麻豆女优 Health News Southern correspondent Sam Whitehead discussed high Affordable Care Act premiums on WUGA’s The Georgia Health Report on March 27.

• Read Renuka Rayasam’s “When Health Insurance Costs More Than the Mortgage.”

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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 鈥� who is also the director of the National Institutes of Health 鈥� has to give up that title, leaving no one at the helm of the nation’s primary public health agency.听

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.听

This week’s panelists are Julie Rovner of 麻豆女优 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 鈥� and even membership 鈥� 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 鈥� 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 鈥� 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 鈥� 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.听

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

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

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

Also mentioned in this week’s podcast:

• Stat’s “,’” by Jonathan Wosen.
• 麻豆女优 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:听This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]听

Julie Rovner:听Hello,听from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to听What the Health?听I’m听Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and听I’m听joined by some of the best and smartest reporters听covering听Washington.听We’re听taping this week on Thursday,听March 26,听at 10听a.m.听As always, news happens fast, and things might have changed by the time you hear this. So,听here we go.听

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

Rachel Cohrs Zhang:听Hi,听everybody.听

Rovner:听Shefali Luthra听of听The听19th.听

Shefali Luthra:听Hello.听

Rovner:听And Lizzy Lawrence of Stat News.听

Lizzy Lawrence:听Hello.听

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

So,听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,听ruling it had violated federal administrative procedures听regarding听advisory committees. This week, a federal judge in Portland, Oregon,听ruled the department also听didn’t听follow the required process to block federal reimbursement for transgender-related medical treatment. The case was brought by 21听Democratic-led states. Where does this leave the hot-button issue of care for transgender teens? Shefali,听you’ve听been following this.听

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

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

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

Rovner:听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听鈥μ齰accine policy听definitely is听in limbo.听听

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

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

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

Rovner:听I’ve听assumed听they’ve听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听some certainly medical chops, if not public health chops.听I think听the听head of the health department in Mississippi. There was one other who听I’ve听forgotten, who it is among the names that have been floated听鈥μ�

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

Rovner:听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听to come?听

Cohrs Zhang:听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,听at this point, like, I don’t know what the rush is,听now that the deadline is passed.听

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

Cohrs Zhang:听I听don’t听think so.听

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

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

Rovner:听But she, well听鈥μ齮hat’s听right, she was the听“acting,”听and then once she was nominated, she听couldn’t听be the acting anymore.听

Cohrs Zhang:听Yeah.听

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

Cohrs Zhang:听It was.听So听it’s听not an unprecedented situation, even in this administration.听It’s听just not a good听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.听So听I think there’s definitely a desire for some stability over there.听

Rovner:听And we have measles spreading in lots more states.听I mean, every time I听鈥μ齩pen up my news feeds, it’s like, oh, now we have measles, you know, in Utah, I think,听in Montana.听Washtenaw County, Michigan,听had its first measles case recently.听So听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听and Senate confirmable, which is my way of saying that the Casey听Means nomination still appears to lack the votes to move out of the Senate, Health, Education, Labor听&听Pensions Committee. Do we have any latest听update听on that?听

Cohrs Zhang:听I think the latest update, I mean, my colleagues at Bloomberg Government just听kind of had听an update this week that听they’re听still not to听“yes” 鈥斕齦ike,听there are some key senators that still听haven’t听announced their positions publicly.听So听I think a lot of the same things that听we’ve听been hearing听鈥μ齦ike听Sens.听Susan Collins and听Lisa Murkowski and Bill Cassidy obviously have not听stated听their positions publicly on the nomination.听Sen.听Thom Tillis, who you听know听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.听So听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,听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听鈥斕齮hat all of the complaints are about Dr.听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听鈥μ齪otentially extract some concessions. And听so听there’s听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听table听and really cut some deals to advance her nomination? I just听don’t听think we know the answer to that yet.听

Rovner:听Yeah,听it’s听worth reminding that,听frequently,听nominations get held up for reasons that are totally disconnected from the person involved. We went听鈥斕齀 should go back and look this up听鈥� we went, like, four years in two different administrations without a confirmed head of the Centers for Medicare听&听Medicaid听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,听both Casey听Means and,听you know, her connection to听MAHA,听and the fact that among those who haven’t declared their positions yet,听it’s the chairman of the committee, Bill Cassidy, who’s in this very tight primary to keep his seat.听So听we will keep听on that one.听听

Also, meanwhile, HHS continues to push its听Make America听Healthy听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听mini-proteins听are part of a biohacking trend that many MAHA听adherents say can听benefit听health,听despite their not having been shown to be safe and effective in the normal FDA approval process. The FDA听has听also听formally听pulled听a proposed rule that would have banned teens from using tanning beds. We know that the听secretary is a fan of tanning salons, even though that听has听been shown to cause potential health problems,听like skin cancer. Lizzy,听is Kennedy just going to push as much MAHA听as he can until the courts or the White House stops him?听

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

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

Lawrence:听Right. Right.听But there has been, I mean, the FDA has kind of been pretty severe on GLP-1听compounders听Hims听&听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.听

Rovner:听My favorite piece of FDA听trivia听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听don’t听know if听that’s听a signal or what.听

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

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

So听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.听But I wanted to highlight a听story by my听麻豆女优听Health听News colleague Sam Whitehead听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听“savings”听that are听actually just听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,听they put off care until it becomes more expensive to treat. At that point,听because听they’re听on Medicare, the听federal taxpayer will foot a bill听that’s听even bigger than the bill that would have been paid by the insurance company.听So听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?听

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

Luthra:听I think you听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听go up. Employers are seeing what they pay for insurance听go听up as well. And there absolutely is something to be said about听it’s听been 16 years since the Affordable Care Act听passed,听we听haven’t听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听appetite听around this. You see a lot of talk about affordability, but a lot of听this feels, at least as an observer,听very focused听on insurance, which makes sense. Insurance is听a very easy听villain to cast.听But I think you’ve raised a听really good point:听that addressing these really potent burdens on individuals and eventually on the public just requires something听more systemic and more serious if we actually want to yield better outcomes.听

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

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.听That’s听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.听citizen graduates of foreign medical schools matching to a U.S.听residency position fell to a five-year low of 56.4%.听That compares to a 93.5% matching rate for U.S.听citizen graduates of U.S.听medical schools. Why does that matter? Well, a quarter of the U.S.听physician workforce are immigrants, and they are disproportionately represented, both in lower-paid primary care specialties, particularly in rural areas, both of which听U.S.听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听we’ve听talked about, a general reduction in visa approvals,听and some people听likely not听wanting to even come to the U.S.听to practice. But that rural health fund that Republicans say will revitalize rural health care听doesn’t听seem like听it’s听really going to work without an adequate number of doctors and nurses, I would humbly suggest.听

Lawrence:听Yeah, absolutely. I mean,听it’s听patients that suffer, right? I mean, you need the people doing the work. And听so听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.听

Rovner:听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.听

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

Rovner:听Yeah, and I think听it’s听been left out.听Well,听meanwhile,听over at the National Institutes of Health, a听,听Lizzy,听found that more than a quarter have laid off laboratory workers. More than听2听in听5听have canceled research,听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,听this听isn’t听just about the听future of science. Biomedical research is a听huge piece of the U.S.听economy. Earlier this month, the group听United for听Medical听Research听,听finding听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.听But听it’s听not clear whether听it’s听going to continue to compromise the future workforce. I feel like, you know, we talk about all these missing people and nomination stuff, but听we’re听not really talking a lot about听what’s听going on at the National Institutes of Health, which is a, you know, almost听$50 billion-a-year enterprise.听

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

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

Finally, this week, there is always听reproductive听health听news. This week,听we got the Alan Guttmacher Institute’s听听for the year 2025,听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.听remained relatively stable, despite the fact that it’s outlawed or seriously restricted in nearly half the states.听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.听Last week, anti-abortion Sen.听Josh Hawley of Missouri introduced legislation that would听basically rescind听approval for the abortion pill mifepristone. But that legislation is听apparently giving听some Republicans in the Senate heartburn, as they really听don’t听want to engage this issue before the midterms.听And,听apparently,听the听Trump administration听doesn’t听either, given what we know about the FDA saying that听they’re听still studying this.听On the other hand, Republicans听can’t听afford to lose the backing of the anti-abortion activists either.听They put lots of time, effort,听and money into turning out votes, particularly in times like midterms. How big a controversy is this becoming, Shefali?听

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

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

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

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

Luthra:听That’s听true.听

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

Luthra:听It seems possible.听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.听They have promised they would not go after people who are pregnant, who get abortions.听And this is exactly what they are doing. And听I think what听really stands out to me about this case is so much of it depends on individual prosecutors and individual judges. You have听the law enforcement officials who decided to make this a case, and听they’re听actually using, not the abortion law, even though the language in the case,听right,听really resonates, reflects with the law in Georgia’s听six-week ban. Excuse me, with the听language听in Georgia’s听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.听

Rovner:听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.听And we听will听too.听

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

I am pleased to welcome back to the podcast Katie Keith. Katie is the founding director of the Center for Health Policy and the听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.听It’s听been a minute.听

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

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

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

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

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

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

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

Rovner:听You mentioned that 2025 was the peak not just of enrollment but of popularity.听And we have seen in poll after poll that the changes that the Trump administration听and听Congress听is听making are not popular with the public, including听the vast majority of听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?听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听they’re听weakening听or听are听we off onto other things entirely听right now?听

Keith:听It’s听a great question.听I think you听probably need听a different analyst to ask that听question to. I听don’t听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听sort of a听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听and听the politics听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听maybe would,听could have moved the needle if there was a needle to be moved.听So听I,听it seems like听there’s听much more focus on prescription drugs and other issues, but anything can happen.听So听I guess听we’ll听all听stay tuned.听

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

Keith:听Thanks,听Julie.听

Rovner:听OK,听we’re听back.听It’s听time for our听extra-credit听segment.听That’s听where we each recognize听a听story we read this听week听we think you should read too.听Don’t听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?听

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

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

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

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

Luthra:听My story is from NPR. It is by听Tara听Haelle. The headline is听“.”听Story says exactly what it promises, that if you have an infant, babies听under听6听months, then getting a covid vaccine while you are pregnant will听actually protect听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听are pregnant.听

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

All right, that is this week’s show.听As always, thanks to our editor,听Emmarie听Huetteman;听our producer-engineer, Francis Ying;听and our interview producer,听Taylor Cook.听A听reminder:听What the听Health?听is now available on WAMU platforms, the NPR app,听and wherever you get your podcasts, as well as,听of course,听kffhealthnews.org. Also, as always, you can email听us听your comments or questions.听We’re听at听whatthehealth@kff.org.听Or you can still find me on听X听听or听on Bluesky听. Where are you folks hanging these days?听Shefali?听

Luthra:听I am on听Bluesky听.听

Rovner:听Rachel.听

Cohrs Zhang:听On听X听, or听.听

Rovner:听Lizzy.听

Lawrence:听I’m听on听X听听and听听and听.听

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

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They worked for a bit. But by 2011, Warfield struggled to walk.

And “by that time, I was addicted,” said Warfield, now living in Shelbyville, Kentucky.

After she lost her health insurance, Warfield started buying pills on the street. She tried to quit several times, but the debilitating withdrawal 鈥� so bad she couldn’t get out of bed, she said 鈥� kept driving her back to drug use.

Until last year.

Through her church, Warfield learned about the NET device. It’s a cellphone-sized pack connected to gel electrodes placed near the ear that deliver low-level electrical pulses to the brain.

“Once I got set up on the device, within 30 minutes, I didn’t have any cravings” for opioids, Warfield said.

After three days on the device in August, she stopped using drugs altogether, she said.

Warfield’s treatment was paid for with her county’s opioid settlement dollars 鈥� money from pharmaceutical companies accused of fueling the overdose crisis.

State and local governments nationwide are receiving over nearly two decades and are meant to spend it treating and preventing addiction.

Warfield wants them to allot a good chunk to the NET device, which costs counties about $5,500 a person. The pitch is gaining traction. , which makes the device, said it has signed听about听$1.2 million in contracts with听more than a dozen counties and cities听in Kentucky.听

But some researchers and recovery advocates say the company’s rapid consumption of opioid dollars raises red flags. They see the NET device as the latest in a series of products that have been overhyped as the solution to the addiction crisis, preying on people’s desperation and capitalizing on the windfall of opioid settlements. Many of these products 鈥� from to body scanners for jails 鈥� have little evidence to back their lofty promises. That has not stopped sales representatives from repeatedly pitching elected officials or circulating ready-made templates to request settlement money for the companies’ products.

In fact, a device similar to NET called the Bridge gained popularity several years ago, receiving more than $215,000 in opioid settlement cash nationwide. But about the study backing its effectiveness, and the device is currently off the market.

NET Recovery’s activity “fits the national trends of these industry money grabs,” said , a national expert on opioid settlements based in Tennessee. The device “could be helpful for some,” she said. “But it’s being sold as a silver bullet.”

This year, 237 organizations working to end overdose 鈥� including Christensen’s consulting company 鈥� to guide officials in charge of opioid settlement money. In it, they called the NET device an example of problematic spending on unproven treatment.

Treating Withdrawal or Addiction

The FDA has for a specific use: reducing drug withdrawal symptoms. It has not approved the device to treat addiction.

That’s a crucial distinction, said , executive director of the Institute for Research, Education and Training in Addictions. He co-authored evaluating the evidence on neuromodulation devices like NET.

“The term 鈥榯reatment’ becomes confusing,” Hulsey said. “These devices were cleared to treat opioid withdrawal symptoms, not to treat an opioid use disorder.”

NET Recovery CEO said the company adheres to FDA rules and advertises the device only for withdrawal management. But “we are finding that physicians are prescribing this to folks for long-term behavior based on the results of our study.”

He’s referring to that he co-authored and the company funded, in which researchers followed two groups of addiction patients in Kentucky for 12 weeks. The first group received the NET device for up to seven days, while the second group received a sham treatment.

The study found no significant difference between the groups’ outcomes. Participants who got the NET device were similarly likely to use illicit drugs after treatment as those who got the fake.

Hulsey, who was not affiliated with the study, said the takeaway is clear: “They didn’t find that was effective.”

A subgroup of participants who chose to use the device for more than 24 hours consecutively, however, went on to use illicit drugs less often than other participants.

As the researchers acknowledged in their paper, that subgroup might simply have been more motivated to engage with any form of treatment. The results don’t necessarily show that the device is making a difference, Hulsey said.

Rapid Growth

Winston had a different take. He said the success of the subgroup is “intriguing and outstanding.”

So outstanding, in fact, that the company this month is opening a brick-and-mortar location in Miami, where the device will be available to anyone who can pay $8,000 out-of-pocket. (The cost is higher for individuals than for county governments.) It has also applied for opioid settlement dollars from the state of Kentucky to conduct a larger research study and aims to bring the NET device into metro areas such as Louisville and Lexington.

Last year, NET Recovery hired a magistrate in Franklin County, Kentucky, to head up its operations in the state. (Magistrates function as county commissioners.) , who is also a mental health clinician, travels to different counties, extolling the benefits of the device and encouraging officials to contract with the company.

Her county to NET Recovery prior to her joining the company. Moving forward, Dycus said, she would recuse herself from any contract votes in her county.

Christensen, the national expert on opioid settlements, called Dycus’ new role “extremely strategic” for the company and “an obvious conflict of interest” for a public official.

Giving People Choice

More options for people to enter recovery is generally good, said Jennifer Twyman, who has a history of opioid addiction and now works with , a nonprofit that advocates to end homelessness and the war on drugs.

But settlement funds are finite, she said, and when counties invest in the NET device, that leaves less money to support options like mental health treatment, housing, and transportation programs 鈥� critical for many people who use drugs.

“People slip through these big, huge gaps we have and they die,” Twyman said, pointing to photos of dead friends that line her office wall.

She added that people should have the option of taking medications such as methadone and buprenorphine 鈥� for treating opioid addiction. only 1 in 4 people with opioid addiction get them.

Many people can’t afford them, find a doctor willing to prescribe them, or get transportation to appointments, Twyman said. against those who use medications, with detractors saying they’re not truly abstinent or clean.

Companies like NET Recovery sometimes lean into that stigma, Twyman said.

For instance, Scott County, Kentucky, jailer 鈥� whom the company considers a key champion for its device 鈥� to other county officials that medication treatment is just “swapping one drug for another.” It’s a common refrain from critics that .

Winston told 麻豆女优 Health News his company is supportive of all types of recovery but that the NET device can help the “underserved population” of people who don’t want medication.

Longtime addiction researcher has led studies for NET Recovery and consults for , one of the leading producers of medications for opioid use disorder. He said he sees value in both approaches. It just depends on whom you’re trying to treat.

For people injecting drugs or accustomed to high doses of fentanyl, who are more likely to return to using drugs after residential treatment, “I would hesitate to recommend the device,” he said. Abstinence-based approaches can . But for people who are “highly motivated to stay abstinent,” the NET device may be a good fit.

“Giving people choices is the right thing to do,” he said.

Community as Part of Recovery

Warfield, who has not used opioids since August, credits not just the NET device with her recovery but her community too.

“It’s not a miracle cure,” she said of the device. “You still have to manage your triggers, but it’s easier.”

She regularly attends individual and group therapy to address childhood trauma. She’s found close friends within her church and has reconnected with her daughter. She installed a car seat in her vehicle so she can drive her grandson to preschool.

Warfield explained her hope for opioid settlement money to reach others in her community simply: “I want people to get as much help as they can.”

麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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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 麻豆女优 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 鈥� 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 鈥� 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 “.”
• 麻豆女优 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:听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:听This transcript听was generated听using both transcription software and a human’s light touch. It has听been edited听for style and clarity.]听

Julie Rovner:听Hello from听麻豆女优听Health听News and WAMU听public radio听in Washington, D.C. Welcome to听What the听Health?听I’m听Julie Rovner,听chief Washington correspondent for听麻豆女优 Health听News, and听I’m听joined by听some of听the best and smartest reporters covering Washington. We are taping this week on Thursday, March 12, at 10听a.m.听As always, news happens fast and things might have changed by the time you hear this. So,听here we go.听

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

Shefali Luthra:听Hello.听

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

Anna Edney:听Hi,听everybody.听

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

Joanne Kenen:听Hi,听everybody.听

Rovner:听Later in this episode,听we’ll听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听is something听completely different from any fraud-fighting effort听we’ve听seen before. But first,听this week’s news听鈥斕齛nd听some of听last听week’s.听

Let’s听start at the Department of Health and Human Services, where I think听it’s听safe to say Secretary Robert F Kennedy Jr.听is not having听a great week. The听secretary听reportedly had听to have his rotator cuff surgically repaired on Tuesday.听It’s听not clear if he injured it during one of his famous video workouts. But it is clear, at least according to听听from the University of Pennsylvania’s Annenberg Center, that the American public is not buying what听he’s听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.听

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

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

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

Edney:听Yeah, I think听there’s a lot of overpromising and underdelivering, and that can kind of create this issue where this administration听鈥斕齛nd RFK Jr.听has been doing this as well听鈥斕齥ind 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,听or at least听have an idea that there was a discussion out there. And听that’s听not happening. So听that’s听not something听that’s听creating听a lot of听trust.听I think people听are seeing that as unscientific and chaotic.听

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

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

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

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

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

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

Edney:听Well, I think, Prasad was an FDA critic before he came to the agency. And so听essentially,听when he was out in public, particularly during covid, but there were even criticisms he had before that.听He was criticizing these career scientists at the agency. And听so听he got there, and the way he appeared to听operate听was that he knew听best听and he听didn’t听need to talk to any of these people that had been there,听some听for decades, and that was getting him in听a lot of听trouble. But he was听being defended听and protected by FDA听Commissioner Martin Makary, and he really supported Prasad, and he called him a genius and wanted him to stay on.听So听the first time Prasad left, he convinced him to come back. And now this time, I think, things听maybe just听went听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,听particularly,听several听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听maybe wholly听unsafe. But they think听anyone听should be able to try it. And听so听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.听

Rovner:听Well, and he,听this was,听this incredibly unusual听听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听center at FDA is basically trashing a company,听trying to do it on background. Was that kind of the last straw?听

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

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

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

Rovner:听Yes.听

Kenen:听鈥攏ot being at the FDA very much, at a time when everybody else has听been forced听to come back to work?听So,听but I do confess that I keep looking at my phone to check if听he’s听still out or听is he听already back again.听

Rovner:听Right.听

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

Rovner:听Yeah,听I was not kidding when I said听on-again听off-again on-again听off-again. All right. Well, moving over to the National Institutes of Health, which also has a director听that’s听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听be settled, like funding for the NIH,听which Congress听actually increased听in the spending bill that passed at the end of January. To that end, a shout-out to our podcast panelist听Sandhya Raman, formerly of CQ,听now at Bloomberg, for听听grant funding that still pays for most of the nation’s basic biomedical research is still being held up. This is months after it听was ordered听resumed by courts and appropriated by Congress.听

Shout-out as well to my听麻豆女优 Health听News colleagues听Rachana Pradhan听and Katheryn听Houghton for听their project听on the people and research projects that have been disrupted by all the cuts at NIH,听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听basically the听economic and health engine of NIH would be getting much,听much,听much听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听of drip,听drip, drip at NIH is going to turn into a very long-term hole听that’s听going to be听very difficult听to fill.听A听lot of听these things have years-听if not decades-long runways.听These great scientific achievements start somewhere, and it looks like听they’re听just听sort of pulling听out the whole starting part.听

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

Rovner:听I say,听are you guys as surprised as I am, though, that this isn’t听鈥斕齮he 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听basically being听dismantled in front of our eyes, and nobody’s saying very much about听it.听

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

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

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

Rovner:听That’s听right.听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听whether we’re going to have, as听some听are saying, the first听surgeon听general who does not have an active license to practice medicine. Shefali, you wanted听to add something.听

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

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

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

Last week, CMS banned the Medicare Advantage plan听operated听by听Elevance听Health, which has听nearly 2听million Medicare patients currently enrolled,听from adding any new enrollees starting March 31,听for what the agency described as, quote,听“substantial and persistent noncompliance with Medicare Advantage risk adjustment data.”听And on Tuesday, the听congressional Joint Economic Committee reported that overpayments to those Medicare Advantage听plans raised premiums by an estimated $200 per Medicare enrollee annually听鈥斕齛nd听that’s听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.听

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

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

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

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

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

Rovner:听Oh, it is.听

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

Rovner:听I was going to say,听it’s听important to remember at the beginning of Medicare Advantage, which was a Republican proposal back in 2003,听they purposely overpaid it. They gave it more money because they know that when they give them more money, the insurance companies听are required听to听return听some of听that money to beneficiaries in the form of these extra benefits.听That’s听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听sort of Republicans’听intent at the beginning. It was to听sort of not听so much push people into it but entice people into it.听

Kenen:听And听then鈥斕�

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

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

Rovner:听Absolutely.听

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

Rovner:听Well after,听that failed because they cut it when they were听鈥斕�

Kenen:听Right.听Right.听

Rovner:听They cut all the funding when they were balancing the budget听鈥斕�

Kenen:听Right.听听

Rovner:听鈥斕齣n听1997.听

Kenen:听But that听gave them听the听excu鈥斕齬ight.听

Rovner:听They made it听fail.听

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

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

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

Rovner:听The ones that passed by voters.听

Luthra:听Exactly. And听so听what we’re really thinking about is anti-abortion activists are not really that confident in the听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.听

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

Luthra:听I thought听this was so interesting. It was this听NBER听[National Bureau of Economic Research]听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听Dobbs听decision, rental prices declined听relative听to places without bans, compared to those in those that had them.听And this is听really interesting.听It just听sort of continues.听Rental prices went down,听and also听vacancies went up.听And what the researchers say is this is听a very, very dramatic听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,听because听we’ve听seen residents make choices about where they will practice.听We’ve听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听actually that听affects the economy of communities, and it really underscores that where we live just simply will look different based on things听like abortion rights and abortion policy and other of these things that听are treated听as social but really do affect people’s economic behaviors.听

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

Luthra:听And one point听actually that听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,听Oh, this reflects social values or gender beliefs?听Or does it also suggest听maybe more听anti-LGBTQ+听laws?听And all of that can create a picture that is broader than simply abortion or听not, and听determine听where and how people want to live their lives.听

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

Rovner:听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听many听years on Capitol Hill helping write and shape Medicaid law as a top aide to California Democratic听congressman听Henry Waxman听鈥斕齛nd听many听hours explaining it to me.听I have asked him here to help untangle the Medicaid fraud fight now taking place between the federal government and,听at least so far, mostly听Democratic-led states. Andy, thanks for being here.听

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

Rovner:听So,听it’s听not like fraud in Medicaid听鈥斕齛nd other health programs,听for that matter听鈥斕齣s anything new.听Who are the major perpetrators of health care fraud?听It’s听not usually the听patients, is it?听

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

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

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

Rovner:听We know that Minnesota has been experiencing a Medicaid fraud problem,听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?听And why is听this听different from what the federal government has traditionally done when听it’s听trying to ensure that states are appropriately trying to minimize fraud?听

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

Rovner:听Right.听Gov.听Walz, for those who听don’t听remember, was the听vice presidential听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?听

Schneider:听Yeah. Now听you’re听into听the Medicaid听weeds, but since you asked the question,听I’ll听take you there. So in January, the听administra鈥斕齮he Center for Medicare听&听Medicaid Services听鈥斕齱e’ll call them CMS here听鈥斕齮hey announced they were going to withhold about听$2 billion听a year going forward, not looking back听but going forward,听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听vice听president announced was withholding temporarily听鈥斕齱e’ll see how temporary it is听鈥斕齜ut withholding temporarily听$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.听30, 2025.听So听both the past expenditures and future expenditures are targets for these CMS actions.听

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

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

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

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

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

Schneider:听Yeah,听that’s听a terrific point.听So听it听always has听been听bipartisan, because听money is green.听It’s听not red.听It’s听not blue.听It’s听green. And trying to keep bad actors from ripping it off from Medicaid or Medicare听has always been a bipartisan undertaking. The reason that’s important, particularly in a program like Medicaid, where the federal government and the state听have to听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听sharing听information听as necessary,听etc.听When that gets politicized,听it’s听very bad听for the results and for the effective operation of the program.听

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

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

Rovner:听OK,听we’re听back.听Now听it’s听time for our听extra-credit听segment.听That’s听where we each recognize the story we read this听week听we think you should read,听too.听Don’t听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听this week?听

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

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

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

Rovner:听That’s听what it was for.听

Kenen:听That was the听initial听reason, but it got bigger.听So听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听think听a听kid’s听in imminent danger,听they’re听not allowed to make a follow-up call to make sure听they’re听OK.听So听this kid has been trying for two years.听There’s听a state lawmaker.听They’re听refining a law. They say听it’s,听they’re听refining a bill.听They say听it’s听going to go through. But really this,听talk about unintended consequences. We have a national mental health crisis, particularly acute for teens. This is not solving any problems.听

Rovner:听It is not.听Shefali.听

Luthra:听My story is in听The New York Times. It is by听Apoorva听Mandavilli. The headline is听“.”听And听it’s听just听a good story听about what is happening with the Ryan White AIDS听Drug听Assistance听Programs, which people use to get their HIV medications paid for or for free. They get insurance support. And these are听really important.听Funding has been听pretty flat听for quite听some听time because they’re funded by Congress.听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听very difficult听choices, and they are cutting benefits. They are changing who is eligible, because听it’s听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听a very useful听look at听some of听the consequences of the policy choices that are making听all of听these health programs more expensive and health care,听in general, harder to afford.听

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

OK.听That’s听this week’s show. As always, thanks to our editor,听Emmarie Huetteman,听and our producer-engineer.听Francis Ying. A听reminder:听What the听Health?听is now available on WAMU platforms, the NPR app,听and wherever you get your podcasts, as well as, of course,听kffhealthnews.org.听Also, as always, you can email听us听your comments or questions.听We’re听at whatthehealth@kff.org.听Or you can still find me on听X,听, or on听Bluesky,听. Where are听you guys听hanging these days?听Shefali?听

Luthra:听I am at Bluesky,听.听

Rovner:听Anna.听

Edney:听听and听,听@annaedney.听

Rovner:听Joanne.听

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

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

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The midterm elections are months away, yet changes at the Department of Health and Human Services suggest the Trump administration is focusing on how to win on health care, which remains a top concern for voters. Facing growing concern about the administration’s actions on vaccines in particular, the Food and Drug Administration this week reversed course and said it would review a new mRNA-based flu vaccine after all.

And some top HHS officials are changing seats as the Senate prepares for the long-delayed confirmation hearing of President Donald Trump’s nominee for surgeon general, Casey Means.

This week’s panelists are Mary Agnes Carey of 麻豆女优 Health News, Tami Luhby of CNN, Shefali Luthra of The 19th, and Lauren Weber of The Washington Post.

Panelists

Among the takeaways from this week’s episode:

• After a week of bad press, the FDA announced it would review Moderna’s application for a new flu vaccine. Yet the agency’s original refusal fits a pattern of agency decision-making based on individual officials’ views rather than set guidelines 鈥� and reinforces a precedent that’s problematic for drug development.
• Those caught up in the latest HHS leadership shake-up include Jim O’Neill, who, as acting director of the Centers for Disease Control and Prevention, signed off on changes to the childhood vaccine schedule. His removal from that role comes as the White House is showing more interest in controlling health care messaging ahead of the midterms 鈥� and as polling shows Americans are increasingly concerned about federal vaccine policy.
• Senators will hear from Means next week as they consider her nomination as surgeon general. Means, a key figure in the “Make America Healthy Again” movement, is expected to be asked about her medical credentials and past, problematic claims about medicine.
• And while early numbers show that Affordable Care Act marketplace enrollment has not dipped as much as feared, Americans are still absorbing the rising cost of health care this year. The collapse of congressional efforts to reach a deal on renewing enhanced premium subsidies could be an issue for voters come November.

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

Mary Agnes Carey: Politico’s “,” by Robert King and Simon J. Levien.听

Lauren Weber: NiemanLab’s “,” by Laura Hazard Owen.听

Tami Luhby: The City’s “,” by Claudia Irizarry Aponte and Ben Fractenberg.听

Shefali Luthra: NPR’s “,” by Jasmine Garsd.听

Also mentioned in this week’s episode:

• Politico’s “,” by Lauren Gardner and Tim Röhn.
• The Washington Post’s “,” by Rachel Roubein, Lena H. Sun, and Lauren Weber.
• CNN’s “,” by Meg Tirrell.
• The Washington Post’s “,” by Lauren Weber and Rachel Roubein.
• 麻豆女优’s “,” by Shannon Schumacher, Audrey Kearney, Mardet Mulugeta, Isabelle Valdes, Ashley Kirzinger, and Liz Hamel.
• CNN’s “,” by Adam Cancryn.
• Health Affairs’ “,” by Katie Keith.
• Health Affairs’ “,” by Katie Keith and Matthew Fiedler.
• Health Affairs’ “,” by Katie Keith.

[Editor’s note:听This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]听

Mary Agnes Carey:听Hello from听麻豆女优听Health News and WAMU Public Radio听in Washington, D.C. Welcome to听What the听Health?听I’m听Mary Agnes Carey, managing editor of听麻豆女优 Health News, sitting in for your host, Julie Rovner.听I’m听joined by some of the best and smartest health reporters covering Washington.听We’re听taping this week on Thursday, Feb.听19, at 10听a.m.听As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today,听we’re听joined via video conference by Lauren Weber of The Washington Post.听

Lauren Weber:听Hello,听hello.听

Carey:听Tami听Luhby of听CNN.听

Tami Luhby:听Glad to be here.听

Carey:听And Shefali听Luthra听of听The听19th.听

Shefali听Luthra:听Hello.听

Carey:听Let’s听start today with the Food and Drug Administration. The FDA has now agreed to听review听Moderna’s application for a new flu vaccine, reversing the agency’s decision from just a week ago to reject the application because it said the company’s research design was flawed. What happened?听

Weber:听I think we听got to take a step back, and we got to think about this in the lens of the midterms, because, of course, we got to talk about听the midterms on this听podcast.听

Carey:听Of course.听

Weber:听But what听we’ve听seen, really, since the beginning of January, after听[Health and Human Services Secretary] Robert F.听Kennedy听[Jr.]听overhauled the vaccine schedule under Jim O’Neill, is a lot of changes. And part of that, I think, is due to a big poll that came out by a Republican pollster, the Fabrizio poll, that听indicated听that some of the vaccine changes were making voters nervous.听Basically, it听told the president, and it told Republicans,听that听maybe you听shouldn’t听mess with the vaccine schedule as much. And ever since that poll has听kind of reached听the ether,听you’ve听seen a lot more tamping down of conversation about vaccines.听So听you’ve听seen Kennedy stay a lot more on听message听about food. And then you saw what happened this past week with the听Moderna flu reversal. So what ended up happening is the FDA came out and said they were not going to review the听Moderna flu vaccine, which was an mRNA vaccine, which, as we all remember, was the vaccine technology that became quite famous during the covid pandemic that听[President Donald]听Trump really championed in his first term.听So听the FDA came out and was like,听You听know what,听we’re听not going to review this听鈥斕齱hich was a huge issue. It caused massive shock waves through the vaccine industry. A lot of vaccine and pharma insiders听said this could really听dampen their ability to develop future vaccines, because they felt like this action was made without enough explanation.听And after a week of听pretty much听bad headlines and bad press, the decision was reversed.听And Lauren Gardner from Politico had a听, along with a colleague听[Tim听Röhn], where she pointed out that this reversal happened after a meeting with the FDA head in the White House,听where Trump expressed some concern over the handling of vaccines. So I think this reversal that you’re seeing fits into the broader picture of the unpopularity of Kennedy’s push around vaccines, and I expect that, considering their hesitancy, along with a really contentious midterms race, we may see more pushback to whether or not Kennedy is able to continue on his push against vaccines.听

Carey:听So,听what are the implications for drug and vaccine manufacturers in the months ahead?听How will this听impact听them? Does it provide stability and reassurance that if you spend billions of dollars on drug development,听you’re听not going to be stopped by federal agencies?听

Weber:听I think听the reversal听maybe does, but,听I mean, certainly听they’re听still spooked. I mean, the reality is that听it’s听a little unclear. Obviously, there was a pressure campaign to reverse this, and it has been reversed.听But the current makeup of the FDA, with听Vinay Prasad,听has led many to be unclear on what will and will not get approved.听Under this HHS administration,听there’s听been a big push for placebo-controlled trials and so on, and听somewhat a听shifting of expectations. And I think that while the reversal will settle feelings a bit, you also听鈥μ齮his is on a backdrop of hundreds of millions of dollars being canceled in mRNA vaccine contracts.听So听I think听there’s听a lot of unease, and听there’s听a lot of fear that this could continue to听[dampen]听vaccine development.听

Luthra:听I think,听to add to what Lauren’s saying, it’s just pretty hard to imagine that after the past year and change that anything could really feel predictable if you are in the business of developing biopharmaceuticals in any form.听It’s听just so听much听has changed, and so much really seems to depend on the whims of where the politics are and where the different players are and听who’s听carrying influence.听It’s听just hard听to really think about how you would want to invest听鈥斕齬ight?听鈥斕齛 lot of money in developing these products,听where you may or may not have success. But one other thing that I am just so struck by in this whole episode is there is a lot of tension in听different parts听of the health policy听community groups around how the FDA is approaching different policies.听And one area I’ve been thinking about a lot is where the FDA has been on abortion is a source of real frustration for a lot of abortion opponents, and seeing this episode play out if the White House did get involved, I think it raises a really interesting question for people who oppose abortion and want the FDA to take a harder look at it.听Are they going to expect similar movement from the听president, similar intervention,听or conversations from the White House?听And if they don’t get that, how does听that affect, again,听just another issue that feels really salient as we head into a midterm election that gets closer and closer.听

Carey:听And听I think you听know, this is a sign of what health care might mean and play in the fall election, so听we’ll听keep our eye on that. Lauren, you just听mentioned recently听some changes at the Department of Health and Human Services.听We’re听going to shift from the FDA to HHS, where听there’s听been a shake-up in top leadership.听Jim O’Neill, who had served as the HHS deputy secretary and as acting director for the Centers for Disease Control and Prevention, is leaving those positions. Other agency changes include Chris Klomp, who oversees Medicare, being named听chief counselor at HHS, where he will oversee agency operations.听And National Institutes of Health. Director Dr.听Jay听Bhattacharya will also serve as acting director of the CDC.听Clearly, there听is a lot going on here. Why are these changes happening now?听

