There are more than 600 measles cases in Texas alone as the U.S. outbreak spreads further. Federal health officials have said that number is also likely an undercount.

West Texas is the epicenter of the largest outbreak in the country, while the number of cases nationally has topped 800.

Amid the surge in cases, a new survey from health policy research group KFF found measles misinformation is also rising and more Americans are being exposed to it.

The survey showed 33 percent of respondents had “heard” or “read” the false claim that “getting the measles vaccine is more dangerous than becoming infected with measles.” That’s compared to 18 percent who reported hearing the claim in 2024, according to the tracking poll.

Knowledge about the outbreak is also highly polarized. About two-thirds of Republican-leaning parents said they were unaware of an uptick in measles cases this year, while about two-thirds of Democratic ones said they knew about it, according to the latest poll.

About 35 percent of Republicans in the survey said they thought the discredited theory linking the measles, mumps and rubella (MMR) vaccine to autism was definitely or probably true — compared with just 10 percent of Democrats.

Food and Drug Administration Commissioner Marty Makary touted the MMR vaccine in a Wednesday interview on CNN, though stopped short of saying that parents should go get their kids the shot.

“Vaccines save lives, and any child who dies from a vaccine preventable disease is a tragedy,” Makary said in an interview with Dana Bash.

When asked directly if parents should vaccinate their children, Makary said, “I believe in the MMR shot.”

Nearly all the cases in Texas are among unvaccinated individuals.

Two unvaccinated children in Texas have died from measles, and the death of one unvaccinated adult in New Mexico has been linked to the outbreak. The adult tested positive for measles, but the official cause of death is still under investigation.
The children had no known underlying conditions.

The West Texas outbreak has predominantly centered among members of a local Mennonite community.

A Centers for Disease Control and Prevention official last week said more than 90 percent of the cases are “driven by transmission in close-knit, undervaccinated communities.”

There are more than 600 measles cases in Texas alone as the U.S. outbreak spreads further. Federal health officials have said that number is also likely an undercount.

They’re the fixers, the ones who step in when Affordable Care Act enrollees have a problem with their coverage, like a newborn incorrectly left off a policy or discovering that a rogue broker had signed them up or switched their plan without consent.

Specially trained caseworkers help resolve such issues, which might otherwise cause consumers to rack up large doctors’ bills or prevent them or their family members from getting care.

Now, though, the broad federal reduction in force set in motion by the Trump administration has cut the ranks of those caseworkers, slashing two out of six divisions of caseworkers, according to one affected worker and a former Centers for Medicare & Medicaid Services official familiar with the situation, Jeffrey Grant.

Currently, the number of ACA enrollees is at an all-time high of 24 million. The ACA — known as Obamacare — has long drawn disfavor from Republicans and Trump himself. The health law faces additional changes next year that, if adopted, could sow confusion and more problems. Consumers would face a new learning curve with extra paperwork and rules. And the caseworker cuts might extend the time needed to resolve any difficulties.

“It impacts not only our jobs, but all these people we serve,” said one New York City-based caseworker, who was let go in a Feb. 14 purge affecting federal employees in their probationary periods. “Usually, we would have on average 14 days to take care of a case that was very difficult, although the urgent cases would be solved within two to three business days. It will now be delayed so much more. Whole teams got wiped out completely.”

NPR and KFF Health News are not naming the two affected workers in this article because they fear professional or personal repercussions for speaking to the media.

The two teams of caseworkers were dismantled in a haphazard fashion that left some workers without an official notice but locked out of their computers.

The cuts have demoralized caseworkers, whose jobs demand a grasp of complex and arcane health insurance rules in a little-known government department that most consumers don’t interact with — CMS’ Exchange Customer Solutions Group — until they need help.

“The loss in staffing is going to reduce the ability for people to get through” to caseworkers after contacting the marketplace or other organizations for help, said Jackie Kiger, executive director of Pisgah Legal Services, a nonprofit that provides legal and ACA help for North Carolina consumers and is facing a budget reduction under a separate effort by the Trump administration to cut “navigator” funding by 90%. Navigators are government-funded nonprofits that help people enroll in the ACA or resolve problems with coverage.

