The Host
Julie Rovner 鶹Ů Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of 鶹Ů Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.The enhanced premium tax credits that since 2021 have helped millions of Americans pay for insurance on the Affordable Care Act marketplaces will expire Dec. 31, despite a last-ditch effort by Democrats and some moderate Republicans in the House of Representatives to force a vote to continue them. That vote will happen, but not until Congress returns in January.
Meanwhile, the Department of Health and Human Services canceled a series of grants worth several million dollars to the American Academy of Pediatrics after the group again protested HHS Secretary Robert F. Kennedy Jr.’s changes to federal vaccine policy.
This week’s panelists are Julie Rovner of 鶹Ů Health News, Lizzy Lawrence of Stat, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico.
Panelists
Lizzy Lawrence Stat Tami Luhby CNN Alice Miranda Ollstein PoliticoAmong the takeaways from this week’s episode:
- The House on Wednesday passed legislation containing several GOP health priorities, including policies that expand access to association health plans and lower the federal share of some Affordable Care Act exchange marketplace premiums. It did not include an extension of the expiring enhanced ACA premium tax credits — although, also on Wednesday, four Republicans signed onto a Democratic-led discharge petition forcing Congress to revisit the tax credit issue in January.
- In vaccine news, the American Academy of Pediatrics spoke out against the federal government’s recommendation of “individual decision-making” when it comes to administering the hepatitis B vaccine to newborns — and HHS then terminated multiple research grants to the AAP. Meanwhile, the Centers for Disease Control and Prevention is funding a Danish study of the hepatitis B vaccine in West Africa through which some infants will not receive a birth dose, a strategy that critics are panning as unethical.
- Also, a second round of personnel cuts at the Department of Veterans Affairs is expected to exacerbate an existing staffing shortage and further undermine care for retired service members.
- The FDA is considering rolling back labeling requirements on supplements — a “Make America Health Again”-favored industry that is already lightly regulated.
- And abortion opponents are pushing for the Environmental Protection Agency to add mifepristone to the list of dangerous chemicals the agency tracks in the nation’s water supply.
Also this week, Rovner interviews Tony Leys, who wrote the latest “Bill of the Month” feature, about an uninsured toddler’s expensive ambulance ride between hospitals.
Plus, for a special year-end “extra-credit” segment, the panelists suggest what they consider 2025’s biggest health policy themes:
Julie Rovner: The future of the workforce in biomedical research and health care.
Lizzy Lawrence: The politicization of science.
Tami Luhby: The systemic impacts of cuts to the Medicaid program.
Alice Miranda Ollstein: The resurgence of infectious diseases.
Also mentioned in this week’s podcast:
- The Washington Post’s “.,” by Lena H. Sun and Paige Winfield Cunningham.
- MedPage Today’s “,” by Jeremy Faust.
- The Washington Post’s “,” by Meryl Kornfield, Hannah Natanson, and Lisa Rein.
- NBC News’ “,” by Berkeley Lovelace Jr.
- Politico’s “,” by Alice Miranda Ollstein and Ariel Wittenberg.
- The Washington Post’s “,” by Paige Winfield Cunningham.
- Politico’s “,” by Joanne Kenen.
[Editor’s note:This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner:Hello,from 鶹Ů Health News and WAMU Public Radio in Washington, D.C., and welcome toWhat the Health?I’mJulie Rovner, chief Washington correspondent for 鶹Ů Health News, andI’mjoined by some of the best and smartest health reporters in Washington.We’retaping this week on Thursday,Dec.18,at 10a.m. As always, news happens fast,and things might have changed by the time you hear this. So, here we go.
Today, weare joinedvia video conference by Tami Luhby of CNN.
Tami Luhby:Hello.
Rovner:AliceOllsteinof Politico.
Alice MirandaOllstein:Hi, there.
Rovner:And I am pleased to welcome to the podcast panel Lizzy Lawrence of StatNews. Lizzy, so gladyou’llbe joiningus.
Lizzy Lawrence:Thanks so much for having me.I’mexcited.
Rovner:Later in this episode,we’llhave my interview with Tony Leys, who reported and wrote the latest 鶹Ů Health News“Bill of the Month”about yet anothervery expensiveambulance ride. But first, this week’s news.
