Itemoids

Louisiana

RFK Jr. Has a Lot to Learn About Medicaid

The Atlantic

www.theatlantic.com › health › archive › 2025 › 01 › rfk-jr-hearing-medicaid › 681504

Put on the spot, a lot of Americans might hesitate over the difference between Medicaid and Medicare. People who aren’t affected by one of these programs, which together enroll about 150 million people in the U.S., don’t generally have a need to be well versed in their intricacies, and the two programs sound quite similar. The names don’t really hint that Medicare is a federal program that covers older Americans and Americans with disabilities, and that Medicaid covers low-income people in the United States.

Most Americans, though, are not nominated to become secretary of the Department of Health and Human Services. Robert F. Kennedy Jr. is. And yet today, at his confirmation hearing before the Senate Finance Committee, he made clear that he also does not know very much about Medicare and Medicaid.

As HHS secretary, Kennedy would oversee a suite of government agencies, including the FDA, CDC, and National Institutes of Health, that are focused on improving American health. He also would oversee the Centers for Medicare and Medicaid Services, which, as the name implies, manages those two programs. HHS services, in other words, touch the lives of every American—and Medicaid and Medicare are, in particular, two of the most common ways for people to directly benefit from the government’s services.

During the three-and-a-half-hour hearing, in which the Senate committee pressed Kennedy on a range of issues—his anti-vaccine views, endorsements of conspiracy theories, stance on abortion, potential financial conflicts—senators grilled Kennedy on various aspects of the two government programs. In his new role, Kennedy could be charged with overseeing substantial changes to one of them. Donald Trump has pledged to preserve Medicare. He has made no such promise about Medicaid, which health-policy experts anticipate may be targeted for spending cuts. (On Tuesday, Medicaid reimbursement portals abruptly stopped working after the Trump administration ordered a freeze on federal grants and loans; states have since regained access to the portals.) Some Republicans have argued that an increased focus on public-health insurance in the U.S. won’t make Americans healthier, and Kennedy appeared to echo that viewpoint today when he criticized Medicaid, saying “our people are getting sicker every single year,” and lamented the program’s expansion to people with higher incomes. “The poorest Americans are now being robbed,” he said.

But Kennedy also seemed to mix up the two programs when he described them. Part of the issue with Medicaid, he said, is that “the premiums are too high, the deductibles are too high.” The majority of people enrolled in Medicaid don’t pay premiums or deductibles; federal law actually prohibits premiums for the program’s lowest-income enrollees. (He did seem better versed in Medicare Advantage, a program that provides private insurance coverage for older Americans and that he himself is enrolled in.)

To be fair, Kennedy was in a high-pressure situation. But being HHS secretary is a high-pressure job. Kennedy had time to prepare in advance of today’s hearing. If confirmed, he won’t need to master every minute detail of Medicare and Medicaid, but he will need to be able to navigate both programs—their differences, their weaknesses, and how they might evolve. People who are eligible for both programs, for instance, have created sticking points in the health-care system, in part because coordinating coverage between the two is difficult and can complicate care. When pressed by Senator Bill Cassidy of Louisiana on how to deal with that issue, Kennedy suggested that the programs should be “consolidated” and “integrated”—but when asked how that might happen, said, “I’m not exactly sure.”

Kennedy struggled with other policy specifics, too. One of his goals, Kennedy said, is to fulfill Trump’s directive to improve the quality of care and lower the price of care for all Americans. But he was vague on any plans to reform Medicaid, explaining that he’d “increase transparency” and “increase accountability.” When pushed by Cassidy to clarify, Kennedy said, “Well, I don’t have a broad proposal for dismantling the program.”

Nor did Kennedy have a clear sense of how he would approach one of the more contentious and legally sensitive health questions of the past few years: whether women whose lives are threatened by pregnancy should be able to receive emergency abortions under EMTALA, the law that requires emergency rooms that receive Medicare funding to provide care to anyone in a life-threatening situation. The Biden administration argued that this federal law supersedes state abortion bans, and in 2024, after the Supreme Court demurred on the issue, the administration made clear to doctors, in a letter co-authored by Health and Human Services Secretary Xavier Becerra, that abortions could qualify as emergency treatment. Kennedy admitted this morning that he didn’t know the scope of the authority he’d have to enforce the law in his new job.

Jacinda Abdul-Mutakabbir, a clinical pharmacist at UC San Diego, told me that Kennedy's apparent failure to understand the intricacies of the two programs wasn’t just a harmless fumble. If the health secretary is not well versed in the programs he’s tasked to run, he might not appreciate the impacts of his decisions. Should health coverage for some of the most vulnerable Americans be altered—perhaps even taken away—then health disparities in this country would likely widen. And if any part of his agenda does include increasing transparency, as Kennedy described in today’s hearing, expertise will have to be a prerequisite. “You can’t increase transparency on something you don’t have clarity on,” Abdul-Mutakabbir told me. (Kennedy’s press team did not immediately return a request for comment on his performance at today’s hearing.)

During the hearing, Kennedy’s more radical views on vaccines and infectious disease did come up. He copped to describing Lyme disease as “highly likely a militarily engineered bioweapon.” (The bacterium, which has been around for at least tens of thousands of years, is not.) He stood by his assertion that the measles vaccine killed two children in Samoa in 2018. (The vaccine did not; those children died following the administration of an improperly mixed vaccine by two nurses who were ultimately sentenced to five years in prison for the act.) He said that young children are at “basically … zero risk” from COVID-19. (Young children are at risk, especially babies under six months of age, who have similar hospitalization rates from the disease as adults 65 to 74 years old.) Kennedy’s falsehoods about infection and immunity were already well known, though. What the country learned today was that he may lack basic competency in some of the most wide-reaching aspects of his future job—and didn’t take the time to prepare answers for Congress, which he’ll ultimately have to answer to.

A Day for Pseudoscience in Congress

The Atlantic

www.theatlantic.com › health › archive › 2025 › 01 › rfk-jr-congress-confirmation-hearings › 681499

Shortly after birth, newborns in the United States receive a few quick procedures: an Apgar test to check their vitals, a heel stick to probe for genetic disorders and various other conditions, and in most cases, a hepatitis B vaccine. Without that last one, kids are at risk of getting a brutal, and sometimes deadly, liver condition. Senator Bill Cassidy of Louisiana happens to know quite a lot about that. Before entering Congress in 2009, he was a physician who has said he was so affected by an 18-year-old patient with liver failure from the virus that he spearheaded a campaign that vaccinated 36,000 kids against hepatitis B.

