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President Trump's tax and spending bill set in motion nearly $1 trillion in cuts to Medicaid and other health policy changes that could loom over the midterm elections.

• But the real effects likely won't be felt until well after the ballots are cast.

Why it matters: Bill supporters could be insulated from political blame by a slow drip of policy changes that will play out over the next decade — a contrast to when Republicans tried to repeal Obamacare in 2017.

• "Republicans backloaded a lot of the Medicaid and ACA cuts," said Larry Levitt, executive vice president at KFF. "There will be few tangible effects in health care from this bill before the midterms."
• That creates a messaging challenge for Democrats, he added. "There's not going to be a day where everyone wakes up and all of a sudden ... more people are uninsured."

What's inside: Medicaid work requirements, which account for many of the nearly 12 million people projected to lose coverage under the bill, generally won't kick in until 2027, and some states could get extensions.

Yes, but: People covered through the Affordable Care Act exchanges will see changes more swiftly. The bill does not extend the Biden-era enhanced premium subsidies that expire at year's end, and the GOP-led Congress has shown little appetite for finding other legislative vehicles.

• Obamacare premiums would increase by more than 75% on average for enrollees next year without the enhanced subsidies.
• That would give Democrats "a very potent talking point going into the midterms," Levitt noted.

Reality check: Hospitals and clinics have to plan ahead and already are making contingencies for the Medicaid cuts and coverage losses. That could translate into facility closures or the elimination of some services.

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There have been 1,267 confirmed cases of measles in the U.S. this year, almost 4.5 times the total for all of last year and on track to pass the highest annual count since the disease was declared eliminated in 2000, according to the CDC.

Why it matters: While the disease isn't consistently spreading due to immunization campaigns, there have been outbreaks well beyond West Texas, where low immunization rates and high school exemptions stoked spread of the highly contagious virus early this year.

Driving the news: 27 outbreaks have been reported in the U.S. so far this year, accounting for 88% percent of the cases. In comparison, there were 16 outbreaks in all of 2024, and 69% of cases were associated with them.

• There have been three confirmed deaths this year.
• Measles cases have been confirmed in 38 states.
• Of the 1,267 cases, 360 (28%) were in kids younger than 5 and 464 (37%) were in kids between the ages of 5 and 19 years old.

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It's not food, it's not chewing tobacco and it's not gum — though it might look like it when you see it — but it is becoming America's new addictive obsession.

Why it matters: Sales of Zyn nicotine pouches are soaring, prompting the tobacco company that makes them to scramble to boost U.S. production to meet demand.

The big picture: People are popping nicotine pouches into their mouths at games, at the movies, at the workplace, at home, at the store — it's America's new addictive habit.

• Actor Josh Brolin even admitted to using it while sleeping (which is not recommended).

How it works: Zyn pouches are placed between the gum and lip, gradually releasing nicotine over time.

• The pouches are discreet and don't produce smoke or odors like cigarettes.

Threat level: The product is addictive because nicotine is addictive.

• But it does not cause cancer since it doesn't contain tobacco, whose harmful chemicals are carcinogenic. As a result, advocates say nicotine pouches can serve as a safer alternative to smoking.
• Philip Morris International U.S. CEO Stacey Kennedy argued that nicotine is "misunderstood" and contains "cognitive benefits."

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America’s beverage companies are providing Americans with the choices they want and the information they need to make the best decisions for their families. We’ve transformed the beverage aisle and are empowering Americans to find balance.

Learn more at BalanceUS.org.

Senate health committee Chair Bill Cassidy (R-La.) is due to unveil a bill today that would make it easier for companies to offer benefits to gig workers without making them full-fledged employees.

Why it matters: As more Americans turn to gig work and self-employment, there's a growing push to get them access to things like paid sick leave, health insurance and retirement benefits.

Zoom in: The bill is part of legislative package from Cassidy, along with Sen. Tim Scott (R-S.C.) and Sen. Rand Paul (R-Ky.).

How it works: Under the legislation, companies would be able to voluntarily offer benefits without taking on the liabilities involved in actually employing these workers and having to pay for unemployment insurance, overtime pay and workers' comp.

The big picture: There's been a decade-long fight over the employment status of gig workers.

• Labor advocates argued companies like Uber and Lyft should treat them like employees. The Biden administration and some states tried to push businesses in this direction with proposed laws and lawsuits.
• Companies and Republicans — even some workers — aggressively fought back, arguing that drivers were independent contractors. They largely won.

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