Well, remember when House Speaker Mike Johnson complained during the government shutdown that the issue of theadditionalACA[Affordable Care Act]subsidies expiring was a December problem? Well, he sure was right about that. On Wednesday, the House,along party lines,passedabill that Republicans are calling the“Lower Healthcare Premiumsfor All[Americans]Act,”whichactually doesn’t, butwe’llget to that in a moment. Notably,notpart of that bill was any extension of the enhanced tax credits that now aregoingto expire at the end of this year, thus doubling or,in some cases,tripling what many consumers who get their coverage from the ACA marketplaces will have to pay monthly starting in January. Speaker Johnson said he was going to let Republican moderates offer an amendment to the bill to continue theadditionalsubsidies with some changes, but in the end, hedidn’t.
So, four of those Republicans,from more purple swing districts worried about their constituents seeing their costs spike, yesterday signed onto a Democratic-led discharge petition, thus forcing a vote on the subsidies, although not until Congress returns in January. Before we get to the potential future of the subsidies though, Tami, tell uswhat’sin that bill that just passed the House.
Luhby:Well, there are four main measures in it, but none of them, as you say…they will lower potentially some premiums for certain people, butthey’rereally a bit of a laundry list of Republican favorite provisions.
So, one of the main ones is association health plans. They would allow more small businesses—and,importantly, the self-employed—to band together across industries. This could lower health insurance premiums for some people, but these plans alsodon’thave to adhere toall ofthe ACA protections and benefits that are offered. So, it may attract more healthier people or be more beneficial for healthier people, but not for everyone, for sure.
There are some PBM, pharmacy benefit manager,reforms. They would have to provide a little more information to employers about drug prices and about the rebates they get, but it may not really have… the experts I spoke to saidit’sreally justtinkering around at the edges and may not be that consequential.
Rovner:Andit’snot even as robust a PBM bill as Republicans and Democrats had agreed to last year…
Luhby:Exactly.
Rovner:… that Elon Musk got struck at the last minute because the bill was too long.
Luhby:Exactly,it’sa narrower transparency. There are narrower transparency provisions. It would also,importantly, refund thecost-sharingprovisions. And remember, there are two types of subsidies in the Affordable Care Act. There arethe premiumsubsidies, which is what everyone is talking about, the enhanced premium subsidies.But these are cost-sharing reductions that lower-income people on the exchanges receive to actually reduce their deductibles and their copayments and coinsurance, theirout-of-pocketexpenses.
President[Donald]Trump, during his first term,in an effort toweaken the Affordable Care Act, ended the federal funding for these cost-sharing subsidies, but the law requires that insurers continue to provide them.Sowhat the insurers did was they increased the premiums of the“silver”plansin order tomake up some of the difference, but those silver plans, remember, are tied to…the cost of those silver plans are whatdeterminesthe premium subsidies that people get. So, basically,by refunding or by once again funding these cost-sharing subsidies, insurers will lower the premiums for those silver plans, which will,in turn,lower the premium subsidies that the governmenthas topay and save the government money.
The people in silver plansprobably won’tbe affected as much, but what happened after Trump ended the cost-sharing subsidy funding is that with these increased premium subsidies that are tied to the silver plans, a lot of people were able to buy“gold”plans. They were able to buy better plans for less because they got bigger premium subsidies, or they were able to buy“bronze”plans forreally cheap.So basically, thisprovision will end, will reduce the premiumassistancethat people get,andit’lleffectively raise premium payments for people in a lot of plans, which will make it more difficult for them.
Rovner:Which was a wonderful explanation, by the way, ofsomethingthat’ssuper complicated.
Luhby:Thank you.
Rovner:ButI’vebeen trying to say itbasically movesmoney around. It takes money that had been…it lowers how much the federal government will have to pay, while at the same time loading that back onto consumers.
Luhby:Right.
Rovner:So, hence my original statement that the“Lower Premiumsfor All”Actdoesn’tlower premiums for all. So, this is…
Luhby:No, there’ll be a lot of people in gold and bronze and“platinum”plans who will be paying a lot more, or they’ll have to, if they’re in gold, they may have to shift to silver, which means they’ll just be paying more out-of-pocket when they actually seek care.
And thenthere’sa fourth provisionthat’snot as consequential:It’scalled choice plans.It’sto help employers give…it’sto make it easier for employers to give money to people to buy coverage on the exchanges.
Rovner:Yeah, whichI think nobodydisagrees with. But Alice,there’sanother even catch to the cost-sharing reductions, which is thatit’sonly for states that ban abortion or thatdon’tban abortion. Now Iforget, which is it?
