President Donald Trump this week nominated a former deputy surgeon general who has expressed support for vaccines to lead the Centers for Disease Control and Prevention. Considered a more traditional fit for the job, Erica Schwartz would be the agency’s fourth leader in roughly a year, should she be confirmed by the Senate.听

And Health and Human Services Secretary Robert F. Kennedy Jr. appeared on Capitol Hill this week in the first of several hearings discussing Trump’s budget request for the department. But the topics up for discussion deviated quite a bit from the subject of federal funding, with lawmakers raising issues of Medicaid fraud, measles outbreaks, the hepatitis B vaccine, peptides, unaccompanied minors, and much, much more.听

This week’s panelists are Mary Agnes Carey of 麻豆女优 Health News, Anna Edney of Bloomberg News, Emmarie Huetteman of 麻豆女优 Health News, and Joanne Kenen of the Johns Hopkins University Bloomberg School of Public Health and Politico Magazine.

Panelists

Among the takeaways from this week’s episode:

• Trump on Thursday named four officials to the CDC’s leadership team. Schwartz, whom he picked as director, is a physician and Navy officer who served as a deputy surgeon general during Trump’s first term. She has voiced support for vaccines and played a key role in the covid-19 pandemic response.
• RFK Jr. testified before three committees of the House of Representatives this week on the president’s budget request for HHS. While the hearings touched on a wide variety of topics, notable moments included a slight softening of Kennedy’s stance on the measles vaccine, including the acknowledgment that being immunized is safer than having measles 鈥� although he also stood by the decision to remove the recommendation for the newborn dose of the hepatitis B vaccine.
• New studies on the use of acetaminophen during pregnancy and the effects of water fluoridation on cognitive function refute Trump administration claims. And a White House meeting that brought together Trump, Kennedy, and other leaders of the Make America Healthy Again movement aimed to soothe concerns among supporters 鈥� yet there’s reason to believe the overture won’t completely mend fences between the Trump administration and the MAHA constituency ahead of the midterm elections.

Also this week, 麻豆女优 Health News’ Julie Rovner interviews Michelle Canero, an immigration attorney, about how the Trump administration’s policies affect the medical workforce.

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

鈥�Mary Agnes Carey: Politico’s “,” by Alice Miranda Ollstein.

Joanne Kenen: The New York Times’ “,” by Teddy Rosenbluth.

Anna Edney: Bloomberg’s “,” by Anna Edney.

Emmarie Huetteman: 麻豆女优 Health News’ “Your New Therapist: Chatty, Leaky, and Hardly Human,” by Darius Tahir.

Also mentioned in this week’s podcast:

• JAMA Pediatrics’ “,” by Kira Philipsen Prahm, Pingnan Chen, Line Rode, et al.
• Proceedings of the National Academy of Sciences’ “,” by John Robert Warren, Gina Rumore, Kamil Sicinski, and Michal Engelman.
• 麻豆女优 Health News’ “Pennsylvania Town Faces Fallout From Trump’s Environmental Rule Rollback,” by Stephanie Armour and Maia Rosenfeld.
• The New York Times’ “,” by Sheryl Gay Stolberg.
• Wakely Consulting Group’s “,” by Michelle Anderson, Chia Yi Chin, and Michael Cohen.

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According to new data from the Centers for Disease Control and Prevention, there were 3.6 million births in 2025, a from 2024. The fertility rate dropped to 53.1 births per 1,000 women ages 15 to 44, down 23% since 2007.

The Trump administration has said it wants to reverse this trend. President Donald Trump has called for “a new baby boom,” and aides have solicited proposals from outside advocates and policy groups ranging from baby bonuses to expanded fertility planning. The administration is also the federal government’s only dedicated family planning program: Title X.

For more than five decades, Title X has been geared 鈥� with bipartisan support 鈥� toward giving low-income women access to contraception, screening for sexually transmitted infections, and reproductive health care regardless of ability to pay. At its peak, the served more than 5 million patients a year. Title X clients have reported the program as their sole source of health care in a given year.

In early April, the Department of Health and Human Services for Title X grants for fiscal year 2027, which begins in October. The 67-page Notice of Funding Opportunity included only one mention of contraception 鈥� describing it as overprescribed, associated with negative side effects, and part of a broader “overreliance on pharmaceutical and surgical treatments.”

The grant notification reshapes the program from its traditional public health intervention efforts to focus on fertility, family formation, and reproductive health conditions such as polycystic ovary syndrome, endometriosis, low testosterone, and erectile dysfunction.

While Title X will continue to help women “achieve healthy pregnancies,” the grant document does not explicitly reference preventing unintended pregnancies 鈥� a long-standing goal of the program.

Jessica Marcella, who oversaw the Title X program as a senior official in the Biden administration, said the new funding notice amounts to a wholesale redefinition of family planning.

“What we’re seeing is trying to use our nation’s family planning as a Trojan horse for an entirely different agenda,” Marcella said, noting that Trump eliminating Title X altogether.

Birth Rates and Fertility Trends

The administration is overhauling Title X in the context of declining birth rates. But researchers who study fertility trends say the decline is driven by forces that have little to do with contraception access and that restricting it is unlikely to produce more births.

The most important factors, according to demographer Alison Gemmill of UCLA, are timing-related. “Childbearing is increasingly delayed as part of a broader shift toward later adult milestones, including stable employment, leaving the parental home, and marriage,” she said.

Most American women, she said, still complete their childbearing years with an average of two children, suggesting a shift toward smaller families rather than an increase in childlessness.

“Having children has become more contingent and more planned,” she said.

Much of the decline since 2007 reflects women postponing births rather than forgoing them.

“The average number of babies women are having in their whole lives has not fallen. It’s still more than 2.0 for women aged 45,” said Philip Cohen, a professor of sociology at the University of Maryland.

Phillip Levine, an economist at Wellesley College, said the birth rate has declined due to shifts in how women approach work, leisure, and parenting. “Efforts to reverse those patterns would be more successful if they can make childbearing more desirable, not make it harder to prevent a pregnancy,” he said.

Asked about the role of contraception in reducing maternal mortality and how the new funding notice advances that goal, HHS press secretary Emily Hilliard said in a statement: “Applicants for the 2027 Title X funding cycle will be expected to align with the administration’s stated priorities in the released Notice of Funding Opportunity. HHS, under the leadership of Secretary Kennedy and President Trump, will continue to support policies that support life, family well-being, maternal health, and address the chronic disease epidemic. HHS remains focused on improving maternal outcomes and ensuring programs are administered consistent with applicable law.”

Marcella said the new funding notice is the product of two converging forces: the Make America Healthy Again movement, with its skepticism of conventional medicine and emphasis on lifestyle and behavioral interventions, and a pronatalist agenda that seeks to boost birth rates by steering policy toward family formation.

The document’s language reflects both: It repeatedly invokes “optimal health” and “chronic disease” while sidelining the contraceptive services that have defined Title X for .

Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, which represents health professionals focused on family planning, said tying Title X to birth-rate goals replaces individual decision-making with a government objective. The program “is designed to facilitate access to family planning services, including services to achieve and prevent pregnancy,” she said.

Title X’s New Focus

The administration’s changes have been welcomed on the right.

Emma Waters, a senior policy analyst at the conservative Heritage Foundation, who has advocated for what she calls “restorative reproductive medicine,” said the new funding notice reflects overdue attention to neglected aspects of women’s health.

“I was particularly encouraged to see language that spoke to the delays in diagnosis for conditions like endometriosis, the need for women to practically understand how their cycle and fertility works, and to ensure that real root-cause was promoted through Title X,” Waters said.

She described the notice as an expansion, not a narrowing, of the program’s mission: “I see this iteration of Title X as the fulfillment of its purpose. The goal was never just 鈥榤ore contraception’ but a wholesale empowerment of women to govern their own fertility.”

Waters also argued that untreated reproductive health problems may contribute to lower birth rates.

“One of the interesting aspects of this debate, and one that is often overlooked, is the degree to which painful and unaddressed reproductive health problems may suppress or create ambivalence around a woman’s desire to have kids,” she said, pointing to endometriosis.

An estimated of reproductive age have endometriosis, and of those, . Scientifically speaking, the relationship is an association, not a proven cause. Women aren’t screened for endometriosis if they don’t have symptoms, and the condition may be more prevalent than is recognized. Researchers still do not fully understand why some women with endometriosis struggle to conceive while others do not, and treating the disease does not reliably restore fertility.