Weber:听So听our understanding听from听reporting听is that the White House wanted to shake things up before the midterms. I mean, if you know听鈥斕齥ind of what I alluded to in my last comments is, you know, Jim O’Neill was the person who signed off on the childhood vaccine schedule. I mean, his name was plastered all over that in January, and now听he’s听been shipped off to be head of the National Science Foundation, but certainly not as high profile of an HHS deputy role or CDC acting director. From our understanding,听that’s听because the White House wants a bit tighter control over messaging and overall听thrust听of HHS heading into the midterms.听And I think听it’s听noticeable听鈥� you mentioned Chris Klomp,听I mean,听let’s听note where he came from. He came from听CMS. You know,听you’re听seeing a fair amount of folks from CMS,听from听“Oz Land,”听come into HHS and exert seemingly, it听looks like,听more power, based on the White House’s judgment, along with Kennedy. Kennedy is said to have also signed off on these changes.听But it remains to be seen听how this will听impact听HHS focus going forward.听

Carey:听So听while听we’re听talking about HHS,听let’s听look at听Secretary Robert F.听Kennedy Jr.’s first year in office. There’s so much we could talk about:听the firing of members of the Advisory Committee on Immunization Practices, also known as ACIP,听and the addition of several members who oppose some vaccines;听major changes in the childhood vaccine schedule, changes that the American Academy of Pediatrics has called听“dangerous and unnecessary”;听pullbacks of federal funding for vaccination programs at local departments that were later reversed by a federal judge;听the firing of Senate-confirmed CDC director Susan听Monarez, who had only served听in听that position for less than a month;听new dietary guidelines aimed at getting听ultra-processed foods out of our diets, but adding red meat and whole milk听鈥斕齠oods that many nutritionists have steered people away from. This is an open question for the panel:听What do you make of Kennedy’s tenure so far?听

Luhby:听I mean,听he’s听certainly been changing the agency in听ways that we somewhat听expected听and, you know, other ways that we听didn’t. I will let the others speak to some of the听vaccine and others. But one thing听that’s听also notable is the makeup of the agency.听They’ve听laid off or prompted many people to quit or retire. You know, there’s major staffing changes there as well, and听there’s听a large brain drain, which has concerned a lot of people.听

Weber:听Yeah,听I’ll听chime in and say, I mean, I think public health officials have been horrified by his first year in office. There is a growing fear that,听obviously,听his many vaccine changes could have long-term consequences for vaccine听[uptake]听and an increase in vaccine hesitancy.听There’s听been a lot of concern among public health officials and experts that Congress really has not stepped in to stop any of this.听That said,听there are currently听鈥μ齮here’s a lawsuit the AAP has brought against these changes, which could have an outcome in the coming days that may or may not impact whether or not they’re going forward.听You mentioned how he reconstituted ACIP, the听federal听advisory听committee on vaccination.听You know, what’s really interesting is, right now, we’re unclear if that ACIP meeting is still happening at the end of February.听And again, it听goes听back to my point of vaccines seem to be,听after this polling, not where Republicans want to be talking. And听so听a lot of Kennedy’s primary concern, even though he talked a lot about food in his first year in office,听听of his social media, and he talked way more about food than he talked about vaccines. But his focus,听and ultimately, what听he was able to upend a lot of,听was vaccine infrastructure. And I think this year we will听see.听More of the impacts of that, and also whether or not he’s allowed to make some of these changes, if there is enough backlash, or if there is enough pushback, or if there is enough political detriment that pushes back on what he has done.听听

Luthra:听And I think听a really important听thing for us to think about, that Lauren just alluded to, is a lot of the consequences of this first year are things we will be seeing play out for many years to come. There has been this听dramatic upending of the vaccine infrastructure. We have seen medical groups try and step in and try and offer independent forms of authority and听expertise听to give people useful medical information. But听that’s听a very big听role听to fill听in the context of this tremendous brain drain. And I think what we are waiting to see is, how does that translate to decision-making on the individual level and on the aggregate level?听Do people feel like they can trust the information听they’re听given? Do they get the vaccines they would have gotten in the past for their families, for their children? Is it easier? Is it harder?听Does听those difficulties matter in the end?听And听that’s听the kind of impact and consequence that we can talk about now, but that听we’ll听only really understand in years to come when we look at whether and how population health outcomes shift.听

Carey:听Sure.听And听so听we’re听talking about, you know, Lauren and the full panel听has听made this clear, talking about some of the shifts in the messaging out of HHS as we head into the fall elections.听Lauren, if I heard you correctly, you were saying on Secretary Kennedy’s social media feeds, he had talked a lot more about food than vaccines,听but yet, the vaccine message seems to have resonated more.听So,听as you look towards the fall elections, right?听We’re听talking about听affordability,听in a moment听we’re听going to be talking about the Affordable Care Act.听We’ve听read a lot听鈥μ齛nd folks have talked on this podcast about drug prices. Are the steps enough that are happening here on the messaging? Is it enough to听focus听the message, and is it going to land with voters, or will they be looking at it in听a different way?听

Weber:听And will he stay on message?听

Carey:听Exactly.听

Weber:听I’ve听watched,听I’ve听watched hundreds of hours of Kennedy speaking, and the man,听when let rip听鈥斕齀 mean, recently he said in a podcast, he talked about snorting听cocaine听off a toilet seat. I mean, that was something that came up in a long-form conversation. Obviously,听there’s听more context around it.听But he is known for听speaking off the cuff. And so, I think it remains to be seen if, if they are able to see how that messaging听鈥斕齣n order to talk about drug prices, talk about affordability听鈥斕齣f that continues to play for the midterms, and if it doesn’t, what the consequences of that may be. I think听it’s听important听too听鈥μ齀 mean, last night, Trump issued an executive order that is aimed at encouraging the domestic production of glyphosate, which is a really widely used weed killer that has been key in a bunch of health lawsuits around听Roundup and other pesticides, is a real shot against,听across the bow for the MAHA听[“Make America Healthy Again”]听crowd, and it puts Kennedy in a tough position. I mean, he’s issued a statement saying he supports the president, but I mean, this is a man who’s advocated against glyphosate and pesticides for years and years and years, and it’s really divided the MAHA movement that,听you know听鈥μ齧any folks who said they joined MAHA,听many听MAHA听moms, pesticides are a huge issue, and this could fracture this movement,听you know,听that听, just as they’re starting to try to get on message.听

Luhby:听One thing also that my colleague, I wanted to talk about, my colleague Meg Tirrell did a听fantastic piece last week听about Kennedy’s first year, and听it’s听headlined听“.”听So I think that that’s one thing that also we have to look at is that Trump had said that there would be historic reforms to health and public health, and that, you know, it would bring back people’s trust and confidence in the American health听care systems after covid听鈥� and you know, after what he criticized the Biden administration for.听But听also听it shows that actually,听if you look at听recent polling from听麻豆女优, it shows that trust in government health agencies has plummeted over the last year. So听that’s听going to be something that they also听will听have to contend with, both in the midterms and going forward.听

Carey:听We’ll听keep our eye on those issues now and in the months ahead. And right now,听we’re听taking a quick break.听We’ll听be right back.听

All right,听we’re听back and returning to the upcoming confirmation hearing for Dr.听Casey Means.听She’s听President Trump’s nominee to be听surgeon听general.听The Senate Health, Education, Labor听&听Pensions, or HELP,听Committee, as it is known, will consider that nomination next Wednesday, Feb.听25.听You might remember that听Means’听confirmation hearing was scheduled for late October, but it was delayed when she went into labor.听She was expected then to face tough questions about her medical credentials and her stance on vaccines, among other areas. Means is known as a wellness influencer, an entrepreneur, an author,听and a critic of the current medical system, which she says is more focused on managing disease than addressing its听root causes. If confirmed as听surgeon听general, she would oversee the more than 6,000 members of the U.S.听Public Health Service, which includes physicians, nurses,听and scientists working at various federal agencies. What do you expect from the hearing,听and what should people look for?听

Weber:听So听I did a听听last fall. And what we learned,听in听really digging into reading her book, going through her newsletters, going through her public comments, is that this is someone who left the medical establishment. She left her residency near the end of听it, and听has really promoted and become central in听MAHA听world due to her book,听Good听Energy, which, you know, some folks in politics referred to as the听bible of听MAHA.听So听if听confirmed, I think she could play a rather听large role听in shepherding the MAHA movement. But I think听she’ll听face a lot of questions from folks about her medical license and practicing medicine.听So听Casey听Means currently has a medical license in Oregon that she voluntarily placed in听inactive status, which, according to the Oregon State Medical Board, means she cannot practice medicine in the state as of the beginning of 2024.听Additionally, she has received over half a million dollars in partnerships from various wellness products and diagnostic companies, you know, some of which in her disclosure forms talked about elixirs and supplements and so on. And I expect听that听will get a lot of scrutiny from senators as well. And I will just note,听too, I think it’s important to look at a passage from her book that a lot of public health experts that we spoke to were a bit concerned about, because she wrote in her book that听“the ability to prevent and reverse”听a variety of ailments, including infertility and Alzheimer’s,听“is under your control and simpler than you think.”听And statements like that really听worried听a fair amount of the public health experts I spoke to. [They]听said she would have this听bully听pulpit to speak about health, but听they’re听concerned that she听doesn’t听underpin it with enough scientific reasoning. And听so听we’ll听see if those issues and,听also obviously having to answer for Kennedy and the HHS shake-ups and Kennedy and vaccines听鈥斕齀’m听sure a lot of that will come up as well. It should听鈥μ齀 expect it to be a hearing with a fair听amount听of fireworks.听

Carey:听Do you think the fact that听鈥μ齮hey’ve听scheduled this hearing means that they have the votes for confirmation? Or is it simply a sign that the administration just wants to get moving on this, or shift a bit from some of the hotter issues that have happened recently?听

Weber:听I mean, this is a long time for the American public to not have a surgeon general.听So听I mean,听I think they听were hoping to get this听moving, to get her in the position.听As I said, she could be听a very strong听voice for听MAHA,听considering her book underpins a lot of the MAHA movement. I think,听in general, Republicans do have the votes to confirm her, but it just depends on how much they are agitated by her medical credentials and some of her past comments. I think we could see some fireworks, but, you know, we saw fireworks听in听the Kennedy hearing, and he got approved. So, you know,听I think it听remains to be seen what happens next week.听

Carey:听Sure. Well, thanks for that.听Let’s听move on to the Affordable Care Act,听or the ACA.听More Americans than expected enrolled in ACA health plans for this year, even though the enhanced premium subsidies expired Jan.听1. But听it’s听unclear if these folks are going to keep their coverage as their health care costs increase. Federal data released late last month showed a听year-over-year听drop of about 1.2 million enrollments across the federal and state听marketplaces. But these aren’t the final numbers, right?听

Luhby:听No.听What’s听going to happen is people have time听now,听they still听have to听pay their premiums. The numbers that were being released were the number of people who signed up for plans.听So听what experts expect is that,听over time, people who receive their bills may not pay them.听A听lot of people,听remember, get automatically enrolled, so they may not be even aware of how much their premiums are going to increase until they actually get their bill.听So听they may not pay the bills, or they may try to pay the bills for听a short time听and find that听they’re听just too high. Remember that the premiums,听on average, premium payments were expected to increase by 114% according to听麻豆女优. So that just may be unmanageable. The experts听I’ve听spoken to expect that we should get better numbers around April or so to see what the numbers of actual enrollees are.听Because people,听actually, if they don’t pay their premiums, can stay in the plants for three months, and then they get washed out.听So听we’re听expecting to see if, hopefully,听CMS will release it, but听we’re听hoping to see better numbers in April.听

Carey:听Shefali, I know you closely follow abortion. How much has the abortion and the Hyde Amendment played in all these discussions about Congress trying to find,听if they really want to find,听a resolution to this subsidy issue?听

Luthra:听It’s听so interesting. A lot of anti-abortion activists have been quite firm. They say that there cannot be any permission that ACA-subsidized plans cover abortion if the subsidies are renewed.听That, of course, would go听against laws in some states that require those claims to cover abortion using state funds, not using federal funds, because of the Hyde Amendment.听The president听relatively recently, even though it feels like a lifetime, said,听Oh, we should be flexible on this abortion restriction that anti-abortion activists want. They were, of course, furious with him and said,听We听can’t听compromise on this.听This is听very important听to our base.听And they view it as the federal government making听abortion听more available. And听so听I think听it’s听still an open question as to whether this will听ultimately be听a factor.听It’s,听to your point, not really clear that lawmakers are anywhere close to coming to a deal on the subsidies.听They very well may not,听right?听They still听have to听figure out funding for听DHS听[Department of Homeland听Security].听They have many other things that听are keeping听them quite occupied.听But this is absolutely something that abortion opponents will remain very firm on. And I mean, they听haven’t听had the victories they really would have hoped for in this administration so far, and I think听it’d听be听very difficult听for them to take another loss.听

Carey:听So,听Lauren,听what’s听going on with the discussions on Capitol Hill about potentially extending the enhanced ACA subsidies?听We’re听hearing reports from negotiators that the deal might be dead. How would that impact voters in November?听

Weber:听I think people should be interested in getting a solution, because I think听鈥斕齮alk about hitting voters’听pocketbooks and actual consequences. I mean, this seems like this is a thing听that’s听only going to continue to pick up speed. I was fascinated听鈥μ齀 know you want to talk more about that great听Politico piece that dives into the听ticktock of how this all happened. But听鈥μ�

Carey:听Yes,听great story.听

Weber:听I think, in general, the ACA听subsidies fall into a trap of most of the contentious two-party system that we’re in right now, where different issues that are issues that we can’t touch end up blowing up problems that affect听everyday听Americans in their day-to-day, and then no action gets made, and then we end up closer to the midterms,听where people actually may or may not want to do something.听So听I’m听not sure that people听don’t听want to do something.听I’m听just not sure that听there’s听enough consensus around what that would be, and in the meantime, actual people are feeling the pain.听So听we’ll听see how that continues to play out.听听

Carey:听Sure.听

Luthra:听I听just听wanna听say, just to add one more point to what Lauren mentioned about political pressure and backlash.听The听听shows that health听care costs are voters’听No. 1听affordability concern. And we know there was that听brief moment听when the听president said,听We听should be the affordability party,听not听Zohran Mamdani听and the Democrats. And听so听I think that’s really interesting, right? Are they able to stick to that? Are they able to address this policy that voters are saying is such a high priority for them, because it is so visceral, right? You know what听you’re听paying, and you know that your bills are higher than last听year.听And if they can’t, is that the kind of thing that actually does shape how voters react in November, especially given so many other听cost-of-living听concerns many of them have.听

Luhby:听Right, well, one of听听about how the Trump administration’s messaging,听or what听they’re听suggesting that the GOP message for the midterms is lower drug prices, which is something that they have been听very active听on.听So听they听don’t听want to discuss the exchanges, and听we’ll听talk a little bit about the new rule that听they’ve听just proposed.听But yeah, I think the administration is going to focus on health care.听They’re aware of the concerns of health care, and their message is going to be听“most favored nation,”听TrumpRx,听and the other efforts that they’ve made to lower drug prices, which is something,听of course, Trump was also very focused on in his first term as well, but to less effect.听

Carey:听Speaking of that rule, Tami, can you tell us more about that?听

Luhby:听Sure.听Well, CMS wants to make sweeping changes for ACA plans for 2027.听It issued a proposed rule last week that would give more consumers access to catastrophic policies. Now these are policies that have听very high听deductibles and听out-of-pocket costs,听generally offer听skimpier benefits, but,听importantly听for the administration, have lower premiums. The proposed rule would also repeal a requirement that exchanges offer standardized plans, which are designed to make it easier for people to compare options. It would ease network adequacy rules and require, as we were just talking about, require more income verifications to get subsidies and crack down on brokers and agents who,听we’ve just discussed about, you know, have been听鈥μ齭ome of whom have been complicit in fraud. The goal is to lower the ACA premiums and give people more choice,听according to CMS. Premiums, of course, have been a big issue, as we discussed听鈥μ齜ecause of the increase in monthly听payments due to the听expiration听of the subsidies. But notably, the agency itself says that up to听2 million people听could lose ACA coverage because of this proposed rule.听It’s听a sweeping,听577-page rule, I think?听And if you want to get more information, I highly recommend you read Georgetown’s Katie Keith’s听, which was published in Health Affairs.听

Carey:听All right, well,听we’ll听have to keep our eye on that rule and all the comments that I听am听sure will come in.听

Luhby:听Many comments.听

Carey:听Many.听I’m听also intrigued about some of the GOP talking points on potential fraud in the program. For example, the House Judiciary Committee has subpoenaed eight health insurers,听asking for information on their subsidized ACA enrollees and potential听subsidy-related听fraud. It has been a Republican talking point that听it’s听their听perception, for many Republicans, that there is a lot of fraud in the program that needs to be investigated. Is there any merit to the claim, and will this discussion of fraud shift away from this听really critical听affordability issue that听we’re听all talking about?听

Luhby:听Well, we know that there has been fraud in the program, particularly after the enhanced subsidies went into effect. I mean, even the Biden听administration released reports and information about brokers and agents that were听basically switching听people into different plans, switching them into low-cost plans,听enrolling them听in order to听get the commissions.听And听it’s听one听that听actually played听also into the argument on Capitol Hill about extending the subsidies,听whereas听the Republicans were very forceful about not having zero-premium subsidies, because they felt that this helped contribute to the fraud.听So听you know,听that’s听not an issue anymore, because the subsidies were not renewed, but both CMS and Congress are still focused on this idea of fraud with the subsidies.听

Carey:听All right, well,听we’ll听keep watching that now听and in the months听ahead.听听

So听that’s听the news for this week. And before we听get to听our extra credits, we need to correct the name of the winner of our听Health听Policy Valentines contest. The winner is Andrew Carleen of Massachusetts, and thanks again to everyone who entered.听听

All right, now听it’s听time for our听extra-credit听segment.听That’s听where we each recognize a story that we read this week and think you should read,听too.听Don’t听worry if you miss it.听We’ll听post the links in our show notes. Lauren, why don’t you start us off this week?听