Cassidy, a Republican, will now play a major role in determining the fate of Robert F. Kennedy Jr., Donald Trump’s pick for health secretary, whose confirmation hearings begin today on Capitol Hill. Kennedy has said that the hepatitis B vaccine is given to children only because the pharmaceutical company Merck colluded with the government to get the shot recommended for kids, after the drug’s target market (“prositutes and male homosexuals,” by Kennedy’s telling) weren’t interested in the shot. Kennedy will testify in front of the Senate Finance Committee, where Cassidy and 26 other senators will get the chance to grill him about his views. Though it might seem impossible for an anti-vaccine conspiracist to gain the support of a doctor who still touts the work he did vaccinating children, Cassidy has not indicated how he will vote. Similar to the Democratic senators who have come out forcefully against Kennedy, Cassidy, in an interview with Fox News earlier this month, said that RFK Jr. is “wrong” about vaccines. But he also said that he did agree with him on some things. (Cassidy’s office declined my request to interview the senator.)

That Kennedy even has a chance of winning confirmation is stunning in its own right. A longtime anti-vaxxer with a propensity for far-fetched conspiracy theories, RFK Jr. has insinuated that an attempt to assassinate members of Congress via anthrax-laced mail in 2001 may have been a “false flag” attack orchestrated by “someone in our government” to gin up interest in the government preparing for potential biological weapon threats. He has claimed that COVID was “targeted to attack Caucasians and Black people,” and that 5G is being used to “harvest our data and control our behavior.” He has suggested that the use of antidepressants might be linked to mass shootings. Each one of these theories is demonstrably false. The Republican Party has often found itself at war with mainstream science in recent years, but confirming RFK Jr. would be a remarkable anti-science advance. If Republican senators are willing to do so, is there any scientific belief they would place above the wishes of Donald Trump?

A number of Republicans have already signaled where they stand. In the lead-up to the confirmation hearings, some GOP senators have sought to sanewash RFK Jr., implying that his views really aren’t that extreme. They have reason to like some of what he’s selling: After the pandemic, many Republicans have grown so skeptical of the public-health establishment that Kennedy’s desire to blow it up can seem enticing. And parts of RFK Jr.’s “Make America Healthy Again” agenda do in fact adhere to sound scientific evidence. His views on how to tackle America’s epidemic of diet-related diseases are fairly well reasoned: Cassidy has said that he agrees with RFK Jr.’s desire to take action against ultra-processed foods. Kennedy appears to have won over the two other Republican doctors on the committee, Senators Roger Marshall of Kansas and John Barrasso of Wyoming. Marshall has been so enthusiastic about Kennedy’s focus on diet-related diseases that he has created a “Make America Healthy Again” caucus in the Senate. Although Barrasso hasn’t formally made an endorsement, he has said that Kennedy would provide a “fresh set of eyes” at the Food and Drug Administration. (Spokespeople for Barrasso and Marshall did not respond to requests for comment.)

[Read: Everyone agrees Americans aren’t healthy]

Meanwhile, Kennedy appears to have gone to great lengths to sand down his extremist views and present himself as a more palatable candidate. “He told me he is not anti-vaccine. He is pro–vaccine safety, which strikes me as a rational position to take,” Senator John Cornyn of Texas told Politico. He has also done more to drum up unnecessary fear about COVID shots than perhaps anyone else in the country. Nearly four years ago, Kennedy petitioned the federal government to revoke authorization for the shots, because “the current risks of serious adverse events or deaths outweigh the benefits.” (COVID shots are highly safe and effective. A spokesperson for Kennedy did not respond to a request for comment.)

Especially on the right, Kennedy’s conspiracy theories have not consumed his candidacy: With concerns about conflicts of interest, his support of abortion, and generally strange behavior (such as dumping a dead bear in Central Park), there is much to debate. If Republican senators skirt around his falsehoods during today’s confirmation hearings, it will be evidence of their prevailing capitulation to Trump. And it also may be a function of Kennedy’s rhetorical sleights. As Benjamin Mazer recently wrote in The Atlantic, Kennedy is not simply a conspiracy theorist, but an excellent one. He’s capable of rattling off vaccine studies with the fluency of a virologist, which boosts his credibility, even though he’s freely misrepresenting reality.

[Read: RFK Jr. is an excellent conspiracy theorist]

During his recent appearance on Joe Rogan’s podcast, Kennedy claimed that thimerosal, a preservative containing mercury used to protect vaccines from contamination, was found to cause “severe inflammation” in the brain of monkeys. Kennedy was able to quickly name the lead author and introduce the methods as if he has read the study hundreds of times. But Kennedy’s central claim—that the brains of monkeys given thimerosal were severely inflamed—is a “total misrepresentation” of the study, its lead author, Thomas M. Burbacher, told me. The problem is that Kennedy gets away with these claims because very few listeners are going to log onto PubMed to track down the study Kennedy is referencing, let alone read through the entire thing.

In theory, senators should be equipped to push back on his schtick. RFK Jr.’s positions are hardly a mystery, and senators have advisers to help them prepare for such hearings. Regardless of Kennedy’s pseudoscientific beliefs, some Republicans may support him simply because they are wary of bucking their president. Before Kennedy even makes it to a full vote from the Senate, he has to receive approval from the Senate Finance Committee: Given the tight margins in the committee, Kennedy can’t afford to lose a single vote from Republicans sitting on that panel, assuming that no Democrats support his nomination. I reached out to the offices of seven Republican senators on the committee who haven’t already backed Kennedy for clarity on where they stand; none of them gave me a straight answer on how they’d vote.

In all likelihood, the first big decision in Kennedy’s nomination will fall to Cassidy. He has proved willing to oppose Trump before. Cassidy was one of seven Republicans who voted to convict Trump during his second impeachment proceedings. That led Louisiana’s Republican Party to formally censure him, and has drawn him a primary challenger for his 2026 reelection bid. Although Cassidy criticized Trump during the 2024 campaign, he now seems eager to support him. “Today, the American people start winning again,” Cassidy wrote in a statement on Inauguration Day.

Perhaps Cassidy will still dissect Kennedy’s views with the precision of a surgeon’s scalpel. He likes to dive deep into health-care minutiae any chance he gets. (I would know: He once pulled out his iPad and lectured me and other reporters about some arcane drug-pricing policy.) But if today’s meeting is full of softball questions, it could put RFK Jr. on his way to confirmation. That would send a message that, science-wise, the Senate is willing to cede all ground. Trump could pursue the most radical parts of the Project 2025 agenda, such as splitting up the CDC, or Kennedy could launch a full-blown assault on vaccines—and the Senate would be in a much less powerful position to stop it even if it wanted to. If senators hand the keys of a nearly $2 trillion health-care agency to a known conspiracy theorist, anything goes.

The Future of the Internet Is Age-Gated

The Atlantic

www.theatlantic.com › ideas › archive › 2025 › 01 › supreme-court-online-pornography › 681397

In the pre-internet era, turning 18 in America conferred a very specific, if furtive, privilege: the right to walk into a store and buy an adult magazine.

