Medicare Advantage was established as part of the Balanced Budget Act of 1997 passed by the 105th United States Congress and signed into law by then President Clinton.  It was originally named Medicare+Choice, and was renamed Medicare Advantage in 2003.  There are approximately 1,000 Medicare Advantage plans which enrolled 3.7 million people in 2025; about half of all Medicare recipients:

https://rollcall.com/2026/04/02/senate-democrats-call-on-cms-to-rein-in-medicare-advantage-abuses/

Senate Democrats call on CMS to rein in Medicare Advantage abuses
Senators urge CMS to shore up the program, rather than enroll more individuals in it
By Ariel Cohen - April 2, 2026

A group of Democratic senators led by Elizabeth Warren is pushing the Centers for Medicare and Medicaid Services to rein in abuses from Medicare Advantage insurers as the Trump administration considers a policy that would enroll more seniors in the program.

The senators allege that Medicare Advantage is rife with waste, fraud and abuse, and CMS should focus on shoring up the program, rather than enrolling more individuals in it. They argue CMS should do so by adopting the congressional Medicare advisers’ recommendations to rein in the program.

“CMS must do more to preserve the Medicare program’s mission of providing older adults and people with disabilities with affordable, high-quality health care,” the senators wrote in a Wednesday letter to CMS Administrator Mehmet Oz, referring to the 2027 proposed payment rate for Medicare Advantage plans.

Lawmakers signing the letter in addition to Warren, D-Mass., include Cory Booker, D-N.J., Richard Blumenthal, D-Conn., Richard J. Durbin, D-Ill., Edward J. Markey, D-Mass., Jeff Merkley, D-Ore., Bernie Sanders, I-Vt., and Tina Smith, D-Minn.

The Medicare Payment Advisory Commission, often referred to as MedPAC, offered recommendations that included excluding diagnoses from all chart reviews and health risk assessments from risk scores and addressing the favorable selection of healthier patients that leads to overpayments.

The Democrats also say that CMS should protect patients from Medicare Advantage prior-authorization denials, strengthen network adequacy requirements and examine whether plans are evading medical-loss ratio requirements by buying up providers.

They say that changes are essential in light of the Trump administration’s floated policy to enroll more Americans in Medicare Advantage. Last month, Stat reported that Medicare Director Chris Klomp said that CMS is considering models that would automatically enroll beneficiaries into Medicare Advantage, and individuals could opt into a different service arrangement.

“Aside from the numerous financial problems and patient care concerns such a proposal raises, it also very likely violates the requirements for any Centers for Medicare and Medicaid Services Innovation Center models to reduce taxpayer spending,” the Democrats wrote of Klomp’s proposal.

Shifting all seniors to Medicare Advantage as a default option was first proposed in The Heritage Foundation’s Project 2025 as part of a larger effort to encourage more competition between Medicare Advantage and private plans.

But Republicans on Capitol Hill also support some changes to the program. Senate Health, Education, Labor and Pensions Chair Bill Cassidy, R-La., last year introduced legislation aimed at reducing overpayments on care in the program.

Medicare Advantage enrollees face more delays when seeking care compared to seniors on traditional Medicare because of more prior-authorization requirements and restricted physician networks. The average enrollee has access to “just under half of all physicians available to traditional Medicare beneficiaries in their area,” according to KFF, and Medicare Advantage insurers denied around 4.1 million prior-authorization requests in 2024.

Medicare Advantage insurers received nearly 53 million prior-authorization requests in 2025. By contrast, traditional Medicare beneficiaries submitted just 625,000 prior-authorization requests that year, according to KFF.

The lawmakers say CMS should take more steps to strengthen network adequacy requirements and penalize insurers who are out of compliance, as well as protect Medicare Advantage enrollees from inappropriate delays to care.

MedPAC estimates that overpayments to Medicare Advantage could reach $76 billion in 2026 and $1.3 trillion over the next decade, all while seniors enrolled in the program receive worse care compared to traditional Medicare. The Democrats say that by overlooking the fact that Medicare Advantage enrollees are typically healthier than the average Medicare enrollee, the federal government systematically overpredicts the program’s spending, leading to overpayment.

Medicare Advantage insurers are increasingly owned by large health care conglomerates that also own medical providers, and critics say that when the same entity both pays for and provides care, it creates anti-competitive behavior.

In their letter, the Democrats also allege that many Medicare Advantage insurers might be using profit-shifting strategies to evade the caps on what percentage of patients’ premium dollars they can spend on profits and administrative costs.

They want CMS to crack down on these profit-shifting practices by collecting better ownership data of plans and providers, as well as establishing benchmarks for common health care services.

“As Americans struggle to keep up with rising health care costs, insurers continue to rake in billions in overpayments, abusing taxpayer dollars, while inappropriately obstructing enrollees from accessing medical care,” they wrote. “We urge CMS to turn its focus to the legitimate fraud, waste, and abuse in and address the program’s longstanding problems that prevent seniors and people with disabilities from receiving medically necessary care.”

https://hoodline.com/2026/04/msu-shakes-up-med-schools-in-big-bet-on-detroit-grand-rapids/

MSU Shakes Up Med Schools in Big Bet on Detroit, Grand Rapids
By Marcus Taylor - April 3, 2026

Michigan State University is pulling its two medical schools under one leadership roof and doubling down on Grand Rapids and Detroit as its main research and clinical hubs. The overhaul is meant to better align the MD and DO degree tracks, centralize administration, and widen access to clinical rotations and translational research sites across Michigan. University leaders say the shift is about becoming a stronger partner to large health systems and a tougher contender for grants and private investment.

As reported by Crain's Detroit Business, the change folds the College of Human Medicine and the College of Osteopathic Medicine into a more coordinated structure that highlights MSU's footprint in the state's two biggest cities. Crain's describes the move as both an administrative consolidation and a strategic wager on Detroit and Grand Rapids as growth engines, with centralized back-office work paired with an expansion of clinical sites and research partnerships.

MSU is branding the shift under its "One Team, One Health" strategy, which explores a "One College of Medicine, Two degree pathways" model that keeps MD and DO identities intact while syncing curriculum oversight, research priorities, and institutional strategy, according to MSU. The planning materials outline task forces on accreditation, college structure, and research that will recommend a path forward, and MSU says town halls and community conversations will continue as the work moves along.

Anchors in Grand Rapids and Detroit

On the west side, Grand Rapids remains the key anchor. The College of Human Medicine is based at the Secchia Center on the Medical Mile, which MSU touts as a hub for preclinical education, simulation, and growing research activity, according to MSU College of Human Medicine. In Detroit, MSU's clinical integration has been speeding up through a multi-year partnership with Henry Ford Health that features shared services, an electronic health record migration, and plans for a Detroit research center, according to a Henry Ford Health press release. Together, the two hubs give MSU a stronger foothold in both of Michigan's largest health care markets.