Weber:听Yeah, I have two pieces, a piece from听NiemanLab:听“.”听And then I also have one from my听publication听at听The Washington Post.听It’s听from Scott Nover.听The Atlantic’s听essay about measles was听gut-wrenching.听And some readers feel deceived. And for a little bit of background for anyone who听didn’t听read it, Elizabeth wrote a very striking, beautifully written piece in The Atlantic from the perspective of a mom who lost her child to measles after a fatal complication that can happen for measles. But the way it was written, a lot of people did not realize it was fiction, or creative nonfiction,听or creative听fiction to some degree.听And听so听it was written from the perspective like it was听Bruenig’s听story, but at the very end of the piece, and it turns out this was attached later,听after听publication, was an editor’s note saying this piece is based on interviews.听I听gotta听say, as,听when I initially听read it, as a savvy consumer, I initially was like,听Is听this her story?听until I got to the听editor’s听note at the end.听The听NiemanLab听reporting says that that听editor’s听note wasn’t actually even on the piece when it started.听I think this听is a fascinating question,听in general. I think that in an era where vaccine misinformation is rampant and the truth is important, it seems like having a pretty clear听editor’s听note at the top of this piece is essential.听But听that’s听just my two cents on that, and I thought both the discussion and the online discussion about it was really fascinating this week.听

Carey:听That’s听fascinating. Indeed. Tami,听what’s听your extra credit?听

Luhby:听My extra credit is titled听“,”听by听Claudia Irizarry Aponte and Ben听Fractenberg听in听The听City, an online publication covering New York.听We’ve听been having a major nurses’听strike in New York City. It’s, you know, notable听in听the size and number of hospitals and length of the strike, which has been going on already for over a month.听It’s听affected several large hospitals听鈥斕齅ount Sinai,听Montefiore,听and听NewYork-Presbyterian听鈥斕齱ith nurses demanding stronger听nurse-to-patient听staffing ratios, which, you know, has been a long-standing issue at many hospitals. Now, the interesting development is that the city uncovered a rift between听NewYork-Presbyterian’s听nurses听union and their leadership.听So听what happened is the nurses at Montefiore and Mount Sinai have recently approved their contracts听and are back to work, but the听NewYork-Presbyterian nurses did not approve their contract because the language differed on the staffing-ratio enforcement and did not guarantee job security for existing nurses. And what actually apparently happened is that the听union’s听executive committee rejected the contract, but the union leaders still forced the vote on it, which was,听actually,听ended听up voting down. So now the nurses have demanded a formal disciplinary investigation into the union听leaders for听forcing this vote. So more than 1,500 nurses听at听NewYork-Presbyterian signed the petition,听and more than 50 nurses delivered it to the New York State Nurses Association headquarters. One nurse told听The听City they are overriding our voices. The union president urged members not to rush to judgment. Now, the听NewYork-Presbyterian nurses remain on strike, which has lasted already for more than a month, and it’s going to be interesting to watch how this develops, especially because you have, obviously, the contentious negotiations between the hospital and the听nurses听union, but now you also have this revolt, and, you know, issues within the听nurses听union itself.听

Carey:听Wow, that is also an amazing story. Shefali?听

Luthra:听Sure. My piece is from NPR. It is听by听Jasmine Garsd. The headline is听“.”听And the story looks at something that we know from research happens, but on the ground in Minneapolis, of people concerned about听ICE听[Immigration and Customs Enforcement]听and immigration presence at medical centers, delaying important health听care that can be treatment for chronic ailments, it can also be treatment for acute conditions. And what I like about this story is that it highlights that this is something that is going to have consequences, even now with this surge of DHS law enforcement in Minnesota winding down.听The consequences of听missed听health听care can last for听a very long听time. And something I have heard often when just talking to immigrants and medical providers in the Minneapolis metropolitan area is exactly this fear that they听actually don’t听know what the coming weeks and months are going to bring.听They don’t know when they will feel safe getting health care again, when it will feel as if the consequences of this really concentrated federal blitz will be ameliorated in any way.听And I love that this story听takes that longer view and highlights that we are going to be navigating the medical effects of something so seismic and frankly听pretty unprecedented听for quite some time. And I encourage people听to read it.听

Carey:听Thank you for that. My extra credit is from Politico by Robert King and Simon听J. Levien, called听“.”听The piece is an inside look at why and how Congress听failed to听take action听on extending the enhanced Affordable Care Act subsidies, which led to the longest government shutdown听in U.S.听history and higher ACA premiums for millions of Americans.听

OK, that’s this week’s show.听As always,听thanks to our editor, Emmarie听Huetteman, and our producer and engineer,听Francis Ying.听A听reminder:听What the听Health?听is now available on WAMU platforms, the NPR app,听and wherever you get your podcasts听鈥斕齛s well as, of course,听kffhealthnews.org.听Also, as always, you can email us with your comments or questions.听We’re听at听whatthehealth@kff.org,听or you can find me on听X听.听Lauren, where can people find you these days?听

Weber:听On听听and on听:听@LaurenWeberHP.听The听HP stands for听health听policy.听

Carey:听All right.听Shefali.听

Luthra:听On听Bluesky:听听

Carey:听And Tami.听

Luhby:听You can find me听at听.听

Carey:听We’ll听be back in your feed next week. Until then, be healthy.听

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The Food and Drug Administration is back in the headlines, with a political appointee overruling agency scientists to reject an application from the drugmaker Moderna for a new flu vaccine, and FDA Commissioner Marty Makary continuing to take criticism from anti-abortion Republicans in the Senate for alleged delays reviewing the safety of the abortion pill mifepristone.

Meanwhile, in a very unlikely pairing, Sen. Elizabeth Warren, the Massachusetts Democrat, and Sen. Josh Hawley, the conservative Republican from Missouri, are co-sponsoring legislation aimed at breaking up the “vertical integration” of health care 鈥� when a single company owns health insurers, drug middlemen, and clinician practices.

This week’s panelists are Julie Rovner of 麻豆女优 Health News, Jackie Fortiér of 麻豆女优 Health News, Lizzy Lawrence of Stat, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• A top FDA official overruled agency staff in refusing to consider Moderna’s application for a new flu vaccine. The rejection, which Moderna is challenging, comes after the company consulted with the agency under President Joe Biden on how to develop the clinical trial for the vaccine and then spent considerable time and money. Clear, consistent federal guidance is important to maintaining the drug development ecosystem, and the decision stands as a warning to other companies developing new treatments.
• With measles cases rising and trust in federal vaccine recommendations falling, the Vaccine Integrity Project, based at the University of Minnesota’s Center for Infectious Disease Research & Policy, and the American Medical Association are launching their own vaccine review process 鈥� a parallel vaccine recommendation project offering an alternative to what are seen as ideologically driven federal recommendations.
• President Donald Trump unveiled the new TrumpRx website, billed as helping people save money on prescription drugs. But the site’s offerings are limited and offer limited benefits: It serves only those trying to buy drugs without insurance coverage, and some of the biggest savings are on popular obesity drugs rather than other commonly needed treatments. Nonetheless, it offers Trump a chance to stamp his name on an effort to lower drug prices.
• And more reporting is illuminating the health-related side effects of Trump’s immigration crackdown, including infectious disease outbreaks at detention centers. While at least some of the problems are not new to immigration enforcement, the large numbers of people being detained are intensifying the problems.

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

Julie Rovner: ProPublica’s “,” by Mica Rosenberg.听听

Alice Miranda Ollstein: Politico’s “,” by Amanda Chu.听听

Lizzy Lawrence: 麻豆女优 Health News’ “US Cancer Institute Studying Ivermectin’s 鈥楢bility To Kill Cancer Cells,’” by Rachana Pradhan.听听

Jackie Fortiér: Stat’s “,” by Ariana Hendrix.听听

Also mentioned in this week’s episode:

• Stat’s “,” by Lizzy Lawrence.
• 麻豆女优 Health News’ “Public Health Workers Are Quitting Over Assignments to Guantánamo,” by Amy Maxmen.
• 麻豆女优 Health News’ “鈥業 Can’t Tell You’: Attorneys, Relatives Struggle To Find Hospitalized ICE Detainees,” by Claudia Boyd-Barrett.

[Editor’s note:听This transcript听was generated听using both transcription software and a human’s light touch. It has听been edited听for style and clarity.]听

Julie Rovner:听Hello from 麻豆女优 Health News and WAMU听public radio听in Washington, D.C. Welcome to听What the Health?听I’m听Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and听I’m听joined by听some of听the best and smartest health reporters covering Washington.听We’re听taping this week on Thursday, Feb. 12, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So,听here we go.听

Today,听we听are joined听via听videoconference by Alice Miranda听Ollstein听of Politico.听

Alice Miranda听Ollstein:听Hello.听

Rovner:听Lizzy Lawrence听of听Stat听News.听

Lizzy Lawrence:听Hi.听听

Rovner:听And up early to join us from California, my 麻豆女优 Health News colleague听Jackie听Fortiér. Welcome, Jackie.听听

Jackie听Fortiér:听Hey,听everyone.听

Rovner:听No interview this week, but听plenty of听news.听So听let’s听jump right in. We will start this week at the Food and Drug Administration, where things are听鈥� why听don’t听we call it听鈥斕齨ewsmaking. The biggest FDA story that broke this week was controversial vaccine chief Vinay Prasad outright rejecting an application for a new flu vaccine from听Moderna, maker of the mRNA covid vaccine that so many anti-vaxxers have criticized. Lizzy, you听. Congratulations. What happened exactly?听And why is this听such a big deal听beyond the flu vaccine?听

Lawrence:听This听is a big deal听because to refuse to file is a pretty rare occurrence in general, because in general the FDA and industry like to have agreed-upon standards for clinical trials before companies embark on them and听pour millions of dollars into them. So that was surprising. And then鈥斕�

Rovner:听And refuse to file means that they said that听they’ve听got the application and said:听Yeah,听we’re听not accepting that.听We’re听not going to review this.听Right?听

Lawrence:听Yes, yes. And Prasad wrote that the听grounds听for this was that it听wasn’t听an adequate, controlled trial. Well,听Moderna is saying that听actually the听FDA greenlit this trial back under the Biden administration in 2024. They acknowledged that there was听basically a听control vaccine that the FDA听say听they听would prefer that听Moderna use for the older population. But they said, however,听it’s听acceptable if you听don’t听do that.听

Rovner:听And I want to make sure I understand this. The complication here is that this is supposed to be a better vaccine for older people, but right now there’s vaccines for older people that start at age 65 and this is a vaccine听that’s听supposed to start at age 50, right?听So听it was unclear who they were going to听test听it against, whether it was going to be the 50-to-64s or the 65s and older. Because there听isn’t听a vaccine right now听that’s听approved for 50 and up, right?听

Lawrence:听Exactly, exactly. So it was there’s the high-dose vaccine, which听is recommended听for the above-65s,听but that听is not recommended听for the 50-to-64,听which is part of why听Moderna didn’t use that high-dose vaccine, because the population that they were studying was broader than this over-65s. So anyway, so听yeah, so refusing to file is already rare, and then for there to be an overriding refuse to file, where the,听I听was told, basically, while听there may have been individuals who agreed with Dr.听Prasad’s听assessment, the review team,听every discipline,听thought that it was reviewable. And the head of vaccines wrote a memo explaining why he thought it was听viable, so that the career staff听kind of documented听their thoughts here.听It’s听not clear whether this will听be made听public ever, but one would hope,听with radical transparency, but听we’ll听see. Despite that, Dr.听Prasad still refused to review听Moderna’s application.听

Rovner:听So obviously听it’s听a big deal for the flu vaccine, but听it’s听a big deal beyond this. Moderna’s听CEO was on cable news this morning, said that, as you said, after consulting with the FDA officials about the trial, they spent a billion dollars on this trial. How do we expect companies to invest in new medicines like this if the FDA is听basically acting听on vibes?听

Lawrence:听I听don’t听know.听Yeah. And听it’s听interesting. It听doesn’t听seem like听there’s听a ton of sympathy听from听this administration. Even back last year,听[FDA]听Commissioner听[Marty]听Makary tweeted something听鈥� this was when they were limiting, wanted to require more data for covid vaccines for the under-65 crowd. And听I think he听said something like:听Our goal is not to save companies money.听That’s听not something听we听鈥斕齱hich听of听course that听isn’t.听The FDA’s听goal is to promote public health. But听it’s听definitely a听change in tune. I think that in the past, the FDA has understood that you’re听really only听going to get innovation if you have clear, consistent guidance and that it’s a听really worst-case听scenario for a company to spend a billion dollars on a clinical trial and then there’s nothing to show for it and nothing for it to benefit patients,听either. So.听

Rovner:听Is this over? What听happens听now?听

Lawrence:听So now听Moderna has requested a meeting to challenge this decision, and now there begins a kind of negotiation. It might be possible听that听the FDA would, in fact,听would review听at听least the 50-to-64 cohort, because they听don’t听have any objections听there, seemingly. But听we’ll听have to see. On a call yesterday, a senior FDA official talked about听Moderna听kind of coming听to the agency with humility and acknowledging that the FDA had recommended this high-dose vaccine. And听so听I听don’t听know.听I think companies听are definitely听鈥斕齣t’s听a lesson that听they’re, especially if听you’re听in the vaccine space, you听have to听tread very carefully.听

Rovner:听Yeah. And I would听think听others in the drug space,听too.听It’s听not just听鈥斕齮hat’s听the point of this听鈥斕齣t’s听not just vaccines.听Alice, you wanted听to say something.听

Ollstein:听Oh,听yeah.听Not only the monetary investment, which听we’ve听touched on a bunch, but听companies spend years.听So听it’s听the听time investment as well. And why would you dedicate years of effort to something that听you’re听not sure if a political appointee is going to swoop in and override career scientific officials’听assessment, if听you听can’t听trust the regulatory system to work as听it’s听always worked. There really is just听a lot of听risk there, and you听might see people not making these submissions on all kinds of fronts.听Of course, this is coming as we’ve had a听really bad听flu season.听I’ve had people in my life get听really sick听and say it’s been really,听really bad.听So听the prospect of having something that works better to prevent,听or even just make it milder,听not coming to fruition听is rough.听

Rovner:听Yeah. And this year, as we know, this year’s flu vaccine was not very well matched to the strains that ended up circulating. And that’s听kind of the听point of this听Moderna vaccine, this mRNA vaccine, is that they say it would be much faster for them to match strains to听what’s听going around. If it works as the clinical trials suggest it would听actually be听a better flu vaccine than we have now.听

Well, meanwhile, cases of measles are also continuing to multiply, as they do when people听aren’t vaccinated, and not just in the places we’ve talked about, like Texas and South Carolina, but also all around us here in the nation’s capital, apparently,听as a result of听people traveling here for the anti-abortion March for Life in January. There have been more than 730 confirmed cases of measles in the U.S.听already this year.听That’s听four times more than have been typical for a full year, and听it’s听not yet the middle of February. Yet that听doesn’t听seem to be deterring the administration from its anti-vaccine activities. So now, the American Medical Association and the University of Minnesota听Vaccine听Integrity听Project have announced听they’ll听convene听a parallel group of experts to make vaccine recommendations,听basically saying听they听are done听following the Centers for Disease Control and Prevention. This has been brewing for a while.听Right,听Lizzy?听

Lawrence:听Yes. As soon as the secretary fired听all of听the experts who served听on the advisory panel to the CDC on vaccines, I think听there’s听been unease. And now, as you said,听there’s听an active parallel public health establishment听that’s听trying to spread credible information and provide an alternative resource, because听it’s听clear that HHS听[the Department of Health and Human Services]听has become compromised when it comes to vaccine recommendations. And yet,听you’re听seeing the spread of infectious diseases right now.听

Fortiér:听Having听kind of this听rival court is not surprising, because听they’ve听refused to听participate听in any of the Advisory Committee on Immunization Practices meetings for听months and months. I do wonder if this will听maybe change听some of听the tone. We do have an upcoming ACIP meeting in February. Normally we would have听a听agenda out by now.听Before Secretary听[Robert F.]听Kennedy听[Jr.]听we would have them weeks in advance,听and we haven’t seen one yet, so we’re听really not听totally sure听what they’re going to be talking about.听But Dr.听[Mehmet]听Oz did say this week that he finally听advised people听鈥斕齢e’s听the CMS听[Centers听for听Medicare & Medicaid Services]听director鈥斕齮o take the vaccine.听And听there’s听been over 933听cases in just South Carolina during this outbreak that started last October. And so when I talk to people on the ground who are treating folks in South Carolina and have been treating them for months, and they’ve been doing vaccine clinics and things like that, they听were just so fed听up with Dr.听Oz and the administration, because they partially blame them for these various outbreaks. And I had one of them tell me, like, well,听it’s听like a band-aid on a bullet hole. Like, now听they’re听finally encouraging people to get vaccinated when we could have had this months ago.听

Rovner:听And,听of course, the CDC听doesn’t听have a director听at the moment,听because the Senate-approved director听was summarily fired听and/or quit, not clear听which,听after refusing to听basically rubber-stamp听the immunization panel’s recommendations that had not听been made听at the time.听So听the American Academy of Pediatrics is suing to stop this February ACIP meeting. I did not hear what the last decision was on that, but I know that听there’s听still听a lot of听movement around here.听I guess the big worry听is:听Who should the public trust now? Is it going to be this听sort of grouping of medical societies led by the AMA, or the CDC, which people and doctors听are used听to following the advice of?听

Ollstein:听And听there’s听all these state alliances forming to do the same thing. And听so听I think,听yeah, the more competing recommendations听the average person听hears, the more they just听sort of throw听their hands up and say:听I听don’t听even know who to trust anymore.听I’m听not listening to any of these people.听And the trust that’s eroded in the federal government,听that’s going to be听really hard听to recuperate in the future.听You听can’t听just flip a switch and say:听OK,听it’s听a different government. We trust them again.听Once those seeds of doubt听are planted听in people’s minds, it’s听really hard听to unearth.听And so, if not permanent damage, all of this is doing at least very long-term damage to the idea of听expertise听and authoritative information.听

Rovner:听And science, which this administration insists it wants to follow. Well, turning to FDA-related听“MAHA” [“Make America听Healthy听Again”]听news, the agency said last week it would relax enforcement of its food additive regulations to make it easier for manufacturers to say听they’re听not using artificial dyes. Now this was a huge deal when the agency announced the phaseout of artificial coloring. Looking at you,听fancy-colored Froot Loops. Now the administration says听it’s听going to allow听foodmakers听to say听they’re听not using artificial colors as long as听they’re听not using petroleum-based dyes.听Apparently, natural听dyes are听OK. But even that is controversial, and听it appears that this whole effort听really relies on manufacturers’听willingness to comply rather than, you know, actual regulation, which is听kind of what听the FDA does for a living.听It’s听a regulatory agency.听