Technically, it still does, for those hypothetical teenagers who prefer to get their smut in print. For practical purposes, however, American children can access porn as soon as they can figure out how to navigate a web browser. That’s because, since the 1990s, America has had two sets of laws concerning underage access to pornography. In the physical world, the law generally requires young-looking customers to show ID proving they’re 18 before they can access adult materials. In the online world, the law has traditionally required, well, nothing. Under Supreme Court precedent established during the internet’s infancy, forcing websites to verify the age of their users is burdensome and ineffective, if not impossible, and thus incompatible with the First Amendment.

That arrangement finally appears to be crumbling. Last week, the Court heard oral arguments in a case concerning the legality of Texas’s age-verification law, one of many such laws passed since 2022. This time around, the justices seemed inclined to erase the distinction between accessing porn online and in person.“Explain to me why the barrier is different online than in a brick-and-mortar setting,” Justice Amy Coney Barrett requested of the lawyer representing the porn-industry plaintiffs. “Do you agree that, at least in theory, brick-and-mortar institutions shouldn’t be treated differently than online?” asked Justice Neil Gorsuch.

If the Court indeed allows Texas’s law to stand, it will mark a turning point in the trajectory of internet regulation. As more and more of our life has moved online, the two-track legal system has produced an untenable situation. And lawmakers are fed up with it. Roughly 130 million people today live in states that have a law like Texas’s, all enacted in the past three years.

[Elizabeth Bruenig: Pornography shouldn’t be so easy for kids to access]

Technology has come a long way since the Court first struck down age-verification requirements. Age verification services are now effective, easily used, and secure enough to be widely deployed. However the Court rules in this particular case, the era of the online pornography free-for-all seems to be coming to a close.

Before the internet, limiting children and teens’ access to porn was pretty simple. Businesses weren’t allowed to sell porn to kids, and to ensure that they didn’t, they were generally required to ask to see some ID.

The Communications Decency Act of 1996 was supposed to establish a similar regime for the commercial internet, which only a few years into existence was already beginning to hint at its potential to supercharge the distribution of adult material. The law made it a crime to “display in a manner available to a person under 18 years of age” any sexual content that would be “patently offensive as measured by contemporary community standards.”

The Supreme Court unanimously struck down this section of the law in the 1997 case Reno v. American Civil Liberties Union, concluding that it amounted to a “blanket restriction on speech.” The law’s biggest problem was its vague and overbroad definitions of prohibited material, but practical concerns about the difficulty of compliance also played a large role in the Supreme Court’s ruling. It repeated the lower court’s finding that “existing technology did not include any effective method for a sender to prevent minors from obtaining access to its communications on the Internet without also denying access to adults.” And in a concurring opinion, Justice Sandra Day O’Connor wrote, “Until gateway technology is available throughout cyberspace, and it is not in 1997, a speaker cannot be reasonably assured that the speech he displays will reach only adults because it is impossible to confine speech to an ‘adult zone.’”

After that defeat, Congress passed a new, narrower law designed to survive First Amendment scrutiny. The Child Online Protection Act of 1998 required websites to prevent minors from accessing “prurient” or pornographic material. That law, too, was struck down, in part because the Supreme Court opined that optional parental filters would solve the problem more effectively while restricting less speech. In the end, parental filters were never widely adopted, and within a few years, kids started getting their own devices, which were mostly out of parents’ reach.

The Supreme Court decisions, and the legislative inaction that followed them, bifurcated the rules around kids’ access to porn. In the physical world, their sins were tightly controlled—no strip clubs, no nudie mags, at least not without a fake ID. Online, they did as they pleased. According to a 2023 report, 73 percent of teens ages 13 to 17 have watched online porn. A young boy or girl can take out their smartphone, type a free porn site’s URL into their browser, and be met with an endless array of quickly loading high-definition videos of adults having sex, much of it rough. Seeing an R-rated movie at a theater would require infinitely more work.

The first crack in this regime emerged in 2022, when the Louisiana Republican state representative Laurie Schlegel first decided to act. Schlegel, a practicing sex-and-porn-addiction counselor, had been inspired to act after hearing the pop star Billie Eilish describe how porn had affected her as a child. “I started watching porn when I was, like, 11,” Eilish said on The Howard Stern Show. “I think it really destroyed my brain, and I feel incredibly devastated that I was exposed to so much porn.”

[Read: The age of AI child abuse is here]

Schlegel was also inspired by the new technology available for online identity and age verification. In 2018, Louisiana had implemented a digital-ID-card app, called LA Wallet, that state residents could use instead of a physical ID. Schlegel realized that the same system could be used to share a user’s “coarse” age—whether they are older or younger than 18, and nothing else—with a porn company. The “gateway technology” that O’Connor noted didn’t exist in 1997 was now a reality.

Schlegel’s bill, which passed the State House 96–1 and the State Senate 34–0, required businesses that publish or distribute online porn to verify that their users are at least 18, using either a digital ID or another reasonable method. The law initially flew under the national media’s radar. (“I think there were only two [journalists] that called me in 2022 asking about the law,” Schlegel told me.) But legislators in other states took notice, and by 2024, 18 more states had passed similar legislation. In states without a digital identification program like Louisiana’s, porn sites must pay third-party age-verification providers to use software to compare a user’s face with their ID photo, held up to the camera, or to use AI to determine if their face looks obviously older than 18. According to a report from the National Institute of Standards and Technology, the average margin of error for these commercial face-estimation services is about three years, meaning that those older than 21 are unlikely to ever need to show ID. In practice, this is much the same as a porn shop back in the day: Most people get through with a quick glance at their face, but people who look particularly young have to show ID.

These state laws have some weaknesses. They apply only where at least one-third of “total material on a website” is pornographic. (At oral arguments, discussion of this fact prompted Justice Samuel Alito to quip, referring to porn sites, “Is it like the old Playboy magazine? You have essays on there by the modern-day equivalent of Gore Vidal and William F. Buckley Jr.?”) The law is also toothless against websites that are hosted abroad, including the Czech porn giant XVideos, which hasn’t complied at all with state age-verification rules, a fact that millions of teenagers in those states likely already know. Underage users can also evade the restrictions by employing virtual private networks to disguise their IP address.

Still, even prohibitions that can be circumvented tend to screen many people away from a given activity, as the country’s recent experience with sports gambling and marijuana suggests in reverse. Three of the biggest porn sites in America—xHamster (which contracts an age-verification provider called Yoti), Stripchat (which uses Yoti or VerifyMy, user’s choice), and Chaturbate (which uses Incode)—have chosen to comply with the state laws.