The federal force reduction aims to decrease the number of employees at agencies within the Department of Health and Human Services from 82,000 to 62,000, including the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, and CMS.

CMS, which oversees the ACA and other government health programs, will lose about 300 workers, including about 30 caseworkers scattered nationwide. The cuts come amid thousands of other federal job losses, including front-line workers across an array of agencies, from Social Security field offices to the National Park Service.

In a press release, HHS estimated its reduction in force will save taxpayers $1.8 billion per year. No one from CMS responded to KFF Health News’ questions about the caseworker reductions.

What will be affected?

When consumers have a problem with their ACA plan, their first step is usually to call the federal or state marketplace where they purchased coverage.

Those call centers can handle basic questions about plans purchased on the federal exchange, which serves 31 states. (State marketplaces handle their own complex cases and don’t rely on federal caseworkers.)

When someone calls the federal marketplace 800 number with coverage problems, the inquiry probably winds up on a caseworker’s desk, said one affected caseworker. That employee received a reduction-in-force notice several days after losing access to their work computer on April 1.

Caseworkers usually don’t speak directly with consumers, the worker said. Using information sent over by the federal marketplace — including notes taken when consumers called in with problems, as well as ACA applications — they handle or oversee consumer requests, such as canceling a plan or adding a member.

One of the last problems handled by that caseworker involved a child born in November who was not added correctly to the family’s plan for 2024, meaning any care the child received during the last two months of the year was not covered and the family risked being stuck with the bills.

“This person did everything right, including calling the marketplace within 60 days to report the birth and add the newborn to their coverage,” said the worker, who was quickly able to resolve it because it was a marketplace error.

The worker, who is now soured on federal employment and will look for a new job in the private sector, said that caseworkers handled an average of 30 issues a day, but that in recent months the number kept climbing, heading past 45, and grew even more intense after the Feb. 14 dismissal of probationary employees.

“It’s not an easy job,” the worker said, noting the challenge of constantly evolving rules and policies governing health plans.

Ferreting out fraud

In the past year, caseworkers have dealt with cases involving unauthorized enrollments or switching, a problem that ticked up in late 2023, according to KFF Health News investigations, and continued through much of last year, resulting in at least 274,000 complaints to CMS through August.

The complaints centered on practices by rogue brokers who enrolled or switched coverage for consumers without their express knowledge. The result could leave them without access to their health provider networks, drug coverage, or even facing a tax bill.

Though it is unclear how many such complaints fell to a federal caseworker, some improperly switched consumers want to be restored into plans they had originally chosen, while others want them canceled.

“I have seen people who were enrolled and every two or three months a broker would switch them to a different plan,” said the caseworker who was locked out in April. “The more health plans they were enrolled in, the more difficult it was to handle on the back end.”

New hires spend months learning the ropes.

The New York-based worker let go in February during her probationary period said she had joined CMS in October and spent three months in training. Just about a month after completing that training, she was let go — a bitter irony, she said, because she had sought stability in a job with the federal government, having experienced a layoff during her private-sector career.

“I took a huge pay cut — over $40,000 — when I went from the private sector into the government,” said the mother of three whose husband serves in the military. Her federal salary was about $76,000, which is not high for an expensive market like the New York metropolitan area. “But I took it as an opportunity to get in the door and move up. Then, boom, I get hit with another layoff.”

“I can only imagine how hard it is for people with 10 to 15 years with the government who are banking on it for retirement,” she said.

Starting next year, the Trump administration has proposed several changes to the ACA, including ending year-round eligibility for very low-income applicants, requiring additional financial and eligibility documentation, and charging some people a monthly $5 fee when auto-reenrolled in coverage until they confirm their eligibility.

Such changes will “make things harder, so there you will have more things that go wrong,” said Grant, the former CMS official, who founded Schedule F Healthcare Strategies after leaving CMS. “You will then also have fewer caseworkers to handle the work.”

