The 68-year-old Wisconsin farmer chose the pump, called a HeartMate 3 — currently the only FDA-approved device of its kind in use. Instead of extending his life, though, the device led to his death, according to a lawsuit filed in December 2020 by his daughter Jamie Edwards.

The lawsuit alleged that Herrman died because a defect in the locking mechanism of the HeartMate 3 prevented the device from sealing, causing multiple strokes and leading to a severe brain injury and multiorgan failure. Herrman “could not have anticipated the danger this defect … created for him,” the lawsuit said.

Herrman’s death was reported to a Food and Drug Administration database where the public can learn about device-related deaths, serious injuries, and malfunctions. The event was also described in the peer-reviewed Journal of Heart and Lung Transplantation.

In September 2021, Ramon Flores Sr. had the same device implanted at Methodist Hospital of San Antonio. A lawsuit his family filed in August alleges that the locking mechanism defect led to air embolism strokes. Flores died eight days after surgery, at age 76.

“How many other people is this going to happen to?” said his daughter, Alanna Flores Blanco, 52. “We never, ever were explained that the device could malfunction and this could happen.”

After the deaths of Herrman and Flores, Thoratec Corp., the device’s manufacturer, evaluated the pumps involved. In both cases, Thoratec, a subsidiary of Abbott Laboratories, confirmed a bent locking arm. But “a direct correlation” between the HeartMate 3 and the deaths “could not conclusively be established,” the manufacturer reported to the FDA.

Abbott did not respond to questions about the deaths or the alleged defects. The manufacturer denied liability in both cases. It settled Herrman’s lawsuit this fall, and the Flores case is ongoing.

The men’s deaths are among more than 4,500 reports since August 2017 in which the HeartMate 3 may have caused or contributed to a patient’s death, according to a California Healthline analysis of the FDA’s database of medical device incidents, known as the Manufacturer and User Facility Device Experience, or MAUDE. Hospitals, doctors, and others report device-related deaths, serious injuries, and malfunctions to manufacturers, who are required to investigate and report cases to the FDA.

In nearly 90% of those 4,500-plus reports, Thoratec said it found no problem with the device or how it was used, according to a California Healthline review of the FDA database.

In cases where Abbott finds the HeartMate 3 did not cause or contribute to a death or serious injury, the company files “corrective reports,” said Justin Paquette, an Abbott public affairs director.

He added, “The complexity of the device – combined with patients battling late stage heart failure and associated comorbidities – creates very dynamic clinical care situations.”

Abbott said the HeartMate 3 is the safest iteration yet of any left ventricular assist device, or LVAD, a type of mechanical heart pump introduced in the 1960s and refined over the last six decades.

The HeartMate 3 was first approved by the FDA, for use in patients awaiting a heart transplant, in August 2017, and one year later it was approved as a long-term therapy. The device is often considered only for patients with end-stage heart failure, and even then it is a last resort.

HeartMate 3 has “dramatically improved the safety of LVADs by reducing rates of complications that had historically challenged heart pump technology, including clotting, stroke and bleeding,” Paquette said.

As recently as August, the FDA also expressed support for the device. “The FDA believes the benefits of HeartMate 3 continue to outweigh the risks for this vulnerable patient population with few available alternatives,” said Jeremy Kahn, an agency spokesperson.

Others aren’t so sure. Former FDA medical device official Madris Kinard sees the high number of death reports as a warning.

“To me this is a safety signal and it’s hard to know if the FDA is working on something to address it,” said Kinard, founder of Device Events, a company that makes FDA device data more user-friendly for hospitals, law firms, investors, and others. “You have to wonder why [death reports are] still happening, and at the same rate.”

Larry Kessler, a former director in the FDA’s medical device office, agrees the death reports for HeartMate 3 need more study. “The FDA may be missing some signals,” he said. Perhaps “there’s a little more here than meets the eye.”

Not all device problems are reported to MAUDE, and submitting a report is not necessarily an admission that a device caused a death or a serious injury. Device problem reports can be inaccurate or incomplete, or lack verification, and a single incident may be reported more than once — or not at all.

Those limitations ultimately can leave patients and their caregivers uninformed about risks associated with a device such as the HeartMate 3, said Sanket Dhruva, a cardiologist and expert in medical device safety and regulation at the University of California-San Francisco.

“They’re making perhaps the biggest decision of their lives: Do I proceed with an LVAD or not? And even if I proceed, what are the risks I’m facing?” he said. “And they are left with incomplete data and uncertainty about how to make that determination.”

Even doctors cannot use the FDA database as a tool to effectively counsel patients, Dhruva added.

“lf you don’t know what is a real safety signal and what’s not,” he said, “then how can that information help us to calibrate our benefits-and-risks discussion with patients?”

Tracking Incident Reports

The HeartMate 3 is not the only device whose safety profile is hard to ascertain in MAUDE, Dhruva said. The information in the FDA database is insufficient to give patients an adequate understanding of any medical device’s safety risks and reflects “the overall weakness of postmarket surveillance” after a device has been approved for sale, he said.

Under federal regulations, device manufacturers typically must report adverse events to the FDA within 30 days of learning about them, and that data is often used by researchers and regulators to identify potential safety concerns. Reports also can be submitted voluntarily by doctors, patients, or others. The FDA says that reports don’t need to be filed if the manufacturer determines that a device did not cause or contribute to an adverse event.

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But with millions of reports for thousands of devices, it can be difficult to detect and prevent problems that put patients at risk.

Hospitals and surgeons also might self-censor what they report to manufacturers due to concerns about being sued, said Kessler, now a professor at the University of Washington.

“Health care facilities, and risk managers in particular, they aren’t always forthcoming with detailed data about events,” he said.

Reports in MAUDE show that patients with a HeartMate 3 have experienced adverse events, such as bleeding, infection, and respiratory failure, that the manufacturer warned were possible in its instructions for use.

About 400 reports cited infusion or flow problems with the HeartMate 3. In thousands of other cases, the manufacturer said it did not observe any problems with the device, making it even more difficult for a doctor or a patient’s family to understand the safety history of the product.

Reports in MAUDE also describe fatal incidents due to complications not mentioned in the manufacturer’s instructions, such as the locking mechanism malfunction. In one report, a patient died of smoke inhalation after an external battery charger caught fire.

Each report in MAUDE has dozens of data points and summaries describing what happened. What’s lacking in the database: context and details that would be useful for patients and doctors, such as the total number of devices in use and the name of the hospital where the event occurred.

Flores Blanco had never heard of MAUDE before her father’s surgery. Even if she had, it’s unlikely she would have found a locking mechanism issue amid the morass of records, much less anticipated what might happen.

Missed Signals?

A routine FDA inspection of Abbott’s manufacturing plant in 2017 showed that Thoratec had fallen behind schedule reporting adverse events, according to agency records obtained by California Healthline under a Freedom of Information Act request.

The company updated training and hired additional staff to handle complaints submitted by hospitals, doctors, patients, and others, according to an inspection report. It provided the FDA inspector with “quantitative evidence” that late reporting to the FDA had decreased.

By October 2020, during a follow-up inspection, Thoratec was using a database to enter and process complaints and submit device reports electronically, according to an inspection report.

FDA inspectors did not cite any deficiencies with how Thoratec handled complaints after the visit. Inspectors noted the company had received 8,115 complaints related to the HeartMate 3 during the 12 months prior to the inspection in October 2020, the records show.

It’s not clear what the complaints concerned. Abbott did not respond when asked how many of the complaints led to an adverse event report to the FDA.

In Kinard’s view, device-makers in general often take longer than 30 days to investigate the root cause of an incident and frequently conclude that an adverse event was due to user error.

“They are using this regularly to downplay the problems with the device,” she said.

In Herrman’s case, a Thoratec representative was in the operating room and witnessed the incident, according to a deposition in the lawsuit. The company submitted a report to the FDA about Herrman’s injury within 30 days of the June 2019 incident.

Herrman’s surgeon, John Stulak, was experienced at implanting the device, according to the lawsuit, and he was also a principal investigator on the clinical trial that brought the HeartMate 3 to market. Stulak did not respond to interview requests. But, in 2020, he and two Mayo Clinic colleagues described Herrman’s case in The Journal of Heart and Lung Transplantation, where they noted the locking mechanism malfunction. “The lack of a tight seal from this defect resulted in the multiple subsequent air embolism events and irrecoverable neurological damage,” they wrote.

The article describes how Stulak replaced the device with a new one, but it was too late to prevent the injuries to Herrman. Thoratec submitted at least three follow-up reports to the FDA about the incident and said its investigation could not determine whether the HeartMate 3 caused Herrman’s death.

Herrman’s death certificate cites complications of ischemic heart disease. Flores’ death certificate says he died of cardiac arrest and hypoxic ischemic encephalopathy, or brain damage.

The FDA has had its own problems keeping the MAUDE database up to date.

The agency is years behind schedule on anonymizing and releasing adverse event reports for all medical devices.

Kinard said the FDA has yet to publicly release “millions” of follow-up reports that manufacturers have filed after their initial adverse event report for a medical device.

The FDA acknowledged that the agency is not up to date on public reporting but could not say how many reports are pending — for the HeartMate 3 or any device.

“We are currently working on redaction for public posting in MAUDE, of all supplemental reports dated 2021-2023,” said Kahn, the FDA spokesperson. “It is difficult to determine how many of those – pending redaction of supplemental reports – pertain to the subject device.”

FDA press officer Lauren-Jei McCarthy noted that, besides adverse event reports, the agency also monitors published literature, patients, patient advocacy groups, professional societies, individual health care providers, and other sources to determine whether further action is warranted.

“We review and take seriously all reports of adverse events associated with medical devices,” McCarthy said. She said patients and providers who use the HeartMate 3 “remain a high priority” and that the agency cannot comment on investigations.

A Last-Resort Treatment

Before he got a HeartMate 3 implanted in January 2022, Sid Covington, of Austin, Texas, said he had researched the device during years of medication therapy and cardiac rehabilitation to treat his congestive heart failure.

“I looked at case studies. I looked at a number of the different heart studies,” Covington said. “I looked at their marketing brochures and all that stuff, just whatever I could find.”

Covington, 76, said he was familiar with MAUDE and Intermacs, a private registry that tracks LVAD patients, but didn’t consult them. When he had to decide whether to get the device, he was in the hospital with chest pain, shortness of breath, and fatigue from advanced heart failure. Covington said his only option was the HeartMate 3.

“When it comes down to the moment, you really don’t have much choice,” he said. “It’s any port in the storm at that point.”

