ProPublica

by Margaret Coker, The Current

This article was produced for ProPublica’s Local Reporting Network in partnership with The Current. Sign up for Dispatches to get stories like this one as soon as they are published.

Last summer, as political debate swirled over the future of Georgia’s experiment with Medicaid work requirements, Gov. Brian Kemp held a press conference to unveil a three-minute testimonial video featuring a mechanic who works on classic cars.

Luke Seaborn, a 54-year-old from rural Jefferson, became the de facto face of Georgia Pathways to Coverage, Kemp’s insurance program for impoverished Georgians. In a soft Southern drawl, Seaborn explained how having insurance had improved his life in the year that he had been enrolled: “Pathways is a great program that offers health insurance to low-income professionals like myself.”

Kemp lauds Pathways as an innovative way to decrease the state’s high rate of uninsured adults while reining in government spending, holding the program up as an example to other Republican-led states eager to institute Medicaid work requirements.

But in the nine months since Seaborn’s video testimonial was released, his opinion of Pathways has plummeted. His benefits have been canceled — twice, he said, due to bureaucratic red tape.

“I used to think of Pathways as a blessing,” Seaborn recently told The Current and ProPublica. “Now, I’m done with it.”

Rather than an enduring symbol of success, Seaborn’s experience illustrates why the program struggles to gain traction even as the state spends millions of dollars to burnish Pathways’ brand. The Current and ProPublica previously reported that many of the approximately 250,000 low-income adults potentially eligible for the health insurance program struggle to enroll or maintain coverage.

The politics of Pathways were not on Seaborn’s mind when he received a phone call last summer from an insurance executive who handles Pathways clients. One of the first Georgians to enroll in the program in 2023, Seaborn had written a letter thanking his insurance provider for covering a procedure for his back pain. The executive from Amerigroup Community Care wanted to know: Would he take part in a promotional video for Pathways?

Seaborn, a supporter of the governor, said yes without hesitation. Soon afterward, Kemp’s press secretary, Garrison Douglas, arrived at his auto repair shop, located a few miles from the governor’s hometown, and spent hours filming in the garage filled with vintage Ford and Chevy trucks and handpainted gas station signs.

A trained chemical engineer, Seaborn had quit his corporate job to embrace his dream of repairing classic cars. But the realities of being a small business owner made that path difficult, Seaborn said, especially when it came to shouldering the cost of health insurance for himself and his son. Pathways eased the way, he said.

Seaborn said he was surprised when the governor called him out by name weeks later at the press conference during which his testimonial video was released. He wasn’t expecting to be the singular face of Pathways.

By November, though, Seaborn encountered some of the problems that other Georgians say have soured their opinion on Pathways. Seaborn said he had logged his work hours into the online system once a month as required. But his benefits were canceled after he failed to complete a new form that he said the state had added without adequate warning. Seaborn said the form asked for the same information he had been submitting every month, just in a different format. The state’s Medicaid agency did not respond to questions about Seaborn’s experience or the new form.

He said he called the same insurance executive who had asked him to take part in the testimonial. She told him she would be lunching with one of Kemp’s aides that day and promised to help, he recalled. Within 24 hours, Seaborn said, his benefits were restored, and a representative from Georgia’s Division of Family and Children Services, which administers federal benefits programs, called to apologize.

Douglas said the governor’s office “had no involvement in Mr. Seaborn’s case.” The insurance company did not respond to requests for comment.

Pathways enrollees must submit paperwork every month proving they had completed the requirements necessary for coverage: 80 hours of work, study or volunteering. But the state says it is not verifying the information on a monthly basis — only during enrollment and upon annual renewal.

Seaborn said that after his coverage was restored, his insurance company told him he would no longer have to file his work hours monthly; the next time he would need to submit such documentation would be during his annual reenrollment. Nevertheless, Seaborn said he signed up for text and email notifications from the Pathways program so that he wouldn’t be caught off guard if requirements changed again.

Even so, technical glitches and more red tape caused him to lose his coverage once more, he said. He stopped receiving texts from the Pathways program in February. When he logged in to the digital platform in early March to make sure everything was in order, a notice informed him that his benefits would be terminated on April 1. The reason: he had missed filing an annual income statement. He said the surprise requirement had popped up on the digital platform even though his coverage was not up for renewal.

“My head exploded,” he said. “I didn’t get a text or an email. I did what I was supposed to, but that wasn’t good enough.”

Seaborn said he went ahead and filed the information, although it was late. He tried to call his insurance provider again for an explanation — and help. He reached out to the Division of Family and Children Services as well. This time, however, he said no one called him back.

In April, Seaborn paid out of pocket for his and his son’s prescription medications, an extra $40 that he said is difficult for him to afford.

Ellen Brown, a spokesperson for Georgia’s Division of Family and Children Services, would not say why Seaborn’s benefits were terminated.

“We are sorry to hear this happened and are looking into how we can better serve our customers and resolve communication gaps in the future,” Brown said in a written statement Friday. “Every Georgian that seeks our services is important, and we take these matters very seriously.”

Meanwhile, Seaborn received a phone call that day from the same Division of Family and Children Services representative who had apologized to him after he was kicked off Pathways last fall. He said she told him she would make sure he got his coverage back. The representative did not respond to a request for comment from The Current and ProPublica.

On Monday evening, Seaborn received a text message to alert him to a notification in the Pathways digital platform. He logged on: A notice confirmed that he had been reenrolled, a change of fortune that he credited to The Current and ProPublica’s questions to state officials about his predicament because he had already given up on contacting people for help.

“I am so frustrated with this whole journey,” Seaborn said. “I’m grateful for coverage. But what I don’t understand is them leaving me like a mushroom in the dark and feeding me nothing, no information, for more than a month.”

by Margaret Coker, The Current

This article was produced for ProPublica’s Local Reporting Network in partnership with The Current. Sign up for Dispatches to get stories like this one as soon as they are published.

When the state of Georgia handed Deloitte Consulting a $10.7 million marketing contract last July to promote the nation’s only Medicaid work requirement program, the initiative was in need of serious PR.

At the time, a year after the program’s rollout, less than 2% of those eligible for Georgia Pathways to Coverage had enrolled, well short of state targets.

To get the word out, the state turned again to the firm that it had relied on to build and manage the program. About 60% of the marketing contract went toward creating and placing ads about Pathways on television and radio, including during NFL games and morning talk shows.

Much of the remainder of the seven-month contract would go toward two efforts: $250,000 per month for Deloitte-trained teams to hand out brochures and Pathways-branded merchandise at community events and $300,000 a month for Deloitte to produce reports about its own performance.

When Deloitte’s publicity campaign ended in February, enrollment in Pathways remained less than 3% of the approximately 250,000 Georgians who are potentially eligible.

The marketing contract is part of a larger suite of services that Georgia has commissioned from Deloitte for its Medicaid experiment. Deloitte has made at least $51 million as of Dec. 31 to manage Pathways, including creating and maintaining its problematic software platform, as The Current and ProPublica previously reported. It is also earning at least $3 million more to oversee the state’s relationship with federal regulators, including its application to extend the experiment beyond its expiration this fall.

Deloitte’s outsize — and unusual — role in promoting the program it has built has allowed the firm to keep pulling in payments despite Pathways’ struggles. And there is virtually no public accounting of how well it is increasing enrollment, a key goal of the policy experiment.

An excerpt of Deloitte’s marketing contract shows its $300,000 per month expenditure on reports on its own performance, $250,000 per month for community outreach and $10.7 million total budget. (Obtained by The Current and ProPublica. Highlighted by ProPublica.)

The marketing contract, obtained through a public records request, allows Deloitte to charge the state nearly half a million dollars for a final report on its publicity campaign, which was due to be submitted in February. When The Current and ProPublica requested the monthly and final performance reports, the state said they needed to be “reviewed” first and demanded $900 for that work. The news outlets did not pay because previous responses to public records requests for Deloitte’s Pathways contracts were heavily redacted, with the general counsel’s office at the Department of Community Health citing “confidential/trade secret.” The agency did not charge for those records.

The state recently approved another $10 million to Deloitte, Fiona Roberts, spokesperson for the Department of Community Health, Georgia’s Medicaid agency that oversees Pathways, said in response to questions about the effectiveness of Deloitte’s marketing efforts. The new marketing contract, which runs until November, includes more community meetings and a text message campaign by Salesforce Marketing Cloud rolling out in May to potentially eligible Georgians, Roberts said.

“In 20 years of researching these kinds of programs, I can’t think of another instance like this” in which a state has selected a for-profit company to both manage and market a federal benefit program, said Joan Alker, executive director for Georgetown University’s McCourt School of Public Policy Center for Children and Families, where researchers have concluded that Medicaid work requirements prevent people from accessing health insurance.

Deloitte has designed and managed Medicaid and other benefit programs for many states, including Georgia, making the firm one of the nation’s experts in government health policy. But Alker said that when states want to educate and enroll residents in federal safety net programs, they typically select local nonprofits that have established relationships with low-income communities. Georgia’s arrangement with Deloitte raises questions, she said, about “whether the state is more committed to spending money on consultants or poor people.”

Deloitte, which has been in charge of the Pathways communications strategy for the past three years, declined to answer questions about its Georgia Pathways work, referring requests for information to the Department of Community Health. A contract signed in 2023 worth approximately $7 million stipulates that Deloitte would “develop first draft of response to media inquiries” on behalf of the Department of Community Health, but that responses “will be submitted by DCH and not Deloitte.” Deloitte’s duties also include drafting talking points for media interviews, including for the governor.

Roberts declined repeated requests for an interview with agency officials. When asked about Deloitte’s marketing and outreach work and whether the firm has met the state’s goals, she described the effort as a “robust, comprehensive awareness and outreach campaign throughout the state” that has generated 1.6 million visitors to the Pathways website since the campaign’s August 2024 launch.

“The state has invested heavily in marketing and outreach to reach Georgians potentially eligible for Pathways,” Roberts said in a written statement.

In 20 years of researching these kinds of programs, I can’t think of another instance like this.

—Joan Alker, executive director for Georgetown University’s McCourt School of Public Policy Center for Children and Families

Gov. Brian Kemp has described Pathways as an innovative alternative to expanding Medicaid, something 40 other states have done. By contrast, Georgia’s program covers only the poorest individuals who can prove they are working, studying or volunteering at least 80 hours a month. Congressional Republicans are pointing to similar work requirements as a model in their budget negotiations.

In early 2024, less than a year after Pathways’ launch, however, Georgia legislators — including some of Kemp’s Republican allies — considered ending the experiment and instead expanding Medicaid without any work requirements. Georgia’s uninsured rate was 11.4%, or 1.2 million people, compared to the national average of 8% in 2023, the latest data available, according to KFF, a nonprofit focused on national health issues. State data showed that Pathways enrollment was well under the first-year target of 25,000 published in Georgia’s agreement with the federal government. As of April 25, approximately 7,400 Georgians were enrolled, according to the Department of Community Health.

An independent evaluation team commissioned by the state recommended ways to boost enrollment in a December 2024 report. The evaluators, Public Consulting Group, highlighted North Carolina’s strategy of allowing residents from rural communities and communities of color to help create outreach campaigns for its expanded Medicaid program in 2023. North Carolina Medicaid officials told The Current and ProPublica that they designed their outreach efforts to maximize participation in the new program, with a two-year target of enrolling 600,000 people. They achieved that goal within one year.

Georgia and Deloitte, however, took a different tack. The $10.7 million marketing contract does not lay out specific enrollment goals as a way of measuring the success of Deloitte’s efforts. The purpose of Pathways “is not and has never been to enroll as many Georgians as possible,” according to the state’s application to the federal government to continue the experiment.

The contract budgeted $247,000 to create up to four testimonial videos featuring satisfied Pathways clients; only one can be found on the state Medicaid agency’s YouTube channel, where it has received approximately 350 views since it was posted in January. The state did not respond when asked how many testimonials Deloitte produced.

Few people stopped by the Georgia Pathways booth at the Washington County Health Fair in Sandersville, Georgia, in March. (Nicole Craine for ProPublica)

Meanwhile, another part of Deloitte’s marketing strategy has also failed to catch wind: Deloitte had sent public relations teams to dozens of community events including farmers markets, a school Christmas pageant and a catfish festival to plug Pathways and encourage applications.

In March, one such team drove two hours from Atlanta to a health fair in Central Georgia’s rural Washington County. At the Pathways booth, the Deloitte team barely looked up from their phones for three hours. Residents largely bypassed the team to chat with locals staffing other kiosks where they could receive diapers, information on subsidized in-home nursing care and blood pressure screenings. Of those who stopped at the Pathways booth, only a handful asked about enrollment.

Other public events were tied to the state’s pursuit of federal permission to extend the Pathways program beyond September, when its original five-year mandate expires. Georgia is once again paying Deloitte to ensure that happens.

The monthslong process, managed by Deloitte, requires opportunities for public comment. A summary of these comments must be submitted with the application, which Deloitte is drafting. Health advocacy organizations say public outreach for this effort, especially to Black Georgians, has been superficial at best.

The only notice for two virtual public meetings appeared on a Department of Community Health web page that was not linked from the agency’s homepage. During both virtual events, health care advocates criticized the program’s inequitable access, but state officials did not engage with the speakers.

A third event — an in-person meeting in the rural 10,000-person town of Cordele — was added later and posted on the same website just one week before it was scheduled to occur. Only about a dozen people, some traveling for more than 80 miles, showed up to the noon meeting on St. Patrick’s Day.

Georgians traveled up to 80 miles to speak at a public meeting about Pathways held by the Georgia Department of Community Health in Cordele in March. (Nicole Craine for ProPublica) The town of Cordele has a population of around 10,000 people. (Nicole Craine for ProPublica)

The low attendance reflected the meeting’s out-of-the-way location and holiday timing, not a lack of public interest, said attendee Sherrell Byrd, executive director of Sowega Rising, a community advocacy group based in the majority Black town of Albany.

Inside the one-story cinder block building, three state health officials sat along a table at the front of the largely vacant room. One by one, attendees rose to the microphone to complain of technical glitches in the Pathways enrollment process, the lack of customer service and the generational health care inequalities faced by Black Georgians.

Tanisha Corporal, who lives approximately 140 miles away in Atlanta, was the only person to participate virtually. She told the Department of Community Health officials that she had submitted a Pathways application three times over the Deloitte-built digital portal only to have her file disappear. The licensed clinical social worker whose nonprofit job ended in January 2024 said state agencies offered her little enrollment support.

Grant Thomas, deputy commissioner for the Georgia Department of Community Health, sits in the back of the room during a public meeting on the Georgia Pathways program in Cordele. (Nicole Craine for ProPublica)

The state health officials did not respond to any of the speakers during the meeting. Grant Thomas, Kemp’s former health policy advisor and deputy director of the state Medicaid agency, sat in the back of the room and did not interact with the attendees. Thomas declined to speak on the record.

“There is a lot of disdain for real-life problems of Georgians who look like us,” Byrd said.

Robin Kemp of The Current contributed reporting.

by Tony Schick and Monica Samayoa, Oregon Public Broadcasting

This article was produced for ProPublica’s Local Reporting Network in partnership with Oregon Public Broadcasting. Sign up for Dispatches to get our stories in your inbox every week.

Electric companies in Oregon and Washington are hurtling toward deadlines to stop using power generated by coal, gas and other fuels that contribute to global warming. Yet the states are nowhere near achieving their goals, and the dramatic consequences are already being felt.

During a winter storm in January 2024, for example, the Northwest barely had enough power to meet demand as homeowners cranked up electric heaters and energy prices surged to more than $1,000 per megawatt-hour, or 18 times higher than the usual price. Power lines were so congested that owners of the transmission network made an extra $100 million selling access to the highest bidder.

Multiple utilities were operating in states of emergency during the storm, preparing for rotating power outages.

The storm “highlighted a tipping point and demonstrated how close the region is to a resource adequacy crisis,” the Western Power Pool, a regionwide organization of utilities, wrote in its assessment of the event.

Price spikes like this are one reason customers of major utilities in Oregon are paying 50% more on their power bills than they were in 2019. The number of utility customers disconnected last year for failure to pay soared to 70,000, the highest number on record.

Forecasters predict periods of extreme weather in the Northwest will only bring more trouble in the future: the threat of rolling blackouts within the decade if the region’s current energy trends continue.

Wind, solar and other renewables are the only forms of power that can be added to solve the problem, thanks to Oregon’s and Washington’s green energy mandates. Yet better transmission lines are needed to carry new energy sources in the windy and sunny eastern parts of the region to big cities west of the Cascade Mountain Range.

Experts say adding transmission lines in corridors that currently lack them would also enable utilities to keep power flowing when ice storms or wildfires threaten other parts of the grid.

The biggest owner of these transmission lines, the federal Bonneville Power Administration, has been slow to spend on upgrades — and slow to approve new green projects until upgrades are made.

Bonneville’s parent agency, the Energy Department, declined to make officials available for an interview, but Bonneville answered written questions.

“The potential for blackouts in the Pacific Northwest is incredibly low,” the agency said. “Grid planners and operators will continue to ensure reliability.”

Washington and Oregon lawmakers failed to address the Bonneville bottleneck when they approved clean energy mandates in 2019 and 2021, as ProPublica and OPB reported recently.

Oregon Rep. Ken Helm, a Portland-area Democrat who was a sponsor of the 2021 legislation, said the failure to prioritize transmission lines wasn’t the only flaw with the legislation. He said the bill failed to provide accountability, having no penalties for when a utility did not reach certain deadlines for acquiring either solar or wind energy. Helm said now, House Bill 2021 is “dead letter law.”

“Senators and representatives like me, we cannot continue to believe our own PR, that we have been successful in promoting a renewable electricity future,” said Helm, a member of the House Committee on Climate, Energy and Environment. “We are not heading in that direction, and we’re going to have to take action to change that or nothing will happen.”

Some lawmakers tried to play catch-up this year. Legislators in each state drew up plans for state transmission authorities that could finance improvements independent of utilities and Bonneville. Those efforts failed.

“Oregon desperately needs to take some leadership here,” said Nicole Hughes, executive director of the group Renewable Northwest, which advocates for weaning the region off of fossil fuels.

The Northwest’s situation is only expected to get worse. The region’s electrical demand is forecast to double over the next 20 years, in large part because data centers, rewarded with tax breaks in both Oregon and Washington, are driving an increase in power use the region hasn’t experienced since the early 1980s.

Abandoning Oregon’s and Washington’s renewable energy laws wouldn’t help, Oregon’s Citizens’ Utility Board says, because new fossil fuel power plants would cost ratepayers more than wind or solar. Those plants would still have to contend with transmission lines that have no room for their power.

The region’s utilities, meanwhile, say they’d like to add 29,000 megawatts of generating capacity over the next 10 years — an unprecedented addition that would be roughly equivalent to all the electricity that the Northwest currently consumes at any given time. The projects on their to-do list are powered entirely by renewable energy.

Yet the utilities added only a little over half the power to their systems that they planned for last year. In fact, of the 469 projects that applied to connect to Bonneville’s grid in the past decade, the only one to win the agency’s approval was in 2022. Growth in green energy in 2024 came from projects that began seeking a connection to Bonneville’s grid prior to 2015 or that connected to smaller transmission networks owned by private utilities.

If the utilities continue to fall as short of their goals as they did in 2024, then projections from the Western Electricity Coordinating Council suggest residents will spend the equivalent of nearly a month annually under the threat of brownouts — the inability to power all the circuits in a household — or blackouts.

“In the next few years, we may start having to make some tough choices about the availability of electricity,” Hughes said.

Hughes has spent 20 years in the renewables industry.

For now, she said, her family decided to buy a gas generator for times when their house loses power.

by Becca Savransky, Idaho Statesman

This article was produced for ProPublica’s Local Reporting Network in partnership with the Idaho Statesman. Sign up for Dispatches to get our stories in your inbox every week.

Time and again, the U.S. Department of Education has been the last resort for parents who say the state of Idaho has failed to educate their children. The federal agency in 2023 ordered Idaho to stop blocking some students with learning disabilities, like dyslexia, from special education. That same year, it flagged that the state’s own reviews of districts and charters obscured the fact that just 20% were fully complying with the federal disability law. Last year, it told the state it must end long delays in services for infants and toddlers with disabilities, which could include speech or physical therapy.

Now President Donald Trump has pledged to dismantle the department.

Idaho’s superintendent of public instruction Debbie Critchfield has celebrated the proposal. She insisted that the move would not change the requirement that states provide special education to students who need it. That would take an act of Congress.

But parents and advocates for students with disabilities say they are worried that no one will effectively ensure schools follow special education law.

“Historically, when left to their own devices, states don’t necessarily do the right thing for kids with disabilities and their families,” said Larry Wexler, a former division director at the federal Office of Special Education Programs, who retired last year after decades at the department.

Former federal Education Department employees who worked on special education monitoring said oversight measures would likely be hampered by the layoffs, which included attorneys who worked with the special education office to provide state monitoring reports.

Gregg Corr, a former division director with that office, said that without the group of attorneys who were focused on enforcing special education law, it will be “really difficult for staff to finalize and issue these reports to states.” He added there may also be a reluctance to take on more complicated issues without running them by attorneys.

“What might have been, you know, inconsistent with the legal requirements six months ago may be fine now — it just depends on how it’s interpreted,” Wexler said.

Before Federal Law, Millions Denied Services

For parents who have been fighting for services for years, the federal oversight has been critical.

After Ashley Brittain, an attorney and mom to children with dyslexia, moved to Idaho in 2021, she realized a key problem: Idaho’s criteria for qualifying students with specific learning disabilities such as dyslexia or dysgraphia was so narrow it disqualified some eligible students from receiving services, she said.