Summary: New research reveals how dopamine helps the brain learn to avoid unpleasant outcomes by responding differently in distinct brain regions during negative experiences. In a study with mice, scientists tracked dopamine activity over time as animals learned to escape an adverse event, showing that one brain area adapted early in learning while another supported long-term avoidance behavior.

These findings challenge simplistic views of dopamine as purely “rewarding” and suggest it plays a critical role in adaptive — and maladaptive — learning from threats. The study may offer insights into psychiatric conditions marked by excessive avoidance, like anxiety and OCD, and underscores why the trendy idea of a “dopamine detox” misses the complexity of this vital brain chemical.

Dopamine is the brain’s motivational spark, driving us to chase what feels good, say scrolling another reel on social media, and steer clear of what doesn’t, like touching a hot stove.

But scientists haven’t fully understood how dopamine helps us learn to avoid bad outcomes — until now.

A new study from Northwestern University shows that dopamine signals in two key brain areas involved in motivation and learning respond differently to negative experiences, helping the brain adapt based on whether a situation is predictable or controllable.

While previous research has shown that dopamine can respond to negative experiences, this is the first study to track how those signals evolve over time as animals move from novices to experts in avoiding them.

The study will be published April 22 in the journal Current Biology. 

The study authors said the findings help explain how we learn from bad experiences, and why some people learn to avoid danger better than others.

They also shed light on how excessive avoidance — a hallmark symptom of multiple psychiatric conditions such as anxiety, obsessive-compulsive disorder and depression — may come to be via alterations in dopamine function.

This can lead to an overestimation of danger in the environment and a decreased quality of life as the brain prioritizes avoiding certain experiences.

Finally, the study helps explain why the concept behind the recent “dopamine-detox” wellness trend is too simplistic.

“Dopamine is not all good or all bad,” said first author Gabriela Lopez, a doctoral candidate in the Interdepartmental Neuroscience Program at Northwestern University Feinberg School of Medicine.

“It rewards us for good things but also helps us tune into cues that signal trouble, learn from consequences and continuously adapt our learning strategies in unstable environments.”

How the study worked

In the study, scientists trained mice to respond to a five-second warning cue that predicted an unpleasant outcome. If the mice moved to the other side of a two-chamber box during the warning cue, they could avoid the outcome entirely.

As the mice learned the task, researchers recorded dopamine activity in two areas of the nucleus accumbens, a brain region involved in motivation and learning.

Previous research had suggested that dopamine in the ventromedial shell of the nucleus accumbens increases during bad experiences, while dopamine in the core of the nucleus accumbens decreases.

Therefore, the scientists wanted to understand how these different dopamine responses work together when the mice learn to avoid bad experiences.

They found that the two areas of the nucleus accumbens responded differently:

• In the ventromedial shell, dopamine levels initially surged in response to the unpleasant event itself. As the mice actively learned about the meaning of the warning cue, the dopamine response shifted to the cue itself. Eventually, though, the dopamine response faded away as the mice became skilled at avoiding the outcome.
• In the core, dopamine decreased for both the unpleasant event and the warning cue. The reduction in dopamine in response to the warning cue steadily increased throughout training, especially as the mice became more successful at avoiding the event.

“These responses are not only different in their sign — where in one area, dopamine goes up for something bad and, in the other area, it goes down for something bad — but we also saw that one is important for early learning while the other one is important for later-stage learning,” said corresponding author Talia Lerner, associate professor of neuroscience and psychiatry and behavioral sciences at Feinberg.

Later, the researchers tested what would happen when the outcome couldn’t be avoided, regardless of the mice’s actions.

Under those conditions, dopamine patterns returned to what they looked like earlier in training — suggesting that these brain signals are sensitive to context and may help animals adapt their behavior when the environment changes.

“This shows that the dopamine signals are flexible, sensitive to task rules, and may help us adapt to changes in the environment,” Lopez said.