Infertility rates in the U.S., meanwhile, have not risen. An found them essentially flat between 1995 and 2019, even as the national birth rate fell sharply 鈥� a divergence that points away from untreated reproductive disease as an explanation.

Meanwhile, in February, the American College of Obstetricians and Gynecologists enabling earlier diagnosis of endometriosis without surgery, a step toward addressing the delays Waters described. But the first-line treatment ACOG recommends is hormonal therapy, part of the same category of care the funding notice dismisses as part of an “overreliance on pharmaceutical and surgical treatments.” The effect, reproductive health experts say, is a contradiction: Title X is now prioritizing diagnosis of endometriosis while deemphasizing the drugs clinicians use to treat it.

Treatments that have been shown to improve fertility in women with endometriosis, such as laparoscopic surgery and in vitro fertilization, are . When President Richard Nixon signed Title X into law in 1970, as a way to expand access to family planning services 鈥� helping women determine the number and spacing of their children by making contraception and related preventive care more widely available, particularly for those who could not afford it. , not Title X, is the primary government health insurance program covering health care for low-income women, but, like many commercial insurance plans, it .

Many of the conditions prioritized in the funding notice deserve attention, said Liz Romer, a former chief clinical adviser for the HHS Office of Population Affairs who helped write updated guidelines for the family planning program. But they fall outside the scope of what Title X can realistically provide.

“There’s not even enough funding to support the core premise of contraception,” Romer said. “And so, if you want to expand Title X funding, you can expand the scope, but you can’t move away from the foundation.”

The emergence of an anticontraception ideology within federal health policy is striking, she said, given how broadly the public supports access to birth control. Eight in 10 women of childbearing age surveyed by 麻豆女优 in 2024 reported having in the previous 12 months.

Laura Lindberg, director of the Concentration in Sexual and Reproductive Health, Rights and Justice at Rutgers School of Public Health, said, “If contraception is sidelined in Title X, it won’t just change language on paper but will show up as fewer options and more barriers for patients.” Funding could move away from providers who offer a full range of contraceptive care, she added, “toward organizations that are ideologically opposed to contraception and don’t deliver the same standard of health care services.”

The Stakes Are High

The United States already has one of the highest maternal mortality rates among wealthy nations 鈥� as of 2024. According to the CDC, in the U.S. may be preventable. Medical research shows that pregnancy carries substantially higher risks of blood clots, stroke, and cardiovascular complications than hormonal contraception.

And since the Supreme Court’s Dobbs decision in 2022, which overturned the constitutional right to abortion established by Roe v. Wade, access to abortion has been significantly curtailed across much of the country. While national abortion numbers have risen, driven largely by telehealth and interstate access, research shows births have increased in states with bans, with an estimated , disproportionately among young women and women of color.

Dr. Christine Dehlendorf, who directs the Person-Centered Reproductive Health Program at the University of California-San Francisco, said “there is absolutely no evidence for any positive outcome of restricting access to contraception.” Restrictions would instead increase demand for abortion care and make it harder for women to prevent high-risk pregnancies.

Since Trump returned to office, more than a dozen Title X grantees have had their grants frozen, forcing some health centers to stop delivering services, lay off staff, or close. During the first Trump administration, regulatory changes led to a decline in Title X participation from more than . The program grew slowly under the Biden administration, reaching about 3 million clients, before the current round of disruptions began.

The second Trump administration’s overhaul of the program, Marcella said, “directly undermines the public health intent of our nation’s family planning program and will potentially exclude millions of individuals from getting the care they have relied on for decades. It’s bad policy.”

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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In a humbling exercise, employees were waiting to test whether their entry badges still worked at the Department of Health and Human Services 鈥� or whether they’d be walked back out by security because they were among the 10,000 unlucky ones whose jobs had suddenly been eliminated.

I thought back to that day recently as I researched and听reported on听a significant, under-the-radar proposal from the Office of Personnel Management, which oversees federal workers.听

According to a听听in December, OPM is听seeking听personally identifiable medical and pharmaceutical claims information on federal employees and retirees, as well as their family members, who are enrolled in the Federal Employees Health Benefits or Postal Service Health Benefits programs. Just over 8 million Americans get coverage through such plans.

Right now, 65 insurance companies听maintain听data the agency wants, including information on prescriptions, diagnoses, and treatments. That would put a tremendous amount of personal information about federal employees in the hands of an administration that has earned a reputation for taking听听against some workers and听sharing sensitive data听across agencies as part of its immigration and fraud crackdowns.听听

My colleague Maia Rosenfeld and I wanted to know what lawyers and ethicists who work on health policy issues think about this proposal.听听

On the one hand, sources told听us,听this sort of detailed data could be used by the federal government to improve the largest employer-sponsored health insurance system in the country.听

But doubts about the Trump administration’s motives percolated through every conversation we had.听

“The concern here is the more information they have, they听could use it to discipline or target people who are not cooperating politically,” Sharona Hoffman, a health law ethicist at Case Western Reserve University, told me.听听

And, though the notice states that insurers are legally听permitted听to听disclose听“protected health information” to the agency for “oversight,” Hoffman and others raised questions about OPM’s access to such a sweeping database of medical records under federal health privacy laws.听听

Insurance companies 鈥� several of which declined to comment 鈥� would have to provide monthly reports to OPM with data on their members. One insurer, CVS Health, said in a public comment that insurers would be breaking the law by providing the information for OPM’s “vague and broad general purposes.” The association that听represents听many of those companies also has voiced objections to the proposal, which has not yet been听finalized.听听

OPM spokespeople did not respond to our repeated requests for comment.

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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This story can be republished for free (details).

At the Trump administration’s request, a federal judge in Louisiana this week agreed to delay a ruling affecting the continued availability of the abortion drug mifepristone. That angered anti-abortion groups that want the drug, if not banned, at least more strictly controlled. But the administration clearly wants to avoid big abortion fights in the run-up to November’s midterm elections.

Meanwhile, the administration’s proposed budget for fiscal year 2027 calls for more than $15 billion in cuts to programs at the Department of Health and Human Services. It’s a significant number, but less drastic than cuts it proposed for fiscal 2026.

This week’s panelists are Julie Rovner of 麻豆女优 Health News, Lauren Weber of The Washington Post, Alice Miranda Ollstein of Politico, and Maya Goldman of Axios.

Panelists

Among the takeaways from this week’s episode:

• The Trump administration says it is conducting a thorough scientific review of the abortion pill mifepristone at the Food and Drug Administration. Yet advocates on both sides of the abortion debate think the administration is just trying to buy time to avoid a controversial decision about medication abortion before November’s midterm elections.
• It’s budget time on Capitol Hill. With the unveiling of the president’s spending plan for fiscal 2027, Cabinet secretaries will make their annual tour of congressional committee hearings. HHS Secretary Robert F. Kennedy Jr., whose Hill appearances have been few during his tenure, is scheduled to testify before six separate House and Senate committees before the end of the month.
• Back at HHS, Kennedy appears to be trying to reconstitute the Advisory Committee on Immunization Practices in a way that will enable him to restock it with vaccine skeptics without running afoul of a March court ruling that he violated federal procedures with his replacements last year.
• Continuing his efforts to promote his Make America Healthy Again agenda, Kennedy announced this week that he will launch his own biweekly podcast. He also announced efforts to combat microplastics in the water supply and to get hospitals to stop serving ultraprocessed food to patients.

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

Julie Rovner: The Atlantic’s “,” by Katherine J. Wu.

Maya Goldman: 麻豆女优 Health News’ “Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records,” by Amanda Seitz and Maia Rosenfeld.

Lauren Weber: CNN’s “,” by Holly Yan.

Alice Miranda Ollstein: Politico’s “,” by Simon J. Levien.

Also mentioned in this week’s podcast:

• JAMA Internal Medicine’s “,” by Lauren J. Ralph, C. Finley Baba, Katherine Ehrenreich, et al.
• 麻豆女优 Health News’ “Immigrant Seniors Lose Medicare Coverage Despite Paying for It,” by Vanessa G. Sánchez, El Tímpano.
• The New York Times’ “,” by Ellen Barry.
• Stateline’s “,” by Nada Hassanein.
• The Washington Post’s “,” by Lena H. Sun.