The HeartMate 3 requires constant attention and care from patients, who must keep the external parts of the device dry at all times and avoid jumping and contact sports. Patients must also ensure that it always has an external source of power, which is supplied through a cord attached to the pump that exits the body through a surgical opening.

Patients who get the device are often out of options to treat their end-stage heart failure, said Larry Allen, a cardiologist with the University of Colorado and member of a multidisciplinary medical team that cares for heart failure patients.

“We wouldn’t proceed with an LVAD unless we think the risk of death is really high and we’ve tried everything else,” he said.

That informs the regulatory view, too, Kessler said.

“When you’re talking about people who are seriously ill, then the FDA will accept a potentially higher risk,” he said, “but not an irresponsible one, and certainly not one that couldn’t be communicated to clinicians and the public.”

Allen, who helped develop a decision aid for patients considering an LVAD, said reliable data on safety and risks to patients is key.

“It’s about as high-risk, high-reward a choice as there can be,” Allen said. “It’s a really complicated decision to make and I think standard informed consent approaches are really inadequate for fully understanding that.”

Data Exists but Is Confidential

Long-term data for the HeartMate 3 — including performance metrics for the more than 180 U.S. hospitals certified to implant the device — are kept in Intermacs, managed by The Society of Thoracic Surgeons, which has promised to provide transparency but has yet to deliver.

The registry tracks mortality and injury rates for patients with an LVAD and logs the number of devices implanted each year.

But Intermacs is proprietary, and access at hospitals requires a principal investigator and at least one trained staff member, who can use the data to evaluate their facility’s performance against an aggregate from their peers across the nation.

Francis Pagani, a heart transplant and LVAD surgeon at University of Michigan Health, leads a medical society task force that oversees Intermacs. He said 12,000 to 14,000 HeartMate 3 implants have been recorded in Intermacs since 2017. The HeartMate 3 has “the best outcomes of any other LVAD, ever,” he said.

Over the years, federal regulators have made it easier for patients to access LVADs, reducing surgery volume requirements for implant centers and no longer requiring patients to be on a transplant waiting list to receive one of the pumps.

Though the HeartMate 3 is presently the only LVAD being implanted in the United States, it once had a competitor, Medtronic’s HeartWare, which the manufacturer removed from the market in June 2021, citing a high risk of stroke and pumps failing to restart if stopped.

While the FDA provides consumers with concise information about key clinical trials supporting the approval of new drugs, the agency provides no comparable data for medical devices. And though Medicare reimburses hospitals nearly $200,000 for most HeartMate 3 implants, federal administrators do not track patient outcomes or enforce performance standards for the heart pumps.

James Kirklin, a cardiac surgeon and researcher, was the principal investigator for Intermacs when the FDA, Centers for Medicare & Medicaid Services, and National Heart, Lung, and Blood Institute awarded a contract to the University of Alabama at Birmingham to establish the registry in 2005.

Federal agencies paid about $15 million over 10 years for Intermacs, Kirklin said, because they wanted to better understand the risk factors for death and other adverse events with so-called mechanical circulatory support devices, including LVADs, as well as the factors that indicated a higher likelihood of patients doing well on the pumps.

The FDA monitors annual reports of Intermacs data, including adverse events, and allows companies to use the registry’s data to analyze their devices’ performance and to fulfill reporting requirements after a device enters the market.

LVAD implant centers are required to report their data to Intermacs in order to be certified by the accrediting nonprofit The Joint Commission. And while CMS requires that centers implant at least 10 devices every three years to continue receiving Medicare reimbursement, there are no requirements for outcomes or other quality metrics. CMS does not track LVAD patient outcomes at individual facilities, said Sara Lonardo, CMS press secretary at the time.

Kirklin said he is working with The Society of Thoracic Surgeons to create a risk model that would allow the public to see quality scores for individual hospitals that implant LVADs, a need the group has recognized since at least 2018. But it will be a year before the tool is ready.

Kirklin and Pagani said the number of death reports for the HeartMate 3 in the FDA’s MAUDE database can be misleading without the outcome and longitudinal perspective that Intermacs provides.

“When you see a lot of deaths it means, ‘Let’s investigate.’ I couldn’t agree more,” Kirklin said. “But it’s rather limited. It’s not time-related and you don’t know the denominator. If you look up Intermacs, it’s all there.”

The families of Herrman and Flores filed lawsuits, in part, to find out what went wrong. Herrman’s family settled the lawsuit and agreed to confidentiality. Thoratec has filed a motion to dismiss the ongoing Flores case based on the FDA’s approval of the device.

Alanna Flores Blanco said she and her father were aware of the HeartMate 3’s positive outcomes, including published research that shows those who receive the device have a better than 50% chance of living five years or more.

“That’s why he took the chance to do it,” she said.

Flores Blanco said her father was a model patient, meeting regularly with cardiologists and other specialists, attending classes to learn how to live with the device, and receiving approval for surgery from the medical review board at Methodist Hospital in San Antonio.

The family felt informed and her father was prepared, she said.

“He did everything he was supposed to do,” she said. “What failed him ultimately was that device.”

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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

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Both men have led their respective states since 2019, and they’ve lately been engaged in an escalating feud. While Newsom isn’t running for president himself — yet — he’s a key surrogate for President Biden. Fox News is playing up the faceoff, which it’ll host, as “The Great Red Vs. Blue State Debate.” 

The Health 202 is a coproduction of The Washington Post and KFF Health News.

The debate promises to put America’s culture wars front-and-center. Abortion. Homelessness. Transgender health care. The coronavirus pandemic response. Health coverage for undocumented immigrants. Even drag shows, DEI and Disney’s First Amendment rights.

Though conservative TV host Sean Hannity is moderating the 90-minute showdown in Alpharetta, Ga., seemingly a home-field advantage for DeSantis, Newsom is relishing the confrontation after goading Florida’s governor into going head-to-head. 

Both men use each other’s states as punching bags. DeSantis portrays Newsom as too liberal for America, presiding over a failed state where homelessness and crime are rampant, citizens are forced to mask up and get vaccinated, and access to abortion and public assistance like Medicaid is too easy, breaking society morally and financially.

In a fundraising video for his presidential campaign, DeSantis called California “the petri dish for American leftism,” adding that “everything Biden is doing — they would accelerate and they would cause this country to collapse. That is not the future that we need. Florida shows a model for revival, a model based on freedom.”

Newsom has blasted DeSantis as a “small pathetic man” and argues that small-d democracy itself is at stake in the presidential election. His political operation paid for an ad on Florida’s airwaves this year in which Newsom told Sunshine State residents: “Freedom — it’s under attack in your state.”

He has knocked DeSantis’s education policies that restrict teaching gender and sexuality to schoolchildren as well as laws the Florida governor pushed through the legislature banning abortion after six weeks and limiting gender transition-related health care. 

“Your Republican leaders, they’re banning books, making it harder to vote, restricting speech in classrooms,” Newsom said in his ad. “Even criminalizing women and doctors. Join us in California, where we still believe in freedom.”

Newsom’s health and education policies are largely the opposite of DeSantis’s. He’s expanded access to gender-affirming care for children and adults, and is expanding Medicaid beginning Jan. 1 to cover lower-income undocumented immigrants. Backed by the Democratic-controlled state legislature, Newsom led an effort in 2022 to enshrine the right to abortion in the state constitution, and he’s fought to block local school districts from restricting access to certain books.

While DeSantis directs resources to the presidential campaign, where he’s struggling to maintain his second-place standing in the GOP primary behind front-runner Donald Trump, Newsom struck again this month with another Florida ad buy, this time centered on reproductive health and abortion access. 

The ad alleges that DeSantis has criminalized doctors and women seeking an abortion after six weeks and argues that they could be arrested “by order of Governor Ron DeSantis.”

Both men face a monumental test in their debate. Newsom must demonstrate his loyalty to Biden, the Democratic Party leader and the actual candidate next November, while scoring points against DeSantis.

DeSantis, a wooden public speaker who struggles to connect with his audiences, has faced some criticism in Republican circles for a lackluster campaign. He’s got to persuade GOP voters that he’s a formidable option to Trump, without any major gaffes. 

The proxy battle could shape not only next year’s presidential contest, but the 2028 field of White House contenders as well.

One other hot-button issue we’re watching for is homelessness, considering nearly one-third of all homeless Americans live in California. Expect DeSantis to hammer Newsom over Californians fleeing for cheaper living elsewhere — including to Florida. Newsom, meanwhile, will play up the unprecedented investment he’s spearheaded to combat the humanitarian crisis (without clear results as of yet).

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On the campaign trail to win another term in the White House, though, he also has knocked the use of those very vaccines. In October, for example, he unleashed a barrage of social media attacks on Ron DeSantis’ pandemic record by reposting claims that the Florida governor — who is running against him in the Republican presidential primaries — was too active in vaccinating Sunshine State residents.

In a further twist, Trump simultaneously circulated an MSNBC article suggesting DeSantis wasn’t vaccinating his constituents enough.

Trump’s tap dance — touting Operation Warp Speed’s success at developing vaccines while criticizing vaccine use — is emblematic of how pandemic politics are intensifying broader vaccine politics. Republican presidential candidates currently trailing the former president in polls are contorting their messaging to court the party’s vaccine-skeptical voters. No one embraces, without qualification, the utility of a public health measure that has saved millions of lives.

Like Trump, even the more establishment candidates can’t seem to avoid embracing the anti-vaccine leanings of the party’s base. Take Nikki Haley, who formerly served as governor of South Carolina and ambassador to the United Nations and has been rising in the polls. In the waning days of the Trump administration, she was pro-vaccine. But by the end of November 2021, in an interview with the Christian Broadcasting Network, she repeated dubious anti-vaccine claims: for instance, that the vaccine could undermine a woman’s fertility. (Studies consistently show no effect.)

The GOP has gained the allegiance of “a minority of people who feel very strongly about the safety of vaccines,” Robert Blendon, a Harvard professor of public health, told California Healthline. Presidential candidates are trying to use this sensibility as “a cultural issue” to signal distrust in scientists, other experts, and government authority in general, he said.

The resulting dynamic carries the risk of reaching beyond the current election cycle to affect public health policy in years to come, leading to lower rates among schoolchildren and seniors of vaccinations that protect them from measles, shingles, and HPV. Even as candidates try to weaponize this rhetoric, they’ve had little luck in changing the former president’s front-runner status.

A recent KFF survey of adults about their plans to get vaccinated against the flu, respiratory syncytial virus, known as RSV, and covid found that partisanship remains a key predictor of how people view vaccines. Confidence in the safety of the updated covid vaccines split sharply along party lines, with more than 8 in 10 Democrats saying they trust the new shots, compared with 1 in 3 Republicans.