Why Students, Hospital Partners and Patients Should Care

University officials say the unified approach could open up more clinical rotation slots for students and smooth out recruitment pipelines for hospitals, a core part of MSU's broader strategic pitch highlighted by MSUToday. Hospital systems could see tighter clinical networks and shared hiring pipelines, while researchers are eyeing a combined college as a way to boost MSU's odds for federal grants and philanthropic funding. At the same time, hospital leaders, faculty, and students are waiting to see how governance, budgets, and the split of clinical revenue and overhead are sorted out.

Accreditation and governance are still unresolved. The university has created an accreditation task force and promised more analysis before landing on a final structure, according to MSU. Any change to how the MD and DO programs are run will need careful review from accrediting bodies and campus stakeholders, and MSU has signaled there will be more community conversations in the months ahead.

For now, MSU is stressing that both degree pathways will remain in place and that the goal is to amplify its statewide presence, not close campuses. The finer points, including timelines, projected savings, and what all of this means for day-to-day clinical placements, are expected to surface as task forces report back and more town halls take place.

https://www.justice.gov/usao-cdca/pr/8-arrested-health-care-fraud-takedown-including-owners-hospices-billed-taxpayers

8 Arrested in Health Care Fraud Takedown, Including Owners of Hospices that Billed Taxpayers Millions of Dollars to Serve the ‘Dying’
Thursday, April 2, 2026; Updated April 3, 2026
For Immediate Release
U.S. Attorney's Office, Central District of California Press Release

More Than $50 Million in Intended Health Care Fraud Losses Charged

LOS ANGELES – In coordination with the Vice President’s Task Force to Eliminate Fraud, eight defendants, including three nurses, a chiropractor, and a purported psychologist, have been arrested on federal charges that they schemed to defraud the nation’s health care system out of more than $50 million – including by running sham hospice care facilities that bilked Medicare by using people without terminal illnesses as beneficiaries, the Justice Department announced today.

Six of the defendants arrested today are expected to make their initial appearances this afternoon in United States District Court in downtown Los Angeles. One defendant is expected to make his initial appearance in U.S. District Court in Idaho.

“We are enforcing a zero-tolerance policy for criminals who defraud American taxpayers,” said First Assistant United States Attorney Bill Essayli. “The defendants arrested this morning who are charged with stealing millions of dollars of health care benefits got caught and now face years in federal prison.”

“The Southern California region is a high-risk environment for hospice-related and many other forms of health care fraud,” said Akil Davis, the Assistant Director in Charge of the FBI’s Los Angeles Field Office. “The United States loses hundreds of billions of dollars annually to healthcare fraud at the expense of all American taxpayers, whose benefits decrease as premiums, co-payments and taxes grow. Our aim is to reverse that trend with ‘Operation Never Say Die’ and others like it.”

“The defendants charged today allegedly turned hospice care into a cash producing operation, resulting in more than $50 million in losses to taxpayers. The magnitude of the losses underscores a deliberate abuse of the authority and trust afforded to health care providers,” said Inspector General T. March Bell of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “Today’s takedown reflects HHS-OIG’s commitment to deploy every tool at our disposal, and collaborate with our law enforcement partners, to dismantle hospice operations built on deception. Anyone who seeks to weaponize hospice care to bilk Medicare should expect to be held accountable.”

“Today’s arrests are another decisive strike in our war on fraud,” said U.S. Department of Labor Inspector General Anthony P. D’Esposito. “My office is relentlessly pursuing those who target union benefit plans and exploit employee healthcare programs for personal gain. Working side-by-side with the FBI, the Department of Labor’s Employee Benefits Security Administration, and our law-enforcement partners, we are aggressively dismantling fraud schemes and taking down those who exploit American workers. Let this be a warning: If you steal from workers or taxpayers, your time is up. We will find you, investigate you, and hold you accountable.”

“When employee benefit plans become targets for fraud, it’s not just the plans that are hurt – everyday working Americans who earned those benefits honestly, their families, and the communities they live in are hurt,” said Robert Prunty, Acting Regional Director U.S. Department of Labor Employee Benefits Security Administration’s Los Angeles Regional Office. “In the Trump Administration, we will relentlessly seek out fraud and ensure those responsible are brought to justice.”

“Health care fraud undermines federal programs, threatens public trust, diverts resources away from legitimate patient care, and is a calculated attack on programs meant to protect the vulnerable,” said Tyler Hatcher, Special Agent in Charge, IRS‑CI Los Angeles Field Office. “The enforcement actions taken today demonstrate IRS‑CI’s commitment to uncovering the financial lies behind these schemes and holding accountable those who profit at the expense of taxpayers and patients. Our agents will continue to work alongside our law‑enforcement partners to protect the integrity of our healthcare system and ensure that those who abuse it are brought to justice.”

MEDICARE HOSPICE CARE FRAUD

USA v. Minerd

Lolita Beronilla Minerd, 65, a.k.a. “Lolita Beronilla Rice,” of Anaheim, a licensed vocational nurse, was arrested today on a federal criminal complaint charging her with health care fraud.

According to court documents, Minerd owned and operated the Artesia-based Topanga Hospice Care Inc. From July 2020 to April 2025, Minerd used this company to submit more than $9,174,117 in fraudulent hospice claims to Medicare, which paid more than $8,510,448 on these claims.

Through Topanga, Minerd billed Medicare for hospice services for beneficiaries who were not terminally ill. Numerous beneficiaries had common addresses and lived far from the facility, which is consistent with being recruited by marketers. The investigation further revealed that Minerd paid kickbacks to beneficiaries and marketers for the referral of purported hospice patients to her company.

One beneficiary couple was approached at a market about signing up and then were visited at home by Minerd and three other Topanga employees, who promised them if they signed up everything would be free, and they each would receive $300 per month. The money was delivered in an envelope in cash: $600 per month for six months. Neither beneficiary stated they had a terminal illness, which their physician confirmed. The couple also reported receiving unneeded items such as nutritional shakes, non-prescription vitamins, and wheelchairs.

Topanga had a non-death discharge rate of approximately 85%, nearly five times the national average of 17.2% from 2021.

The FBI is investigating this matter along with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).

Assistant United States Attorney Alexandra M. Michael of the Major Frauds Section is prosecuting this case.

USA v. Gill, et al.

Gladwin Gill, a 66-year-old purported psychologist, and his wife, Amelou Gill, a 70-year-old registered nurse, both of Covina, were arrested today on a federal criminal complaint charging them with health care fraud.

According to an affidavit filed with the complaint, the Gills owned and operated the Glendale-based 626 Hospice Inc., which did business as St. Francis Palliative Care.

The Gills allegedly schemed to defraud Medicare by paying illegal kickbacks for the referral of patients who were not dying. The Gills also submitted more than $5.2 million in fraudulent claims to Medicare for hospice services that either were not medically necessary or were not provided. Medicare paid the Gills more than $4 million on these fraudulent claims.

They then laundered the scheme’s proceeds and spent their ill-gotten gains on personal expenses such as mortgage payments, car payments, international flights, restaurants, and personal bills.

The Gills are expected to make their initial appearance this afternoon in U.S. District Court in downtown Los Angeles.

HHS-OIG, the FBI, IRS Criminal Investigation, and the Food and Drug Administration are investigating this matter with assistance from United States Trustee, Region 16, Los Angeles Field Office.