Ollstein:So, it’s,yeah.Sothe great compromise of the Affordable Care Act was thatit’sup to states whether to allow, require, or prohibit plans on the Obamacare exchanges from covering abortion. And as states do, they went in different directions, so about half ban it and about the other half, it’s50-50 on requiring abortion coverage and just allowing it, leaving it up to individual plans. And so yes, this provisionsoughtto penalize states that allowed abortion. And so, it’s expanding the definition of the Hyde Amendment from where it was before, basically saying if any federal funding is going to a plan that uses other money to pay for abortion, then that counts as funding abortion, even though the money is coming out of different buckets.
And so, this has been a big fight on Capitol Hill this year. And as I wrote yesterday,it’snowhere near being resolved. I mean, even if lawmakers were going to come together on everything else related to the subsidies, which they are not, the abortion debate was still in the way asan impediment, including in the Senate as well.
Rovner:Yeah. So, what are the prospects for theseadditionalsubsidies? And I should go back and reiterate that what Tami and I were talking about were the original tax credits that were passed with the Affordable Care Act, not the enhanced ones, the bigger tax credits that are expiring at the end of the year. So, Republicans have now forced this vote, so we know that the House is going to vote on extending these subsidies—in January,afterthey’veexpired, which is a whole issue of complication itself. But I mean, is there any prospect for a compromise here?Might they go home and get enough pushback from constituents who are seeing their costs go up so much they’re going to have to drop their insurance that they might change their minds?
Ollstein:Well, Democrats and advocacy groups are trying to ramp up that pressure.We’vebeen covering some ad campaigns and efforts. Democrats are holding town halls in Republican districts where the representatives are not holding town halls to shine a light on this.They’rehighlighting the stories of individual, sympathetic-character folks who are having their premiums goway up.
So, there were press conferences just this week I saw with retirees and people who are onSocialSecurityDisability and small-business owners and single parents,andit’snot hard to find these stories;this is happening to tens of millions of people. And so,I think thisis going to be a major, major political message going into next year. Whetherit’senough to make Republicans who are still so ideologically opposed to the Affordable Care Act agree onsome kind of anextension, that remains to be seen. And we reallyhaven’t, despite the defection of a small handful this week in joining the Democrats on an extension—which wasreally notableand a sign that Speaker Johnson is not keeping his caucus in array.But the vote hasn’t happened yet, and we’ll see if spending time back in the districts over the holidays makes people more or less willing to compromise.It cango either way.
Rovner:I saw a lot of people yesterday saying that,Well, even if the House were to pass the clean three-year extension of the enhanced subsidies—which is what’s in the Democrats’bill—the Senate just voted on it last week and voted it down, so it wouldn’t have any chance.To which my response was,“Hey, Epstein files.”When the jailbreak happened in the House on that, the Senate voted, I believe, unanimously for it. So, things can change in the Senate. Sorry, Tami, I interrupted you;you wanted to say something.
Luhby:No, I was just going to say that yes, things can certainlychangeand there have been surprises before, but this is obviously also not a new issue. I mean, the Democrats have been running ads, people have been speaking out. We have all beenwritingstories aboutthe cancersurvivors or cancer patients who may have to drop their coverage in the middle of their treatment because theycan’tafford the new premiums, orall ofthese stories. So, none of this is new, butwe’llsee.There’sobviously…what issomewhat newis the administration’s message on increasing affordability, and this is a huge affordability issue. So,maybe thatwill spur some change in votes or change in mindset.
Rovner:Well, definitely a January story too.
Well, moving on to this week in vaccine news, the Centers for Disease Control and Prevention has made it official—after being blessed by the acting director of the agency, who is neither a doctor nor a public health professional—the U.S.government is no longer recommending a birth dose of the hepatitis B vaccine, which by the way, has been shown to reduce chronic hepatitis B in children and teenagers by 99% since the recommendation was first issued in 1991.
And merging two stories from this week, there’s alsonews about the American Academy of Pediatrics, which has been among the most vocal medical groups protesting the vaccine schedule changes. The AAP said the hepatitis B change will“harm children, their families, and the medical professionals who care for them.”And in a move that seems not at all coincidental, the Department of Health and Human Services on Wednesdayterminatedseven federal grants to the AAP worth millions of dollars, for work on efforts including reducing sudden infant deaths, preventing fetal alcohol syndrome, andidentifyingautism early. According toThe Washington Post, which, an HHSspokesmansaid the grants were canceled because they“no longer align with theDepartment’s mission or priorities.”
First, this is not normal. Second, however,it’sHHS in 2025 in a microcosm, isn’t it? Either get with the program or get out. Lizzy,you’renodding.