[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 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 health reporters covering Washington.听We’re听taping this week on Thursday,听April 9, at 9:30听a.m.听As always, news happens fast, and things might have changed by the time you hear this. So here we go.听

Today, we are joined via video conference by Lauren Weber听of听The Washington Post.听

Lauren Weber:听Hello,听hello.听

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

Alice Miranda听Ollstein:听Hi,听everybody.听

Rovner:听And my fellow Michigan Wolverine this national championship week,听Maya Goldman of Axios.听Go,听Blue!听

Maya Goldman:听Go,听Blue.听

Rovner:听No interview this week, but plenty of news.听So听let’s听get right听to听it.听We’re听going to start with reproductive health. On Tuesday, a federal judge in Louisiana ruled for the Trump administration and against anti-abortion forces in a lawsuit over the availability of the abortion pill听mifepristone.听Wait, what? Please explain,听Alice,听how the administration and anti-abortion groups ended up on opposite sides of an abortion pill lawsuit.听

Ollstein:听Yeah.听So听this has been building for a while, and it is not the only lawsuit of its kind out there. There are several.听A听bunch of different state attorneys general,听who are very conservative and anti-abortion, have been suing the FDA听in an attempt to听either completely get听rid of the availability听of the abortion pill听mifepristone听or reimpose previous restrictions on it.听So right now, at least according to federal rules, not according to every state’s听rules,听you can get it via telehealth.听You can get it delivered by听mail. You can pick it up at a retail听pharmacy. You听don’t听have to get it in person handed to you from a doctor like you used to.听So听these lawsuits are听attempting听to bring back those restrictions or get the kind of national ban that a lot of groups want.听And听so听you have听other ones听pending:听Florida, Texas,听Missouri,听you have a bunch of ones.听So听this is the Louisiana version. And the Trump administration,听it’s听important to note, they are not defending the FDA or the abortion pill on the merits. They are saying,听we听don’t听want this lawsuit and this court to force us to do something.听We want to go through our own careful process and do our own internal review of the safety of mifepristone, and then we may decide to impose restrictions. But听they’re听asking courts to give them the time and space to complete that process and saying, you know,听This听is our power we should have in the executive branch. And so,听in this case, the judge,听in ruling for the Trump administration,听basically just听hit pause. This听doesn’t听get rid of the case. It just puts听a stay on it for now, and听that’s听important.听In some of these other cases, the Trump administration has asked the courts to throw out the case, but that was not the situation here.听So听this听doesn’t听mean that abortion pills are going to be available forever. This听doesn’t听mean听nothing’s听going to happen,听and听they’re听going to be banned. This just means, you know,听we’re听kicking the can down the road.听听

Rovner:听I was saying,听just to be clear. I mean, we know that this FDA quote-unquote听“study”听鈥斕齱hether it is or isn’t going on听鈥斕齣s part of, kind of,听a delaying tactic by the administration, because they don’t want to really make abortion a big front-and-center issue in the midterms.听So听they’re听trying to听sort of run听the clock out here. Is that not听sort of the听interpretation听that’s听going on right now?听听

Ollstein:听That’s听what people on both sides assume is going on.听It’s听really been fascinating how everyone is being kept in the dark about听what’s听happening inside the FDA听鈥斕齛nd if this review is even happening, if听it’s听real, if听it’s听in good faith, what is it based on? And听so听it’s听become this sort of Rorschach test,听where people on the left are saying, you know,听They’re听laying the groundwork to do a national ban. This is just听political听cover. They just want to wait until after the midterms, and then听they’re听going to go for it. And people on the right are saying, you know,听The听administration is cowardly, and they听aren’t听really doing anything, and听they’re听just trying to get us to shut up and be patient. We听don’t听know if either of those interpretations or听neither of听them听are true.听听

Rovner:听Lauren,听you听want to add something?听

Weber:听I just think it’s听pretty clear听this is also just on a听[Health and Human Services Secretary Robert F.]听Kennedy听[Jr.]听priority.听I mean,听let’s听go back. The man听鈥μ齝omes from one听of听the top Democratic political families originally. You know,听there’s听obviously been a lot of chatter around his anti-abortion beliefs. Now, obviously,听he’s听on a Republican ticket. I think some of that plays into this as well. And he already has his hand on the stove on so many other听hot issues听that,听[if]听I had to guess,听I听don’t听think that听they’re听trying to rock the boat on this one.听鈥μ齀 think, some background context too, to some of听what’s听going on.听听

Rovner:听We’ll听get to some of those hotter issues. But,听meanwhile, the Journal of the American Medical Association听[Internal Medicine]听has a听听suggesting that medication abortion is so safe that it could be provided over the counter听鈥斕齮hat’s听without any consultation with a medical professional, either in person or online. This听doesn’t听feel like听it’s听going to happen anytime soon, though, right? While听we’re听still debating the existence of medication abortion in general.听

Ollstein:听That’s听right. I mean, there are a lot of people who听can’t听get this medication prescribed by a valid doctor right now, let alone over the counter. I will say it is common in a lot of parts of the world to get it over the counter,听whereas听in the United States, the most common way to have a medication abortion is with a two-pill combination,听mifepristone听and misoprostol. In a lot of parts of the world, people just use misoprostol alone, and it is听effective听and it is听largely safe.听It’s听slightly less safe than using both pills together. And听so听I think听there’s听a lot of international data out there, and people point to that and advocate for this. And I will say there are activist groups in the United States who are setting up networks, underground networks, to get these pills to people with no doctor’s involvement. And so that is already going on. I think that a lot of people would prefer to get it from a doctor if they could.听But because of bans and restrictions, they听can’t. And听so听people are turning to these activist groups.听

Rovner:听I will point out, as a person who covered the entirety of the fight to have emergency contraception听鈥斕齱hich is not the abortion pill听鈥斕齧ade over the听counter,听it took like, 15 years. It shortened my听life听covering that story. Lauren, did you听want to add something?听听

Weber:听Yeah, I just wanted to say I find it听really interesting.听Obviously, reproductive issues end up taking 15 years, as you pointed out, to make it over the counter.听But there are a lot of things that are considered potentially more dangerous that you can听order up听in听a pretty basic telehealth visit or even just buy in not-so-sketchy ways that the administration is also even looking to deregulate.听So听I think the differences听of听access听of听this compared to other less studied, potentially more unsafe medication is quite striking.听

Goldman:听Part of听[President Donald]听Trump’s听“Great听Healthcare听Plan”听is making more medications available over the counter.听So听this is certainly something that they have said they want to do, in general.听This is a political nightmare, though, to do that for abortion.听

Ollstein:听Yeah,听and people have been pointing to this and a lot of other policies for a while to argue about something they call abortion exceptionalism, in which people apply a different standard to anything related to abortion, a different safety standard, a different standard of scrutiny than they do to medications for lots of other purposes.听And听you’ve听seen that, and that comes up in lawsuits and political arguments about this. And I think,听you know, people can point to this as another example.听

Rovner:听So last week, we听talked about the federal family planning program听Title听X, which finally got funded after months of delays. But Alice, you warned us that the administration was planning to make some听big changes听to the program, and now those have finally been announced. Tell us what the plan is for a program that’s provided birth control and other types of primary and preventive care since the early 1970s.听

Ollstein:听Well, the changes have听sort of听been announced. They’ve听more been teased. What we are still waiting for is an actual rule,听like we saw in the first Trump administration, that would impose conditions on the program. And听so听what we saw recently, it was part of a wonky document called a听“Notice of Funding Opportunity,”听or NOFO, for those in the D.C.听lingo. And听basically听it was signaling that when groups reapply听鈥斕齮hey just got this year’s money,听but when they reapply for next year’s money听鈥斕齣t sets up听sort of new听priorities and a new focus for the entire program. And what was really striking to me is, you听know,听this is a family planning program. It was created in the 1970s and it is primarily about delivering contraception to people who can’t afford it around the country, providing it to millions of people听who听depend on this program, and the word听“contraception”听did not appear in the entire 70-page document other than an assertion that it is overprescribed and has bad side effects. And instead, they signaled that they want to shift the program to focus on, quote,听“family formation.”听So听this is really striking to me.听I think we听saw some signs that something like this was coming. You know, about a year ago, there was some听Title听X听money approved to focus on helping people struggling with infertility.听But that was听sort of just听a subset of the program, and now it looks like they want to make that, you know, an overriding focus of the program.听So听I think when the actual rule to this effect drops, and we听don’t听know when that will be听鈥斕齱ill they wait till after the midterms听to, you know, avoid blowback? Who knows? I think there will certainly be lawsuits then.听But I think right now, this is just sort of a sign of where they want to go in the future.听And听it’s听important to note that it came very quickly on the heels of a big backlash from the anti-abortion movement over the approval of this year’s funding going out to听all of听the clinics that got it before, including Planned Parenthood听clinics.听The听anti-abortion groups were agitating for Planned Parenthood to be cut off at once, you know, not in the future,听right now.听

