But Republican lawmakers in some states think the new rules — part of the GOP’s One Big Beautiful Bill Act, signed last July by President Donald Trump — don’t go far enough.

Indiana is leading that charge, with a new law that requires applicants to prove they’ve been working or participating in a similar activity for three consecutive months to get benefits.

Meanwhile, residents in many other states will have to show they’ve been working just one month, the least cumbersome option under Trump’s signature tax-and-domestic-spending law. It instructs states to decide whether to require one, two, or three months of work history.

As in Indiana, Republican Idaho lawmakers approved a three-month requirement, and the state’s governor signed the bill into law on April 10.

The efforts, along with similar moves in Arizona, Missouri, and Kentucky, are aimed at restricting flexibility to implement the federal law at the state level.

“Normally, you would not see state legislators weighing in on these decisions,” said Lucy Dagneau, a senior official with the American Cancer Society’s advocacy arm.

The nonpartisan Congressional Budget Office estimated 18.5 million adults will be subject to the new rules, which will be enforced across 42 states and the District of Columbia. In Indiana, work rules will target about 33% of the state’s Medicaid population. The rules generally wouldn’t apply to children, people 65 or older, or people with disabilities or serious health issues.

Typically, state administrators — not lawmakers — detail how they plan to comply with new federal standards, and they often look to federal regulators for guidance. But officials at the Centers for Medicare & Medicaid Services have yet to tell states how to comply with many aspects of the sweeping budget law, leaving state lawmakers to intervene.

Gov. Mike Braun, a Republican, signed the Indiana bill into law on March 4, making his state the first to set the Medicaid work requirement at three months — the longest period allowed under the federal law.

Republican state Sen. Chris Garten introduced a bill in January, saying it was needed to “align” state law with the new federal Medicaid rules. He also pitched the bill as a way to crack down on “waste, fraud, and abuse” in public programs.

When ineligible people get enrolled, it robs “the truly vulnerable Hoosier who actually needs the help,” Garten said during a January committee hearing.

Democratic state Sen. Fady Qaddoura expressed skepticism during the hearing and questioned the necessity of the legislation. Qaddoura asked Indiana Family and Social Services Administration Secretary Mitch Roob to provide an estimate of the number of ineligible people who enrolled in Medicaid in the state.

“I think very few,” Roob replied. “It’ll never be none.”

After hearing Roob’s answer, Qaddoura said there is no evidence of a widespread problem in Indiana. He accused Republicans of using waste, fraud, and abuse as justification to deny health benefits and food aid to vulnerable Hoosiers.

Garten later called Qaddoura’s accusation a “fundamental mischaracterization” of the bill.

Republicans have said imposing these limits protects the Medicaid program’s longevity.

“We believe in a safety net for our most vulnerable, not a hammock for able-bodied adults that choose not to work,” Garten said. “By tightening these screws, we ensure that our safety net remains sustainable.”

Indiana’s Medicaid enrollment is expected to decrease because of Garten’s legislation, according to an analysis from Indiana’s nonpartisan Legislative Services Agency.

Medicaid helps keep people healthy, so they can continue to work, said Adam Mueller, executive director of the Indiana Justice Project, a nonpartisan legal advocacy organization focusing on health, housing, and food insecurity.

Mueller worries that people will struggle to prove their work history, especially those with nontraditional jobs.

“If the point is to get people engaged, the one month would do it,” Mueller said.

Ultimately, he fears the law will harm Hoosiers with the greatest need for assistance. “They’re going to get tripped up by the bureaucratic hurdles.”

An analysis by the Center on Budget and Policy Priorities predicted that work rules will and that how states choose to implement the rules will “significantly affect the number of people who lose coverage.” State policy decisions will determine just “how intense the burden is,” the left-leaning think tank found, and opting for a shorter look-back period “will enable more people to enroll.”

Lawmakers in multiple states considered limits. And the same right-leaning lobbying group, the Foundation for Government Accountability, testified in favor of these measures in Arizona, Indiana, and Missouri.

In Missouri, FGA lobbyist James Harris said the measure intends to “move people from dependency and give them back that dignity and pride of work.”

Missouri state Rep. Darin Chappell proposed requiring a three-month look-back period like the measure in Indiana. But the latest version of the bill he sponsored would require applicants to show they were working for only one month before enrolling.

Chappell, a Republican, said his initiative would encourage a “working mindset.”

Anna Meyer, owner of a small bakery in Columbia, Missouri, said the implication is that she and others on Medicaid are lazy. “I have been working since I was 15 years old,” she said. “I’m 43 now.”

Meyer, who voiced her opposition, said she previously had problems submitting information to the state Medicaid agency. She fears new reporting requirements will put her and others at risk of losing coverage, even if they meet the work rule.

She has fibromyalgia, a chronic condition that increases overall sensitivity to pain. She also has food allergies. Medicaid helps pay for medications and doctor visits that keep her healthy and allow her to keep working.

“I work very hard,” Meyer said.

In St. Louis, Jessica Norton, an OB-GYN, treats many Medicaid patients at an Affinia Healthcare clinic. She said they struggle to remain insured even though Missouri extends a full year of Medicaid coverage to eligible women after they give birth. Some of her patients are inexplicably kicked off that coverage by the time of their checkups six weeks after birth. She fears red tape from the new work requirements will make it harder to hang on to insurance, even though pregnant women and new mothers are supposed to be exempt.

Norton criticized lawmakers for the message this policy sends to vulnerable patients. They are saying, “Oh, actually, health care is a privilege, and you have to earn it,” she said.

of adults ages 19 to 64 on Medicaid already work, according to �鶹Ů��. The reason many of the remaining adults on Medicaid are not working is that they are retired, serving as a caregiver, or too sick, �鶹Ů�� has found.

Some states are not only setting the strictest requirements but also blocking out the optional leniency built into the federal rules.

For example, states may adopt additional exemptions from work rules, such as allowing people to claim a “short-term hardship,” designed to provide continued Medicaid coverage to people with medical conditions that prevent them from working.

Missouri lawmakers are seeking a constitutional amendment to bar their state from offering such optional exemptions. But patient advocates warn these limits would harm the state’s vulnerable residents when they need coverage the most, particularly Missouri’s rural cancer patients.

Often, rural Missouri patients must travel to Kansas City or St. Louis for treatment, disrupting their ability to work, Emily Kalmer, a lobbyist for the American Cancer Society’s advocacy arm, testified at the January hearing. Recognizing this, the federal law provides certain exemptions for this kind of scenario.

But this short-term hardship exemption would be off the table in Missouri.

Time is “very important in the life of a cancer patient or a cancer survivor,” Kalmer said.

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“La primera vez, el teléfono suena sin parar. La siguiente, te manda al buzón de voz y se corta la llamada”, dijo la mujer de 48 años, que vive en Delaware. “A veces te contesta alguien que dice que no es la persona indicada. Te transfieren y se corta. A veces contestan y no hay nadie en la línea”.

Pasó meses tratando de averiguar si su cobertura de Medicaid había sido renovada. Hasta finales de marzo, todavía no le había llegado la renovación anual para el programa estatal y federal que ofrece seguro de salud a personas con bajos ingresos y con discapacidades.

Crouch, quien sufrió un aneurisma cerebral debilitante hace una década, también tiene Medicare, que cubre a personas de 65 años o más, o a aquellas con discapacidades. Medicaid pagaba sus deducibles mensuales de Medicare de $200, pero en los últimos tres meses ha tenido que cubrirlos ella misma, lo que ha afectado el ingreso fijo de su familia, contó.

Los problemas de Crouch con el centro de llamadas de Medicaid en Delaware no son un caso aislado. Las agencias estatales de Medicaid pueden tener dificultades para mantener suficiente personal que ayude a las personas a inscribirse en los beneficios y atender llamadas de afiliados con preguntas.

La falta de estos trabajadores puede impedir que las personas usen plenamente sus beneficios, dijeron investigadores de políticas de salud.

Ahora, la ley One Big Beautiful Bill Act de los republicanos aprobada por el Congreso, que el presidente Donald Trump firmó el verano pasado, pronto exigirá más al personal de las agencias estatales en los lugares donde los legisladores ampliaron Medicaid a más adultos con bajos ingresos, que son casi todos los estados y el Distrito de Columbia.

Según la ley, que se espera reduzca el gasto de Medicaid en casi $1.000 millones en los próximos ocho años, estos trabajadores deberán no solo determinar si millones de afiliados cumplen con los nuevos requisitos laborales del programa, sino también verificar con mayor frecuencia que califican: cada seis meses en lugar de una vez al año.

�鶹Ů�� Health News contactó a agencias que deberán implementar estas reglas de trabajo, y muchas dijeron que necesitarán más personal.

Estas exigencias pondrán más presión sobre una fuerza laboral ya sobrecargada, lo que podría dificultar que afiliados como Crouch reciban servicios básicos de atención al cliente. Y muchos podrían perder acceso a beneficios a los que tienen derecho por ley, según afirmaron defensores del consumidor e investigadores de políticas de salud, algunos con experiencia directa trabajando en agencias estatales.

Los estados ya están “teniendo grandes dificultades”, dijo Jennifer Wagner, directora de elegibilidad e inscripción de Medicaid en el Center on Budget and Policy Priorities y ex subdirectora del Departamento de Servicios Humanos de Illinois. “Habrá desafíos adicionales importantes por culpa de estos cambios”.

Largos tiempos de espera para recibir ayuda

Los republicanos sostienen que los cambios en Medicaid, que entrarán en vigencia el 1 de enero de 2027 en la mayoría de los estados, incentivarán a los afiliados a conseguir empleo. Investigaciones sobre otros programas con requisitos laborales en Medicaid han encontrado poca evidencia de que aumenten el empleo.

La Oficina de Presupuesto del Congreso (CBO, por sus siglas en inglés) provocarán que más personas pierdan la cobertura de salud para 2034: indicó que más de 5 millones de personas podrían verse afectadas.

Muchos estados no tienen suficiente personal para procesar solicitudes o renovaciones de Medicaid con rapidez, dijeron defensores.

Los Centros de Servicios de Medicare y Medicaid (CMS, por siglas en inglés) supervisan si los estados pueden procesar el tipo más común de solicitud de beneficios dentro de un plazo de 45 días.

En diciembre, alrededor del 30% de todas las solicitudes de Medicaid y del Programa de Seguro de Salud Infantil (CHIP, por sus siglas en inglés) en Washington, D.C., y Georgia en procesarse. Más de una cuarta parte tardó ese tiempo en Wyoming. En Maine, una de cada 5 solicitudes no cumplió ese plazo.

Los CMS comenzaron a compartir públicamente datos de los centros de llamadas de Medicaid en 2023, lo que mostró un sistema bajo presión, según investigadores y defensores.

En Hawaii, las personas esperaron más de tres horas al teléfono en diciembre. En Oklahoma, casi una hora, y en Nevada, más de una hora.

En 2023, las agencias estatales de Medicaid comenzaron a verificar que todavía calificaban a los afiliados que habían sido protegidos para que no perdieran su cobertura durante la pandemia de covid. Ese proceso no funcionó bien en muchos estados, y más de .

Investigadores y defensores dicen que implementar las nuevas reglas será un reto mayor. Las reglas laborales requerirán cambios amplios en los sistemas informáticos y capacitación para los trabajadores que verifican la elegibilidad en un plazo ajustado.

“Es un nivel mucho mayor de complejidad administrativa”, señaló Sophia Tripoli, directora de políticas en Families USA, una organización de defensa de salud del consumidor.

Después de meses intentando hablar con alguien, Crouch dijo que finalmente obtuvo respuestas sobre sus beneficios de Medicaid luego de escribir a la oficina de la representante federal Sarah McBride (demócrata de Delaware). La oficina contactó a la agencia estatal de Medicaid, que finalmente la llamó con una actualización, dijo.

Crouch en realidad no calificaba para Medicaid. Dijo que eso nunca había surgido en dos años de interacciones con el estado.

“No tiene ningún sentido que el estado no se haya dado cuenta antes”, dijo.

La agencia de Medicaid de Delaware no respondió a solicitudes de comentarios sobre su caso.

Estados con poco personal para Medicaid

A fines de marzo, algunos estados dijeron a �鶹Ů�� Health News, que necesitarán más personal para implementar las reglas laborales de manera efectiva.

Idaho informó que tiene 40 vacantes para trabajadores de elegibilidad. Nueva York estimó que necesitará 80 nuevos empleados para manejar el trabajo administrativo adicional, con un costo de $6,2 millones. Pennsylvania tiene casi 400 puestos vacantes en oficinas de servicios humanos de los condados. La agencia de Medicaid de Indiana tiene 94 vacantes. Maine quiere contratar 90 trabajadores adicionales, y Massachusetts busca sumar 70 más. Montana llenó 39 de los 59 puestos que dice que necesitará.

La agencia de servicios sociales de Missouri ha reducido personal y tiene 1.000 trabajadores de primera línea menos que hace aproximadamente una década, esto con más del doble de afiliados en Medicaid y en el Programa de Asistencia Nutricional Suplementaria (SNAP, por sus siglas en inglés), según comentarios de su directora, Jessica Bax,

“El departamento pensó que habría una mejora en la eficiencia gracias a las actualizaciones del sistema de elegibilidad”, dijo Bax. “Muchas de esas mejoras no se concretaron”.

Los estados podrían tener dificultades para encontrar personas interesadas en estos trabajos, que requieren meses de capacitación, pueden ser emocionalmente exigentes y generalmente ofrecen salarios bajos, afirmó Tricia Brooks, investigadora del Centro para Niños y Familias de la Universidad de Georgetown.

“Reciben muchos reclamos y gritos”, dijo Brooks, quien antes dirigió el programa de atención al cliente de Medicaid y CHIP en New Hampshire. “Las personas están frustradas. Lloran. Están preocupadas. Están perdiendo acceso a la atención médica, y no es un trabajo fácil cuando es difícil ayudar”.

Los estados están pagando millones de dólares a contratistas del gobierno para ayudar a cumplir con la nueva ley federal.

Maximus, un contratista de servicios gubernamentales, brinda apoyo en elegibilidad, como la gestión de centros de llamadas, en 17 estados que ampliaron Medicaid y atiende a casi 3 de cada 5 personas inscritas en el programa a nivel nacional, según la empresa.

Durante una llamada de resultados en febrero, la empresa dijo que puede cobrar según el número de gestiones que realiza para los afiliados, independientemente de cuántas personas estén inscritas en el programa en un estado.

Maximus no tiene “un enfoque único” para los servicios que ofrece ni para cómo cobra por ellos, dijo su vocera Marci Goldstein a �鶹Ů�� Health News.

La empresa, que reportó ingresos de $1.760 millones en 2025 en el área que incluye trabajo relacionado con Medicaid, espera que esos ingresos sigan creciendo, incluso si menos personas permanecen en el programa, “debido a las gestiones adicionales que serán necesarias”, señaló David Mutryn, director financiero y tesorero de Maximus.

Perder la cobertura de Medicaid no es solo una molestia, ya que muchas personas inscritas probablemente no ganan lo suficiente para pagar atención médica por su cuenta y pueden no calificar para ayuda financiera bajo la Ley de Cuidado de Salud a Bajo Precio (ACA), dijo Elizabeth Edwards, abogada del National Health Law Program.

Las personas podrían no poder pagar medicamentos o recibir atención esencial, lo que podría tener impactos “devastadores” en la salud, dijo.