Lawrence:Absolutely. Yeah, I think this has become very commonplace in this administration.And alsointerestingly, yesterday, the HHS posted in the federal register that the CDC offered a $1.6 million grant to a group of Danish researchers who study in Guinea,West Africa,to run a placebo-controlled trial of hepatitis B vaccine for newborns. And so,we’reseeing an active removal of funds from the American Academy ofPediatricians[Pediatrics], andthen giving funds now to research. And this is a research groupactually thatRFK Jr. has cited their studies before, they study overall health effects of vaccines. And so, it will bereally interestingto see if this is a trend that continues, ifthey’rekind of…we already know that HHS, the CDC’s vaccine panel,there’sbeen discussions about making our vaccine schedule closer to Denmark’s. Nowthere’sthis money being given to Danish researchers who align with the way that they think about vaccines issimilar toKennedy and to another official at FDA,called Tracy Beth Høeg, who is also on the CDC’s panel as the FDA representative. So,yeah.
Rovner:And who is Danish, I believe.
Lawrence:Yes, her husband is Danish, and so she lived in Denmark for many years.
Rovner:I saw some scientists complain about that study in Guinea-Bissau, because they sayit’sactually unethicalto use a placebo to study the hepatitis B vaccine because we know that it works.Soifyou’regiving a placebo to children,you’rebasically exposingthem to hepatitis B.
Lawrence:Right.
Ollstein:Yeah. I sawthattoo. And a lot of folks were saying this would never be approved to be done in the U.S. And so, doing it in another country is reminding people ofcolonial experimentsinmedicine that werereally unethicaland subjected people to more risks than would be allowed here. And like you said,basically knowinglywithholding something that is safe and effective and giving someone a placebo instead.
Another issue I saw raised was that it is not a double-blind study;it is a single-blind study. And so, that allows for potential biases there as well.
Lawrence:Right. And I was also seeing that the Guinea Ministry of Health is planning to mandate a universal hep B dose in 2027.
Rovner:Oops.
Lawrence:So, that’s a crazy…yeah, you have babies born before that year who are not given this dose, and then after…so yeah, it raises all kinds of ethical concerns,and it’s just remarkable that the government would just pull away and offer this money to them.
Rovner:HHS in 2025.Specifically on thecovidvaccine, thereweretwo stories this week. One is a study in the Journal of the American Medical Association that found that pregnant women vaccinated againstcovid-19 are less likely to be hospitalized, less likely to need intensive care, and less likely to deliver early, if they can track the virus, than those who are unvaccinated. And over at,editor Jeremy Faust,who’sboth a doctor and a health researcher, says that FDAvaccinechief Vinay Prasad overstated his case when he said the agency has found at least 10 childrenwho’vediedas a result ofreceiving thecovidvaccine. Turns out the actual memo from the scientists assigned to research the topic concludes the number is somewhere between zero and seven, and five of those cases have only a 50-50 chance of being related to the vaccine. Thisisn’tgreat evidence for those who want to stop giving the vaccine to children and pregnant women, I would humbly suggest.
Lawrence:Right,right.Yeah, the memo that Vinay Prasad sent, which wasimmediatelyleaked, was remarkable in that it included no data backing up his claims.And this is a really tricky area, when I’ve talked to scientists at the agency who focus on these issues.I think sometimesit’shard to say that there are cases that are very subjective, and so this is a discussion that needs to be handled delicately,andit’sareally severeclaim to say that this has killed 10 children. And so, that discussion needs to be shared transparently andallow forexperts to really weigh in.
Rovner:Yeah. Well, another issuethat’sgoing to bleed over into January. Allright,we’regoing to take a quick break.We will be right back.
Soin other administration health news, it appears, at least, that the on-again,off-againcuts to medical personnel at the Department of Veterans Affairs are on again. ThePost is reporting that the VA is planning to eliminate up to 35,000 doctors, nurses, and support personnel.That’son top of a cut of 30,000 people earlier in 2025. Altogether,it’sabout a 10% cut in total.Apparently, mostof the positions are currently unfilled, but thatdoesn’tmean thatthey’reunneeded, particularly after Congress dramatically expandedthenumber of veterans eligible for health benefits by passing the PACT Act during the Bidenadministration.That’sthe bill that allowed people to claim benefits if they were exposed to toxic burn pits. What is this second round of cuts going to mean for veterans’ability to gettimelycare from the VA? Nothing good, I imagine.