Ollstein:听Well, every time the word听“natural”听comes up, I always laugh because there is no definition of that. And there are听plenty of听things that are natural that could kill you or hurt you very badly. And there are听plenty of听things that听are听synthetically manufactured听that are helpful and fine for you. And听so听it has this veneer of safety, veneer of health with no actual substance.听So听my red flags go up whenever I hear that word, and I think everyone should be skeptical.听

Rovner:听But it goes with RFK Jr.’s quest now that you should,听quote,听“eat real food.”听

Lawrence:听Right.听Yeah.听I was going to听say same with听“chemical.”听I feel like,听“chemical”听abortion drug,听“chemical.”听And听it’s听like,听a lot of听things are chemicals.听That’s听not鈥斕�

Ollstein:听Yeah, like in your own body, naturally.听

Lawrence:听Yeah.听

Ollstein:听You have chemicals.听

Lawrence:听We are chemicals.听

Ollstein:听We are chemicals.听

Rovner:听You guys are all too young to remember the Dow Chemical advertising line听“Better Living Through Chemistry,”听which at the time,听in the听’60s and听’70s, was true.听There was,听there听鈥斕齱e’ve听had听a听lot of听better living through chemistry. And听some of听it has turned out to be听maybe not听so good for us, but听a lot of听it has turned out to be pretty darn good for us.听

Well, finally, in FDA听land,听Commissioner Marty Makary this week met with anti-abortion senators about that ongoing review of the abortion pill听mifepristone, which senators want the FDA to remove from the market. Alice,听how’d听that meeting go?听

Ollstein:听Not great for the FDA,听from what I听was told.听I got on the phone with Sen.听Josh Hawley after it, and he was extremely frustrated. He said he听didn’t听get answers to any of the questions听he’s听been sending in public letters to the FDA for months and now asking in this briefing behind closed doors that they held听on听Capitol Hill this week.听He said he听didn’t听get answers about what the timeline is for this review of the abortion pill mifepristone, what the review consists of,听whether听it’s听even begun, really, whether听it’s听even underway. And听so听he is听sort of concluding听that this is not going anywhere, and he wants Congress to step in and听take action.听Now,听Congress has tried to step in and听take action听before.听They’ve听tried to put restrictions on mifepristone in the FDA funding bill.听That听didn’t听pass.听So听I听don’t听know if this is even plausible in this environment where Congress听can’t听really pass much of anything anymore.听

But听Hawley听is听not just another Republican senator. He is very intertwined with the anti-abortion movement. His wife is an听extremely prominent anti-abortion lawyer听who’s听led听a lot of听the major cases trying to restrict or ban mifepristone. They founded their own anti-abortion advocacy group. And听so听it really shows that the听tensions,听clashes, whatever we want to call them, between the anti-abortion movement and the Trump administration, so after backing the Trump administration for years and years,听they’re听really听getting fed听up. And听they’re听fed up that even after they achieved their grand goal of overturning听Roe v.听Wade, there are听actually more听abortions happening now than before, and听that’s听largely through听these pills and people’s ability to get them. And听so听they’re听getting increasingly impatient with the Trump administration, who has been听sort of stringing听them along and saying:听Yeah,听we’re听working on it.听We’re听working on it.听But they want to see听results. Now, of course, if there were听some听sort of restrictions imposed, that could have a big political effect. And听so听a lot of听Republicans are very torn about that. But not Sen.听Hawley. Sen.听Hawley听wants to see it.听听

Rovner:听That’s听right. Well, moving to what I call FDA-adjacent news, one of the听many听thorny听issues that FDA has been dealing with is the compounding of those听very popular听and very pricey obesity drugs. When the drugs were in shortage, it was legal for compounders to make their own copies. But now the shortage for听both of the leading听medications听鈥斕齭emaglutide, made by Novo Nordisk,听and听tirzepatide, made by Eli Lilly听鈥斕齣s over, and those cheaper copycats were supposed to听be pulled听from the market.听So听it was a bit of a surprise when the company Hims, one of those direct-to-consumer drug sites, announced the unveiling of a semaglutide tablet just weeks after the first such drug听was approved听by the FDA, by Novo Nordisk. The FDA promptly referred the company to the Justice Department for听possible violation听of federal drug laws, after which听Hims听said,听Oh,听maybe we听won’t听start selling the drug after all.听Oh, and Novo is听suing for听patent infringement. But I would think that the war over the听“fat”听drugs, as President听[Donald]听Trump likes to call them, is likely to lower prices just as effectively as government regulation might. Or am I misreading that? Lizzy, this has been quite the sideshow, if you will.听

Lawrence:听Yeah. It might. I think that the compounding,听the FDA’s crackdown on听Hims was听very interesting听to me because I think before the commissioner had come into his role, there was听some听speculation.听He had worked for a telehealth company that prescribed compounded drugs. And听there’s听also, I think听compounders have tried to tap into a little bit of the MAHA medical freedom aspect. But clearly听that’s听not been听the case, at听least at the FDA. They are clearly听very upset听about this听and听mean business, and I think听it’s听tying听into their crackdown on direct-to-consumer drug advertising as well. But as far as听price,听yeah. I think the deals that Trump has managed to strike with the companies听could听actually be听reducing price for patients. I think听we’ll听have to see.听I know there’s obviously drug pricing programs听as well that听they could pursue. So,听yeah,听we’ll听have to see.听听

Rovner:听All right. Well,听we’re听going to听take a quick break. We will be right back.听

OK.听We’re听back.听And speaking of President Trump,听there’s听also听drug news this week听that’s听not听directly related听to the FDA.听That’s听the official unveiling of听TrumpRx, the website the听president says will lower drug prices like no one’s听“ever seen before.”听That’s听a direct听quote, by the way. Except it turns out听that’s听not quite the听case. First, these discounts are only for people who are paying out-of-pocket, not those with insurance, which makes them valuable mostly for people who have no coverage or people who take drugs that insurance often听doesn’t听cover, like those for obesity or infertility. Yet of the 43 drugs so far that听are promoted听on the听TrumpRx听website, about half already have cheaper generic copies available through sites like听GoodRx听and Mark Cuban’s听Cost听Plus听Drugs. And really, the website just points people to already existing manufacturer websites that were already offering those lower prices.听So听what is the point of听TrumpRx?听

Lawrence:听Great question.听Yeah.听This administration has been听very focused听on, obviously, media and wins听and听attaching President Trump’s name to things.听So听it听accomplishes听that goal.听Maybe it听does raise awareness for these other sites that already exist. But that’s a theme of听a lot of听the movement on health听care so far,听has been听鈥斕齮here’s been听a lot of听chaos, and then there’s also sometimes things that they announce as like a grand,听brand-new,听no-one’s-ever-thought-of-it-before policy, but then there are already, of course, existing programs or avenues for that.听

Rovner:听And to be fair, Trump has听jawboned听down听some听prices, including听some听prices for the obesity drugs,听by听basically dragging听in the CEOs of these companies and saying,听You听will lower prices.听

Lawrence:听Yeah,听yeah. The dealmaking has been effective. And听I think the question听is: Will this last beyond his administration? Will there be a legacy there?听

Ollstein:听I think听there’s听also听some听danger in听overpromising, because听he’s听out there saying things that听don’t听comport with how math works.听He’s听basically suggesting听prices will come down so many percents that听we’ll听be getting paid to take drugs, because听that’s听what more than 100%听is. And people who are hearing that, voters who are hearing that, if they aren’t seeing that show up in their bills, if they’re not actually seeing those drastic, drastic drops that they’re听being promised听by the听president,听are they going to get upset? And is that going to听impact听how they vote? So yes, there has been听some,听on听the听margins,听improvements, but when听you’re听out there promising 600% reductions听and not delivering,听there’s听a risk to that.听

Rovner:听Jackie, you wanted to add something.听

Fortiér:听Well, I was going to听say, I think it’s also confusing for a lot of people, from a consumer perspective, because听you log on and I think people, they hear these huge promises, like Alice is talking about, and then they think that they can, necessarily, buy the drugs through there and听immediately get them shipped, what these third parties like听Hims and Weight Watchers are doing a lot of听with the GLP-1s. And听that’s听not how this works.听You still have another step of getting a prescription and then going to the pharmacy and听using these to potentially get听discounts听and lower prices,听in the same way that听these have been available from pharmaceutical manufacturers and other things like听GoodRx听for years. But it’s that disconnect between, even if you can get a discount,听actually getting听the discount and crediting the Trump administration for that that I think is going to be听really difficult听for听a lot of听voters to make that connection in the way that the administration wants them to.听

Rovner:听And this was ever the case with rebates听鈥斕齠or other consumer products, not just talking about drugs.听We’ll听give you a $15 rebate, but you听have to听fill out 87 forms and听send it to this place and get it exactly right, do听it before the end date, and听we’ll听send you back $15.听Because they count on most people not being able or willing to follow听all of听the various steps. So instead of giving everybody the discounted price, they make you听really basically听work for your discount, which is a consumer thing, but it’s听pretty popular听in听the drug听space as well. Rather than just lowering prices,听they’re听going to say,听We听will give you a discount, but听you’re听going to have to do this, that,听and the other thing听in order to听get it.听

Fortiér:听Right.听But when听you’re听president and you want credit for it,听it’s听going to be a little more听鈥斕齣t’s听harder听in order to听make that connection. Sorry.听

Rovner:听Yes,听that’s听true. That is a good point. All right,听moving听on. We have talked听a lot听about consolidation in the health听care industry, particularly companies like UnitedHealthcare, which used to be just an insurer, now owns its own PBM听[pharmacy benefit manager], its own claims processing company, and听thousands听of medical practices around the country. Well, now an extremely unlikely pair in the Senate, Massachusetts Democrat Elizabeth Warren and Missouri Republican Josh Hawley,听have joined to introduce something called the听Break听Up听Big听Medicine Act, which would听basically outlaw听so-called vertical integration, like that of听United and,听to a听somewhat lesser听extent, Cigna and CVS Health, which owns Aetna, the insurer.听Some听are referring to this as the health version of the 1932 Glass-Steagall Act, which separated commercial from investment banking听鈥� and,听side note, whose repeal in 1999听is considered听a major factor setting off the听financial crisis听of 2008.听But that was a听risk听thing. It听was done听to prevent another stock market crash like the one in 1929.听This is a听cost听thing. This is to go after high health care costs. Could it work? Could it pass? And is this the beginning of the next听big thing听in health reform?听

Lawrence:听Perhaps.听Yeah. Last year,听I听worked with my colleagues on听听kind of examining UnitedHealth Group and the effects of consolidation on doctors and patients. And at the time, I think,听there were听some听vocal lawmakers on either side of the aisle who were criticizing this, especially in the wake of the murder of the UnitedHealth CEO, and which had a surprising听鈥斕齮he public sort of had this reaction听and听to鈥斕�

Rovner:听Not in United’s favor.听

Lawrence:听Not in United’s favor. And so听I think that there听is, this is a political issue that affects听everyone, Republican and Democrat, the,听well,听cost in general, but I think there’s听a lot of听resentment and anger, and it seems like that is bringing together these听unlikely and pretty powerful senators.听I’m听not an expert on听the听Hill. I听don’t听know if this has a chance. Especially,听it’s听targeting massive, powerful companies with hands in every part of the health care system.听So听it’s听something that you would imagine the entire health听care industry would fight against. But,听yeah, I听don’t听know.听

Rovner:听And I will point out that Sen.听Josh Hawley, in addition to all his anti-abortion activities, last year, when Congress was debating the Medicaid cuts, kept vowing not to vote for those Medicaid cuts.听So听he’s听鈥斕齱hich, of course, in the end, he did听鈥斕齜ut听he’s听been听sort of听on听the consumer side of health听care for a while now.听It’s听just听this is not brand new to him.听

Lawrence:听Right.听And听I’m听not sure how听many听other Republican senators would follow him down this path.听But it’s听definitely a听noteworthy development,听and听curious to see where it goes.听

Rovner:听Yeah,听I’m听curious to see sort of if the听populist part of health care costs sort of rises to the fore.听We’ll听have to, we will have听to watch that space. Well, finally this week, more on the impact of the Trump administration’s immigration crackdowns and health.听My听麻豆女优听Health听News colleague Amy听Maxmen听has听a story听about health professionals in the U.S.听Public Health Service Commissioned听Corps听actually resigning听rather than accepting postings to Guantánamo Bay,听Cuba, where some immigrants are being detained in prisons that used to hold al-Qaida suspects. Another听麻豆女优 Health News听story听by Claudia Boyd-Barrett describes how when people detained by ICE听[Immigration and Customs Enforcement]听end up in the hospital, often their immediate families and their lawyers听aren’t听even allowed to know where. And remember, last week we talked about cases of measles in听some听immigration detention facilities. Well, now there are two confirmed cases of tuberculosis at the听ICE听facility at Fort Bliss in El Paso,听Texas.听I’m听thinking听maybe the听health part of this is starting to听kind of get听to people as听much听as the whole depriving-civil-liberties part.听

Fortiér:听Yeah, and听there’s听also been cases of covid-19, which makes sense.听You’re听going to have respiratory viruses as you get hundreds of people grouped together. That makes sense. A judge in California a couple听days听ago ordered that there had to be adequate health provided to detainees in one specific California听鈥� it was a prison and now听it’s听an听ICE听detainee facility.听That’s听specific to听there, but it’s听鈥斕齧ore and more听senators, I think, are also looking at this and pointing out that听they’re听just not providing the health facilities that people need. And especially ongoing care听鈥斕齛听lot of听folks need diabetes treatment, and that treatment just听isn’t听really happening in听many听cases.听

Rovner:听Yeah,听we’ve听talked about this at听some听length, over听many听weeks, that people in detention are not getting health care, even though it听is听required,听that we keep hearing stories about people not getting needed health care. I听didn’t听know until I read this story that people who听actually end听up听being hospitalized, that their family members听are not allowed听to know.听That’s听allegedly, well, it is because of security, because the idea is that if somebody听who’s听in detention is in a hospital, you听don’t听necessarily want bad people knowing that and being able to come to the hospital. But these are people听often听who are,听as we have documented at length, do not have criminal records, and听it’s听hard to find out where they are. Alice, you wanted听to add something.听

Ollstein:听Yeah. So there was a recent GAO听[Government Accountability Office]听report about this, and it found that听people were not getting evaluated when they entered a facility to see if they were medically vulnerable and at risk of having听a really bad episode or emergency, and that even听children, pregnant women, vulnerable populations weren’t getting that听initial evaluation, which then led to problems down the road. And it also said that people upon their release听鈥斕齟ither deportation or release within the United States if听that’s听what听a court ordered听鈥斕齮hey听weren’t听being given听their medical records, their prescriptions. And听so听the continuity of care听was disrupted. And听it’s听important to note that that GAO report was about听a few听years ago under the Biden听administration.听So听this听isn’t听new. These problems听aren’t听new, but听they’re听getting听much听worse, because the number of people detained is at record levels and so听everything’s听just getting multiplied.听

Rovner:听Yeah, it is. Well, we will keep watching that space. OK, that’s this week’s news. Before we听get to our听extra credits, I am pleased to present the winner of our annual听麻豆女优 Health听News听Health听Policy Valentine contest.听It’s听from听[Andrew Carleen]听of Massachusetts, based on a story about Medicare Advantage overpayments. And it goes like this:听“I thought it was love. My heart felt spring-loaded. Turns out our relationship was significantly听upcoded.” Congratulations,听and happy Valentine’s Day to all.听

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

Ollstein:听Sure.听So听I have a kind of fun story听[“”]听from my co-worker Amanda Chu about how the听Oura ring has taken over D.C. They have been heavily lobbying the Trump administration and Congress to prevent tough regulations.听Basically, there’s听a debate about whether it should听be regulated听as a medical device or not.听

Rovner:听Tell us again what it does.听

Ollstein:听It’s听a ring you wear听on your finger that听monitors听different health metrics. And听so听the Trump administration听MAHA听movement has gone all in on this. They love it. The Pentagon has a huge contract with them. Other government agencies are looking at it,听too. I think听it’s听interesting because it is this very sort of conservative mindset of individual responsibility in health care听and, oh, if you could just听track your own metrics and do the right things.听That’s听an approach that is听sort of counter听to the idea of public health听and government protecting your health through policy.听

Rovner:听And we know HHS Secretary Kennedy is听a big fan听of wearables.听

Ollstein:听Exactly, and this is one of the most popular ones right now. And听so听this story does听a good job听digging into all the lobbying听and also听into concerns about data privacy and pointing out that听these technologies are moving much faster than government can regulate them. And that is leaving听some听lawmakers really concerned about who could have access to this data.听

Rovner:听Jackie.听

Fortiér:听Mine is听by Ariana Hendrix.听She’s听a writer based in Norway.听It’s听entitled听“.”听It听was published听in听Stat. And she writes eloquently听about being a parent in Norway and knowing that her children听wouldn’t听go to day听care until they were about 16 months old, because Norway has paid parental leave. And she points out, beyond the vaccine debate听there’s听a bigger issue,听that the U.S.听lacks universal health care and federal paid parental leave.听So听changes in infant vaccines in the U.S.听have a large effect, because babies in the U.S.听often go to day听care,听when听they’re听around听a lot of听other kids when听they’re听just听a few听weeks old.听So听she points to the,听in January, the infant RSV听[respiratory syncytial virus]听vaccine听was moved听to the high-risk category of shots, so now it听isn’t听routinely recommended听for all babies in the U.S. And RSV, of course, is the most common cause of hospitalizations for infants, and that’s听due to the fact that听they’re exposed to the virus in day听care听a lot听earlier than other children in other countries like Norway and Denmark whose vaccine schedules U.S.听officials are now听kind of trying听to emulate.听So听she does a really听great job听of laying out how families face greater health and financial risks in the U.S.听without the same safety net that other countries have.听

Rovner:听Or just the same social policies that other countries have.听

Fortiér:听Yeah,听it reminded听me鈥斕�

Rovner:听It’s听hard to,听right,听it’s听hard to import another country’s听鈥斕齪art of another country’s听鈥斕齪olicies without importing all of them. It is听really听good story. Lizzy.听

Lawrence:听Yeah. So my piece is by Rachana Pradhan and听麻豆女优听Health听News, and it’s about the听“US Cancer Institute Studying Ivermectin’s 鈥楢bility To Kill Cancer Cells.’”听And I thought this piece was very interesting, just because in general I’ve been fascinated by听鈥斕齪oliticization of medicine isn’t new听鈥斕齜ut just like right-wing-coded products and left-wing-coded products. And in this piece,听Rachana听talks about NIH听[National Institutes of Health]听Director Jay Bhattacharya听kind of talking听about how,听It’s听the people’s NIH and if听a lot of听people are using it, well, we want to investigate it.听So听she听just, she听does a really听good job听of kind of unpacking why this is problematic, that听they’re听kind of just听choosing a random medication and听there’s听not really any scientific reason to be investing in it as much as they are. And she听got a response from NIH after the fact as well, kind of where they were trying to defend this decision to pour this听much听investment.听And so,听yeah, I think it’s just听a really interesting听development in NIH land.听

Rovner:听It is.听My extra credit this week听is from ProPublica,听by Mica Rosenberg, and听it’s听called听“.”听It’s听about what immigration detention looks like from the point of view of children听being held听at a family facility in Dilley, Texas.听That’s听the one where the two cases of measles听were diagnosed听earlier this winter. The story includes听some听pretty wrenching letters and video calls from kids who were living elsewhere in the U.S., while their parents were mostly working within the immigration system. And these kids had听been ripped听from their daily lives, their other parents and siblings in听some听cases, their听schools听and their classmates, and in听many听cases, from听hope itself. Wrote听one听14-year-old from Hicksville, New York, quote: “Since I got to this听Center all you will feel is sadness and mostly depression.”听It听really is听a must-read story.听

OK. That is this week’s show. As always, thanks to our editor,听Emmarie Huetteman,听and our producer-engineer, Francis Ying. A听reminder:听What the听Health?听is now available on WAMU platforms, the NPR app,听and wherever you get your podcasts, as well as, of course,听kffhealthnews.org.听Also, as always, you can email听us听your comments or questions.听We’re听at听whatthehealth@kff.org. Or you can find me on听X,听, or on Bluesky,听.听Where are you folks hanging these days? Jackie.听

Fortiér:听Bluesky mainly,听.听

Rovner:听Alice.听

Ollstein:听Mainly on听Bluesky,听,听and still on听X,听.听

Rovner:听Lizzy.听

Lawrence:听On听X,听. On听Bluesky,听.听

Rovner:听We’ll听be back in your feed next week. Until then, be healthy.听

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“There are enough reports of it, enough interest in it, that we actually did 鈥� ivermectin, in particular 鈥� did engage in sort of a better preclinical study of its properties and its ability to kill cancer cells,” said Anthony Letai, a physician the Trump administration appointed as NCI director in September.