Why a ‘dopamine detox’ is too simplistic

People have been singing the praises of the “dopamine detox” wellness trend — cutting out things that trigger a dopamine rush, like eating junk food or scrolling social media, to regain control over these behaviors.

But this study helps explain why the concept of a “dopamine detox” is too simplistic.

“We think of dopamine as a learning molecule that is important for normal behavior in everyday life,” Lopez said. “So, cutting it out completely can do more harm than good.”

Next steps

“The dopamine signals we are studying are important for representing aversive signals that are involved in problems like chronic pain, depression and withdrawal from addictive substances,” Lopez said.

“Overactive avoidance learning may also be a pathway that contributes to obsessive-compulsive disorder and other clinical anxiety disorders. We hope to follow up on these basic research findings to address clinical problems affecting patients.”

A simple blood test could reveal who is at high risk of skin cancer recurrence after tumor-removal surgery.

The test can detect fragments of tumor DNA with a simple blood draw to reveal the lingering presence of Stage III melanoma — a metastatic form of the deadliest form of skin cancer — that can’t be seen with CT scans. Although the test isn’t perfect, it could help flag patients who need aggressive treatment because their cancer is likely to come back.

“We’re envisioning the test being used to monitor patients over time (perhaps every month or couple of months in the first 1-3 years after surgery) for an early indication that the melanoma is recurring,” study senior author Dr. David Polsky, a dermatologic oncologist at the New York University Grossman School of Medicine, told Live Science in an email.

If the test showed signs of tumor DNA, Polsky continued, the doctor might choose to use more advanced imaging techniques to search for small, easy-to-miss tumors, or they might move to a more aggressive treatment regimen that uses a combination of cancer drugs instead of just one, for example.

Melanoma is a cancer of melanocytes, a type of pigmented skin cell. It accounts for only 1% of skin cancers, but it causes the most skin cancer deaths because it can quickly spread to other organs, or metastasize. Early detection is one of the best ways to boost the likelihood of survival.

Polsky and his colleagues focused on Stage III melanoma, which is melanoma that has spread to nearby lymph nodes, where immune cells are made and stored. Doctors perform surgery to remove as much of the cancer as possible before starting medications to kill any remaining tumor cells.

Patients then get CT scans to look for any signs of recurrence, but some patients have tiny deposits of melanoma that are too small to be detected by CT. To catch those deposits earlier, Polsky and his team turned to circulating tumor DNA, or ctDNA. These are DNA fragments released from tumor cells during their normal life cycle. The fragments circulate in the plasma — the liquid portion of the blood — and can be detected by telltale mutations that are unique to cancer.

As part of a larger clinical trial of a combination of cancer drugs, the research team studied blood samples from 597 patients who had recently undergone surgery. The participants also had follow-up blood samples taken three months, six months, nine months and 12 months after either starting a treatment or receiving a placebo.

Immediately after surgery, 13% of the patients had detectable ctDNA in their blood plasma. Every single one of these patients experienced a cancer recurrence, the researchers found. Patients were also more likely to see their melanoma return when their ctDNA rose during the follow-up tests or if the ctDNA remained persistently high over the course of the testing.

The presence of the ctDNA predicted the return of the cancer 100% of the time; no one with a positive test escaped melanoma relapse. But the absence of ctDNA did not mean the patients were out of the woods. A negative test was correct 71% of the time in predicting that the person’s cancer would not return. But some patients with no detectable ctDNA still saw recurrence.

“[T]he tests are highly accurate when they are positive, but not as accurate when they are negative,” Polsky said.

The study’s results were published April 15 in the journal The Lancet Oncology. The next step, Polsky said, is to make the test available to a clinical molecular pathology laboratory, where it can be used to make decisions about treatment. A clinical trial can then show whether using the blood test leads to better outcomes than not using them — a measure called “clinical utility.”

“Demonstrating clinical utility of the test would be a major advance for the management of melanoma patients whose disease has spread beyond the skin,” Polsky said.