies to ensure that children with disabilities have their needed medical care covered in a way that is not financially burdensome to families.3 This study is limited by the cross-sectional nature of the survey design, which does not allow for assessment of causality. Nonetheless, recognizing that nearly one-fourth of families of children with disabilities face financial hardships, worry about the cost of health care, and/or delay or forgo health care for their children with disabilities should be a call to action to improve insurance adequacy.

RFK Stokes Antivax Movement

In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.

A number of posts discussed Trump's support for the discredited notion.

 Another leading anti-vaxxer is presidential candidate Robert F. Kennedy, Jr.  He has repeatedly compared vaccine mandates to the Holocaust.  Rolling Stone and Salon retracted an RFK article linking vaccines to autism.  He is part of the "Disinformation Dozen." He helped cause a deadly 2019 measles outbreak in Samoa.

He is now Trump's secretary of HHS.

Sheryl Gay Stolberg at NYT:

The Association of Immunization Managers, a national organization of state and local immunization officials, is tracking 545 vaccine-related bills in state legislatures around the country, 180 more than last year — evidence, the group’s leaders say, that Mr. Kennedy is changing the national conversation. After peaking at the height of the coronavirus pandemic, the number of vaccine-related bills had come down in recent years.

But the big fear of public health leaders that began during the pandemic, and accelerated with Mr. Kennedy’s political rise — that states will undo school vaccine mandates — has so far not come to pass.

“For the 10 years that Texans for Vaccine Choice has existed, we have had a federal government that has been wholly irrelevant or working against us,” said [Rebecca] Hardy, the group’s president. “We’re excited about having individuals in the federal government who will actually cooperate with us. But what exactly that means, we don’t know.”

...

As health secretary, Mr. Kennedy has broken with his predecessors by refusing to advocate for vaccination. In response to the measles outbreak, he acknowledged that vaccines “do prevent infection,” but cast the decision to vaccinate as a personal one. Testifying before Congress last week, he refused to say whether, if he were a new parent, he would vaccinate his children against measles, polio or chickenpox.

“I don’t want to seem like I’m being evasive,” Mr. Kennedy said, “but I don’t think people should be taking medical advice from me.”

With vaccination rates already dropping, public health experts say it may not matter whether bills eroding vaccine mandates become law; all states already offer either religious or philosophical exemptions to school vaccine requirements. But the vocal activism surrounding the bills is encouraging more parents to seek those exemptions, experts say.

From  CDC:

As of May 15, 2025, a total of 1,024 confirmed* measles cases were reported by 31 jurisdictions: Alaska, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, New Jersey, New Mexico, New York City, New York State, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, Virginia, and Washington.

here have been 14 outbreaks** (defined as 3 or more related cases) reported in 2025, and 92% of confirmed cases (947 of 1,024) are outbreak-associated. For comparison, 16 outbreaks were reported during 2024 and 69% of cases (198 of 285) were outbreak-associated.

 

RFK the Unifier

In The Politics of Autism, I analyze the myth that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.    Examples include measles, COVID, flu, and polio.

A number of posts discussed Trump's support for the discredited notion.

 Another leading anti-vaxxer is presidential candidate Robert F. Kennedy, Jr.  He has repeatedly compared vaccine mandates to the Holocaust.  Rolling Stone and Salon retracted an RFK article linking vaccines to autism.  He is part of the "Disinformation Dozen." He helped cause a deadly 2019 measles outbreak in Samoa.

He is now Trump's secretary of HHS. This week, he lied about autism research, saying that HHS has not laid off scientists.

At Scientific American, Allison Parshall talks with Helen Tager-Flusberg, an autism researcher and a professor emerita at Boston University.,who organized a coalition of scientists to push back against RFK. The Coalition of Autism Scientists now has 258 members and is still growing.

Kennedy’s approach seems to step right on that fissure in the autism community. Is there a way to prevent this rift from developing further?

I don't think I have the answer to that. It’s a big question in the community because people are looking at the agendas in very different ways. But I will say one thing. I have been really impressed, over the past couple of weeks, since beginning this coalition, with how [autistic] folks who are self-advocates have joined the coalition. I think the one thing that unifies us is a belief in the importance of scientific research. Maybe we define the scope of that science in different ways, but that’s always true. That’s something that we all hold to.

And I think we all, at this moment, believe that the direction that’s been described so far by the administration is not the way we should go. We should not be opening up the question of vaccines again. We should be very cautious about using “registries” and make sure the research that’s done is ethical and maintains the confidentiality of individuals in those databases. We all agree about that.

We also all agree that, so far, we’re not hearing from the administration that they have a very deep understanding of autism. They have failed to engage most of us, whether scientists or advocates or nonprofit organizations. None of us have been involved in these discussions. So I think we actually have a moment in time where there is some agreement, and I think it behooves the administration to think about why that is and whether they need to change their course.