Assistant United States Attorney David Y. Pi of the Major Frauds Section is prosecuting this case.

USA v. Palma, et al.

Nita Almuete Paddit Palma, 76, a thrice-convicted health care fraudster now incarcerated at a federal prison in Seattle, and her husband, Adolfo Cezar Catbagan, 68, of Glendale, are charged in an 11-count indictment with operating at least three fraudulent hospice care facilities – including while Palma was free on bond awaiting a hospice fraud trial. Law enforcement arrested Catbagan this morning.

Palma, who is a lawful permanent resident from the Philippines, and Catbagan are charged in an indictment with one count of conspiracy to commit wire fraud and health care fraud and 10 counts of health care fraud.

According to the indictment, from June 2022 to April 2024, Palma and Catbagan opened three Glendale-based hospice care facilities despite Palma being legally barred from doing so: One Up Hospice Care Inc., Rosewood Hospice and Palliative Care Inc., and Advance Hospice and Palliative Care Inc.

Catbagan was named as the nominal owner and CEO of the three hospices when Palma in fact owned and exercised operating control of them – despite her exclusion – so Medicare would not deny the companies’ claims. The defendants submitted false claims to Medicare for beneficiaries who were not terminally ill and the physicians supposedly providing hospice services did not treat the patients.

Palma and Catbagan submitted at least $4.8 million in fraudulent claims through these companies, resulting in Medicare payments of at least $4.2 million.

HHS-OIG and the FBI are investigating this matter.

Assistant United States Attorneys Andrew M. Roach and Roger A. Hsieh of the Major Frauds Section are prosecuting this case. Assistant United States Attorney Alexander Su of the Asset Forfeiture and Recovery Section is handling asset forfeiture matters for this case.

USA v. Tindimobuna

Evelyn Tindimobuna, 51, a licensed vocational nurse from Chatsworth, is charged in a federal criminal complaint with health care fraud. According to an affidavit filed with the complaint, from January 2022 to September 2025, Tindimobuna used the Tarzana-based Comfort Choice Hospice Inc. to submit to Medicare hundreds of fraudulent claims for purported hospice services to dozens of beneficiaries. For those claims, Comfort Choice sought more than $3.8 million, of which Medicare paid approximately $3.4 million.

For example, in November 2022, Comfort Choice submitted a claim to Medicare in the amount of $7,021, for reimbursement of hospice services for a beneficiary. Law enforcement later interviewed this beneficiary and other Comfort Choice patients who said they were not terminally ill, a requirement to qualify for hospice care.

Tindimobuna allegedly also paid kickbacks to marketers for their referral of hospice patients to Comfort Choice in violation of the Anti-Kickback Statute.

HHS-OIG is investigating this matter.

Special Assistant United States Attorney Yervant P. Hagopian of the Major Frauds Section is prosecuting this case.

USA v. Lauritzen

Ivan Verne Lauritzen, 50, of Simi Valley, was arrested Tuesday on a federal criminal complaint charging him with health care fraud. According to court documents, Lauritzen was the CEO and CFO of the Simi Valley-based Valley Pacific Hospice Inc., whose Medicare enrollment was revoked in August 2024.

In 2022, the live discharge rate of Valley Pacific patients was more than 75%, vastly higher than the national average that year of approximately 17%. Based on an audit examining 18 Valley Pacific Medicare claims from August 2023 to March 2024, CMS determined the company had a pattern and practice of submitting claims that failed to meet Medicare’s hospice standards and requirements. To facilitate this fraud, Lauritzen forged the signature of at least one physician on the Medicare enrollment forms.

During the alleged scheme, Valley Pacific billed Medicare more than $580,000 and was paid more than $526,000.

Lauritzen made his initial appearance Tuesday and was ordered released on $10,000 bond. His arraignment is scheduled for April 27.

HHS-OIG is investigating this matter.

Assistant United States Attorney Neil P. Thakor of the Major Crimes Section is prosecuting this case.

PRIVATE HEALTH CARE PLAN FRAUD

USA v. Aulava-Moala, et al.

Four defendants with South Bay ties – one of them a licensed chiropractor – have been charged in a two-count information with conspiracy to commit health care fraud and wire fraud in connection with a $19 million scheme to defraud a labor union’s health plan via false claims for chiropractic services and physical therapy that weren’t needed or never provided.

The defendants charged are:

• Tolu Aulava-Moala, 51, of Carson, who was the director of the facilities;
• John Nicola, 77, of El Segundo, a licensed chiropractor;
• Crysta Richter, 40, of Torrance, who owned a medical billing company; and
• John Keohuloa, 49, of Long Beach.

These defendants will be summonsed into Los Angeles federal court and are expected to make their initial appearances in the coming weeks.

According to court documents, from January 2010 to September 2023, they fraudulently submitted at least $19,005,463 in claims to International Longshore and Warehouse Union Pacific Maritime Association and other private health insurers on behalf of several chiropractic and physical therapy service companies: Ohana Wellness Center, Ohana Management Corp., and R3New Wellness – all based in Carson – and the Huntington Beach-based One Life Acupuncture APC.

Aulava-Moala and Keohuloa induced beneficiaries to visit clinics to receive medically unnecessary services, such as massages or endoscopies, in exchange for kickback payments. Nicola knowingly created fake client notes for beneficiaries, and Aulava-Moala, Nicola, and Richter submitted false and fraudulent claims to health insurers for reimbursement for medical services.

In August 2022, the former owner of the Ohana companies testified under oath at a civil trial that the companies falsified patient chart notes and billed claims under chiropractors’ names and insurance numbers without their knowledge. A state court later that month found the Ohana companies liable for the fraud scheme.

In addition, from March 2016 to June 2023, Aulava-Moala and Keohuloa conspired to submit approximately $700,000 in fraudulent receipts for a charity donation program operated by a Los Angeles-based oil refinery for which the company paid at least $500,000.

The FBI, the U.S. Department of Labor Office of Inspector General (DOL-OIG), and the U.S. Department of Labor – Employee Benefits Security Administration are investigating this matter with assistance from Homeland Security Investigations (HSI) and the United States Secret Service.

Assistant United States Attorney Jason C. Pang of the Transnational Organized Crime Section is prosecuting this case.

USA v. Cartmell; USA v. Surace

Gregory Cartmell, 62, of Coeur D’Alene, Idaho, a licensed chiropractor, was arrested today on a four-count indictment charging him with two counts of health care fraud and two counts of aggravated identity theft. He is expected to make his initial appearance today in U.S. District Court for the District of Idaho. He will be arraigned in Los Angeles in the coming weeks.

According to the indictment, from December 2018 to November 2022, Cartmell submitted approximately $9.14 million in fraudulent claims to the ILWU-PMA health plan for chiropractic services – including for services not rendered – and received approximately $6.43 million in payment from the union’s health plan, which had terminated him from the plan in December 2020.

To circumvent his termination, Cartmell arranged with a co-conspirator – Vincent Surace, 87, of McKinney, Texas – to bill ILWU-PMA’s health plan under the co-conspirator’s name and identification number. In exchange for allowing his name and ID number to be used in the scheme, Cartmell paid Surace a portion of the proceeds the union’s plan paid for the fraudulent claims.