Letai did not cite new evidence that might have prompted the institute to research the effectiveness of the antiparasitic drug against cancer. The drug, largely used to treat people or animals for infections caused by parasites, is a popular dewormer for horses.

“We’ll probably have those results in a few months,” Letai said. “So we are taking it seriously.”

He spoke about ivermectin at a Jan. 30 event, “Reclaiming Science: The People’s NIH,” with National Institutes of Health Director Jay Bhattacharya and other senior agency officials at Washington, D.C.’s Willard Hotel. The MAHA Institute hosted the discussion, framed by the “Make America Healthy Again” agenda of Health and Human Services Secretary Robert F. Kennedy Jr. The National Cancer Institute is the largest of the NIH’s 27 branches.

During the covid pandemic, ivermectin’s popularity surged as fringe medical groups promoted it as an effective treatment. it isn’t effective against covid.

Ivermectin has become a symbol of resistance against the medical establishment among MAHA adherents and conservatives. Like-minded commentators and wellness and other online influencers have hyped 鈥� without evidence 鈥� ivermectin as a miracle cure for a host of diseases, including cancer. Trump officials have pointed to research on ivermectin as an example of the administration’s receptiveness to ideas the scientific establishment has rejected.

“If lots of people believe it and it’s moving public health, we as NIH have an obligation, again, to treat it seriously,” Bhattacharya said at the event. at Duke University, Bhattacharya recently said he wants the NIH to be “the research arm of MAHA.”

The decision by the world’s premier cancer research institute to study ivermectin as a cancer treatment has alarmed career scientists at the agency.

“I am shocked and appalled,” one NCI scientist said. “We are moving funds away from so much promising research in order to do a preclinical study based on nonscientific ideas. It’s absurd.”

麻豆女优 Health News granted the scientist and other NCI workers anonymity because they are not authorized to speak to the press and fear retaliation.

HHS and the National Cancer Institute did not answer 麻豆女优 Health News’ questions on the amount of money the cancer institute is spending on the study, who is carrying it out, and whether there was new evidence that prompted NCI to look into ivermectin as an anticancer therapy. Emily Hilliard, an HHS spokesperson, said NIH is dedicated to “rigorous, gold-standard research,” something the administration has repeatedly professed.

A preclinical study is an early phase of research conducted in a lab to test whether a drug or treatment may be useful and to assess potential harms. These studies take place before human clinical trials.

The scientist questioned whether there is enough initial evidence to warrant NCI’s spending of taxpayer funds to investigate the drug’s potential as a cancer treatment.

The FDA has approved ivermectin for certain uses in humans and animals. Tablets are used to treat conditions caused by parasitic worms, and the FDA has approved ivermectin lotions to treat lice and rosacea. Two scientists involved in its discovery , tied to the drug’s success in treating certain parasitic diseases.

The FDA that large doses of ivermectin can be dangerous. Overdoses can cause seizures, comas, or death.

Kennedy, supporters of the MAHA movement, and some conservative commentators have promoted the idea that the government and pharmaceutical companies quashed ivermectin and other inexpensive, off-patent drugs because they’re not profitable for the drug industry.

“FDA’s war on public health is about to end,” Kennedy wrote in an that has since gone viral. “This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma.”

Previous laboratory that ivermectin could have anticancer effects because it promotes cell death and inhibits the growth of tumor cells. “It actually has been studied both with NIH funds and outside of NIH funds,” Letai said.

However, there is no evidence that ivermectin is safe and effective in treating cancer in humans. from a small clinical trial that gave ivermectin to patients with one type of metastatic breast cancer, in combination with immunotherapy, found no significant benefit from the addition of ivermectin.

Some physicians are concerned that patients will delay or forgo effective cancer treatments, or be harmed in other ways, if they believe unfounded claims that ivermectin can treat their disease.

“Many, many, many things work in a test tube. Quite a few things work in a mouse or a monkey. It still doesn’t mean it’s going to work in people,” said Jeffery Edenfield, executive medical director of oncology for the South Carolina-based Prisma Health Cancer Institute.

Edenfield said cancer patients ask him about ivermectin “regularly,” mostly because of what they see on social media. He said he persuaded a patient to stop using it, and a colleague recently had a patient who decided “to forgo highly effective standard therapy in favor of ivermectin.”

“People come to the discussion having largely already made up their mind,” Edenfield said.

“We’re in this delicate time when there’s sort of a fundamental mistrust of medicine,” he added. “Some people are just not going to believe me. I just have to keep trying.”

by clinicians at Cincinnati Children’s Hospital Medical Center in Ohio detailed how an adolescent patient with metastatic bone cancer started taking ivermectin “after encountering social media posts touting its benefits.” The patient 鈥� who hadn’t been given a prescription by a clinician 鈥� experienced ivermectin-related neurotoxicity and had to seek emergency care because of nausea, fatigue, and other symptoms.

“We urge the pediatric oncology community to advocate for sensible health policy that prioritizes the well-being of our patients,” the clinicians wrote.

The lack of evidence about ivermectin and cancer hasn’t stopped celebrities and online influencers from promoting the notion that the drug is a cure-all. On a January 2025 episode of Joe Rogan’s podcast, actor Mel Gibson claimed that a combination of drugs that included ivermectin cured three friends with stage 4 cancer. The episode has been viewed more than 12 million times.

Lawmakers in a handful of states have made the drug available over the counter. And Florida 鈥� which, under Republican Gov. Ron DeSantis, has become a hotbed for anti-vaccine policies and the spread of public health misinformation 鈥� announced last fall that the state plans to fund research .

The Florida Department of Health did not respond to questions about that effort.

Letai, previously a Dana-Farber Cancer Institute oncologist, started at the National Cancer Institute after months of upheaval caused by Trump administration policies.

“What you’re hearing at the NIH now is an openness to ideas 鈥� even ideas that scientists would say, 鈥極h, there’s no way it could work’ 鈥� but nevertheless applying rigorous scientific methods to those ideas,” Bhattacharya said at the Jan. 30 event.

A second NCI scientist, who was granted anonymity due to fear of retaliation, said the notion that NIH was not open to investigating the value of off-label drugs in cancer is “ridiculous.”

“This is not a new idea they came up with,” the scientist said.

Letai didn’t elaborate on whether NCI scientists are conducting the research or if it has directed funding to an outside institution. Three-quarters of the cancer institute’s research dollars go to outside scientists.

He also aimed to temper expectations.

“At least on a population level,” Letai said, “it’s not going to be a cure-all for cancer.”

麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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Covid, for instance, is now linked in studies to in children of mothers who were infected during pregnancy, as well as a decline in mental cognition and greater risk of heart problems. It’s even been shown to trigger the awakening of dormant cancer cells in people who are in remission.听听

Policies around covid and vaccination have economic ramifications. The annual average burden of the disease’s long-term health effects is estimated at $9,000 per patient in the U.S., according to a in November in the journal NPJ Primary Care Respiratory Medicine. In this country, the annual lost earnings are estimated to be about $170 billion.听

The virus that causes covid, SARS-CoV-2, leaves damage that can linger for months and sometimes years. In the brain, the virus leads to an immune response that triggers inflammation, can damage brain cells, and can even shrink brain volume, according to published in March 2022 in the journal Nature.听听

, a clinical epidemiologist who has studied longer-term health effects from covid, estimated the virus may have increased the number of adults in the U.S. with an IQ less than 70 from 4.7 million to 7.5 million 鈥� dealing with “a level of cognitive impairment that requires significant societal support,” he wrote.听

Meanwhile, data from more than a suggests covid vaccines can help reduce risk of severe infection as well as longer-lasting health effects, although researchers say more study is needed. But last May, Health and Human Services Secretary Robert F. Kennedy Jr. said on X that the Centers for Disease Control and Prevention would for , citing a . The FDA has since issued new guidelines limiting the vaccines to people 65 and older and individuals 6 months or older with at least one risk factor, though many states continue to make them more widely available.听

麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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Yet anti-abortion activists remain frustrated, in some cases even more so than before Roe was overturned.

Why? Because despite the new legal restrictions, abortions have not stopped taking place, not even in states with complete bans. In fact, the number of abortions has not dropped at all, .

“Indeed, abortions have tragically increased in Louisiana and other pro-life states,” Liz Murrill, Louisiana’s attorney general, said at a Senate Health, Education, Labor, and Pensions Committee hearing this month.

That’s due in large part to the easier availability of medication abortion, which uses a combination of the drugs mifepristone and misoprostol, and particularly to the pills’ availability via mail after a telehealth visit with a licensed health professional.

Allowing telehealth access was a major change originally made on a temporary basis during the covid pandemic, when visits to a doctor’s office were largely unavailable. Before that, unlike most medications, mifepristone could be dispensed only directly, and only by a medical professional individually certified by the Food and Drug Administration.

The Biden administration later permanently eliminated the requirement for an in-person visit 鈥� a change the second Trump administration has not undone.

While the percentage of abortions using medication had been growing every year since 2000, when the FDA first approved mifepristone for pregnancy termination, the Biden administration’s decision to drop the in-person dispensing requirement supercharged its use. More than 60% of all abortions were done using medication rather than a procedure in 2023, the most recent year for which . More than a quarter of all abortions that year were managed via telehealth.

Separately, President Donald Trump’s FDA in October approved a second generic version of mifepristone, angering abortion opponents. FDA officials said at the time that they had no choice 鈥� that as long as the original drug remains approved, federal law requires them to OK copies that are “bioequivalent” to the approved drug.

It’s clear that reining in, if not canceling, the approval of pregnancy-terminating medication is a top priority for abortion opponents. This month, Susan B. Anthony Pro-Life America called abortion drugs “,” referencing their growing use in ending pregnancies as well as claims of safety concerns 鈥� such as the risk a woman could be given the drugs unknowingly or suffer serious complications. Decades of research and experience show medication abortion is safe and complications are rare.

Another group, Students for Life, has been trying to make the case that the biological waste from the use of mifepristone is , though environmental scientists refute that claim.

Yet the groups are most frustrated not with supporters of abortion rights but with the Trump administration. The object of most of their ire is the FDA, which they say is dragging its feet on a promised review of the abortion pill and the Biden administration’s loosened requirements around its availability.

President Joe Biden’s covid-era policy allowing abortion drugs to be sent via mail ”should’ve been rescinded on day one of the administration,” SBA Pro-Life America’s president, Marjorie Dannenfelser, said in a recent statement. Instead, almost a year later, she continued, “pro-life states are being completely undermined in their ability to enforce the laws that they passed.”

Lawmakers who oppose abortion access are also pressing the administration. “At an absolute minimum, the previous in-person safeguards must be restored immediately,” Senate HELP Committee Chairman Bill Cassidy said during the hearing with Murrill and other witnesses who want to see abortion pill availability curtailed.

Sen. Jim Banks (R-Ind.) said at the hearing that he hoped “the rumors are false” that “the agency is intentionally slow-walking its study on mifepristone’s health risks.”

The White House and spokespeople at the Department of Health and Human Services have denied the review is being purposely delayed.

“The FDA’s scientific review process is thorough and takes the time necessary to ensure decisions are grounded in gold-standard science,” HHS spokesperson Emily Hilliard said in an emailed response to 麻豆女优 Health News. “Dr. Makary is upholding that standard as part of the Department’s commitment to rigorous, evidence-based review.” That’s a reference to Marty Makary, the FDA commissioner.

Revoking abortion pill access may not be as easy as advocates hoped when Trump moved back into the White House. While the president delivered on many of the goals of his anti-abortion backers during his first term, especially the confirmation of Supreme Court justices who made overturning Roe possible, he has been far less doctrinaire in his second go-round.

Earlier this month, Trump unnerved some of his supporters by advising House Republicans that lawmakers “have to be a little flexible” on the Hyde Amendment to appeal to voters, referring to a decades-old appropriations rule that bans most federal abortion funding and that some Republicans have been pushing to enforce more broadly.

And while the anniversary of Trump’s inauguration has many analysts noting how much of the has been realized, the most headline-grabbing portions on reproductive health have yet to be enacted. The Trump administration has not, for example, revoked the approval of mifepristone for pregnancy termination, nor has it invoked the 1873 Comstock Act, which could effectively ban abortion nationwide by stopping not just the mailing of abortion pills but also anything else used in providing abortions.

Still, abortion opponents have decades of practice at remaining hopeful 鈥� and playing a long game.

HealthBent, a regular feature of 麻豆女优 Health News, offers insight into and analysis of policies and politics from 麻豆女优 Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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Millions of Americans are facing dramatically higher health insurance premium payments due to the Jan. 1 expiration of enhanced Affordable Care Act subsidies. But much of Washington appears more interested at the moment in culture war issues, including abortion and gender-affirming care.

Meanwhile, at the Department of Health and Human Services, personnel continue to be fired and rehired, and grants terminated and reinstated, leaving everyone who touches the agency uncertain about what comes next.

This week’s panelists are Julie Rovner of 麻豆女优 Health News, Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• Congress remains undecided on a deal to renew enhanced ACA premium subsidies, as it is on spending plans to keep the federal government running when the existing, short-term plan expires at the end of the month. While some of the bigger appropriations hang-ups are related to immigration and foreign affairs, there are also hurdles to passing spending for HHS.
• ACA plan enrollment is down about 1.5 million compared with last year, with states reporting that many people are switching to cheaper plans or dropping coverage. Enrollment numbers are likely to drop further in the coming months as more-expensive premium payments come due and some realize they can no longer afford the plans they’re enrolled in.
• A key Senate health committee on Wednesday hosted a hearing on the abortion pill mifepristone, focused on the safety concerns posed by abortion foes 鈥� though those concerns are unsupported by scientific research and decades of experience with the drug. Many abortion opponents are frustrated that the Trump administration has not taken aggressive action to restrict access to the abortion pill.
• As the Trump administration moved this week to rehire laid-off employees and abruptly cancel, then restore, addiction-related grants, overall government spending is up, despite the administration’s stated goal of saving money by cutting the federal government’s size and activities. It turns out the churn within the administration is costing taxpayers more. And new data, revealing that more federal workers left on their own than were laid off last year, shows that a lot of institutional memory was also lost.

Also this week, Rovner interviews 麻豆女优 Health News’ Elisabeth Rosenthal, who created the “Bill of the Month” series and wrote the latest installment, about a scorpion pepper, an ER visit, and a ghost bill. If you have a baffling, infuriating, or exorbitant bill you’d like to share with us, you can do that here.

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

Julie Rovner: The New York Times’ “,” by Maxine Joselow.

Alice Miranda Ollstein: ProPublica’s “,” by Anna Clark.

Joanne Kenen: The New Yorker’s “,” by Dhruv Khullar.

Anna Edney: MedPage Today’s “,” by Joedy McCreary.

Also mentioned in this week’s podcast:

• The Washington Post’s “,” by Paul Kane.
• HealthAffairs’ “,” by Mica Hartman, Anne B. Martin, David Lassman, and Aaron Catlin.
• Politico’s “,” by Alice Miranda Ollstein.
• JAMA’s “,” by Sophie Dilek, Joanne Rosen, Anna Levashkevich, Joshua M. Sharfstein, and G. Caleb Alexander.