But unease about covid or the vaccines is not Republican primary voters’ top issue — Blendon said concerns around the border, crime, and inflation are — and it’s not clear vaccine-focused attacks hurt Trump.

“I didn’t like his response to covid,” says an Iowa business owner featured in a critical ad from a well-funded political action committee that questioned Trump’s handling of the pandemic. “I thought he probably got led a little bit by the bureaucrats,” he says, hitting Trump on his bragging about the development of the vaccine and contrasting Trump unfavorably with certain governors the man in the ad thought performed better against covid. (Images of DeSantis, otherwise unnamed, flash by.)

The result? The ad “produced a backlash” and, when audience-tested with focus groups, improved the former president’s support, according to a memo summarizing the political action committee’s attempts to dent the front-runner.

Candidates nonetheless are trying to make hay, acknowledged Joe Grogan, who led the Domestic Policy Council during the Trump administration. But “I think people have a lot of other targets for ire about the pandemic.”

“Trump is not at the top of the list for Republican primary voters,” Grogan said. “He’s not on Page 2. Or 3, or 4. It begins with the media, the public health bureaucracy, or Big Tech companies.”

Voters have strong, yet divided and sometimes inconsistent, opinions. Some, like Joshua Sharff, 48, of Chesapeake, Virginia, are opposed to the covid vaccines and to candidates who support the shots as safe and effective. Sharff describes himself as a conservative voter who intends to support the Republican nominee for president. Though he’s vaccinated, he said, “If you’re a governor or a president and you tell me that I have to take a vaccine that has not been tried, that has not been tested, and ignores the science, that’s a problem for me. You’re taking away my freedoms as an American citizen.”

These positions have led Sharff away from Trump — and toward DeSantis, who has promoted anti-vaccine and anti-public health positions in his quest for the nomination.

Trump “pushed the vaccine very hard and recently came out, when he began to get pushback on it, that it was somebody else’s fault,” Sharff said. “That’s not true.”

Other Republican voters said the vaccine is not key to their vote.

“It will not sway my vote one way or another,” said Kimberly Hunt, 59, of Melville, Tennessee.

In chasing these voters, some candidates are distancing themselves from initial, pro-vaccine positions to embrace outspoken views against the shot. Vivek Ramaswamy, a biotech entrepreneur, started out as a vaccine cheerleader. But then he flipped, coming out against vaccine mandates and saying this summer that he regretted getting vaccinated. (His wife, a doctor, said she had no regrets.)

The most vocal of all is DeSantis.

Appearing on the right-leaning “PBD Podcast” on Oct. 30, DeSantis attacked Trump and “the corrupt medical swamp in D.C.” for overselling a vaccine that, despite the initial federal guidance, could not prevent infection or transmission of covid. The Centers for Disease Control and Prevention recommends the vaccine for anyone 6 months and older to protect against serious illness.

Though he initially encouraged people to get vaccinated in early 2021, DeSantis pivoted months later, banning vaccine passports for businesses and government entities, and later approving legislation prohibiting vaccine mandates in the state. That fall, he also appointed a new Florida surgeon general, physician Joseph Ladapo, whose guidance on covid vaccines contradicts CDC recommendations. DeSantis formed a Public Health Integrity Committee to assess, and generally dispute, federal health recommendations.

When the CDC released new vaccine guidance in September, Florida responded with its own advisory casting doubt on the safety of the boosters.

This anti-vaccine positioning hasn’t helped DeSantis. He has been losing support nationally and is generally polling third behind Haley and Trump in New Hampshire, a key early primary state. He headlined a “medical freedom” town hall in Manchester on Nov. 1 with Ladapo as a special guest.

Among the candidates remaining, DeSantis may be the most famous convert to the politics of anti-vaccination, but, with this subject, Haley has more experience.

In the 2021 CBN interview, she said “mandates are not what America does.” But the forceful declaration is merely the end of an ambivalent record, and, for critics, demonstrates her willingness to get in sync with the demands of the GOP base. As a state legislator, she supported 2007 legislation that included a mandate for HPV vaccines before voting against it; and later, as governor, she vetoed an effort to promote those vaccinations.

Bakari Sellers — now a commentator on CNN, but at the time a lawmaker who spearheaded that bill — told California Healthline, “That’s the biggest Nikki Haley issue that there is: She kind of has her finger in the air.”

The issue of vaccines may affect the general election: Even as Trump defends his vaccine record, it’s nevertheless clear he has support from the anti-vaccine crowd. An analysis by Politico, for example, found overlap among donors to independent presidential candidate Robert F. Kennedy Jr., who is staunchly opposed to vaccines, and Trump.

The willingness among politicians to assail what’s traditionally looked on as a foundational achievement of public health is likely to lead to turbulence for doctors themselves. Allison Ferris, a primary care physician and an associate professor at Florida Atlantic University, said people should be listening to their doctors and not to presidential candidates about whether to take the new covid vaccines. But that message is hard to deliver in the current climate.

“It is a tricky position to be in,” said Ferris, who co-authored recently released guidance advising doctors to counsel patients that frequent covid vaccination will likely become a necessity.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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

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Sin embargo, en la campaña electoral para conseguir otro mandato en la Casa Blanca, Trump ha criticado el uso de esas mismas vacunas.

En octubre, por ejemplo, desató una ola de ataques contra Ron DeSantis en las redes sociales al postear afirmaciones relacionadas con la estrategia del gobernador de Florida durante la pandemia. Trump acusó a DeSantis, quien compite contra él para representar al partido republicano en las elecciones presidenciales de 2024, de ser demasiado activo a favor de la vacunación en su estado. 

Y, en un giro inesperado, Trump hizo circular simultáneamente un artículo de MSNBC sugiriendo que DeSantis no estaba vacunando lo suficiente a los residentes de la Florida.

Los vaivenes de Trump, que promociona el éxito de la “Operación Warp Speed” en el desarrollo de vacunas y al mismo tiempo critica su uso, es emblemático de cómo la politización de la pandemia sigue influenciando el discurso alrededor de las vacunas.

Los otros aspirantes republicanos a la presidencia también usan el argumento de las vacunas para cortejar a los votantes, aunque hayan salvado millones de vidas.

Al igual que Trump, incluso los candidatos más conservadores no han podido eludir las tendencias antivacunas de la base del partido. Nikki Haley, ex gobernadora de Carolina del Sur y ex embajadora de Estados Unidos ante las Naciones Unidas, que ha estado subiendo en las encuestas, estaba a favor de las vacunas en los últimos días del gobierno de Trump.

Pero a fines de noviembre de 2021, en una entrevista con Christian Broadcasting Network, repitió falsas afirmaciones, por ejemplo que las vacunas podrían impactar en la fertilidad de las mujeres. (Estudios científicos no han demostrado ningún efecto).

El partido republicano se ha ganado la lealtad de “una minoría con opiniones fuertes acerca de la seguridad de las vacunas”, dijo a JFF Health News Robert Blendon, profesor de salud pública de la Universidad de Harvard. Los candidatos presidenciales están usando esta postura como “una cuestión cultural” para señalar la desconfianza en los científicos, otros expertos y la autoridad gubernamental en general, agregó.

La dinámica resultante podría impactar más allá del ciclo electoral, y afectar la política de salud pública en los próximos años. Esto derivaría en tasas de vacunación más bajas para enfermedades como el sarampión, el herpes zóster y el VPH entre los niños en edad escolar y las personas mayores.

Pero incluso cuando los candidatos intentan manipular este discurso, no han podido superar al ex presidente.

Según una encuesta reciente de KFF que preguntó a adultos si se iban a vacunar contra la gripe, el virus respiratorio sincitial (conocido como RSV) y covid, el partidismo siguió siendo un predictor clave de cómo la gente ve las vacunas.

La confianza en la seguridad de las vacunas actualizadas de covid se divide en líneas partidistas: más de 8 de cada 10 demócratas dicen que confían en las nuevas vacunas, en comparación con 1 de cada 3 republicanos.

Pero la inquietud por covid o las vacunas no es la principal preocupación de los votantes en las elecciones primarias presidenciales. Blendon dice que la situación en la frontera con México, el crimen y la inflación son temas más presentes, y no está claro que los ataques enfocados en las vacunas perjudiquen a Trump.

“No me gustó su respuesta al covid”, dice el propietario de un negocio de Iowa en un anuncio crítico publicado por un comité de acción política bien financiado que cuestionó el manejo de la pandemia por parte de Trump. “Pensé que seguramente se dejó guiar por los burócratas”, agrega el hombre, al tiempo que critica a Trump por hacer alarde del desarrollo de la vacuna y lo compara desfavorablemente con ciertos gobernadores que en su opinión se desempeñaron mejor contra el covid. (Aunque no se lo menciona por nombre, el anuncio invoca imágenes de DeSantis).

¿El resultado? El anuncio produjo “una respuesta negativa”, y en un sondeo con grupos de enfoque, aumentó el respaldo al ex presidente, según un memorando que resume los intentos del comité de acción política de frenar el avance de Trump.

Los votantes tienen opiniones fuertes pero divididas y a veces inconsistentes. Algunos, como Joshua Sharff, que tiene 48 años y vive en Chesapeake, Virginia, se oponen a las vacunas contra covid y a los candidatos que las califican como seguras y eficaces.

Sharff se describe a sí mismo como un votante conservador que va a apoyar al candidato republicano. Aunque está vacunado, dijo: “Si eres gobernador o presidente y me dices que tengo que ponerme una vacuna que no ha sido probada y que ignora la ciencia, eso es un problema para mí. Me estás quitando mis libertades como ciudadano estadounidense”.

Esto ha alejado a Sharff de Trump y lo ha acercado a DeSantis, que ha promovido posturas antivacunas y anti-salud pública en su campaña para la nominación. Trump “impulsó mucho la vacuna, y cuando empezó a recibir críticas por eso, dijo que fue culpa de otra persona”, dijo Sharff. “Eso no es cierto.”

Para otros votantes republicanos, la vacuna no es un factor clave. “No influirá en la dirección de mi voto”, dijo Kimberly Hunt, que tiene 59 años y vive en Melville, Tennessee.

Para tratar de atraer a estos votantes, algunos candidatos se están distanciando de sus posturas iniciales a favor de las vacunas y adoptan abiertamente la postura opuesta. Vivek Ramaswamy, un empresario de biotecnología, comenzó como un fuerte defensor de las vacunas. Pero luego dio un giro y se manifestó en contra de los mandatos de vacunación, diciendo este verano que se arrepentía de haberse vacunado. (Su esposa que es doctora dijo que no se arrepentía).