Luhby:Well,I’vebeen speaking over the past year or twotoa VA medical staffer,who wishes to remain anonymous for obvious reasons.And one thing they told me is that their boss, who was also a medical practitioner, took one of the retirements, and that they have to now cover their boss’shift.Andthey’veasked if the boss is going to be replaced because they obviouslycan’tdo two people’s jobs well, andthey’vebeen told that the boss will not be replaced.
There’salso,on top of all of this,there’sa hiring freeze and there’s restrictions in hiring. So,it’sbeenvery difficultfor agencies, including the VA, includingthe medicalpersonnel, to get new people. And again, the personI’vespoken to said that the veterans are not getting the care, asgood careas they were last year because this person justcan’tdo two people’s jobs. Andit’son the medical side, but the source also said thatit’sthroughout the hospital with the support staff and even the custodial staff. I mean, just…there’sa lot of unfilled positions that are affecting overall care.
Rovner:I feel like a big irony here is that during the first Trumpadministration, improving care at the VA and lowering the wait times was a huge priority for President Trump, not just for the administration. He talked about it all the time. And yet, herehe’sbasically undoingeverything that he did for veterans during the first administration.
All right. Well, meanwhile,that the FDA is considering rolling back the rule that requires dietary supplement makers to note on their labels that their products have not been reviewed by FDA for safety and efficacy. This was a compromise reached by Congress after a gigantic fight over supplements in 1994—I still have scars from that fight—following a series of illnesses and deaths due to tainted supplements a couple of years before that. The idea was to let supplements continue to be sold without direct FDA approval,as long ascustomers were informed that they were not intended to“diagnose, treat, cure, or prevent any disease,”a phrase thatI’msureyou’veheard many times in commercials. Of course, diet supplements arepractically anarticle of faith for followers of the“Make America Healthy Again”movement. I would assume that this is part of RFK Jr.’s vow to loosen what he has called the“aggressive suppression”of vitamins and dietary supplements. Lizzy,you’renodding.
Lawrence:Yeah, this is super interesting because this was one of the first things a year ago,whenRFK was announced as the HHSsecretary, when people werespeculatingon what some of his priorities would be, deregulating supplements was a big one.And so, I think this will be a really interesting space to watch and see.Andit’semblematic,too,of the uneven view of products regulated by the FDA,where there are some products where there’s…that RFK and other leaders at the FDA are super“pro”andwell, wedon’tactually needas much evidence here. And then others, like vaccines or SSRIs[selective serotonin reuptake inhibitors], whereit seems that theywant to really raise evidence standards, which is not how the FDA is supposed to work.It’ssupposed to bedispassionately, with no bias, reviewing medical products.
Rovner:And I would point out, in case Iwasn’tclear before, that supplements are barely regulated now. Supplements are regulated so much less than most everything else that the FDA regulates. Sorry, Alice, you wanted to say something.
Ollstein:Yeah. It also, I think, reveals an interesting public perception issue, where the message that a lot of people are getting is that the pharmaceutical industry is this big, bad, evil corporate thing that is out to harm you, and it has all these documented harms, whereas supplements are natural and wellness and seen as the underdog and the upstart. And I think people should remember that supplements are a huge corporate industry as well, and,like Julie and Lizzy have been saying, regulated a lot less than pharmaceuticals. So, ifyou’retaking a prescription drug,it’sbeen tested a lot more than ifyou’retaking a supplement.
Rovner:Yeah, absolutely. So while most of the coverage of HHS in 2025 has been pretty critical, this week, two of our fellow podcast panelists,Joanne KenenandPaige Winfield Cunningham, have stories on how the breakout star at HHS in this first year of Trump 2.0 turns out to be Dr. Oz. Apparently being an Ivy League-trained heart surgeon with an MBA actually does give you some qualifications to run the agency that oversees Medicare, Medicaid, the Children’s Health Insurance Program, and the AffordableCare Act.I think Inoted way back during his confirmation hearings that he clearly already had the knack of how to deal with Congress:flatter them and take their parochial concerns seriously.That’s something that his boss, RFK Jr., has most certainly not mastered as of yet.And it turns out that Dr. Oz has both leadership and policy chops. Who could have predicted this going into this year?
Luhby:Well, one thingthat’sinteresting is that we were all, I think, watching what Dr. Oz would do with Medicare and Medicare Advantage, becauseit’sobviously something that he had promoted on his shows.It’ssomething that the Bidenadministration was trying to crack down on. And it has been interesting that he has not been giving carte blanche to the insurers. He has been cracking down on them as well. I listened to a speech that he gave before the Better Medicare Alliance, which is the group that works with Medicare Advantage insurers. And hesaid basically,“You guys have to step up,”and so,it’llbe interesting tosee going forwardwhatadditionalmeasures they take. Butyeah,he’scertainly not bending over to the insurers.
