State-level efforts to regulate fertility coverage reveal the gauntlet of budgetary and political hurdles such initiatives face — obstacles that have led to millions of people being left out even when mandates become law.

A KFF Health News analysis underscores how the terminations have spared no part of the country, politically or geographically. Of the organizations that had grants cut in the first month, about 40% are in states President Donald Trump won in November.

Republicans are pushing to implement requirements that Medicaid recipients work in order to obtain or retain coverage. Some states try to help enrollees find jobs. But states lack the data to show whether they’re effective.

Some rural hospitals have canceled — or are considering ending — contracts with insurance companies that offer Medicare Advantage plans, saying the private policies jeopardize their finances and impede patient care.

Public health and science researchers are concerned about the Trump administration’s cuts to the Centers for Disease Control and Prevention. Reductions in staff and budgets could undermine the nation’s ability to respond to threats, they say.