The big holdout is Pornhub, the most popular porn site in America and one of the most viewed sites on the internet, with billions of monthly visits. It has stopped operating in all but one age-verification state. (The exception: Louisiana, thanks to its digital-ID program.) In an emailed statement, the company said that the laws “have made the internet more dangerous for adults and children” by failing to “preserve user privacy” and nudging them toward “darker corners of the internet.” A Pornhub spokesperson who goes by Ian (he declined to provide his last name) told me that age-verification laws will lead children to seek out porn from even more troubling sources.

Joining Pornhub and other porn distributors in opposition are free-speech groups, including the American Civil Liberties Union and the Foundation for Individual Rights and Expression. They argue that the age-verification laws are “overinclusive,” because they would restrict young people’s access even to a hypothetical website that was one-third porn, two-thirds non-porn. At the same time, they point out, the laws are “underinclusive,” because, thanks to the one-third rule, they leave kids free to access porn on general-interest platforms such as Reddit and X, which have quite a bit of it. And, the free-speech groups say, device-based content filters are still a better, less restrictive way to achieve the desired result.

Much of the supposed burden on free speech centers on the notion that verifying one’s age requires surrendering a great deal of privacy. That fear is understandable, given the long history of internet-based companies violating their stated privacy commitments. But a company such as Yoti is not analogous to, say, a social-media company. It isn’t sucking up user data while offering a free product; its entire business model is performing age verification. Its survival depends on clients—not only porn sites but also alcohol, gambling, and age-specific messaging sites—trusting that it isn’t retaining or selling user data. Its privacy policy states that after it verifies your age with your ID, or estimates it with AI, it deletes any personal information it has received.

[From the May 2023 issue: The pornography paradox]

“From a data-protection perspective, all of our data, all the data we collect, is only used for the purpose it was collected for—i.e., to complete an age check—and it’s immediately deleted after the age check’s completed,” Andy Lulham, the COO of VerifyMy, told me. “This is standard across the industry.” (One company that appears to trust the industry’s assurances of privacy: Pornhub. Following a 2020 article by Nicholas Kristof in The New York Times that drew attention to the site’s hosting of rape videos, Pornhub began requiring online age and identity verification, conducted by Yoti, for every performer on the site. Ian, the Pornhub spokesperson, conceded to me that extending Yoti to its users would not raise privacy concerns.)

Recent estimates suggest that most kids have watched porn by age 12. Societally, America long ago agreed that this wasn’t acceptable. Now, finally, technology has caught up to the intuition that kids shouldn’t have unfettered access to porn just because it’s on the internet.

At oral arguments, the Supreme Court seemed inclined to allow Texas’s age-verification law to stand, although it might first send the case back to the Fifth Circuit Court of Appeals with instructions to subject it to a higher standard of scrutiny than it originally did. Either way, some form of age-gating is likely here to stay.

“Were we to lose in Free Speech Coalition v. Paxton, we’ve got some new legislation ready to go,” Iain Corby, the executive director of the Age Verification Providers Association, told me. “They’re fighting a rearguard action in the porn industry, but I don’t think they’re going to be able to fight for long.”

Republican Leaders Once Thought January 6 Was ‘Tragic’

The Atlantic

www.theatlantic.com › politics › archive › 2025 › 01 › january-6-insurrection-republicans › 681360

Donald Trump promised his supporters that if he won the presidency again, he would pardon at least some of the January 6 rioters who have been prosecuted. “Tonight I’m going to be signing on the J6 hostages pardons to get them out,” he told the crowd at Capital One Arena on Monday night. “And as soon as I leave, I’m going to the Oval Office, and will be signing pardons for a lot of people.”

Many prominent Republicans seem to agree with Trump’s view that the January 6 insurrectionists, including men convicted of assaulting police officers, are government “hostages.” The view seems to be that Democrats are using the events of January 6 as an excuse to carry out what Trump calls a “witch hunt.”

Prominent Republicans weren’t always blasé about January 6. Immediately following the attack on the Capitol, and even into the following year, many leading Republicans condemned the attack on the Capitol and the police officers assigned to protect it.

As an antidote to amnesia, here is an incomplete compilation of remarks about the January 6 violence made by Republicans who now are seeking Cabinet-level positions in the new Trump administration, or are otherwise in Trump’s inner circle.

Elise Stefanik, United Nations Ambassador-Designate, January 6, 2021 (press release now deleted): “This is truly a tragic day for America. I fully condemn the dangerous violence and destruction that occurred today at the United States Capitol. Americans have a Constitutional right to protest and freedom of speech, but violence in any form is absolutely unacceptable and anti-American. The perpetrators of this un-American violence and destruction must be prosecuted to the fullest extent of the law.”

Marco Rubio, Secretary of State nominee, January 6, 2021: “There is nothing patriotic about what is occurring on Capitol Hill. This is 3rd world style anti-American anarchy.”

Kristi Noem, Homeland Security Secretary nominee, January 6, 2021 (tweet now deleted): “We are all entitled to peacefully protest. Violence is not a part of that. What’s happening in the Capitol right now must stop.”

Doug Burgum, Interior Secretary nominee, January 6, 2021: “We support the right to peacefully protest. The violence happening at our nation’s capitol is reprehensible and does not represent American values, and needs to stop immediately.”

Vivek Ramaswamy, Department of Government Efficiency co-leader, September 13, 2022: “It was a dark day for democracy. The loser of the last election refused to concede the race, claimed the election was stolen, raised hundreds of millions of dollars from loyal supporters, and is considering running for executive office again. I’m referring, of course, to Donald Trump.”

Kevin McCarthy, then–Speaker of the House, January 13, 2021: “The president bears responsibility for Wednesday’s attack on Congress by mob rioters. He should have immediately denounced the mob when he saw what was unfolding. These facts require immediate action from President Trump—accept his share of responsibility, quell the brewing unrest, and ensure that President-Elect Biden is able to successfully begin his term. And the president’s immediate action also deserves congressional action, which is why I think a fact-finding commission and a censure resolution would be prudent. Unfortunately, that is not where we are today.”

Lindsey Graham, South Carolina senator, January 6, 2021: “Those who made this attack on our government need to be identified and prosecuted to the fullest extent of the law. Their actions are repugnant to democracy.”

Mike Lee, Utah senator, January 6, 2021: “The violence at the United States Capitol is completely unacceptable. It is time for the protesters to disperse. My staff and I are safe. We are working to finish our constitutional duty to finish counting votes today.”

Ted Cruz, Texas senator, January 5, 2022: “A violent terrorist attack on the Capitol where we saw the men and women of law enforcement … risk their lives to defend the men and women who serve in this Capitol.”

Nikki Haley, 2024 presidential candidate, January 12, 2021: “We need to acknowledge [Trump] let us down. He went down a path he shouldn’t have, and we shouldn’t have followed him, and we shouldn’t have listened to him. And we can’t let that ever happen again.”

Ron DeSantis, governor of Florida and 2024 presidential candidate, January 6, 2021: “Violence or rioting of any kind is unacceptable and the perpetrators must face the full weight of the law.”

