The escalation of ICE activity in Minnesota is disrupting care at hospitals and clinics that already were navigating shifting legal standards on immigration enforcement in their facilities.

Why it matters: Health workers say many patients aren't coming in for necessary care out of fear they'll be detained by federal agents.

• "This has become a public health crisis," Janell Johnson Thiele, a nurse and union leader at Hennepin County Medical Center in Minneapolis, told Axios.

State of play: ICE agents have been reported at and near hospitals around the Twin Cities as President Trump's immigration crackdown continues.

• At a news conference last week, Minnesota OB-GYN Erin Stevens said she's seen an increase in requests for home births from patients afraid to enter hospitals.
• "Many of our patients, undocumented immigrants, naturalized citizens and U.S.-born citizens alike, fear leaving their homes for access to health care," Stevens said at the news conference. "They expressed to us a feeling of being hunted."
• Family physician Roli Dwivedi described a mother and child being forcibly separated in a clinic parking lot while visiting to fill a prescription. Some patients are even hesitating to make telehealth appointments because they're scared to take phone calls, she said.

Zoom out: Similar incidents have been reported elsewhere. Agents reportedly detained a mother, father and child outside of a Portland, Oregon, hospital earlier this month as the family was on their way into the emergency room.

Department of Homeland Security Assistant Secretary Tricia McLaughlin said in an email to Axios that ICE does not conduct enforcement at hospitals.

• "If anyone is impeding Minnesotans from making appointments or picking up prescriptions, it's violent agitators who are blocking roadways, ramming vehicles and vandalizing property," she said.

Yes, but: Health care providers say federal agents' presence is keeping them from doing their jobs.

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Medicare administrators yesterday proposed keeping federal payments to private Medicare plans roughly flat in 2027 and eliminating a practice that allows the insurers to add diagnoses after reviewing patients' medical records.

Why it matters: It was bad news for UnitedHealth Group, Humana, CVS Health and Elevance, among other carriers, who received a more than 5% payment bump this year. Shares of big insurers fell on the announcement.

Driving the news: The average 2027 rate increase of .09% for Medicare Advantage plans — equivalent to $700 million — reflects growth rates of underlying health costs and efforts to ensure greater payment accuracy, CMS said in a notice.

• Diagnoses that are not reported or associated with documented treatment also would not factor in payments — a move that addresses coding practices that have received scrutiny and that the Wall Street Journal found added billions of extra payments from 2018 to 2021.
• Medicare has given insurers the option to add diagnoses to reflect conditions doctors may have missed.

CMS administrator Mehmet Oz had pledged to go after overpayments to insurers during his confirmation hearing last year.

• The agency yesterday said it's proposing updates to the Medicare prescription drug risk adjustment model that account for changes to the Part D benefit stemming from the Inflation Reduction Act.
• The payment proposal "is inadequate to offset acute pressure from the rising medical costs," Evercore ISI analyst Elizabeth Anderson wrote in a note.
• The insurer group AHIP said the proposal could result in benefit cuts and higher costs for 35 million Medicare recipients when they renew their MA coverage.

The medical association representing pediatricians broke with the CDC on childhood immunizations yesterday, issuing revised recommendations against 18 diseases that contrast with the administration's recently slimmed-down vaccine schedule.

Why it matters: The American Academy of Pediatrics' guidance is largely unchanged from 2025 but reflects the deepening rift between the federal government and medical establishment over inoculating kids.

• A dozen medical and health care organizations endorsed the group's recommendations.

What's inside: The pediatricians' schedule continues broad endorsements of vaccines targeting RSV, hepatitis A and B, rotavirus, influenza, meningococcal disease, measles and pertussis.

• It also stresses the importance of measles vaccines in light of recent outbreaks, noting more than 2,200 measles cases and three associated deaths in the past year.

What they're saying: "It is important that we have a stable, trusted, evidence-based immunization schedule to follow," said Pia Pannaraj, a member of the AAP Committee on Infectious Diseases and a professor of pediatrics at the University of California San Diego.

The other side: An HHS spokesperson said: "AAP is angry that CDC eliminated corporate influence in vaccine recommendations by reconstituting the Advisory Committee on Immunization Practices."

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The administration is threatening to cut federal funding to Illinois over abortion access.

Driving the news: HHS last week alleged the state is violating federal conscience laws by requiring Illinois health care providers who oppose abortion on religious or moral grounds to provide counseling and refer patients to a provider who does perform abortions.

Why it matters: Since the Supreme Court overturned Roe v. Wade, Illinois emerging as a leader in providing abortion care. This move by HHS is an attempt by the feds to chip away at access in the state.

• It's unclear how much funding is at stake. HHS did not respond, and the governor's office did not specify an amount when Axios asked.

Catch up quick: The HHS notice was in response to a 2018 complaint from the Chicago-based Thomas More Society, a law firm that regularly challenges reproductive rights laws.

• The organization filed the suit on behalf of a physician at Hope Life Center who could not in conscience "perform or promote" abortion, which he argued Illinois law forces him to do by providing patients with information on how to obtain that care.

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🏛️ Casey Means' nomination hearing for surgeon general was rescheduled for Feb. 25 after it was postponed due to her pregnancy. (National Journal)

🦠 Britain and several other European countries have lost their measles elimination status, the World Health Organization said, after a jump in infections across the continent. (Reuters)

⚕️ Nearly half of the mortality gap between Black and white adults can be traced to the cumulative toll of stress and heightened inflammation, a new study found. (WashPost)