Rovner:Yeah. I will say, like I said, I noticed from the beginning, from when he came to his confirmation hearing,that somebody had briefed him well.Apparently, according, I think,he’sbeen talking regularly to his predecessors from both parties about how to run the agency, which surprised me a little bit. I will be interested to see how this all progresses, but if you had asked me to bet at the beginning of the year of the important people at HHS who were running these agencies who would do the consensus best job, I’m not sure I would’ve had Dr. Oz at the top of my list.
Luhby:Well, and one thing to also point out that was, particularly,is that whatwe’vebeen hearing at other agencies—the CDC, and across the Trumpadministration—that a lot of the political appointees are really at odds with the staff.They’renot communicating with the staff;there were concerns about that after the CDC shooting over the summer. And one thing that,obviously,Dr. Oz is verypersonable,he knows how to reach out to an audience. And in this case, his audience is also his staff. And it was notable that Paigedetailed abouthow he really is interacting a lot with the staff. AndI’msurethat’sobviously helping morale and helping the mission at CMS. Also, of course,it’san agency that RFK has not focused on.
Rovner:I say, what a shock, treating career staff with some respect,like they know whatthey’redoing.
All right. Well, finally, we end this year on reproductive health,pretty much thesame way we began it, with anti-abortion groups attacking the abortion pill, mifepristone. We know that despite the fact that abortion is now illegal in roughly half the states, the number of abortions overall has not fallen, and that is because of the easy availability,even across state lines,ofmedicationabortion. Alice,you’vegot quite the story this week about an unusual way to go after the pill. Tell us about it.
Ollstein:Yeah.Sothis is atrendI’vebeen coveringfor the last few years, andit’santi-abortion groupstryingto use various environmental laws to achieve the ban on the pills that they want to achieve. And so,there’sbeen some various iterations of this over the years. The latest one is that groups are jumping onaEPA[Environmental Protection Agency]public comment processthat’sgoing to kick off any day now. So, this is what the EPA does. Every few years, they update the list of chemicals that need to be tracked in water around the country.Sothisis a big deal.It costs a lot to track these chemicals.Therecan only be so many chemicals on the list. And these groups are trying to rally people around the country to demand that the EPA add mifepristone and its components to this list.
Rovner:This is wastewater, right? Not drinking water?
Ollstein:No, this is drinking water.
Rovner:Oh, it is drinking water.
Ollstein:There are other efforts to use wastewater laws to restrict abortion pills, yes.Sowe talked to scientists that say there is no evidence that mifepristone in the water supply is causing any harm whatsoever. On the other hand, there is tons of evidence of other chemicals, and so we havetalking about how if they put mifepristone on this list, it would push out another more dangerous chemical from being on that list.
So, just to zoom out a little bit, while thisparticular campaigntactic, whatever you want to call it, may not succeed, I thinkit’spart of a bigger project to sow doubt in the public’s mind about the safety of mifepristone invarious ways.We’vebeen seeing this all year, and for several years. But I think that this kind of gross-out factor ofthere’sabortions in the water!Even without scientific evidence of that,I think itcontributes tothe publicperception. And 鶹Ů had some polling recently showing that doubt about the safety of the pills has increased over the past few years. And so, these kinds of campaigns are working in the court of public opinion, ifnot quite yetat federal agencies.
Rovner:Another one we will be watching. All right, that is this week’s news. Nowwe’llplay my“Bill of the Month”interview with Tony Leys, and thenwe’llcome back and do ourvery specialyear-end extra credits.
I am pleased to welcome back to the podcast 鶹Ů Health News’Tony Leys, who reported and wrote the latest 鶹Ů Health News“Bill of theMonth.”Tony, welcome back.
Tony Leys:Thanks for having me, Julie.
Rovner:So, this month’s patient hada very expensiveambulance ride, alas, a storywe’veheard as part of this series several times. Tell us who he is and what prompted the need for an ambulance.
Leys:He is Darragh Yoder, a toddler from rural Ohio. He had a bacterial skin infection called[staphylococcal]scalded skin syndrome, which causes blisters and swelling. His mom, Elisabeth, took him to their local ER,where doctors said he needed to be taken by ambulance to a children’s hospital in Dayton,about 40 miles away. They put in an IV and then put him in the ambulance. His mom wentwithand said the driverdidn’tgo particularly fast or use thesiren, butdid get them there in about 40 minutes.