Historically, when left to their own devices, states don’t necessarily do the right thing for kids with disabilities and their families.

—Larry Wexler, a former division director at the federal Office of Special Education Programs

Together with Robin Zikmund, the founder of Decoding Dyslexia Idaho who has a son with dyslexia and dysgraphia, Brittain has spent years trying to get the state to acknowledge the disability and provide services to dozens of kids who needed help.

“We’re at the table time and time again, at the eligibility table, where school teams wouldn’t qualify our dyslexic students,” Zikmund previously told the Idaho Statesman and ProPublica. “And it was like, ‘What is going on?’”

Brittain called state officials and told them they were breaking the law. State officials disagreed. No one took action, she said. In 2022, she wrote to the Office of Special Education Programs. In the letter she sent to the federal department, she said the Idaho Department of Education, under former superintendent Sherri Ybarra, was “refusing to entertain any conversations” about changing the way it determined which students were eligible for special education. Ybarra could not be reached for comment.

Before Congress passed what is now known as the Individuals with Disabilities Education Act in 1975 and created the U.S. Department of Education as an agency under the Cabinet about five years later, Brittain would have been on her own.

At the time, nearly 1.8 million students with disabilities weren’t being served by the public schools, according to estimates. Some states had laws prohibiting students with certain disabilities from attending public schools, according to the federal government’s own history.

The law granted students with disabilities access to a “free appropriate public education” — fitting the individual needs of the student — and gave money to states to fulfill the promise. Now, the law also guarantees infants and toddlers with disabilities access to early interventions, such as physical or speech therapy.

The U.S. Department of Education has since been responsible for making sure states follow the law, providing reviews of state performance, distributing money and offering technical assistance to help states improve learning outcomes for students in special education.

The department conducts an annual review of each state, and a more intensive one that’s supposed to be completed roughly every five years. The annual reviews look at discipline numbers, graduation rates and test scores to identify problems and help states to fix them. A five-year review includes a visit to the state and a look at state policies, student data and annual reports. When states need to take corrective action, the federal special education office monitors that they are making the changes.

Idaho is one of about a dozen states currently being monitored, according to the most recent updates on the federal agency’s website.

We’re at the table time and time again, at the eligibility table, where school teams wouldn’t qualify our dyslexic students. And it was like, ‘What is going on?’

—Robin Zikmund, founder of Decoding Dyslexia Idaho

Parent complaints can also trigger a review, as was the case with Brittain in Idaho. After Brittain alleged that the state was wrongfully keeping kids with dyslexia and other disabilities from special education, she waited over a year before she got an answer from the Office of Special Education Programs: She was right. Idaho, it turned out, accepted a lower percentage of students with specific learning disabilities, such as dyslexia, into special education compared to other states — about half the national average, according to the most recent data reported to the U.S. Department of Education from the 2022-2023 school year.

By then, Idaho had a new state superintendent of public instruction, Critchfield, for whom Brittain campaigned. The Office of Special Education Programs told Critchfield in 2023 that the state needed to demonstrate its policies complied with federal law or update them.

In response, the Idaho Department of Education has updated its special education manual, which has since been approved by the Legislature. It has also directed school districts to review every student found ineligible for special education since 2023 to determine if they needed to be reevaluated.

Parents in Idaho celebrated the victory, which could make it easier for some kids to qualify in a state that has one of the lowest percentages of students who receive special education. But they acknowledged the fix wasn’t perfect and left out students who may have been found ineligible for special education before the federal office identified the problem. The state isn’t tracking the number of students who have since qualified due to the change.

Nicole Fuller, a policy manager at the National Center for Learning Disabilities, said a case like this, in which some students are being missed, “truly underscores the need for federal oversight, and, of course, holding states accountable for accurately identifying disabilities.”

Federal oversight isn’t perfect. By the time Idaho addressed Brittain’s complaint, the state had been out of compliance since at least 2015. States that fall out of compliance can be at risk of losing federal funding, although that penalty does not appear to have been used in decades.

The federal government has never fulfilled its promise to fund 40% of each state’s special education costs, but Idaho relied on federal funding for about 18% — around $60 million — of its special education budget during the 2022-2023 school year, state officials said. The rest is made up by the state or by local school districts through referendums. A recent report by an independent Idaho state office estimated special education was underfunded by more than $80 million in 2023.

But U.S. Education Secretary Linda McMahon, appointed by Trump in March, has said that closing the department wouldn’t mean “cutting off funds from those who depend on them” but would eliminate the “bureaucracy” and regulations associated with them.

Critchfield, Idaho’s superintendent, said on Idaho-based The Ranch Podcast that teachers involved in special education spend a lot of time filling out paperwork instead of “focusing on how to help that child be successful.” The changes are about “removing the bureaucracy.”

But Critchfield acknowledged that cuts at the federal level could pose challenges if states have to take on more of an oversight role.

“As much as I am a champion of states doing that, the reality is there would be implications for Idaho and our department,” she said in a statement to the Statesman and ProPublica. The state is looking at what it can do to prepare and “where gaps would exist” should more responsibilities fall to the states.

Zikmund, the advocate who praised Critchfield for being responsive to parents and having an “open-door policy,” said that parents could be better off after the changes with good leadership at the state level, but without it, they could face a “train wreck.”

One test will come in June, when the Office of Special Education Programs is expected to release reports telling states how they performed in their annual reviews. The layoffs and restructuring under Trump are making some advocates question if the federal government will truly hold states to account.

by Anjeanette Damon and Mollie Simon

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

Ronald Carver was skeptical when his investment adviser first tried to sell him on an “ugly houses” investment opportunity eight years ago. But once the Texas retiree heard the details, it seemed like a no-lose situation.

Carver would lend money to Charles Carrier, owner of Dallas-based C&C Residential Properties, a high-producing franchise in the HomeVestors of America house-flipping chain known for its ubiquitous “We Buy Ugly Houses” advertisements. The business would then use the dollars to purchase properties in which Carver would receive an ownership stake securing his investment and an annual return of 9%, paid in monthly installments.

“Worst case, I would end up with a property worth more than what the loan was,” Carver said of the pitch.

Carver started with a $115,000 loan in 2017. And sure enough, the interest payments arrived each month.

He had worked three decades at a nuclear power plant, and retired without a pension and before he could collect Social Security. He and his wife lived off the investment income.

The deal seemed so good, Carver talked his elderly father into investing, starting with $50,000. As the monthly checks arrived as promised, both men increased their investments. By 2024, Carver estimates they had about $700,000 invested with Carrier.

Then, last fall, the checks stopped. The money Carver and his father had invested was gone.

Carrier is accused of orchestrating a yearslong Ponzi scheme, bilking tens of millions of dollars from scores of investors, according to multiple lawsuits and interviews with people who said they lost money. The financial wreckage is strewn across Texas, having swept up both wealthy investors and older people with modest incomes who dug into retirement savings on the advice of the same investment advisor used by Carver.

As early as 2020, Carrier had begun taking out multiple loans on individual properties — some of which he never owned. In cases reviewed by ProPublica, as many as five notes were recorded against a single property, far exceeding the property’s value. Carrier also failed to properly record many deeds that were supposed to secure the loans, accumulating more debt than he could ever repay while investors remained unaware they had no collateral for their investments.

“It’s incalculable the amount of damage this guy did,” said one investor who lost about $1 million and asked not to be named to avoid embarrassment and not to interfere with a criminal investigation into Carrier’s scheme. “He’s ruined some lives.”

Carrier, who declined an interview request, said in a brief phone conversation that he’s not trying to avoid responsibility for the harm he caused. “When this thing finally stopped, it was completely driven by me saying ‘enough’ and going to the people and saying, ‘Here’s the mess I’ve created,’” he said. “This is a mess created by me.”

Investors also blame HomeVestors. For nearly two decades, Carrier used the company’s carefully cultivated brand as the “largest homebuyer in the United States” to gain investors’ trust. They accuse HomeVestors of failing to provide oversight that could have prevented the fraud, despite claiming to hold its franchises accountable for best business practices. In its answers to their lawsuits, HomeVestors has denied responsibility for Carrier’s actions, claiming its franchises are independently operated, despite earning hundreds of thousands of dollars from Carrier’s business.

HomeVestors revoked Carrier’s franchise on Oct. 24, about the time interest payments stopped arriving in investors’ accounts. The company said it had received a tip on its ethics hotline — created in 2023, after ProPublica detailed predatory buying practices by multiple franchises. When confronted by HomeVestors, Carrier admitted that “he and his business had entered into debts that they could not pay,” a HomeVestors spokesperson said. The company reported him to the FBI. In May, HomeVestors filed suit against Carrier for trademark infringement and for not indemnifying it against these lawsuits.

“We take all allegations of misconduct incredibly seriously as demonstrated by our decisive action,” the spokesperson said. “It is truly disheartening for us that anyone who lent Mr. Carrier money was misled or harmed by his alleged fraudulent activity.”

Now, Carrier is under investigation by the Department of Justice, according to a recording of an April call between the lead prosecutor and potential victims. (The FBI and DOJ declined to comment.) A judge in one of the many lawsuits against Carrier has deemed allegations of fraudulent loans to be true because Carrier never answered the complaint. And the investors are in a race with one another to recoup even a small amount of what they lost, by either waiting for the DOJ to pay restitution, suing Carrier or trying to foreclose on properties still left in his portfolio.

Just months after learning they had lost all of their investments, and before any restitution could be paid, Carver’s father died.

Five notes for a property on Glen Forest Lane in Dallas given to investors between 2019 and 2023. Two of the notes were not recorded until 2024. (Obtained, collaged and highlighted by ProPublica) A Top-Performing Franchise

In 2005, Carrier opened a HomeVestors franchise in Dallas, where HomeVestors is headquartered. In the early days, records show, he relied on a handful of institutional lenders to finance his house purchases. Soon, the Wharton School of Business MBA who had come to house-flipping following a career at Pepsi and a food service equipment company, started cultivating his wealthy friends for loans.

Carrier didn’t fit any stereotype of a glad-handing huckster with a bad loan to sell. Those who knew him describe him as a serious person, “cordial but very direct.” He always had files in front of him, constantly focusing on his business. It made him seem trustworthy, one investor said.

At HomeVestors, he was held up as a model franchise operator. C&C Residential Properties routinely made the top volume and top closer lists and was even named franchise of the year. Carrier led training sessions at company conferences and described his business as “the largest and most successful HomeVestors franchise in the United States” — a claim that remained on the website for Carrier’s business through early May.

“Chas Carrier, for maybe 15 years, was one of the golden boys at HomeVestors,” said Ben Ahern, who over two decades worked for a HomeVestors franchise and later owned one before leaving the company in 2021. “Internally, it was like, ‘Do whatever Chas Carrier’s doing.’”

It isn’t unusual for HomeVestors franchises to rely on private investors to finance their house-flipping. Banks aren’t typically interested in house-flipping loans, which are often short-term and riskier than a standard mortgage. Because of that risk, investors who lend to house-flippers earn a substantially higher return.

To further minimize their risk and ensure they had a legitimate ownership stake in the house, savvy investors would verify the transaction with an independent title company to research whether there were other liens against the property and then record the deed with the county recorder. But many of Carrier’s investors, after years of consistent payments led them to trust him, let Carrier handle recording the deeds and did not confirm that he’d done so.

As Carrier grew his business, he began relying more on individual investors. ProPublica identified through public records at least 124 people who have lent money to Carrier since 2009. Not all of them have lost money.

Carrier’s search for new investors was aided by Robert Welborn, an investment adviser in Granbury, Texas, southwest of Dallas. Welborn had built a network of clients in Granbury, a city of about 12,000 people on the Brazos River, through church, friendships and referrals. Many of his clients were older and had modest nest eggs, which Welborn said were “well diversified.” He said he built a relationship with Carrier in 2012, after researching his background for about two months. That Carrier was a successful franchisee lent him credibility, Welborn said.

“I never imagined the No. 1 franchisee with a fast-growing franchise company, HomeVestors,” would defraud investors, he said.

At the time, Welborn also solicited new investors with invitations to steak dinners where they would hear his pitch. An investment in Carrier’s business, according to Welborn’s sales material, which also featured the HomeVestors caveman mascot, Ug, was both lucrative and secure. “Your investment is protected,” the sales material assured potential clients.

For loans he sent Carrier’s way, Welborn earned a 2% commission, he said. Welborn had at least two dozen clients who invested with Carrier, most of whom had multiple loans to him, according to a public records search. He would not comment on how many of his clients invested with Carrier.

Many investors were happy for years — in some cases, more than a decade. The interest payments came in like clockwork. A lot of Welborns’ clients relied on the payments for retirement income.

“I was real tickled with it,” said Tom Walls, 85, who said he lost $50,000 of his retirement savings by investing with Carrier.

Some investors noticed small problems — a payment that arrived a few days late or an error on the paperwork to secure the loan. But Carrier always fixed the problems promptly, investors said.

“When you have this 10-year continuous, pleasant and mutually beneficial relationship, you build up a great deal of trust,” said John Moses, who estimates he lost more than $1 million to Carrier.

Looking back, the investors who spoke with ProPublica said they wished they had taken those warning signs more seriously.

(Max Erwin for ProPublica) “He Just Pencil Whipped Those Deeds”

By fall 2024, Carrier’s payments to his lenders stopped. That’s when the house of cards fell.

Carrier had spent that summer scrambling for money. Not only did Carrier have to make loan payments to scores of investors, but he also needed to keep up with the HomeVestors franchise fees and advertising payments. The company requires its franchises to make regular reports on sales and to open their books for audits, to provide financial statements when requested, and to report all assets and liabilities. Any of those reports could have called into question Carrier’s ability to stay solvent. But, according to former franchise owners and employees, HomeVestors’ audits of its franchises are mostly geared toward ensuring they’re paying all their franchise fees, which are based on sales.

Before Carrier’s tangle of fraudulent loans collapsed and was exposed in court, there were signs of trouble.

In 2016, Carrier was fined by the Texas Real Estate Commission for managing properties without a license. The HomeVestors franchise agreement requires owners to follow all laws and regulations, particularly real estate regulations. In 2020, two title insurance companies issued special alerts on Carrier’s business, advising their title officers not to enter into transactions with him without further legal and underwriting review. Carrier hasn’t paid taxes on some of his properties since early 2023, according to court and public records, another violation of his franchise agreement. Despite the apparent violations, HomeVestors didn’t terminate Carrier’s franchise agreement.

“I don’t really think they do have much in place to prevent something like this,” Ahern, the former HomeVestors franchise owner, said of the company. “HomeVestors at the time didn’t seem to have an internal system policing how franchises finance buying properties.”

A HomeVestors spokesperson said the company focuses on its franchise customers’ experiences selling their homes and does not “dictate” how franchises raise capital. “The more than 950 franchises of HomeVestors are independent businesses with a wide variety of finance options available to them,” the spokesperson said.

Last spring, Carrier began borrowing against his future receipts in exchange for cash advances with exorbitant fees and annualized interest rates that he later claimed ranged as high as 600%. Between May and October, he did this at least seven times, racking up more than $1.2 million in debt beyond what he owed his investors, exhibits included with court filings show. By fall, he owed more than $75,000 in payments a week, according to the original terms. Seven companies filed suit over the cash-advance agreements, accusing him of default. Carrier has denied the allegations of default and has countersued four of the companies, claiming he was charged unreasonably high interest rates.

The lending scheme appears to have fallen in a gray area for state and federal securities regulations. It’s unclear whether the promissory notes Carrier issued to investors meet the definition of a security, two experts told ProPublica.

In October, Carrier’s investors began to confront him about the missing payments, including Jeff Daly and Steve Needham, two of Carrier’s largest investors who had been lending him money for years. Carrier came clean to Daly, admitting he had been running a lending scheme for “several” years, according to a lawsuit Daly and Needham filed. He told Needham he had taken out multiple loans on individual properties without disclosing them to the investors, according to the lawsuit. The two men claimed in their lawsuit, which resulted in default judgments against Carrier, that combined they had lost $13.5 million to Carrier.

The investor who spoke to ProPublica and asked not to be named said in an interview that Carrier broke down in tears when confronted about losing more than $1 million of the investor’s money. Carrier admitted the loans paid for his operating expenses, not for buying and refurbishing houses, the investor said.

“He just pencil whipped those deeds at the end,” the investor said, explaining that Carrier drew up documents but didn’t record them. Because the deeds were never recorded, the investor had no lien on the properties and therefore no collateral. Some deeds were for houses that Carrier didn’t own or never bought, the investor said. “It was a complete fabrication.”

Welborn’s clients, who typically invested much smaller amounts with Carrier, also learned of the house-flipper’s collapse in the fall, when their payments stopped. Carver said that Welborn called him a couple of days after the October payment was due and said, “Hey, I’m sorry to tell you this, but Chas has called me and admitted to fraud.”

Carver said he got in the car and drove to Welborn’s office, where he learned the nightmarish truth that all the money Carrier had taken was gone.

“A Life-Changing Hit”

Investors are deploying a variety of strategies to get their money back — some of which pit bigger investors against smaller ones and early investors against more recent ones. Those who acted quickly are recovering some money through foreclosures and lawsuit settlements. Although Carrier is denying allegations in lawsuits brought by the cash-advance companies, he’s not fighting individual investors who are suing him. Three of their lawsuits have resulted in judgments against Carrier, and he has so far not defended himself against the others.

Welborn said he’s doing his best to help his clients recover their money by providing the necessary paperwork, connecting them with buyers for the houses used as collateral and researching lien histories on the homes. When he first learned of the scheme, Welborn tried to convince his clients to sign on with his lawyer to sue Carrier. The lawyer, Anthony Cuesta, hoped a court would seize Carrier’s assets to help recover the investors’ lost funds. But he quickly learned there were too many investors and not enough equity in the properties to fund the litigation. Now, many of Welborn’s clients are waiting for the FBI and DOJ to act, while wealthier investors are foreclosing on properties and making them ineligible to be used for restitution. Welborn said some of his clients have been paid restitution through a DOJ-appointed real estate agent’s sale of Carrier’s properties, but he declined to provide details.

Carver isn’t optimistic: “We are not going to get a dime.”

At least one investor went after Welborn individually. According to a Securities and Exchange Commission disclosure, the claim was settled for $130,000. In his response to the SEC disclosure, Welborn denied breaching fiduciary duty to the client and said he “resolved the claim to avoid controversy.” Welborn told ProPublica that $120,000 of the settlement came from the sale of the house used as collateral for the family’s loan and he paid $10,000 for their attorney fees.

Welborn said he’s “devastated” by the loss of his clients’ money. “But every day I drag myself to work with God’s help and spend most of my day helping lenders with their own personal restitution battles,” he said.

Some investors said they will have to go back to work after having retired or are scrambling to find some way to replace their lost income.

Carver wishes he had paid more attention to red flags, like paperwork errors. But the monthly checks were so reliable, he didn’t listen to his gut. Or his wife.

“Every time I added money, my wife would say, ‘Don’t do it,’” Carver said. “My mother, too. She would push on my dad not to add any more. But he liked getting the monthly check.”

Carver’s dad, Larry, believed it was the best performing investment he had ever made. When the money disappeared, Carver went to work trying to recoup some of it. Maybe he could write it off on his taxes, he thought. He wanted to get at least something back for his dad. But Larry was in ill health, and in February, he died.

“My dad passed thinking he lost all of his money to this guy,” Carver said, adding he hopes Carrier “goes to jail for a very long time.”

The investor who asked not to be named said the loss was “a life-changing hit.” He had retired at 53, after sticking it out in a job he hated until his stock options vested. When he finally quit, he put the money into Carrier’s business and lived off of the monthly payments. He may have to go back to work.

“He was an arrogant son of a bitch,” the investor said. “It was gone before he told anyone there was a problem. That’s the unforgivable piece. He squandered it all away. And he had to get backed into a corner before he admitted it was all gone.”

Byard Duncan contributed reporting.

by Tony Schick and Monica Samayoa, Oregon Public Broadcasting

This article was produced for ProPublica’s Local Reporting Network in partnership with Oregon Public Broadcasting. Sign up for Dispatches to get stories like this one as soon as they are published.

On Feb. 17, Oregon Gov. Tina Kotek released a video assuring Oregonians that Donald Trump would not derail the progressive state’s efforts to combat climate change.

As promised during his presidential campaign, Trump had issued executive orders during his first week in office aimed at halting new sources of wind power and freezing Biden-era funding for renewable energy.

Oregon, Kotek said, had been “leading the way for years on courageous state policies to fight climate change.” Along with neighboring Washington state, Oregon has set an ambitious mandate for electric utilities to be carbon neutral within the next two decades.

“It’s going to take all of us working together finding innovative solutions, no matter the obstacles, to confront the climate crisis,” the governor said, “and we are not turning back.”

But the reality is not nearly as inspiring as Kotek made it sound. For all their progressive claims, Oregon and Washington trail nearly all other states in adding new sources of renewable energy. Iowa, a Republican-led state with roughly the same population and usable volume of wind as Oregon, has built enough wind farms to generate three times as much wind power.

What’s held the Northwest back is a bottleneck Oregon and Washington leaders paid little attention to when they set out to go 100% green, an investigation by ProPublica and Oregon Public Broadcasting found: The region lacks the wiring to deliver new sources of renewable energy to people’s homes, and little has been done to change that.

Northwest leaders left it to a federal agency known as the Bonneville Power Administration to arrange badly needed upgrades to an electrical grid that’s nearly a century old in places.