Surace is charged via information with one count of conspiracy to commit health care fraud. He will be summonsed to Los Angeles federal court in the coming weeks.

The FBI, the U.S. Department of Labor Office of Inspector General (DOL-OIG), and the U.S. Department of Labor Employee Benefits Security Administration (DOL-EBSA) are investigating this matter.

Assistant United States Attorneys Jason C. Pang of the Transnational Organized Crime Section and William M. Larsen of the Criminal Appeals Section are prosecuting this case with assistance from Assistant United States Attorney Christopher C. Kendall of the Transnational Organized Crime Section.

USA v. Griffen

Sonia Griffen, 51, of Lakewood, was arrested today on a five-count indictment charging her with health care fraud. From April 2019 to May 2024, Griffen allegedly submitted nearly $5 million in fraudulent claims to ILWU-PMA’s health care plan through her wellness company, Bee Well Holistic Wellness Center, for purported chiropractic services given to union members, even though the plan had previously terminated Bee Well and barred it from submitting claims.

According to the indictment, to circumvent Bee Well’s termination from the ILWU-PMA plan and obtain payments, Griffen concealed Bee Well’s identity and involvement by arranging with two chiropractors to bill the plan under their names and at fictitious addresses. She also submitted false claims billing the plan for chiropractic services that were never rendered.

In total, Griffen submitted approximately $4.9 million in fraudulent claims to the ILWU-PMA plan, resulting in payments of approximately $2.5 million.

The FBI, the United States Department of Labor Office of Inspector General (DOL-OIG), and the Department of Labor – Employee Benefits Security Administration (DOL-EBSA) are investigating this matter.

Assistant United States Attorney Jing Yan of the General Crimes Section is prosecuting this case.

IMMIGRATION HEALTH CARE FRAUD

USA v. Ko

Young Joo Ko, 59, of East Hollywood and a lawful permanent resident from South Korea, was arrested today on a federal criminal complaint charging her with fraud and misuse of visas, permits, and other documents.

According to an affidavit filed with the complaint, Ko engaged in a medical fraud scheme exploiting the green card application process by creating fraudulent immigration documents. Civil surgeons designated by U.S. Citizenship and Immigration Services (USCIS) and operating in the Los Angeles area did not examine green card applicants as required by law.

Instead, Ko – for a fee – fraudulently prepared the required forms by presenting herself as a nurse or doctor and indicating false compliance with medical examination requirements necessary for immigration applicants to register permanent residence or adjust their immigration status.

If convicted, Ko would face a statutory maximum sentence of 10 years in federal prison.

HSI, IRS Criminal Investigation, and USCIS are investigating this matter.

Assistant United States Attorney Brenda N. Galván of the General Crimes Section is prosecuting this case.

Health care fraud-related charges in these cases carry a statutory maximum sentence of 10 years in federal prison. Wire fraud is punishable by up to 20 years in federal prison. Aggravated identity theft carries a mandatory two-year consecutive prison sentence.

Complaints and indictments contain allegations that a defendant has committed a crime. Every defendant is presumed to be innocent until and unless proven guilty in court.

Contact
Ciaran McEvoy
Public Information Officer
ciaran.mcevoy@usdoj.gov
(213) 894-4465

https://michiganadvance.com/2026/04/04/repub/its-a-safe-space-mobile-midwifery-clinics-meet-patients-where-they-are/

‘It’s a safe space’: Mobile midwifery clinics meet patients where they are
By Nada Hassanein - April 4, 2026

MIAMI — Midwife Sheila Simms Watson leaned to gently press on the pregnant woman’s belly. Me’Asia Taylor lay on a bed fitted with tie-dyed purple printed sheets in the corner of the RV.

Far from a typical camper, this RV houses a mobile midwifery clinic for prenatal, postpartum and women’s general health care.

“Roll when you’re getting up, and we can help you. You can sit there for a moment, all right, so you’re not lightheaded, not dizzy,” said Watson, whom patients and doulas call “Mama Sheila.”

Calm and slow, led by Watson’s soothing and attentive demeanor, the appointments are unrushed.

Run by the Southern Birth Justice Network, the mobile midwifery clinic brings care to majority-Black and Latino neighborhoods across Miami-Dade County several times a month. The clinic aims to offer a more relaxed setting, where women are comfortable and heard, their cultures are integrated, and they can connect with doulas from diverse backgrounds.

On the half-moon bench inside the RV, Watson, a doula and a midwife in training sit with patients. They take blood pressures and draw blood. They ask the women about their lives: How is their mental health and sleep? Do they have support at home? Do they want to give birth at a hospital or birth center with a midwife?

Taylor said pre-eclampsia, a dangerous pregnancy condition, runs in her family. She wanted to make sure she had space and time to express her concerns about her first pregnancy.

Taylor said she wants a midwife for her delivery. Many women of color have reported feeling marginalized or dismissed in medical settings. “I’ve just seen too many people have bad experiences,” Taylor told Watson.

The U.S. has markedly higher maternal mortality and infant mortality rates compared with other high-income countries, and women and babies of color fare the worst. Black women’s maternal death rates are three times higher than those of white women, and American Indian and Alaska Native women’s rates are twice that of white women. Researchers point to implicit bias, less regular access to prenatal care and higher rates of poverty.

OB-GYN shortages and labor and delivery units closing continue to make getting care harder. Last year, more than two dozen hospital labor and delivery units across the nation closed, including some in South Florida. And pregnant patients living miles away, or feeling uneasy about going to the doctor, may even forgo care.

Midwives can help fill gaps, maternal health equity advocates say, and mobile clinics can meet patients where they are.

“It really helps to disrupt this idea that patients must navigate these complex systems to receive care — and instead, (mobile midwifery) reimagines care as something that should be responsive to the needs of patients and should be community-centered,” said Tufts University professor and maternal health scholar Ndidiamaka Amutah-Onukagha.

But mobile units are not as common for midwifery as they are for other areas of care, such as dentistry or family medicine, the American College of Nurse-Midwives told Stateline. Other prenatal mobile outreach efforts in the state include an OB-GYN-run mobile unit by the University of Florida that serves areas around north-central Alachua County and an operation called The Midwife Bus in Central Florida.

To increase access to care, maternal health advocates are also pushing states to change regulations that restrict midwifery. The American College of Nurse-Midwives recently filed a lawsuit against Mississippi for requiring nurse-midwives to have agreements with physicians in order to practice. This week, Jamarah Amani, a midwife and the executive director of the Southern Birth Justice Network, joined other plaintiffs in filing a lawsuit against Georgia over its restrictions. But supporters of the rules say they are meant to protect patients and foster communication between clinicians.

Offering culturally centered prenatal care that women are more inclined to use can help address inequities in maternal health, Amani said. The group trains doulas, offers telehealth, provides referrals such as to mental health therapists, and advocates for equitable policies across the South.

Most of the mobile clinic’s clients — about 70% — are on Medicaid or uninsured, and the clinic is funded through federal and university grants, as well as donations.