Rovner:听Just to remind people that the ban on Planned Parenthood听funding from听last year was for Medicaid, not for the听Title听X听program.听

Ollstein:听Right.听听

Rovner:听And that’s why Planned Parenthood got money.听

Ollstein:听Yes, and Planned Parenthood is not allowed to use any Medicaid or听Title听X听money听for abortions, but the anti-abortion groups say it functions like a backdoor subsidy, and so they wanted it to be听cut听off.听So听they were very pissed that this money went out to Planned Parenthood. And so very quickly after,听the administration put out this document, saying,听Look, we are taking things in another direction, and it is not the direction of Planned Parenthood.听

Rovner:听Lauren,听you听want to add something?听

Weber:听Oh, I just wanted to say Alice has really been owning the beat on all the听Title听X听coverage, so听鈥μ�

Rovner:听Absolutely.听听

Weber:听鈥μ齡lad we听are able to听have her explain it to us.听But听just wanted to throw out听a听kudos for breaking all the news on that front.听听

Goldman:听Yeah, great coverage.听

Rovner:听Yes.听Very happy听to have you听for听this. Turning to the budget, which is normally the major activity for Congress听in the spring, we finally got President Trump’s spending blueprint last week. It does propose cuts to discretionary spending at the Department of Health and Human Services to the tune of about听$15 billion,听but those cuts are far less deep than those proposed last year.听And,听as we have noted, Congress didn’t听actually cut听the HHS budget last year by much at all.听And many programs, like the National Institutes of Health,听actually got听small increases. Is this budget a reflection of the fact that the administration is recognizing that cuts to听Health and听Human听Services programs听aren’t听actually popular听with the public or with Congress, for that matter, going into a midterm election?听

Weber:听I think听it’s听that last little piece you mentioned there, Julie. I think听it’s听the听“going into the midterm election.”听I think you听hit the nail on the head听there. Cuts are also not good economically for many Republicans.听You know, we saw Katie Britt be one of the听鈥� the听Alabama Republican senator听鈥斕齜e one of the most outspoken senators in general about some of the cuts that were floated for the budget for HHS last year.听So听I think what听you’re听hinting at, and what听we’re听getting at, is that听it’s听not politically听popular,听it can be economically problematic, on top of the scientific advances that are not found.听So听I suspect you are right听on听that.听

Ollstein:听The administration knows that this is听“hopes and dreams”听and will not become reality. It did not become reality last year. It almost never becomes reality. And I think you can see the sort of acknowledgement that this is about sending a message more than actually making policy in things like听Title听X, because at the same听time they put out this guidance from HHS about the future of听Title听X, moving away from contraception,听in the听president’s budget he听proposed completely getting rid of听Title听X, completely defunding it, which he has in the past as well. And so why would they put out guidance for a program that听doesn’t听exist?听

Goldman:听I think,听also, this is the second budget that听they’re听putting out in this administration, right? So now they are just a little more used to听what’s听going on, and they have more of their feet under them.听

Weber:听As听a preview for listeners,听too,听I’m听sure we will have Kennedy asked about this budget when he appears in a series of so many hearings next week and the week after. And there were a lot of fireworks last year with him and various members of Congress about the budget.听So听I am sure that we will hear a lot more on this front in the听weeks to come.听

Rovner:听Yeah, I would say that’s one thing that the budget process does, is when the听president finally puts out a budget, the Cabinet听secretaries travel to all of the various committees on Capitol Hill to, quote,听“defend the听president’s budget,”听which is sometimes or,听I guess in the case of Kennedy, one of the few chances that they get to actually have him in person to ask him questions. But in the meantime, you know, we have the budget, then we have the president himself, who at an Easter lunch last week听鈥斕齮hat was supposed to be private, but ended up being听live-streamed听鈥斕齭aid, and I quote,听“It’s not possible for us to take care of day听care, Medicare, Medicaid, all these individual things.” The president went on to say that states should take over all that social spending, and the only thing the federal government should fund is, quote,听“military protection.”听Did听I just听hear听a thousand听Democratic campaign ads bloom?听

Goldman:听I think this听is a prime example of when you should take Trump seriously, but听not literally. I听don’t听think that听there’s听any world, at least in the听foreseeable future, where the federal government听isn’t听funding Medicare.听But,听you know, you certainly听have to听watch at听the margins.听It’s听like,听it’s听not a secret that this is something that听they’re听interested in cutting back听spending on.听It’s听super politically difficult to do that, and they know that, and that’s part of why, which听I’m听sure听we’ll听talk about in a little bit,听they bumped up the payment rate for 2027 to Medicare Advantage plans.听听

Rovner:听Which we will get to.听

Goldman:听Yeah, so I mean,听it’s听certainly an eye-opening statement, and you should remember it. But I听don’t听think that听we’re听in immediate jeopardy here.听

Rovner:听This is the听president who ran in 2024,听you know, saying that he was going to protect Medicare and Medicaid. I mean,听it’s听been, you know, against some of the recommendations of his own administration. I was just听sort of shocked听to see these words come out of his mouth. Lauren,听you wanted听to say听something?听听

Weber:听I mean,听it’s听not听that surprising, though. I mean, look at what the听One听Big听Beautiful Bill听[Act]听did to Medicaid.听He’s听already pushed through massive Medicaid cuts, which are听essentially being听offloaded to the states.听So, I mean, I think this ideology has already听borne听out and will continue to bear out, and obviously听it’s听happening amid the backdrop of a war. So that plays into, obviously, the commentary as well.听听

Rovner:听Well, meanwhile,听Republicans are still talking about doing another budget reconciliation bill, the 2.0 version of last year’s听Big听Beautiful听Bill, except this time it’s essentially just to fund the military and听ICE听[Immigration and Customs Enforcement]听and听border听control, because Democrats won’t vote for those things, at least they won’t vote for additional military spending.听What are the prospects for that to听actually happen?听And would Republicans really be able to do it if those programs are paid for with more cuts to Medicare and/or Medicaid, as some听have suggested?听

Goldman:听You know, my co-worker Peter Sullivan wrote about this last week, and there was a lot of听blowback听from politicos, from advocates, from, you know,听kind of across听the spectrum of groups there. I think that it would be extremely politically unpopular, especially going into the midterms, to use health听care as an offset. But I would say that Republicans are听pretty good听at rhetoric, right?听That’s听one of the things that听they’re听known for right now, and听there’s听always a way to spin it.听

Rovner:听Alice and I spoke to a group earlier this week, and I went out on a limb and predicted that I听didn’t听think Republicans could get the votes for another big budget reconciliation this year. I mean, look at how close it was last year. The idea of cutting any deeper seems to me unlikely, just given the margins that they have.听

Goldman:听And听I think that听is something that you听do in听between election years.听That’s听not something you do in an听election year.听

Rovner:听That’s听true, yes听鈥μ齳ou do tend to see these bigger bills in the odd-numbered years rather than the even-numbered years, but 鈥μ�

Ollstein:听And听I think听it’s听important to remember that the reason Republicans are in this bind and that they feel like they听have to听keep reconciliation nearly focused on funding immigration enforcement is because Democrats refuse to fund immigration enforcement.听And听so听they feel pressured to put all their effort and political capital towards that, and听don’t听want to mess that up by adding a bunch of other听health听care things that could cause fights and lose听them听votes.听听

Goldman:听The money听has got to听come from somewhere.听

Rovner:听And听health听care is where all the money is.听Speaking of Medicare and Medicaid,听where most of the money is,听there is news on those fronts,听too.听Maya, as you hinted on Medicare, the administration is out with its payment rule for private Medicare Advantage plans for next year. And remember,听we talked about how HHS was going to really go after overbilling in Medicare Advantage and cut reimbursement dramatically?听Well, you can forget all that. The final rule will provide plans with a 2.48% pay bump next year.听That’s听compared to the less than 1% increase in the proposed rule.听That’s听a difference of about听$13 billion.听The final rule also听eliminated听many of the safeguards that were intended to prevent overbilling. What happened to the crackdown on Medicare Advantage?听Are their听lobbyists really that good?听