Bonneville, under a setup that is unique to the Northwest, owns most of the power lines needed to carry green power from the region’s sunny and windy high desert to its major population centers. Bonneville has no state or local representation within its federally appointed bureaucracy and, by statute, operates as a self-funded business.

The agency decides which energy projects can hook up based on whether its infrastructure can handle the extra load, and it decides how quickly that infrastructure gets expanded. Its glacial pace has delayed wind and solar projects under Democratic and Republican presidents alike.

Of the 469 large renewable projects that applied to connect to Bonneville’s grid since 2015, only one has reached approval. Those are longer odds than in any other region of the country, the news organizations found. No major grid operator is as stingy as Bonneville in its approach to financing new transmission lines and substations needed to grow the power supply, according to industry groups that represent power producers.

Efforts to bypass Bonneville didn’t start until this year, when Oregon and Washington legislators considered bills to create their own state bonding authorities for upgrading the region’s high-voltage network.

Both bills died.

Washington and Oregon Trail the Nation in Renewable Growth

Changes in states’ average annual production of power from wind, solar, hydroelectric and geothermal between the decades of 2005-2014 and 2015-2024

(Source: U.S. Energy Information Administration)

The grid’s severe constraints are hindering the Northwest at a time when it desperately needs more electricity. Oregon and Washington lawmakers lured power-guzzling data centers with tax breaks in recent years, and the industry has helped drive electricity demand sky high.

Having failed to add enough green-energy sources or any new gas-fired power, the Northwest buys electricity from elsewhere, at high prices, during extreme weather. Rates paid by customers of major Oregon utilities are now 50% higher than five years ago. The worsening energy shortage threatens millions of residents with continual rate hikes and sporadic power outages — not to mention dashing the Northwest’s hopes of drastically reducing its contribution to climate change.

“The people who, technically speaking, are in charge of our transmission system are dropping the ball,” said Oregon state Rep. Mark Gamba, a Democrat who sponsored this year’s failed legislation aimed at creating a state grid improvement authority. “We are absolutely looking at rolling blackouts, and we are absolutely looking at not hitting any of our climate targets when it comes to energy production.”

Kotek declined an interview request. Kotek spokesperson Anca Matica said in a statement that the governor is “open to innovative ideas to increase transmission capacity” and labeled it key to achieving the state’s energy goals. She offered no direct response to questions about Oregon’s lack of progress in boosting renewables.

While Washington and Oregon generate a lot of hydro power, their numbers have trended down over the last decade …

Hydroelectric generation by state

… and they’ve added new sources of renewables, such as wind and solar, much more slowly than other states.

Renewable energy net generation by state, excluding hydro

(Source: U.S. Energy Information Administration)

Reuven Carlyle, the former state senator who crafted Washington’s 2019 decarbonization bill, said he was “deeply cognizant” of the region’s transmission challenges at the time but that plans to address the problem “simply slipped.”

“It’s certainly nothing to be proud of that it didn’t get resolved,” said Carlyle, who founded a consulting firm for climate-focused investments after leaving the Legislature. “And it’s embarrassing that Oregon and Washington, which are such good-looking states, simply can’t practically build anything in terms of energy.”

In the final months of the Biden administration, Bonneville announced a plan to do some grid upgrades, and agency Administrator John Hairston has said the self-funded federal agency is investing in transmission as much as it can without taking on too much debt.

Bonneville responded to written questions from OPB and ProPublica by citing recent improvements to its process for connecting energy projects and noting that it’s not the only player responsible for growing the grid. The agency added that it “remains committed to its critical mission of supporting the region with affordable, reliable and secure power.”

But Bonneville’s latest plans for the grid are in jeopardy. In addition to suspending all new federal wind permits, the Trump White House has added Bonneville to the long list of agencies cutting federal jobs. Three Bonneville employees, requesting anonymity for fear of retribution, said the cuts will make building out the transmission system even harder.

With four years of Joe Biden’s climate activism in the rearview mirror, the Pacific Northwest appears to have blown its best chance to realize its ambitions for renewable power.

Projects in Limbo

David Brown is a case study in the long and agonizing path to breaking ground on a Northwest solar farm.

The Portland energy developer has been in the renewables business since 2003, and his firm, Obsidian Renewables, has a plan to put a vast array of solar panels on a piece of southern Oregon high desert that’s the size of 3,000 football fields. Brown said it’s expected to produce enough energy for about 110,000 homes.

Obsidian will handle everything from acquiring the land to getting permits approved, then look to sell the solar farm to an investor or utility once it’s ready for construction.

But any power plant, whether fueled by coal, wind or sunshine, has to be wired into the electrical grid: a system of transmission lines and transformers that pools electricity and channels it to customers. While power lines crisscross the nation, power mainly gets used within the region that generates it.

As in most parts of the Northwest, the nearest transmission lines Brown could plug into belong to Bonneville. He asked the agency for permission to connect his solar farm to its system in 2020. He doesn’t expect approval until at least 2028.

“I don’t know a single place in Oregon or Washington where I can connect a new solar project and get transmission. Not one,” he said.

One part of the holdup is that Bonneville needs to finish studying what kind of substation it will need to safely let a big new power source into the grid.

Brown’s 400-megawatt solar farm has been through three such “interconnection” studies so far. The first time, Bonneville estimated Brown’s business would need to pay $23 million to build a substation, which Bonneville would own. The second study bumped the price to $70 million. By the third, Brown said, it was $212 million. He said the agency blamed supply chain and labor issues, in part, for the near-tripling in cost over four years.

David Brown’s company, Obsidian Renewables, has proposed to build one of the state’s largest solar farms but has been waiting for five years for Bonneville Power Administration’s approval. (Kristyna Wentz-Graff/Oregon Public Broadcasting)

There are hundreds of projects like Brown’s: more than 200,000 megawatts worth of renewable energy awaiting Bonneville’s signoff, or enough to power the Northwest nearly 10 times over. One proposed wind farm has been in Bonneville’s queue for more than 16 years.

Among projects 20 megawatts or bigger that were proposed in the past decade, the only one that made it through Bonneville’s waitlist was an add-on to an existing Portland General Electric wind farm that didn’t require any major transmission upgrades. It won approval in 2022.

The Northwest is not the only region with a backlog of projects waiting to plug in. Grid operators across the country have navigated a deluge of new wind, solar and mass-storage battery requests in recent years. Many applicants proved to be merely testing the waters, with nearly 3 in 4 ultimately pulling their plans, according to Joseph Rand, an energy researcher at the Lawrence Berkeley National Laboratory.

But other regions managed to sort out problems better than the Northwest, OPB and ProPublica found.

The news organizations used data from Bonneville and from a national database compiled by researchers at the Berkeley Lab to analyze how many large renewable energy projects waiting for grid connections made it to the finish line.

The data showed that for large projects proposed since 2015, Bonneville’s one approval translates to a success rate of 0.2%, the lowest rate of any region. By contrast, about 10% of new applications for major projects in the Midwest and 28% in Texas made it through.

Bonneville has said one reason for the slow progress is that its waitlist is jammed up with too many “speculative” projects — more dream than financial reality. (There’s no evidence that Bonneville has it worse, though; data shows that the share of developers who back out after seeking Bonneville’s approval, 76%, is close to the national average.)

Renewable advocates and energy developers say Bonneville struggles to hire and retain people to process connection requests because the agency pays less than the private sector. In January, Washington U.S. Reps. Marie Gluesenkamp Perez, a Democrat, and Dan Newhouse, a Republican, introduced a bill to make Bonneville’s compensation more competitive, but it hasn’t moved since.

To speed things up, Bonneville has halted new requests for grid connections and changed its approach to reviewing applications. Where specialists used to review proposals one at a time, in the order received, they now plan to prioritize projects that are closest to ready. The agency said the new approach will increase the number of projects that get connected while cutting processing time in half, from an expected 15 years.

Bonneville said in a statement that it is “confident the interconnection reforms we adopted” will prove “sufficient to meet our customers’ needs.”

The changes have not yet helped Brown, who has been awaiting Bonneville’s approval to start work in southern Oregon since 2020. For now, the planned solar project remains in limbo.

“It’s gonna take me years and a couple million dollars to get land use approval,” Brown said, “and why do I want to get land use approval if I don’t know whether or not I have transmission?”

“There’s No Room for Your Project”

The predicament Brown and dozens of other wind and solar developers face is a product of the Northwest’s unusual history with electric power.

Oregon and Washington were blessed with powerful rivers fed by abundant snow and rainfall. Beginning in the New Deal era, the federal government built dozens of hydroelectric dams and a sprawling transmission system to electrify the rural West. The region’s energy supply was cheaper and emitted less carbon than the rest of the nation’s. Bonneville was at the helm.

Even today, hydropower supplies almost 35% of Oregon’s electricity and more than 50% of Washington’s, according to the most recent data available.

But hydroelectric dams are a finite and increasingly shaky power source. Output from existing dams dips whenever droughts sap water from the Columbia River basin. New dams are a nonstarter because dams have decimated the region’s salmon populations.

That leaves wind, solar and battery storage as the most promising places for the Northwest to turn as it approaches self-imposed deadlines to fully wean utilities off electricity that comes from oil, coal or gas.

Bonneville has now become a barrier to accommodating the new power sources, six green energy developers told OPB and ProPublica.

An agency that erected more than 4,800 miles of high-voltage transmission lines from 1960 to 1990 built fewer than 500 miles from 1990 to 2020. In the past five years, it built 1.

Bonneville has the ability to borrow money, at low interest rates, for projects that would enable the grid to carry more power. Congress pushed the agency to do so in 2021, more than doubling Bonneville’s debt limit specifically to finance transmission upgrades.

The chairs of the Oregon and Washington public utility commissions, in a joint 2022 letter, urged Bonneville to spend the money: “The region needs BPA to be a leader in delivering a transmission system that serves the entire region.”

Bonneville, however, has been reluctant to take on debt. It is still paying off billions of dollars in bonds from failed nuclear plants in the 1970s. As recently as 2019, the agency’s finances were so poor that some economists expected it to become insolvent.

Bonneville’s transmission planners, for their part, have told OPB and ProPublica in previous interviews that they want to avoid building expensive transmission lines that no one ends up using.

“We can’t speculate and build a transmission line to nowhere,” Jeff Cook, the agency’s vice president for transmission planning, said in May 2024.

First image: Contractors repair a transformer box in Portland, Oregon. Second image: Solar panels on the Wheatridge farm, the only project Bonneville approved out of the hundreds that applied for a grid connection in the past decade. (Kristyna Wentz-Graff/Oregon Public Broadcasting)

When Bonneville announced in the fall it would tap some of its expanded debt limit to help pay for $5 billion in transmission upgrades over a decade, renewable energy advocates characterized the work as long overdue maintenance that wouldn’t provide the expansion the grid needs.

Most of the work Bonneville announced was “the equivalent of fixing potholes, installing some new round-abouts, doing some repaving,” Spencer Gray, executive director of the Northwest & Intermountain Power Producers Coalition, said in an email.

A further frustration for wind and solar developers that is unique to Bonneville: The grid operator makes them absorb an outsize share of the cost for projects that help the transmission network accommodate their electricity — and it requires a big deposit up front. That’s true even if the new power lines benefit a wide network and will be around for many generations of customers.

“Lately, the answer to these individual developers has been, ‘There’s no room for your project. If you want to put this project on our system, it’s going to cost you this many millions of dollars to help us upgrade the system,’” said Sarah Edmonds, president of a coalition of utilities known as the Western Power Pool.

The approach, Edmonds said, has had “a chilling effect on the ability of developers to get their projects online.”

Michelle Manary, Bonneville’s vice president of transmission marketing and sales, said requiring up-front deposits keeps existing ratepayers from getting stuck with the tab if a developer backs out and that Bonneville has begun work on a transmission upgrade. She said other regions have more control over who pays these costs because their entire distribution networks are under one operator. Bonneville’s transmission lines are more like highways, from which electric utilities serve as exit ramps that deliver power the last mile to Northwest neighborhoods.

Manary denied that Bonneville’s current way of allocating costs has stifled green energy projects. But she acknowledged the agency needs to reevaluate its policy amid the flood of applications for new projects, and she said that process is underway.

“Texas Is Kicking Our Ass”

The rest of the nation has taken a different approach to bringing green power online — with better outcomes.

In most parts of the country, each grid has a central, independent operator, known as a regional transmission organization, typically run by a board that represents customers, electric utilities and other groups. Bonneville recently rejected joining a California-based energy market that advocates described as the Northwest’s best bet at accelerating the adoption of renewables.

In Texas, which runs its own grid, large renewable projects applying to connect in the past decade took a median of 19 months to get the green light, or nearly two years less than the one project Bonneville approved in that time frame. California and the Midwest were also faster than Bonneville.

Texas doesn’t require project-by-project grid upgrades the way other grid operators do. It essentially tells developers it will connect their project, and then it figures out how to balance the added electricity after the fact.

Texas and other regional grid operators spend billions more than Bonneville on transmission upgrades annually, and they spread the costs across a wider swath of customers than Bonneville does. (Bonneville says the federal agency differs so much from regional operators that they’re not a fair comparison group.)

Texas brought more energy online in the past two years than any other power region. That’s helped the oil and gas powerhouse become the country’s biggest producer of wind and solar energy. Last year alone it added more than enough renewable energy to power the entire Northwest.

“Texas is kicking our ass,” said Gamba, the Oregon state representative.

Oil well pumps and wind turbines in Lamesa, Texas, in February (Julio Cortez/AP)

Northwest lawmakers were told that they’d need to find effective ways of confronting their region’s aging transmission system if they wished to phase out coal and natural gas.

As Washington lawmakers debated a mandate for renewable power in 2019, Nicholas Garcia of the Washington Public Utility Districts Association testified that replacing coal plants with wind and solar would require “more transmission, significantly more transmission.”

In 2021, when Oregon lawmakers debated their own mandate for carbon-free energy, Republicans also raised concerns that the state’s transmission lines were maxed out. It became one more GOP argument against the bill, in addition to saying more should be done to ensure green energy projects were built in Oregon.

Numerous reports — from the Oregon and U.S. departments of energy, for example — supported the assertion that heftier transmission lines were needed.

Bonneville would be key to meeting that need, with one utilities lobbyist calling Bonneville’s grid “the backbone for decarbonization” in testimony to Oregon lawmakers.

But Oregon state Rep. Pam Marsh, who led the 2021 effort, said in a recent interview she was focused on getting utilities to cut their carbon emissions and that green energy advocates weren’t demanding transmission improvements at the time.

“I was not thinking personally about the role that Bonneville might play in this,” said Marsh, a Democrat representing southern Oregon.

Washington’s Legislature took some action on the need for better transmission: It required the state to study the issue. The resulting 2022 report concluded that the grid was indeed inadequate but led to little in the way of solutions. Instead, lawmakers decided to require utilities to plan out transmission needs 20 years ahead rather than 10, and they created a statewide environmental review in hopes of streamlining the state’s approval process for transmission. It did nothing about impediments posed by Bonneville.

The Legislature was “a little complacent” about relying on Bonneville to upgrade the grid, said Sen. Sharon Shewmake, a freshman lawmaker in 2019 when Washington enacted its energy mandate.

Shewmake and Gamba both introduced legislation this year following states like Colorado, New Mexico, North Dakota and Wyoming in creating independent authorities to finance transmission infrastructure. Gamba said he led an 80-person group of interested parties through 18 months of drafting. Democratic Washington Gov. Bob Ferguson labeled Shewmake’s bill a priority.

The legislation didn’t make it through either state’s Democrat-controlled legislatures, however.

Brown, the energy developer who’s been awaiting Bonneville’s solar approval since 2020, said the future of the Northwest’s energy dreams looks dim.

“We don’t have a prayer of meeting our heralded, flag-waving renewable energy goals,” he said. “The dialogue will be to blame Trump; it won’t be to blame ourselves for poor planning and extremely low expectations.”

Ellis Simani assisted with data analysis.

by Christopher Bing and Avi Asher-Schapiro

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

The ranking member of the House Oversight Committee is launching an investigation into whether the General Services Administration has given preferential treatment to a technology startup competing for a lucrative government contract. The startup is backed by some of President Donald Trump’s most influential Silicon Valley allies.

The committee’s action follows reporting by ProPublica last month that revealed the GSA was eyeing New York-based payments company Ramp to remake a massive, $700 billion federal credit card program known as SmartPay. Our reporting showed that senior GSA officials met with Ramp executives at least four times before publicly opening up a SmartPay contract opportunity.

Ethics experts flagged the early meetings as unusual and potentially problematic. Insiders at the GSA told ProPublica that, internally, Ramp was seen as the clear favorite for an initial $25 million pilot contract, which could act as an introduction to larger SmartPay work. The contract for the pilot program hasn’t been awarded yet.

A letter sent Friday to the GSA by Rep. Gerald Connolly, D-Va., and reviewed by ProPublica says Democrats on the committee want information about the GSA’s dealings with “Ramp, a company with zero federal contracting experience that is backed by prominent Trump supporters, Trump family connections, and allies of Elon Musk.”

Connolly’s letter demands an array of GSA documents, including “all communications between any GSA official, contractor or subcontractor and any representative of Ramp.”

Ramp did not respond to a request for comment about the investigation.

The GSA did not respond to questions Friday. Asked about Ramp for a previous article, a GSA spokesperson told ProPublica that the agency “refutes any suggestion of unfair or preferential contracting practices” and that the “credit card reform initiative has been well known to the public in an effort to address waste, fraud, and abuse.”

SmartPay, which provides Visa and Mastercard charge cards to government employees, enables the federal workforce to purchase office supplies and equipment, book travel and pay for gas. The cards typically are used for purchases up to $10,000.

Sources within the GSA say Trump appointees at the agency, including acting Administrator Stephen Ehikian and Commissioner Josh Gruenbaum, the nation’s top procurement officer, came into their roles saying SmartPay and other government payment programs were rife with fraud or waste.

Yet both GOP and Democratic budget experts call this view inaccurate, saying SmartPay has implemented effective safeguards and monitoring tools.

SmartPay has been worth hundreds of millions of dollars in fees for the financial institutions that currently operate it, U.S. Bank and Citibank. The GSA will decide by year’s end whether to extend SmartPay with the current contract or to remake the program more fundamentally.

Ramp’s investors include some of Silicon Valley’s most powerful figures, such as Peter Thiel, the billionaire venture capitalist who provided crucial early support to Trump and spent millions on Vice President JD Vance’s Ohio Senate run. Other major backers include Keith Rabois of Khosla Ventures, who sits on Ramp’s board; Thrive Capital, founded by Joshua Kushner, the brother of Trump’s son-in-law Jared Kushner; and 8VC, a firm run by Musk and Trump allies.

In late April, as the GSA received a flurry of business pitches on the SmartPay pilot program, Ramp’s CEO, Eric Glyman, and Rabois appeared at a high-profile conference in Washington that brings together tech entrepreneurs, lawmakers and other senior government officials.

During a livestreamed panel titled “First Principles for a Smarter, Leaner Government,” the pair touted Ramp as a transformational solution for government payments. Later, during an interview, Rabois pointed to the fact that SmartPay issues more charge cards than there are total government employees as evidence of fraud.

But SmartPay experts say this betrays a fundamental misunderstanding of how the program works. Employees are issued separate cards for different types of purchases and often hold multiple cards at once.

Rabois did not respond to questions from ProPublica on Friday. In his response for an earlier story, Rabois said he had “no involvement in any government-related initiatives for the company.”

In the oversight committee’s letter to the GSA, Connolly writes that “the Trump Administration’s false claims about the SmartPay program may be an attempt to discredit the program to provide a new, Trump-affiliated contractor with a lucrative contract.”

by Lexi Churchill, ProPublica and The Texas Tribune

This article is co-published with The Texas Tribune, a nonprofit, nonpartisan local newsroom that informs and engages with Texans. Sign up for The Brief Weekly to get up to speed on their essential coverage of Texas issues.

Two years ago, Texas lawmakers quietly cut millions of dollars in funding for kits intended to help track down missing kids, after ProPublica and The Texas Tribune revealed there was no evidence they had aided law enforcement in finding lost children.

The company that made the kits had used outdated and exaggerated statistics on missing children to bolster their sales and charged for the materials when similar products were available for less or for free.

Now, some Texas legislators are again pushing to spend millions more in taxpayer dollars to purchase such kits, slipping the funding into a 1,000-page budget proposal.

Although the proposal does not designate which company would supply them, a 2021 bill introduced by Republican state Sen. Donna Campbell all but guarantees Texas will contract with the same vendor, the National Child Identification Program. Back then, Campbell made clear that her intent was to enshrine into law a long-standing partnership between the state and NCIDP that goes back more than two decades. Her legislation, signed into law that June, also specified that whenever the state allocated funding for such materials, the Texas Education Agency must purchase identification kits that are “inkless,” a technology that NCIDP has patented.

The Waco-based company is led by former NFL player Kenny Hansmire, who ProPublica and the Tribune found had a history of failed businesses and financial troubles, including millions of dollars in federal tax liens and a ban from conducting certain finance-related business in Connecticut due to his role in an alleged scheme to defraud investors.

Hansmire cultivated relationships with powerful Texas legislators who went on to support his initiatives. Lt. Gov. Dan Patrick, who oversees the Senate, championed Campbell’s legislation funding the kits and later told the news organizations that the state should prioritize anything that can speed up the return of a missing child. Campbell told lawmakers in a hearing that the bipartisan measure, which was brought to her by Hansmire and Patrick, was important to “protect our children.”