[Peter Wehner: No one will remember Jack Smith’s report]

Steve Scalise, Louisiana representative, now–House Majority Leader, January 12, 2021: “Like many Americans, I am deeply upset and outraged over the domestic terrorism we witnessed last week in our nation’s Capitol. It is clear that tensions in our country are dangerously high. It is incumbent upon leaders to be focused, first and foremost, on uniting our country and ensuring a smooth transition of power to the Biden administration over the coming days.”

John Barrasso, Wyoming senator, now–Senate Majority Whip, January 6, 2021: “This violence and destruction have no place in our republic. It must end now.”

Tom Emmer, Minnesota representative, now–Majority Whip of the House of Representatives, January 6, 2022: “One year ago, we saw an unacceptable display of violence that runs counter to everything we stand for as a country. Those responsible for the violence must continue to be held accountable, and Congress must focus on providing our men and women in law enforcement around the Capitol—and across the nation—with the resources, training, and support they need to ensure something like this never happens again.”

Lisa McClain, Michigan representative, now–chair of the House Republican Conference, January 6, 2021: “Today was an atrocious day for Democracy. What started out as Members of Congress following a sacred and Constitutional tradition, quickly was overcome by violent protestors. I wholeheartedly condemn the violence and vandalism at the Capitol and all who participated in such evil behavior. These vile acts are a slap in the face to peace-loving Americans.”

Kevin Hern, Oklahoma representative, now–Chair of the House Republican Policy Committee, January 7, 2021: “Our Capitol building has been a symbol of American freedoms and democracy around the world, yet it was invaded by law breakers seeking to undermine our republican form of government and erode those ideals. There is no excuse for the violent actions witnessed in the halls of Congress. This summer, when Antifa rioters burned American cities to the ground and held Portland hostage for over 100 days, I called for the investigation, arrest, and prosecution of those involved. I consider the crimes committed at the Capitol today to be of the same magnitude, and I support the investigation, arrest, and prosecution of those involved in the violent acts to the full extent of the law.”

Mario Díaz-Balart, Florida representative, January 6, 2021: “The Capitol building is the center and sacred symbol of democracy. Today’s violent actions undermine the principles and values that our nation was founded on. Individuals who broke into the US Capitol or assaulted our law enforcement should face the full consequences of the law.”

[Read: What I saw on the January 6 committee]

Dan Crenshaw, Texas representative, January 7, 2021: “On Wednesday the Capitol of the most powerful nation the world has ever known was stormed by an angry mob. Americans surely never thought they’d see such a scene: members of Congress barricaded inside the House chamber, Capitol Police trampled, and four Americans dead. A woman was shot near the elevator I use every day to enter the House floor. It was a display not of patriotism but of frenzy and anarchy. The actions of a few overshadowed the decent intentions of many.”

Cynthia Lummis, Wyoming senator, January 6, 2021: “Call it what it is: An attack on the Capitol is an attack on democracy. Today we are trying to use the democratic process to address grievances. This violence inhibits our ability to do that. Violent protests were unacceptable this summer and are unacceptable now.”

Cathy McMorris Rodgers, then–Washington representative, January 6, 2021 (press release now deleted): “What happened today and continues to unfold in the nation’s capital is disgraceful and un-American. Thugs assaulted Capitol Police Officers, breached and defaced our Capitol Building, put people’s lives in danger, and disregarded the values we hold dear as Americans. To anyone involved, shame on you. We must have a peaceful transfer of power. The only reason for my objection was to give voice to the concern that governors and courts unilaterally changed election procedures without the will of the people and outside of the legislative process. I have been consistent in my belief that Americans should utilize the Constitutional tools and legal processes available to seek answers to their questions about the 2020 election. What we have seen today is unlawful and unacceptable. I have decided I will vote to uphold the Electoral College results and I encourage Donald Trump to condemn and put an end to this madness.”

Rick Scott, Florida senator, January 6, 2021: “Everyone has a right to peacefully protest. No one has a right to commit violence. What happened today at the Capitol is disgraceful and un-American. It is not what our country stands for.”

John Thune, South Dakota senator, now–Senate Majority Leader, January 6, 2021: “I hope that the types of people who stormed the capitol today get a clear message that they will not stop our democracy from moving forward.”

Marsha Blackburn, Tennessee senator, January 6, 2021: “These actions at the US Capitol by protestors are truly despicable and unacceptable. While I am safe and sheltering in place, these protests are prohibiting us from doing our constitutional duty. I condemn them in the strongest possible terms. We are a nation of laws.”

John Kennedy, Louisiana senator, January 6, 2021: “I condemn this violent assault on the democratic process & will not be intimidated by a mob that confuses chaos & destruction with strength & wisdom. I’ll continue to work for LA.”

[Listen: January 6 and the case for oblivion]

Steve Daines, Montana senator, January 6, 2021: “Today is a sad day for our country. The destruction and violence we saw at our Capitol today is an assault on our democracy, our Constitution and the rule of law, and must not be tolerated. As Americans, we believe in the right to peaceful protest. We must rise above the violence. We must stand together. We will not let today’s violence deter Congress from certifying the election. We must restore confidence in our electoral process. We must, and we will, have a peaceful and orderly transition of power.”

Tim Scott, South Carolina senator and 2024 presidential candidate, January 6, 2021: “The violence occurring at the United States Capitol right now is simply unacceptable, and I fully condemn it.”

The One Trump Pick Democrats Actually Like

The Atlantic

www.theatlantic.com › politics › archive › 2025 › 01 › trump-labor-secretary-democrats-chavez-deremer › 681326

Democrats spent more than $20 million last year to end then-Representative Lori Chavez-DeRemer’s congressional career. Now, however, the Republican they worked so hard to defeat is their favorite nominee for President-Elect Donald Trump’s Cabinet.

Trump’s selection of Chavez-DeRemer for labor secretary came as a pleasant surprise to many Democrats and union leaders, who expected him to follow past Republican presidents and name a conservative hostile to organized labor. But Chavez-DeRemer endeared herself to unions during her two years in Congress. A former mayor of an Oregon suburb who narrowly won her seat in 2022, she was one of just three House Republicans to co-sponsor the labor movement’s top legislative priority: a bill known as the PRO Act, which would make unionizing easier and expand labor protections for union members.

After Chavez-DeRemer’s nomination was announced, two senior Democratic senators, Elizabeth Warren of Massachusetts and Patty Murray of Washington State, issued cautiously optimistic statements about her—a rare sentiment for Democrats to express about any Trump nominee. In addition, Sean O’Brien, the Teamsters president who spoke at last year’s Republican National Convention and whose union stayed neutral in the presidential race after repeatedly backing Democratic nominees, has championed Chavez-DeRemer’s nomination. And it has given more progressive union leaders hope that, after winning the largest vote share from union households of any Republican in 40 years, Trump might change how his party treats the labor movement.