El más expresivo de todos es DeSantis.

En su aparición en el programa de derecha “PBD Podcast” el 30 de octubre, DeSantis atacó a Trump y “el pantano médico corrupto de Washington, DC” por promover excesivamente una vacuna que, a pesar de las pautas iniciales del gobierno federal, no previene la infección o la transmisión del covid. Los Centros para el Control y Prevención de Enfermedades (CDC) recomiendan la vacuna para todas las personas de 6 meses en adelante para protegerse contra síntomas graves.

Aunque al principio de 2021 alentó a la gente a vacunarse, DeSantis dio un giro meses después, aprobando una ley que prohibió los mandatos de vacunas en el estado. Ese otoño, también nombró a un nuevo cirujano general de Florida, el doctor Joseph Ladapo, cuyas recomendaciones con respecto a las vacunas contra covid contradicen las de los CDC. DeSantis estableció un Comité de Integridad de Salud Pública para evaluar y, en general, cuestionar las pautas de salud federales.

En septiembre, cuando los CDC publicaron recomendaciones actualizadas para las vacunas, Florida respondió con su propio aviso, arrojando dudas sobre la seguridad de los nuevos refuerzos contra covid.

Este posicionamiento antivacunas no ha ayudado a DeSantis. Ha perdido apoyo a nivel nacional y ocupa el tercer lugar en las encuestas, por debajo de Haley y Trump, en New Hampshire, un estado clave para las primarias. DeSantis encabezó una asamblea pública sobre “libertad médica” en Manchester el 1 de noviembre, con Ladapo como invitado especial.

Entre los candidatos restantes, DeSantis puede ser el converso más famoso a la política antivacunas, pero Haley tiene más experiencia en el tema.

En la entrevista con Christian Broadcasting Network en 2021, dijo que “los Estados Unidos no hacen mandatos de vacunas”. Pero esta contundente declaración llega después de una larga trayectoria de posturas ambivalentes y, para los críticos, demuestra su disposición a adaptarse a las demandas de la base republicana. Como legisladora estatal, Haley apoyó una ley de 2007 que incluía el mandato de vacunar contra el VPH pero después votó en contra. Luego, como gobernadora, vetó un esfuerzo para promover esa misma vacuna.

Bakari Sellers, un ex-legislador que encabezó ese proyecto de ley y que ahora es comentarista de CNN, dijo a KFF Health News: “Ese es el mayor problema de Nikki Haley, que siempre sigue la corriente”.

La cuestión de las vacunas podría afectar las elecciones generales: aunque Trump defiende su narrativa sobre las vacunas, está claro que cuenta con el apoyo de los antivaxx. Según un análisis de Politico, por ejemplo, Trump comparte donantes con el candidato presidencial independiente Robert F. Kennedy Jr., que se opone firmemente a las vacunas.

El hecho de que los políticos estén dispuestos a atacar algo que tradicionalmente se consideró un logro fundamental de la salud pública probablemente genere problemas para los profesionales médicos. Allison Ferris, doctora de atención primaria y profesora asociada de Florida Atlantic University, dijo que la gente debería escuchar a sus doctores y no a los candidatos presidenciales al momento de decidir si recibir las vacunas contra covid. Pero ese mensaje es difícil de transmitir en el clima político actual.

“Es una posición difícil”, dijo Ferris, coautora de una guía reciente para profesionales de salud sobre las nuevas vacunas. Ferris aconseja que los doctores le comuniquen a sus pacientes que la vacunación frecuente contra covid probablemente se convertirá en una necesidad.

Esta historia fue producida por KFF Health News, conocido antes como Kaiser Health News (KHN), una redacción nacional que produce periodismo en profundidad sobre temas de salud y es uno de los principales programas operativos de KFF, la fuente independiente de investigación de políticas de salud, encuestas y periodismo. 

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

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Gobernador Ron DeSantisEdad: 45Población de Florida: 22.2 million

California

Gobernador Gavin NewsomEdad: 56Población de California: 39 million

El candidato presidencial republicano Ron DeSantis y el gobernador demócrata Gavin Newsom —rivales políticos y representantes de la América roja y azul— se enfrentarán en un debate sin precedentes el 30 de noviembre en Georgia.

Newsom, un agitador liberal en su segundo mandato como gobernador de California, no se presenta a las elecciones presidenciales de 2024. Pero incitó a DeSantis, en su segundo mandato como gobernador de Florida, a un cara a cara. “Yo llevaré mi gomina. Tú trae tu laca”, bromeó en las redes sociales.

El enfrentamiento promete ser una acalorada pelea entre estrellas políticas en ascenso que lideran dos de los estados más poblados y diversos del país. Y será la primera vez que los políticos se vean las caras, a pesar de que en las últimas semanas han intercambiado insultos en videos para recaudar fondos y anuncios de campaña.

Los temas principales serán la falta de vivienda y la salud, prioridades de los votantes y cuestiones que han definido, en gran medida, las políticas y los estilos de liderazgo de los gobernadores. Desde el aborto hasta las vacunas contra covid-19, Newsom y DeSantis no podrían ser más opuestos.

A principios de este año, DeSantis criticó a California por ser demasiado generosa con los programas públicos como Medicaid, que el Estado Dorado ha ampliado a todos los residentes elegibles, independientemente de su estatus migratorio. Esa política de gran alcance entra en vigencia en enero y va mucho más allá de la expansión opcional de Medicaid que la Ley de Cuidado de Salud a Bajo Precio (ACA) ofreció a los estados. En Florida, uno de los 10 estados que se ha negado a ampliar Medicaid bajo ACA o Obamacare, DeSantis alardea de la tasa de residentes del estado sin seguro de salud, que es del 11%, como si fuera una medalla de honor.

“No vamos a ser como California y tener un número masivo de personas en programas gubernamentales sin requisitos de trabajo”, dijo DeSantis en un debate de primarias presidenciales en el sur de California a principios de este año.

DeSantis ha llevado a su estado a restringir el aborto y la atención médica de afirmación de género, y a prohibir las máscaras relacionadas con covid y los mandatos de vacunación.

Newsom, un hábil e impetuoso sustituto del presidente demócrata Joe Biden, ha arremetido contra DeSantis por poner a los floridanos en peligro y despojarlos de sus derechos.

“Únete a nosotros en California, donde todavía creemos en la libertad”, expresó Newsom en un anuncio político a principios de este año.

Newsom se ha ganado el apodo de “gobernador de la atención de salud” al catapultar este asunto a lo más alto de sus prioridades políticas. Ha hecho de California un santuario del aborto y está ampliando drásticamente las prestaciones de salud. Durante su primera campaña, prometió estabecer el sistema de salud de pagador único al estado más poblado del país, pero esa idea encontró una dura oposición política al principio de su mandato. Y ahora Newsom se jacta de haber conseguido que la tasa de personas sin seguro en el estado haya alcanzado un mínimo histórico del 6,5% al ampliar la cobertura de otras maneras.

Se espera que estas cuestiones sean el centro del debate de 90 minutos televisado a todo el país por Fox News. Un debate que podría tener importantes repercusiones en la contienda presidencial del próximo año, e incluso ayudar a conformar el grupo de aspirantes a la Casa Blanca en 2028.

Con miras al debate, KFF Health News analizó 10 de las principales posiciones de los gobernadores en materia de salud y cómo sus políticas han mejorado —o perjudicado— la salud de los residentes a los que representan.

Obamacare

Florida

DeSantis se ha negado a ampliar la elegibilidad de Medicaid a más personas bajo la Ley de Cuidado de Salud a Bajo Precio (ACA). Una de las consecuencias es que, hacia febrero, más de 3 millones de floridanos tenían cobertura a través del mercado de seguros federal del Obamacare, más que cualquier otro estado. Florida no cuenta con un mercado estatal, ni ofrece subsidios patrocinados por el estado.

California

El estado ha adoptado con entusiasmo la Ley de Cuidado de Salud a Bajo Precio (ACA), ampliando Medicaid y creando su propio mercado de seguros, Covered California. Con Newsom, se ha ido mucho más allá de las disposiciones del Obamacare y se ha creado un requisito estatal que obliga a los californianos a tener un seguro de salud, después de que se eliminara el mandato federal.

Aborto

Florida

DeSantis aprobó en abril una ley que prohíbe los abortos después de las seis semanas de embarazo. Sin embargo, la Corte Suprema de Florida ha tomado un recurso de apelación sobre la prohibición de las 15 semanas introducida en 2022, lo que determinará si la prohibición de las seis semanas puede entrar en vigencia.

California

Newsom encabezó en 2022 la iniciativa de enmendar la constitución estatal para consagrar el derecho al aborto y al control de la natalidad. También aprobó $60 millones para ayudar a pacientes sin seguro y a personas de fuera del estado a pagar abortos en California, y firmó leyes de atención a la salud reproductiva, incluida una que protege a los médicos que envían píldoras abortivas por correo a otros estados.

Atención transgénero

Florida

Bajo DeSantis, Florida aprobó este año una ley que prohíbe la atención médica de afirmación de género para menores trans y obliga a los pacientes adultos a firmar formularios de consentimiento informado antes de iniciar o continuar un tratamiento hormonal. La ley también limita la capacidad de los médicos para ordenar la terapia hormonal y prohíbe el uso de la telesalud para nuevas recetas. Está previsto que a mediados de diciembre se celebre un juicio por una demanda federal contra esta ley.

California

Newsom y otros líderes estatales han modificado la ley estatal para garantizar que todos los adultos y niños de California tengan derecho a servicios de atención médica de afirmación de género. Y las compañías de seguros que operan en California deben incluir información sobre los proveedores de la red de servicios de afirmación de género para 2025. Las agencias de salud estatales diseñan “normas de calidad aplicables” para garantizar que los pacientes trans tengan acceso a una atención integral.

Vivienda

Florida

DeSantis no ha declarado que la falta de vivienda sea una prioridad. En un video grabado en las calles de San Francisco, y publicado en redes sociales en junio, utilizó el tema como un arma de campaña para criticar lo que llamó “políticas de izquierda” en California. Florida experimenta con el uso de fondos de Medicaid para hacer frente a la falta de vivienda, pero el programa es limitado. Casi 26,000 personas carecen de hogar en Florida, es decir, 12 de cada 10,000 residentes.