“(Midwifery) presents like a luxury concierge-type of service,” Amani said. “Our goal is to really change that and to bring it back to the community in a very grassroots way.”

Preserving tradition

The Southern Birth Justice Network keeps a small drum on a table at a nearby booth. It represents the heartbeat, and ancestral reverence, Amani said. Drums are a universal language, and the instrument is meant to symbolize culture.

For doulas and many midwives like Amani and Watson, bringing their profession to communities today is the continuation of a significant part of Black American heritage.

Throughout history, Black midwives were venerated in their communities. Many practices were rooted in West African traditions. These midwives were the keepers of Black ancestral records, and delivered many white women’s babies. Enslaved women who were midwives traveled for deliveries. Some routes, long and traversed by foot, were dangerous in the deep rural South. During the Jim Crow era, Black Americans were denied care at hospitals or given inferior care.

“They only had protection if someone would send a carriage for them if they were going to deliver a white woman’s baby. But to care for the Black families, they often had to go in the middle of the night, alone,” Amani said. “We talk about the legacy of Black midwives as health care providers, but also as social pillars, as community leaders, as resistors of oppression.”

In the 20th century, medical institutions began to oppose midwifery, sometimes using racist and sexist campaigns to target the practice. They argued it was unhygienic and lobbied across states to dismantle midwifery. At the same time, while developing the field of obstetrics, doctors conducted gynecological experiments on Black women. The American College of Obstetricians and Gynecologists has acknowledged this history and said it’s committed to fighting racism and inequities.

Dr. Jamila Perritt, an OB-GYN and president and CEO of Physicians for Reproductive Health, said that in order to address structural barriers and close gaps, policies have to prioritize access to care, such as allowing midwives to expand their practices. Throughout the South especially, states still restrict midwives from practicing independently, despite widespread maternal health care deserts. She also pointed to research showing midwifery is associated with fewer C-sections, less preterm labor and better patient satisfaction.

“Expanding access to midwifery care, and expanding collaborations between physicians and midwives, only improves outcomes,” Perritt said.

Cultivating trust

On a recent breezy and brisk Saturday morning, the Southern Birth Justice Network’s midwives and doulas were stationed in the parking lot of the Freedom Lab, a local community center that hosts food and clothing distribution and a free urgent care center.

At the booth by the mobile clinic, under the shade of a royal-purple awning, meditation music, low-key and mellow, reverberated from a small speaker. There was a cooler filled with oranges, water and other snacks for the clinic’s pregnant patients.

“I’m going to keep giving you food. You need to eat enough,” one doula told a patient, handing her an orange and a liter of spring water.

Staff had surveys to help assess a new patient’s needs, and Florida-specific pamphlets on pregnant patients’ rights. The group is working on other state-specific guides for Louisiana, Massachusetts, Tennessee and Texas.

The table also held a portrait of the late midwife Ada “Becky” Sprouse, who started the mobile midwife clinic around 2008. She’d drive it to the city of Homestead, an agricultural hub in Miami-Dade County. There, she offered free midwifery care to migrant farmworkers, many of whom couldn’t afford care throughout their pregnancies.

Sprouse passed the clinic on to Amani, who relaunched the mobile unit and broadened the scope of the Southern Birth Justice Network.

Patients told Stateline trust was one of the main reasons they sought out the clinic. One patient said she spent 2 1/2 hours on public transit that day so that she could see the team.

For now, deliveries take place at hospitals or neighboring birth centers, where some of the group’s midwives also work. But the organization recently bought a building to open its own freestanding birth center, aiming for next year, along with a larger RV.

One patient, Isis Daaga, turned to Amani to deliver her other children after her first birth at a hospital. Despite the pressure she felt and her need to push during labor, Daaga recalled, hospital staff prevented her from delivering.

“They literally held my knees together,” Daaga said. “They were like, ‘the doctor’s not here yet,’ and the nurses were scared to deliver the baby.” In many hospitals, protocol is to wait for the doctor in case an emergency occurs.

By the time the doctor came, Daaga had a severe perineal tear, and she delivered the baby in one push. She had been in labor for 15 hours.

“I was in pain, I was upset,” said Daaga, a mental health therapist who is 35 weeks pregnant.

At the mobile clinic and with the midwives, Daaga said she feels supported.

“They make me feel the way I try to make my clients feel, like, it’s a safe space. You’re not judged here. I have a lot going on,” she said. “If I’m MIA or something, most of them will call and text me and (say), ‘Girl, you need to come in.’”

https://www.bls.gov/news.release/empsit.nr0.htm

Health care added 76,000 jobs in March. Employment in ambulatory health care services rose by 54,000, reflecting an increase of 35,000 in offices of physicians as workers returned from a strike. Employment also increased in hospitals (+15,000). Over the prior 12 months, health care had added an average of 29,000 jobs per month.

Go to the extensive charts and text at the hyperlink, above, for more information and data.  Table B-1. Employees on nonfarm payrolls by industry sector and selected industry detail tells the health care story:

https://www.bls.gov/news.release/empsit.t17.htm

https://www.whitehouse.gov/presidential-actions/2026/04/adjusting-imports-of-pharmaceuticals-and-pharmaceutical-ingredients-into-the-united-states/

BY THE PRESIDENT OF THE UNITED STATES OF AMERICA

A PROCLAMATION

1. The Secretary of Commerce (Secretary) recently transmitted to me a report on his investigation into the effects of imports of pharmaceuticals and pharmaceutical ingredients on the national security of the United States under section 232 of the Trade Expansion Act of 1962, as amended, 19 U.S.C. 1862 (section 232). Based on the facts considered in that investigation, and taking into account the close relation of the economic welfare of the Nation to our national security and other relevant factors, see 19 U.S.C. 1862(d), the Secretary found and advised me of his opinion that pharmaceuticals and associated active pharmaceutical ingredients (APIs), including key starting materials, are being imported into the United States in such quantities and under such circumstances as to threaten to impair the national security of the United States.

2. The Secretary found that the present quantities and circumstances of imports of pharmaceuticals and pharmaceutical ingredients threaten to impair the national security and economy. Despite being the world leader in research and development (R&D) for most innovative pharmaceuticals (those that are typically patented and branded, as compared to generic pharmaceuticals or pharmaceuticals approved pursuant to section 505(j) of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. 355(j)), the United States is heavily reliant on imports, threatening to limit United States access to life-saving medications in the event of global supply chain disruption due to geopolitical or economic disruption. According to the Food and Drug Administration, as of 2025, approximately 53 percent of patented pharmaceutical products distributed domestically are produced outside the country. The degree of import reliance is significant at the API level with only 15 percent of patented APIs by volume domestically produced for the United States market.

3. The Secretary found that patented pharmaceuticals and associated pharmaceutical ingredients are essential to the United States’ military and civilian healthcare. A self-sufficient domestic manufacturing and industrial base for pharmaceutical products is vital for the ability to support national defense requirements and maintain public health security during a national emergency or wartime. Patented pharmaceuticals are pivotal for treating cancer, rare diseases, autoimmune disorders, infectious diseases, and other critical health challenges. The Secretary further found that foreign government intervention has undermined the competitiveness of the United States patented pharmaceutical industry. This intervention has led to further dependence on foreign production of patented pharmaceuticals that have fragile supply chains.