Patrick, Campbell and Hansmire did not respond to interview requests for this story. Hansmire previously told the newsrooms that his debts and other financial issues had been resolved. He also defended his company’s kits, saying they have helped find multiple missing children, and instructed reporters to ask “any policeman” about the kits’ usefulness. However, none of the dozen Texas law enforcement agencies that the news organizations reached — including three that Hansmire specifically named — could recall any examples.

Stacey Pearson, a child safety consultant and former Louisiana State Police sergeant who oversaw that state’s Clearinghouse for Missing and Exploited Children, said she has never seen any cases demonstrating that these kits work, including in the last two years since lawmakers discontinued the funding.

“I don’t understand why we’re going back to this,” said Pearson, who spoke with the newsrooms recently and for their previous investigation. “It wasn’t a good idea in 2023 and it’s not a good idea now.”

Despite the lack of evidence, Pearson said companies like NCIDP are able to profit off the kits by marketing them as part of a larger child safety program, a strategy that makes opposing lawmakers look as if they are against protecting children. Texas allocated nearly $6 million for the kits between 2021 and 2023.

Lawmakers did not explain their reasoning when they decided to stop paying for the kits in 2023. Republican state Sen. Joan Huffman, who chairs the high chamber’s Finance Committee, told the newsrooms at the time that both the House and the Senate had agreed to remove the funding “after review and consideration.”

During this year’s budgeting process, Democratic state Rep. Armando Martinez proposed adding $2 million to the House’s budget to provide kits to families with children in kindergarten through second grade.

Martinez did not respond to an interview request.

State Rep. Greg Bonnen, who chairs the House Appropriations Committee, did not respond to interview requests or written questions.

Bonnen was among the 33 lawmakers who voted against Campbell’s bill that established the child identification kit funding four years ago. The newsrooms attempted to reach a handful of those legislators, but none responded.

Huffman and the Senate have so far chosen not to restore the program’s funding. Huffman declined the newsrooms’ interview requests.

“The entire budget process is ongoing,” she wrote in an emailed statement. “No final decisions have been made on most issues.”

Legislators from the two chambers will continue hashing out the differences between their budget proposals in a joint committee that operates behind closed doors. There’s no guarantee that the funding will make it into the final budget, which lawmakers must pass before the legislative session ends in early June.

Pearson cautioned legislators to question whether the kits are the best use of state funding, given the absence of documented success.

“My advice would be for lawmakers to ask themselves, ‘If this was your personal money and not the taxpayers’, would you spend it on this program?’” Pearson said. “And the answer is going to be no.”

by David Armstrong

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

In the U.S., the price of Revlimid, a brand-name cancer drug, has been increasing for two decades. It now sells for nearly $1,000 a pill. In Europe, the price has been consistently lower — in some countries by two-thirds.

I started reporting on Revlimid after I was prescribed the drug following a diagnosis of multiple myeloma, an incurable blood cancer. Stunned by the high price, I found that the drugmaker, Celgene, had used Revlimid as its own personal piggy bank for more than a decade, raising the price in the U.S. whenever it saw fit.

Even with lower prices in Europe, Celgene still made a profit there, a former executive told Congress. That added to the more than $21 billion in net earnings the company made after Revlimid was introduced in 2005.

Of course, Revlimid isn’t the only drug with a price disparity. Americans pay more in general for prescription drugs than people in other wealthy countries. And costs keep going up, saddling patients with crippling debt or forcing them to choose between filling prescriptions or buying groceries. So why do we pay so much more? And is anything being done about it?

In most other wealthy countries, governments set a single price for a drug that is usually based on analysis of the therapeutic benefit of the medicine and what other countries pay. In the U.S., drug companies determine what to charge for their products with few restraints. Insurance companies can refuse to cover a drug to try to negotiate a lower price, but for some diseases like cancer, that poses a risk of public backlash. Cancer is a “very politically charged disease,” said Dr. Aaron Kesselheim, a Harvard Medical School professor who studies drug pricing and regulation. Some states also mandate that insurers cover certain cancer drugs.

Pharmaceutical companies have consistently argued that American drug prices reflect the cost of research and development. Americans may pay more, but they also benefit from having first-line access to cutting-edge treatments. (Celgene has since been acquired by Bristol Myers Squibb, which says its price for Revlimid, which it increased in the U.S. last year by 7%, “reflects the continued clinical benefit Revlimid brings to patients, along with other economic factors.”)

Dr. Hagop Kantarjian, a leukemia specialist at MD Anderson Cancer Center who studies drug pricing, said that pharmaceutical companies often overstate the cost of developing drugs and that many drug discoveries originate in hospital and academic labs funded through government grants. Funding from the U.S. National Institutes of Health contributed to all but two of the 356 drugs approved by the Food and Drug Administration from 2010 to 2019, according to a Bentley University study. Companies also don’t spend all their profits on innovation: The 14 largest drug companies in the world spent more on stock buybacks and dividend payments to investors than on research and development, according to a 2021 analysis by the U.S. House Oversight Committee.

One possible solution to bring down costs: tie American prices to what drugmakers charge in other wealthy countries. The Congressional Budget Office found last year that this would have the biggest impact on reducing costs of seven proposals it studied. It’s an idea with bipartisan support.

Sens. Josh Hawley, R-Mo., and Peter Welch, D-Vt., introduced a bill this week that would penalize pharmaceutical companies that sell their drugs at higher prices than the average of the prices in Canada, France, Germany, Japan, Italy and the United Kingdom. Companies that sell above the average would face civil penalties equal to 10 times the difference between the U.S. list price and the average price in those other countries.

President Donald Trump has advocated for similar actions. During his first term, he issued an executive order directing the Medicare program to employ a “most favored nation” approach in paying for drugs. The administration later developed a rule directing Medicare to select the lowest price from a basket of similar countries and make that the maximum amount the agency would pay for 50 drugs administered by doctors. A court blocked the rule from being implemented in the last days of the first administration.

Now, according to reports this week, the administration is pushing plans to tie Medicaid and Medicare prices to lower prices charged in other countries.

Linking U.S. prices to those in other countries is opposed by industry groups who say it would leave decisions on medications to the government rather than doctors and patients.

“Government price setting in any form is bad for American patients,” said Alex Schriver, a spokesperson for the Pharmaceutical Research and Manufacturers of America, an industry group. He said efforts should be focused on fixing “the flaws in the U.S. system,” including money that flows to intermediaries such as pharmacy benefit managers.

Some critics also warn so-called international reference pricing can be gamed and allows foreign governments to essentially set the value of medicines sold in the U.S.

The Trump administration is expected to announce drug pricing plans as early as next week, according to a report. The White House did not respond to a request for comment.

by Vernal Coleman and Eric Umansky

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

Democratic House members on Thursday blasted the Trump administration’s moves to shrink the Department of Veterans Affairs and demanded more transparency from its leaders after a ProPublica investigation revealed widespread disruptions across the agency’s health care system.

“There are real-life dangerous impacts for veterans,” said Rep. Chris Deluzio of Pennsylvania, citing the news organization’s work.

This week, ProPublica reported on dozens of emails sent from staff at VA hospitals and clinics across the country to headquarters warning how cuts could, and in some cases are, degrading the agency’s ability to provide for the roughly 9 million veterans who rely on it.

Hiring freezes and other edicts from the White House have left medical providers scrambling and short-staffed amid an ever-shifting series of policy moves, including the cancellation of contracts with companies that maintain cancer registries, the emails said. Staffers at VA centers in Pennsylvania warned the cuts were causing “severe and immediate impacts,” including to “life-saving cancer trials.”

“Enrollment in clinical trials is stopping,” one wrote, “meaning veterans lose access to therapies.” Staffers at the hospital warned more than 1,000 veterans would lose access to treatment for diseases ranging from metastatic head and neck cancers, to kidney disease, to traumatic brain injuries.

On Thursday, the House members, several of whom are veterans, demanded VA leadership provide more details on how cuts are affecting such work, in which service members often receive treatment they would not otherwise have access to.

“We all want to cut waste, fraud and abuse, but what we see today is when you cancel a contract, it means the end of a clinical trial that’s going to save someone’s life,” Rep. Maggie Goodlander of New Hampshire said.

Notably, Deluzio, an Iraq War veteran whose Pittsburgh-area district includes a VA facility, and other lawmakers said they had learned about the impact for the first time from ProPublica’s reporting. On Thursday, they accused agency Secretary Doug Collins of stonewalling their efforts to find out what positions have been laid off, what contracts have been canceled and what future cuts will look like.

“We want the country to understand that this administration is hiding what they are doing, not just from us and the Congress, but from veterans and the American people,” Deluzio said.

“And the worst part is, we don’t know if anyone has died,” he added.

President Donald Trump has long said his administration will prioritize veterans and not compromise their care.

The disruptions at the VA have come even as the department has laid off just a few thousand staffers — a small fraction of the employees it said it ultimately plans to remove. Collins has said the agency is developing plans with Elon Musk’s Department of Government Efficiency to cut at least 70,000 employees — a number that he has underscored is a “goal.” “Could be more, could be less,” he told lawmakers this week.

On Thursday, in a post on X, Collins pushed back on criticism, calling ProPublica’s reporting “misleading” and saying it was based on “some outdated reports from the internal system VA uses to quickly identify and fix issues across the department.”

In a statement, VA press secretary Pete Kasperowicz said that Collins was working to fix a “broken bureaucracy” that has long had problems with patient safety and access to care, among other issues. “Unfortunately, many in the media, government union bosses and some in Congress are fighting to keep in place the broken status quo,” he said. “Our message to Veterans is simple: Despite major opposition from those who don’t want to change a thing at VA, we will reform the department to make it work better for Veterans, families, caregivers and survivors.”

Kasperowicz previously told the news organization that the issues in Pennsylvania have been resolved, though locals there with knowledge of the issues said that’s not the case and that the impact is ongoing. Kasperowicz also said in regard to the contracts to maintain the cancer registries that there had been “no effect on patients.” He added that the VA is moving to create a national contract to administer them.

According to some providers, even the temporary disruptions have hurt the care of veterans. One clinical trial to treat veterans for opioid addiction was hobbled by temporary layoffs. “We couldn’t give veterans a tool that could save their lives,” said Ellie Gordon, the CEO of the startup Behavior, which is testing biosensors to alert veterans to the risk of relapse.

Collins touted the cuts in a sometimes-contentious hearing on Tuesday before the U.S Senate Committee on Veterans’ Affairs.

“We’re going to maintain VA’s mission-essential jobs like doctors, nurses and claims processors, while phasing out non-mission essential roles like interior designers and DEI officers,” he said in an opening statement. The funds saved will be rerouted into direct health care and benefits for veterans, he added.

Some Republicans at the hearing defended the administration’s proposed cuts. “The VA has become a bloated bureaucracy,” said Sen. Tommy Tuberville, who represents Alabama. “I think most of us will agree with that.”

But Sen. Richard Blumenthal, D-Conn., pushed back on Collins’ statements, saying that laying off such a large portion of the staff will inevitably involve letting go of health care workers, like nurses and doctors. “You cannot slash and trash the VA without eliminating those essential positions which provide access and availability of health care,” he said. “It simply cannot be done.”

Others at the hearing took Collins to task for a lack of transparency. Sen. Angus King, I-Maine, admonished the secretary for refusing to provide a list of the 538 canceled contracts since his appointment. Collins said he would provide the information, but only after it’s finalized.

“We’re looking at every step we can, but also, I’m not going to play it out in a public arena,” he said.

J. David McSwane contributed reporting.

by Bianca Fortis

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

Columbia University has agreed to a $750 million settlement with 576 patients of a former doctor who sexually abused them while working at the school.

In 2023, a ProPublica investigation, published with New York Magazine, revealed how Columbia had ignored women, undermined prosecutors and ultimately protected a predator. Obstetrician-gynecologist Robert Hadden worked at the university for 20 years despite decades of complaints about him.

The university had even cleared Hadden to see patients three days after he was arrested when a patient called 911 to report that he had assaulted her during a postpartum exam. University higher-ups had been informed of the arrest but allowed Hadden to continue working for another five weeks. Patients he saw during that time also reported being assaulted.

The latest settlement, combined with payouts from previous cases, means that Columbia will have paid out more than $1 billion to resolve claims of sexual abuse by Hadden. Columbia also said that it has now settled more than 1,000 claims of sexual abuse by Hadden’s former patients.

Hadden was convicted of sex crimes in federal court in January 2023 and is now serving a 20-year prison sentence.

Laurie Kanyok, the patient who called 911, said the settlement is bittersweet. “It’s emotional because it’s been 13 years,” she told ProPublica.

She also said that financial compensation does not amount to justice.

“I’m grateful that I’m involved in this,” Kanyok said. “At the same time, I feel like I want to see people held accountable and not just somebody’s insurance company or checkbook.”

Unlike in other high-profile cases involving sexual abuse by doctors, no administrators from Columbia have been fired or have stepped down as a result of the Hadden case.

In a statement, Columbia acknowledged failing to protect Hadden’s patients. “We deeply regret the pain that his patients suffered, and this settlement is another step forward in our ongoing work and commitment to repair harm and support survivors,” the statement said. “We commend the survivors for their bravery in coming forward.”

The latest settlement puts Columbia on par with the largest payout ever by a university to settle sexual abuse claims. In 2021, the University of Southern California agreed to pay $1.1 billion to survivors of George Tyndall, a university gynecologist who abused thousands of women.

Anthony DiPietro, the attorney who handled most of the Columbia claims, said the lesson from this week’s settlement is clear: Institutions “cannot continue to cover up sexual exploitation and abuse by their doctors because they’re going to be held accountable.”

Weeks after ProPublica’s investigation, Columbia announced that it would set up a $100 million settlement fund for patients who did not want to file civil suits. Survivors have about another week, until May 15, to submit a claim.

As part of the same announcement, Columbia also said it would notify all of Hadden’s nearly 6,500 former patients of the doctor’s crimes and that it would commission an external investigation to examine failures that allowed the abuse to go on for so long.

Asked about the status of that investigation, which was announced a year and a half ago, the university said it is ongoing. Columbia did not give a time frame for the report’s completion.

by David Armstrong

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

The pain jolted me awake. It was barely dawn, a misty February morning in 2023. My side felt as if I’d been stabbed.

I had been dealing with pain for weeks — a bothersome ache that felt like a bad runner’s cramp. But now it was so intense I had to brace myself against the wall to stand up.

A few hours after arriving at the emergency room, I heard my name. A doctor asked me to follow him to a private area, where he told me a scan had uncovered something “concerning.”

There were lesions, areas of bone destruction, on top of both of my hip bones and on my sternum. These were hallmarks of multiple myeloma. “Cancer,” he said.

Multiple myeloma is a blood cancer that ravages bone, leaving distinctive holes in its wake. Subsequent scans showed “innumerable lesions” from my neck to my feet as well as two broken ribs and a compression fracture in my spine. There is no cure.

I walked out of the ER in search of fresh air. I sat on a metal bench and did what many patients do. I turned to Google. The first link was a medical review stating that the average lifespan of a newly diagnosed patient was three to five years. My stomach churned.

I soon learned that information was outdated. Most patients today live much longer, in large part due to a drug with a horrific past. It was a doctor at the hospital who first told me I would likely take a thalidomide drug as part of my treatment.

That couldn’t be possible, I told him.

I knew the story of thalidomide, or at least I thought I did. It represented one of the darkest chapters in the history of modern medicine, having caused thousands of severe birth defects after it was given to pregnant women in the 1950s and 1960s. The drug was banned in most of the world, and the scandal gave rise to the modern-day U.S. Food and Drug Administration.

It turns out the drug once relegated to a pharmaceutical graveyard had new life as a cancer fighter.

That drug I take is called Revlimid. It is a derivative of thalidomide, a slightly tweaked version of the parent compound.

Revlimid is now one of the bestselling pharmaceutical products of all time, with total sales of more than $100 billion. It has extended tens of thousands of lives — including my own.

But Revlimid is also, I soon learned, extraordinarily expensive, costing nearly $1,000 for each daily pill. (Although, I later discovered, a capsule costs just 25 cents to make.)

That steep tab has put the drug’s lifesaving potential out of reach for some cancer patients, who have been forced into debt or simply stopped taking the drug. The price also helps fuel our ballooning insurance premiums.

For decades, I’ve reported on outrageous health care costs in the U.S. and the burden they place on patients. I’ve revealed the tactics used by drug companies to drive sales and keep the price of their products high.

Even with my experience, the cost of Revlimid stood out. When I started taking the drug, I’d look at the smooth, cylindrical capsule in my hand and consider the fact I was about to swallow something that costs about the same as a new iPhone. A month’s supply, which arrives in an ordinary, orange-tinged plastic bottle, is the same price as a new Nissan Versa.

I wanted to know how this drug came to cost so much — and why the price keeps going up. The price of Revlimid has been hiked 26 times since it launched. Some of what happened was reported at the time. But no one has pieced together the full account of what the drugmaker Celgene did, how federal regulators failed to rein it in and what the story reveals about unrestrained drug pricing in America.

What I discovered astonished even me.

My journey started with an indefatigable New York City lawyer on a quest to give her dying husband a chance.

Tiny and Terrifying

Beth Wolmer’s story begins on a moon-splashed beach in the Cayman Islands in the winter of 1995. She and her husband, Ira, were holding hands as they walked in the sand, enjoying a rare break from a hectic life as parents to a 1-year-old daughter and demanding jobs as 30-something professionals in New York City.

They had met through friends and clicked from the start. On Sunday mornings, they sat together for hours, sharing sections of the newspaper and eating bagels. They planned trips to Europe and outings to the Metropolitan Museum of Art.

Ira was an interventional cardiologist who followed his father into medicine. Beth was a lawyer at the high-powered firm Skadden Arps.

“We had a great life,” Beth told me. “I specifically remember coming home on the bus and thinking: ‘My life is just perfect, perfect. I’m not going to change a thing.’”

As they walked that night in the Caribbean, Ira felt a sharp pain in his cheekbone. The pain flared several more times during the trip, becoming so intense that it brought tears to his eyes.

When he got home, Ira made an appointment to figure out what was wrong. Imaging tests revealed multiple myeloma. The prognosis was grim. The couple was told Ira had two years to live.

Specialists recommended treatments that would only provide a brief reprieve. The couple searched for someone who could offer something more. That’s when they found Dr. Bart Barlogie in Little Rock, Arkansas.

I’ve never been more scared of a spouse of a patient than I was of her.

—Dr. David Siegel, who treated Ira Wolmer

Barlogie had been recruited to the University of Arkansas for Medical Sciences from the more prestigious MD Anderson Cancer Center in Houston. In Texas, Barlogie had been frustrated by a medical culture that he viewed as too timid in its approach to multiple myeloma.

He remembers working on a Sunday when a newly diagnosed patient was admitted to the hospital. With few options, Barlogie decided to put the patient on a taxing, four-drug chemotherapy cocktail used for lymphoma patients. It didn’t work. The patient died from a sepsis infection, a known complication of the treatment.

The attending physician later admonished him, Barlogie said, saying, “Bart, we have to learn to treat myeloma gently.” Barlogie said he thought to himself, “Fuck you.”

In Arkansas, Barlogie was in charge. He quickly developed a reputation as a practitioner willing to try anything to fight the fatal disease. Patients from around the world — including the actor Roy Scheider from the movie “Jaws” — flocked to his clinic.

Beth and Ira heard Barlogie before they saw him. The cowboy boots he’d taken to donning since his time in Houston clacked down the linoleum hallway floors. A short, slight man, Barlogie had a booming voice with a German accent. He wore leather jackets and round, red-framed glasses on his bald head.

When he strode into the exam room, he hugged Beth and Ira and told them they had come to the right place.

Now retired, Barlogie recalls being struck by Beth’s intensity. He said she told him “you must do something” to help Ira.

I met Barlogie at his home in Little Rock. We sat in his office, which is filled with photos of the red Ducati motorcycle he used to ride to work. An old license plate with the letters “MMCURED” sat on a shelf, reflecting his goal to find a cure for multiple myeloma.

When Beth and Ira found him, Barlogie told me, he had been having some success with a novel approach that put patients through two stem cell transplants a few months apart, which he called a tandem stem cell transplant. With a transplant, a patient is bombarded with high-dose chemotherapy to kill the cancerous plasma cells. The patient is then infused with healthy stem cells that travel to the bone marrow.

The intense chemotherapy can be grueling and poses a small risk of death.

Ira underwent three transplants. Each time, he relapsed. By the fall of 1997, after two years of treatment, Ira’s thick black hair was gone. He was losing weight. Then he had a stroke. His kidneys failed and required dialysis. He developed pneumonia and had to be intubated.

Beth was determined to keep him alive long enough for their toddler daughter to remember him. With a photograph of Ira smiling with their baby as motivation, she applied her lawyer’s tenacity to the case. She pored over medical journals and peppered oncologists with questions about why what they were trying wasn’t working or quizzing them about a promising study. When doctors told her there was nothing more they could do for her husband, she refused to accept it.

“She is a tiny person, but she is terrifying,” said Dr. David Siegel, part of the team that treated Ira in Arkansas. “I’ve never been more scared of a spouse of a patient than I was of her.” He meant it as a compliment.

By late fall in 1997, Ira was dying and Beth was desperate.

A researcher told her about the work of Dr. Judah Folkman, a surgeon and researcher at Boston Children’s Hospital. Folkman believed the growth of cancerous tumors could be stunted by starving them of a supply of new blood vessels.

“Thank You, God”

Folkman was a workaholic who, when he wasn’t in the operating room or the research lab, was traveling across the world to promote his novel theory of how to attack cancer. Peers had ridiculed his idea since he first proposed it in the 1970s. The prevailing belief at the time was that tumors didn’t need a new blood supply to grow.