Rovner:But itstill wasan ambulance ride. So, how big was the bill?
Leys:$9,250.
Rovner:Whoa. Now, this familydoesn’thave insurance, whichwe’lltalk about in a minute. So, itwasn’tan in-orout-of-networkthing. Was this unreasonably high compared to other ground ambulance rides of this type?
Leys:It’s really hard to say because the charges can be all over the place,iswhat national experts told me. But if Darragh had been on Medicaid, the ambulance companywould’vebeen paid about $610, instead of$9,200.
Rovner:Whoa. So, what eventually happened with the bill?
Leys:The company agreed to reduceitabout 40% to$5,600 if the family would pay it in one lump sum. Theydid,they wound up putting it on a credit card, a no-interest credit card,so they could pay it off overtime.
Rovner:Now, as we mentioned, this familydoesn’thave insurance, but they belong to something called ahealthsharingministry. What is that?
Leys:Members pool their money together and basically agree to help each other pay bills. And they were thinking that that would covermaybe aboutthree-quarters of what they owed, so…
Rovner:Have they heard about that yet?
Leys:I have not heard.
Rovner:OK. So,what’sthe takeaway here? I imagine if a doctor says your kid who has an IV attached needs to travel to another facility in an ambulance, youshouldn’tjust bundle them into your car instead, right?
Leys:I surewouldn’t.Yeah, no. I mean, at that point,she felt like she had no choice. I mean, she did say if shewould’vejust driven straight to the children’s hospital instead of stopping at the local hospital, theywould’vegotten there sooner than if once she stopped at the local hospital and they ordered an ambulance. So,that’sin retrospect what she wishes shewould’vedone. But ifthey’dhad insurance, the insurerwould’vepresumably negotiateda lower rate,and theywouldn’thave had to do the negotiation themselves.
Rovner:So, they are paying this off, basically?
Leys:Yeah, they paid it in one lump sum, which is a stretch for them, but they felt like they had no choice.
Rovner:All right. Tony Leys, thank you very much.
Leys:Thanks for having me, Julie.
Rovner:OK,we’reback.It’stime for ourextra-creditsegment.That’susually where we each recognize a story we read thisweekwe think you should read too. But since this is our last podcast of the year, I wanted to do something a little bit different.I’veasked each of our panelists to take a minute or two totalk about what they see, not necessarily as the biggest single health story of the year, but the most important theme thatwe’llremember 2025 for. Tami, why don’t you start us off?
Luhby:OK. Well, I think that Medicaid has been a big issue in 2025 and will continue to be going forward. Among the most consequential health policies enacted this year were the sweeping Medicaid changes contained in the One Big Beautiful Bill[Act], which Congress passed over the summer. The legislation enacts historic cuts to[the]nation’s safety net,with the biggest chunk coming from Medicaid, which serves low-income Americans. It would slash more than$900 billionfrom Medicaid, according to the Congressional Budget Office. About 7.5 million more people would be uninsured in 2034 due to these Medicaid provisions. And most of that spike would come fromCongressadding work requirements to Medicaid for the first time. We know that that happened in 2018, states were trying to do…well, the Trumpadministration allowed certain states to do that. It really only took effect in Arkansas, and about18,000 peoplelost coverage within months from the work requirements, many of whom,the advocates say,many people areworking,they’re going to get caught up in red tape.They’reeither working orthey’reeligible for exemptions, butthey’llget caught up in red tape.
So, what the Big Beautiful Bill requires is in states that have expanded Medicaid, working-age adults without disabilities or[dependent]children under age 14 would have to work, volunteer, or attend school or job training programs at least80 hoursa month to remain eligible, unless they qualify for another exemption,such as being medically frail or having substance abuse disorder. The package also limits immigrants’eligibility for Medicaid, requires enrollees to pay some costs, and caps state and local government provider taxes, which is a key funding source forstatesand which will have ripple effects across hospitals and across states in general.
Now,what’simportant to noteis,most of these provisionshaven’ttaken effect yet.Most of them actually take effect after the midterm elections next year.So,they’llbe rolling out in comingyearsand the full impact is yet to come.
Rovner:Alice.