California

Newsom ha destinado más de $20,000 millones a la crisis de los sin techo, y miles de millones más a servicios sociales y de salud. Por ejemplo, algunos californianos sin hogar pueden obtener servicios sociales a través del programa estatal de Medicaid, como dinero para depósitos de alquileres, pagos para servicios públicos, y para el primer y último mes de alquiler. Newsom también lideró una nueva iniciativa estatal que podría obligar a algunas personas sin hogar a someterse a tratamientos de salud mental o de adicciones. En California hay más de 171,000 personas sin hogar, es decir, 44 de cada 10,000 residentes.

Salud mental

Florida

DeSantis ha reiterado su promesa de abogar por programas de tratamiento de salud mental como gobernador, aunque Florida todavía ocupa el puesto 43 a nivel nacional en el acceso a la atención de salud mental y tiene la cuarta tasa más alta de adultos con enfermedades mentales sin seguro, según el Miami Center for Mental Health and Recovery. Con DeSantis, Florida ha aumentado la financiación estatal para programas de salud mental en las escuelas y servicios de salud mental entre pares para personal de primeros auxilios, y ha canalizado fondos para la prevención del suicidio.

California

Newsom firmó en 2020 una de las leyes de paridad en salud mental más estrictas del país, que obliga a las compañías de seguros a cubrir los trastornos mentales y las adicciones de la misma forma que lo harían con las afecciones físicas. Financia una iniciativa de $4,700 millones para proporcionar tratamiento de salud mental en las escuelas. Newsom también lidera en 2024 la campaña a favor de una medida de bonos estatales de $6,400 millones para renovar y ampliar los programas comunitarios de salud mental, incluidas miles de nuevas camas para tratamientos.

Addicciones

Florida

La tasa de muertes por sobredosis de drogas en Florida fue de 37,5 por cada 100,000 personas en 2021. En agosto, DeSantis anunció un nuevo programa estatal para recuperarse de las adicciones, calificado como “el primero de su tipo” en Estados Unidos, que utiliza consejeros pares, tratamiento asistido con medicamentos y una red coordinada de servicios de apoyo. DeSantis también autorizó a los condados de Florida a adoptar programas de intercambio de agujas en 2019 para reducir la propagación de enfermedades por transmisión sanguínea y fomentar el tratamiento de adicciones.

California

La tasa de muertes por sobredosis de drogas en California fue de 26,6 por cada 100, 000 habitantes en 2021. Newsom ha enviado a la Patrulla de Carreteras del estado y a la Guardia Nacional a San Francisco para combatir el comercio de fentanilo al aire libre e impulsa programas de recuperación de adicciones en todo el estado. Pero el año pasado vetó una ley que habría permitido a Los Angeles, San Francisco y Oakland establecer sitios seguros para inyectarse.

Medicamentos recetados

Florida

Una propuesta de DeSantis, presentada a la FDA en 2020, incluye permitir la importación de medicamentos de Canadá. Una nueva ley estatal también establece límites de precios para los administradores de beneficios farmacéuticos —intermediarios entre aseguradoras, farmacias y fabricantes— y crea nuevas normas para ellos en torno a la transparencia de precios. La ley también obliga a las farmacéuticas a revelar aumentos de precios significativos.

California

Newsom encabeza una iniciativa de $100 millones, la primera en el país, que sitúa a California en el negocio de la fabricación de medicamentos genéricos, empezando por la insulina y la naloxona, un fármaco para revertir el efecto de los opioides. California ya contaba con una ley de transparencia de precios cuando Newsom asumió el cargo. Este año, firmó una ley que endurece la normativa estatal para los administradores de beneficios farmacéuticos.

Cuidado de salud asequible

Florida

En 2019, DeSantis firmó la Ley de Ahorro del Paciente, que permite a las aseguradoras de salud compartir los ahorros de costos con los afiliados que compran servicios de atención médica, como imágenes y pruebas de diagnóstico. Bajo su liderazgo, los legisladores de Florida también han permitido planes de salud a corto plazo, que duran menos de un año, y acuerdos de atención médica directa entre un paciente y un proveedor de salud que no se consideran seguros, y no están sujetos al código de seguros de Florida.

California

Una de las primeras iniciativas de Newsom en materia de salud consistió en financiar subvenciones estatales al seguro médico para residentes ingresos bajos y medios que contraten un seguro a través de Covered California. También acordó este año reducir los copagos y eliminar algunos deducibles de los planes vendidos a través del mercado. La recién creada Office of Health Care Affordability de California limita los aumentos de costos del sector y podría regular la consolidación de la industria de la salud. California prohíbe los planes de salud a corto plazo.

Salud Pública

Florida

DeSantis firmó una ley en 2021 que prohíbe al gobierno, las escuelas y los empleadores privados exigir la vacunación contra covid. En 2023, presionó a los legisladores para que aprobaran leyes que prohibieran ciertos requisitos de vacunas y uso de máscaras. También estableció un Comité de Integridad de Salud Pública dirigido por su cirujano general elegido a dedo, Joseph Ladapo, cuya orientación oficial sobre las vacunas de covid contradice las recomendaciones de los CDC. La tasa de vacunación de refuerzo contra covid-19 en el Estado del Sol para los residentes de 5 años en adelante es del 12,4%.

California

Newsom fue el primer gobernador de Estados Unidos en emitir una orden para permanecer en casa en todo el estado al comienzo de la pandemia de covid-19. Impulsó fuertes mandatos de vacunación y máscaras, y acusó a DeSantis de ser débil en materia de salud pública. Newsom también ha firmado leyes que refuerzan los mandatos de vacunación infantil, incluida una severa medida contra las falsas exenciones médicas concedidas por los doctores. La tasa de vacunación de refuerzo contra covid-19 en el Estado Dorado para los residentes de 5 años en adelante es del 21,9%.

Atención de salud del inmigrante

Florida

Al tener DeSantis la inmigración como una prioridad, los legisladores aprobaron una ley estatal que obliga a todos los hospitales de Florida a preguntar en sus formularios de admisión si un paciente es ciudadano estadounidense o se encuentra legalmente en el país. Médicos, enfermeras y expertos en políticas de salud afirman que la ley afecta a personas marginadas, que ya tienen dificultades para desenvolverse en el sistema de salud, y que los disuadirá aún más de buscar atención médica.

California

A partir de enero, todos los inmigrantes que cumplan los requisitos de ingresos podrán acogerse al programa estatal de Medicaid. Antes que Newsom asumiera el cargo, California ya había ampliado la elegibilidad a los niños inmigrantes indocumentados hasta los 18 años. Newsom firmó luego leyes que ampliaron el programa a adultos jóvenes hasta los 26 años, a adultos mayores de 50 años y, más tarde, a los inmigrantes de cualquier edad que cumplieran con los requisitos de elegibilidad.

Esta historia fue producida por KFF Health News, conocido antes como Kaiser Health News (KHN), una redacción nacional que produce periodismo en profundidad sobre temas de salud y es uno de los principales programas operativos de KFF, la fuente independiente de investigación de políticas de salud, encuestas y periodismo. 

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

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Gov. Ron DeSantisAge: 45Florida population: 22.2 million

California

Gov. Gavin NewsomAge: 56California population: 39 million

Republican presidential candidate Ron DeSantis and Democratic Gov. Gavin Newsom — political rivals from opposite coasts and proxies for red and blue America — are set to square off for a first-of-its-kind debate Nov. 30 in Georgia.

Newsom, a liberal firebrand in his second term as governor of California, isn’t running for president in 2024. But he goaded DeSantis, in his second term as governor of Florida, to go mano a mano. “I’ll bring my hair gel. You bring your hairspray,” he taunted on social media.

The matchup promises to be a heated brawl between rising political stars who lead two of the nation’s most populous and diverse states. And it will mark the first time the politicians meet in person even as they have very publicly traded barbs and insults, in recent weeks attacking each other in fundraising videos and campaign ads.

Front and center will be homelessness and health care, top priorities for voters — and issues that have largely defined the governors’ policies and leadership styles. From abortion to covid-19 vaccines, Newsom and DeSantis could not be further apart.

Earlier this year, DeSantis blasted California for being too generous with public benefit programs, such as Medicaid, which the Golden State has expanded to all eligible residents regardless of immigration status. That sweeping policy takes effect in January and goes well beyond the optional expansion of Medicaid that the Affordable Care Act offered states. In Florida, one of 10 states that have refused to expand Medicaid under Obamacare, DeSantis wears the state’s 11% rate of uninsured residents as a badge of honor.

“We’re not going to be like California and have massive numbers of people on government programs without work requirements,” DeSantis said at a presidential primary debate in Southern California earlier this year.

DeSantis has led his state to restrict abortion and gender-affirming care and to ban covid-related mask and vaccine mandates.

Newsom, a slick and brash surrogate for Democratic President Joe Biden, has slammed DeSantis for putting Floridians in danger and stripping them of their rights.

“Join us in California, where we still believe in freedom,” Newsom said in a political ad earlier this year.

Newsom has earned the moniker of “health care governor” by catapulting the issue to the top of his policy priorities. He made California an abortion sanctuary and is dramatically expanding health care benefits. He had promised to bring single-payer health care to the nation’s most populous state while campaigning for his first term, but that idea hit stiff political opposition early in his tenure. And now Newsom boasts about bringing the state’s uninsured rate to an all-time low of 6.5% by expanding coverage in other ways.

These issues are expected to take center stage during the nationally televised 90-minute debate on Fox News, which could have major reverberations for the presidential contest next year and could even help shape the 2028 field of White House contenders.

In advance of the showdown, KFF Health News analyzed 10 of the governors’ top health care positions and how their policies have improved — or hindered — the health of the residents they represent.

Obamacare

Florida

DeSantis has refused to expand Medicaid eligibility to more people under the Affordable Care Act. Partly as a result, more than 3 million Floridians had coverage through the federal Obamacare exchange as of February, more than any other state. Florida does not have a state-based exchange or offer state-sponsored subsidies.

California

The state has enthusiastically embraced the Affordable Care Act, expanding Medicaid while setting up its own insurance exchange, Covered California. Under Newsom, it has also gone well beyond the provisions of Obamacare and created a state requirement for Californians to have health insurance after the federal mandate was eliminated.

Abortion

Florida

DeSantis approved legislation in April banning abortions after six weeks of pregnancy. However, the Florida Supreme Court has taken up a challenge to the 15-week ban introduced in 2022, which will determine if the six-week ban can take effect.

California

Newsom spearheaded the effort in 2022 to amend the state constitution to enshrine the right to abortion and birth control. He also approved $60 million to help uninsured patients and people from out of state pay for abortions in California, and signed reproductive health care laws, including one protecting doctors who mail abortion pills to other states.