[Editor’s note:听This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]听

Julie Rovner:听Hello from 麻豆女优 Health News and WAMU听public听radio in Washington, D.C., and welcome to听What the Health?听I’m听Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and听I’m听joined by some of the best and smartest health reporters in Washington.听We’re听taping this week on Thursday, Jan. 15, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go.听

Today,听we are joined via video conference by Anna Edney听of听Bloomberg News.听

Anna Edney:听Hi, everyone.听

Rovner:听Alice [Miranda]听Ollstein听of Politico.听

Alice Miranda听Ollstein:听Hello.听

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

Joanne Kenen:听Hi, everybody.听

Rovner:听Later in this episode,听we’ll听have my interview with 麻豆女优 Health News’听Elisabeth Rosenthal, who reported and wrote the latest听“Bill of the Month,”听about an ER trip, a scorpion pepper, and a ghost bill. But first,听this week’s news.听Let’s听start this week on Capitol Hill, where both houses of Congress are here and legislating. This week alone, the Senate rejected a Democratic effort to accept the House-passed bill that would renew for three听years听the Affordable Care Act’s expanded subsidies听鈥斕齮he ones that expired Jan. 1.听听

The Senate also turned back an effort to cancel the Trump administration’s regulation covering the ACA, which, although it has gotten far less attention than the subsidies, would also result in a lot of people losing or dropping health insurance coverage.听听

Meanwhile, in the House, Republicans are struggling just to keep the lights on. Between resignations, illnesses, and deaths, House Republicans are听very nearly听鈥斕齣n the words of longtime Congress watcher听听鈥斕齛听[majority]听in name only, which I guess is pronounced听“MINO.”听Their majority is now so thin that one or two votes can hand Democrats a win, as we saw earlier this week in a surprise defeat on an otherwise听fairly routine听labor bill.听Which brings us to the prospects for renewing those Affordable Care Act subsidies. When the dust cleared from last week’s House vote, 17 Republicans joined all the听House’s Democrats听to pass听the bill and send听it to the Senate.听But it seems that the bipartisan efforts in the Senate to get a deal are losing steam.听What’s the latest you guys are hearing?听

Ollstein:听Yeah, so it听wasn’t听a good sign when the person who has听sort of come听out as a leader of these bipartisan negotiations,听Ohio Sen.听Bernie听Moreno, at first came out听very strong听and said,听We’re听in the end zone.听We’re听very听close听to a deal.听We’re听going to have听bill听text.听And that was several days ago, and now听they’re听saying that听maybe听they’ll听have something by the end of the month. But the initial enthusiasm very quickly fizzled as they really got into the negotiations, and,听from what my colleagues have reported, there’s still disagreements on several fronts, you know, including this idea of having a minimum charge for all plans, no zero-premium plans anymore, which the right says is to crack down on fraud, and the left says would really deter low-income people from getting coverage. And there, of course, is, as always, a fight about abortion, as we spoke about on this podcast before.听There is听not听agreement on how Obamacare currently treats abortion, and thus there can be no agreement on how it听should听treat abortion.听

And听so听the two sides have not come to any kind of compromise. And I don’t know what compromise would be possible, because all of the anti-abortion activist groups and their allies in Congress, of which there are many, say that the only thing they’ll accept is a blanket national ban on any plan that covers abortion receiving a subsidy, and that’s a听nonstarter听for most, if not all, Democrats.听So听I听don’t听know where we听go听from here.听

Rovner:听Well, we will talk more about both abortion and the ACA in a minute, but first, lawmakers have just over two weeks to finish the remaining spending bills, or else risk yet another government shutdown. They听seem to听[be]听making some headway on many of those spending bills, but not so much on the bill that funds most of the Department of Health and Human Services. Any chance they can听come up with听a bill that can get 60 votes in the Senate and a majority in the much more conservative House?听That is a pretty narrow needle to thread.听I听don’t听think abortion is going to be a听huge issue in听Labor,听HHS,听because听that’s听where the Hyde Amendment lives, and we usually see the Hyde Amendment renewed. But, you know, I see a lot of Democrats and, frankly, Republicans in the Senate wanting to put money back for a lot of the things that HHS has cut, and the听House听[is]听probably not so excited about putting all of that money back.听I’m听just wondering if there really is a deal to be had, or if听we’re听going to see for the,听you know, however many听year[s]听in a row, another continuing resolution, at least for the Department of Health and Human Services.听

Ollstein:听Well,听you’re听hearing a lot more optimism from lawmakers about the spending bill than you are about a[n]听Obamacare subsidy deal or any of the other things that听they’re听fighting about. And I would say,听on the听spending,听I think the much bigger fights听are going to be outside the health care space. I think听they’re听going to be about immigration, with everything听we’re听seeing about foreign policy, whether and how to put restraints on the Trump administration, on both of those fronts.听On health,听yes, I think听you’ve听seen efforts to restore funding for programs that was slashed by the Trump administration, and you are seeing some Republican support for that. I mean, it听impacts听their districts and their voters too. So that makes sense.听

Kenen:听We’ve听also seen the Congress vote for spending that the administration听hasn’t听been spent.听So听Congress has just voted on a series of things about science funding and other听health-related听issues, including global health. But it remains to be seen whether this administration takes appropriations as law or听suggestion.听

Rovner:听So听while the effort to revive the听additional听ACA subsidies appears to be losing steam, there does seem to be some new hope for a bipartisan health package that almost became law at the end of 2024, so 13 months ago.听Back then, Elon Musk got it stripped from the year-end spending bill because the bill, or so Musk said, had gotten too big. That health package includes things like reforms for pharmacy benefits managers and hospital听outpatient payments,听and continued funding for community health centers. Could that finally become law? That thing that they said,听Oh,听we’ll听pass it first thing next year, meaning 2025.听

Edney:听I think听it’s听certainly looking more likely than the subsidies that听we’ve听been talking about. But I do think听we’ve听been here before several times, not just at the end of last year听鈥斕齜ut,听like with these PBM reforms, I feel like they have certainly gotten to a point where听it’s听like,听This听is happening.听It’s听gonna听happen.听And, I mean,听it’s听been years, though, that听we’ve听been talking about pharmacy benefit manager reforms in the space of drug pricing.听So basically, you听know, from听when听[President Donald]听Trump won. And so, you know, I say this with, like, a huge amount of caution:听Maybe.听

Rovner:听Yeah, we will, but听we’ll听believe it when听鈥μ齱e get to the signing ceremony.听

Ollstein:听Exactly.听

Rovner:听Well, back to the Affordable Care Act, for which enrollment in most states听end听today.听We’re getting an early idea of how many people actually are dropping coverage because of the expiration of those subsidies.听Sign-ups on the federal marketplace are down about听1.5听million from the end of last year’s enrollment period, and听that’s听before most people听have to听pay their first bill. States that run their own marketplaces are also reporting that people are dropping coverage, or else trying to shift to cheaper plans.听I’m听wondering if these early numbers听鈥斕齱hich are听actually stronger听than many predicted, with fewer people听actually dropping听coverage听鈥斕齬eflect people who signed up hoping that Congress might听actually renew听the subsidies this month. Since we kept saying that was听possible.听

Ollstein:听I would bet that most people are not following the听minutiae of听what’s听happening on Capitol Hill and have no听idea听the mess听we’re听in,听and听why,听and听who’s听responsible. I would love to be wrong about that. I would听love for听everyone to be super informed.听Hopefully听they听listen听to this podcast. But you know, I think that a lot of people just听sign up听year after year and听aren’t听sure of听what’s听going on until听they’re听hit with the giant bill.听听

Rovner:听Yeah.听

Ollstein:听One thing I will point out about the emerging numbers is it does show,听at least early indications,听that the steps a lot of states are taking to make up for the shortfalls and put their own funding into helping people and subsidizing plans,听that’s really working.听You’re听seeing听enrollment up听in some of those states, and so I wonder if听that’ll听encourage any others to get on board as well.听

Kenen:听But听鈥� I think what Julie said听is听it’s听鈥μ齮he follow-up is less than expected. But for the reasons Julie just听said听is that you haven’t gotten your bill yet.听So听either you听haven’t听been paying attention, or听you’re听an optimist and think听there’ll听be a solution.听So, and听people might even pay their first bill thinking that听there’ll听be a solution next month, or that听we’re听close. I mean, I would think听there’d听be drop-off soon, but there might be a steeper听cliff a month or two from now, when people realize this is it for the year, and not just a tough, expensive month or two. So just because听they’re听not as bad as some听people听forecast听doesn’t听say that this is going to be a robust coverage year.听

Edney:听And I think,听I mean, they are the whole picture when you’re talking about who’s signing up, but a lot of these people that I’ve read about or heard about are on the radio programs and different things are signing up,听are drastically changing their lives to be able to afford what they think might be their insurance. So how does that play out听in other aspects?听I听think听will be听..听of the economy of jobs, like, where does that lead听us? I听think听will be something to watch out for too.听

Rovner:听And by the way, in case you’re wondering why health insurance is so expensive, we got the听, and total health expenditures grew by 7.2% from the previous year to听$5.3 trillion, or 18% of the nation’s GDP听[gross domestic product],听up from 17.7% the year before. Remember, these are the numbers for 2024,听not 2025,听but it makes听it听pretty听hard听for Republicans to blame the Affordable Care Act itself for rising insurance premiums. Insurance is more expensive because听we’re听spending more on health care.听It’s not really that complicated, right?听

Kenen:听This 17%-18% of GDP has been听pretty consistent, which听doesn’t听mean听it’s听good;听it just means听it’s听been around that level for many, many, many years. Despite all the talk about听how it’s听unsustainable,听it’s听been sustained,听with pain, but sustained.听$5.7 trillion,听even if听you’ve听been doing听this听a long time听鈥μ�

Rovner:听It’s听$5.3 trillion.听

Kenen:听$5.3 trillion.听It’s听a mind-boggling听number.听It’s听a lot of dollars!听So the ACA made insurance more听鈥斕齮he out-of-pocket cost of insurance for millions of Americans, 20-ish million听鈥斕齜ut the underlying burden we’ve not solved听the 鈥� to use the word of the moment, the听“affordability”听crisis in health听care is still with us and arguably getting worse. But like, I think听we’re听sort of numb. These numbers are just so insane, and yet you say听it’s听unsustainable, but听鈥μ齀 think it听was听Uwe’s听line, right?听

Rovner:听It was, it was a famous听Uwe听Reinhardt line.听

Kenen:听No,听it’s听sustainable, if听we’re听sustaining it at a high听鈥斕齣n听economically听鈥斕齴any price.听听

Rovner:听Right.听

Kenen:听And, like, the other thing is, like, where is the money?听Right? Everybody in health听care says they听don’t听have any money, so I听can’t听figure out who has the听$5 trillion.听

Rovner:听Yeah, well, it’s not听鈥μ齣t does not seem to be the insurance companies as much as it is,听you know, if you look at these numbers听鈥斕齛nd I’ll post a link to them听鈥斕齳ou know, it’s hospitals and drug companies and doctors and all of those who are part of the health听care industrial complex, as I like to call听it.听

Kenen:听All听of them say they听don’t听have enough.听听

Rovner:听Right.听All right. So we know that the Affordable Care Act subsidies are hung up over abortion, as Alice pointed out, and we know that the big abortion demonstration, the March for Life, is coming up next week, so I guess it shouldn’t be surprising that Senate听health听committee听chairman and ardent anti-abortion听senator Bill Cassidy would hold a hearing not on changes to the vaccine schedule, which he has loudly and publicly complained about, but instead about听the reputed dangers of the abortion pill,听mifepristone.听Alice, like me, you watched yesterday’s hearing. What was your takeaway?听

Ollstein:听So, you know, in a sense, this was a show hearing. There听wasn’t听a bill under consideration. They听didn’t听have anyone from the administration to grill. And听so听this is just听sort of your听typical听each side听tries to make their point hearing. And the bigger picture here is that conservatives, including senators and the activist groups who are sort of goading them on from the outside听鈥斕齮hey’re really frustrated right now about the Trump administration and the lack of action they’ve seen in this first year of this administration on their top priority, which is restricting the abortion pill.听Their bigger goal is outlawing all abortion,听but since abortion pills comprise the majority of abortions these days, that’s what they’re targeting.听And听so听they’re听frustrated that, you know, both听[Robert听F.]听Kennedy听[Jr.]听and听[Marty]听Makary have promised some sort of review or action on the abortion pill, and they say,听We听want to see it.听Why haven’t you done it yet?听And听so听I think that pressure听is only going to mount, and this hearing was part of that.听

Rovner:听I was fascinated by the Louisiana听attorney听general saying,听basically,听the听quiet part听out loud, which is that听we banned abortion, but because of these abortion pills, abortions are still going up in our state.听That was the first time I听think听I’d听heard an official say that. I mean that,听if you wonder why听they’re听going after the abortion pill,听that’s听why听鈥斕齜ecause they听struck down听Roe听[v. Wade]听and assumed that the number of abortions would go down, and it really has not, has it?听

Ollstein:听That’s听right. And so not only are people increasingly using pills to听terminate听pregnancies, but听they’re听increasingly getting them via telemedicine.听And you know, that’s absolutely true in states with bans, but it’s also true in states where abortion is legal.听You know, a lot of people just really prefer the telemedicine option,听whether because听it’s cheaper, or they live really far away from a doctor who is willing to prescribe this, or, you know, any other reasons.听So听the right听鈥斕齳ou know, again, including senators like Cassidy, but also these activist groups听鈥斕齮hey’re听saying, at a bare minimum, we want the Trump administration to ban telemedicine for the pills and reinstate the in-person dispensing requirement. That would really roll back access across the country. But what they really want is for the pills to be taken off the market altogether. And听they’re听pretty open听about saying that.听听

Rovner:听Well, rather听convenient timing from the听, which published a peer-reviewed study of 5,000 pages of documents from the FDA that found that over the last dozen years, when it comes to the abortion pill and its availability, the agency followed the evidence-based recommendations of its scientists every single听time, except once, and that once was during the first Trump administration.听Alice,听is there anything that will convince people that the scientific evidence shows that mifepristone is both safe and effective and actually has a very low rate of serious complications?听There were,听how many, like 100,听more than 100 peer-reviewed听studies that听basically听show听this,听plus the experience of many millions of women in the United States and around the world.听

Ollstein:听Well, just like听I’m听skeptical that听there’s听any compromise that can be found on the Obamacare subsidies,听there’s听just no compromise here. You know, you have the groups that are making these arguments about the pills’听safety say very openly that, you know, the reason they oppose the pills is because they cause abortions. They say it听can’t听be health care if听it’s听designed to end a life, and that kind of rhetoric. And听so听the focus on the rate of complication听鈥μ齀 mean,听I’m听not saying听they’re听not genuinely concerned. They may be, but, you know, this is one of many tactics听they’re听using to try to curb access to the pills.听So听it’s听just one argument in their arsenal.听It’s听not听their,听like,听primary driving, overriding goal is, is the safety which, like you said, has been well听established听with many, many peer-reviewed studies over the last several years.听

Rovner:听So, in between these big, high-profile anti-abortion actions like Senate hearings, those supporting abortion rights are actually still prevailing in court, at least in the lower courts. This week, [a lawsuit filed by the American Civil Liberties Union and the National Family Planning and Reproductive Health Association against the Trump administration after the administration also quietly gave Planned Parenthood and other family planning groups] back the Title X family planning money that was appropriated to it by Congress. That was what Joanne was referring to, that Congress has been appropriating money that the administration hasn’t been spending. But this wasn’t really the big pot of federal money that Planned Parenthood is fighting to win back, right?

Ollstein:听It was one pot of money听they’re听fighting to win back. But yes, the much bigger Medicaid cuts that Congress passed over last听summer,听those are still in place. And so听that’s听an order of magnitude more than this pot of听Title听X听family planning money that they just got back. So that aside,听I’ve听seen a lot of conservatives conflate the two and accuse the Trump administration of violating the law that Congress passed and restoring funding to Planned Parenthood. This is different funding, and听it’s听a lot less than the cuts that happened. And so I talked to the organizations impacted, and it was clear that even though they’re getting this money back, for some it came too late, like they already closed their doors and shut down clinics in a lot of states, and they can’t reopen them with this chunk of money. This money is when you give a service to a听patient,听you can then听submit听for reimbursement. And听so听if the clinic’s not there,听it’s听not like they can use this money to, like, reopen the clinic, sign a lease, hire people, etc.听听

Rovner:听Yeah.听The wheels of the courts, as we have seen, have moved very slowly.听

OK,听we’re听going to take a quick break. We will be right back.听

So听while abortion gets most of the headlines,听it’s听not the only culture war issue in play. The Supreme Court this week heard oral arguments in a case challenging two of the 27 state laws barring transgender athletes from competing on women’s sports teams. Reporters covering the argument said it seemed unlikely that听a majority of听justices would strike down the laws,听which would allow all of those bans to stand. Meanwhile, the other two branches of the federal government have also weighed in on the gender issue听in recent weeks.听The House passed a bill in December, sponsored by now former Republican听congresswoman听Marjorie Taylor Greene that would make it a felony for anyone to provide gender-affirming care to minors nationwide.听And the Department of Health and Human Services issued proposed regulations just before Christmas that听wouldn’t听go quite that听far, but听would have听roughly the听same effect. The regulations would ban hospitals from providing gender-affirming care to minors or risk losing their Medicare and Medicaid听funding, and听would bar funding for gender-affirming care for minors by Medicaid or the Children’s Health Insurance Program. At the same time, Health and Human Services Secretary Kennedy issued a declaration, which is already being challenged in court, stating that gender-affirming care, quote,听“does not meet professionally recognized standards of health care,”听and therefore practitioners who deliver it can be excluded from federal health programs. I get that sports听team听exclusions have a lot of public support, but does the public really support effectively ending all gender-affirming care for minors?听That’s听what this would do.听

Edney:听Well, I think that when a lot of people hear that, they think of surgery, which is the much, much, much, much, much less likely scenario here that听we’re听even talking about. And so those who are against it have done an effective job of making that听the issue. And so there听鈥μ齱ho support gender-affirming care, who have听looked into听it, would see that a lot of this is hormone treatment, things like that, to drugs听鈥μ�

Rovner:听Puberty blockers!听

Edney:听鈥μ齮hey’re taking听鈥斕齟xactly听鈥斕齛nd so it’s not, this isn’t like a permanent under-the-knife type of thing that a lot of people are thinking about, and I think,听too,听talking about, like mental health, with being able to get some of these puberty blockers, the effect that it can have on a minor who doesn’t want to live the way they’ve been living, so it’s so helpful to them.听So听I think that there’s just a lot that has, you know, there’s been a lot of misinformation out there about this, and I feel like听that that’s kind of winning the day.听