Ollstein:So, I have chosen the resurgence of infectious diseases that we are seeing right now.I think measlesisreally the canary in the coal mine.Becauseit’sso infectious,that’swhat’sshowing up first, butit’snot going to be the last infectious disease that the country had almost squashed out of existence that is now, as I said, resurging. And so,I think that a lot of different policies and trendsare feeding into this. AndI think wehave the rollback of vaccine requirements at the state level, at the federal level. We have policies that deter people from seeking out testing and treatment, especially some of these anti-immigrant policies thatwe’reseeing. And then just cuts to public health and public health staff, cuts to surveillance, soit’sjust harder to know where the outbreaks are happening and how bad they are.It’shard to get reliable data on that. AndsoI think, yes,we’reseeing measles first, but now we are starting to see whoopingcough,we’restarting to see some other things, andit’sreally troubling,and it could have a political impact too.
I have talked to a bunch of candidates who are running in next year’s midterms who say that they’re able to point to outbreaks right there in their state to say,“This is the consequence of Republican healthpolicies, and this is why you should vote for me.”So, Iwould be keepingan eye on that in the coming year.
Rovner:Lizzy.
Lawrence:So, my chosen theme is the politicization of science. And my focus has been on the FDA as an FDA beat reporter, butthere’sbeen the politicization of science in every agency. And this is something that used to bepretty taboo, right? I keep thinking these days about the[Barack]Obama HHSsecretary,Kathleen Sebelius,and the legal and political repercussions she faced when she vetoed an FDA decision to makePlan Bover-the-counter. And those days seemvery faraway, because nowwe’reseeing atthe FDA speedier drug reviews being used as a bargaining chip in deals between the White House and companies in exchange for companies lowering their prices.
At the FDA and CDC,you’reseeing skeptics or more political officials completely taking over operations, reopening debates on things like vaccines, antidepressants during pregnancy, RSV, monoclonal antibodies, based on thin or evenreally noor debunked evidence.
You’reseeing the White House just today use CMS to pull funding from hospitals that perform gender-affirming surgeries.You’reseeing NIH[the National Institutes of Health]pull funding from research studies that go against Trumpadministration ideology.So, there’s really so many examples, too many to count, of political leaders wielding in power and trying to shape science to fit their agendas in the way that they see the world.
And thenI’dsay that has a trickle-down effecttothe way that everyday people think about science,and it calls everything into question and makes…People look to politicians and to the heads of public health agencies to tell them the truth. I mean,maybe notpoliticians, butit seems that doctors and medical experts’voicesare increasingly being drowned out by the political re-litigating of science that has been settled for a long time. So,I think thisisa very importanttopic and one thatI’llkeep watchingclosely in thenext year.
Rovner:Yep.Somy topic builds on Lizzy’s.It’show this administration is using a combination of personnel and funding cuts and new regulations to jeopardize the future of the scientific and healthcare workforce well into the future. The administration has frozen orterminatedliterally billionsof dollars in grants from the National Institutes of Health and the National Science Foundation, not just causing the shutdown of many labs, but making students who are pursuing research careers rethink their plans, including those who are well into their graduate studies. Some are even going to other countries, which are happily poaching some of our best and brightest.
And aswe’vetalked about so many times before in this year’s podcast, the administration also seems intent onbasically chokingoff the future healthcare workforce. The big budget bill includes caps on how much medical students can borrowinfederal loans.That’san effort to get medical schools to lower their tuition, but most observers thinkthat’sunlikely to happen. TheEducationDepartment has decreed that those studying to be nurses, physician assistants, public health workers, and physical therapists are not pursuing a“profession,”thus also limiting how much they can borrow. And a new $100,000 visa feeis going to make it even more difficult for hospitals and clinics, particularly those in rural areas, to hire doctors and nurses from outside the U.S., at a time when international medical workers areliterally theonly ones working in many shortage areas. These are all changes that are going to have ramifications, not just for years, but potentially for generations. So, these are all themes that we will continue to watch in2026.
OK, that is this week’s show and our last episode for 2025. Thank you to all of you listeners for coming with us on this wild news ride. As always, thanks to our editor, Emmarie Huetteman, and this week’s producer-engineer, Taylor Cook. A reminder:What the Health?is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as,of course, kffhealthnews.org. Also, as always, you can email us your comments or questions.We’reatwhatthehealth@kff.org, or you can still find me on X, or on Bluesky. Where areyou guyshanging these days, Alice?
Ollstein:Mostly on Bluesky, and still on X.
Rovner:Tami.
Luhby:You could find me at.
Rovner:Lizzy.
Lawrence:You can find me at, on LinkedIn at, on X, and on—and I forget my username, butI’msomewhere there.
Rovner:Don’tworry about it.OK, we will be back in your feed in January. Until then, be healthy.
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