“Lo que está en juego son las vidas de las personas”, concluyó.

Los corresponsales de �鶹Ů�� Health News Katheryn Houghton y Samantha Liss contribuyeron con este artículo.

�鶹Ů�� Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at �鶹Ů��—an independent source of health policy research, polling, and journalism. Learn more about .

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“The first time, it’ll ring interminably. Next time, it’ll go to a voicemail that just hangs up on you,” said the 48-year-old, who lives in Delaware. “Sometimes you’ll get a person who says they’re not the right one. They transfer you, and it hangs up. Sometimes, it picks up and there’s just nobody on the line.”

She spent months trying to figure out whether her Medicaid coverage had been renewed. As of late March, she hadn’t been reapproved for the year for the state-federal program, which provides health insurance for people with low incomes and disabilities.

Crouch, who suffered a debilitating brain aneurysm a decade ago, also has Medicare, which covers people who are 65 or older or have disabilities. Medicaid had been paying her monthly Medicare deductibles of $200, but she’d been on the hook for them for the past three months, straining her family’s fixed income, she said.

Crouch’s challenges with Delaware’s Medicaid call center aren’t unique. State Medicaid agencies can struggle to keep enough staff to help people sign up for benefits and field calls from enrollees with questions. A shortage of such workers can keep people from fully using their benefits, health policy researchers said.

Now, congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, will soon demand more from staff at state agencies in places where lawmakers expanded Medicaid to more low-income adults — nearly all states and the District of Columbia.

Under the law, which is expected to reduce Medicaid spending by almost $1 trillion over the next eight years, these staffers will have to not only determine whether millions of enrollees meet the program’s new work requirements but also verify more frequently that they qualify for the program — every six months instead of yearly.

�鶹Ů�� Health News reached out to agencies that will need to stand up the work rules, and many said they’ll need additional staff.

The mandates will put extra strain on an already-stressed workforce, potentially making it harder for enrollees like Crouch to get basic customer service. And many could lose access to benefits they’re legally entitled to, said consumer advocates and health policy researchers, some of them with direct experience working at state agencies.

States are already “struggling significantly,” said Jennifer Wagner, the director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities and a former associate director of the Illinois Department of Human Services. “There will be significant additional challenges caused by these changes.”

Long Wait Times for Help

Republicans argue the Medicaid changes, which will take effect Jan. 1, 2027, in most states, will encourage enrollees to find jobs. Research on other Medicaid work requirement programs has found little evidence they increase employment.

The Congressional Budget Office would cause more people to lose health coverage by 2034 than any other part of the GOP budget law. It said last year more than 5 million people could be affected.

Many states don’t have the staff to process Medicaid applications or renewals quickly, said consumer advocates and researchers.

The Centers for Medicare & Medicaid Services tracks whether states can handle the most common type of benefit application within a 45-day window.

In December, about 30% of all Medicaid and Children’s Health Insurance Program, or CHIP, applications in Washington, D.C., and Georgia to process. More than a quarter took that long in Wyoming. In Maine, 1 in 5 applications missed that deadline.

CMS began publicly sharing state Medicaid call center data in 2023, revealing a taxed system, researchers and consumer advocates said.

In Hawaii, people waited on the phone for more than three hours in December. They waited for nearly an hour in Oklahoma, and more than an hour in Nevada.

In 2023, state Medicaid agencies began making sure enrollees who were protected from being dropped from the program during the covid pandemic still qualified for coverage. That Medicaid unwinding process didn’t go well in many states, and lost their benefits.

Health policy researchers and consumer advocates say rolling out the new Medicaid rules will be a bigger challenge. The Medicaid work rules will require extensive IT system changes and training for workers verifying eligibility on a tight timeline.

“It is a much larger scale of administrative complexity,” said Sophia Tripoli, senior director of policy at Families USA, a health care consumer advocacy organization.

After months of trying to get someone on the phone, Crouch said, she finally got answers to questions about her Medicaid benefits after writing to the office of U.S. Rep. Sarah McBride (D-Del.). McBride’s office contacted the state’s Medicaid agency, which eventually called with an update, Crouch said.

Crouch didn’t qualify for Medicaid after all. She said that had never come up in two years of interactions with the state.

“It makes absolutely no sense” that the state never realized she shouldn’t have been on the program, Crouch said.

Delaware’s Medicaid agency didn’t respond to requests for comment on Crouch’s situation.

States Short-Staffed for Medicaid

Some states told �鶹Ů�� Health News in late March that they’ll need more staff to roll out the work rules effectively.

Idaho said it has 40 eligibility worker vacancies. New York estimated it will need 80 new employees to handle the additional administrative work, at a cost of $6.2 million. Pennsylvania said it has nearly 400 open positions in county human services offices in the state. Indiana’s Medicaid agency has 94 open positions. Maine wants to hire 90 additional staffers, and Massachusetts wants to hire 70 more.

As of early March, Montana had filled 39 of 59 positions state officials projected it would need. The state still plans to roll out the rules early, starting July 1, despite its long struggle with system backlogs that applicants said have delayed benefits.

Missouri’s social services agency has been cutting staff and has 1,000 fewer front-line workers than it did roughly a decade ago — with more than double the number of enrollees in Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, according to comments Jessica Bax, the agency director, made in November.

“The department thought that there would be a gain in efficiency due to eligibility system upgrades,” Bax said. “Many of those did not come to fruition.”

States could have a hard time finding people interested in taking those jobs, which require months-long training, can be emotionally challenging, and generally offer low pay, said Tricia Brooks, a researcher at the Georgetown University Center for Children and Families.

“They get yelled at a lot,” said Brooks, who formerly ran New Hampshire’s Medicaid and CHIP customer service program. “People are frustrated. They’re crying. They’re concerned. They’re losing access to health care, and so sometimes it’s not an easy job to take if it’s hard to help someone.”

States are paying government contractors millions of dollars to help them comply with the new federal law.

Maximus, a government services contractor, provides eligibility support, such as running call centers, in 17 states that expanded Medicaid and interacts with nearly 3 in 5 people enrolled in the program nationally, according to the company.

During a February earnings call, company leadership said Maximus can charge based on the number of transactions it completes for enrollees, independent of how many people are enrolled in a state’s Medicaid program.

Maximus has “no one-size-fits-all approach” to the services it offers or the way it charges for those services, spokesperson Marci Goldstein told �鶹Ů�� Health News.

The company, which reported bringing in $1.76 billion in 2025 from the part of its business that includes Medicaid work, expects that revenue to continue to grow, even as people fall off the Medicaid rolls, “because of the additional transactions that will need to take place,” David Mutryn, Maximus’ chief financial officer and treasurer, said during the earnings call.

Losing Medicaid health coverage isn’t just an inconvenience, since many people enrolled in the program probably don’t make enough money to pay for health care on their own and may not qualify for financial help for Affordable Care Act coverage, said Elizabeth Edwards, a senior attorney with the National Health Law Program.

People could be unable to afford medications or get essential care, which could lead to “devastating” health impacts, she said.

“The human stakes of this are people’s lives,” she said.

�鶹Ů�� Health News correspondents Katheryn Houghton and Samantha Liss contributed to this report.

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But seven months later, findings from five states shared with �鶹Ů�� Health News show that the reviews have uncovered little evidence of a widespread problem.

Only U.S. citizens and some lawfully present immigrants are eligible for Medicaid, which covers health care costs for people with low incomes and disabilities, and the closely related Children’s Health Insurance Program. Both programs are administered by states.

Spokespeople from Pennsylvania’s and Colorado’s Medicaid agencies said, as of March, the states had found no one who needed to be terminated from Medicaid. That was after checking a combined 79,000 names.

Texas has reviewed records of more than 28,000 Medicaid enrollees at the Trump administration’s request and terminated coverage for 77 of them, according to Jennifer Ruffcorn, a spokesperson for the Texas Department of Human Services.

Ohio has checked 65,000 Medicaid enrollees, of which 260 people were disenrolled from the program, said Stephanie O’Grady, a spokesperson for the Ohio Department of Medicaid.

In Utah, 42 of the 8,000 enrollees identified by the Trump administration had their Medicaid coverage terminated, said Becky Wickstrom, a spokesperson for the state’s Department of Workforce Services.

In announcing the reviews, Health and Human Services Secretary Robert F. Kennedy Jr. said: “We are tightening oversight of enrollment to safeguard taxpayer dollars and guarantee that these vital programs serve only those who are truly eligible under the law.”

Leonardo Cuello, a research professor at Georgetown University’s Center for Children and Families, said the reviews ordered by the federal Centers for Medicare & Medicaid Services were unneeded because states check immigration status when people sign up.

“It is entirely predictable that all of these burdensome reviews that the federal government is forcing upon states would yield no pay dirt,” Cuello said. “The states had already done the reviews once, and CMS was just making them reverify the same information they had already checked. Making states go through the same bureaucratic process twice is incredibly wasteful and inefficient.”

CMS spokesperson Chris Krepich said in a statement to �鶹Ů�� Health News that the ongoing checks are verifying eligibility “for certain enrollees whose status could not be confirmed through federal data sources.”

“CMS provides states with regular reports for follow-up review, and states are responsible for independently verifying eligibility and taking appropriate action consistent with federal requirements,” he said.

But the findings shared with �鶹Ů�� Health News also suggest that many of the enrollees whose eligibility the Trump administration said it could not confirm are indeed U.S. citizens. O’Grady said Ohio found that, of the 65,000 names referred by the federal government, the state already had information on 53,000 confirming them as citizens and an additional 11,000 showing appropriate immigration status for Medicaid.

Caseworkers then worked on the remaining 1,000 names to review their information or reach out for more details, she said.

CMS did not answer questions about the findings from the states sampled by �鶹Ů�� Health News or provide information about responses it received from all 50 states and the District of Columbia, which were instructed to perform verification checks.

The agency also did not respond to a question about whether it’s forwarding the names of those whose Medicaid coverage was terminated to federal immigration officials.

In June, advisers to Kennedy ordered CMS to share information about Medicaid enrollees with the Department of Homeland Security, prompting a lawsuit by some states alarmed that the administration would use the information for its deportation campaign against residents living in the U.S. without authorization.

A federal judge that Immigration and Customs Enforcement workers could access information only about people in the country unlawfully in the Medicaid databases of the states that sued.

CMS continues to send states lists of names at least every few months, though state officials say the numbers have declined since the first batch last summer.

People without legal status are ineligible for federally funded health coverage, including Medicaid, Medicare, and plans through the Affordable Care Act marketplaces. Medicaid does reimburse hospitals for providing emergency care to people without legal status if they meet income and other program requirements.

Seven states and the District of Columbia provide health coverage regardless of immigration status, funding the programs with their own money.

In March 2025, CMS began financial reviews of those programs. “CMS has identified over $1.8 billion in federal funds that are being recouped through voluntary returns and deferrals of future federal Medicaid payments,” Krepich said. He did not answer how much has been collected so far or from which states.

Medicaid’s overall spending topped $900 billion in fiscal year 2024.

�鶹Ů�� Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at �鶹Ů��—an independent source of health policy research, polling, and journalism. Learn more about .

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The Trump administration this week missed a deadline to nominate a new director for the Centers for Disease Control and Prevention. Without a nominee, current acting Director Jay Bhattacharya — who is also the director of the National Institutes of Health — has to give up that title, leaving no one at the helm of the nation’s primary public health agency.��

Meanwhile, a week after one federal judge blocked changes to the childhood vaccine schedule made by the Department of Health and Human Services, another blocked a proposed ban on gender-affirming care for minors.��

This week’s panelists are Julie Rovner of �鶹Ů�� Health News, Rachel Cohrs Zhang of Bloomberg News, Lizzy Lawrence of Stat, and Shefali Luthra of The 19th.

Panelists

Among the takeaways from this week’s episode:

• A federal judge ruled against the Trump administration’s declaration intended to limit trans care for minors, though the ruling’s practical effects will depend on whether hospitals resume such care. And a key member of the remade federal vaccine advisory panel resigned as the panel’s activities — and even membership — remain in legal limbo.
• Two senior administration health posts remain unfilled, after President Donald Trump missed a deadline to fill the top job at the Centers for Disease Control and Prevention — and the Senate made little progress on confirming his nominee for surgeon general.
• The percentage of international graduates from foreign medical schools who match into U.S. residency positions has dropped to a five-year low. That’s notable given immigrants represent a quarter of physicians, many of them in critical but lower-paid specialties such as primary care — particularly in rural areas. Meanwhile, new surveys show that more than a quarter of labs funded by the National Institutes of Health have laid off workers and that federal research funding cuts have had a disproportionate effect on women and early-career scientists.
• And new data shows the number of abortions in the United States stayed relatively stable last year, for the second straight year — largely due to telehealth access to abortion care. And a vocal opponent of abortion in the Senate, with his eyes on a presidential run, introduced legislation to effectively rescind federal approval for the abortion pill mifepristone.

Also this week, Rovner interviews Georgetown Law Center’s Katie Keith about the state of the Affordable Care Act on its 16th anniversary.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Stat’s “,” by John Wilkerson.��

Shefali Luthra: NPR’s “,” by Tara Haelle.��

Lizzy Lawrence: The Atlantic’s “,” by Nicholas Florko.��

Rachel Cohrs Zhang: The Boston Globe’s “,” by Tal Kopan.��

Also mentioned in this week’s podcast:

• Stat’s “,’” by Jonathan Wosen.
• �鶹Ů�� Health News’ “Rising Health Costs Push Some Middle-Aged Adults To Skip the Doc Until Medicare,” by Sam Whitehead.
• Guttmacher’s “,” by Isaac Maddow-Zimet and Kimya Forouzan.
• United for Medical Research’s “.”