4. In light of these findings, the Secretary recommended actions to adjust imports of patented pharmaceuticals and associated pharmaceutical ingredients, including continuing to negotiate onshoring agreements related to Most-Favored-Nation (MFN) pharmaceutical pricing agreements; imposing significant tariffs on pharmaceuticals and pharmaceutical ingredients, so that such imports will not threaten to impair the national security of the United States; and granting preferential treatment to those companies that commit to onshore production of pharmaceuticals and pharmaceutical ingredients.

5. After considering the Secretary’s report, the factors in section 232(d) (19 U.S.C. 1862(d)), and other relevant factors and information, among other things, I concur with the Secretary’s finding that pharmaceuticals and associated pharmaceutical ingredients are being imported into the United States in such quantities and under such circumstances as to threaten to impair the national security of the United States. In my judgment, and in light of the Secretary’s report, the factors in section 232(d) (19 U.S.C. 1862(d)), and other relevant factors and information, I have also determined that it is necessary and appropriate to adopt a plan of action, as described below, to adjust such imports of pharmaceuticals and associated pharmaceutical ingredients so that such imports will not threaten to impair the national security of the United States.

6. I have decided to direct the Secretary and the Secretary of Health and Human Services to pursue negotiations of agreements or continue any current negotiations of agreements, such as agreements contemplated in section 232(c)(3)(A)(i) (19 U.S.C. 1862(c)(3)(A)(i)), to address the threatened impairment of the national security with respect to imported patented pharmaceuticals and associated pharmaceutical ingredients, with any party the Secretary and the Secretary of Health and Human Services deem appropriate, and to update me on the progress of such negotiations within 90 days of the date of this proclamation. Under current circumstances and in light of future requirements of the United States, this action is necessary and appropriate to address the threatened impairment of the national security.

7. I have determined that it is necessary and appropriate to impose a 100 percent ad valorem duty rate on the import of patented pharmaceuticals and associated pharmaceutical ingredients, as identified in Annex I to this proclamation, and except as otherwise provided in this proclamation. Pharmaceutical products and ingredients that are subject to the section 232 zero tariff at this time are listed in Annex IV to this proclamation.

8. I have determined that it is necessary and appropriate that the ad valorem duty rate be 20 percent on imports of patented pharmaceuticals and associated pharmaceutical ingredients produced by companies that have plans, approved by the Secretary, to onshore production of such pharmaceuticals and pharmaceutical ingredients. The aforementioned 20 percent rate shall increase to 100 percent 4 years after the date of this proclamation.

9. I have further determined that it is necessary to implement pharmaceutical-related commitments in existing trade deals with the European Union, Japan, the Republic of Korea, and Switzerland and Liechtenstein jointly, as well as a future pharmaceutical-related deal with the United Kingdom (on which the United States and the United Kingdom have reached an agreement in principle as of December 1, 2025). These deals further United States economic and national security interests.

10. I further find that it is necessary and appropriate to impose no tariffs on imports of patented pharmaceuticals and associated pharmaceutical ingredients produced by companies that have fully executed agreements or are negotiating agreements with the Secretary and the Secretary of Health and Human Services regarding MFN pricing and onshoring of production and R&D of patented pharmaceuticals and pharmaceutical ingredients. Such agreements further United States economic and national security interests by making pharmaceuticals more accessible and affordable in the United States and by strengthening the domestic manufacturing base.

11. I have further determined not to adjust imports of generic pharmaceuticals and their associated ingredients, including biosimilar products, at this time. This determination includes purchases of generic pharmaceuticals and ingredients for the Strategic API Reserve. I find that such products should not be subject to section 232 tariffs at this time.

12. In my judgment, based on current circumstances as well as the future needs of the United States, the actions in this proclamation are necessary and appropriate to address the threatened impairment of the national security posed by imports of pharmaceuticals and pharmaceutical ingredients.

13. Section 232 authorizes the President to take action to adjust the imports of an article and its derivatives that are being imported into the United States in such quantities or under such circumstances as to threaten to impair the national security. Section 232 includes the authority to adopt and carry out a plan of action, with adjustments over time, to address the national security threat. This plan of action may include negotiations of agreements along with other actions to adjust imports to address the national security threat, including tariffs. If action under section 232 includes the negotiation of an agreement, such as one contemplated in section 232(c)(3)(A)(i) (19 U.S.C. 1862(c)(3)(A)(i)), the President may also take other actions he deems necessary to adjust imports to eliminate the threat that the imported article poses to the national security, including if such an agreement is not entered into within 180 days of the date of this proclamation, is not being carried out, or is ineffective. See 19 U.S.C. 1862(c)(3)(A).

14. Section 604 of the Trade Act of 1974, as amended (19 U.S.C. 2483) (section 604), authorizes the President to embody in the Harmonized Tariff Schedule of the United States (HTSUS) the substance of statutes affecting import treatment, and actions thereunder, including the removal, modification, continuance, or imposition of any rate of duty or other import restriction.

NOW, THEREFORE, I, DONALD J. TRUMP, President of the United States of America, by the authority vested in me by the Constitution and the laws of the United States, including section 232, 19 U.S.C. 1862; section 604, 19 U.S.C. 2483; and section 301 of title 3, United States Code, do hereby proclaim as follows:

(1) The Secretary and the Secretary of Health and Human Services, and any senior official they deem appropriate, shall pursue or continue pursuing negotiations of agreements, as contemplated in section 232(c)(3)(A)(i) (19 U.S.C. 1862(c)(3)(A)(i)), to address the threatened impairment of the national security with respect to imported pharmaceuticals and pharmaceutical ingredients.

(2) I hereby ratify, and delegate to the Secretary the authority necessary to enter into, the company-specific tariff agreements listed in Annex II to this proclamation that the Secretary entered into prior to this proclamation. I also hereby delegate to the Secretary the authority to enter into and implement similar agreements in the future, as referenced in clause (1) of this proclamation. The Secretary is authorized to monitor and enforce these agreements as he deems appropriate, consistent with clause (6) of this proclamation and applicable law.

(3)(a) Imports of patented pharmaceuticals and associated pharmaceutical ingredients, as listed in Annex I to this proclamation, will be subject to a 100 percent ad valorem duty rate.

(b) The ad valorem duty rate for patented pharmaceuticals and associated pharmaceutical ingredients, as listed in Annex I to this proclamation, shall be 20 percent for products of companies that have, or that the Secretary assesses are likely soon to have (e.g., based on agreements in principle), onshoring plans approved by the Secretary. The aforementioned 20 percent rate shall increase to 100 percent on April 2, 2030.

(c) The ad valorem duty rate for patented pharmaceuticals and associated pharmaceutical ingredients, as listed in Annex I to this proclamation, shall be 15 percent for products of Japan, the European Union, the Republic of Korea, and Switzerland and Liechtenstein jointly, unless a lower rate applies under clause (3) of this proclamation. The tariff rate on patented pharmaceuticals and associated pharmaceutical ingredients for products of the United Kingdom shall be 10 percent and then reduce to zero to the extent required by any future agreement between the United States and the United Kingdom on pharmaceutical pricing. The Secretary shall publish a Federal Register notice should the rate for the United Kingdom be reduced to zero.