Kenen:听I think,听like,听from the beginning, because, like, five or six years ago was the first time I wrote about this. The听playbook has been very much like the anti-abortion playbook. They talk about it in terms of protecting women’s health, and now听they’re听talking about it in protecting children’s health. And,听as Anna said,听they’re听using words like mutilation. Puberty blockers are not听mutilation. Puberty听blockers are a medication that delays the onset of puberty, and it is not irreversible.听It’s听like a听brake. You take your foot off the brake,听and puberty starts.听There’s听some controversy about what age and how long, and听there’s听some听possible bone听damage. I mean, there’s some questions that are raised that need to be answered, but the conversation that’s going on now听鈥斕齧ost of the experts in this field, who are endocrinologists and psychologists and other people who are working with these kids,听cite a lot of data saying that not only this is safe, but it’s beneficial for a kid who really feels like they’re trapped in the wrong body.听So听you know, I think it’s really important to repeat听鈥μ齮he point that Anna made, you know, 12-year-olds are not getting major surgery.听Very few minors are, and when they are,听it’s听closer听鈥� they听may be under 18,听it’s听rare. But if听you’re听under 18,听you’re听closer to 18,听it’s听later in听teens. And听it’s听not like you walk into an operating room and say, you know,听do this to me.听There’s听years of counseling and evaluation and professional teams. It really did strike a nerve in the campaign. I think Pennsylvania,听in particular.听This is something that people听don’t听understand and get听very upset听about, and the inflammatory听language,听it’s听not creating understanding.听

Rovner:听We’ll听see how听this one plays听out. Finally, this week, things at the Department of Health and Human Services听continues听to be chaotic. In the latest round of听“we’re cutting you off because you don’t agree with us,”听the Substance Abuse and Mental Health Services Administration sent hundreds of letters Tuesday to grantees听canceling听their funding听immediately.听It’s听not entirely clear how many grants or how much money was involved, but it听appeared to be听something听in the neighborhood of听$2 billion听鈥斕齮hat’s听around a fifth of SAMHSA’s听entire budget. SAMHSA, of course, funds programs that provide addiction and mental health treatment, treatment for homelessness and suicide prevention, among other things. Then,听Wednesday night, after a furious backlash from Capitol Hill and听just about every听mental health and substance abuse group in the country, from what I could tell from my email, the administration canceled the cuts.听Did they miscalculate the scope of the reaction here, or was chaos the actual goal in this?听听

Edney:听That is听a great question. I really听don’t听know the answer. I don’t know what it could serve anyone by doing this and reversing it in 24 hours, as far as the chaos angle, but it does seem, certainly,听like there was a听miscalculation of how Congress would react to this, and it was a bipartisan reaction that wanted to know why, what is it even your justification? Because these programs do seem to support the priorities of this administration and HHS.听

Rovner:听I听didn’t听count, but I got dozens of emails yesterday.听听

Edney:听Yeah.听

Rovner:听My entire email box was overflowing with people听basically freaking听out about these cuts听to SAMHSA. Joanne,听you wanted听to say something?听

Kenen:听I think that one of the shifts over听鈥斕齀’m not exactly sure how many years听鈥斕�7,听8,听9, years, whatever we’ve been dealing with this opioid crisis, the country has really changed and how we see addiction, and that we are much more likely to view addiction not as a criminal justice issue, but as a mental health issue.听It’s听not that everybody thinks that.听It’s听not that every lawmaker thinks that, but we have really turned this into, we听have seen it as, you know, a health problem and a health problem that strikes red states and blue states. You know, we are all familiar with the听“deaths of despair.”听Many of us know at least an acquaintance or an acquaintance’s family that have experienced an overdose death. This is a bipartisan shift. It is,听you know,听you’ve听had plenty of conservatives speaking out for both more money and more compassion. So I think that the backlash yesterday, I mean, we saw the public backlash, but I think there was probably a behind-the-scenes听鈥斕齭ome of the听“Opioid听Belts”听are very conservative states,听and Republican governors, you know, really saying we’ve had progress.听Right? The last couple of years, we have made progress. Fatal overdoses have gone down, and Narcan is available. And just like our inboxes, I think their听telephones, they听were bombarded.听听

Rovner:听Yeah.听Well, meanwhile, several听hundred听workers have听reportedly been听reinstated at the National Institute of Occupational Safety and Health听鈥斕齮hat’s听a听subagency of CDC听[the Centers for Disease Control and Prevention].听Except that those RIF听[reduction in force]听cancellations came nine months after the original RIFs, which were back in April. Does the administration think these folks are just sitting around waiting to be called back to work?听And in news from the National Institutes of Health,听Director Jay Bhattacharya told a podcaster last week that the DEI-related听[diversity, equity, and inclusion]听grants that were canceled and then reinstated due to court orders are likely to simply not be renewed. And at the FDA, former longtime drug regulator Richard听Pazdur听said at the J.P.听Morgan听[Healthcare] Conference in San Francisco this week that the听firewall听between the political appointees at the agency and its career听drug reviewers has been,听quote,听“breached.”听How is the rest of HHS expected to actually, you know, function with even so much uncertainty about who works there and who’s calling the shots?听

Ollstein:听Not to mention听all of听this back and forth and chaos and starting and stopping is costing more,听is costing taxpayers more.听Overall spending is up. After all of the听DOGE听[Department of Government Efficiency]听and听RIFs听and all of it, they have not cut spending at all because it’s more expensive to pay people to be on administrative leave for a long time and then try to bring them back and then shut down a lab and then reopen a lab. And all of this has not only meant, you know, programs not serving people, research not happening, but it听hasn’t听even saved the government any money, either.听

Kenen:听Like, you know, the game we played when we were kids, remember,听“Red听Light-Green听Light,”听you know, you’d听run in one direction, you run back. And if you were听8听years old, it would end with someone crying. And that’s听sort of the听way听we’re听running the government听these听days听[laughs].听The amount of people fired, put on leave. The CDC has had this incredible yo-yoing of people. You听can’t听even keep track. You听don’t听even know what email to use if听you’re听trying to听keep听in听touch听with them听anymore. The churn,听with what logic?听It’s, as Alice said,听just听more expensive, but it’s,听it’s听also just听鈥μ齦ike听you听can’t听get your job done.听Even if you want a smaller government, which many of conservatives and Trump people do,听you still want certain functions fulfilled.听But there’s still a consensus in society that we need some kind of functioning health system and health oversight and health monitoring.听I mean, the American public is not against research, and the American public is not against keeping people alive.听You know, the inconsistency is pretty mind-boggling.听

Edney:听Well, there’s a lot of rank-and-file, but we’re seeing a lot of heads of parts of the agencies where, like at the FDA, with the drug center, or many of the different institutes at NIH that really don’t have anyone in place that is leading them. And I think that that, to me, like this is just my humble opinion, is听it听kind of seems听like the message as听anybody can do this part, because听it’s听all coming from one place. There’s really just one leader, essentially, RFK, or maybe it’s Trump, or they want everyone to do it the way that they’re going to comply with the different,听like you said, everyone wants research, but I,听Joanne, but I do think they only want certain kinds of research in this case.听So听it’s听been interesting to watch how many leaders in these agencies that are going away and not being replaced.听

Rovner:听And all the institutional memory听that’s听walking out the door. I mean,听more people听鈥斕齛nd to听Alice’s point about how this听hasn’t听saved money听鈥斕齧ore people have taken early retirement than have听been actually, you听know,听RIF’d听or fired or let go. I mean, they’ve just听鈥μ齛 lot of people听have basically, including听a lot of leaders of many of these agencies, said,听We听just听don’t听want to be here under these circumstances.听Bye.听Assuming at some point this government does want to use the Department of Health and Human Services to get things done,听there might not be the personnel around to actually effectuate it.听But we will continue to watch that space.听

OK, that’s this week’s news. Now we will play my听“Bill of the听Month”听interview with Elisabeth Rosenthal, and then we will come back and do our extra credits.听

I am pleased to welcome back to the podcast Elisabeth Rosenthal, senior contributing editor at听麻豆女优听Health听News and originator of our听“Bill of the Month”听series, which in its听nearly eight听years has analyzed听nearly $7 million听in dubious, infuriating,听or inflated medical charges. Libby also wrote the latest听“Bill of the听Month,”听which听we’ll听talk about in a minute. Libby, welcome back to the podcast.听

Elisabeth Rosenthal:听Thanks for having me back.听

Rovner:听So听before we get to this month’s patient, can you reflect for a moment on the impact this series has had, and how frustrated听are you that eight years on,听it’s听as relevant as it was when we began?听

Rosenthal:听We were听worried it听wouldn’t听last a year, and here we are, eight years later, still finding plenty to write about. I mean,听we’ve听had some wins.听I think we听helped contribute to the听No听Surprises听Act being passed.听There are听states clamping down on facility fees, you know, and making sure that when you get something done in a hospital rather than an outpatient clinic,听it’s听the same cost. The听country’s听starting to address drug prices.听But,听you know, we听seem to be听the billing听police, and听that’s听not good.听We’ve听gotten a lot of bills written off for our individual patients. Suddenly, when a reporter calls,听they’re听like,听Oh, that was a mistake听or听Yeah,听we’re听going to write that off. And听I’m听like,听You’re听not writing that off;听that听shouldn’t听have been billed. So sadly, the series is still going strong, and medical billing has proved endlessly creative. And you know, I think the sad thing for me is our success is a sign of a deeply, deeply dysfunctional system听that听has听left,听as we know, you know, 100 million adult Americans with medical debt.听So听we will keep going until听it’s听solved,听I hope.听

Rovner:听Well, getting on to this month’s patient, he gives new meaning to the phrase听“It must have been something I ate.”听Tell us what it was and how he ended up in the emergency room.听

Rosenthal:听Well, Maxwell听[Kruzic]听loves eating spicy foods, but听he’s听never had a problem with it. And suddenly, one night, he had just听excruciating, crippling abdominal pain. He drove himself to the emergency room. It was so bad he had to stop three times, and when he got there, it was mostly on the right-lower quadrant. You know, the doctors were so convinced, as he was, that he had appendicitis, that they called a surgeon right away, right?听So听they were all听like,听ready to go to the operating room. And then the scan came back, and it was like,听whoops,听his appendix is normal. And then,听oh, could he have kidney stones?听And听it’s听like no sign of that either. And finally, he thought, or someone asked,听Well, what did you eat last night?听And of course, Maxwell had ordered the hottest chili peppers from a bespoke chili pepper-growing company in New Mexico. They have some chili pepper rating of 2 million听[Scoville heat units], which is,听like,听through the roof, and it was a reaction to the chili peppers.听I didn’t even know that could happen, and I trained as a doctor, but I guess your intestines don’t like really, really, really hot stuff.听

Rovner:听So听in the end, he was听OK.听And the story here isn’t even really about what kind of care he got, or how much it cost.听The $8,000 the hospital charged for his few hours in the ER听doesn’t听seem all that out of line compared to some of the bills听we’ve听seen.听What was most notable in this case was the fact that the bill didn’t actually come until two years later.听How much was he asked to pay two years after the hot pepper incident?听

Rosenthal:听Well, he was asked to pay a little over $2,000,听which was his coinsurance for the emergency room visit. And as he said, you know, $8,000听鈥μ齨ow we go,听well,听that’s听not bad.听I mean, all they did,听actually, was do a couple of scans and give him some IV fluids.听But听in this day and age,听you’re听like, wow, he got away听鈥� you know, from听a听“Bill of a听Month”听perspective, he got away cheap, right?听

Rovner:听But I would say, is it even legal to send a bill two years after the fact? Who sends a bill two years later?听

Rosenthal:听That’s听the problem,听like,听and Maxwell听鈥斕齢e’s听a pretty smart guy, so he was checking his portal repeatedly. I mean, he paid something upfront at the ER, and he kept听thinking,听I must owe something. And he checked and he听checked听and he checked and it kept saying zero. He actually called his听insurer and听to make sure that was right. And they said,听No, no, no,听it’s听right. You owe zero. And then, you know, after like, six months, he thought,听I guess I听owe zero. But then he听didn’t听think about it, and then almost two years later, this bill arrives in the mail, and听he’s听like,听What?!听And what I discovered, which is a little disturbing, is it is not, I wouldn’t say normal, but we see a bunch of these ghost bills at听“Bill of the听Month,”听and in many cases, it’s legal, because听of听what was going on in those two-year periods. And of course, I called the hospital, I called the insurer, and they were like,听Yeah, you know, someone was away on vacation, and someone left their job, and we听couldn’t听鈥μ齳ou know, the hospital听billed them听correctly. And the hospital said,听No, we听didn’t.听And they were just听kind of doing听the usual听back-end negotiations to figure out what a service is worth.听And when they finally agreed two years later听what should be paid,听that’s听when they sent Maxwell the bill. And the problem听is,听whether听it’s听legal really depends on your insurance contracts, and whether they allow this kind of late billing.听I do not know to this day if Maxwell’s did, because as soon as I called the insurer听and听the hospital, they were like,听Never听mind. He听doesn’t听owe听anything. And you know, as he said,听he’s听a geological engineer. He has lots of clients, and as he said, you know, if I called them two years later and said,听Whoops, I forgot to bill for something, they would be like,听Forget听it!听you听know.听So听I do think this is something that needs to be addressed at a policy level, as we so often discover on听“Bill of the听Month.”听

Rovner:听So听what should you do if you get one of these ghost bills? I should say听I’m听still negotiating bills from a surgery that I had six months ago.听So听I guess I should听count听myself lucky.听

Rosenthal:听Well, I think you should check with your insurer and check with the hospital. I think more听with听your insurer听鈥斕齣f the contract says this is legal to bill.听It’s听unclear听to me,听in this case, whether it was.听The hospital was very much like,听Oh, we made a mistake;听because it took so long,听we听actually听couldn’t听bill Maxwell.听So听I think in his case, it听probably was听in the contract that this was too late to听bill. But, you know, I think a lot of hospitals, I hate to say it, have this attitude.听Well,听doesn’t听hurt to try, you know,听maybe听they’ll听pay听it. And people are afraid of bills, right? They听pay听them.听听

Rovner:听I know the feeling.听

Rosenthal:听Yeah, I do think, you know, they should check with their insurer about whether there’s a statute of limitations,听essentially,听on billing, because there may well be and I would say it’s a great asymmetry, because if you submit an insurance claim more than six months late, they can say,听Well, we won’t pay this.听

Rovner:听And just to tie this one up with a bow, I assume that Maxwell has changed his pepper-eating ways, at least听modified听them?听

Rosenthal:听He said he will never eat听scorpion peppers again.听

Rovner:听Libby Rosenthal, thank you so much.听

Rosenthal:听Oh, sure.听Thanks听for having me.听

Rovner:听OK,听we’re听back, and now听it’s听time for our听extra-credit听segment.听That’s听where we each recognize a story we read this听week听we think you should read,听too.听Don’t听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?听

Edney:听Sure.听So听my extra credit is from听MedPage听Today:听“.”听I appreciated this article because it answered some questions that I had,听too,听after the sweeping change to the childhood vaccine schedule. There听was听just a lot of discussions I had about, you know, well, what does this really mean on the ground? And will听parents听be confused? Will pediatricians听鈥斕齢ow will they be talking about this? You know, will they stick to the schedule we knew before? And there was an article in JAMA听Perspectives听that lays out, essentially, to听clinicians, you know, that they should not fear malpractice听..听issues if听they’re听going to talk about the old schedule and not adhere to the newer schedule. And听so听it lays out some of those issues.听And I thought that was really helpful.听

Rovner:听Yeah, this was a big question that I had,听too.听Alice, why don’t you go next?听

Ollstein:听Yeah, so I have a piece from ProPublica.听It’s听called听“.”听So听this is about how听there’s听been this huge push on the right to end public water fluoridation that has succeeded in a听couple听places and could spread more. And the proponents of doing that say that听it’s听fine because there are all these other sources of fluoride. You can get听a treatment听at the听dentist,听you can get it in stuff you buy at the drugstore and take yourself. But at the same time, the people who听arepushing听for ending fluoridated public drinking water听are also pushing for restricting those other sources. There have been state and federal efforts to crack down on them, plus听all of听the just rhetoric about fluoride, which is very misleading. It misrepresents studies about its alleged听neurological impacts. But it also,听that kind of rhetoric makes people afraid to have fluoride in any form, and people are very worried about that, what听that’s听going to do to the nation’s teeth?听

Rovner:听Yeah,听it’s听like vaccines. The more you听talk听it听down,听the less people want to do it.听Joanne.听

Kenen:听This is听a piece by听Dhruv Khullar听in听The New Yorker called听“,”听and it was really great, because there’s certain things I think that we who听鈥斕齦ike, I don’t know how all of you watch it听鈥斕齜ut like, there’s certain things that didn’t even strike me, because I’m so used to writing about, like, the connection between poverty, social determinants of health, and, like, of course, people who come to the ED听[emergency department]听have, you know, homelessness problems and can’t afford food and all that. But听Dhruv听talked听about听how it听sort听of brought that home to him, how our social safety net, the holes in it, end up in our听EDs.听And he also talked about some of it is dramatized more for TV, that not everybody’s heart stops every 15 minutes. He said that sort of happens to one patient听a听day. But he talked about compassion and how that is rediscovered in this frenetic ED/ER听scene.听It’s听just a very thoughtful piece about why we all love that TV show. And听it’s听not just because of听Noah Wyle.听

Rovner:听Although that helps. My extra credit this week is from听The New York Times.听It’s听called听“,” by Maxine听Joselow.听And while it’s not about HHS, it most definitely is about health.听It seems that for the first time in literally decades, the Environmental Protection Agency will no longer calculate the cost听to听human health when setting clean air rules for ozone and fine particulate matter, quoting the story:听“That would most likely lower costs听for companies while resulting in dirtier air.”听This is just another reminder that the federal government is听charged with ensuring the help of Americans from a broad array of agencies, aside from HHS听鈥斕齩r in this case, not so much.听听

OK, that’s this week’s show.听As always, thanks to our editor, Emmarie听Huetteman,听and our producer-engineer, Francis Ying.听We also had听help听this week from producer Taylor Cook.听A听reminder:听What the听Health?听is now available on WAMU platforms, the NPR app,听and wherever you get your podcasts, as well as, of course, at听kffhealthnews.org.听Also, as always, you can email us your comments or questions.听We’re听at听whatthehealth@kff.org,听or you can find me still on X听, or on Bluesky听.听Where are you folks hanging these days?听Alice.听

Ollstein:听Mostly听on听Bluesky听听and still on听X听.听

Rovner:听Joanne.听

Kenen:听I’m听mostly on听听or on听听.听

Rovner:听Anna.听

Edney:听听or听X听.听

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

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