A young researcher in his lab, an ophthalmologist named Robert D’Amato, was at work on the top question Folkman had posed. Could they come up with a drug, in pill form, that blocks the growth of new blood vessels?

Folkman has since died, but it wasn’t difficult for me to track down D’Amato. He still works at Boston Children’s Hospital, where he has his own lab and holds the Judah Folkman Chair in Surgery. Now in his early 60s, D’Amato has a youthful energy and speaks in a rapid, matter-of-fact clip.

D’Amato told me that he had set out to find existing drugs that block blood vessel growth. He started by thinking of his own body and side effects caused by certain drugs. A drug that causes hair loss might be the result of the blood supply to hair follicles being shut off, for example. But this exercise wasn’t producing any viable candidates.

After giving it some thought, D’Amato realized he had myopically narrowed his search. What about a woman’s body? There were drugs that stopped menstrual cycles. Then there were drugs that caused birth defects in pregnant women. In both of those cases, it was possible the drug was inhibiting blood vessel growth. He came up with a list of 10 drugs. At the top of the list was one with a devastating history: thalidomide.

Beginning in the 1950s, pregnant women in Europe, Australia and other countries were frequently prescribed thalidomide as a treatment for morning sickness and to help them sleep. The drug was thought to be harmless and in Germany was sold over the counter. An advertisement for thalidomide in the United Kingdom claimed it could “be given with complete safety to pregnant women and nursing mothers without adverse effect on mother or child.”

They were wrong.

The drug was eventually linked to birth defects in more than 10,000 babies. Those babies were born without limbs or with shortened limbs, malformed hands, disfigured faces and damage to internal organs. Nearly half died within months of being born.

By the early 1960s, the drug was widely banned, considered a shameful chapter in the history of pharmaceuticals. It was never sold in the U.S. thanks to the unwavering objections of a resolute reviewer at the FDA named Frances Oldham Kelsey. The close call, however, prompted Congress to require more rigorous safety and efficacy data from drug manufacturers and empower the FDA to monitor the industry more closely.

D’Amato theorized that the thalidomide birth defects were the result of the drug stopping the growth of new blood vessels that the fetus needs to develop. He walked me through his experiments: He cracked a fertilized chicken egg on a glass petri dish and placed thalidomide on the surface. After two days, if no blood vessels grow on the embryo, a halo should appear around the thalidomide sample, showing the drug worked. It didn’t.

Folkman told D’Amato to move on. But D’Amato couldn’t shake the disappointing results. He did more research and realized thalidomide needs to first be broken down in the body to have an effect on humans. He purchased metabolites of thalidomide, repeated the test and this time found a halo around the sample.

He kept experimenting and in 1994 published a paper finding that thalidomide had “clear implications” for treating tumors.

So when Beth called three years later, Folkman told her they should try it.

Barlogie told me he didn’t think it would work. Beth said she had to convince him to try it.

Barlogie agreed to test it on Ira and two other patients who were out of treatment options in early December.

I wanted him alive forever.

—Beth Wolmer

The drug did not work for Ira. Beth said just before he died, Ira sat up in bed, kissed her and smiled. It was March 10, 1998. He was 38.

After years of frantically searching for anything that would help, the finality of his death was difficult to accept, she said. “I wanted him alive forever.”

It is unclear what happened with the second patient. The third patient, however, started to get better.

His name was Jimmy. Little more is known about him except that he was a patient of another oncologist at the hospital, Dr. Seema Singhal, and near death before he started the drug. “I told him it might work, but at the very least it would help him sleep,” Singhal said. Shortly after Jimmy took his first dose of thalidomide, Singhal left for a vacation.

Dr. Bart Barlogie and Dr. Seema Singhal (Painting by James Lee Chiahan for ProPublica)

When she returned two weeks later, her mailbox was full of lab results for Jimmy. He was still alive. She sat down to double-check the results, which showed declining amounts of a cancer marker. “For 30 minutes, I was the only person in the world who knew this worked,” she said.

Singhal walked down to Barlogie’s office to give him the news. “He took me by the hand, opened a window and shouted, ‘Thank you, God,’” she said.

“Violent Arguments”

Word of Jimmy’s stunning recovery in Arkansas quickly made its way to the offices of Celgene Corp., located in a small corporate park in a rural patch of northern New Jersey.

The company had just wrapped up a brutal year-end accounting, which showed losses of $27 million on revenue of just $1.1 million. Money was so tight that executives engaged in what one of them called “violent arguments” over whether to charge employees for coffee.

Celgene had acquired the rights to thalidomide patents held by researchers at Rockefeller University in 1992. The company, which was new to pharmaceuticals, planned to use the experience of obtaining FDA approval for thalidomide to develop other drugs.

“It wasn’t meant to be a blockbuster,” said Sol Barer, who started at the company in 1987 and later became CEO.

When Celgene announced plans to develop the disgraced drug for new uses, the only analyst following the company on Wall Street dropped coverage and told Celgene officials they didn’t know what they were doing.

The company thought the largest market would be as a treatment for AIDS patients experiencing dangerous weight loss. To win approval of the drug, however, Celgene selected a use that was already in practice in parts of the world for a small group of patients.

In July 1998, the FDA approved thalidomide for the treatment of a painful complication of leprosy. It was a momentous decision, coming just a few decades after the drug caused so much harm.

The market for leprosy was tiny, but what happened with Jimmy in Arkansas changed everything for the company.

Blocked Exits

The Arkansas doctors had been busy since first testing thalidomide on Ira Wolmer, Jimmy and the other patient. They quickly got approval to conduct a larger experiment funded by a grant from the U.S. National Institutes of Health. Now, in December 1998, they were ready to share their initial findings at the annual meeting of the American Society of Hematology.

It had been three decades since a new therapy for multiple myeloma had been approved, and there was a buzz among the oncologists gathered in Miami Beach for the conference. So many doctors crowded into the room for the presentation that the fire marshal had to intervene several times to clear exit ways. Word had already spread among multiple myeloma specialists about Jimmy. Now, the assembled doctors wanted to know whether it had been a fluke or a discovery that would fundamentally change how they practiced.

Singhal was tasked with presenting the data. It was a big stage for the 32-year-old doctor, who had only been practicing in the U.S. for two years.

It completely changed the treatment landscape.

—Dr. Seema Singhal

The 89 patients in the study were high-risk cases who had undergone prior treatment. They were patients who, like Ira, had run out of options. Now, after thalidomide treatment, one-third had declines in myeloma activity.

Those were stunning numbers, unlike anything seen before in the treatment of multiple myeloma. When Singhal finished, the room erupted in applause.

“It completely changed the treatment landscape,” she said.

I wasn’t able to track down Jimmy, but I have a sense of how he might have felt when he realized the treatment was working.

After my initial emergency room visit, it took time to confirm my diagnosis and do some additional testing. While I waited, the pain worsened. Painkillers barely made a dent. All I could picture was this cancer eating away at my bones, doing more damage every day.

David Armstrong (Painting by James Lee Chiahan for ProPublica)

Some patients wait months for care. I was lucky enough to meet my oncologist within weeks. He had a script for Revlimid ready to go, part of a regimen of four drugs I would take as standard induction therapy, and I was able to start it within days.

The initial dose of Revlimid cost $18,255 for a month’s supply, and my insurance covered the cost.

Within a month, my blood tests showed a massive drop in a key cancer indicator.

My pain gradually subsided too. By the end of April, I wrote in my journal that the pain was a 3 or 4 instead of the usual 9 or 10. “It doesn’t hurt to get out of bed anymore,” I wrote.

A Piggy Bank

The discovery in Arkansas made thalidomide, which Celgene sold as Thalomid, an instant hit.

As a result, Celgene’s revenue increased nearly sevenfold to $26.2 million in the year after the Miami presentation. It sold its thalidomide pills for $7.50 each.

From those modest beginnings, Celgene took a slightly altered version of that pill and turned it into one of the bestselling and most expensive prescription drugs in history. Celgene’s success with Thalomid was the result of remarkable good fortune, a case where the heavy lifting of discovery and initial testing had already been done, by Beth Wolmer, D’Amato, Barlogie, Singhal and others.

The development of the drug that would become Revlimid took me deep into the confounding, sharp-elbowed world of drug patents, which ostensibly protect drugmakers, allowing them to recoup the massive investments they made in developing a new product. Celgene drew on patent law, a drug safety system and even patient assistance programs to guard the exclusivity of its prized drug and the massive revenue it generated.

Those tactics, detailed in reams of court filings, allowed Celgene to treat Revlimid like a piggy bank, tapping it whenever it wanted.

There was a common internal theme at Celgene that cancer patients were willing to pay almost any amount Celgene charged.

—David Schmidt, a former Celgene executive

Amid the early success of Thalomid, Celgene identified two potential threats: One was obvious. Thalidomide caused birth defects, a looming risk that could result in it being pulled from the market.

The other was that Celgene held limited patents on the drug. Patents are exclusive legal rights to inventions, and researchers file them on nearly every aspect of drug development as soon as they can, locking up everything from specific sets of ingredients to the way the drug is used and administered. The more robust patents a company has, the longer it can potentially ward off competitors.

Thalidomide was an old drug and Celgene’s patents did not cover the active ingredient, leaving it open to competition. The patents it did have, covering items such as the optimal dosages and its use in treating particular diseases, were considered weaker and open to a court challenge. If Celgene could create a new version of thalidomide — ideally one that didn’t cause birth defects — the company could seek more and stronger patents that would extend beyond those of the original drug.

So researchers at Celgene tested analogs of thalidomide, which are drugs that have a similar effect but are different from the parent compound in minor ways, such as having one less oxygen atom. The analogs are also more potent than the original, meaning they can achieve a similar effect at lower doses.

Celgene was not alone in its efforts. D’Amato was also studying thalidomide analogs and filing patents on their use, which he and Boston Children’s Hospital licensed to a Celgene competitor, EntreMed Inc.

With dueling patents, the companies sued each other in 2002.

Celgene was newly flush with cash from rising sales of thalidomide. EntreMed, on the other hand, was burning through money as it focused most of its resources on developing other drugs discovered in Folkman’s lab.

In December of 2002, the companies settled.

Celgene agreed to pay Boston Children’s Hospital royalties from future sales of Revlimid. In exchange, the hospital and D’Amato licensed their patents of thalidomide analogs to Celgene. Celgene also agreed to pay EntreMed $27 million.

For Celgene, the fight with EntreMed was a valuable experience. It learned that competition can be neutralized.

The Rise of Revlimid

Celgene had kept the price of Thalomid low when it was initially intended for AIDS patients, CEO John Jackson told investors in 2004, as the company “didn’t want huge numbers of people demonstrating in front” of its office.

That wasn’t a problem with cancer patients. There was “plenty of room for very substantial increases” in the price of the drug now, Jackson told investors.

It is time for us to take Jimbo to the wood shed.

—A senior Celgene official discussing a doctor critical of Revlimid

Just two days earlier, Celgene had hiked the price of Thalomid to $47 a pill.

“There was a common internal theme at Celgene that cancer patients were willing to pay almost any amount Celgene charged,” wrote David Schmidt, a former national account manager at the company, in a whistleblower lawsuit he filed after his employment was terminated in 2008. The lawsuit was voluntarily dismissed by Schmidt. (Jackson didn’t respond to requests for comment; Schmidt declined to talk to me.)

When Celgene launched Revlimid in December of 2005, it set the initial price at $55,000 a year, or $218 a pill, which was about double what analysts expected.

Seven months later, when the FDA approved the drug for multiple myeloma, the price jumped to $70,560 a year, or $280 a pill.

The Price of Revlimid Has Increased 26 Times Since FDA Approval

Each dot indicates a new manufacturer list price per pill.

(Source: AnalySource)

The cost to manufacture each Revlimid pill, meanwhile, was 25 cents. I found a deposition marked “highly confidential” in which a top Celgene executive testified that the cost started at a quarter and never changed.

Even on Wall Street, which cheered higher pricing, the initial cost of Revlimid prompted concern among analysts who tracked the company that such aggressive maneuvering would cause insurers to push back. In the U.S., that is one of the only real checks on the price of prescription drugs.

That fear turned out to be unfounded, and Celgene would repeatedly test the bounds of how high it could go.

At the same time, Celgene worked to mute any criticism of Revlimid.

In 2005, Celgene received reports that Los Angeles oncologist Dr. James Berenson was “bashing” Revlimid in presentations sponsored by patient groups.

In one email, a senior company official said, “it is time for us to take Jimbo to the wood shed.” The company discussed a range of options for dealing with the doctor, from taking legal action to arranging a sit-down with Celgene’s chief executive.

Ultimately, the company appears to have decided on a friendlier course of action. Berenson became a frequent paid speaker and consultant for the company, with payments totaling at least $333,000, according to Celgene disclosures. Berenson declined to comment.

He wasn’t the only doctor the company befriended. Payment records show that between 2013 and 2018, Celgene paid doctors $11 million for speaking engagements and consulting work related to Revlimid. At one point, Celgene rented a suite at the Houston Astros baseball stadium to throw a party for the entire multiple myeloma department at the MD Anderson Cancer Center, according to court testimony. The center said it was unable to verify any of those details.

They remind me of an octopus with many, many tentacles, and at the end of each tentacle is a wad of cash.

—David Mitchell, president of Patients For Affordable Drugs

Celgene went on to spread its largesse across the multiple myeloma world. It funded patient groups, sponsored medical meetings and contracted with prestigious academic medical centers.

“They remind me of an octopus with many, many tentacles, and at the end of each tentacle is a wad of cash,” said David Mitchell, a former Washington, D.C., communications executive who launched a nonprofit organization to fight for lower prices after he was diagnosed with multiple myeloma. “Everybody relies on the money.” Mitchell said his group, Patients For Affordable Drugs, does not accept donations from any entity that profits from the development or distribution of pharmaceuticals.

At the same time it showered doctors and patient groups with money, Celgene was shutting Beth Wolmer out. She told me that John Jackson, the CEO at the time, had promised her a paid board seat at the company as a way of compensating her for her role in the discovery before the company cut off communication.

Wolmer sued Celgene in federal court in 2009, seeking $300 million or more for alleged misappropriation of her idea and what she termed the “unjust enrichment” of Celgene.

Celgene said it never promised to compensate Wolmer. The company also suggested she greatly inflated her role in the discovery and, in any event, waited too long to take legal action.

In 2010, a judge granted Celgene’s motion for summary judgment in the case, agreeing that the statute of limitations had expired while at the same time expressing “admiration” for Wolmer’s “contribution to the struggle against this terrible disease.”

Ira and Beth Wolmer in the Cayman Islands (Painting by James Lee Chiahan for ProPublica)

Wolmer has remarried and changed her name to Jacobson. She remains disappointed about the way she was treated by Celgene. “There was no ambiguity about who found the purpose of this drug, and I’m thrilled that it’s helping so many people,” she said. “Why they treated me that way? I don’t know.”

The Generic Threat

After the FDA approved Revlimid in late 2005, it also granted Celgene something else: seven years of market exclusivity because the drug treats a rare disease. In those seven years, Celgene raised the price of the drug nine times, increasing the price per pill by 82% to $397 in 2012.

The company also fended off challengers by claiming its patents protected the drug from competition until 2027.

But by 2010 generic makers were already working on copies of the drug, preparing to challenge those patents and enter the market earlier. A government analysis has found that generics generally lower the price of brand name drugs by an average of 85% after just one year.

Celgene was well aware of the danger generics posed and warned in a 2012 financial filing that their entry into the market could have a “material adverse effect” on its finances. At that point, Revlimid sales made up 70% of the company’s revenue.

Celgene needed another move.

The drug still posed a risk of birth defects like the parent compound. In approving the drug, the FDA had mandated a strict safety program to control its prescription and distribution.

Celgene realized early on that this could also be a tool to thwart competition. An internal company presentation at the time noted that the safety program could make it “more difficult for generic companies to access” thalidomide for testing.

Generic drug makers are required by the FDA to test their version against the brand name drug, so they need to buy small amounts of Revlimid from the company.

By 2012, at least six generic makers had requested to purchase Revlimid for testing. In every case, Celgene refused.

Federal regulators took notice. The FDA had warned Celgene that it could not use the safety program “to block or delay approval” of generic competitors. Now, it appeared to be doing just that.

The Federal Trade Commission, which enforces antitrust laws, had been investigating Celgene for years and in June of 2012 notified the company it was poised to take action.

In a previously unreported letter, the FTC said that its staff had recommended filing a legal complaint against the company for refusing to sell to competitors, thereby keeping them out of the marketplace.

The commission’s patience is wearing thin.

—FTC official Richard Feinstein to a Celgene attorney

In its letter, the FTC noted that while Celgene refused to sell its drugs to potential competitors, it routinely provided Revlimid to other third parties around the world, including researchers and universities studying the drug.

Then, in August of 2012, the FDA directed Celgene to sell a small amount of Revlimid to a generic competitor.

With both federal agencies bearing down on Celgene, a closed-door meeting was held at FDA headquarters at the end of August. The FTC sent five lawyers, and 11 FDA staffers attended. Celgene showed up with a large contingent that included in-house lawyers and outside counsel.

Celgene started by denying it was using the safety program to block generics, according to minutes of the meeting. (The minutes were filed in a court case against Celgene, and it is unclear if they were prepared by the agencies or the company.) Citing the threat of birth defects, the company said that it had legitimate safety concerns about selling Revlimid to generic companies and that it needed to protect its investment in the drug.

Jane Axelrad, an associate director for the FDA, told Celgene that it was raising safety concerns because “the company does not want generics on the market,” according to the minutes. She declined to comment.

The meeting ended without a resolution. The FDA had no way of enforcing its directive to Celgene. The FTC staff, however, was still determined to act. The agency had spent more than two years investigating Celgene. It hired experts, deposed Celgene officials and obtained internal company documents.

The staff drafted a complaint alleging the company engaged in unfair actions to maintain a monopoly, hoping either that it would push the company to agree to sell to competitors to avoid legal action or that Celgene would be forced to do so by the courts, according to a person familiar with the agency’s stance.

“The commission’s patience is wearing thin,” FTC official Richard Feinstein wrote to the company’s lawyer in February 2013. “We have reached a point where the staff may be instructed in the very near future to commence litigation.” (Feinstein did not respond to emails seeking a comment.)

Celgene appeared to relent, telling the FTC that it would sell to generic makers, as long as the FDA approved their safety plan. In July, the FDA approved the safety protocols of generic maker Mylan.

Still, Celgene refused to sell.

Jon Leibowitz, who was the chairman of the FTC at the time, told me that Celgene’s promise to cooperate, even if it didn’t result in any sales to generic makers, lessened interest in the case among his fellow commissioners. Three of five commissioners need to vote in favor of commencing litigation. Now, in retrospect, he said that “if we knew then what we know now” about the delays, “we certainly would have brought a case.”

The agency would close its case in 2017 without taking any action.

With would-be generic competitors sidelined by Celgene’s refusal to sell drugs for testing, the company continued to raise the price of Revlimid.

They could raise their price any time they wanted to.

—Francis Brown, former Celgene sales executive

On a Saturday morning in early March of 2014, Celgene President Mark Alles sent an internal email complaining of disappointing first quarter Revlimid sales. Revenue from the star drug, which had surpassed $1 billion the previous quarter, was down by about 1% — or $11.4 million.

“I have to consider every legitimate opportunity available to us to improve our Q1 performance,” he wrote. But the only idea he proposed was a familiar one: raise the price of the drug.

Alles said he wanted a meeting the following Monday to discuss an immediate 4% price increase, followed by another increase of 3% at the beginning of September.

The company implemented those hikes, along with a third in December. It brought the price of Revlimid to $9,854 a month, or $469 a pill, and helped boost Revlimid sales for the year to $5 billion. Alles didn’t respond to my requests for comment.

“They could raise their price any time they wanted to,” said Francis Brown, a former sales executive at the company, in a 2015 deposition. I wasn’t able to reach Brown for comment.

Celgene found a solution to the generic threat when it struck a deal to settle a lawsuit brought by generic maker NATCO Pharma in 2015. NATCO could bring a generic to market, Celgene agreed, but not for seven more years — in March 2022. Even then, the generic would be limited to less than 10% of the total market for Revlimid in the first year, with gradual increases after that.

The deal set the bar for deals with other rivals for limited generic sales, and it ensured that unlimited generic competition — and lower prices — would not arrive until 2026.

The delayed entry of generics may have been bad news for patients and health care payors, but there was one constituency that was thrilled with the 2015 deal. Celgene’s stock jumped nearly 10% the day after it was announced.

“Ridiculous,” “Ugly” and “Killer”

Revlimid turned out to be a unicorn for Celgene, a drug whose financial success proved impossible to replicate.

In October of 2017, Celgene announced it was abandoning a once-promising effort to develop a drug for Crohn’s disease. Shares of Celgene declined by 11%.

As it had done so many times in the past, Celgene tapped Revlimid to try to mitigate the damage. The day it announced the failure of the Crohn’s drug, it quietly raised the price of Revlimid by 9%.

By the end of the year, Celgene had cumulatively raised the cost 20% to $662 a pill, the largest one-year increase in the drug’s history.

That made Revlimid the most expensive Medicare drug that year, with the government insurance program spending $3.3 billion to provide it to 37,459 patients.

At Celgene, the brash increases triggered rare internal dissent. Betty Swartz, the company’s vice president of U.S. market access, objected to the measures in a pricing meeting with the CEO, who at the time was Alles, and other top executives. She said her concerns were swiftly dismissed, according to a whistleblower lawsuit she filed and later dismissed.