[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. Welcome to��What the Health?��I’m��Julie Rovner, chief Washington correspondent for �鶹Ů�� Health News, and��I’m��joined by some of the best and smartest reporters��covering��Washington.��We’re��taping this week on Thursday,��March 26,��at 10��a.m.��As always, news happens fast, and things might have changed by the time you hear this. So,��here we go.��

Today,��we are joined via video conference by Rachel��Cohrs Zhang��of Bloomberg News.��

Rachel Cohrs Zhang:��Hi,��everybody.��

Rovner:��Shefali Luthra��of��The��19th.��

Shefali Luthra:��Hello.��

Rovner:��And Lizzy Lawrence of Stat News.��

Lizzy Lawrence:��Hello.��

Rovner:��Later in this episode��we’ll��have my interview with Katie Keith of Georgetown University about the state of the Affordable Care Act as it turns 16��—��old enough to drive in most states. But first,��this week’s news.��

So,��it has been another busy week at the Department of Health and Human Services. Last week, a federal judge in Massachusetts blocked the department’s vaccine policy,��ruling it had violated federal administrative procedures��regarding��advisory committees. This week, a federal judge in Portland, Oregon,��ruled the department also��didn’t��follow the required process to block federal reimbursement for transgender-related medical treatment. The case was brought by 21��Democratic-led states. Where does this leave the hot-button issue of care for transgender teens? Shefali,��you’ve��been following this.��

Luthra:��I mean, I think it’s still really up in the air.��A lot of this depends on how hospitals now respond��—��whether they feel confident in the court’s decision,��having staying��power enough to actually resume offering services.��Because a lot of them stopped.��And so that’s something we’re still waiting to actually see how this plays out in practice.��Obviously,��it’s��very symbolic, very legally meaningful, but whether this will translate into changes in practical health care access, I think, is��an open question still.��

Rovner:��Yeah, we will��definitely have��to see how��this one plays��out��— and,��obviously,��if and when��the administration��appeals��it. Well, speaking of that vaccine ruling from last week��—��which,��apparently,��the��administration has not yet appealed, but is going to��—��one of the most contentious members of that very contentious Advisory Committee on Immunization Practices has resigned. Dr.��Robert Malone, a physician and��biochemist, said he��didn’t��want to be part of the��“drama,”��air quotes.��But he caused a lot of��the drama, didn’t he?��

Cohrs Zhang:��He has been��pretty outspoken, and��I think he��isn’t��like a Washington person necessarily��—��isn’t��somebody��who’s��used to,��like,��being on a public stage and having your social media posts appear in large publications.��So��I think��it’s��questionable, like, whether he had a position to resign from.��I think his nomination��was stayed,��too.��But I think it is��…��the back-and-forth,��I think,��there is a good point that this limbo can be frustrating for people when meetings��are canceled��at��the last minute, and people have travel plans,��and it does��…��just changes the calculus for kind of making it worth it to serve on one of these advisory committees.��

Rovner:��And I’m not sure whether we mentioned it last week, but the judge’s ruling not only said that the people were incorrectly appointed to ACIP, but it also stayed any meetings of the advisory committee until there is further court action, until basically, the case is done or it’s overruled by a higher court. So��…��vaccine policy��definitely is��in limbo.����

Well, meanwhile, yesterday was the deadline for the administration to nominate someone to head the Centers for Disease Control and Prevention since Susan��Monarez��was abruptly dismissed, let��go, resigned, whatever, late last summer. Now that that deadline has passed, it means that acting��Director Jay Bhattacharya, who had added that title to his day job as head of the National Institutes of Health,��can no longer��remain��acting��director of CDC.��Apparently, though��he’s��going to��sort of remain��in charge, according to HHS spokespeople, with some authorities reverting to��[Health and Human Services]��Secretary��[Robert F.]��Kennedy��[Jr.].��What’s��taking so long to find a CDC director?����

To quote D.C.��cardiologist and frequent cable TV health policy commentator��,��“The problem here is that��there’s��no candidate��who’s��qualified, MAHA acceptable, and Senate confirmable. Those job requirements are mutually exclusive.”��That feels kind of accurate to me.��Is that actually��the��problem?��Rachel, I see you smiling.��

Cohrs Zhang:��Yeah.��I think it is tough to find somebody who checks all of those boxes.��And though it has been��210 days��since the clock��has started, I would just point out that there has been a significant leadership shake-up at HHS, like among the people who are kind of running this search, and they came in, you know, not that long ago.��It’s��only been, you know,��a��month and a half or so.��So��I think there certainly have been some��new faces��in the room who might have different opinions.��But��I think it��isn’t��a good look for them to miss this deadline when they have this much notice. But I think��there’s��also, like,��legal experts that��I’ve��spoken with��don’t��think that��there’s��going to be a huge��day-to-day��impact on the operations of the CDC. It��kind of reminds��me of that office where there’s,��like,��an��“assistant��to��the��regional��manager vibe”��going on, where, like,��Dr.��Bhattacharya is now acting in the capacity of CDC director, even though he��isn’t��acting��CDC director��anymore. So,��I think I��don’t��know that��it’ll��have a huge��day-to-day��impact, but it is��kind of hanging��over HHS at this point, as they are already struggling with the��surgeon��general nomination,��to get that through the Senate.��So��it just creates this backlog of nominations.��

Rovner:��I’ve��assumed��they’ve��floated some names, let us say, one of which is Ernie Fletcher, the former governor of Kentucky, also a former member of the House Energy and Commerce health subcommittee, with��some certainly medical chops, if not public health chops.��I think��the��head of the health department in Mississippi. There was one other who��I’ve��forgotten, who it is among the names that have been floated��…��

Cohrs Zhang:��Joseph Marine.��He’s��a cardiologist at Johns Hopkins, who has��—��is kind of like in the kind of Vinay Prasad world of critics of the FDA and,��like,��CDC’s covid��booster strategy.��

Rovner:��And yet, apparently, none of them could pass, I guess, all three tests. Do we think it might still be one of them? Or do we think there are other names that are yet��to come?��

Cohrs Zhang:��Our understanding is that there are other candidates whose names have not become public, and I think there’s also a possibility they don’t choose any of these candidates and just drag it on for a while because,��at this point, like, I don’t know what the rush is,��now that the deadline is passed.��

Lawrence:��Yeah, is there another deadline to miss?��

Cohrs Zhang:��I��don’t��think so.��

Lawrence:��I think this��was the only one.��

Cohrs Zhang:��This was the big one that they now have.��It’s��vacant, but it was vacant before as well. Like, I think, earlier in the��administration, when��Susan��Monarez��was nominated.��

Rovner:��But she, well��…��that’s��right, she was the��“acting,”��and then once she was nominated, she��couldn’t��be the acting anymore.��

Cohrs Zhang:��Yeah.��

Rovner:��So��I guess��it��was vacant while she was being considered.��

Cohrs Zhang:��It was.��So��it’s��not an unprecedented situation, even in this administration.��It’s��just not a good��look, I guess. And I think there is value in having a leader that can interface with the White House and with different leaders, and just having a direction for the agency, especially because it’s in Atlanta, it’s a little bit more removed from the everyday goings-on at HHS in general.��So��I think there’s definitely a desire for some stability over there.��

Rovner:��And we have measles spreading in lots more states.��I mean, every time I��…��open up my news feeds, it’s like, oh, now we have measles, you know, in Utah, I think,��in Montana.��Washtenaw County, Michigan,��had its first measles case recently.��So��this is something that the CDC should be on top of, and yet there is no one on top of the CDC. Well, Rachel, you already alluded to this, but it is also apparently hard to find a surgeon general who’s both acceptable to MAHA��and Senate confirmable, which is my way of saying that the Casey��Means nomination still appears to lack the votes to move out of the Senate, Health, Education, Labor��&��Pensions Committee. Do we have any latest��update��on that?��

Cohrs Zhang:��I think the latest update, I mean, my colleagues at Bloomberg Government just��kind of had��an update this week that��they’re��still not to��“yes” —��like,��there are some key senators that still��haven’t��announced their positions publicly.��So��I think a lot of the same things that��we’ve��been hearing��…��like��Sens.��Susan Collins and��Lisa Murkowski and Bill Cassidy obviously have not��stated��their positions publicly on the nomination.��Sen.��Thom Tillis, who you��know��is kind of in a lame-duck scenario and doesn’t really have anything to lose, has, you know, said he’s not really made a decision.��So��I think they’re kind of in this weird limbo where they, like, don’t have the votes to advance her, but they also have not made a decision to pull the nomination at this time. So either, I think,��they have to push harder on some of these senators, and I think senators see this as a leverage point that I don’t know that a lot of��—��that all of the complaints are about Dr.��Means specifically, but anytime that there is frustration with the wider department, then this is an opportunity for senators to have their voice heard, to��…��potentially extract some concessions. And��so��there’s��a question right now, are they going to change course again for this position, or are they going to, you know, sit down at the bargaining��table��and really cut some deals to advance her nomination? I just��don’t��think we know the answer to that yet.��

Rovner:��Yeah,��it’s��worth reminding that,��frequently,��nominations get held up for reasons that are totally disconnected from the person involved. We went��—��I should go back and look this up��— we went, like, four years in two different administrations without a confirmed head of the Centers for Medicare��&��Medicaid��Services because members of Congress were angry about other things, not because of any of the people who had actually been nominated to fill that position. But in this case, it does seem to be, I think,��both Casey��Means and,��you know, her connection to��MAHA,��and the fact that among those who haven’t declared their positions yet,��it’s the chairman of the committee, Bill Cassidy, who’s in this very tight primary to keep his seat.��So��we will keep��on that one.����

Also, meanwhile, HHS continues to push its��Make America��Healthy��Again priority. Secretary Kennedy hinted on the Joe Rogan podcast last month that the FDA will soon take unspecified action to make customized peptides easier to obtain from compounding pharmacies. These��mini-proteins��are part of a biohacking trend that many MAHA��adherents say can��benefit��health,��despite their not having been shown to be safe and effective in the normal FDA approval process. The FDA��has��also��formally��pulled��a proposed rule that would have banned teens from using tanning beds. We know that the��secretary is a fan of tanning salons, even though that��has��been shown to cause potential health problems,��like skin cancer. Lizzy,��is Kennedy just going to push as much MAHA��as he can until the courts or the White House stops him?��

Lawrence:��I guess so. I mean, we do have this new structure at HHS��now that’s trying to��—��clearly��…��there are warring factions with the MAHA agenda and the White House really trying to focus more on affordability and less on��…��vaccine scrutiny and the medical freedom movement that is really popular among Kennedy’s supporters.��…��I’m��very curious about��what’s��going to happen with peptides, because��it’s��a sign of Kennedy’s regulatory philosophy, where��there’s��some products that are good and some that are bad.��It’s��very atypical, of course, for��…��

Rovner:��And that he gets��to decide��rather than the scientists, because he��doesn’t��trust the scientists.��

Lawrence:��Right. Right.��But there has been, I mean, the FDA has kind of been pretty severe on GLP-1��compounders��Hims��&��Hers, so it’ll be interesting to see, you know, how much Kennedy is able to exert his will here, and how much FDA regulators will be able to push back and make their voices heard.��

Rovner:��My favorite piece of FDA��trivia��this week is that FDA is posting the jobs that are about to be vacant at the vaccine center, and one of the things that it actually says in the job description is that you don’t have to be immunized. I��don’t��know if��that’s��a signal or what.��

Lawrence:��Yeah,��I think it��said no telework, which Vinay Prasad famously was teleworking from San Francisco. So,��yeah, I��don’t��know.��But��this��was,��I think it��was for his deputy, although��I’m��sure, I mean, they do need a CBER��[Center for Biologics Evaluation and Research]��director as well.��

Rovner:��Yeah,��there’s��a lot of openings right now at HHS.��All right,��we’re��gonna��take a quick break. We will be right back.��

So��Monday was the 16th anniversary of the signing of the Affordable Care Act, which we will hear more about in my interview with Katie Keith.��But I wanted to highlight a��story by my���鶹Ů����Health��News colleague Sam Whitehead��about older Americans nearing Medicare eligibility putting off preventive and other care until they qualify for federal coverage that will let them afford it. For those who listened to my interview last week with Drew Altman, this hearkens back to one of the big problems with our health system. There are so many quote-unquote��“savings”��that are��actually just��cost-shifting, and often that cost-shifting raises costs overall. In this case, because those older people can no longer afford their insurance or their deductibles,��they put off care until it becomes more expensive to treat. At that point,��because��they’re��on Medicare, the��federal taxpayer will foot a bill��that’s��even bigger than the bill that would have been paid by the insurance company.��So��the savings taxpayers gained by Congress cutting back the Affordable Care Act subsidies are lost on the Medicare end. Is this cost-shifting the inevitable outcome of addressing everything in our health care system except the actual prices of medical care?��

Cohrs Zhang:��I think��it’s��just another example of how people’s behavior responds to these weird incentives. And I think��we’re��seeing this problem, certainly among early retirees,��exacerbated��by the��expiration��of the Affordable Care Act subsidies that��we’ve��talked about very often on this podcast, because it affects these higher earners, and it can dramatically increase costs for coverage. And��I think people��just hope that they can hold on. But again, these��statutory deadlines that lawmakers make up sometimes,��not with a lot of forethought or rational��reasoning,��they have consequences.��And obviously, the Medicare program continues to pay beyond age 65 as well.��And I think��it’s��just another symptom of what the administration talks about when they talk about emphasizing, you know, preventative care and addressing chronic conditions��—��like,��that is a real problem. And,��yeah, I think��we’re��going to see these problems in this population continue to get worse as more people forgo care, as it becomes more expensive on the individual markets.��

Luthra:��I think you��also make a good point, though, Julie, because the increase in costs and cost sharing is not limited to people with marketplace plans, right? Also, people with employer-sponsored health care are seeing their out-of-pocket costs��go up. Employers are seeing what they pay for insurance��go��up as well. And there absolutely is something to be said about��it’s��been 16 years since the Affordable Care Act��passed,��we��haven’t��really had meaningful intervention on the key source of health care prices, right? Hospitals, providers, physicians. And it does seem, just thinking about where the public is and the politics are, that there is possibly��appetite��around this. You see a lot of talk about affordability, but a lot of��this feels, at least as an observer,��very focused��on insurance, which makes sense. Insurance is��a very easy��villain to cast.��But I think you’ve raised a��really good point:��that addressing these really potent burdens on individuals and eventually on the public just requires something��more systemic and more serious if we actually want to yield better outcomes.��

Rovner:��Yeah, there’s just, there’s so much passing the hat that, you know,��I don’t want to do this,��so��you��have to do this.��You know, inevitably, people need health care.��Somebody has to pay for it.��And I think that’s��sort of the��bottom line that nobody really seems to want to address.��

Well, the other theme of 2026 that I feel like I keep repeating is what funding cutbacks and other changes are doing to the future of the nation’s biomedical and medical workforces. Last week was Match Day.��That’s��when graduating medical school seniors find out if and where they will do their residency training. One big headline from this year’s match is that the percentage of non-U.S.��citizen graduates of foreign medical schools matching to a U.S.��residency position fell to a five-year low of 56.4%.��That compares to a 93.5% matching rate for U.S.��citizen graduates of U.S.��medical schools. Why does that matter? Well, a quarter of the U.S.��physician workforce are immigrants, and they are disproportionately represented, both in lower-paid primary care specialties, particularly in rural areas, both of which��U.S.��doctors tend to find less desirable. This would seem to be the result of a combination of new fees for visas for foreign professionals that��we’ve��talked about, a general reduction in visa approvals,��and some people��likely not��wanting to even come to the U.S.��to practice. But that rural health fund that Republicans say will revitalize rural health care��doesn’t��seem like��it’s��really going to work without an adequate number of doctors and nurses, I would humbly suggest.��

Lawrence:��Yeah, absolutely. I mean,��it’s��patients that suffer, right? I mean, you need the people doing the work. And��so��I think that the impacts will start being felt sooner rather than later. That is something that hopefully people will start to feel the pain from.��

Rovner:��I feel like when people think about the immigrant workforce, they think about lower-skilled, lower-paid jobs that immigrants do, and they don’t think about the fact that some of the most highly skilled, highly paid jobs that we have, like being doctors, are actually filled by immigrants, and that if we cut that back, we’re just going to exacerbate shortages that we already know we have.��

Luthra:��And training doctors takes, famously,��a very long��time. And��so��if you are disincentivizing people from coming here to practice, cutting off this key source of supply,��it’s��not as if you can��immediately��go out and say,��Here,��let’s��find some new people and make them doctors. It will take years to make that tenable, make that attractive,��and make that a reality. And it just seems,��to Lizzy’s point,��that even in the scenario where that was possible��—��which I would be somewhat doubtful;��medicine is a hard and difficult career;��it’s not like you can make someone want to do that overnight��—��patients will absolutely see the consequences. I��don’t��know if��it’s��enough to change how people think about immigration policy and ways in which we recruit and engage with immigrant workers, but��it’s��absolutely something that should be part of our discussion.��

Rovner:��Yeah, and I think��it’s��been left out.��Well,��meanwhile,��over at the National Institutes of Health, a��,��Lizzy,��found that more than a quarter have laid off laboratory workers. More than��2��in��5��have canceled research,��and two-thirds have counseled students to consider careers outside of academic research. A separate study published this week found that women and early-career scientists have been disproportionately affected by the NIH cuts, even though most of the money goes to men and to later-career scientists. As I keep saying,��this��isn’t��just about the��future of science. Biomedical research is a��huge piece of the U.S.��economy. Earlier this month, the group��United for��Medical��Research��,��finding��that every dollar invested produced $2.57 for the economy. Concerned members of Congress from both parties last week at an appropriations hearing got NIH Director Jay Bhattacharya to again promise to push all the money that they appropriated out the door.��But��it’s��not clear whether��it’s��going to continue to compromise the future workforce. I feel like, you know, we talk about all these missing people and nomination stuff, but��we’re��not really talking a lot about��what’s��going on at the National Institutes of Health, which is a, you know, almost��$50 billion-a-year enterprise.��

Lawrence:��Right.��In some labs, the damage has already been done. You��know, even if Dr.��Bhattacharya��[follows through],��try spending all the money that has been appropriated. There are young��researchers that have been shut out and people that have had to choose alternative career paths. And��I think this��is one of those things��that’s��difficult politically or, you know, in��the public��consciousness, because it is hard to see the immediate impacts��it’s��measured. And I think my colleague Jonathan wrote��[that]��breakthroughs��are��not��discovered��things, you know.��So��it’s��hard to know what��is being missed.��But the immediate impact of the workforce and��not missing this whole generation of scientists that has decided to go to another country or go to do something else, those impacts will be felt for years to come.��

Rovner:��Yeah, this is another one where you��can’t��just turn the spigot back on and have it��immediately��refill.����

Finally, this week, there is always��reproductive��health��news. This week,��we got the Alan Guttmacher Institute’s����for the year 2025,��which both sides of the debate consider the most accurate, and it found that for the second year in a row, the number of abortions in the U.S.��remained relatively stable, despite the fact that it’s outlawed or seriously restricted in nearly half the states.��Of course, that’s because of the use of telehealth, which abortion opponents are furiously trying to get stopped, either by the FDA itself or by Congress.��Last week, anti-abortion Sen.��Josh Hawley of Missouri introduced legislation that would��basically rescind��approval for the abortion pill mifepristone. But that legislation is��apparently giving��some Republicans in the Senate heartburn, as they really��don’t��want to engage this issue before the midterms.��And,��apparently,��the��Trump administration��doesn’t��either, given what we know about the FDA saying that��they’re��still studying this.��On the other hand, Republicans��can’t��afford to lose the backing of the anti-abortion activists either.��They put lots of time, effort,��and money into turning out votes, particularly in times like midterms. How big a controversy is this becoming, Shefali?��

Luthra:��This is a huge controversy, and��it’s��so interesting to watch this play out. When I saw Sen.��Hawley’s bill, I mean, that stood out to me as positioning for 2028.��He clearly wants to be a favorite among the anti-abortion��movement��heading into a future presidential primary. But at the same time, this is teasing out��really potent��and powerful dynamics among the anti-abortion movement and Republican lawmakers,��exactly what you said. Republican lawmakers know this is not popular. They do not want to talk about abortion, an issue at which they are at a huge disadvantage��with��the public. Susan B Anthony��List and other such organizations are trying to make the argument that if they are taken for granted,��as they feel as if they are, that will result in an enthusiasm gap.��Right? People will not turn out. They will not go door-knocking,��they��won’t��deploy their tremendous resources to get victories in a lot of these contested,��particularly Senate and House,��races. And obviously, the��president cares a lot about the midterms.��He’s��very concerned��about what happens��when��Democrats take control of Congress. But I think what Republicans are wagering, and��it’s��a fair thought, is that where would anti-abortion activists go? Are they going to go to Democrats,��who��largely support��abortion rights? And a lot of them seem confident that they would rather risk some people staying home and,��overall, not alienating a very large sector of the American public that does not support restrictions on abortion nationwide, especially those that many are concerned are not in keeping with the actual science.��

Rovner:��Yeah, I think the White House, as you said, would like to make this not front and center, let’s��put it that way,��for the midterms. But��yeah, and just to be clear, I mean, Sen.��Hawley introduced this bill. It��can’t��pass.��There’s��no way it gets 60 votes in the Senate.��I’d��be surprised if it could get 50 votes in the Senate.��So��he’s��obviously doing this just to turn up the heat on his colleagues, many of whom are not��very happy��about that.��

Luthra:��And anti-abortion activists are already thinking about 2028.��They are, in fact, talking to people like Sen.��Hawley, like the��vice��president, like Marco Rubio, trying to figure out who will��actually be��their champion in a post-Trump landscape. And so far, what��I’m��hearing,��is that they are��very optimistic��that anyone else could be better for them than the��president��is because they are just so dissatisfied with how little��they’ve��gotten.��

Rovner:��Although they did get the overturn of��Roe v.��Wade.��

Luthra:��That’s��true.��

Rovner:��But you know, it goes back to��sort of my��original thought for this week, which is that the number of abortions��isn’t��going down because of the��relatively easy��availability of abortion pills by mail. Well, speaking of which, in a��somewhat related��story, a woman in Georgia has been charged with murder for taking abortion pills later in pregnancy than��it’s��been approved for, and delivering a live fetus who��subsequently��died. But the judge in the case has already suggested the prosecutors have a giant hill to climb to convict her and set her bail at $1.��Are we going to see our first murder trial of a woman for inducing her own abortion?��We’ve��been��sort of flirting��with this possibility for a while.��

Luthra:��It seems possible.��I think it’s a really good question, and this moment certainly feels like a possible Rubicon, because going after people who get abortions is just so toxic for the anti-abortion movement.��They have promised they would not go after people who are pregnant, who get abortions.��And this is exactly what they are doing. And��I think what��really stands out to me about this case is so much of it depends on individual prosecutors and individual judges. You have��the law enforcement officials who decided to make this a case, and��they’re��actually using, not the abortion law, even though the language in the case,��right,��really resonates, reflects with the law in Georgia’s��six-week ban. Excuse me, with the��language��in Georgia’s��six-week ban. But then you have a judge who says this is very suspect. And what feels so significant is that your rights and your protection under abortion laws depend not only on what state you live in, but who happens to be the local prosecutor, the local cop, the local judge, and that’s just a level of micro-precision that I think a lot of Americans would be very surprised to realize they live under.��

Rovner:��Yeah, absolutely. We should point out that the woman has been charged but not yet indicted, because many, many people are watching this case very, very carefully.��And we��will��too.��

All right, that is this week’s news. Now��I’ll��play my interview with Katie Keith of Georgetown University Law Center, and then��we’ll��come back with our extra credits.��

I am pleased to welcome back to the podcast Katie Keith. Katie is the founding director of the Center for Health Policy and the��Law at the Georgetown University Law Center and a contributing editor at Health Affairs, where she keeps all of us up to date on the latest health policy, legal happenings. Katie, thanks for joining us again.��It’s��been a minute.��

Katie Keith:��Yeah.��Thanks for having me,��Julie,��and happy ACA anniversary.��

Rovner:��So��you are my��go-to for all things Affordable Care Act, which is why I wanted you this week in particular,��when the health law turned 16. How would you describe the state of the ACA today?��

Keith:��Yeah,��it’s��a great question. So,��the ACA��remains��a hugely important source of coverage for millions of people who do not have access to job-based coverage. I am thinking of��farmers,��and��self-employed people,��and small-business owners.��And you know, in 2025,��more than��24 million people��relied on the marketplaces all across the country for this coverage.��So��it��remains��a hugely��important place��where people get their health insurance. And we are already starting to see real erosion��in��the gains made under the Biden administration��as a result of, I think, three primary changes that were made in 2025.��So��the first would be Congress’��failure to extend the enhanced premium tax credits, which you have covered a ton,��Julie��and the team,��as having��a huge impact��there. The second is the changes from the��One��Big��Beautiful Bill��Act. And then the third is some of the administrative changes made by the Trump administration that��we’re��already seeing.��So��we��don’t��yet have full data to understand the impact of all three of those��things yet.��We’re��still waiting.��But the preliminary data shows that already enrollments��down��by more than a million people.��I’m��expecting that to drop further. There was some���鶹Ů����survey data out last week that about��1��in 10 people are going uninsured from the marketplace already, and that’s not even, doesn’t even account for all the people who are paying more but getting less, which their survey data shows is about, you know,��3��in 10 folks.��So��you know what makes all of this really,��really tough, as you and I have discussed before, is, I think,��2025, was really a peak year. We saw peak enrollment at the ACA. We saw peak popularity of the law, which has been more popular than not ever since 2017,��when Republicans in Congress tried to repeal it the first time.��And��…��but now it feels like we’re sort of on this precipice for 2026,��watching what’s going to happen with the data into this really important source of coverage for so many people.��

Rovner:��And��…��there’s��been so much news that I think��it’s��been hard for people to absorb. You know, in 2017,��when Republicans tried to repeal the Affordable Care Act, they said��that,��We’re��trying to repeal the Affordable Care Act. Well,��the��2025 you know,��“Big,��Beautiful��Bill,”��they��didn’t��call it a repeal, but it had��pretty much the��same impact, right?��

Keith:��It had��a quite��significant impact. And I think a lot,��like,��you know, there was so much coverage about how Democrats in Congress and the White House learned,��in doing the Affordable Care Act, learned from the failed effort of the Clinton health reform in the��’90s. I think similarly here you saw Republicans in Congress, in the White House, learn from the failed effort in 2017 to be successful here. And��so��you’re exactly right. You did not hear any talk of��“repeal and replace,”��by any stretch of the imagination. I think in 2017 Republicans were judged harshly��—��and appropriately so, in my opinion��—��by the��“replace”��portion��of what,��you know, what they were going to do, and it just��wasn’t��there. And��so��you did not see that kind of framing this time around. Instead, it really is an attempt to do death by��a thousand��paper cuts and impose administrative burdens and a real focus on��kind of who��—��you can’t see me, but air quotes,��you know��—��who��“deserves”��coverage and a focus on immigrant populations. So��…��those changes,��when you layer all of them on��—��changes to Medicaid coverage, Medicaid financing, paperwork burdens, all across all these different programs��—��you know, the��One��Big��Beautiful Bill��Act,��it really does erect new barriers that fundamentally change how Medicaid and the Affordable Care Act will work for people. And��so��it’s��not repealed. I think those programs will still be there, but they will look very different than how they have and,��you know, the CBO��[Congressional Budget Office]��at the time, the coverage losses almost��…��they look quite close to, you know, the skinny repeal that we all remember in the middle of the morning��—��early,��like,��late night,��Sen.��John McCain with his thumbs down.��The coverage losses were almost the same,��and you’ve got��the��CBO now saying,��estimating about 35 million uninsured people by 2028,��which,��you know,��is not��…��it’s just��erasing, I think, not all, but a lot of the gains we’ve made over the past 15, now 16,��years under the Affordable Care Act.��

Rovner:��And now the Trump��administration is proposing still more changes to the law, right?��

Keith:��Yep,��that’s��right.��They’re��continuing, I think, a lot of the same.��There’s��several changes that, you know, go back to the first Trump administration that��they’re��trying to reimpose. Others are sort of��new ideas.��I’m��thinking some of the same ideas are some of the paperwork burdens. So really, in some cases, building��off of��what has been pushed in Congress.��What’s��maybe new��this time around for 2027 that��they’re��pushing is a significant expansion of catastrophic plans. So huge, huge, high-deductible plans that,��you know,��really��don’t��cover much until you hit��tens��of��thousands��of dollars in out-of-pocket costs. You get your preventive services and three primary care visits, but��that’s��it.��You’re��on the hook for anything else you might need until you hit these��really catastrophic��costs.��They’re��punting to��the states on core things like network adequacy. You know, again, some of��it’s��sort of new. Some of��it’s��a throwback to the first Trump administration, so not as surprising. And then on the legislative front, I��don’t��know what the prospects are, but you do continue to see President��[Donald]��Trump call for, you know,��health��savings��account expansions. We think, I think, you know, the idea is to send people money to buy coverage, rather than send the money to the insurers, which I think folks have interpreted as health savings accounts.��There’s��a continued focus on funding cost-sharing reductions, but that issue continues to be snarled by abortion restrictions across the country. So��that’s��something that continues to be discussed, but I��don’t��know if it will ever happen. And you know anything else that’s��kind of under��the so-called��Great��Healthcare��Plan that the White House has put out.��

Rovner:��You mentioned that 2025 was the peak not just of enrollment but of popularity.��And we have seen in poll after poll that the changes that the Trump administration��and��Congress��is��making are not popular with the public, including��the vast majority of��independents and many, many Republicans as well. Is there any chance that Congress and President Trump might relent on some of these changes between now and the midterms?��We did see a bunch of Republicans, you know, break with the rest of the party to try to extend the, you know, the enhanced premiums. Do you see any signs that��they’re��weakening��or��are��we off onto other things entirely��right now?��

Keith:��It’s��a great question.��I think you��probably need��a different analyst to ask that��question to. I��don’t��think my crystal ball covers those types of predictions. But to your point, Julie, I thought that if there would have been time for a compromise and��sort of a��path forward, it would have been around the enhanced premium tax credits. And it was remarkable, you know, given what the history of this law has been��and��the politics��surrounding it, to see 17 Republicans join all Democrats in the House to vote for a clean three-year extension of the premium tax credits. But no, I think especially thinking about where those enhanced tax credits have had the most benefit, it is states like Georgia, Florida, Texas, and I thought that��maybe would,��could have moved the needle if there was a needle to be moved.��So��I,��it seems like��there’s��much more focus on prescription drugs and other issues, but anything can happen.��So��I guess��we’ll��all��stay tuned.��

Rovner:��Well,��we’ll��do this again for the 17th anniversary. Katie Keith, thank you so much.��

Keith:��Thanks,��Julie.��

Rovner:��OK,��we’re��back.��It’s��time for our��extra-credit��segment.��That’s��where we each recognize��a��story we read this��week��we think you should read too.��Don’t��worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Lizzy, why don’t you start us off this week?��

Lawrence:��Sure.��So��my extra credit is by��Nick��[Nicholas]��Florko, former��Stat-ian,��in��The Atlantic,��“”��I��immediately��read this��piece, because��this is something��that’s��been driving me��kind of crazy. Just seeing��—��if��you’ve��missed it��—��there have been��…��HHS has been posting AI-generated videos of Secretary Kennedy wrestling a Twinkie,��wearing waterproof jeans,��all of��these things. And this has been, this is not unique to HHS��—��[the]��White House in general has really embraced AI slop as a genre, and I��can’t��look away. And��so��I thought��Nick did��a good job��just acknowledging how crazy this is, and then also what goes��unsaid in these videos.��I think I��personally am just very curious if this resonates with people, or if��it’s��kind of disconcerting��for the average American��seeing these videos like,��Oh, my government is��making��AI slop.��Like I,��you know, social media strategy is so important, so��maybe for��some��people are��really��liking��this. But��yeah,��I’m��just��kind of curious��about public sentiment.��

Rovner:��I know I would say, you know, the National Park Service and the Consumer Product Safety Commission have been��sort of famous��for their very cutesy social media posts, but��not quite to��this extent. I mean,��it’s��one thing to be cheeky and funny. This is��sort of beyond��cheeky and funny.��I agree with you. I have no idea how this is going over the public, but they keep doing it.��It’s a really good story.��Rachel.��

Cohrs Zhang:��Mine is a story in The Boston Globe, and the headline is��“”��by��Tal Kopan.��And this was a really good profile of Tony Lyons, who is Robert F.��Kennedy Jr.’s book publisher, and he’s kind of had the role of institutionalizing all the political energy behind RFK Jr.��and trying to make this into a more enduring political force.��So��I think he��is, like, mostly a behind-the-scenes guy, not really like a D.C.��fixture, more of like a New York book publishing figure.��But I think his efforts and what they’re using, all the money they’re raising for, I think,��is a really important thing to watch in the midterms, and like, whether they can actually leverage this beyond a Trump administration, or beyond however long Secretary Kennedy will be in his position.��So��I think it��was just a good overview of��all the tentacles of institutional MAHA��that are trying to, you know, find their footing here, potentially for the long term.����

Rovner:��I had��never heard of him, so I was glad to read this story.��Shefali.��

Luthra:��My story is from NPR. It is by��Tara��Haelle. The headline is��“.”��Story says exactly what it promises, that if you have an infant, babies��under��6��months, then getting a covid vaccine while you are pregnant will��actually protect��your baby, which is great because there is no vaccine for infants that young. I love this because it’s a good reminder of something that we were starting to see, and now it just really underscores that this is true, and in the midst of so much conversation around vaccines and safety and effectiveness, it’s a reminder that really, really good research can show us that it is a very good idea to take this vaccine, especially if you��are pregnant.��

Rovner:��More fodder for the argument, I guess. All��right,��my extra credit this week is a clever story from��Stat’s John Wilkerson called��“.”��And,��spoiler,��that loophole is that��one way��companies can avoid running afoul of their promise not to charge other countries less for their products than they charge��U.S.��patients is for them to simply delay launching those drugs in those other countries that have price controls.��Already, most drugs are launched in the U.S.��first, and��apparently some��of the companies that have done deals with the administration limited their promises to three years,��anyway. That way they can charge��U.S.��consumers however much they think the market will bear before they take their smaller profits overseas. Like I said,��clever.��Maybe that’s��why so many companies were ready to do those deals.��

All right, that is this week’s show.��As always, thanks to our editor,��Emmarie��Huetteman;��our producer-engineer, Francis Ying;��and our interview producer,��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’re��at��whatthehealth@kff.org.��Or you can still find me on��X����or��on Bluesky��. Where are you folks hanging these days?��Shefali?��

Luthra:��I am on��Bluesky��.��

Rovner:��Rachel.��

Cohrs Zhang:��On��X��, or��.��

Rovner:��Lizzy.��

Lawrence:��I’m��on��X����and����and��.��

Rovner:��We will be back in your feed��next week.��Until then, be healthy.��

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The , the public health insurance program that pairs state and federal money. Federal officials have announced unprecedented actions in Minnesota this year, declaring they could withhold over $2 billion in payments slated for the state and claw back nearly $260 million from last year.

The actions in Minnesota came as part of the administration’s declared crackdown on fraud, but critics have likened them to using a bludgeon instead of a scalpel, probably harming patients who rely on Medicaid for care but are not responsible for fraud in the program.

“It’s going to hurt a lot of people if they end up going through with this,” said Sumukha Terakanambi, a 27-year-old who has Duchenne muscular dystrophy and works as a public policy consultant with the Minnesota Council on Disability.

“Of course we support going after fraud,” Terakanambi said, but “this overly aggressive action is missing the point. It’s not punishing fraudsters. It’s punishing the people.”

Longtime Medicaid observers also doubt the federal actions will achieve their purported objective. , a senior managing director with the consulting firm Manatt, that actions of this magnitude by the federal government are unprecedented, partly because punitive measures against states have “really never been an effective way to address fraud.”

Meanwhile, fraud prosecutions as the U.S. attorney’s office there grapples with the exodus of nearly half its attorneys and a surge in cases from the Trump administration’s immigration crackdown.

Despite these concerns, Centers for Medicare & Medicaid Services head Mehmet Oz said the techniques the federal government is using in Minnesota could be applied to other states, and he has launched social media campaigns alleging high-dollar public benefit fraud��in , , , and . And a February release of by the Trump administration’s Department of Government Efficiency appears to be part of a campaign to paint the program as riddled by fraud, Guyer said.

, a research professor at Georgetown University’s Center for Children and Families, said that campaign by the administration seems particularly focused on services designed to keep people with disabilities out of institutions, and he described withholding $2 billion from Minnesota’s Medicaid program as “.”

A ‘Political Football’

Scrutiny of Minnesota’s public benefit programs began early in the Biden administration, years before the most recent investigations. The spotlight on the state’s Medicaid system grew after FBI raids in December 2024.

The following May, an into Medicaid housing stabilization services in Minnesota prompted further scrutiny from federal prosecutors, and from Gov. Tim Walz.

Under the Democratic governor, the state launched investigations into 85 autism providers, ordered a third-party audit of 14 types of Medicaid services deemed to be “high-risk” for fraud, and delayed payments for those services for up to 90 days. Many of the services are ones people with disabilities receive at home, making them more difficult to monitor. ��

Terakanambi worried the state’s “heavy-handed approach” would destabilize the entire home care system. While his own care was not disrupted — his parents provide the 10 hours of daily personal care he qualifies for through Medicaid — other Minnesotans with disabilities have said they experienced interruptions and .

In December, one man was after losing his in-home care services amid the crackdown.

“We’re losing sight of the people that have done nothing wrong, that rely on these supports and services to live in the community,” said Sue Schettle, chief executive of , a Minnesota nonprofit that represents organizations supporting people with disabilities. “It becomes a political football.”

Schettle said she took her concerns about the crackdown to state officials, who have since met routinely with her and other advocates. The subsequent federal actions, however, have left her “shell-shocked,” she said.

The ‘Nuclear Option’

In December, a , with help from state Republicans, supercharged the issue in Minnesota, alleging widespread fraud in child care centers owned by members of the Somali community. A follow-up state investigation of the child care centers that were featured in the video determined that all were “.”

On Jan. 6, CMS’ Oz sent Walz a letter alleging Minnesota’s Medicaid program was out of compliance with federal rules on fraud, waste, and abuse, setting the stage for the Trump administration’s move to withhold over $2 billion in federal Medicaid funds to Minnesota this year, about 18% of what the state received the year before.

Minnesota is appealing.

The Republican-aligned Paragon Health Institute, a think tank that recently published a calling for similar enforcement actions across the country, applauded the federal moves.

“That will spur states to take necessary action, thus ensuring that Medicaid funds go to those who are truly eligible,” said , a legal research analyst who co-authored the brief.

Georgetown’s Schneider questioned the necessity and effectiveness of withholding the money.

“I don’t see any relationship between that and actually reducing fraud against the Minnesota Medicaid program, given the state has already taken a lot of action,” he said.

In late February, Oz went further, announcing that on top of withholding $2 billion in future payments to Minnesota, the administration was in federal Medicaid payments to the state.

“We have notified the state that we will give them the money, but we are going to hold it and only release it after they propose and act on a comprehensive corrective action plan to solve the problem,” Oz said at with Vice President JD Vance.

Minnesota the deferment in court.

“We’re waiting for feedback from CMS on our corrective action plan, which is why we were surprised and confused when Dr. Oz said in a news conference with the vice president last week that we needed to provide one,” Minnesota Medicaid director John Connolly said at a March 3 news briefing.

‘Another Minnesota’

Oz and Vance both said during the February news conference that they are not specifically targeting Democratic-led states. Oz noted Florida has a “big fraud problem” and in mid-March sent a letter to state officials with a list of questions about their Medicaid program. Until then, the letters and most of Oz’s social media videos had been limited to California, Maine, and New York, all led by Democrats.

“We might have another Minnesota on our hands,” Oz said in posted the same day as sent to Maine Gov. Janet Mills, a Democrat, requesting information on how the state was addressing Medicaid fraud.

“And if we’re not satisfied with their progress, we reserve the right to cut off payments entirely,” Oz said in the video.

The video and letter were prompted by a in Maine that found the state had made at least $45.6 million in improper Medicaid payments. Similar audits in , , and had comparable findings.

In , Mills called Oz’s letter a “pretense to send ICE and other weaponized federal agents into states led by Democrats.”

CMS spokesperson Chris Krepich said the agency does not take funding actions lightly. “The focus is on strengthening oversight, improving accountability, and ensuring that vulnerable patients receive the services they are entitled to,” Krepich said.

But Terakanambi said it’s not difficult to see how federal actions like those in Minnesota could put services in jeopardy. The amount of money Minnesota could lose from the CMS actions announced this year is already equivalent to about two-thirds of the state’s rainy-day fund.

Many states are looking to reduce or even eliminate funding for home care services over much smaller budget shortfalls. And further cuts are anticipated, with congressional Republicans’ One Big Beautiful Bill Act, signed into law last year, expected to reduce federal Medicaid spending by more than $900 billion over the next decade.

“People will die,” Terakanambi said. “People will lose critical supports and will no longer be able to participate in their community the way they want to.”

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Oz, who heads the U.S. Centers for Medicare & Medicaid Services, there was approximately $3.5 billion of fraud in the hospice and home health care industry in Los Angeles County alone. “This administration under President [Donald] Trump is not going to tolerate taxpayer dollars being stolen because people aren’t paying attention anymore. We’re focused on this,” . He claimed the fraud was largely orchestrated by the “Russian, Armenian mafia” and said that most of the money spent on home and community-based services across California “might be fraudulent.”

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Yet about 82% of the comments are identical to a letter that appeared on the website of a secretive advocacy group called Medicare Advantage Majority, a data analysis by �鶹Ů�� Health News has found.

The “” group does not reveal its funders or much else — other than to say it is “dedicated to protecting and strengthening Medicare Advantage” and is “powered by hundreds of thousands of local advocates nationwide.”

“Our campaign provides information and offers tools for concerned Americans to use to reach decision makers,” spokesperson Darren Grubb said in an email. The group has spent more than $3.1 million on hundreds of Facebook ads since September 2024, according to , a database of the social media company’s online ads.

There’s no doubt health insurers are unhappy with a from the Centers for Medicare & Medicaid Services, or CMS, to keep Medicare Advantage reimbursement rates essentially flat in 2027 — far less than they expected from the Trump administration.

Medicare Advantage plans differ from traditional Medicare because private insurance companies administer them. The insurance plans enroll about members, more than half the people eligible for Medicare. The plans offer things like vision and drug coverage, but Medicare Advantage insurers restrict the hospitals and doctors that patients can use and require prior approval for various procedures.

CMS is set to announce a final decision by early next month on the rate proposal. The agency solicited on the proposal from Jan. 26 through Feb. 25 to give interested parties and the public a chance to air their views.

Medicare Advantage Majority, which says the rate proposal amounts to a “cut” in services and warns of dire consequences for seniors should it go through, accounted for at least 13,522 of the 16,422 comments published as of March 12.

The proposed rate plan “puts my access to care at risk,” the group’s template letter to policymakers reads in part. “If the investment made by Washington in the Medicare Advantage program is nearly flat year-over-year, I could lose benefits I rely on every day, including affordable prescriptions, capped out of pocket costs, and access to trusted doctors and specialists.”

“Medicare Advantage is not optional for me. The cost protections alone have saved me thousands of dollars and made my health care manageable. Without this program, I would face higher costs, fewer providers, and fewer benefits at a time when I can least afford it,” the letter states.

Critics warn that these sorts of campaigns may create a misleading impression of grassroots support, especially when it’s not clear who is financing them.

“It puts a different spin on a massive groundswell of comments to know all are being driven by one specific organization,” said Michael Beckel, director of money in politics reform for Issue One, a group that seeks to limit the influence of money on government policy and legislation.

“There’s no way for the public to know what wealthy donors or special interests are funding dark money groups like this,” he said. “That means there’s no scrutiny of who’s really calling the shots.”

Some health care policy experts, who have long argued that the government overpays Medicare Advantage plans by tens of billions of dollars every year, believe industry groups or their surrogates routinely overstate possible negative impacts of rate decisions they don’t like.

“The plans always say that the sky is falling,” said Matthew Fiedler, a health care policy expert with the Brookings Institution. “The industry has a lot of money at stake here. They try to exert pressure on policymakers any way they can.”

At the same time, even critics concede that some of the millions of people enrolled in Medicare Advantage plans could face service cuts if insurance companies are not satisfied with government payments.

“It is legitimate for people to be worried,” said Julie Carter, counsel for federal policy at the Medicare Rights Center, a group that advocates for older adults and people with disabilities.

Her group argues that Medicare Advantage plans have never attained expected cost savings and instead have been overpaid for years at least partly due to “actions to maximize profits.” She said the health plans “are supposed to be saving money, not taking extra.”

People struggling to pay health care bills may have little use for the policy debate in Washington.

“If it wasn’t for being able to have this program, I really wouldn’t be able to afford any kind of medical services, to be honest,” said EsterAlicia Rose, 75, who works at the front desk of a hotel in Pagosa Springs, Colorado. She said she signed the Medicare Advantage Majority form letter to reach policymakers.

Kathy Lovely-Marshall, 66, a retired nurse who lives in Brookville, Ohio, did too. She said she receives “a lot of perks” from her plan, such as dental care, eyeglasses, and prescriptions.

“All those things are a big plus as far as I am concerned,” she said. “I’m very happy with the plan I have.”

But Corenia Branham, 90, a widow and cancer survivor who lives in Alum Creek, West Virginia, said she wants nothing to do with Medicare Advantage plans run by private health insurance companies. She said she didn’t turn in any of the four form letters under her name, which were posted online by CMS on Feb. 23 and signed, “Miss Corenia Branham Branham.” It’s not clear why her last name is signed twice.

Branham said she’s not on Medicare Advantage and doubts she could count on it for needed care.

“I wouldn’t recommend it to nobody,” she said. “I sure don’t want anything to do with it.”

Grubb, the Medicare Advantage Majority spokesperson, disputed that account. He said Branham responded to an ad on Facebook. On Feb. 6, she “completed the form with her information and chose to send her comment to CMS as well as to her representatives in Congress and the White House,” he said.

Other Medicare Advantage advocacy groups have stepped up ad campaigns as the rate decision looms.

The Better Medicare Alliance, whose “allies” include a range of health insurers, health care providers, and consumers, is urging seniors to “Tell Washington to Stand Up for Medicare Advantage.”

“We’ve mobilized beneficiaries to write letters and make phone calls, and we’ve run digital ads on streaming platforms,” spokesperson Susan Reilly said.

Reilly said that this year roughly 3 million seniors “were forced to find new coverage” because plans either shuttered operations or left some areas.

She also said Medicare Advantage plans have “scaled back” benefits such as offering transportation to medical appointments, nutrition support, and dental and vision coverage, while over the past two years beneficiaries have faced an average $900 increase in out-of-pocket maximums.

“We do view this as especially serious,” Reilly said. “This isn’t a single bad year; it’s the cumulative effect of years of underfunding and policy disruption from the previous administration that has left the program increasingly vulnerable.”