(d) The ad valorem tariff rate shall be zero for drugs and associated ingredients, where all approved indications are designated as orphan pursuant to the Orphan Drug Act, 21 U.S.C. 360aa et seq., and its implementing regulations; nuclear medicines; plasma derived therapies; fertility treatments; cell and gene therapies; antibody drug conjugates; medical countermeasures related to chemical, biological, radiological, and nuclear threats; or other specialty pharmaceutical products to be identified by the Secretary, as well as pharmaceutical products for animal health, provided that the Secretary, in consultation with the United States Trade Representative (Trade Representative) and the Secretary of Health and Human Services, determines that: (1) they are products of a jurisdiction that has a current or forthcoming trade and security framework agreement as referenced in Executive Order 14346 of September 5, 2025 (Modifying the Scope of Reciprocal Tariffs and Establishing Procedures for Implementing Trade and Security Agreements), or (2) they meet an urgent United States health need. The Secretary shall publish a Federal Register notice whenever he makes such a determination.

(e) For companies that are eligible for the tariff treatment outlined in clause (3)(b) of this proclamation, and that have entered into MFN pharmaceutical pricing agreements with the Secretary of Health and Human Services, the applicable ad valorem tariff rate for pharmaceuticals and associated pharmaceutical ingredients shall be zero until January 20, 2029. The Secretary shall apply this zero tariff rate to companies that he determines are likely to be eligible soon (e.g., because they have agreements in principle with the Secretary and the Secretary of Health and Human Services). For avoidance of doubt, this zero tariff rate shall also apply per the terms of the agreements listed in Annex II to this proclamation.

(f) The Secretary may increase the tariff rates referenced in clause (2) of this proclamation, and in clauses (3)(b) and (3)(e) of this proclamation, to address companies’ failure to fulfill commitments under the relevant plans and agreements. The Secretary, in consultation with the Trade Representative, may increase the tariff rates referenced in clause (3)(c) of this proclamation to address foreign jurisdictions’ failure to fulfill commitments under agreements with the United States. The Secretary shall publish a Federal Register notice when tariff rates are increased.

(4) The tariffs and tariff treatment imposed by this proclamation shall be effective with respect to goods entered for consumption, or withdrawn from warehouse for consumption, on or after 12:01 a.m. eastern daylight time on July 31, 2026, for the companies listed in Annex III to this proclamation and September 29, 2026, for other companies and shall continue in effect, unless such actions are expressly reduced, modified, or terminated.

(5) Generic pharmaceuticals and their associated ingredients shall not be subject to tariffs pursuant to section 232 at this time. Within 1 year of the date of this proclamation, the Secretary shall, in consultation with any senior executive branch officials the Secretary deems appropriate, inform the President of any circumstances that, in the Secretary’s opinion, might indicate the need to take action to adjust the imports of generic pharmaceuticals and their associated ingredients.

(6) The Secretary, in consultation with the Secretary of Health and Human Services, shall establish criteria for onshoring plans referenced in clause (3)(b) of this proclamation, to be published in the Federal Register. All onshoring plans shall be subject to approval, monitoring, and enforcement by the Secretary. The Secretary shall require companies with qualifying onshoring plans to submit periodic reports to the Secretary regarding progress towards fulfilling onshoring milestones. The Secretary may require that such reports be audited by an external auditing firm. In cases where the executive branch assesses that a company engaged in fraud or deliberately misled the United States Government with respect to onshoring commitments, the Secretary may reimpose tariffs discussed in this proclamation both prospectively and retroactively on imports from relevant companies, and he may impose other tariffs and penalties to the extent consistent with applicable law.

(7) If a product is subject to tariffs under this proclamation and Column 1 of the HTSUS (Column 1 Duty Rate), then the sum of the additional section 232 tariff imposed pursuant to this proclamation and the applicable Column 1 Duty Rate shall be equal to the applicable rate listed in clause (3) of this proclamation, unless the Column 1 Duty Rate is greater than the applicable rate listed in clause (3) of this proclamation, in which case only the Column 1 Duty Rate shall apply. This clause does not apply to the tariff treatment for products of the United Kingdom described in clause (3)(c) of this proclamation.

(8) If a product is subject to more than one rate of duty under this proclamation, then the lowest applicable rate shall apply.

(9) The Secretary, in consultation with the Chair of the United States International Trade Commission and the Commissioner of U.S. Customs and Border Protection (CBP), shall determine whether any modifications to the HTSUS or other administrative measures are necessary to effectuate or implement this proclamation or any actions taken pursuant to this proclamation. Any changes shall be published in a notice in the Federal Register.

(10) Drawback shall be available with respect to the duties imposed pursuant to this proclamation.

(11) Imports of United States-origin pharmaceutical products shall not be subject to the tariffs imposed by this proclamation at this time.

(12) To the extent permitted by applicable law, CBP may take any necessary or appropriate measure to administer the tariffs imposed or altered by this proclamation. Importers shall provide to CBP information necessary to carry out this proclamation.

(13) Any product described in clause (4) of this proclamation, except those eligible for admission as “domestic status” as described in 19 CFR 146.43, that is subject to a duty imposed by this proclamation and that is admitted into a United States foreign trade zone on or after the effective date of this proclamation, must be admitted as “privileged foreign status” as described in 19 CFR 146.41 and will be subject upon entry for consumption to any ad valorem rates of duty related to the classification under the applicable HTSUS subheading.

(14) The Secretary shall continue to monitor imports of patented and generic pharmaceuticals and pharmaceutical ingredients. The Secretary also shall, from time to time, in consultation with any senior executive branch officials the Secretary deems appropriate, review the status of such imports with respect to the national security. The Secretary shall inform me of any circumstances that, in the Secretary’s opinion, might indicate the need for further action by the President under section 232. The Secretary shall also inform me of any circumstance that, in the Secretary’s opinion, might indicate that the tariff imposed in this proclamation is no longer necessary.

(15) To the extent consistent with applicable law and the purpose of this proclamation, the Secretary, the Secretary of Health and Human Services, and the Secretary of Homeland Security are directed and authorized to take all actions that are appropriate to implement and effectuate this proclamation and any actions contemplated by this proclamation, including, consistent with applicable law, the issuance of regulations, rules, guidance, and procedures and the temporary suspension or amendment of regulations, within their respective jurisdictions, and to employ all powers granted to me under section 232.

(16) The Secretary, the Trade Representative, and the Secretary of Homeland Security may, consistent with applicable law, including section 301 of title 3, United States Code, redelegate any of these functions within their respective executive departments or agencies.

(17) Any provision of previous proclamations and Executive Orders that is inconsistent with this proclamation is superseded to the extent of such inconsistency. If any provision of this proclamation or the application of any provision of this proclamation to any individual or circumstance is held to be invalid, the remainder of this proclamation and the application of its provisions to any other individual or circumstance shall not be affected.