“Why would you be afraid to take an increase on our products?” she said the CEO told her. “What could be the worst thing that happens ... a tweet here or there and bad press for a bit.” Swartz declined to comment.

The price increases added to the burden faced by many patients. In online groups, patients use words like “ridiculous,” “ugly” and “killer” when talking about the financial pain they have experienced related to the high costs associated with Revlimid. Some have taken out mortgages, raided retirement funds or cut back on everyday expenses like groceries to pay for Revlimid. Others have found overseas suppliers who ship the drug for pennies on the dollar, although doctors caution there’s no way to guarantee quality. Some just decide not to take the drug.

By increasing the price of Revlimid, Celgene executives in several instances boosted their pay. That’s because bonuses were tied to meeting revenue and earnings targets. In some years, executives would not have hit those targets without the Revlimid price increases, a congressional investigation later found.

In total, Celgene paid a handful of top executives about a half-billion dollars in the 12 years after Revlimid was approved.

Robert Hugin, who worked as Celgene’s CEO and then executive chairman, received $51 million in total compensation from 2015 to 2017. Hugin retired in 2018 to launch an unsuccessful Senate bid.

Even sales reps earned more than $1 million a year and were rewarded with trips to resorts such as the Four Seasons in Maui. That pay is more than two times what the average oncologist earns.

I connected with Hugin just before Christmas while he was driving. He was ardent in his defense of the pricing of Revlimid. He told me the drug passes any cost-benefit analysis because of its impact on multiple myeloma patients like myself. “People recognize when you have a breakthrough therapy and you have an opportunity to deliver that, you want to deliver that across the world,” he said. “And I think Revlimid is an example of a product that ends up to be a global lifesaver because of what it did.”

Hugin told me that when Revlimid has unlimited generic competition, the price will be “cheaper than aspirin” and patients will benefit from that low price for many decades.

Celgene also cited the cost of developing drugs and its expansive research efforts as reasons for the high cost of Revlimid. Celgene said it spent $800 million to develop Revlimid and spent several hundred million more on additional trials to study the use of the drug in other cancers. Those combined figures represent about 2% to 3% of Revlimid sales through 2018.

The drug didn’t get any better. The cancer patients didn’t get any better. You just got better at making money. You just refined your skills at price gouging.

—Former Rep. Katie Porter, D-Calif.

By the end of 2018, Celgene’s stock was down 56% over the past 15 months amid development failures. Despite the raft of bad news, Alles’ total pay that year increased by $3 million to $16.2 million.

Celgene tried desperately to boost its flagging stock price by buying back $6 billion of its own shares that year.

Ultimately, the buyback was not enough. Just days into the new year in 2019, Celgene announced it had agreed to be acquired by Bristol Myers Squibb in a deal valued at $74 billion.

As part of a severance agreement, top Celgene executives stood to make millions once the deal closed. For Alles, that meant a potential estimated payday of $27.9 million.

In the fall of 2020, Alles appeared before the House Oversight Committee, which was investigating the high cost of prescription drugs. He said pricing decisions “reflected our commitment to patient access, the value of a medicine to patients and the health care system, the continuous effort to discover new medicines and new uses for existing medicines, and the need for financial flexibility.”

When it came time for questions, then-Rep. Katie Porter, D-Calif., quizzed Alles in rapid-fire style about Revlimid. Did the drug change as the price increased? Did it work faster? Were there fewer side effects? The drug was the same, Alles responded.

“So, to recap here,” Porter said. “The drug didn’t get any better. The cancer patients didn’t get any better. You just got better at making money. You just refined your skills at price gouging.”

The Drumbeat Continues

High prices have consequences beyond individual patients. While there have been tremendous advancements in the treatment of my disease, there is still no cure. The specter of relapse hovers over every blood test, every new ache or pain.

The day I learned I was in remission, in November 2023, was bittersweet. I wrote at the time that I didn’t get to ring a bell — the traditional sign that a cancer patient has finished treatment. Instead, my doctor explained the next step: “maintenance” treatment.

This includes not only continuing Revlimid, but making monthly visits to my cancer center to get a shot of a bone-strengthening drug, have another drug injected into my stomach and blood drawn for lab tests.

“The visit,” I wrote that day, “only reinforced the fact that I’m a patient, and I always will be.”

For most of us, cancer will return at some point after treatment. And for most patients, the drugs eventually stop working.

Revlimid can also be difficult to live with. Some patients quit the drug after developing severe gastrointestinal issues, infections or liver problems. The drug also poses an increased risk of stroke, heart attack and secondary cancers.

Those are the trade-offs for keeping multiple myeloma in check.

Meanwhile, the drumbeat of price increases continues under Bristol Myers Squibb, helping the company bring in $48 billion in revenue from Revlimid since it purchased Celgene. Bristol said its pricing “reflects the continued clinical benefit Revlimid brings to patients, along with other economic factors.” The company said it is “committed to achieving unfettered patient access to our medicines” and provides some financial support for eligible patients. “While BMS develops prices for its medicines, we do not determine what patients will pay out of pocket.”

Last July, the cost of my monthly Revlimid prescription increased by 7% to $19,660.

At the beginning of this year, my insurer switched me to generic Revlimid. I didn’t fight it, thinking it would result in a dramatic decrease in what ProPublica’s health plan pays for the drug.

It turns out it is not much of a savings: The generic costs $17,349 a month.

Alec Glassford contributed research.

by Annie Waldman

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

For more than two months, the Trump administration has been subject to a federal court order stopping it from cutting funding related to gender identity and the provision of gender-affirming care in response to President Donald Trump’s executive orders.

Lawyers for the federal government have repeatedly claimed in court filings that the administration has been complying with the order.

But new whistleblower records submitted in a lawsuit led by the Washington state attorney general appear to contradict the claim.

Nearly two weeks after the court’s preliminary injunction was issued, the National Institutes of Health’s then-acting head, Dr. Matthew J. Memoli, drafted a memo that details how the agency, in response to Trump’s executive orders, cut funding for research grants that “promote or inculcate gender ideology.” An internal spreadsheet of terminated NIH grants also references “gender ideology” and lists the number associated with Trump’s executive order as the reason for the termination of more than a half dozen research grants.

The Washington attorney general’s allegation that the Trump administration violated a court order comes as the country lurches toward a constitutional crisis amid accusations that the executive branch has defied or ignored court orders in several other cases. In the most high-profile case so far, the administration has yet to comply with a federal judge’s order, upheld unanimously by the Supreme Court, requiring it to “facilitate” the return of Kilmar Armando Abrego Garcia, who was mistakenly deported to El Salvador in March.

The records filed in the NIH-related lawsuit last week also reveal for the first time the enormous scope of the administration’s changes to the agency, which has been subject to massive layoffs and research cuts to align it with the president’s political priorities.

Other documents filed in the case raise questions concerning a key claim the administration has made about how it is restructuring federal agencies — that the Department of Government Efficiency has limited authority, acting mostly as an advisory body that consults on what to cut. However, in depositions filed in the case last week, two NIH officials testified that DOGE itself gave directions in hundreds of grant terminations.

The lawsuit offers an unprecedented view into the termination of more than 600 grants at the NIH over the past two months. Many of the canceled grants appear to have focused on subjects that the administration claims are unscientific or that the agency should no longer focus on under new priorities, such as gender identity, vaccine hesitancy and diversity, equity and inclusion. Grants related to research in China have also been cut, and climate change projects are under scrutiny.

Andrew G. Nixon, the director of communications for the Department of Health and Human Services, the NIH’s parent agency, told ProPublica in an email that the grant terminations directly followed the president’s executive orders and that the NIH’s actions were based on policy and scientific priorities, not political interference.

“The cuts are essential to refocus NIH on key public health priorities, like the chronic disease epidemic,” he said. Nixon also told ProPublica that its questions related to the lawsuit “solely fit a partisan narrative”; he did not respond to specific questions about the preliminary injunction, the administration’s compliance with the order or the involvement of DOGE in the grant termination process. The White House did not respond to ProPublica’s questions.

Mike Faulk, the deputy communications director for the Washington state attorney general’s office, told ProPublica in an email that the administration “appears to have used DOGE in this instance to keep career NIH officials in the dark about what was happening and why.”

“While claiming to be transparent, DOGE has actively hidden its activities and its true motivations,” he said. “Our office will use every tool we have to uncover the truth about why these grants were terminated.”

Since Trump took office in January, the administration has provided limited insight into why it chose to terminate scientific and medical grants.

That decision-making process has been largely opaque, until now.

Washington Fights to Overturn Grant Termination

In February, Washington state — joined by Minnesota, Oregon, Colorado and three physicians — sued the administration after it threatened to enforce its executive orders by withholding federal research grants from institutions that provided gender-affirming services or promoted “gender ideology.” Within weeks, a federal judge issued an injunction limiting the administration from fully enforcing the orders in the four states that are party to the suit.

The same day as the injunction, however, the NIH terminated a research grant to Seattle Children’s Hospital to develop and study an online education tool designed to reduce the risk of violence, mental health disorders and sexually transmitted infections among transgender youth, according to records filed in the court case. The NIH stated that it was the agency’s policy not to “prioritize” such studies on gender identity.

“Research programs based on gender identity are often unscientific, have little identifiable return on investment, and do nothing to enhance the health of many Americans,” the notice stated, without citing any scientific evidence for its claims. The NIH sent another notice reiterating the termination four days later.

The Washington attorney general’s office requested the termination be withdrawn, citing the injunction. But the administration refused, claiming that it was in compliance as the termination was based on NIH’s own authority and grant policy and was not enforcing any executive order.

The Washington attorney general asked the judge to hold the administration in contempt for violating the injunction. While the request was denied, the court granted an expedited discovery process to better assess whether the administration had breached the injunction. That process would have required the administration to quickly turn over internal documents relating to the termination. In response, the administration reinstated the grant for Seattle Children’s Hospital and declared the discovery process moot, or no longer relevant. However, U.S. District Judge Lauren J. King, who was appointed by former President Joseph Biden, permitted it to continue.

Whistleblower Documents Reveal Sweeping Changes at NIH

In recent months, whistleblowers have made the plaintiffs in the lawsuit aware of internal records that more closely connect the grant terminations to the administration’s executive orders.

In an internal spreadsheet of dozens of grants marked for cancellation at an NIH institute, the stated reason for termination for several was “gender ideology (EA 14168),” including the grant to Seattle Children’s Hospital.

The rationale appears to reference Executive Order 14168, which banned using federal funds to “promote gender ideology,” again seeming to conflict with the administration’s stance that the termination was not based on the executive orders. The termination dates of the grants, according to the spreadsheet, were after the injunction went into effect.

Another internal document, which provides extraordinary insight into the administration’s efforts to reshape the NIH, also states the executive order was the impetus for grant terminations.

In the March 11 memo from Memoli, the NIH cataloged all actions that the agency had taken thus far to align with the president’s executive orders. In a section detailing the steps taken to implement the “gender ideology” executive order, one of the 44 actions listed was the termination of active grants.

“NIH is currently reviewing all active grants and supplements to determine if they promote gender ideology and will take action as appropriate,” the memo stated, noting that the process was in progress.

While the administration has said in court filings that it is following the judge’s injunction order, the Washington state attorney general’s office told ProPublica that it disagreed.

“Their claim to have complied with the preliminary injunction is almost laughable,” said Faulk, the office’s deputy communications director. “The Trump administration is playing games with no apparent respect for the rule of law.”

Depositions Reveal DOGE Links

In depositions conducted last month as part of the lawsuit, the testimony of two NIH officials also raised questions about why the research grants were terminated and how DOGE was involved.

Liza Bundesen, who was the deputy director of the agency’s extramural research office, testified that she first learned of the grant terminations on Feb. 28 from a DOGE team member, Rachel Riley. Bundesen said she was invited into a Microsoft Teams video call, where Riley introduced herself as being part of DOGE and working with the Department of Health and Human Services.

Riley, a former consultant for McKinsey & Co., joined HHS on Jan. 27, according to court filings in a separate lawsuit, and has reportedly served as the DOGE point person at the NIH.

The executive order detailing DOGE’s responsibilities describes the cost-cutting team as advisers that consult agency heads on the termination of contracts and grants. No language in the orders gives the DOGE team members the authority to direct the cancellation of grants or contracts. However, the depositions portray Riley as giving directions on how to conduct the terminations.

“She informed me that a number of grants will need to be terminated,” Bundesen testified, adding that she was told that they needed to be terminated by the end of the day. “I did not ask what, you know, what grants because I just literally was a little bit confused and caught off guard.”

Bundesen said she then received an email from Memoli, the NIH acting director, with a spreadsheet listing the grants that needed to be canceled and a template letter for notifying researchers of the terminations.

“The template had boilerplate language that could then be modified for the different circumstances, the different buckets of grants that were to be terminated,” she said. “The categories were DEI, research in China and transgender or gender ideology.”

Bundesen forwarded the email with the spreadsheet to Michelle Bulls, who directs the agency’s Office of Policy for Extramural Research Administration. Bundesen resigned from the NIH a week later, on March 7, citing “untenable” working conditions.

“I was given directives to implement with very short turnaround times, often close of business or maybe within the next hour,” she testified. “I was not offered the opportunity to provide feedback or really ask for clarification.”

Bulls confirmed in her own deposition that the termination list and letter template originally came from Riley. When Bulls started receiving the lists, she said she did what she was told. “I just followed the directive,” she said. “The language in the letters were provided so I didn’t question.”

Bulls said she didn’t write any of the letters herself and just signed her name to them. She also said she was not aware whether anyone had assessed the grants’ scientific merit or whether they met agency criteria. The grant terminations related to gender identity did not stem from an independent agency policy, she testified, appearing to contradict the administration’s assertion that they were based on the agency’s own authority and grant policy.

As of April 3, Bulls said she had received more than five lists of grants that needed to be terminated, amounting to “somewhere between five hundred and a thousand” grants.

Most grant recipients endure a rigorous vetting process, which can involve multiple stages of peer review before approval, and before this year, Bulls testified that grant terminations at the NIH have historically been rare. There are generally two main types of terminations, she said, for noncompliance or based on mutual agreement. Bulls said that she has been “generally involved in noncompliance discussions” and since she became the director of the office in 2012, there had been fewer than five such terminations.

In addition to the termination letters, Bulls said she relied on the template language provided by Riley to draft guidance to inform the 27 centers and institutes at the NIH what the agency’s new priorities were to help them scrutinize their own research portfolios.

Following the depositions, the Washington state attorney general’s office said that the federal government has refused to respond to its discovery requests. It has filed a motion to compel the government to respond, which is pending.

Riley, Bundesen, Bulls and Memoli did not reply to ProPublica’s requests for comment.

While the administration did not answer ProPublica’s questions about DOGE and its involvement in the grant terminations, last week in its budget blueprint, it generally justified its proposed cuts at the NIH with claims that the agency had “wasteful spending,” conducted “risky research” and promoted “dangerous ideologies that undermine public health.”

“NIH has grown too big and unfocused,” the White House claimed in its fiscal plan, adding that the agency’s research should “align with the President’s priorities to address chronic disease and other epidemics, implementing all executive orders and eliminating research on climate change, radical gender ideology, and divisive racialism.”

Jeremy Berg, who led the National Institute of General Medical Sciences at the NIH from 2003 to 2011, told ProPublica that the administration’s assessment of the institution was “not fair and not based on any substantial analysis or evidence,” and the proposed cuts “would be absolutely devastating to NIH and to biomedical research in the United States.”

“It is profoundly distressing to see this great institution being reduced to a lawless, politicized organization without much focus on its actual mission,” he said.

by Kavitha Surana, Lizzie Presser and Andrea Suozzo

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

Nearly four years ago in Texas, the state’s new abortion law started getting in the way of basic miscarriage care: As women waited in hospitals cramping, fluid running down their legs, doctors told them they couldn’t empty their uterus to guard against deadly complications.

The state banned most abortions, even in pregnancies that were no longer viable; then, it added criminal penalties, threatening to imprison doctors for life and punish hospitals. The law had one exception, for a life-threatening emergency.

Heeding the advice of hospital lawyers, many doctors withheld treatment until they could document patients were in peril. They sent tests to labs, praying for signs of infection, and watched as women lost so much blood that they needed transfusions.“You would see the pain in peoples’ eyes,” one doctor said of her patients.

Not every hospital tolerated this new normal, ProPublica found. A seismic split emerged in how medical institutions in the state’s two largest metro areas treated miscarrying patients — and in how these women fared.

Leaders of influential hospitals in Dallas empowered doctors to intervene before patients’ conditions worsened, allowing them to induce deliveries or perform procedures to empty the uterus.

In Houston, most did not.

The result, according to a first-of-its-kind ProPublica analysis of state hospital discharge data, is that while the rates of dangerous infections spiked across Texas after it banned abortion in 2021, women in Houston were far more likely to get gravely ill than those in Dallas.

As ProPublica reported earlier this year, the statewide rate of sepsis — a life-threatening reaction to infection — shot up more than 50% for women hospitalized when they lost a second-trimester pregnancy.

A new analysis zooms in: In the region surrounding Dallas-Fort Worth, it rose 29%. In the Houston area, it surged 63%.

After Texas Banned Abortion, the Sepsis Rate Spiked in Houston, but not Dallas Note: For hospitalizations at facilities in the Houston and Dallas-Fort Worth perinatal care regions involving a pregnancy loss between 13 weeks’ gestation and the end of the 21st week. Rates are annual. (Lucas Waldron/ProPublica)

ProPublica has documented widespread differences in how hospitals across the country have translated abortion bans into policy. Some have supported doctors in treating active miscarriages and high-risk cases with procedures technically considered abortions; others have forbidden physicians from doing so, or left them on their own to decide, with no legal backing in case of arrest.

This marks the first analysis in the wake of abortion bans that connects disparities in hospital policies to patient outcomes. It shows that when a state law is unclear and punitive, how an institution interprets it can make all the difference for patients.

Yet the public has no way to know which hospitals or doctors will offer options during miscarriages. Hospitals in states where abortion is banned have been largely unwilling to disclose their protocols for handling common complications. When ProPublica asked, most in Texas declined to say.

ProPublica’s Texas reporting is based on interviews with 22 doctors in both the Houston and Dallas-Fort Worth metro areas who had insight into policies at 10 institutions covering more than 75% of the births and pregnancy-loss hospitalizations in those areas.

The findings come as evidence of the fatal consequences of abortion bans continue to mount, with a new report just last month showing that the risk of maternal mortality is nearly twice as high for women living in states that ban abortion. Last year, ProPublica documented five preventable maternal deaths, including three in Texas.

One second-trimester pregnancy complication that threatens patients’ lives is previable premature rupture of membranes, called PPROM, when a woman’s water breaks before the fetus can live on its own. Without amniotic fluid, the likelihood of the fetus surviving is low. But with every passing hour that a patient waits for treatment or for labor to start, the risk of sepsis increases.

The Texas Supreme Court has said that doctors can legally provide abortions in PPROM cases, even when an emergency is not imminent.

Yet legal departments at many major Houston hospitals still advise physicians not to perform abortions in these cases, doctors there told ProPublica, until they can document serious infection.

Dr. John Thoppil, the immediate past president of the Texas Association of Obstetricians and Gynecologists, said he was “blown away” by this finding. He said it’s time for hospitals to stop worrying about hypothetical legal consequences of the ban and start worrying more about the real threats to patients’ lives.

“I think you’re risking legal harm the opposite way for not intervening,” he said, “and putting somebody at risk.”

“We Have Your Back”

In the summer of 2021, Dr. Robyn Horsager-Boehrer, a Dallas specialist in high-risk pregnancy, listened as hospital lawyers explained to a group of UT Southwestern Medical Center doctors that they would no longer be able to act on their clinical judgment.

Dr. Robyn Horsager-Boehrer, a retired maternal-fetal medicine specialist in Dallas (Lexi Parra for ProPublica)

For decades, these UT Southwestern physicians had followed the guidance of major medical organizations: They offered patients with PPROM the option to end the pregnancy to protect against serious infection. But under the state’s new abortion ban, they would no longer be allowed to do so while practicing at the county’s safety net hospital, Parkland Memorial, which delivers more babies than almost any other in the country. Nor would they be permitted at UT Southwestern’s William P. Clements Jr. University Hospital.

Lawyers from the two hospitals explained in a meeting that the law’s only exception was for a “medical emergency” — but it wasn’t clear how the courts would define that. With no precedent or guidance from the state, they advised the doctors that they should offer to intervene only if they could document severe infection or bleeding — signs of a life-threatening condition, Horsager-Boehrer recalled. They would need to notify the state every time they terminated a pregnancy. ProPublica also spoke with six of Horsager-Boehrer’s colleagues who described similar meetings.

As the new policy kicked in, the doctors worried the lawyers didn’t understand how fast sepsis could develop and how difficult it could be to control. Many patients with PPROM can appear stable even while an infection is taking hold. During excruciating waits, Dr. Austin Dennard said she would tell patients at Clements, “We need something to be abnormal so that we can offer you all of the options that someone in New York would have.” Then she would return to the physicians’ lounge, lay down her head and cry.

Dr. Austin Dennard, an OB-GYN in Dallas (Lexi Parra for ProPublica)

Their only hope, the doctors felt, was to collect data and build a case that the hospital’s policy needed to change.

Within eight months, 28 women with severe pregnancy complications before fetal viability had come through the doors of Parkland and Clements. Twenty-six of them were cases in which the patients’ water broke early. Analyzing the medical charts, a group of researchers led by Dr. Anjali Nambiar, a UT Southwestern OB-GYN, found that a dozen women experienced complications including hemorrhage and infection. Only one baby survived.