[Annie Lowrey: The rise of the union right]

“It’s a positive move for those of us who represent workers and who want workers to have a better life,” Randi Weingarten, the president of the American Federation of Teachers and a close ally of Democratic Party leaders, told me. She noted that Chavez-DeRemer bucked her party not only by supporting the PRO Act but also by voting against private-school vouchers and cuts to public-education funding.

Trump courted union members throughout his campaign, seeing them as a key part of a blue-collar base that helped him flip states such as Michigan and Pennsylvania, which Joe Biden won in 2020. In September, his running mate, J. D. Vance, told reporters that the drop in private-sector union membership in recent decades was “a tragedy”—a statement sharply at odds with the GOP’s long-running advocacy of laws that would make unionizing harder, including in Vance’s home state of Ohio. O’Brien and congressional Republicans reportedly pushed for Trump to pick Chavez-DeRemer after the election. The decision may have been a reward for the Teamsters’ snub of Kamala Harris.

Yet until his selection of Chavez-DeRemer, Trump’s support for unions had stopped at rhetoric. He’s surrounded himself with conservative billionaires and generally sided with business interests by opposing minimum-wage increases, enhanced overtime pay, and other policies backed by organized labor. With that record in mind, Democrats have added qualifiers to their embrace of Chavez-DeRemer. “If Chavez-DeRemer commits as labor secretary to strengthen labor unions and promote worker power,” Warren said in her statement, “she’s a strong candidate for the job.”

That remains a big if. A spokesperson for the Trump transition, Aly Beley, told me that Chavez-DeRemer no longer supports the PRO Act—a major shift that will disappoint Democrats but might help her secure the GOP support she needs to win confirmation. “President Trump and his intended nominee for secretary of labor agree that the PRO Act is unworkable,” Beley said.

For the same reasons that Democrats like Chavez-DeRemer, conservatives are concerned and have pushed her to renounce her pro-union stances before Republicans agree to vote for her. “This is the one that stands out like a sore thumb,” Grover Norquist, the conservative activist and president of Americans for Tax Reform, told me of her nomination. Her support for the PRO Act, Norquist said, reflected “very bad judgment.” An anti-union group, the National Right to Work Committee, wrote in a letter to Trump before he announced Chavez-DeRemer’s nomination that she “should have no place” in his administration: “She would not be out of place in the Biden-Harris Department of Labor, which completely sold out to Big Labor from the start.”

In the Senate, Chavez-DeRemer’s nomination is not moving nearly as quickly as those of other Trump picks. The Health, Education, Labor, and Pensions Committee (HELP), which oversees the Labor Department, has not scheduled her confirmation hearing. (Republicans have prioritized hearings for Trump’s national-security nominees.) And she hasn’t met with the committee’s chair, Republican Senator Bill Cassidy of Louisiana, who issued a noncommittal statement after her nomination was announced. “I will need to get a better understanding of her support for Democrat legislation in Congress that would strip Louisiana’s ability to be a right to work state, and if that will be her position going forward,” Cassidy posted on X. Rand Paul, who also serves on the committee and is the leading sponsor of major anti-union legislation, has said little publicly about Chavez-DeRemer—and didn’t respond to a request for comment—but his chief strategist replied to the post, urging Cassidy to “stop her.” (Cassidy has been similarly lukewarm about another nominee within the committee’s jurisdiction: Robert F. Kennedy Jr., Trump’s pick for health and human services secretary.)

Chavez-DeRemer added her name to the PRO Act only a few months before last year’s election. Norquist speculated that she did so to appease unions in her district in the hopes of keeping her seat. If that was her strategy, it failed: Chavez-DeRemer lost to Democrat Janelle Bynum after one of the most expensive campaigns in the country.

Other Republicans see Chavez-DeRemer’s pro-labor stances as sincere, not strategic. A former colleague of hers, Representative Cliff Bentz of Oregon, praised her nomination and said that Trump had picked her for the Labor Department not in spite of her close ties to unions but because of them. “The fact that President-Elect Trump reached out to labor shows that he understands the need to create a better relationship between labor on the one hand and Republican folks on the other,” he told me. “And he saw in Lori exactly what he is trying to do.” Bentz said he would be surprised if Chavez-DeRemer “walks much of anything back.”

But Chavez-DeRemer wouldn’t be the first Trump Cabinet nominee to disavow a past position in order to win over Republican skeptics in the Senate. Tulsi Gabbard, the nominee for director of national intelligence, reversed her opposition to a key surveillance tool known as FISA Section 702, which was enacted after the September 11 terrorist attacks. And Kennedy is reportedly softening his long-standing attacks on vaccines in meetings with GOP senators.

[Read: America’s class politics have turned upside down]

If Chavez-DeRemer turns against the PRO Act, Democrats and unions will surely cool on her, but they won’t be shocked. Union leaders told me that they were under no illusions that Republicans would completely retract their hostility toward the labor movement, even if her nomination represented a move in that direction. “We have seen Project 2025,” Jody Calemine, the director of advocacy for the AFL-CIO, said. “That agenda is anti-worker to its very core.”

How much influence Chavez-DeRemer would have in an administration populated by corporate leaders is unclear. The PRO Act, for example, is unlikely to go anywhere in a Republican-controlled Congress even with a supportive labor secretary, and Norquist expects that the White House will exert tight control over policies enacted by Cabinet leaders, as it has during recent administrations of both parties.

To progressives, Chavez-DeRemer is clearly preferable to some of the other names Trump reportedly considered for labor secretary. Most notably, these include Andrew Puzder, the fast-food CEO whose nomination in 2017 collapsed amid ethical conflicts, revelations that he employed an undocumented immigrant as a housekeeper, and reports of labor-law violations at his company’s restaurants. She is also seen as friendlier to unions than either of Trump’s labor secretaries during his first term, Alexander Acosta and Eugene Scalia.

Chavez-DeRemer might be the best nominee Democrats can get under Trump. But labor leaders such as Weingarten will be watching closely to see how she squares her recent support for union-friendly legislation with an administration that is, in other key positions, empowering business leaders and billionaires. “This is where the rubber hits the road about whether the parties stay in their own preexisting camps” with regard to labor, Weingarten told me. She said she would lobby Democratic senators to support Chavez-DeRemer if the nominee sticks by her pro-union positions. But if she renounces them, Weingarten said, “then all bets are off.”

Time for Senate Republicans to Decide

The Atlantic

www.theatlantic.com › newsletters › archive › 2025 › 01 › time-for-senate-republicans-to-decide › 681302

This is an edition of The Atlantic Daily, a newsletter that guides you through the biggest stories of the day, helps you discover new ideas, and recommends the best in culture. Sign up for it here.