As of March 12, CMS said it had received 46,884 comments but had posted only 16,422 online.

CMS spokesperson Catherine Howden said the agency would make more comments public “as soon as practicable.”

“The agency focuses on reviewing the substance of timely submissions and does not speculate on volume, sentiment, or potential impact of comments while the comment period is open/under review,” she said in a statement.

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It’s been a tough week for Health and Human Services Secretary Robert F. Kennedy Jr. In addition to Kennedy having surgery to repair a torn rotator cuff, personnel issues continue to plague the department: The nominee to become surgeon general, an ally of Kennedy’s, may lack the votes for Senate confirmation. The controversial head of the Food and Drug Administration’s vaccine center will be resigning next month. And a new survey finds Americans have less trust in HHS leaders now than they did during the pandemic.

Meanwhile, the Trump administration continues its crackdown over claims of rampant health care fraud. In addition to targeting the Medicaid programs in states led by Democratic governors, the Centers for Medicare & Medicaid Services is also taking aim at previously sacrosanct Medicare Advantage plans.

This week’s panelists are Julie Rovner of �鶹Ů�� Health News, Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Shefali Luthra of The 19th.

Panelists

Among the takeaways from this week’s episode:

• Americans feel more confident in career scientists at federal health agencies than in the agencies’ leaders, according to a new survey from the Annenberg Public Policy Center at the University of Pennsylvania. Yet the survey also sheds more light on the erosion of trust in public health officials and scientific research.
• The FDA’s vaccine chief, Vinay Prasad, is leaving — again. Prasad was a critic of the agency before he joined it, and his tenure has been shaped by the same attitude, affecting career officials’ morale and the agency’s interactions with outside companies.
• The Trump administration has extended its fraud crackdown campaign into Medicare Advantage plans. The privately run alternative to traditional Medicare coverage has been a GOP darling from the get-go. Yet President Donald Trump is nudging the party away from its pro-business stance on private insurance, arguing the government should give money to patients rather than insurers — a justification for policies undermining the Affordable Care Act.
• And Wyoming became the latest state to enact a six-week abortion ban, a move that’s being challenged in court. The development points to the fact that while federal policymaking on abortion has largely stalled, the issue is still very much in play in the states as abortion opponents keep pushing back on access to the procedure.

Also this week, Rovner interviews Andy Schneider of Georgetown University about the Trump administration’s crackdown on what it alleges is rampant Medicaid fraud in Democratic-led states.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The Marshall Project’s “,” by Shannon Heffernan, Jesse Bogan, and Anna Flagg.

Anna Edney: The Wall Street Journal’s “,” by Christopher Weaver, Tom McGinty, and Anna Wilde Mathews.

Shefali Luthra: The New York Times’ “,” by Apoorva Mandavilli.

Joanne Kenen: The Idaho Capital Sun’s “,” by Laura Guido.

Also mentioned in this week’s podcast:

• The Annenberg Public Policy Center’s “.”
• �鶹Ů�� Health News’ “Six Federal Scientists Run Out by Trump Talk About the Work Left Undone,” by Rachana Pradhan and Katheryn Houghton.
• Bloomberg Law’s “,” by Sandhya Raman.
• The 19th’s “,” by Shefali Luthra.
• The Georgetown University McCourt School of Public Policy Center for Children and Families’ “,” by Andy Schneider.

Clarification:��This page was updated at 5:10 p.m. ET on March 12, 2026, to clarify that Vinay Prasad, the FDA’s vaccine chief, will be leaving his job in April. In an email after publication, William Maloney, an HHS spokesperson, said Prasad is “leaving of his own accord.”

[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. Welcome to��What the��Health?��I’m��Julie Rovner,��chief Washington correspondent for���鶹Ů�� Health��News, and��I’m��joined by��some of��the best and smartest reporters covering Washington. We are taping this week on Thursday, March 12, at 10��a.m.��As always, news happens fast and things might have changed by the time you hear this. So,��here we go.��

Today��we��are joined��via videoconference by Shefali Luthra��of the 19th.��

Shefali Luthra:��Hello.��

Rovner:��Anna��Edney of��Bloomberg News.��

Anna Edney:��Hi,��everybody.��

Rovner:��And��Joanne��Kenen��at the Johns Hopkins Bloomberg School of Public Health and��Politico��Magazine.��

Joanne Kenen:��Hi,��everybody.��

Rovner:��Later in this episode,��we’ll��have my interview with Andy Schneider of Georgetown University, who will try to explain how the federal government’s fraud crackdown on blue-state Medicaid programs��is something��completely different from any fraud-fighting effort��we’ve��seen before. But first,��this week’s news��—��and��some of��last��week’s.��

Let’s��start at the Department of Health and Human Services, where I think��it’s��safe to say Secretary Robert F Kennedy Jr.��is not having��a great week. The��secretary��reportedly had��to have his rotator cuff surgically repaired on Tuesday.��It’s��not clear if he injured it during one of his famous video workouts. But it is clear, at least according to����from the University of Pennsylvania’s Annenberg Center, that the American public is not buying what��he’s��selling when it comes to policy. According to the survey, public trust in HHS agencies, which already took a dive during the pandemic, has fallen even more since Kennedy took over the department. Although, interestingly, public trust in career HHS officials is higher than it is for their political leaders. And trust in outside professional health organizations, places like the American Heart Association and the American Academy of Pediatrics, is higher than for any of the government entities.��

Perhaps related to that is another piece of HHS��news from��this week.��The FDA��[Food and Drug Administration]��approved a label change for the drug leucovorin, which Secretary Kennedy last fall very aggressively touted as a potential treatment for autism. But the drug��wasn’t��approved��to treat autism. Rather, the label changes to treat a rare genetic condition. Kennedy bragged about leucovorin, by the way, at��the same press conference that President��[Donald]��Trump urged pregnant women not to take Tylenol, which has not��been shown��to contribute to the rise in autism.��Maybe it’s��fair to say the public is paying attention to the��news��and that helps explain the results of this Annenberg Center survey?��

Luthra:��Maybe.��I was just thinking, we do know that Tylenol prescriptions for people who are pregnant did go down,��right? There’s research that shows,��after that press conference,��behaviors did change. And��so��to your point,��it’s��clear there is��a lot of��confusion, and confusion��maybe breeds��mistrust. But I��don’t��know that we can necessarily say that American voters and the public at large are very obviously informed as��much��as they are��perhaps disenchanted��by things that seem as if they��were told��would restore trust and make things clearer and in fact have not done so.��

Rovner:��That’s��a��fair assessment.��Anna.��

Edney:��Yeah, I think��there’s a lot of overpromising and underdelivering, and that can kind of create this issue where this administration��—��and RFK Jr.��has been doing this as well��—��kind of is making these decisions from the top, rather than having these normal conversations with the career scientists and things like that, where the public can kind of follow along on why the scientific decisions are being made if they so choose to,��or at least��have an idea that there was a discussion out there. And��that’s��not happening. So��that’s��not something��that’s��creating��a lot of��trust.��I think people��are seeing that as unscientific and chaotic.��

Rovner:��I was��particularly interested in one of the findings in the survey,��is that Dr.��Fauci, Dr.��Tony Fauci, who was��sort of��the��bête noire��of the pandemic, has a higher approval rating than either RFK Jr.��or��some of��his top deputies.��Joanne, I see you nodding.��

Kenen:��Yeah��that was so��stri—��I mean,��it’s��still not high. It was,��I believe it��was��—��I’m��looking for my note��—��but I��think��was 54%,��which is not great. But it��was better than��Dr.��[Mehmet]��Oz��[head of the Centers for Medicare & Medicaid Services]. It was better than Kennedy. It��was better than a bunch of people.��So,��but it also shows that��half��the country still��doesn’t��trust him.��It was��a really interesting��survey, but the gaps in trust in credible science are still significant. What was interesting is the declining trust in our government officials in health��care, but��there’s��still,��nationally, the U.S.��population,��there’s��still��a lot of��skepticism of science and public health. Maybe not as bad as it was, but still��pretty bad.��

Luthra:��And Julie, you alluded to these famous push-up and workout videos. And part of what��you’re��getting at��—��right?��—��is that the communications that we see��are targeted��toward a not necessarily��very large��audience.��It is these people who are hyper-online,��in particular internet��spaces and communities, and that’s��somewhat divorced��from most people and how they live their lives.��And when you focus��your message and you’re campaigning on this very particular slice, it’s just��a lot��easier to lose sight of where people are and what they want from their government and what they will��actually appreciate.��

Rovner:��It’s��true.��The online��America is very separate from the rest of America, which is a��whole lot bigger.��Well—��

Kenen:��And��there’s��also the young people who��probably��aren’t��in these surveys who,��teenagers,��who��are getting��a lot of��information on TikTok about supplements and raw milk.��And the young men and the teenage boys and the supplements��is a big deal, and��that’s��online. And��also��we have been��seeing��for a while, but I think��it’s��probably creeping��up,��the recommendations about psychedelics.��So��there’s��all this stuff out there that��isn’t��going to��be picked��up by that poll. But yes, it was an interesting poll.��

Rovner:��All right. Well, meanwhile over at the Food and Drug Administration, in-again��out-again in-again��vaccine chief Vinay Prasad is��apparently out��again, or��will be as of later this spring. I feel like Prasad’s very rocky��tenure has been��kind of a��microcosm for the difficulties this administration has had working with��career��scientists at FDA and elsewhere, at HHS.��Anna, what made him so controversial?��

Edney:��Well, I think, Prasad was an FDA critic before he came to the agency. And so��essentially,��when he was out in public, particularly during covid, but there were even criticisms he had before that.��He was criticizing these career scientists at the agency. And��so��he got there, and the way he appeared to��operate��was that he knew��best��and he��didn’t��need to talk to any of these people that had been there,��some��for decades, and that was getting him in��a lot of��trouble. But he was��being defended��and protected by FDA��Commissioner Martin Makary, and he really supported Prasad, and he called him a genius and wanted him to stay on.��So��the first time Prasad left, he convinced him to come back. And now this time, I think, things��maybe just��went��a bridge too far when there was sort of this behind-the-scenes but very public fight with a company trying to make a rare-disease drug. And this is something that,��particularly,��several��senators really, really hate, is when the FDA is getting in the way of a rare-disease drug getting to market, because they don’t think that that’s something the agency should be trying to do unless the drug is��maybe wholly��unsafe. But they think��anyone��should be able to try it. And��so��when this exploded and FDA officials were and HHS officials were behind the scenes, but very publicly, calling this company a liar, it was just a bridge too far.��

Rovner:��Well, and he,��this was,��this incredibly unusual����in which he tried to not be quoted by name, but kind of hard when the head of the agency, or the head of the��center at FDA is basically trashing a company,��trying to do it on background. Was that kind of the last straw?��

Edney:��Yeah, I think so. And��sort of an��aside��on��that.��I’m��curious how that phone call��even��was��allowed��to be set up and called.��Because,��it’s��not like he did it on his own. There��were,��there was an infrastructure around him that helped him set that up.��So��I’m��curious about why that even went down, but��I think that��was��definitely what��pushed him out the door. You know, this company wanted to get this drug approved. The FDA had said,��No, not unless you do this extremely difficult trial, which the company said would require drilling holes in people’s heads,��for what they were trying to get approved, and that it would be a placebo, essentially, for some of those patients, even when you get a hole drilled in your head, and this could be a 10-hour sham surgery, is what the company said. And then��Prasad comes��out and��says:��No,��they’re��lying.��That��definitely could��be a half-hour.��No big deal.��And��I just think that there��were��senators frustrated with this, the White House��not wanting to��see another thing blow��up over rare-disease drugs, because that has, there��have��been��a lot of��issues at FDA under his tenure, of just drugs not being able to get to market. Or��having issues with vaccines that have been years in development not being able to��get even reviewed, and then that��being reversed.��So��it was��just,��that was��kind of the��last straw.��

Rovner:��And��of��course��President Trump himself has been a big proponent of this whole Right to Try effort,��that it should be easier for people with, particularly with terminal diseases to be able to try drugs that may or may not help.��Joanne, you want to add something.��

Kenen:��Also��wasn’t��he still,��Prasad, still living in California and running up��really huge��travel bills and—��

Rovner:��Yes.��

Kenen:��—not being at the FDA very much, at a time when everybody else has��been forced��to come back to work?��So,��but I do confess that I keep looking at my phone to check if��he’s��still out or��is he��already back again.��

Rovner:��Right.��

Kenen:��I’m��really not��totally convinced that this is the end of Prasad, but��yeah.��

Rovner:��Yeah,��I was not kidding when I said��on-again��off-again on-again��off-again. All right. Well, moving over to the National Institutes of Health, which also has a director��that’s��doing more than one job in more than one place. I know there’s so much news that it’s hard to keep track of it all, but I do think it’s important to continue to follow things that look to��be settled, like funding for the NIH,��which Congress��actually increased��in the spending bill that passed at the end of January. To that end, a shout-out to our podcast panelist��Sandhya Raman, formerly of CQ,��now at Bloomberg, for����grant funding that still pays for most of the nation’s basic biomedical research is still being held up. This is months after it��was ordered��resumed by courts and appropriated by Congress.��

Shout-out as well to my���鶹Ů�� Health��News colleagues��Rachana Pradhan��and Katheryn��Houghton for��their project��on the people and research projects that have been disrupted by all the cuts at NIH,��as well as new bureaucratic hurdles put in place. I feel like if there weren’t so much else going on, what’s happening at��basically the��economic and health engine of NIH would be getting much,��much,��much��more attention, particularly because of the continuing brain drain with researchers moving to other countries and students choosing different careers rather than becoming researchers. I wonder if this sort��of drip,��drip, drip at NIH is going to turn into a very long-term hole��that’s��going to be��very difficult��to fill.��A��lot of��these things have years-��if not decades-long runways.��These great scientific achievements start somewhere, and it looks like��they’re��just��sort of pulling��out the whole starting part.��

Kenen:��It’s��already affecting the pipeline. In graduate schools,��many��schools fund their PhD candidates, and��it’s��NIH money, or partly NIH money.��It’s��different��—��I’m��not an expert in every single school’s��support��systems��for PhD candidates, but I do know that the pipeline has��been shrunken��in��some��fields at��some��schools, and��that’s��been��reported��on��widely. And��there’s��been��a lot of��coverage about years and��years of research. You��can’t��just restart a multiyear,��complicated clinical trial or research project. Once you stop it,��you’re��losing everything to date, right? You��can’t��just��sort of say,��Oh,��I’ll��put it on hold for a couple of years and resume it.��You��can’t��do that.��So��we’ve already reached��some kind of��a��critical��point.��It’s��just a matter of how much worse it gets, or whether the ship begins to stabilize in any way going forward. But there’s already damage.��

Rovner:��I say,��are you guys as surprised as I am, though, that this isn’t��—��the NIH has been this sort of bipartisan jewel that everybody has supported over the decades that I’ve been covering it, and now it’s��basically being��dismantled in front of our eyes, and nobody’s saying very much about��it.��

Kenen:��It’s��also an engine of economic growth.��You see different ROI��[return on investment]��numbers when you look at NIH, but I think the lowest number you hear is��two and a half dollars of benefit for every dollar we invest. And��I’ve��seen��reports��up to $7.��I��don’t��know what the magic number is, but this is an engine of economic growth in the United States. This is basic biomedical research that the private sector or the academic sector cannot do.��It��has to��come from the government.��And I��don’t��think any of us have really gotten our heads around��— why harm the NIH��when it is��bipartisan,��it is economically successful,��and it has humanitarian value.��It’s��the basis.��The drug companies develop the drug and bring it to the market. But that basic, basic,��earlier��what’s��called bench science,��that’s��funded by the��NIH.��

Rovner:��I know.��It’s��a mystery. Well, adding to RFK Jr.’s bad week are the growing divisions within his base,��the��Make America��Healthy��Again��movement. While the White House, seeing that the public doesn’t really support��MAHA’s��anti-vaccine positions,��is trying to get HHS to tone it down, there was a major MAHA��meetup just blocks from the White House this week, with sessions urging a complete end to the childhood vaccine schedule and the removal of all vaccines from the market, quote, until they can be proven��“safe and effective.”��By the way,��most��of��them have��been already. Meanwhile,��lots of��MAHA��followers are still angry that the White House is supporting the continuing production of glyphosate, the weed killer sold commercially as Roundup. Democrats,��, are trying to exploit the divisions in the MAHA movement, which leads to the question:��Will��MAHA��be a net plus or a net minus for this fall’s midterm elections?��On the one hand,��I think Trump��appointed Kennedy because he was hoping that��the MAHA movement would be��a boost to turnout.��On the other hand, MAHA��seems��pretty split��right now.��

Edney:��Well, I think��that’s��the million-dollar question,��is��which way��they’re��going to swing if they swing at all. And it’s hard to say right now, because��I think they��are angry at certain aspects of things this administration is doing,��the two things you mentioned,��on��Roundup and on vaccines, kind of telling RFK to kind of talk a little bit less about those. But will they be able to then vote for Democrats instead? I��think,��it’s��only March,��so��it’s��so difficult to say��what will happen between now and then.��I think there’s still things that the health secretary could do on food that��he’s��talked about, that could draw attention away from that anger, that might make��many��of them happy.��I think there��were��some��things he��kind of started��doing early in his term��that��hasn’t��been talked��about as much.��And also, I think there’s still the prospect of Casey��Means becoming��surgeon��general��—��or not��—��out there, and that’s��kind of a��big piece of this.��If she is to get into the administration, and that is sort of up in the��air��right now, then that could��kind of give��them something else to focus on, because she is a large part of this playbook of the MAHA movement.��

Rovner:��That’s��right.��And we are waiting to see sort of if she can get the votes even to get out of committee, much less get to the floor, see��whether we’re going to have, as��some��are saying, the first��surgeon��general who does not have an active license to practice medicine. Shefali, you wanted��to add something.��

Luthra:��No, I just think��we’ve��talked about this before on the podcast, that the food stuff is much more popular than the vaccine stuff. The vaccine components of��MAHA��remain very unpopular.��It’s��difficult to really see or say sort of what the White House can do on food in a sustained, focused way,��without going��off-script, that is also popular. But I think to Anna’s point,��it’s��just so hard to say to what extent this��ultimately matters��in November, because there are just so many concerns right now. People��can’t��afford their health insurance, and gas prices are going up. And��I just think we��have to��wait and see to what extent people are voting based on food policy.��

Rovner:��Yeah, well, we will see. All��right,��we’re��going to take a quick break. We will be right back.��

OK, turning to another Trump administration priority, fighting fraud. This week, the administration accused another��Democratic-led state, New York, of not policing Medicaid fraud forcefully enough. This comes after the Centers for Medicare��&��Medicaid Services said it will withhold hundreds of millions of dollars from Minnesota, which our guest,��Andy Schneider,��will talk about at more length. Minnesota, by the way, last��week sued the federal government over its Medicaid efforts. So that fight will continue for a while. But��it’s��not just blue states, and��it’s��not just Medicaid. In something I��didn’t��have on my bingo card, this administration is also going after fraud in the Medicare Advantage��program, which has long been a Republican darling.��

Last week, CMS banned the Medicare Advantage plan��operated��by��Elevance��Health, which has��nearly 2��million Medicare patients currently enrolled,��from adding any new enrollees starting March 31,��for what the agency described as, quote,��“substantial and persistent noncompliance with Medicare Advantage risk adjustment data.”��And on Tuesday, the��congressional Joint Economic Committee reported that overpayments to those Medicare Advantage��plans raised premiums by an estimated $200 per Medicare enrollee annually��—��and��that’s��all Medicare enrollees, not just those in the private Medicare Advantage plans. Is this the end of the honeymoon for Medicare Advantage? Joanne, you were there with me when Republicans were pushing this.��

Kenen:��I’ve��been surprised, as you have,��Julie, because��basically Medicare��Advantage has been the��darling, and it��is popular with people.��It’s grown and grown and grown,��not because the government forced people in. It has good marketing and��some��benefits for the younger, healthier post-65 population, gyms and things like that.��But��—��and vision and dental, which��are a big deal. But��we’ve��also seen a backlash, in��some��ways, because there’s the prior authorization issues in Medicare Advantage have gotten��a lot of��attention��the last couple of years. But not just am I surprised by��sort��of��the��swing��that��we’re��hearing��about��generally.��I’m��surprised by Dr.��Oz, because when he ran for Senate a couple��years��ago in Pennsylvania, and��much��of his public persona has been really, really,��really gung-ho, pro Medicare Advantage.��

And yet,��some of��you were at or,��like me, watched the live stream of��—��he did��a very interesting, thoughtful, and,��I’ve mentioned this at least one time before, hourlong conversation with��a lot of��Q&A at the Aspen Institute here in D.C.��a couple of months ago. And one of the questions was someone said:��Dr.��Oz,��you’ve��just turned 65.��Are you doing Medicare Advantage, or��are��you doing traditional Medicare?��And the expected answer for me was, well, I knew that��he’s��on government insurance now.��So��he, you��have to,��at 65 you��have to��go into Medicare Advanta—��Medicare A,��whether��you��—��that’s automatic.��That’s��the hospital part. But you have the choice. But if��you’re��still working and getting insurance or government��—��he’s��on a government plan. He��doesn’t��have to do that. But��he actually, and��he pointed that out, but the next sentence really surprised me, because he said:��I��don’t��know. My wife and I are still talking about that.��And I thought that was��A)��a��very honest answer. He��didn’t��have to even��say. But it was also,��it just was interesting to me that after all that��Rah-rah��Medicare Advantage��we were hearing about, his own personal choice��was,��Not��sure if that one’s right for me.��So��—��

Rovner:��I was going to say,��I feel like the Republicans are sort of twisting right now between Medicare Advantage, which they’ve always pushed��—��they want to privatize Medicare because they don’t like government health insurance��—��and then there’s��the current populist��push against big insurance companies, because, of course, all those Medicare Advantage��plans belong to those big insurance companies that Republicans are suddenly saying are too big and getting too much money.��So��they’re��sort of caught��between��trying to have it both ways.��I’ll��be interested to see how they come down. One of the things that did strike me, though, even before Dr.��Oz��sort of started��his little crusade against Medicare Advantage, was,��I think it��was at Kennedy’s confirmation hearing that Sen.��Bill Cassidy was suddenly questioning Medicare Advantage. That was, I think, the first Republican I saw to like,��Oh.��That made me raise my eyebrows.��And I think since then, I’ve��kind of seen��why.��

Kenen:��The��populist talk��against��insurance companies,��not giving money to insurance companies,��is part of the Republican��—��and,��specifically, President Trump’s��—��desire to not extend the ACA,��the Affordable Care Act,��enhanced subsidies. That was the basic:��Well,��we’re��not going to do this,��because��we’re��just throwing money at these insurance companies. And we��don’t��want to do that. We want to empower��the patients.��That was��the,��I’m��not, and the missing piece of that argument is:��Yes, the ACA subsidies go to insurance companies. However, all of us are benefiting in��some��way or other from government policies that��benefit��insurance companies.��The tax breaks our employers get. The tax breaks we get for our insurance.��And then the biggie, of course, is Medicare Advantage.��

We are paying Medicare Advantage more than we are paying traditional Medicare.��So��Medicare Advantage is��private��insurance��companies, and the government has��been just��sending them��lots��and��lots of��money for years.��So��I’m not sure it’s��—��this Medicare Advantage thing is just bubbling up, and we’re not��really sure��how this plays out. But��I think that��the rhetoric��against insurance companies��is��the rhetoric��against the ACA.��

Rovner:��Oh, it is.��

Kenen:��Rather that��hasn’t��yet��been connected��to the Medicare Advantage. I think��they’re,��yes, we all know��they’re��connected. But I think the political debate, it’s��not Medicare��Advantage��is bad because insurance companies are bad.��It’s the��ACA is bad because it enriches insurance companies.��There’s��a different ideological parade going down the road.��

Rovner:��I was going to say,��it’s��important to remember at the beginning of Medicare Advantage, which was a Republican proposal back in 2003,��they purposely overpaid it. They gave it more money because they know that when they give them more money, the insurance companies��are required��to��return��some of��that money to beneficiaries in the form of these extra benefits.��That’s��why there are gym memberships and dental and vision and hearing coverage in these Medicare Advantage plans. It does make them popular, so people sign up. And that was��sort of Republicans’��intent at the beginning. It was to��sort of not��so much push people into it but entice people into it.��

Kenen:��And��then—��

Rovner:��And then maybe cut it back later.��

Kenen:��No, but��it’s exceeded��expectations.��

Rovner:��Absolutely.��

Kenen:��The number of people going into Medicare Advantage has been��really high, higher than people expected.��And��it’s��also hard to get out, depending on what state you live in.��It’s��not impossible, but��it’s��costly and difficult, except for��a few,��I think��it’s��seven or eight��states��make it��pretty easy. But also remember that the earlier version of what we now call Medicare Advantage was��—��which��was the��’90s, right Julie?��—��I think the Medicare Part C,��and that failed.��So��—��

Rovner:��Well after,��that failed because they cut it when they were��—��

Kenen:��Right.��Right.��

Rovner:��They cut all the funding when they were balancing the budget��—��

Kenen:��Right.����

Rovner:��—��in��1997.��

Kenen:��But that��gave them��the��excu—��right.��

Rovner:��They made it��fail.��

Kenen:��That��gave them an excuse to give them more money later that, when they revived it, renamed it,��and launched it��in��2003 legislation,��that initial push to give them a ton of money, because they could say,��Well, we didn’t give them enough money, and that’s why they��fa—.��There��are��all sorts of political��things going on that��weren’t��strictly money. But��yeah,��it was part of the narrative of��Why we��have to��give them more money,��is��They need it.��

Rovner:��Yeah.��Anyway,��we’ll��also watch that space. Well, finally, this week, there’s news on the reproductive health front, because there’s always news on the reproductive health front. Shefali,��Wyoming has become the latest state to enact a so-called heartbeat ban, barring abortions when cardiac activity can��be detected.��That’s��often around six weeks, which is before��many��people are even aware of being pregnant. I thought the Wyoming Supreme Court said just this past January that its constitution prevents abortion bans.��So��what’s��up here?��

Luthra:��They did, in fact, say that, and so we are seeing this law taken to court.��It was��actually added��in a court filing to a preexisting case challenging other abortion restrictions in the state.��I’m��sure��that’s��going to play out for quite��some��time. But��what’s��interesting about the Wyoming��Constitution��—��right?��—��is that it protects the right to make health care decisions,��in an effort to��sort��of��fight against the ACA. That was this��conservative approach that now has come to really��benefit��abortion rights supporters as well. But what I think��this underscores��is that even as we are seeing��fairly little��abortion policy in Washington, at least in a meaningful way,��a lot��is still happening on the state level. That really is where the bulk of action is, whether you see that in Wyoming,��in Missouri, where��they’re��trying to undo the abortion rights protections there, and just—��

Rovner:��The ones that passed by voters.��

Luthra:��Exactly. And��so��what we’re really thinking about is anti-abortion activists are not really that confident in the��president’s desire, interest, ability, what have you, to get their agenda items done. And for now, they are really focusing on the states, and that is where their interest, I think, will only remain, at least until the primary for the next presidential race begins in earnest.��

Rovner:��Well,��Shefali,��I also want to ask you about����this week on just how many things ripple out economically from abortion restrictions. Now��it’s��having an impact on rent prices?��Please explain.��

Luthra:��I thought��this was so interesting. It was this��NBER��[National Bureau of Economic Research]��paper that came out this week, and they looked at comparably trending rental markets in states with abortion bans and those without them. And what they saw was that after the��Dobbs��decision, rental prices declined��relative��to places without bans, compared to those in those that had them.��And this is��really interesting.��It just��sort of continues.��Rental prices went down,��and also��vacancies went up.��And what the researchers say is this is��a very, very dramatic��and clear relationship, and it illustrates that people, when they have a choice, are considering abortion rights in terms of where they want to live. And anecdotally, we know that,��because��we’ve��seen residents make choices about where they will practice.��We’ve��seen doctors decide where they will live. We have seen people move. Companies offer relocation benefits if people want them. And this is more data that illustrates that��actually that��affects the economy of communities, and it really underscores that where we live just simply will look different based on things��like abortion rights and abortion policy and other of these things that��are treated��as social but really do affect people’s economic behaviors.��

Rovner:��And as we pointed out before,��it’s��not just about quote-unquote��“abortion,”��because when doctors choose not to live in a certain place,��it’s��other types of health��care.��It’s��all��health��care. And we know that doctors tend to marry or partner with other doctors. So sometimes if an OB GYN��doesn’t��want to move to a certain place, then that OB-GYN’s��partner, who may be��some��completely other type of��doctor,��isn’t��going to move there either.��So��we are starting to see��some of��these geographical shifts going on.��

Luthra:��And one point��actually that��the researcher made that I thought was so interesting was that abortion policy, it can be emblematic, in and of itself, a reason people choose not to live somewhere, but people may also be making these decisions because of what it represents. Do I look at an abortion policy and say,��Oh, this reflects social values or gender beliefs?��Or does it also suggest��maybe more��anti-LGBTQ+��laws?��And all of that can create a picture that is broader than simply abortion or��not, and��determine��where and how people want to live their lives.��

Rovner:��It’s��a really interesting��story.��We will��link��to it.��All right, that is this week’s news. Now��I’ll��play my interview with Andy Schneider of Georgetown University, and then we will be back to do our extra credits.��

Rovner:��I am pleased to welcome to the podcast Andy Schneider, a research professor of the practice at the Georgetown University McCourt School of Public Policy. And he spent��many��years on Capitol Hill helping write and shape Medicaid law as a top aide to California Democratic��congressman��Henry Waxman��—��and��many��hours explaining it to me.��I have asked him here to help untangle the Medicaid fraud fight now taking place between the federal government and,��at least so far, mostly��Democratic-led states. Andy, thanks for being here.��

Andy Schneider:��Thanks for having me,��Julie.��

Rovner:��So,��it’s��not like fraud in Medicaid��—��and other health programs,��for that matter��—��is anything new.��Who are the major perpetrators of health care fraud?��It’s��not usually the��patients, is it?��

Schneider:��No,��it’s��usually��some��bad-actor providers or bad-actor businesspeople.��

Rovner:��So how are fraud-fighting efforts at both the federal and state level, since Medicaid funding��is shared, supposed to work?��How does the federal government and the state government��sort of try��and make fraud as minimal as possible? Since��presumably they’re��never going to get��rid of it.��

Schneider:��Unfortunately, I��don’t��think��you’re��ever going to get rid of it in Medicaid or Medicare or private insurance or in other��walks of life. There are bad actors out there.��They’re��going to try to take��advantage.��So��you need your defenses up.��So��the short of this is,��Medicaid��is administered��on a day-to-day basis by the states. The federal government��pays for��a majority of��it and oversees how the states run their programs. In that context, the state Medicaid agency and the state��fraud��control��unit have a��primary role in��identifying��where there might be fraud, investigating,��and then,��in��appropriate cases,��prosecuting. The federal government also has a role, however. Depending on the scope of the fraud, it could involve the FBI. It could involve the Office of Inspector General at the Department of Health and Human Services.��So��there’s��both federal and state presence, but the primary responsibilities were the��states’.��

Rovner:��We know that Minnesota has been experiencing a Medicaid fraud problem,��because both the state and the federal government have been working on it for more than a year now. What is the Trump administration doing in Minnesota?��And why is��this��different from what the federal government has traditionally done when��it’s��trying to ensure that states are appropriately trying to minimize fraud?��

Schneider:��Well, usually the��vice��president of the United States does not get up at a White House press conference and announce he and the Centers for Medicare��&��Medicaid��Services are��withholding $260 million in federal funds,��called��a��deferral. That is highly, highly unusual. And normally��the��head of the Centers��for Medicare��&��Medicaid Services does not��go and make��videos in the state before something like this��is announced.��So��I would say that this is��way out��of the ordinary, and��I think it��has to do with��some��animus in the administration towards��Gov.��[Tim]��Walz and his administration.��

Rovner:��Right.��Gov.��Walz, for those who��don’t��remember, was the��vice presidential��candidate in 2024 running against President Trump, who did win, in fact. But there have been two different efforts to withhold Medicaid money for Minnesota, right?��

Schneider:��Yeah. Now��you’re��into��the Medicaid��weeds, but since you asked the question,��I’ll��take you there. So in January, the��administra—��the Center for Medicare��&��Medicaid Services��—��we’ll call them CMS here��—��they announced they were going to withhold about��$2 billion��a year going forward, not looking back��but going forward,��in matching funds that the federal government would otherwise pay to the state of Minnesota for the services that it was providing to its over 1 million beneficiaries. In February at this White House press conference, what the��vice��president announced was withholding temporarily��—��we’ll see how temporary it is��—��but withholding temporarily��$260 million in federal Medicaid matching funds that applied to state spending that’s already occurred, happened in the past, happened in the quarter ending Sept.��30, 2025.��So��both the past expenditures and future expenditures are targets for these CMS actions.��

Rovner:��So��what happens if the federal government��actually doesn’t��pay the state this money? I assume more than people who are committing fraud would��be��impacted.��

Schneider:��Well,��let’s��be clear.��The��amounts of money here,��there’s��no relationship between those and however��much��fraud is going on in Minnesota. And there has been fraud against Medicaid in Minnesota.��Everybody’s��clear about that. The state is clear about it. The feds are clear about it. But��$2 billion��going forward in a year,��$1 billion��going,��looking backwards,��$260 million times four��—��there’s��no relationship between those amounts, right? Should they��come to pass��—and all of this is still in process��—��should those amounts��come to pass, you’re looking at, depending on who’s doing the estimates, between��7��and 18% of the amount of money the federal government pays,��helps the state with,��each year in Medicaid.��That’s��just an enormous hole for a state to fill, and it��doesn’t��have��many��good options. It can cut eligibility. It can cut services. It can cut reimbursement rates. Filling in that hole with state revenues,��that’s��going to be a real stretch.��

Rovner:��So��it’s��not just Minnesota. Now the administration says it is seeing concerning things going on in New York and has launched a probe��there. Is there any��indication��that this administration is going after states that��are not run��by Democrats?��

Schneider:��So��the only letters that��we’ve��seen from the administration have been to California, New York,��and Maine. There may be other letters out there. We only access the public��record.��So��so��far, based on what we know,��it’s��just��been��Democratically��run��states.��

Rovner:��As long as��I’ve��been covering this, which is now a long time, fraud-fighting has been��pretty bipartisan.��It’s��been something that Congress has worked on, Democrats and Republicans in Congress, Democrats and Republicans in the��states.��What’s��the danger of politicizing fraud-fighting,��which is what��certainly seems to be��going on right now?��

Schneider:��Yeah,��that’s��a terrific point.��So��it��always has��been��bipartisan, because��money is green.��It’s��not red.��It’s��not blue.��It’s��green. And trying to keep bad actors from ripping it off from Medicaid or Medicare��has always been a bipartisan undertaking. The reason that’s important, particularly in a program like Medicaid, where the federal government and the state��have to��talk to one another when they are flagging potential fraud, when they’re investigating it, when they’re prosecuting it, you don’t want the agencies tripping all over one another. You want them��sharing��information��as necessary,��etc.��When that gets politicized,��it’s��very bad��for the results and for the effective operation of the program.��

Rovner:��Well��we will keep watching this space, and��we’ll��have you back to explain it more. Andy Schneider, thank��you very much.��

Schneider:��Julie��Rovner, thank you very much.��

Rovner:��OK,��we’re��back.��Now��it’s��time for our��extra-credit��segment.��That’s��where we each recognize the story we read this��week��we think you should read,��too.��Don’t��worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Anna, why don’t you start us off��this week?��

Edney:��Sure.��Mine is in��The Wall Street Journal.��It’s��[“”].��This is a look at the booming business of providing therapy to children with autism. And��that’s��particularly��been big in the Medicaid��program. And I��don’t��want to give away too much, because there��are��just so many jaw-dropping details��in��this.��So��I guess the reporters��were able to��kind of go��through the data and billing records in a way that showed��some of��these companies and what they were doing and how they were becoming millionaires, people who had never done anything in autism before.��So��if you enjoy a sort of jaw-dropping read, I think you should��take a look��at it.��

Rovner:��Yeah, jaw-dropping is��definitely the��right description.��Joanne.��

Kenen:��So��I��sort of rummaged��around the internet to the less widely read sources, and I came across this��great story��from the Idaho��Capital��Sun by Laura Guido. It has a long headline.��Reminder that 988 is the mental health crisis line and suicide help. The headline is:��“”��The story is that a 15-year-old boy named Jace��Woods called��two years ago��—��so this still��hasn’t��been fixed��after two years��—��and they cut��him��off. They��sort of gently��cut��him��off. But they��can’t��talk to these kids who have,��who are in crisis,��without parental consent. They do a quick assessment. If they think someone’s life is��immediately��in��danger��right then and there, they can stay on. But a kid��who’s��what they call suicidal ideation, seriously depressed and at risk, and knows��he’s��at risk or��she’s��at risk, and made this phone��call,��they��don’t��talk to them unless they think��it’s��imminent.��So��it also affects,��these parental,��it affects sexual health and STDs and abortion and��whole��lot of other��things.��

Rovner:��That’s��what it was for.��

Kenen:��That was the��initial��reason, but it got bigger.��So��a kid who calls in a crisis can get no help at all. And even in those emergency situations where they can stay on the line and try to get emergency help if they do��think��a��kid’s��in imminent danger,��they’re��not allowed to make a follow-up call to make sure��they’re��OK.��So��this kid has been trying for two years.��There’s��a state lawmaker.��They’re��refining a law. They say��it’s,��they’re��refining a bill.��They say��it’s��going to go through. But really this,��talk about unintended consequences. We have a national mental health crisis, particularly acute for teens. This is not solving any problems.��

Rovner:��It is not.��Shefali.��

Luthra:��My story is in��The New York Times. It is by��Apoorva��Mandavilli. The headline is��“.”��And��it’s��just��a good story��about what is happening with the Ryan White AIDS��Drug��Assistance��Programs, which people use to get their HIV medications paid for or for free. They get insurance support. And these are��really important.��Funding has been��pretty flat��for quite��some��time because they’re funded by Congress.��And what the story gets into is that with growing financial pressure on these programs, there is more-expensive drugs, there are more-expensive insurance premiums, more people might be losing Medicaid. States are having to make��very difficult��choices, and they are cutting benefits. They are changing who is eligible, because��it’s��getting more expensive and there is more need and there is no support coming. And I wasn’t really on top of this and did not know what was going on, and I just thought it was interesting and��a very useful��look at��some of��the consequences of the policy choices that are making��all of��these health programs more expensive and health care,��in general, harder to afford.��

Rovner:��My extra credit this week is from��The Marshall Project.��It’s��called��“.”��It’s��by Shannon��Heffernan��and Jesse��Bogan��and Anna Flagg. It answers the question that I’ve been wondering about since the whole immigration crackdown began, which is:��What happens to the people who��are snatched��off the streets or out of their cars or homes,��flown to a distant state, and then someone says:��Oops, sorry. You can go.��How do you get home from Texas or Louisiana to Minnesota or Massachusetts? Authorities��don’t��give you plane or even bus tickets��to get back to where you��were picked��up, even though��that’s��where��most of��those��being released��are��required��to go to report back to immigration authorities. It turns out��there’s��a small network of charities that is helping. But as the story details��pretty vividly, the harm to these families��doesn’t��end when their detention��does./��

OK.��That’s��this week’s show. As always, thanks to our editor,��Emmarie Huetteman,��and our producer-engineer.��Francis Ying. 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’re��at whatthehealth@kff.org.��Or you can still find me on��X,��, or on��Bluesky,��. Where are��you guys��hanging these days?��Shefali?��

Luthra:��I am at Bluesky,��.��

Rovner:��Anna.��

Edney:����and��,��@annaedney.��

Rovner:��Joanne.��

Kenen:��A��little bit of����and more on��,��@joannekenen.��

Rovner:��We��will��be back in your feed next week. Until then, be healthy.��

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But plans to spend those nine-digit awards aren’t all warmly received.

At least one group of Republican state lawmakers appears to have scuttled an initiative preapproved by federal officials. And at least one hospital association persuaded its state health leaders to alter who greenlights spending. Other critics are taking a more cautious approach.

That’s because the Centers for Medicare & Medicaid Services, which manages the five-year Rural Health Transformation Program, says states could lose money if they make major changes to the plans approved in their applications. Changes could also delay states’ ability to get projects rolling in time to show the agency that they’re meeting progress deadlines.

“During the application period, states were advised to only propose initiatives and state policy actions that the state deemed feasible,” said CMS spokesperson Catherine Howden, who noted that the agency will work with states case by case.

The recent pushback reflects “tension” over state plans — which were approved by the federal government — from state lawmakers and health leaders who want more input amid tight deadlines, said Carrie Cochran-McClain, chief policy officer of the National Rural Health Association, the largest organization representing rural hospitals and clinics.

Cochran-McClain said many states must pass a bill to allow federal dollars to be spent and added that because the program rolled out so quickly “there’s important work that still needs to be done in some states between the legislatures and the governors.”

State lawmakers want to have a say, she said, in “how the funding is being allocated — how the implementation will go.”

Congressional Republicans created the program as a last-minute sweetener to include in their One Big Beautiful Bill Act, signed into law last summer. The funding was intended to offset concerns about the anticipated in rural communities from the law, which is expected to slash Medicaid spending by nearly $1 trillion over a decade.

CMS officials announced first-year funding — ranging from $147 million for New Jersey to $281 million for Texas — on Dec. 29, after scoring applications. Federal officials will begin evaluating progress in late summer and announce 2027 allocations at the end of October.

A chorus of critics say the program won’t make up for harm caused by Medicaid cuts.

The program is “a complete sham,” Sen. Ron Wyden (D-Ore.) said at a rural policy conference in February.

Medicaid, a joint federal-state program for low-income and disabled Americans, serves nearly , and many rural hospitals depend on it to stay afloat.

But the rural health program tilts toward seeding innovative projects and technologies, not shoring up rural hospital finances. States can use only up to 15% of their funding to pay providers for patient care.

That hasn’t stopped some federal officials and lawmakers from framing the program as a rural hospital rescue.

For example, the White House , “President Trump secured $50 billion in funding for rural hospitals.”

Now that applications have been approved, some state Republican lawmakers — who are more likely to represent rural voters than Democrats are — and hospital associations are upset that the political rhetoric doesn’t match what they see.

They’re also lobbing criticisms at specific aspects of their states’ plans, including the proposed projects, what’s not included, and the spending approval process.

In Wyoming, lawmakers didn’t just criticize an initiative from their state’s application. They moved to kill it.

State Rep. John Bear, a Republican, said he and other lawmakers declined to fund “BearCare,” a proposed state-sponsored health insurance plan that patients could use only after medical emergencies. But they did approve other aspects of the rural health program.

The Wyoming Department of Health won’t “proceed with BearCare without express legislative authority to do so,” said spokesperson Lindsay Mills.

While Wyoming lawmakers removed an initiative from their state’s rural health plan, a group in Ohio wants to add something.

Ohio Rep. Kellie Deeter and other Republican lawmakers to use the maximum allowed funding for provider payments — 15% — to support 13 independent, rural hospitals.

“We understand that the rural transformation fund is not designed to be given directly to prop up hospitals,” Deeter said. “We just want to capitalize on the mechanism of the fund that can be utilized for that purpose.”

Those hospitals “operate with very, very narrow margins, and it’s just difficult and, frankly, unsustainable,” she added.

Ken Gordon, a press secretary responding for the governor’s office and the state health department, said, “It’s still very early in this process, and many details are being worked out.”

State lawmakers around the country are also trying to ensure the federal program’s dollars benefit rural areas.

In North Dakota, Rep. Bill Tveit, a Republican who lives in a town with about 2,000 residents, that would have required the state to reserve its funding for programs located more than 35 miles from urban areas and small cities.

During a hearing, lawmakers appeared sympathetic to Tveit’s concerns but quickly shot down his idea.

State Sen. Brad Bekkedahl said the North Dakota health department already committed to prioritizing funding for the most pressing rural health needs. He also said he’s concerned any significant changes could cause the state to lose funding because CMS already reviewed and approved the plan.

Meanwhile, Republican lawmakers in Michigan and North Carolina have criticized their states’ definitions of “partially rural” or “rural,” saying that counties that include urban population centers could take money from lower-density counties, according to and .

Lawmakers aren’t the only ones speaking out.

The Colorado Hospital Association to state lawmakers denouncing how the state created its plan and two of its proposed initiatives.

“Not only were Colorado’s rural hospitals’ recommendations disregarded,” president and CEO Jeff Tieman wrote, but the plan includes ideas “they actively oppose and believe will harm the communities they serve.”

The department responded to one of the association’s concerns by adding rural health leaders to the .

Meanwhile, and Nebraska, some health groups are upset that their states’ plans lack specific funding streams for rural hospitals.

Lauren LaPine-Ray, who oversees rural health policy at the Michigan Health & Hospital Association, predicted the state’s rural hospitals will compete with other organizations, such as academic centers and health clinics, for funding. She said about 65% of the group’s rural members have never applied for a state grant before.

“The rural hospitals, the ones that really need the funding the most, will not be well equipped to apply for and pull down these dollars,” LaPine-Ray said.

Jed Hansen, executive director of the Nebraska Rural Health Association, said the federal funding won’t go to “rural hospitals, rural clinics, and rural providers in a meaningful way.”

“Rural Health Transformation will not save a single hospital in our state,” he said. “I don’t think it will save a hospital nationally.”

�鶹Ů�� Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at �鶹Ů��—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).