The research team compared the results with another study in which patients were offered pregnancy terminations. They found that of patients who followed the “watch and wait” protocol, more than half experienced serious complications, compared with 33% who immediately terminated their pregnancies.

Armed with the research, the doctors, including Horsager-Boehrer, returned to the lawyers for the two hospitals. Everyone agreed the data demanded action. Alongside physicians, the lawyers helped develop language that doctors could include in medical charts to explain why they terminated a pregnancy due to a PPROM diagnosis, Dennard said.

At Parkland, the new protocol required doctors to get signoff from one additional physician, attach the study as proof of the risk of serious bodily harm — part of the “medical emergency” definition in the law — and notify hospital leaders. At Clements, doctors also needed to get CEO approval to end a pregnancy, which could create delays if patients came in on a weekend, doctors said. But it was vastly better than the alternative, Dennard said. The message from the lawyers, she said, was: “We have your back. We are going to take care of you.”

A spokesperson for UT Southwestern said “no internal protocols delay care or otherwise compromise patient safety.” A spokesperson for Parkland said that “physicians are empowered to document care as they deem appropriate” and that hospital attorneys had “helped review and translate the doctors’ proposed language to make sure it followed the law.”

Parkland and UT Southwestern are not the only ones providing this care in Dallas. ProPublica spoke with doctors who have privileges at hospitals that oversee 60% of births and pregnancy loss hospitalizations in the Dallas-Fort Worth region, including Baylor Scott & White and Texas Health Resources. They said that their institutions support offering terminations to patients with high-risk second-trimester pregnancy complications like PPROM.

At Baylor Scott & White, doctors said, the leadership always stood by this interpretation of the law. (When asked, a spokesperson said miscarrying patients are counseled on surgical options, and that its hospitals follow state and federal laws. “Our policies are developed to comply with those laws, and we educate our teams on those policies.”)

Texas Health and other hospitals in the region did not respond to requests for comment.

While efforts to be proactive have meant more patients are able to receive the standard of care in Dallas, that is still not the case at every medical campus in the region. Doctors at Parkland said they have seen patients come to them after they were turned away from hospitals nearby.

In other parts of the state, however, it’s been impossible to know where to turn.

“No Interventions Can Be Performed”

In Houston, one of America’s most prestigious medical hubs, Dr. Judy Levison mounted her own campaign.

The veteran OB-GYN at Baylor College of Medicine wanted hospital leaders to support intervening in high-risk complications in line with widely accepted medical standards. In 2022, she emailed her department chair, Dr. Michael Belfort, who is also the OB-GYN-in-chief at Texas Children’s. She told him colleagues had shared “feelings of helplessness, moral distress and increasing concerns about the safety of our patients.”

Dr. Judy Levison, a retired OB-GYN, at her home in Denver (Rachel Woolf for ProPublica)

They needed training on how to protect patients within the bounds of the law, she said, and language they could include in charts to justify medically necessary abortions. But in a meeting, Belfort told her he couldn’t make these changes, Levison recalled.

He said that if he supported abortions in medically complicated cases like PPROM, the hospital could lose tens of millions of dollars from the state, she told ProPublica. “I came to realize that he was in a really difficult place because he risked losing funding for our residency program if Baylor and Texas Children’s didn't interpret the law the way they thought the governor did.” She wondered if he was deferring to hospital lawyers.

Belfort did not respond to requests for comment about his stance. Nor did Baylor or Texas Children’s.

Although Texas Attorney General Ken Paxton has threatened hospitals with civil action if they allow a doctor to perform what he views as an “unlawful” abortion, he hasn’t filed any such actions. And in the years since the ban, there have been no reports of the state pulling funding from a hospital on account of its abortion policy.

A spokesperson at only one major Houston hospital chain, Houston Methodist, said that it considered PPROM a medical emergency and supported terminations for “the health and safety of the patient.”

Five other major hospital groups that, together, provide the vast majority of maternal care in the Houston region either continue to advise doctors not to offer pregnancy terminations for PPROM cases or leave it up to the physicians to decide, with no promise of legal support if they’re charged with a crime. This is according to interviews with a dozen doctors about the policies at HCA, Texas Children’s, Memorial Hermann, Harris Health and The University of Texas Medical Branch. Together, they account for about 8 in 10 hospitalizations in the region for births or pregnancy loss.

Most of the doctors spoke with ProPublica on the condition of anonymity, as they feared retaliation for violating what some described as a hospital “gag order” against discussing abortion. In a sign of how secretive this decision-making has become, most said their hospitals had not written down these new policies, only communicated them orally.

Several doctors told ProPublica that Dr. Sean Blackwell, chair of the obstetrics and gynecology department at Houston’s University of Texas Health Science Center, which staffs Harris Health Lyndon B. Johnson Hospital and Memorial Hermann hospitals, had conveyed a message similar to Belfort’s: He wasn’t sure he would be able to defend providers if they intervened in these cases. He did not respond to multiple requests for comment, and his institution, UTHealth Houston, declined to comment.

ProPublica reached out to officials at all five hospital groups, asking if they offer terminations at the point of a PPROM diagnosis. Only one responded. Bryan McLeod at Harris Health pointed to the hospital system’s written policy, which ProPublica reviewed, stating that an emergency doesn’t need to be imminent for a doctor to intervene. But McLeod did not respond to follow-up questions asking if patients with PPROM are offered pregnancy terminations if they show no signs of infection — and several doctors familiar with the chain’s practices said they are not.

The state Senate unanimously passed a bill last week to clarify that doctors can terminate pregnancies if a woman faces a risk of death that is not imminent. ProPublica asked the hospitals if they would change their policies on PPROM if this is signed into law. They did not respond.

Last fall, ProPublica reported that Josseli Barnica died in Houston after her doctors did not evacuate her uterus for 40 hours during an “inevitable” miscarriage, waiting until the fetal heartbeat stopped. Two days later, sepsis killed her.

Barnica was treated at HCA, the nation’s largest for-profit hospital chain, which did not respond to a detailed list of questions about her care. With 70% of its campuses in states where abortion is restricted, the company leaves the decision of whether to take the legal risk up to the physicians, without the explicit legal support provided in Dallas, according to a written policy viewed by ProPublica and interviews with doctors. A spokesperson for the chain said doctors with privileges at its hospitals are expected to exercise their independent medical judgment “within applicable laws and regulations.” As a result, patients with potentially life-threatening conditions have no way of knowing which HCA doctors will treat them and which won’t.

Brooklyn Leonard, a 29-year-old esthetician eager for her first child, learned this in February. She was 14 weeks pregnant when her water broke. At HCA Houston Healthcare Kingwood, her doctor Arielle Lofton wrote in her chart, “No interventions can be performed at this time legally because her fetus has a heartbeat.” The doctor added that she could only intervene when there was “concern for maternal mortality.” Leonard and her husband had trouble getting answers about whether she was miscarrying, she said. “I could feel that they were not going to do anything for me there.” Lofton and HCA did not respond to a request for comment.

Brooklyn Leonard was diagnosed with PPROM when she was 14 weeks pregnant in Houston. It took her five days to get care. (Lexi Parra for ProPublica)

It was only after visits to three Houston hospitals over five days that Leonard was able to get a dilation and evacuation to empty her uterus. A doctor at Texas Children’s referred her to Dr. Damla Karsan, who works in private practice and is known for her part in an unsuccessful lawsuit against the state seeking permission to allow an abortion for a woman whose fetus was diagnosed with a fatal anomaly. Karsan felt there was no question PPROM cases fell under the law’s exception. She performed the procedure at The Woman’s Hospital of Texas, another HCA hospital. “She’s lucky she didn’t get sick,” Karsan said of Leonard.

Dr. Damla Karsan, an OB-GYN in Houston (Lexi Parra for ProPublica)

Many Houston doctors said they have continued to call on their leadership to change their stance to proactively support patients with PPROM, pointing to data analyses from Dallas hospitals and ProPublica and referring to the Texas Supreme Court ruling. It hasn’t worked.

Houston hospitals haven’t taken action even in light of alarming research in their own city. Earlier this year, UTHealth Houston medical staff, including department chair Blackwell, revealed early findings from a study very similar to the one out of Dallas.

It showed what happened after patients at three partner hospitals stopped being offered terminations for PPROM under the ban: The rate of sepsis tripled.

Still, nothing changed.

How We Measured Sepsis Rates

To examine second-trimester pregnancy loss outcomes in Houston and Dallas, we used a methodology we developed to determine sepsis rates in inpatient hospitalizations where a pregnancy ended between 13 weeks’ gestation and the end of the 21st week. To assess regional differences, we grouped hospitals by perinatal care region and focused on the two regions with the highest population: Houston and Dallas-Fort Worth.

We grouped hospitalizations in the nine quarters after the implementation of the state’s six-week abortion ban (October 2021 through December 2023) and compared them with hospitalizations in the nine quarters immediately before. Each region had about 2,700 second-trimester pregnancy loss hospitalizations over the course of the time span we examined.

Sophie Chou contributed data reporting, and Mariam Elba contributed research.

by Jake Pearson

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

Last month, a Department of Government Efficiency aide at the nation’s consumer watchdog agency was told by ethics attorneys that he held stock in companies that employees are forbidden from owning — and was advised not to participate in any actions that could benefit him personally, according to a person familiar with the warning.

But days later, court records show, Gavin Kliger, a 25-year-old software engineer who has been detailed to the Consumer Financial Protection Bureau since early March, went ahead and participated in mass layoffs at the agency anyway, including the firings of the ethics lawyers who had warned him.

Experts said that Kliger’s actions, which ProPublica first reported on last week, constitute a conflict of interest that could violate federal criminal ethics laws. Such measures are designed to ensure that federal employees serve the public interest and don’t use their government power to enrich themselves. At the CFPB, which regulates companies that provide financial services, there are strict prohibitions on the investments that employees can maintain.

As ProPublica previously reported, Kliger owns as much as $365,000 worth of shares in Apple Inc., Tesla Inc. and two cryptocurrencies, according to his public financial report. Investments in those businesses are off limits to employees since the bureau can regulate them. A further review now shows that he’s invested in even more companies that are on the agency’s “Prohibited Holdings” list. Kliger also disclosed owning as much as $350,000 worth of stock in Google parent Alphabet Inc., Warren Buffett’s Berkshire Hathaway and the Chinese e-commerce company Alibaba.

That means, at a maximum, Kliger could own as much as $715,000 of investments in seven barred companies, the records show.

Experts said a defanged and downsized consumer watchdog is unlikely to aggressively regulate those and other companies, freeing them of compliance costs and the risk associated with examinations and enforcement actions. That in turn could boost their stock prices and benefit investors like Kliger.

Don Fox, a former general counsel of the independent federal agency that advises executive branch workers on their ethical obligations, said that “this looks like a pretty clear-cut violation” of the federal criminal conflict-of-interest statute.

Richard Briffault, a government ethics expert at Columbia Law School, said the fact that Kliger was warned not to take any actions that could benefit him personally showed that “he’s on notice that this is a problem, as opposed to doing this by accident, or unintentionally.”

But Briffault said there would likely be no recourse for Kliger’s actions given that the Department of Justice under President Donald Trump has “greatly deprioritized public integrity, ethics and public corruption as issues for them.” The New York Times reported last week that the section handling such cases is down to just a handful of lawyers.

From the outset, the Trump administration has been dogged by ethics controversies, from the president’s own foray into the cryptocurrency industry to Elon Musk’s dual roles as both the head of DOGE and a major federal contractor. Kliger’s case is “a nice illustration of how even on this micro level, they are violating the law, acting in ways that positively should cause people to not trust what they’re doing because there is no question that these corporations will benefit,” said Kathleen Clark, an expert on government ethics at Washington University in St. Louis.

Kliger hasn’t returned a phone call or email seeking comment. The CFPB didn’t respond to a request for comment.

The White House didn’t answer questions about the warning, whether Kliger had sought ethics waivers or if he was in the process of divesting. Instead, a spokesperson provided ProPublica the same statement it previously had, writing that Kliger “did not even manage” the layoffs, “making this entire narrative an outright lie.” A spokesperson said that Kliger had until May 8 to divest.

The April 10 ethics warning came amid a heated legal battle over the future of the CFPB.

The following day, an appeals court in Washington, D.C., allowed the agency’s acting director, Russell Vought, to implement mass firings after a lower court judge had stayed them. The court instructed Vought to conduct a “particularized assessment” of the bureau and to lay off only those employees who were deemed to be “unnecessary” to perform the agency’s statutorily required duties. In court filings, the government has said that review was done by the bureau’s chief legal officer, Mark Paoletta, and two other attorneys. In court papers, Paoletta has said the cuts are designed to achieve a “streamlined and right-sized Bureau.”

On April 13, Kliger was among a small team of DOGE and agency officials who received an email from Vought about the coming layoffs with the subject line “CFPB RIF Work” — government parlance for reduction in force, according to emails produced in court records. Vought’s email is redacted in the filing, but hours after he sent it, records show the bureau’s chief information officer wrote to Kliger and another DOGE aide regarding a “follow-up on Russ’s note below” and advised Kliger that he’d been granted access to agency computer systems that “should allow you to do what you need to do,” according to the email.

Layoff notices to more than 1,400 bureau employees went out on April 17.

In the preceding 36 hours, “Gavin was screaming at people he did not believe were working fast enough” to get the notices out and “calling them incompetent,” a federal employee on the layoff team using the pseudonym Alex Doe wrote in sworn declaration filed by lawyers for unionized employees trying to stop the administration from dismantling the bureau.

Among those laid off were the agency’s ethics officer and their “entire team” of lawyers, according to court records.

Those are the very employees who’d twice notified Kliger that he was required to identify any investments in companies on the bureau’s Prohibited Holdings list. The warning last month explicitly instructed him not to participate in any bureau activity that could benefit the businesses whose stocks he owned, said the person familiar with the notice, who spoke on condition of anonymity because of its sensitivity.

Last week, the appeals court reversed course and temporarily stopped the firings at the CFPB amid a flurry of legal challenges. Agency officials then notified the more than 1,400 fired employees who’d been told they were being let go that the pink slips were being rescinded.

The court battle over the CFPB’s future is ongoing, though, with oral arguments before appellate judges in Washington, D.C., scheduled for later this month.

by Matthew Kish, The Oregonian/OregonLive

This article was produced in partnership with The Oregonian/OregonLive. Sign up for Dispatches to get stories like this one as soon as they are published.

In May 2015, President Barack Obama gave a big speech about dropping trade barriers with other nations. He delivered it on a sunny day at Nike’s world headquarters in Oregon.

“Sometimes when we talk about trade, we think of Nike,” Obama said, before making his pitch for a trade deal with Asian countries that he described as the “highest-standard, most progressive trade deal in history.”

President Donald Trump canceled that deal, known as the Trans-Pacific Partnership, less than two years later.

Now, as Trump erects more trade barriers in his second administration, Nike once again is center stage in conversations about globalization, a familiar place for a company that has its roots importing Japanese track shoes and briefly made sneakers in the United States.

Last month, Trump announced sweeping tariffs that would slam imports from the countries where most Nike sneakers and apparel get made. A close look at Nike’s massive supply chain offers a case study in the possible ripple effects of the escalating global trade war and shows how vulnerable factory workers could get squeezed.

Some degree of taxation on imports has long been a feature of international garment trade, and Nike has decades of experience navigating these tariffs. The company has not spoken about how it will handle the current round under Trump, but it’s among 76 companies that signed a letter to the president last week warning about dire consequences for footwear companies unless there is tariff relief.

In response to questions about how tariffs might impact factory workers, Nike said in a statement it is “committed to ethical and responsible manufacturing.”

“We build long-term relationships with our contract manufacturing suppliers because we know having trust and mutual respect supports our ability to create product more responsibly, accelerate innovation and better serve consumers,” the statement said.

Where does Nike make sneakers and clothing?

Nike doesn’t own or operate the overseas factories that make its products. Instead, it works with 532 contract manufacturers that employ nearly 1.2 million workers, according to an online Nike map.

No country is more important to Nike’s manufacturing than Vietnam, where the brand works with 131 factories that employ nearly 460,000 workers. Half of Nike’s sneakers were made in Vietnam last year, according to the company’s annual report.

Nike’s second-largest production base is Indonesia, where its 45 contract factories employ more than 280,000 workers.

The company has been moving production out of China over the last decade. It works with 120 Chinese contract factories that employ more than 100,000 workers — down from more than 350,000 workers in 2012. Some of the footwear and apparel that Nike makes in China is sold to Chinese consumers and therefore not subject to tariffs.

Are tariffs affecting Nike?

Yes. On April 2, Trump announced “reciprocal” tariffs that included 46% on Vietnam, 32% on Indonesia and 34% on China. The next trading day, Nike’s shares fell 14%, wiping out $14 billion in shareholder value.

A week later, the president paused most of the tariffs for 90 days, but a 145% tariff on imports from China and a 10% surcharge on most imports from other countries remain in place.

Tom Nikic, a veteran industry analyst at Needham & Co., calculated that the tariffs, if fully implemented, would nearly wipe out Nike’s profits if the company made no changes to its current pricing or production.

“By my math, their earnings would decline by approximately 95%,” he said in an email.

Will Nike squeeze factories for better deals?

“Almost certainly,” said Jason Judd, executive director of the Global Labor Institute at Cornell University. “The default for a brand or retailer faced with a tariff or some other shock is to press suppliers for discounts.”

“The COVID shock is a good example,” Judd added. “We know from talking to suppliers that the COVID shock meant canceled orders and renegotiations over price.”

The Worker Rights Consortium, a labor monitoring group, estimated brands canceled $40 billion in orders during the pandemic.

When Trump announced tariffs during his first administration, Nike’s top executives said they’d find savings in their supply chain.

“We have a lot of levers we can work with, from sourcing to other levers,” Andy Campion, then Nike’s chief financial officer, said in 2019.

How will tariffs affect Nike’s factory workers?

Factory workers will likely feel the impact directly.

Dara O’Rourke, an associate professor at the University of California, Berkeley, who’s studied wages in Nike factories, said the tariffs could become a “huge hammer.”

“It is likely that you will see this kind of pressure from managers to say to workers, ‘For a period of time, we’re going to have to work harder and longer,’” he said. “Hold the line or you’re going to lose your job.”

That could mean workers are asked to make more sneakers and T-shirts every shift and work longer hours, according to Thulsi Narayanasamy, director of international advocacy for the Worker Rights Consortium.

It is likely that you will see this kind of pressure from managers to say to workers, ‘For a period of time, we’re going to have to work harder and longer.’

—Dara O’Rourke, associate professor at the University of California, Berkeley

“When suppliers are squeezed and workers have unreasonable production targets, they don’t drink water, don’t take food breaks,” she said in an email. She added that in these circumstances, the organization consistently hears about “women having urinary tract infections, struggling with repetitive strain injuries, kidney stones, and having back problems due to rapid, repetitive movements for more than 12 hours a day.”

Narayanasamy said brands like Nike have a choice: “Push costs that they could reasonably absorb onto their suppliers, replete with the knowledge that doing so will immediately harm millions of factory workers, or not.”

In its statement, Nike said it sets clear labor expectations for supplier factories in its Code of Conduct and Code Leadership Standards.

Foreign garment workers could also face furloughs or work without pay, said Cornell’s Judd. That happened across the industry during the pandemic.

In 2021, the Worker Rights Consortium identified 31 garment factories — three of which did work for Nike — that the consortium said didn’t pay $39.8 million in severance benefits owed to 37,637 workers who lost jobs during the pandemic.

Nike previously has disputed that it owed wages to workers at the three factories named in the labor group’s report. In its statement, Nike also said factories are responsible for severance benefits.

“Manufacturing suppliers hold the financial obligation to pay worker severance, social security and other separation benefits to impacted employees in accordance with local law and Nike’s Code of Conduct,” the company said. “And in the event of any closure or divest, Nike works closely with the supplier to conduct a responsible exit.”

Will tariffs force Nike to move manufacturing back to the U.S.?

“To think this will bring jobs back to the U.S. is poorly thought out, would be the nicest thing I could say,” said Berkeley’s O’Rourke.

Footwear and apparel manufacturing remains labor-intensive. Sneakers require gluing and stitching. T-shirts require sewing. Efforts to automate shoe production have mostly flopped.

That’s part of the reason Nike makes most of its products in countries with low wages. ProPublica reported this month on a former Nike factory in Cambodia where most employees made the minimum wage — about $1 per hour.

Ngin Nearadei, center, worked for three years in a Cambodian garment factory that produced baby clothes for Nike and other brands. She told ProPublica she couldn’t have afforded to buy the clothes she helped make. (Sarahbeth Maney/ProPublica)

Nike also uses huge factories that are filled with equipment that’s difficult to transfer to a new location. They’re often located near materials companies that make the rubbers, nylons and polyesters needed to make sneakers.

“The full production system is not easily movable,” O’Rourke said.

Instead of moving the work back to the U.S., industry watchers expect apparel companies will continue to manufacture products in countries with low wages, but manufacturing will shift to those subject to less onerous tariffs.

That could further harm workers in Vietnam, Indonesia, China and other countries with relatively high proposed tariff rates and a lot of Nike manufacturing jobs. In Indonesia, for example, one labor union expects as many as 50,000 workers could lose their jobs if the full Trump tariffs go into effect.

As the number of people looking for work increases, wages in those countries will decrease.

“The line at the gate to find work gets longer,” Judd said. “And that means employers of any kind can start paying new workers less because unemployment has jumped.”

What could tariffs mean for Nike’s prices?

Estimates vary and depend on how much of the cost Nike passes to consumers.