Goldman:听Their lobbyists are听pretty good. This was a year where there were听鈥斕齀 think CMS听[the Centers for Medicare & Medicaid Services]听said there were a record number of public comments on their proposed rate, flat rate increase, flat rate update. But I think听it’s听also not that surprising. Historically, the final rate announcement for Medicare Advantage is听almost always听a little higher than the proposed because they incorporate听additional听data from the end of the previous year that听wasn’t听available when first rate is proposed, the听initial听rate is听proposed.听But听certainly听they backed away from听a big change听to risk adjustment, or,听like, the way to adjust payment based on how sick a听plan’s听enrollees are. You get more pay听鈥μ�

Rovner:听Because听that’s where the overbilling was happening,听that we’d seen a lot of these wonderful stories that plans were basically, you know, inventing diagnoses for patients who didn’t necessarily have them or didn’t have a severe听illness, and听using that to get additional payments.听

Goldman:听Right.听And they did move forward with a plan to prevent diagnoses that are not linked to information听that’s听in a patient’s medical chart from being used for risk adjustment. But a lot of plans听had听said, like,听Yeah, this is,听that’s听the right thing to do, and听it’s听not going to be that impactful for us. You know, overall, this is a win for health insurance. I think one thing to note is that Chris Klomp, the director of Medicare, said,听We’re听still really focused on trying to right-size this program.听That’s听still a priority for us as an听administration, but we also want to safeguard it. And听so听I think insurers听are not听off the hook entirely.听There’s听still going to be a lot of scrutiny, but their lobbyists are听pretty good. And you know, no one wants to be seen as the candidate that cuts Medicare.听

Rovner:听And we have听seen this before, that when Congress cuts听“overfunding”听for Medicare Advantage, the plans,听seeing that they听can’t听make its big profits,听drop out or they cut back on those extra benefits. And the beneficiaries complain because they’re losing their plans, or they’re losing their extra benefits, and they don’t really want to do that in an election year either, because there are a lot of people, many millions of people, who vote who are on these plans. So,听in some ways, the plans have the administration over a political barrel, in addition to how good their lobbyists are.听听

Well, apparently, one听group that HHS is still cracking down on are legal immigrants with Medicare. Most of the publicity around the health cuts in last year’s budget bill focused on the cuts to Medicaid.听But听we at 麻豆女优 Health News have a story this week听about legal immigrants听who’ve听paid into the Medicare system with their payroll taxes for years and are now being cut off from their Medicare coverage. This is听apparently the听first time an entire category of beneficiaries听are听having their Medicare taken away.听I’m听surprised there听hasn’t听been more attention to this, or听if听it’s听just too听much听all happening at once.听

Ollstein:听I mean,听there’s听a lot happening at once, and even just in the space of immigrants’听access to health care, there is so much happening at once. And听so听this is obviously having听a huge impact听on a lot of people, but so are 100 other things. And I think, you know, the zone has been flooded as promised. And really, state officials who are also dealing with听a thousand听other things, Medicaid cuts, you know, these听federal changes,听work requirements,听are grappling with this听as well.听

Rovner:听Lauren,听you wanted听to add something?听

Weber:听Yeah. I mean, I thought it was, there was a striking quote in the story from Michael听Cannon, who听basically said,听The听reason this听isn’t听resonating is because this听won’t听upset the Republican base. And I think听that’s听a striking quote to be听considered.听

Rovner:听Michael听Cannon, libertarian health policy expert,听just听kind of an听observer to this one. But听yeah, I think听that’s听true. I mean, or at least the perception is that these are not Republican voters, although, you know, as听we’ve seen, you know, Congress has tried to take aim at people they think aren’t their voters, and it’s turned out that those are their voters.听So听we will see how this all plays out.听听

Well,听at the same time that听this is all going on, the folks over at the newsletter听“Healthcare听Dive”听are reporting that the Centers for Medicare听&听Medicaid Services are trying to embark on all these new initiatives on fraud,听and work requirements,听and artificial intelligence with a diminished workforce.听While CMS lost far fewer workers in the听DOGE [Department of Government Efficiency]听cuts last year than many other of the HHS agencies听鈥斕齣t was in the hundreds rather than the听thousands听鈥斕鼵MS has long been understaffed,听given the fact that it manages programs that provide health insurance to more than 160 million Americans through not just Medicare and听Medicaid, but also the Children’s Health Insurance Program and the Affordable Care Act. I know last week, FDA听Commissioner Marty听Makary听said he wants to hire more workers to replace the 3,000 who were听RIF’ed听or took early retirement there at the FDA.听And CMS does have lots of job openings听being advertised.听But听it’s听hard to see how replacing trained and experienced workers with untrained, inexperienced ones听are听going to improve efficiency, right?听

Goldman:听Tangentially, I was talking to a health insurance executive yesterday who was saying that his team is so much bigger than CMS, and they cover a fraction of the market, and they’re often the ones coming to CMS and proposing ideas and working with CMS on it. I听don’t,听I think that听is a dynamic that far predates this administration, but听鈥μ�

Rovner:听Oh, absolutely.听

Goldman:听But听it’s听certainly interesting. And听鈥μ鼵MS has听very ambitious听plans, and not that many people to carry them out. But, you know, I think one thing that I also want to note is that when I talk to trade associations and stakeholders about this听CMS, they are generally like, pretty support-听鈥μ齦ike,听they say that they think they’re being heard, and they think that CMS and the career staff are doing, you know, the same kind of caliber of work that they’ve been doing, which I think is notable.听

Rovner:听And as we have mentioned many times, you know, Dr.听[Mehmet]听Oz, the head of CMS, is very serious about his job and doing a lot of听really interesting听things.听It’s听just,听it’s听hard, you know, in the federal government, if you听don’t听have the resources that you want to听鈥μ齣f you听don’t听have the resources to match your ambitions.听Let’s听put it that way.听听

Well, meanwhile, on the Medicaid front,听we’re听already seeing states cutting back, and some of the results of those cutbacks.听听on听how psychiatric units are at risk of being shut down due to the Medicaid cuts, since they often serve a disproportionate number of low-income people听and also听tend to lose money.听And听The New York Times has a听听of an Idaho Medicaid cutback of a program that had provided home visits to people living in the community with severe mental illness, until those people who lost the services began to die or to end up back in more expensive institutional care. Now the state has resumed听funding听the听program, but听obviously will end up having to cut someplace else instead. I know when Republicans in Congress passed the cuts last year, they said that people on Medicaid who were not the able-bodied working-age populations听wouldn’t听see their services cut. But听that’s听not how this is playing out, right?听听

Weber:听I just听think the story by Ellen Barry, who you should always read听on听mental health issues in听The New York Times,听“,”听is such an听illustrative example of unintended consequences from these cuts.听And the reason that听they’re听being reversed听鈥斕齜y Republican legislators, no less听鈥斕齣n Idaho, is because听it’s听more expensive to have cut the money from it than it is efficient. I mean, what they found was, is听that after they cut the money to the schizophrenia program, they saw this massive uptick in law enforcement cases and hospitalizations, uninsured hospitalizations,听that this avoided. And I think听it’s听a real canary in the coal听mine听situation, because听we’re听only starting to see these states cut these things off. And this was听a pretty immediate听multiple-death consequence. And I think听we’re听going to see a lot of stories like this, of a variety of programs that we all听don’t听even have any idea that听exist听in the safety net across the country that听are听being听chipped away at.听听

Rovner:听Well, turning to听other news from the Department of Health and Human Services,听we’re听getting some more competition here at听What听the Health?听Health听secretary Kennedy has announced听he’ll听be unveiling his own podcast,听called听The Secretary Kennedy听Podcast, next week. He promises to,听according to the trailer posted online on Wednesday, quote,听“name the names of the forces that obstruct the paths to public health.”听OK听then,听we look forward to listening.听听

Meanwhile, in actual secretarial work, the听secretary this week also unveiled changes to the charter of the Advisory Committee on听[Immunization]听Practices after a federal judge last month invalidated both the replacement members that he’d appointed last听year听and the changes made to the听federally recommended vaccine schedule.听So听what’s听going to happen here听now?听Will this get around the judge’s ruling by watering down the听expertise听that members of this advisory committee are supposed to have in vaccines? And why hasn’t the administration听appealed听the judge’s听ruling yet?听