Transgender Care

Florida

Under DeSantis, Florida passed a law this year banning gender-affirming health care for trans minors and mandating that adult patients sign informed consent forms before starting or continuing hormone treatment. The law also restricts who can order hormone therapy to physicians and prohibits the use of telehealth for new prescriptions. A federal lawsuit challenging the law is set to go to trial in mid-December.

California

Newsom and other state leaders have amended state law to ensure all California adults and children are entitled to gender-affirming health care services. And insurance companies doing business in California must include information on in-network providers for gender-affirming services by 2025. State health care agencies are designing “enforceable quality standards” to ensure trans patients have access to comprehensive care.

Homelessness

Florida

DeSantis has not declared homelessness a priority. In a video filmed on the streets of San Francisco and posted to social media in June, DeSantis used the topic as a campaign cudgel to criticize what he called “leftist policies” in California. Florida is experimenting with using Medicaid funds to address homelessness, but the program is limited. Nearly 26,000 people are homeless in Florida, or 12 of every 10,000 residents.

California

Newsom has plowed more than $20 billion into the homelessness crisis, with billions more for health and social services. For example, some homeless Californians can get social services through the state’s Medicaid program, such as money for rental security deposits, utility payments, and first and last month’s rent. Newsom also led a new state initiative that could force some homeless people into mental health or addiction treatment. More than 171,000 people are homeless in California, or 44 of every 10,000 residents.

Mental Health

Florida

DeSantis has kept his pledge to advocate for mental health treatment programs as governor, although Florida still ranks 43rd nationally in access to mental health care and has the fourth-highest rate of adults with mental illness who are uninsured, according to the Miami Center for Mental Health and Recovery. Under DeSantis, Florida has increased state funding for mental health programs in schools and peer-to-peer mental health services for first responders, and directed funding to suicide prevention.

California

Newsom in 2020 signed one of the nation’s strongest mental health parity laws, which requires insurance companies to cover mental health and substance use disorders just as they would physical health conditions. He is funding a $4.7 billion initiative to provide mental health treatment in schools. Newsom is also leading the campaign for a statewide, $6.4 billion bond measure in 2024 to revamp and expand community-based behavioral health programs, including thousands of new treatment beds.

Addiction

Florida

Florida’s drug overdose death rate was 37.5 per 100,000 people in 2021. In August, DeSantis announced a new statewide addiction recovery program billed as a “first of its kind” in the United States, using peer counselors, medication-assisted treatment, and a coordinated network of support services. DeSantis also authorized Florida counties to adopt needle exchange programs in 2019 to reduce the spread of blood-borne diseases and encourage addiction treatment.

California

California’s drug overdose rate was 26.6 per 100,000 people in 2021. Newsom is sending the state Highway Patrol and National Guard into San Francisco to combat the open-air fentanyl trade and is boosting addiction recovery programs statewide. But he vetoed legislation last year that would have allowed Los Angeles, San Francisco, and Oakland to establish safe injection sites.

Prescription Drugs

Florida

A DeSantis proposal submitted to the FDA in 2020 includes allowing imported medications from Canada. A new state law also sets price limits for pharmacy benefit managers — intermediaries between insurers, pharmacies, and manufacturers — and creates new rules for them around pricing transparency. The law also requires pharmaceutical companies to disclose significant price hikes.

California

Newsom is spearheading a $100 million, first-in-the-nation initiative that puts California in the generic drugmaking business, beginning with insulin and the opioid reversal drug naloxone. California already had a pricing transparency law when Newsom took office. This year, he signed a law that tightens state regulations for pharmacy benefit managers.

Health Care Affordability

Florida

In 2019, DeSantis signed the Patient Savings Act, which allows health insurers to share cost savings with enrollees who shop for health care services, such as imaging and diagnostic tests. Under his leadership, Florida lawmakers have also allowed short-term health plans lasting less than a year and direct health care agreements between a patient and a health care provider that are not considered insurance and are not subject to Florida’s insurance code.

California

One of Newsom’s first health care initiatives was to fund state-financed health insurance subsidies for low- and middle-income residents who purchase insurance through Covered California. Newsom this year also agreed to lower copays and get rid of some deductibles for plans sold through the exchange. California’s newly created Office of Health Care Affordability is capping industry cost increases and could potentially regulate health industry consolidation. California bans short-term health plans.

Public Health

Florida

DeSantis signed legislation in 2021 banning government, schools, and private employers from requiring covid vaccinations. In 2023, he pushed legislators to adopt laws prohibiting certain vaccine and mask requirements. He also formed a Public Health Integrity Committee led by his hand-picked surgeon general, Joseph Ladapo, whose official guidance on covid vaccines contradicts the CDC’s recommendations. The Sunshine State’s covid-19 vaccine booster rate for residents age 5 and older is 12.4%.

California

Newsom became the first U.S. governor to issue a statewide stay-at-home order at the start of the covid-19 pandemic. He pushed strong vaccination and mask mandates and accused DeSantis of being weak on public health. Newsom has also signed laws strengthening childhood vaccination mandates, including a measure that cracks down on bogus medical exemptions granted by doctors. The Golden State’s covid-19 vaccine booster rate for residents ages 5 and older is 21.9%.

Immigrant Health Care

Florida

With DeSantis making immigration a priority, legislators passed a state law requiring all Florida hospitals to ask on their admission forms whether a patient is a U.S. citizen or lawfully present in the country. Doctors, nurses, and health policy experts say the law targets marginalized people who already have difficulty navigating the health care system and will further deter them from seeking care.

California

Beginning in January, all immigrants who meet income qualifications will be eligible for the state’s Medicaid program. Before Newsom took office, California had already expanded eligibility to immigrant children through age 18 living in the state without authorization. Newsom then signed laws expanding the program to young adults up to age 26, adults 50 and older, and, later, immigrants of any age who otherwise meet eligibility requirements.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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Last week — as polling showed him running a distant second to Donald Trump for the Republican presidential nomination — DeSantis convened a virtual roundtable featuring a panel of covid vaccine skeptics. Their mission: to swat away the FDA’s findings that the new shots are safe and effective for those 6 months and older.

Instead, they advised those younger than 65 not to get vaccinated, suggesting without evidence that the shots could be harmful.

“I will not stand by and let the FDA and CDC use healthy Floridians as guinea pigs for new booster shots that have not been proven to be safe or effective,” said DeSantis, contradicting the FDA’s findings. “Once again, Florida is the first state in the nation to stand up and provide guidance based on truth, not Washington edicts.”

Backing up DeSantis was the handpicked keeper of his public health strategy: his state’s surgeon general, Joseph Ladapo.

“My judgment is that it’s not a good decision for young people and for people who are not at high risk at this point in the pandemic,” Ladapo said.

Ladapo has come under fire from public health experts since DeSantis tapped him for the role. He has been rebuked by federal health officials for promoting misinformation about covid and vaccines generally. And a report by the faculty of the University of Florida’s College of Medicine expressed “concern for research integrity violations” in a state health department study that suggested receiving an mRNA vaccine against covid increased the risk of death among young men.

Ladapo personally altered the study’s findings, Politico reported. And research has shown the risk of cardiac complications among young men is up to 5.6 times as high after covid infection as after covid vaccination.

With public health officials facing an uphill battle to persuade Americans to get one of the updated vaccines — just 17% received the 2022 booster — DeSantis’ tactic could further depress uptake by stoking doubts about the vaccines.

DeSantis is “playing with fire, and this is about life and death,” said Donna Shalala, who served as U.S. Health and Human Services secretary during the Clinton administration and later represented Florida in Congress.

“But I think people will see it for what it is: a desperate attempt at very high risk to people in Florida to reposition himself,” she said.

DeSantis trails Trump by more than 40 points, on average, in polls of GOP primary voters, a gap that has widened despite the governor’s recent efforts to reboot his campaign.

More than 90,000 people in Florida have died from covid-19.

And, while there have been a few serious side effects associated with covid vaccines, their incidence is rare and several studies have shown that vaccinated people are at no greater risk of death from non-covid causes than those who are unvaccinated. More than 600 million doses of covid vaccines have been administered in the U.S., according to Our World in Data.

That information was not mentioned in the discussion last week, when the panel — which notably included no vaccine or infectious disease experts — said without evidence that the shots might have “negative efficacy” or even cause increased infection from the virus.

DeSantis and Ladapo said they were troubled by the lack of human trials before the latest covid vaccines were authorized — though they did not address why they might be less concerned about the risks for those age 65 and older.

Annual flu vaccines also do not undergo clinical testing on humans. But Ladapo called it “sleight of hand” to compare the covid boosters to the flu vaccine, because it has been around for decades. “It is a completely different phenomenon,” he said.

The Florida Health Department did not respond to questions about whether it recommends the flu vaccine in light of its dearth of human testing.

Daniel Salmon, a vaccine expert at Johns Hopkins University who watched the roundtable, said he took issue with the claim that there wasn’t clinical data supporting the new vaccines’ safe use. Like the flu vaccine, the primary covid vaccines went through clinical trials, and there wouldn’t be time to conduct one every time a new strain emerges, he said.

The discussion was not a robust debate around scientific uncertainty among experts, Salmon said. He noted the panelists’ lack of expertise and training in vaccines and infectious disease, saying they instead leaned on their positions as physicians, academics, and the Florida surgeon general to give them credibility.

“They don’t know covid,” Salmon said. “They’re cherry-picking facts to defend their position. And they don’t have the expertise to make those decisions for a large number of people.”

“It felt to me like they were trying to sow doubt,” he said, “and that’s dangerous.”

KFF polling shows that most Americans encounter health misinformation, and many are uncertain about the veracity of claims about the covid vaccines.

DeSantis built his national reputation on bucking the medical establishment and ending 2020’s pandemic lockdown earlier in Florida than many other states did. He also has gained a following — and raised money — by criticizing the federal government under President Joe Biden and guidance from the nation’s former top infectious disease expert, Anthony Fauci, who left his post at the National Institutes of Health in December.

DeSantis’ handling of the covid response helped propel him to a massive reelection victory last year and to the front of the pack of 2024 Republican presidential contenders this spring.

David Richards, chair of the International Relations and Political Science Department at the University of Lynchburg in Virginia, said he is not surprised by DeSantis’ approach to the updated vaccines given his polling numbers, his reputation for pushing “medical freedom,” and his general vaccine policies.

“He needs to remain relevant and set himself apart from other candidates,” he said.

Last year, DeSantis opposed providing covid vaccines to young children after Florida came under fire for being the only state not to preorder doses ahead of the federal government’s approval of vaccination for children under 5.

This year, DeSantis urged Florida’s GOP-controlled legislature to approve pandemic-related legislation that runs counter to some public health recommendations, including measures to permanently ban school mask mandates and bar businesses from firing employees who don’t get vaccinated.