If the 46% tariff on Vietnam goes into effect, the price of a $155 sneaker made in Vietnam would increase to $220, according to the Footwear Distributors and Retailers of America, a trade group that counts Nike as a member.

The example, which isn’t specific to Nike, assumes the importing company passes nearly all of the tariff cost to customers. No athletic footwear brand has given specifics, although Adidas CEO Bjørn Gulden last week said “higher tariffs will eventually cause price increases.”

But Nike’s been in a slump and has been discounting many of its sneakers to boost sales.

It’s possible that Nike will absorb more of the tariff cost to avoid raising prices too steeply.

“It will likely be hard for Nike to raise prices,” the investment bank UBS recently wrote in a research note.

by Mario Ariza

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The Drug Enforcement Administration has quietly ended its body camera program barely four years after it began, according to an internal email obtained by ProPublica.

On April 2, DEA headquarters emailed employees announcing that the program had been terminated effective the day before. The DEA has not publicly announced the policy change, but by early April, links to pages about body camera policies on the DEA’s website were broken.

The email said the agency made the change to be “consistent” with a Trump executive order rescinding the 2022 requirement that all federal law enforcement agents use body cameras.

But at least two other federal law enforcement agencies within the Justice Department — the U.S. Marshals Service and the Bureau of Alcohol, Tobacco, Firearms and Explosives — are still requiring body cameras, according to their spokespeople. The FBI referred questions about its body camera policy to the Justice Department, which declined to comment.

The DEA did not respond to questions about its decision to stop using the cameras, saying that the agency “does not comment on tools and techniques.” Reuters reported on the change as part of a story about budget cuts for law enforcement offices.

One former federal prosecutor expressed concern that the change would make life more difficult for DEA agents.

“The vast majority of times I viewed body camera footage is based on allegations from a defense attorney about what a cop did,” said David DeVillers, former U.S. attorney for the Southern District of Ohio. “And I would say 95% of the time it absolves the cop of wrongdoing.”

The Justice Department started requiring that its federal agents wear the devices in 2021 in the wake of the protests over George Floyd’s death the previous summer.

“We welcome the addition of body worn cameras and appreciate the enhanced transparency and assurance they provide to the public and to law enforcement officers working hard to keep our communities safe and healthy,” then-DEA Administrator Anne Milgram said in a Sept. 1, 2021, press release announcing the use of the cameras.

In May 2022, then-President Joe Biden issued an executive order expanding the use of body cameras to all federal law enforcement officers.

In January, the incoming Trump administration rescinded that order, along with almost 100 others it considered “harmful.”

In early February, U.S. Immigration and Customs Enforcement, which is part of the Department of Homeland Security, was one of the first agencies to get rid of its body cameras. Subsequent videos show plainclothes immigration agents making arrests with no visible body cameras.

The DOJ wrote in a 2022 Office of Inspector General management report that the cameras were a “means of enhancing police accountability and the public’s trust in law enforcement.” Studies have consistently shown that departments that use body cameras experience a drop in complaints against officers, according to the nonprofit Police Executive Research Forum, though it’s not clear if the drop is due to improvements in officer behavior or to a decrease in frivolous complaints.

“Eliminating these videos is really taking away a tool that we’ve seen be of benefit to law enforcement practices,” said Cameron McEllhiney, executive director of the National Association for Civilian Oversight of Law Enforcement. “It’s also a great teaching tool, besides keeping community members safe from the potential misconduct that could occur.”

The DOJ put a lot of money into the body camera initiative. In August of 2021, it awarded Axon, the company that dominates the body camera market, a $30.4 million contract for cameras and the software to handle the evidence they created. The contract, according to Axon, remains active. But only about one-sixth of it has been paid out, according to federal contracting data.

The most recent publicly available version of the DEA’s body camera policy dates to December 2022. It only required agents to wear the devices when they were conducting preplanned arrests or searches and seizures that required a warrant. It also only required DEA officers to wear their body cameras when they were working within the United States.

Agents had 72 hours after the end of an operation to upload their video evidence, unless there was a shooting, in which case they were instructed to upload the video evidence as soon as possible. The policy laid out in detail how and by whom evidence from the cameras should be handled in the event officers used force, and it authorized the DEA to use the video evidence when investigating its own officers.

The DEA had planned to implement the policy in phases so that eventually its officers nationwide would be wearing the devices when serving warrants or carrying out planned arrests. In its 2025 fiscal year budget request to Congress, the agency asked for $15.8 million and 69 full time employees, including five attorneys, “to enable the DEA’s phased implementation plan of nationwide use of Body Worn Cameras.”

Records obtained via Freedom of Information Act request by Citizens for Responsibility and Ethics in Washington show that the Biden-era DOJ had an ambitious plan to capture agencywide metrics and data about the efficiency and use of body cameras by its law enforcement officers.

Laura Iheanachor, senior counsel at CREW, said that before federal law enforcement started wearing body cameras, several local police agencies had declined to participate in federal task forces because doing so would have forced their officers to remove their cameras.

“It’s a protective measure for officers, for the public,” Iheanachor said. “And it allows state and federal law enforcement to work together in harmony.”

by Jasmine Demers, Arizona Center for Investigative Reporting

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Two years after Arizona officials revealed a $2.5 billion Medicaid fraud scheme that targeted Native Americans seeking treatment for addictions, the state has recovered just a fraction of the taxpayer funds lost to fraud.

The Arizona attorney general’s office is leading the criminal investigation into the network of behavioral health providers and sober living homes that from 2019 to 2023 exploited the American Indian Health Program to obtain inflated Medicaid payments. Investigators found fraudulent operators didn’t provide the services they’d billed for and sometimes allowed patients to continue the substance use for which they had sought treatment.

The state has so far indicted more than 100 individuals and recouped $125 million — or about 5% of the funds the state estimates it paid to bad actors.

Attorney General Kris Mayes said in a May 1 press conference that she hopes to retrieve “at least hundreds of millions” from fraudsters. But she warned that “it’s hard, because what happens is these … criminals get the money, they buy lavish homes, they buy multiple expensive cars, they hide the money offshore, they spend the money in ways that is unrecoverable.”

“My team is working day in and day out to seize those assets,” Mayes said.

The Arizona Health Care Cost Containment System struggled to rein in the rampant fraud under two governors, leaving more than 11,000 people vulnerable to the chaos that followed. Prior reporting by the Arizona Center for Investigative Reporting and ProPublica found that at least 40 Indigenous residents of sober living homes and treatment facilities in the Phoenix area died as the state fumbled its response.

The damage also rippled out through the state’s behavioral health industry, which was nearly brought to a standstill when the agency suspended some 300 providers and enacted policies that halted or substantially delayed payments to those still operating. Those reforms included enhanced scrutiny when screening and reimbursing providers.

Gov. Katie Hobbs, a Democrat, recently signed legislation further increasing oversight of sober living homes by requiring the facilities to promptly report resident deaths. But advocates like Reva Stewart, a Diné activist who has helped Indigenous victims of the scheme through her group Stolen People Stolen Benefits, don’t think the state has done enough.

“I feel like I’m on a hamster wheel, and we’re still at the beginning,” Stewart said. “They have a lot of indictments and people being charged, but at the same time … they’re just getting a slap on the wrist.”

The U.S. Department of Justice has also indicted several individuals and is conducting parallel investigations into the fraudulent billing schemes under federal statutes.

Yet despite these state and federal efforts, it’s likely that most of the stolen taxpayer money won’t be recovered.

From 2019 to 2023, the Arizona Health Care Cost Containment System allowed about 13,000 unlicensed providers to enter its system, including some that exploited weak oversight by overbilling or charging for services that were never delivered.

The agency also didn’t act decisively when solutions to stem the fraud were proposed internally. It initially yielded to pressure from special interest groups connected to the behavioral health industry, which argued that reforms to the fee-for-service American Indian Health plan would threaten their financial interests.

Now, AHCCCS says its efforts to unravel the crisis could take many years, describing its investigation as a “highly complex and manual process.”

Officials must review improper payments, whether they were obtained by fraud or not, on a case-by-case basis. Though providers are required to repay AHCCCS as soon as they become aware of overpayments, they often cannot do so in one lump sum. Repayments may occur over months or years.

Because state Medicaid agencies receive much of their funding from the federal government, improper payments come with added financial consequences: States must repay the federal government for its share.

In Arizona, the federal government covered 70% to 76% of Medicaid costs between 2019 and 2023. The rate was even higher for people who received services through the American Indian Health Program.

AHCCCS has repaid $49.1 million to the federal government since January 2023, according to spokesperson Havona Horsefield, who has since left the agency. That amount will likely grow as AHCCCS continues to review fraudulent cases.

The agency is not, however, required to reimburse the federal government for overpayments made to facilities that are now bankrupt or out of business. Of the 322 providers suspended on suspicion of fraud, 90 have closed, according to AHCCCS.

The agency could not provide an estimate of how much those providers were overpaid, but said it notifies the attorney general when a provider goes out of business and provides information to support criminal cases against them.

State Sen. Theresa Hatathlie, a Democrat from Coal Mine Mesa on the Navajo Nation, has been critical of the state’s response and continues to call for stricter regulation of sober living facilities. During a March floor vote, she expressed frustration over the reforms Hobbs later signed into law, contending they did not go far enough.

“It’s time to stop protecting bad actors or even those people who continue to allow bad actors to keep coming back,” she said.

As the state slowly works to untangle the fraud and recover taxpayer funds, national debates over Medicaid’s future are intensifying. Republican majorities in both Arizona’s Legislature and Congress are pushing to cut Medicaid to offset President Donald Trump’s proposed tax cuts. Among their justifications are fraud and abuse of the system.

Health policy experts, however, say that most Medicaid spending pays for legitimate care, and that fraud is typically committed by a small number of providers — not patients.

Instead of the current system where the federal government covers a larger share of Medicaid costs in lower-income states, conservatives are advocating to cap Medicaid funding tied to inflation, a model that would shift more of the cost to state budgets.

Arizona is one of nine states where such a change could trigger the end of Medicaid expansion, which currently insures 648,000 low-income residents, or about 30% of AHCCCS recipients.

Despite Medicaid’s uncertain future, Arizona officials are pressing forward with efforts to address the lasting damage the fraud scandal inflicted on tribal communities. In November, Mayes announced a $6 million grant initiative offering up to $500,000 per organization to fund victim compensation and housing support for those displaced or otherwise affected by fraudulent treatment centers. Recipients include tribal nations and Native health organizations.

But Stewart says the state’s work is far from over, and many of those harmed have yet to see real accountability or support.

“They call it a travesty … and they want to get justice,” she said. “But where’s the justice when it comes to the amount of deaths that we have, the amount of Native relatives that are still missing?”

Hannah Bassett and Christopher Lomahquahu, a Roy W. Howard fellow at the Arizona Center for Investigative Reporting, contributed reporting.

by Anna Clark

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for Dispatches, a newsletter that spotlights wrongdoing around the country, to receive our stories in your inbox every week.

Just one year ago, JD Vance was a leading advocate of the Great Lakes and the efforts to restore the largest system of freshwater on the face of the planet.

As a U.S. senator from Ohio, Vance called the lakes “an invaluable asset” for his home state. He supported more funding for a program that delivers “the tools we need to fight invasive species, algal blooms, pollution, and other threats to the ecosystem” so that the Great Lakes would be protected “for generations to come.”

But times have changed.

This spring, Vance is vice president, and President Donald Trump’s administration is imposing deep cuts and new restrictions, upending the very restoration efforts that Vance once championed. With the peak summer season just around the corner, Great Lakes scientists are concerned that they have lost the ability to protect the public from toxic algal blooms, which can kill animals and sicken people.

Cutbacks have gutted the staff at the Great Lakes Environmental Research Laboratory, part of the National Oceanic and Atmospheric Administration. Severe spending limits have made it difficult to purchase ordinary equipment for processing samples, such as filters and containers. Remaining staff plans to launch large data-collecting buoys into the water this week, but it’s late for a field season that typically runs from April to October.

In addition to a delayed launch, problems with personnel, supplies, vessel support and real-time data sharing have created doubts about the team’s ability to operate the buoys, said Gregory Dick, director of the NOAA cooperative institute at the University of Michigan that partners with the lab. Both the lab and institute operate out of a building in Ann Arbor, Michigan, that was custom built as NOAA’s hub in the Great Lakes region, and both provide staff to the algal blooms team.

“This has massive impacts on coastal communities,” Dick said.

Gregory Dick, director of the Cooperative Institute of Great Lakes Research, which works side by side with the National Oceanic and Atmospheric Administration’s Great Lakes Environmental Research Laboratory, says that cuts to the lab will have a massive impact on coastal communities. (Nick Hagen for ProPublica)

Multiple people who have worked with the lab also told ProPublica that there are serious gaps in this year’s monitoring of algal blooms, which are often caused by excess nutrient runoff from farms. Data generated by the lab’s boats and buoys, and publicly shared, could be limited or interrupted, they said.

That data has helped to successfully avoid a repeat of a 2014 crisis in Toledo, Ohio, when nearly half a million people were warned to not drink the water or even touch it.

If the streams of information are cut off, “stakeholders will be very unhappy,” said Bret Collier, a branch chief at the lab who oversaw the federal scientists that run the harmful algal bloom program for the Great Lakes. He was fired in the purge of federal probationary workers in February.

The lab has lost about 35% of its 52-member workforce since February, according to the president of the lab’s union, and it was not allowed to fill several open positions. The White House released preliminary budget recommendations last week that would make significant cuts to NOAA. The budget didn’t provide details, but indicated the termination of “a variety of climate-dominated research, data, and grant programs, which are not aligned with Administration policy” of ending “‘Green New Deal’ initiatives.”

An earlier document obtained by ProPublica and reported widely proposed a 74% funding cut to NOAA’s research office, home of the Great Lakes lab.

Vance’s office didn’t respond to questions from ProPublica about how federal cuts have affected Great Lakes research. The White House also didn’t respond to messages.

Water samples from bodies of water in the Great Lakes region (Nick Hagen for ProPublica)

Municipal water leaders in Cleveland and Toledo have written public letters of support on behalf of the lab, advocating for the continuation of its work because of how important its tools and resources are for drinking water management.

In a statement to ProPublica, staffers from Toledo’s water system credited the Great Lakes lab and NOAA for alerting it to potential blooms near its intake days ahead of time. This has saved the system significant costs, they said, and helped it avoid feeding excess chemicals into the water.

“The likelihood of another 2014 ‘don’t drink the water’ advisory has been minimized to almost nothing by additional vigilance” from both the lab and local officials, they said.

Remaining staff have had to contend with not only a lack of capacity but also tight limits on spending and travel.

Several people who have worked in or with the lab said that the staff was hampered by strict credit card limits imposed on government employees as part of the effort to reduce spending by the Department of Government Efficiency, which has been spearheaded by presidential adviser Elon Musk.

“The basic scientific supplies that we use to provide the local communities with information on algal bloom toxicity — our purchasing of them is being restricted based on the limitations currently being put in by the administration,” Collier said.

The National Oceanic and Atmospheric Administration’s custom-built hub for the Great Lakes region in Ann Arbor, Michigan (Nick Hagen for ProPublica)

NOAA and the Department of Commerce, which oversees the agency, didn’t respond to messages from ProPublica. Neither did a DOGE official. Eight U.S. senators, including the minority leader, sent a letter in March to a top NOAA leader inquiring about many of the changes, but they never received a response.

The department described its approach to some of its cuts when it eliminated nearly $4 million in funding for the NOAA cooperative institute at Princeton University and emphasized the importance of avoiding wasteful government spending. ProPublica has reported on how the loss of research grants at Princeton and the more significant defunding of the NOAA lab it works with would be a serious setback for weather and climate preparedness.

A number of the staffing losses at the Great Lakes lab came when employees accepted offers of early retirement or voluntary separation; others were fired probationary workers targeted by DOGE across the government. That includes Collier, who had 24 years of professional experience, largely as a research professor, before he was hired last year into a position that, according to the lab’s former director, had been difficult to fill.

A scientist specializing in the toxic algal blooms was also fired. She worked on the team for 14 years through the cooperative institute before accepting a federal position last year, which made her probationary, too.

A computer scientist who got real-time data onto the lab’s website — and the only person who knew how to push out the weekly sampling data on harmful algal blooms — was also fired. She was probationary because she too was hired for a federal position after working with the institute.

And because of a planned retirement, no one holds the permanent position of lab director, though there is an acting director. The lab isn’t allowed to fill any positions due to a federal hiring freeze.

At the same time, expected funds for the lab's cooperative institute are delayed, which means, Dick said, it may soon lay off staff, including people on the algal blooms team.

In March, Cleveland’s water commissioner wrote a letter calling for continued support for the Great Lakes lab and other NOAA-funded operations in the region, saying that access to real-time forecasts for Lake Erie are “critically important in making water treatment decisions” for more than 1.3 million citizens.

In 2006, there was a major outbreak of hypoxia, an issue worsened by algal blooms where oxygen-depleted water can become corrosive, discolored and full of excess manganese, which is a neurotoxin at high levels. Cleveland Water collaborated with the lab on developing a “groundbreaking” hypoxia forecast model, said Scott Moegling, who worked for both the Cleveland utility and Ohio’s drinking water regulatory agency.

“I knew which plants were going to get hit,” Moegling said. “I knew about when, and I knew what the treatment we would need would be, and we could staff accordingly.”

The American Meteorological Society, in partnership with the National Weather Association, spotlighted this warning system in its statement in support of NOAA research, saying that it helps “keep drinking water potable in the Great Lakes region.”

Collier, the former branch chief, said that quality data may be lacking this year, not just for drinking water suppliers, but also the U.S. Coast Guard, fisheries, shipping companies, recreational businesses and shoreline communities that rely on it to navigate risk. In response to a recent survey of stakeholders, the president of a trade organization serving Great Lakes cargo vessels said that access to NOAA’s real-time data “is critically important to the commercial shipping fleet when making navigation decisions.”

Because federal law requires NOAA to monitor harmful algal blooms, the cuts may run against legal obligations, several current and former workers told ProPublica. The blooms program was “federally mandated to be active every single day, without exception,” Collier said.

First image: Harmful algal bloom on Lake Erie, observed during weekly sampling in 2022. Second image: A beaker holding a water sample taken from Lake Erie during a peak harmful algal bloom, shown at its natural concentration in 2017. (The Cooperative Institute of Great Lakes Research at the University of Michigan)

The 2024 bloom in Lake Erie was the earliest on record. At its peak, it covered 550 square miles. Warming temperatures worsen the size and frequency of algal blooms. While the field season was historically only about 90 days, Collier said, last year the team was deployed for 211 days.

As the shallowest of the Great Lakes, Lake Erie is typically first to show signs of problems. But it’s also an emblem of environmental stewardship, thanks to its striking recovery from unchecked industrial pollution. The lake was once popularly declared “dead.” A highly publicized fire inflamed a river that feeds into it. Even Dr. Seuss knocked it in the 1971 version of “The Lorax.” The book described fish leaving a polluted pond “in search of some water that isn’t so smeary. I hear things are just as bad up in Lake Erie.”

But the rise of agencies like the Environmental Protection Agency and NOAA, and labs like the one protecting the Great Lakes, along with legislation that protected water from pollution, led to noticeable changes. By 1986, two Ohio graduate students had succeeded in persuading Theodor Geisel, the author behind Dr. Seuss, to revise future editions of his classic book.

“I should no longer be saying bad things about a body of water that is now, due to great civic and scientific effort, the happy home of smiling fish,” Geisel wrote to them.

Early this year, headlines out of the Midwest suggested that “Vance could be a game-changing Great Lakes advocate” and that he might “save the Great Lakes from Trump.”

A 2023 report to Congress about the Great Lakes Restoration Initiative, a popular funding mechanism for projects that protect the lakes, including the research lab’s, described the lab’s work on harmful algal blooms as one of its “success stories.” Last year, with Vance as a co-sponsor, an act to extend support for the funding program passed the Senate, but stalled in the House. Another bipartisan effort to reauthorize it launched in January.

Nicole Rice was recently fired from her position at the Great Lakes Environmental Research Laboratory after 10 years with the National Oceanic and Atmospheric Administration. A promotion put her on probationary status. She’s worried that federal cuts are placing the Great Lakes system at risk. (Nick Hagen for ProPublica)

Project 2025, the plan produced by the Heritage Foundation for Trump’s second term, recommended that the president consider whether NOAA “should be dismantled and many of its functions eliminated, sent to other agencies, privatized, or placed under the control of states and territories.”

NOAA is “a colossal operation that has become one of the main drivers of the climate change alarm industry,” the plan said, and this industry’s mission “seems designed around the fatal conceit of planning for the unplannable.”

“That is not to say NOAA is useless,” it added, “but its current organization corrupts its useful functions. It should be broken up and downsized.”

When asked at his confirmation hearing in January if he agreed with Project 2025’s recommendation of dismantling NOAA, Howard Lutnick, head of the commerce department, said no.

One month later, the Great Lakes lab’s probationary staff got termination notices. That includes Nicole Rice, who spent a decade with NOAA. A promotion made her communications job vulnerable to the widespread firings of federal probationary workers.

In recent testimony to a Michigan Senate committee, Rice expressed deep concern about the future of the Great Lakes.

“It has taken over a century of bipartisan cooperation, investment and science to bring the Great Lakes back from the brink of ecological collapse,” Rice said. “But these reckless cuts could undo the progress in just a few short years, endangering the largest surface freshwater system in the world.”

Vernal Coleman contributed reporting.

by Eric Umansky, Vernal Coleman and Maryam Jameel

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