Goldman:听You know, I don’t have actual answers to this, but I do wonder and speculate that this is going to end up being some kind of legal whack-a-mole situation where the听secretary and HHS听says,听OK, you don’t like it that way?听We’ll听do it this way, and then听they’ll听do it another way, and advocates will sue, and听we’ll听see how this plays out going forward in the courts.听I think this听is not the end of the story.听Even though the judge’s decision was a big win for vaccine advocates,听it’s听just听we’re听in the midpoint, if that.听

Rovner:听And Lauren, speaking of vaccines, your colleague Lena听H. Sun has听听on HHS and vaccine policy.听

Weber:听Yeah, Lena听Sun is always delivering.听She found out that the acting director of the CDC听[Centers for Disease Control and Prevention]听at the time delayed publication of a report showing that the covid-19 vaccine[s]听cut the likelihood of emergency department visits and hospitalizations for healthy adults last winter by about half. So even though Kennedy is not talking more about vaccines, it appears that, based on this reporting,听that some of his underlings are not necessarily touting the benefits of听vaccine, so to speak.听And I’m very curious, going back to Kennedy’s podcast, I found the rollout of that so interesting because the teaser听was very听leaning into听the Kennedy听that got elected, you know, someone who speaks about, you know, dark truths that are hidden from the public,听and so on. And then the press team had these statements of,听like,听Kennedy will investigate the affordability of health听costs and food听and nutrition.听And I think this dichotomy of who Kennedy is and who the听White House and the press secretary and HHS want Kennedy to be before the midterms really could come to a head in this podcast.听So听I think we will all be listening to hear how that goes.听

Rovner:听Yeah, we keep hearing about听how the听secretary is being, you know,听sort of put听on a leash, if you will. And, you know, told to downplay some of his anti-vaccine views and things like this. And that seems quite听at odds听with him having his own podcast. Alice,听do you want听to 鈥�?听

Weber:听I guess, it depends on听who’s听editing the podcast and who they have on.听I’m听just very听鈥μ齳ou could even tell from the trailer to how his press secretary presented it, there was an interesting differential in framing, and I am curious how that plays out as we see听guests on it.听

Ollstein:听I mean,听it’s听also worth noting that this is an administration of podcasters. I mean, you have听Kash听Patel,听you have so many of these folks who have a history of podcasting,听clearly have a passion for it, just听can’t听let it go while working a听full-time, high-pressure听government job.听听

Rovner:听We shall see.听Meanwhile, HHS, together with the Environmental Protection Agency, is waging听war听on microplastics, those听nearly too听impossible听to听detect bits of plastic that are getting into our lungs and stomachs and body tissues through听air and water听and food. The plan here seems to be to find ways to detect exactly how much microplastics we are all getting in our water and what the health impacts might be, since we听don’t听have enough information to regulate them yet.听I would think this would be one of those things that听pleases听both MAHA听[Make America Healthy Again]听and the science community, right? Or is it just,听as one MAHA听supporter听called it,听theater?听

Goldman:听I think this听is听a great example听of the,听you know, part of the听reason why听MAHA听is so interesting to such a wide swath of people.听Like,听there’s听a lot of legitimate concern, not that other concerns听aren’t听necessarily legitimate, but听there’s听a lot of concern over,听from the scientific community, over microplastics.听I’m听honestly surprised that听we’re听this far into the administration with this announcement. I would have thought that this听is听something they would have done sooner, but they obviously had other priorities听as well.听

Rovner:听Well. Finally, this week, speaking of other priorities, HHS Secretary Kennedy and CMS Administrator Dr.听Oz are declaring war on junk food in hospitals. Again, this seems like a popular and听fairly harmless听crusade;听hospitals听shouldn’t听be serving their patients听ultraprocessed听food.听Except,听almost as soon as the announcement came out, I saw tons of pushback online from doctors and nurses who worried about patients for whom sugary food or drinks are actually medically indicated, or who,听because of medications they’re taking, or illnesses they have, can only eat, or will only eat, highly palatable, often processed food. Nothing in health听care is as simple as it seems, right?听听

Weber:听I think听what’s听also interesting is one of my favorite examples in the memo they put out was they hope that every hospital, as an example, could serve quinoa and salmon. And I听just am听curious to see how fast that gets implemented. And听it’s听a very听valid听鈥斕齛 lot of people complain about hospital food.听It’s听a very valid thing to push for better food. But I also question, as I understand听it,听this seems more like a carrot than a stick when it comes to the regulation they put out.听

Rovner:听As it were.听

Weber:听As it were.听And听so听I’m听curious to see how it gets implemented. That said, there are hospitals that have taken it upon themselves听鈥斕齮he Northwell听[Health]听example in New York is a good example听鈥斕齮o really improve their hospital food. And frankly,听it’s听a money maker. If your food’s better, people come to your hospital, especially听in听an urban area where there is hospital competition.听So听you know, like most MAHA听topics, there’s a lot of interesting points in there, and then there’s a lot of what’s听the reality听and what’听actually going听to happen. And听so听I’听very curious to see how this continues to play.听

Rovner:听I听did听a big听story,听like,听10 years ago on a hospital chain that had its own听gardens,听that听literally grew听its own healthy food.听So听this is not completely new but,听again, interesting.听

All right, that is this week’s news. 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. Alice, why don’t you start us off this week?听

Ollstein:听I听have a piece from my co-worker Simon听[J.]听Levien, and it is called听“.”听This is about听thousands of doctors around the country who are from other countries that are placed on, you know, a list by the Trump administration of places where they want to scrutinize and limit the number of immigrants coming from there. And so these are people who are already here, already practicing, have poured years into their training, have been living here, and,听in some cases, are the only folks willing to work in certain areas that have a lot of medical shortages, and they just can’t practice because their paperwork isn’t getting processed in time. And听so听they’re听sort of in听this scary limbo, and听that’s听putting these hospitals and clinics that they work in in a听really tough听bind. And听so听they’re听hammering the Trump administration to give them answers about what their fate is. You know,听they’re听not trying to deport them yet, but听they’re听not allowing them to continue working either.听听

Rovner:听For an听administration that’s been pushing听really hard听to improve rural health care, this does not seem to be a way to improve rural health care.听Maya.听

Goldman:听My extra credit this week is called听“Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records.”听It’s听a great听麻豆女优听Health听News听scoop听from Amanda Seitz and听Maia Rosenfeld. It’s a really great example of the administration, you know, sort of moving in silence,听doing听these small regulatory announcements that could have听big听impact.听Basically, the听Office of Personnel Management is asking for personally identifiable medical information from health insurers, and its reasoning is to analyze costs and improve the health system, but they could get听very detailed听medical information from federal employees, including things like, did they get an abortion? Are they undergoing gender-affirming care? And,听obviously,听there is a strong听concern that听that could be used against them.听听

Rovner:听Yeah听鈥μ齮his was quite a scoop. Really,听really听interesting听story. Lauren.听

Weber:听Mine听was听a pretty alarming听story by Holly Yan at CNN:听“.”听And basically there’s this type of drug test that the scientists have found is not that effective, and it’s led to things like bird poop being scraped off a man’s car appearing on a drug test as cocaine, a great-grandmother’s medication testing positive for cocaine, and a toddler’s ashes registering as meth or听ecstasy, and horrible legal and other consequences of this听kind of misdiagnosis in the field. And the reason these drug tests are often done is because听they’re听cheaper.听There’s听a more expensive, more听accurate听version, but these are cheaper.听They’re听done in the field.听But the potential side effects and horrible, wrongly accused effects are quite large, and so听Colorado has passed this law to try and move away from this. And听it’s听curious to see if other听states will follow suit.听

Rovner:听Yeah, this was something I knew nothing about until I read this story. My extra credit this week is from听The Atlantic by听Katherine听[J.] Wu,听and听it’s听called听“.” And it’s about how some of the very top career officials from the NIH听[National Institutes of Health],听the CDC,听and other agencies have, after having been put on leave more than a year ago, finally been reassigned to听far-flung听outposts of the Indian Health Service in the western United States. They got news of their proposed reassignments with little description of their new roles and only a couple of weeks to decide whether to move across the country or face termination. Now,听if these officials’听skills matched those needed by the Indian Health Service, this all might make some sense.听But what听the IHS听most听needs听are active clinicians:听doctors and nurses and social workers and lab technicians.听And those who are now being reassigned are largely managers, including听鈥斕齛nd here I’m reading from the story,听quote听鈥� “the directors of several NIH institutes, leaders of several CDC centers, a听top-ranking听official from the FDA tobacco-products听center, a bioethicist, a human-resources manager, a communications director,听and a technology-information officer.”听The听Native populations who are听ostensibly being听helped here听aren’t听very happy听about this, either. Former Biden administration Interior Secretary Deb Haaland, a Native American听who’s听now running for governor in New Mexico, called the reassignment proposals, quote,听“shameful”听and听“disrespectful.”听Also, and this is my听addition, not a very efficient use of human capital.听