Matt Dallek, a political historian at George Washington University in Washington, D.C., said DeSantis’ messaging on the new covid vaccines shows his desire to distance himself from Trump — even though Trump’s 2018 endorsement led to his winning the Florida governor’s race.

“This is a way for him to exploit the issue, though it may come at the expense of lives of anyone who would listen to him in Florida and elsewhere,” he said.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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While Florida joins Kansas, Texas, Mississippi, and a handful of other states in proposing crackdowns on immigrants lacking legal residency, no other state has mandated that hospitals question patients about their citizenship.

Doctors, nurses, and health policy experts say the law targets marginalized people who already have difficulty navigating the health care system and will further deter them from seeking medical help.

Olveen Carrasquillo, a practicing physician and professor at the University of Miami’s Miller School of Medicine, said he’s dismayed that more health care professionals aren’t speaking out against the harm the law may cause.

“Imagine if all the hospitals said, ‘This is wrong. We can’t do it.’ But they just stay silent because they may lose state funding,” Carrasquillo said. “We do have political leaders who are very vindictive and who come after you.”

Touted by Republican Gov. Ron DeSantis as “the most ambitious anti-illegal immigration” legislation in the country, Florida’s law was enacted in July and requires, among other things, that hospitals ask on their admission forms whether a patient is a U.S. citizen and lawfully present in the country.

Hospitals are required to submit the information quarterly to the state’s Agency for Health Care Administration, which will then report total admissions, emergency room visits, and the cost of care for unauthorized residents to Florida lawmakers once a year.

Bailey Smith, communications director for the agency, said in an email the information will deliver “much needed transparency on the burden of illegal immigration on Florida’s health system. Collecting this data allows taxpayers to understand where their hard-earned dollars are being exploited.”

But immigrants in general, particularly those without legal residency, use very little health care, said Leighton Ku, a professor of health policy and management at George Washington University and an expert in immigrant health. Ku added that some studies suggest immigrants pay taxes and premiums that help subsidize the health care of other U.S. residents — countering the narrative that they deplete health care resources.

“Immigrants do help support the system,” he said.

Nearly 80 health care professionals signed a public letter in April opposing Florida’s legislation. Despite this strongly felt but muted opposition to the law, some public hospitals in immigrant-rich Miami-Dade and Broward counties in South Florida are downplaying the effect on patients or their institutions.

“This element of the new law will have almost no impact on Jackson Health System or its patients,” said Krysten Brenlla, a spokesperson for Miami-Dade’s network of four public hospitals.

Brenlla said the hospital asks patients to voluntarily disclose their country of birth and, for those born outside the United States, their immigration status.

Yanet Obarrio-Sanchez, a spokesperson for Memorial Healthcare System, which operates six public hospitals in Broward County, said that while staffers are asking patients about their immigration status at registration using digital forms, the hospital will “continue to care for all.”

But that’s not the message getting through to many immigrants, said Rosa Elera, a spokesperson for the Florida Immigrant Coalition, a nonprofit network of community organizations, farmworkers, and other immigrant advocacy groups.

“It’s creating fear,” she said. “It’s creating concern.”

Besides the requirements for hospitals, the law invalidates out-of-state driver’s licenses for immigrants who lack legal residency in Florida, establishes criminal penalties for transporting such immigrants into the state, and empowers state police to enforce immigration laws.

These sweeping measures have fomented distrust and fueled misinformation, said Elera.

In one instance, Elera said, a woman who went in for her regular checkup at a clinic was turned away because administrative staff members were confused about the new law. “And we’ve been getting questions from parents of U.S.-born children who are now afraid to take their children to pediatric offices,” she said.

Elera said that in the weeks leading up to the law’s effective date on July 1, the coalition launched a “Decline to Answer” campaign. There is no penalty for not answering, advocates say.

Florida’s immigration law follows an executive order DeSantis issued in 2021 compelling state agencies to determine the cost of health care for immigrants lacking legal status. The following year, the state’s Agency for Health Care Administration said that such immigrants had cost Florida hospitals nearly $313 million, with facilities receiving reimbursement for about one-third of the expense. In 2021, Florida hospitals with emergency rooms reported $21.7 billion in total patient care costs, according to state data.

Although the new requirement in Florida law applies only to hospitals that accept Medicaid, administrators at some free and low-cost community health centers fear they may be next. Recent Florida laws restricting abortion, prohibiting instruction of gender identity and sexual orientation in schools, and limiting gender-affirming care for youth all began with a smaller scope and later expanded, noted Laura Kallus, CEO of Caridad Center, a nonprofit clinic serving uninsured people in Palm Beach County.

Caridad Center does not ask patients about immigration status, Kallus said. But she worries the state could add conditions to a state grant the clinic receives to provide HIV testing and counseling.

“What if they said, ‘You don’t get this funding if you don’t take this information?’” she said.

Community health centers do not wield much influence in the state Capitol, Kallus added, and many count on the Florida Legislature to increase funding for free clinics to provide dental and behavioral health, which means they won’t want to risk upsetting lawmakers by criticizing the immigration law.

In his second term as governor, DeSantis has demonstrated a proclivity for punishing his perceived political opponents rather than negotiating with them.

The governor blocked state funding for a new training facility for Major League Baseball’s Tampa Bay Rays when the team posted a tweet calling for gun safety laws following mass shootings in Buffalo, New York, and Uvalde, Texas. He removed an elected state attorney from office, in part, because the Hillsborough County-based prosecutor signed public statements that said prosecutors should not criminalize abortion and gender-affirming care for transgender people. And DeSantis has sought to punish Disney for opposing a Florida law that prohibited discussion of sexual orientation in certain classrooms.

Kevin Cho Tipton, a critical care nurse practitioner who works at two public hospitals in South Florida, said the irony of hospitals’ muted opposition to the state’s immigration law is that the governor ratified another law this year that protects health care workers’ free speech.

The law was partly intended to shield physicians from disciplinary action if they advocate for alternative treatments for covid-19 or question the safety of covid vaccines, but it also protects speech about public policy, including postings on social media.

Tipton said he traveled to Tallahassee in April to urge Florida lawmakers to oppose the immigration bill, and he posted a video on Twitter of his testimony. He also conducted an informal survey of 120 co-workers at a public hospital in Broward County.

“Ninety-eight percent of nurses, doctors, pharmacists, surgeons — all across the spectrum — signed a survey on my phone that says, ‘We disagree with this, its intent, and it’s not what we should do,’” he said.

No one wanted to put their name out in public, though. So, Tipton posted a blurred screenshot of their signatures on Twitter to make a point.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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Aunque Florida se une a Kansas, Texas, Mississippi y otros estados que proponen medidas enérgicas contra los inmigrantes que carecen de residencia legal, ningún otro ha ordenado que los hospitales pregunten a los pacientes por su ciudadanía.

Médicos, enfermeras y expertos en política sanitaria afirman que la ley ataca a personas marginadas que ya tienen dificultades para desenvolverse en el sistema de salud y que les disuadirá aún más de buscar ayuda médica.

Olveen Carrasquillo, médico y profesor de la Facultad de Medicina Miller de la Universidad de Miami, dijo que le consterna que no haya más profesionales de salud que se pronuncien contra el daño que puede causar la ley.

“Imagina que todos los hospitales dijeran: ‘Esto está mal. No podemos hacerlo’. Pero se quedan callados porque pueden perder la financiación estatal”, explicó Carrasquillo. “Tenemos líderes políticos que son muy vengativos y que van a por ti”.

Promocionada por el gobernador republicano Ron DeSantis como “la legislación más ambiciosa contra la inmigración ilegal” del país, la ley de Florida fue promulgada en julio y exige, entre otras cosas, que los hospitales pregunten en sus formularios de admisión si un paciente es ciudadano estadounidense o si se encuentra legalmente en el país.

Los hospitales deben enviar la información trimestralmente a la Agencia Estatal de Administración Sanitaria, que a su vez informará una vez al año a los legisladores de Florida sobre el total de ingresos, visitas a emergencias y costo de la atención a residentes no autorizados.

Bailey Smith, director de comunicaciones de la agencia, dijo en un correo electrónico que la información proporcionará “una transparencia muy necesaria sobre la carga de la inmigración ilegal en el sistema sanitario de Florida. La recopilación de estos datos permite a los contribuyentes entender dónde se abusan sus dólares ganados con esfuerzo”.

Pero los inmigrantes en general, sobre todo los que carecen de residencia legal, recurren muy poco a la atención sanitaria, afirmó Leighton Ku, profesor de política y gestión sanitarias de la Universidad George Washington y experto en salud de los inmigrantes. Ku agregó que algunos estudios sugieren que los inmigrantes pagan impuestos y primas que ayudan a subvencionar la atención sanitaria de los residentes estadounidenses, lo que contrarresta la idea de que agotan los recursos sanitarios.

“Los inmigrantes ayudan a sostener el sistema”, afirmó.

Casi 80 profesionales de la salud firmaron una carta pública en abril oponiéndose a la legislación de Florida. A pesar de esta fuerte oposición a la ley, algunos hospitales públicos de los condados de Miami-Dade y Broward, en el sur de Florida, con significativa población inmigrante, restan importancia al efecto sobre los pacientes o sus instituciones.

“Este elemento de la nueva ley no tendrá prácticamente ningún impacto en el Jackson Health System ni en sus pacientes”, declaró Krysten Brenlla, vocera de la red de cuatro hospitales públicos de Miami-Dade.

Brenlla dijo que el hospital pide a los pacientes que revelen voluntariamente su país de nacimiento y, para los nacidos fuera de Estados Unidos, su estatus migratorio.

Yanet Obarrio-Sánchez, portavoz del Memorial Healthcare System, que gestiona seis hospitales públicos en el condado de Broward, señaló que aunque el personal pregunta a los pacientes sobre su situación migratoria en el momento del registro, mediante formularios digitales, el hospital “seguirá atendiendo a todos”.

Pero ese no es el mensaje que reciben muchos inmigrantes, dijo Rosa Elera, vocera de la Florida Immigration Coalition, una red sin fines de lucro de organizaciones comunitarias, trabajadores agrícolas y otros grupos de defensa de los inmigrantes.

“Se ha creado temor”, dijo Elera. “Hay preocupación”.

Además de los requisitos para los hospitales, la ley invalida las licencias de conducir de otros estados para los inmigrantes que no tienen residencia legal en Florida, establece sanciones penales por transportar a esos inmigrantes al estado y faculta a la policía estatal para hacer cumplir las leyes de inmigración.