IN WITNESS WHEREOF, I have hereunto set my hand this second day of April, in the year of our Lord two thousand twenty-six, and of the Independence of the United States of America the two hundred and fiftieth.

DONALD J. TRUMP

ANNEXES I, II, III & IV

https://www.whitehouse.gov/fact-sheets/2026/04/fact-sheet-president-donald-j-trump-bolsters-national-security-and-strengthens-u-s-supply-chains-by-imposing-tariffs-on-patented-pharmaceutical-products/

Fact Sheet: President Donald J. Trump Bolsters National Security and Strengthens U.S. Supply Chains by Imposing Tariffs on Patented Pharmaceutical Products
The White House
April 2, 2026

• President Trump imposed a 100% tariff on patented pharmaceutical products and ingredients.
• The tariffs will come into effect in 120 days for certain large companies, and 180 days for smaller companies.
• Trade Deal Countries:
• If a pharmaceutical product is from the European Union, Japan, Korea, or Switzerland and Liechtenstein, a 15% tariff will apply. If a pharmaceutical product is from the United Kingdom, a lower tariff will apply, subject to the recently concluded UK pharmaceutical agreement.Onshoring and pricing agreements:
• For companies that enter into Most Favored Nation (MFN) pricing agreements with the Department of Health and Human Services (HHS) and onshoring agreements with the Department of Commerce, a 0% tariff will apply through January 20, 2029. For companies that only enter into onshoring agreements with the Department of Commerce, a 20% tariff will apply.The Department of Commerce and HHS will provide pathways for companies to enter into onshoring and MFN pricing deals with the U.S. Government.
• Generic pharmaceuticals: Generic pharmaceutical products, biosimilars, and associated ingredients are not subject to tariffs at this time. This will be reassessed in one year.
• Specialty pharmaceutical products: Orphan drugs, drugs for animal health, and certain other specialty pharmaceutical products will be exempt, if they are from trade deal countries or meet an urgent public health need.
• The Proclamation establishes strong monitoring and enforcement mechanisms, including external audits and tariff increases on future and past imports.

• President Trump imposed these tariffs following an extensive investigation conducted by the Secretary of Commerce under Section 232 of the Trade Expansion Act of 1962, as amended, to determine the effects on national security of imports of pharmaceuticals, pharmaceutical ingredients, and related products.
• The investigation found that patented pharmaceuticals and associated pharmaceutical ingredients are being imported into the United States in such quantities and under such circumstances as to threaten to impair our national security.
• The impending Section 232 tariffs have already spurred approximately $400 billion in new investment commitments from U.S. and foreign pharmaceutical companies, which will be spent in the United States during President Trump’s current term in office.
• A self-sufficient domestic manufacturing and industrial base for pharmaceutical products is vital for the ability to support national defense requirements and public health.
• Despite being the world leader in research and development for most innovative pharmaceuticals, the U.S. is heavily reliant on imports, threatening to limit U.S. access to life-saving medications in the event of global supply chain disruption.

• In May 2025, President Trump signed an Executive Order to remove regulatory barriers and facilitate the restoration of a robust domestic manufacturing base for prescription drugs, including key ingredients and materials necessary to manufacture prescription drugs.
• In August 2025, President Trump signed an Executive Order to ensure American pharmaceutical supply chain resilience by filling the strategic active pharmaceutical ingredients reserve.
• President Trump’s Administration has launched Section 232 investigations in adjacent sectors such as personal protective equipment, medical consumables, and medical equipment and devices, as well as robotics. These investigations will help ensure that harmful imports in any strategic sector do not compromise national security.

The Centers for Disease Control and Prevention listed on Monday 27 types of testing that have been suspended.  Andrew Nixon, an HHS spokesman, called the pause temporary and attributed it to “a routine review to uphold our commitment to high quality laboratory testing.”  “We anticipate some of these tests will be available through CDC labs again in the coming weeks. In the meantime, CDC stands ready to support our state and local partners to access the public health testing they need.”

Go to the CDC ID Laboratories page to see the tests which have been suspended:

https://cdc.gov/infectious-diseases-labs/php/test-directory/index.html

Note that the CDC is in an interregnum.  Jay Bhattacharya, MD, PhD. is the current acting director of the Centers for Disease Control and Prevention (CDC) after Susan Monarez was canned.

https://reason.com/volokh/2026/04/02/a-short-take-on-chiles-v-salazar/

A Short Take on Chiles v. Salazar
Another religious freedom case in a free speech guise
By Mark Movsesian | April 2, 2026

The Supreme Court ruled this week, 8-1, in Chiles v. Salazar, that Colorado may not apply its ban on conversion therapy for minors to prohibit a licensed counselor's talk therapy. Justice Gorsuch wrote for the Court; Justice Kagan concurred, joined by Justice Sotomayor; Justice Jackson dissented. The Court held that, as applied to therapist Kayla Chiles's conversations with clients, Colorado's law discriminates on the basis of viewpoint and therefore triggers the most searching First Amendment scrutiny.

A couple points. First, this is not, formally speaking, a religion case. It's a Free Speech Clause case. Indeed, as far as I can tell, the word "religion" does not even appear in the Court's opinion. But the case is religion-adjacent. Chiles described herself in the litigation as a practicing Christian whose views about sex and gender are informed by her faith, and she said that some clients seek her out because they want counseling consistent with those convictions. So although religion is not part of the Court's doctrinal analysis, it is very much part of the background.

That feature places Chiles in a familiar line of First Amendment cases. Think of 303 Creative, another Gorsuch opinion. Or Barnette, the WWII-era flag salute case. Both were free speech cases in doctrinal terms, but religious conviction supplied much of the underlying human drama. One sees something similar here. Disputes touching religious freedom often come to the Court not under the Religion Clauses, but in the guise of free speech. Religion influences what people say--or don't say.

The key to the Court's reasoning is viewpoint discrimination. Colorado's law allows counseling that affirms a minor's sexual orientation or gender identity, but forbids counseling that seeks to help a minor change or redirect sexual orientation or gender identity. For the Court, that means the State is not simply regulating treatment as such. It is permitting one side of a contested moral and psychological question while suppressing the other. That, the Court says, is about as serious a First Amendment problem as one can have.

Second, it's notable how little work the formal strict-scrutiny framework seems to do once the Court reaches that conclusion. The Court says that content-based restrictions ordinarily trigger strict scrutiny, and that viewpoint discrimination is an especially egregious form of content discrimination. But it does not linger over the familiar steps of balancing: compelling interest, narrow tailoring, least restrictive means. Instead, once the Court identifies viewpoint discrimination, the case is largely over. The rest of the opinion is devoted mostly to rejecting Colorado's efforts to characterize the law as regulation of professional conduct rather than speech. Chiles thus resembles 303 Creative in this way as well. In 303 Creative, too, the Court avoided applying the strict-scrutiny balancing test in a serious way.

For those interested, I discuss Chiles in a short Legal Spirits episode, here.

The only fault with this analysis is its failure to emphasize that both religious freedom and free speech are guaranteed by the same U.S. Constitutional Amendment, The First!  There is a very good reason the Founding Fathers assembled related rights in the First amendment.