OK, that’s this week’s show.听Thanks听this week to our fill-in editor,听Mary-Ellen听Deily, and our producer-engineer,听Francis Ying.听A reminder:听What the Health?听is now available on WAMU platforms, the NPR app, and wherever you get your podcasts 鈥� as well as, of course,听kffhealthnews.org. Also,听as always, you can email听us听your comments or questions.听We’re听at whatthehealth@kff.org.听Or you can find me on X听, or on Bluesky听.听Where do听you guys听hang听these days? Maya.听

Goldman:听I am on LinkedIn under my first and last name,听, and on听X听at听.听

Rovner:听Alice.听

Ollstein:听I’m听on听Bluesky听听and on听X听.听

Rovner:听Lauren.听

Weber:听Still听@LaurenWeberHP听on听both听听and听.听

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

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A from the Office of Personnel Management could dramatically change which personally identifiable medical information the agency obtains, giving it the power to see prescriptions employees had filled or what treatment they sought from doctors. The regulation would require 65 insurance companies that cover more than 8 million Americans 鈥� including federal workers, retired members of Congress, mail carriers, and their immediate family members 鈥� to provide monthly reports to OPM with identifiable health data on their members.

The proposal is prompting unease from insurers as well as health policy and legal experts, who are concerned about the legality of OPM acquiring such a sweeping database of sensitive health information, and the agency’s ability to safeguard it.

OPM could use the data to analyze costs and improve the system, said Sharona Hoffman, a health law ethicist at Case Western Reserve University in Ohio.

“But,” she said, “they are going to get very, very detailed and granular data about everything that happens. The concern here is the more information they have, they could use it to discipline or target people who are not cooperating politically.”

OPM spokespeople did not respond to repeated requests for comment. The agency’s notice asks insurers that offer Federal Employees Health Benefits or Postal Service Health Benefits plans to furnish “service use and cost data,” including “medical claims, pharmacy claims, encounter data, and provider data.” It says the data will “ensure they provide competitive, quality, and affordable plans.”

The notice, posted and sent to insurers in December, does not instruct them to redact identifying information 鈥� a burdensome process that they would need federal guidance to complete.

Instead, it states that insurers are legally permitted to disclose “protected health information” to OPM. Several experts in health policy and law consulted by 麻豆女优 Health News said they interpreted the request to mean the Trump administration was seeking identifiable data.

The ask comes a year into a Republican administration that has been defined by haphazard mass layoffs and firings of thousands of federal workers, who say they were in acts of or for the . Under President Donald Trump, the government has also routinely tested the legal bounds of sharing sensitive and personally identifiable tax or health information across government agencies in its efforts to carry out mass immigration arrests or pursue identify fraud.

“You can anticipate a scenario where this information on 8 million Americans is now in the hands of OPM and there’s a real concern of how they use it,” said Michael Martinez, senior counsel at Democracy Forward, an advocacy organization that filed a public comment opposing OPM’s proposal in February. Martinez previously worked at OPM.

“They’ve given no information about how they would treat that information once they have it,” he said.

Among Martinez’s concerns is how the administration might use information about employees who have sought abortions 鈥� 41 states have some type of abortion ban 鈥� or transgender treatment, medical care that the Trump administration has tried to curb.

The American Federation of Government Employees, the largest union representing federal workers, did not respond to requests for comment.

Martinez and others who reviewed the notice for 麻豆女优 Health News said the proposal was so vague that they were uncertain, exactly, what medical records OPM wants to access.

At the very least, they said, the proposal would allow the agency to access the medical and pharmaceutical claims of patients with their identifying information, such as names and birth dates. Claims data also includes diagnoses, treatments, visit length, and provider information.

OPM’s request to view “encounter data” could allow the agency to look at “anything and everything,” Hoffman noted.

That could include detailed medical records, such as a doctor’s notes or after-visit summaries.

Jonathan Foley, who worked at OPM advising on the Federal Employees Health Benefits program during the Obama and Biden administrations, said he doubts the agency has the capability to ingest such minutiae.

The agency, however, could easily begin collection of personally identifiable medical and pharmaceutical claims information from insurers, he said.

Foley said he sees a benefit to OPM having broader access to de-identified claims data. In recent years, OPM has ramped up its analysis of claims data, which has allowed it to examine prescription drug costs and encourage plans to offer federal workers cheaper alternatives. He’s worried, though, that the Trump administration’s proposal goes too far, because it appears to seek identifiable data.

“It’s kind of shocking to think of them having protected health information without having strict guardrails,” he said.

The Health Insurance Portability and Accountability Act of 1996, or HIPAA, requires certain organizations that maintain identifiable health information 鈥� such as hospitals and insurers 鈥� to protect it from being disclosed without patient consent.

Those entities can disclose such information without consent only in specific scenarios, with a justification that it is deemed “reasonable” or “necessary.” Even then, HIPAA mandates that they provide only the minimum amount of information required.

OPM argues in its notice that it is entitled to the information from insurers “for oversight activities.”

But several people who reviewed the notice questioned whether OPM’s explanation for requesting the information is sufficient.

“The language in it seems quite broad and encompasses potentially a lot of information and data and is sort of light on justification,” said Jodi Daniel, a digital health strategist who helped develop the legal framework for HIPAA privacy rules over two decades ago.

Several major insurers that offer federal employee health plans 鈥� including the Blue Cross Blue Shield Association, Kaiser Permanente, and UnitedHealthcare 鈥� declined to comment on their plans to comply with the notice or offer insight on where plans to implement the data sharing stood.

Only one insurer individually weighed in with a public comment on OPM’s plan. In March, CVS Health executive Melissa Schulman urged the federal agency to reconsider its proposal.

“OPM’s request raises substantial HIPAA compliance issues,” Schulman wrote, arguing that federal law allows the agency to examine records but not to collect data. Insurers would be breaking the law by providing personal health information for OPM’s “vague and broad general purposes,” she added.

Schulman, who did not respond to additional questions from 麻豆女优 Health News, also raised concerns about a lack of data privacy protections. She noted that insurers could be liable for security breaches or other situations “where consumer health information is inappropriately shared and outside of our control.”

In 2015, OPM announced the personal records of roughly 22 million Americans had been in a data breach that has been blamed on the Chinese government.

The Association of Federal Health Organizations, which represents CVS Health and dozens of other federal health plan carriers, also weighed in with a 122-page comment opposing the notice. In it, AFHO Chair Kari Parsons emphasized that insurance carriers are bound by HIPAA to safeguard personal health information.

Federal law requires carriers “to furnish 鈥榬easonable reports’ OPM determines to be necessary,” Parsons wrote, “not to furnish the individual claims data of every individual.”

This isn’t the first time OPM has requested detailed data from insurers. In the AFHO comment, Parsons noted OPM had made a similar proposal in 2010, prompting HIPAA concerns. She described how, after several years of negotiations with AFHO, they discussed 鈥� but OPM never finalized 鈥� an agreement in 2019 for carriers to share de-identified data with OPM.

But since then, Parsons wrote, OPM has collected such detailed information on enrollees and their families that, with OPM’s new request, the agency may be able to trace even de-identified records to individuals.

OPM has not provided any update since closing comments in March. The agency would need to publish a final decision before anything officially changes.

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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Vestida con ropa de senderismo y collares de cuentas, Carranza, de 67 años, se movía entre árboles y niños en una mañana soleada de diciembre. “Agárrate de esa rama”, dijo en español. “隆Tú puedes, mi amor!”.

Carranza, profesional especializada en desarrollo infantil que creció columpiándose entre árboles y nadando en ríos en El Salvador, dijo que se siente como en casa en el bosque del preescolar al aire libre que cofundó. Ha trabajado con niños y adolescentes como cuidadora y educadora durante más de tres décadas, el tiempo suficiente para saber cuándo intervenir y cuándo dar un paso atrás para que sus estudiantes encuentren su propio equilibrio.