Over the next several days, many of Donald Trump’s Cabinet selections will appear before the Senate for confirmation hearings. By putting forth a series of unqualified candidates who, in other political moments, would likely not have made it this far, Trump has muddled the process before the hearings have even begun: As my colleague David Graham put it in November, “the sheer quantity of individually troubling nominees might actually make it harder for the Senate to block any of them.”

But the outcome of the Senate confirmation hearings is not a foregone conclusion. Yes, Senate Republicans have shown that they are reliably deferential toward Trump (though some drew a line at his selection of Matt Gaetz for attorney general). Many of his picks will be easily confirmed, my colleague Russell Berman, who covers politics, predicted, given the Republicans’ 53–47 majority in the Senate. But with the current makeup of the Senate, each pick can afford to lose only three GOP votes (assuming that every Democrat opposes the nomination), so for the ones who have yet to lock in support from every single Republican, the hearings could make the difference. Democrats, Russell explained to me, will attempt to use the hearings to build a case for the public that some of Trump’s nominees “are either unqualified or don’t reflect the views and values of most Americans.”

Among the first hearings is one that will reveal whether even a few Republicans are willing to defy the president-elect. Tomorrow morning at 9:30 a.m. EST, Pete Hegseth, a former Fox News host and Trump’s nominee to lead the Department of Defense, is scheduled to appear before senators. They will have much to ask him about, including Hegseth’s confirmation that he reached a financial settlement with a woman who accused him of sexual assault (though he has denied the assault allegation), accusations that he is prone to excessive drinking (he has denied having a drinking problem, and one Republican senator has claimed that Hegseth told senators that he has stopped drinking and won’t drink if confirmed), reports of his failures in leading veterans’ organizations and forced departures from those roles (which Hegseth’s camp called “outlandish claims”), and his suggestion that women shouldn’t serve in military-combat positions.

Democrats have already hammered him on these issues: Senator Elizabeth Warren released a scalding 33-page letter last week outlining questions about his fitness to serve. Republicans have also scrutinized Hegseth and other nominees, although none has yet said publicly that they would vote against any of Trump’s picks. Russell advised that in addition to the Republican moderates Senators Lisa Murkowski and Susan Collins, GOP senators to keep a close eye on throughout the hearings include Senator Mitch McConnell, who is somewhat liberated from total deference to Trump because he’s no longer leader of the party, and Senator Bill Cassidy of Louisiana, who voted to impeach Trump after January 6.

Not every pick has a hearing scheduled yet—RFK Jr., Kash Patel, Tulsi Gabbard, and others are not yet on the calendar. In recent decades, just one Cabinet nomination (John Tower, George H. W. Bush’s pick for secretary of defense) has been voted down; others who faced tough odds have withdrawn—a path Hegseth or other nominees may follow if it seems likely they won’t win enough support. Gaetz, Trump’s initial pick to lead the Justice Department, bowed out shortly after being tapped, following an ethics-committee inquiry into allegations that included sexual misconduct and illicit drug use (Gaetz has denied any wrongdoing).

Senators from both parties have pushed to see FBI background checks that, although not legally required, have been customary for a president to mandate (the agreement that Trump’s transition team signed with the DOJ did not specify whether he will require FBI involvement for his picks). Trump and his supporters have for years been attempting to damage the reputation of the FBI, and now some, including Elon Musk, are suggesting that anything the agency digs up won’t be credible. That posture, Russell explained, is another tactic to “speed up the confirmation of nominees whom the Senate might have rejected in an earlier political era.” In an effort to get their way, Trump’s allies seem poised to cast doubt on the whole process, encouraging Americans to mistrust another long-standing government norm. That legacy could last longer than Trump’s second term.

Related:

Donald Trump’s most dangerous Cabinet pick The perverse logic of Trump’s nomination circus

Here are four new stories from The Atlantic:

Maybe it was never about the factory jobs. Should you be prepping for Trump? A wider war has already started in Europe. How the ski business got too big for its boots

Today’s News

Winds are expected to pick up across parts of Los Angeles and Ventura counties, according to the National Weather Service. The wildfires in Southern California have killed at least 25 people, according to the Los Angeles Times. Federal Judge Aileen Cannon allowed the release of a portion of a report written by former Special Counsel Jack Smith about the 2020 election-interference case against Trump. President Joe Biden announced that student loans will be forgiven for more than 150,000 borrowers.

Dispatches

The Wonder Reader: Everyday decisions can accumulate into a life of isolation, Isabel Fattal writes.

Explore all of our newsletters here.

Evening Read

Illustration by Leon Edler

The Easiest Way to Keep Your Friends

By Serena Dai

The hardest part about adult friendship is, by far, scheduling time to see one another, especially when trying to plan for a group. Thursday’s bad for one person, and Saturday’s not good for another. Monday would work—but hold up, the restaurant we want to try isn’t open that day. Let’s wait a couple of weeks. Somehow, though, the day never comes. Your friends forgot to follow up, or maybe you did. Either way, can you even call one another friends anymore?

Read the full article.

More From The Atlantic

Not just sober-curious, but neo-temperate How well-intentioned policies fueled L.A.’s fires A novel that performs an incomplete resurrection Reckless driving isn’t just a design problem.

Culture Break

Illustration by The Atlantic

Explore. Strange turns of phrase online—“he’s so me for this,” “if you even care”—have seeped into daily life. A going theory about the cause is that people have gotten stupider, Kaitlyn Tiffany writes. But maybe this isn’t true.

Read. In her debut novel, Too Soon, Betty Shamieh isn’t trying to educate or enlighten, Gal Beckerman writes. She’s telling a Palestinian story unlike any other.

Play our daily crossword.

Stephanie Bai contributed to this newsletter.

When you buy a book using a link in this newsletter, we receive a commission. Thank you for supporting The Atlantic.

Bird Flu Could Have Been Contained

The Atlantic

www.theatlantic.com › health › archive › 2025 › 01 › bird-flu-embarrassing › 681264

Three years ago, when it was trickling into the United States, the bird-flu virus that recently killed a man in Louisiana was, to most Americans, an obscure and distant threat. Now it has spread through all 50 states, affecting more than 100 million birds, most of them domestic poultry; nearly 1,000 herds of dairy cattle have been confirmed to be harboring the virus too. At least 66 Americans, most of them working in close contact with cows, have fallen sick. A full-blown H5N1 pandemic is not guaranteed—the CDC judges the risk of one developing to be “moderate.” But this virus is fundamentally more difficult to manage than even a few months ago and is now poised to become a persistent danger to people.

That didn’t have to be the reality for the United States. “The experiment of whether H5 can ever be successful in human populations is happening before our eyes,” Seema Lakdawala, a flu virologist at Emory University, told me. “And we are doing nothing to stop it.” The story of bird flu in this country could have been shorter. It could have involved far fewer cows. The U.S. has just chosen not to write it that way.