Estas medidas radicales han fomentado la desconfianza y alimentado la desinformación, según  Elera.

En un caso, contó Elera, una mujer que acudió a su chequeo regular en una clínica fue rechazada porque el personal administrativo no tenía clara la nueva ley. “Y hemos recibido preguntas de padres de niños nacidos en Estados Unidos que ahora tienen miedo de llevar a sus hijos a las consultas pediátricas”, agregó.

Elera explicó que en las semanas previas a la entrada en vigencia de la ley, el 1 de julio, la coalición lanzó la campaña “Niégate a responder”. No hay penalización por no responder, dicen activistas.

La ley de inmigración de Florida sigue una orden ejecutiva que DeSantis emitió en 2021 obligando a las agencias estatales a determinar el costo de la atención médica para los inmigrantes sin estatus legal.

Al año siguiente, la Agencia para la Administración del Cuidado de Salud del estado informó que estos inmigrantes habían costado a los hospitales de Florida casi $313 millones, con centros que recibieron reembolsos por alrededor de un tercio del gasto. En 2021, los hospitales de Florida con salas de emergencias declararon $21,700 millones en costos totales de atención al paciente, según datos estatales.

Aunque el nuevo requisito de la ley de Florida se aplica sólo a los hospitales que aceptan Medicaid, los administradores de algunos centros de salud comunitarios gratuitos y de bajo costo temen que puedan ser los siguientes.

Las recientes leyes de Florida que restringen el aborto, prohíben la enseñanza de la identidad de género y la orientación sexual en las escuelas, y limitan la atención a los jóvenes en procesos de afirmación de género empezaron con un alcance menor y luego se ampliaron, señaló Laura Kallus, CEO de Caridad Center, una clínica sin fines de lucro que atiende a personas sin seguro en el condado de Palm Beach.

Caridad Center no pregunta a los pacientes sobre su estatus migratorio, afirmó Kallus. Pero le preocupa que el estado pueda añadir condiciones a una subvención estatal que la clínica recibe para proporcionar pruebas de VIH y consejería.

“¿Qué pasaría si dijeran: ‘No obtendrán esta financiación si no recogen esta información’?”, se preguntó.

Los centros de salud comunitarios no ejercen mucha influencia en el Capitolio estatal, afirmó Kallus, y muchos cuentan con que la Legislatura de Florida aumente los fondos para que las clínicas gratuitas ofrezcan servicios de salud dental y conductual, lo que significa que no querrán arriesgarse a “molestar” a los legisladores criticando la ley de inmigración.

En su segundo mandato como gobernador, DeSantis ha demostrado una propensión a castigar a sus opositores políticos en lugar de negociar con ellos.

El gobernador bloqueó la financiación estatal de un nuevo centro de entrenamiento para los Tampa Bay Rays de las Grandes Ligas de Béisbol cuando el equipo publicó un tuit en el que pedía leyes de seguridad de armas luego de los tiroteos masivos de Buffalo (Nueva York) y Uvalde (Texas). Destituyó a un fiscal estatal electo, en parte, porque el fiscal con sede en el condado de Hillsborough firmó declaraciones públicas que decían que los fiscales no deberían penalizar el aborto y la atención de afirmación de género para personas transgénero. Y DeSantis ha tratado de castigar a Disney por oponerse a una ley de Florida que prohibía la discusión de la orientación sexual en las aulas.

Kevin Cho Tipton, enfermero de cuidados intensivos que trabaja en dos hospitales públicos en el sur de Florida, dijo que la ironía de la oposición silenciada de los hospitales a la ley de inmigración del estado es que el gobernador ratificó otra ley este año que protege la libertad de expresión de los trabajadores de salud.

La ley pretendía en parte proteger a los médicos de medidas disciplinarias si abogan por tratamientos alternativos para covid-19 o cuestionan la seguridad de las vacunas contra covid, pero también protege la expresión sobre política pública, incluidas las publicaciones en las redes sociales.

Tipton dijo que viajó a Tallahassee en abril para instar a los legisladores de Florida a oponerse al proyecto de ley de inmigración, y publicó un video en Twitter de su testimonio. También realizó una encuesta informal entre 120 compañeros de trabajo de un hospital público del condado de Broward.

“El 98% de las enfermeras, médicos, farmacéuticos, cirujanos —de todo el espectro— firmaron una encuesta en mi teléfono que decía: ‘No estamos de acuerdo con esto, con su intención, y no es lo que deberíamos hacer'”, explicó.

Sin embargo, nadie quiso hacer público su nombre. Por eso, Tipton publicó en Twitter una captura de pantalla borrosa de sus firmas.

Esta historia fue producida por KFF Health News, conocido antes como Kaiser Health News (KHN), una redacción nacional que produce periodismo en profundidad sobre temas de salud y es uno de los principales programas operativos de KFF, la fuente independiente de investigación de políticas de salud, encuestas y periodismo. 

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

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They are part of a new migration of Americans who are uprooting their lives in response to a raft of legislation across the country restricting health care for transgender people.

Missouri, Florida, and Texas are among at least 20 states that have limited components of gender-affirming health care for trans youth. Those three states are also among the states that prevent Medicaid — the public health insurance for people with low incomes — from paying for key aspects of such care for patients of all ages.

More than a quarter of trans adults surveyed by KFF and The Washington Post late last year said they had moved to a different neighborhood, city, or state to find more acceptance. Now, new restrictions on health care and the possibility of more in the future provide additional motivation.

Many are heading to places that are passing laws to support care for trans people, making those states appealing sanctuaries. California, for example, passed a law last fall to protect those receiving or providing gender-affirming care from prosecution. And now, California providers are getting more calls from people seeking to relocate there to prevent disruptions to their care, said Scott Nass, a family physician and expert on transgender care based in the state.

But the influx of patients presents a challenge, Nass said, “because the system that exists, it can’t handle all the refugees that potentially are out there.”

In Florida, the legislative targeting of trans people and their health care has persuaded Arlo Dennis, 35, that it is time to uproot their family of five from the Orlando area, where they’ve lived for more than a decade. They plan to move to Maryland.

Dennis, who uses they/them pronouns, no longer has access to hormone replacement therapy after Florida’s Medicaid program stopped covering transition-related care in late August under the claim that the treatments are experimental and lack evidence of being effective. Dennis said they ran out of their medication in January.

“It’s definitely led to my mental health having struggles and my physical health having struggles,” Dennis said.

Moving to Maryland will take resources Dennis said their family does not have. They launched a GoFundMe campaign in April and have raised more than $5,600, most of it from strangers, Dennis said. Now the family, which includes three adults and two children, plans to leave Florida in July. The decision wasn’t easy, Dennis said, but they felt like they had no choice.

“I’m OK if my neighbor doesn’t agree with how I’m living my life,” Dennis said. “But this was literally outlawing my existence and making my access to health care impossible.”

Mitch and Tiffany Tillison decided they needed to leave Texas after the state’s Republicans made anti-trans policies for youth central to their legislative agenda. Their 12-year-old came out as trans about two years ago. They asked for only her middle name, Rebecca, to be published because they fear for her safety due to threats of violence against trans people.

This year, the Texas Legislature passed a law limiting gender-affirming health care for youth under 18. It specifically bans physical care, but local LGBTQ+ advocates say recent crackdowns also have had a chilling effect on the availability of mental health therapy for trans people.

While the Tillisons declined to specify what treatment, if any, their daughter is getting, they said they reserve the right, as her parents, to provide the care their daughter needs — and that Texas has taken away that right. That, plus increasing threats of violence in their community, particularly in the wake of the May 6 mass shooting by a professed neo-Nazi at Allen Premium Outlets, about 20 miles from their home in the Dallas suburbs, caused the family to decide to move to Washington state.

“I’ve kept her safe,” said Tiffany Tillison, adding that she often thinks back to the moment her daughter came out to her during a long, late drive home from a daylong soccer tournament. “It’s my job to continue to keep her safe. My love is unending, unconditional.”

For her part, Rebecca is pragmatic about the move planned for July: “It’s sad, but it is what we have to do,” she said.

A close call on losing key medical care in Missouri also pushed some trans people to rethink living there. In April, Missouri Attorney General Andrew Bailey issued an emergency rule seeking to limit access to transition-related surgery and cross-sex hormones for all ages, and restrict puberty-blocking drugs, which pause puberty but don’t alter gender characteristics. The next day, Dempsey, 24, who uses they/them pronouns, launched a GoFundMe fundraiser for themself and their two partners to leave Springfield, Missouri.

“We are three trans individuals who all depend on the Hormone Replacement Therapy and gender affirming care that is soon to be prohibitively limited,” Dempsey wrote in the fundraising appeal, adding they wanted to “escape Missouri when our lease is up at the end of May.”

Dempsey said they also got a prescription for a three-month supply of hormone therapy from their doctor in Springfield to tide them over until the move.

Bailey withdrew his rule after the state legislature in May restricted new access to such treatments for minors, but not adults like Dempsey and their partners. Still, Dempsey said their futures in Missouri didn’t look promising.

Neighboring Illinois was an obvious place to move; the legislature there passed a law in January that requires state-regulated insurance plans to cover gender-affirming health care at no extra cost. Where exactly was a bigger question. Chicago and its suburbs seemed too expensive. The partners wanted a progressive community similar in size and cost of living to the city they were leaving. They were looking for a Springfield in Illinois.

“But not Springfield, Illinois,” Dempsey quipped.

Gwendolyn Schwarz, 23, had also hoped to stay in Springfield, Missouri, her hometown, where she had recently graduated from Missouri State University with a degree in film and media studies. She had planned to continue her education in a graduate program at the university and, within the next year, get transition-related surgery, which can take a few months of recovery.

But her plans changed as Bailey’s rule stirred fear and confusion.

“I don’t want to be stuck and temporarily disabled in a state that doesn’t see my humanity,” Schwarz said.

She and a group of friends are planning to move west to Nevada, where state lawmakers have approved a measure that requires Medicaid to cover gender-affirming treatment for trans patients.

Schwarz said she hopes moving from Missouri to Nevada’s capital, Carson City, will allow her to continue living her life without fear and eventually get the surgery she wants.

Dempsey and their partners settled on Moline, Illinois, as the place to move. All three had to quit their jobs to relocate, but they have raised $3,000 on GoFundMe, more than enough to put a deposit down on an apartment.

On May 31, the partners packed the belongings they hadn’t sold and made the 400-mile drive to their new home.

Since then, Dempsey has already been able to see a medical provider at a clinic in Moline that caters to the LGBTQ+ community — and has gotten a new prescription for hormone therapy.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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

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