[Read: America’s infectious-disease barometer is off]

The USDA and the CDC have doggedly defended their response to H5N1, arguing that their interventions have been appropriately aggressive and timely. And governments, of course, don’t have complete control over outbreaks. But compared at least with the infectious threat most prominent in very recent memory, H5N1 should have been a manageable foe, experts outside of federal agencies told me. When SARS-CoV-2, the virus that sparked the coronavirus pandemic, first spilled into humans, almost nothing stood in its way. It was a brand-new pathogen, entering a population with no preexisting immunity, public awareness, tests, antivirals, or vaccines to fight it.

H5N1, meanwhile, is a flu virus that scientists have been studying since the 1990s, when it was first detected in Chinese fowl. It has spent decades triggering sporadic outbreaks in people. Researchers have tracked its movements in the wild and studied it in the lab; governments have stockpiled vaccines against it and have effective antivirals ready. And although this virus has proved itself capable of infiltrating us, and has continued to evolve, “this virus is still very much a bird virus,” Richard Webby, the director of the World Health Organization Collaborating Centre for Studies on the Ecology of Influenza in Animals and Birds, told me. It does not yet seem capable of moving efficiently between people, and may never develop the ability to. Most human cases in the United States have been linked to a clear animal source, and have not turned severe.

The U.S., in other words, might have routed the virus early on. Instead, agencies tasked with responding to outbreaks and upholding animal and human health held back on mitigation tactics—testing, surveillance, protective equipment, quarantines of potentially infected animals—from the very start. “We are underutilizing the tools available to us,” Carol Cardona, an avian-influenza expert at the University of Minnesota, told me. As the virus ripped through wild-animal populations, devastated the nation’s poultry, spilled into livestock, started infecting farmworkers, and accumulated mutations that signaled better adaptation to mammals, the country largely sat back and watched.

When I asked experts if the outbreak had a clear inflection point—a moment at which it was crucial for U.S. leaders to more concertedly intervene—nearly all of them pointed to the late winter or early spring of last year, when farmers and researchers first confirmed that H5N1 had breached the country’s cattle, in the Texas panhandle. This marked a tipping point. The jump into cattle, most likely from wild birds, is thought to have happened only once. It may have been impossible to prevent. But once a pathogen is in domestic animals, Lakdawala told me, “we as humans have a lot of control.” Officials could have immediately halted cow transport, and organized a careful and concerted cull of infected herds. Perhaps the virus “would never have spread past Texas” and neighboring regions, Lakdawala told me. Dozens of humans might not have been infected.

[Read: America’s bird-flu luck has officially run out]

Those sorts of interventions would have at least bought more of the nation time to provision farmworkers with information and protection, and perhaps develop a plan to strategically deploy vaccines. Government officials could also have purchased animals from the private sector to study how the virus was spreading, Cardona told me. “We could have figured it out,” she said. “By April, by May, we would have known how to control it.” This sliver of opportunity was narrow but clear, Sam Scarpino, an infectious-disease modeler and flu researcher at Northeastern University, whose team has been closely tracking a timeline of the American outbreak, told me. In hindsight, “realistically, that was probably our window,” he said. “We were just too slow.”

The virus, by contrast, picked up speed. By April, a human case had been identified in Texas; by the end of June, H5N1 had infected herds in at least a dozen states and more than 100 dairy farms. Now, less than 10 months after the USDA first announced the dairy outbreak, the number of herds affected is verging on 1,000—and those are just the ones that officials know about.

The USDA has repeatedly disputed that its response has been inadequate, pointing out to The Atlantic and other publications that it quickly initiated studies this past spring to monitor the virus’s movements through dairy herds. “It is patently false, and a significant discredit to the many scientists involved in this work, to say that USDA was slow to respond,” Eric Deeble, the USDA’s deputy undersecretary for marketing and regulatory programs, wrote in an email.

And the agency’s task was not an easy one: Cows had never been a known source of H5N1, and dairy farmers had never had to manage a disease like this. The best mitigation tactics were also commercially formidable. The most efficient ways to milk cows invariably send a plume of milk droplets into the air—and sanitizing equipment is cumbersome. Plus, “the dairy industry has been built around movement” of herds, a surefire way to move infections around too, Cardona told me. The dairy-worker population also includes many undocumented workers who have little incentive to disclose their infections, especially to government officials, or heed their advice. At the start of the outbreak, especially, “there was a dearth of trust,” Nirav Shah, the principal deputy director of the CDC, told me. “You don’t cure that overnight.” Even as, from the CDC’s perspective, that situation has improved, such attitudes have continued to impede efforts to deploy protective equipment on farms and catch infections, Shah acknowledged.

Last month, the USDA did announce a new plan to combat H5N1, which requires farms nationwide to comply with requests for milk testing. But Lakdawala and others still criticized the strategy as too little, too late. Although the USDA has called for farms with infected herds to enhance biosecurity, implementation is left up to the states. And even now, testing of individual cows is largely left up to the discretion of farmers. That leaves too few animals tested, Lakdawala said, and cloaks the virus’s true reach.

The USDA’s plan also aims to eliminate the virus from the nation’s dairy herds—a tall order, when no one knows exactly how many cattle have been affected or even how, exactly, the virus is moving among its hosts. “How do you get rid of something like this that’s now so widespread?” Webby told me. Eliminating the virus from cattle may no longer actually be an option. The virus also shows no signs of exiting bird populations—which have historically been responsible for the more severe cases of avian flu that have been detected among humans, including the lethal Louisiana case. With birds and cows both harboring the pathogen, “we’re really fighting a two-fronted battle,” Cardona told me.

Most of the experts I spoke with also expressed frustration that the CDC is still not offering farmworkers bird-flu-specific vaccines. When I asked Shah about this policy, he defended his agency’s focus on protective gear and antivirals, noting that worker safety remains “top of mind.” In the absence of consistently severe disease and evidence of person-to-person transmission, he told me, “it’s far from clear that vaccines are the right tool for the job.”

[Read: How much worse would a bird-flu pandemic be?]


With flu season well under way, getting farmworkers any flu vaccine is one of the most essential measures the country has to limit H5N1’s threat. The spread of seasonal flu will only complicate health officials’ ability to detect new H5N1 infections. And each time bird flu infects a person who’s already harboring a seasonal flu, the viruses will have the opportunity to swap genetic material, potentially speeding H5N1’s adaptation to us. Aubree Gordon, a flu epidemiologist at the University of Michigan, told me that’s her biggest worry now. Already, Lakdawala worries that some human-to-human transmission may be happening; the United States just hasn’t implemented the infrastructure to know. If and when testing finally confirms it, she told me, “I’m not going to be surprised.”