Cuando pasó a trabajar medio tiempo el año pasado, Carranza contaba con recibir Medicare y cheques del Seguro Social, beneficios otorgados a trabajadores estadounidenses e inmigrantes con presencia legal cuando se retiran, si de historial laboral y edad, o si tienen alguna discapacidad.

Carranza ha aportado decenas de miles de dólares a Medicare y al Seguro Social durante 24 años, según su registro de ingresos de la Administración del Seguro Social, revisado por El Tímpano y 麻豆女优 Health News. Pero Carranza es una de un estimado de 100.000 inmigrantes con papeles que pronto quedarán excluidos de Medicare.

La ley One Big Beautiful Bill Act del Partido Republicano, firmada en julio pasado por el presidente Donald Trump, prohíbe que ciertas categorías de inmigrantes con presencia legal 鈥� incluidos beneficiarios del estatus de protección temporal (TPS), refugiados, solicitantes de asilo, sobrevivientes de violencia doméstica, víctimas de trata y personas con visas de trabajo 鈥� accedan a Medicare.

Quienes ya están en el programa, como Carranza, serán dados de baja antes del 4 de enero, una medida de legisladores republicanos para reducir el gasto de Medicare, ya que, junto con Trump, han argumentado que el dinero de los contribuyentes no debe usarse para pagar la atención médica de inmigrantes sin autorización.

“Los demócratas quieren que los inmigrantes ilegales, muchos de ellos CRIMINALES VIOLENTOS, reciban atención médica GRATIS”, dos meses después de firmar la ley. “隆No podemos permitir que esto suceda!”

Sin embargo, las categorías de inmigrantes que ahora perderán cobertura sí tienen estatus legal. Ni la Casa Blanca ni el Departamento de Salud y Servicios Humanos (HHS) respondieron a una pregunta sobre si era justo sacar de Medicare a residentes legales.

Los inmigrantes sin estatus legal ya no eran elegibles para Medicare ni para la mayoría de los beneficios públicos financiados por el gobierno federal.

Carranza teme que también pueda perder el permiso legal para vivir en Estados Unidos si la administración Trump pone fin al TPS para salvadoreños, como intentó hacer durante .

Si eso ocurre, Carranza perdería su residencia legal y podría estar en riesgo de pasar tiempo en un centro de detención migratorio o ser deportada.

“Esto es como una película de terror, una pesadilla completa”, dijo Carranza. “No es así como imaginé envejecer”.

“Bajo ataque constante”

Carranza dejó El Salvador en 1991 durante una guerra civil brutal, dejando atrás a tres hijos pequeños, para ganar dinero y enviarlo a su familia. Permaneció en el país después de que venciera su visa hasta 2001, cuando calificó para el TPS, luego de dos terremotos que azotaron El Salvador, y desplazando a 1,3 millones.

El TPS fue aprobado por el Congreso y promulgado en 1990 por el presidente republicano George H.W. Bush.

Este estatus permite que personas como Carranza, provenientes de ciertos países afectados por conflictos armados, guerras civiles o desastres climáticos, vivan y trabajen en Estados Unidos, si regresar a su país representa un riesgo.

Carranza se perdió la graduación de jardín de infantes de su hija menor y su primera medalla en atletismo. Trabajó turnos nocturnos cuidando recién nacidos y luego como maestra sustituta en escuelas públicas del Área de la Bahía de San Francisco para pagar la educación de sus hijos en El Salvador, así como sus propios estudios en el City College of San Francisco, donde obtuvo un título en desarrollo infantil.

También cuidó a decenas de niños de 3, 4 y 5 años que miraban con asombro mientras descubrían pequeños tesoros en el bosque de secuoyas del parque de Oakland donde cofundó Escuelita del Bosque, un preescolar de inmersión en español que enseña al aire libre.

Se suponía que la recompensa sería una jubilación tranquila. Pero el Congreso limitó la elegibilidad de Medicare a ciudadanos, residentes permanentes legales, nacionales cubanos y haitianos, y personas amparadas por los Compacts of Free Association, acuerdos entre Estados Unidos y naciones insulares del Pacífico.

La medida siguió a los intentos de Trump de excluir a algunos inmigrantes con presencia legal de Medicaid, de los subsidios en el mercado de seguros de salud y de servicios de apoyo social, como asistencia alimentaria, ayuda para vivienda y visitas médicas en centros de salud financiados por el gobierno federal. En total, se proyectaba que 1,4 millones de inmigrantes con presencia legal perderían el seguro de salud, según 麻豆女优, una organización sin fines de lucro de información de salud que incluye a 麻豆女优 Health News.

Taylor Haulsee, vocero del presidente de la Cámara de Representantes, Mike Johnson, no respondió a solicitudes de comentarios.

Michael Cannon, director de estudios de política de salud en el Cato Institute, un centro de tendencia libertaria, dijo que los republicanos querían implementar recortes de impuestos y eliminar el seguro de salud para inmigrantes porque no afectaría a su base.

“No quieren convertir a Estados Unidos en un imán de asistencia social”, opinó. “Y les molesta que el gobierno les haga pagar por un estado de bienestar”.

Aunque no hay datos sobre inmigrantes con presencia legal, los inmigrantes sin papeles aportaron y $25,7 mil millones al Seguro Social en 2022, según el Institute on Taxation and Economic Policy.

La Oficina de Presupuesto del Congreso estimó que solo las restricciones a Medicare reducirían el gasto federal en para 2034.

Expertos en salud dicen que eliminar la cobertura para inmigrantes con estatus legal .

“En realidad, esta es la primera vez que el Congreso le quita Medicare a algún grupo”, dijo Drishti Pillai, directora de políticas de salud para inmigrantes en 麻豆女优. “Este cambio está afectando a inmigrantes con presencia legal en Estados Unidos, muchos de los cuales ya han trabajado y contribuido al sistema durante décadas”.

A medida que adultos mayores como Carranza pierdan su cobertura de Medicare, los médicos anticipan que retrasarán su atención, lo que llevará a un aumento de pacientes gravemente enfermos, especialmente en salas de emergencia.

Los adultos mayores pueden enfermarse de forma repentina y rápida, y son más vulnerables a enfermedades cardiovasculares como afecciones del corazón y presión arterial alta, especialmente si posponen la atención de rutina, dijo Theresa Cheng, médica de emergencias en Zuckerberg San Francisco General Hospital y profesora clínica adjunta de medicina de emergencias en la Universidad de California-San Francisco.

“Es bastante fácil que sufran un deterioro crítico de su salud”, dijo Cheng.

Carranza hace senderismo y se considera saludable, pero reconoce que está envejeciendo y comenzando a tener dificultades para seguir el ritmo de los niños en el bosque.

A finales del año pasado le diagnosticaron hipertensión, y en enero despertó con una presión en el pecho y fue a un centro de urgencias porque su presión había subido a niveles peligrosos. Unas semanas después, tropezó mientras caminaba y se cayó. Al día siguiente despertó con el pie hinchado. En el hospital local, un médico le dijo que tenía artritis.

Dijo que fueron momentos preocupantes, pero estaba agradecida de pagar solo $10 por la visita a urgencias y $5 por ver a su médico de atención primaria. Sin embargo, eso cambiará cuando pierda Medicare a principios del próximo año.

El estrés de saber que perderá su seguro de salud y posiblemente su estatus legal, mientras agentes federales detienen a inmigrantes como ella en todo el país, ha afectado su salud mental, contó. Está buscando terapia y servicios de acupuntura para tratar su insomnio y ansiedad, y la sensación de estar “bajo un ataque constante”.

Sin un lugar a donde ir

En California, hogar del mayor número de , Carranza podría haberse inscrito en un seguro patrocinado por el estado, pero este año la inscripción para adultos de 19 años o más que tienen TPS, están en el país sin autorización o son solicitantes de asilo. Otros estados con gobernadores demócratas como también han reducido sus programas de salud para inmigrantes por presiones presupuestarias.

En enero, el gobernador de California, Gavin Newsom, propuso un presupuesto estatal que no compensaría los recortes federales de atención médica para unos 200.000 inmigrantes con presencia legal, señalando el costo anual de $1.1 mil millones y déficits presupuestarios estatales.

“Dadas estas presiones fiscales, la administración no puede compensar este cambio en la política federal”, dijo H.D. Palmer, vocero del Departamento de Finanzas de California.

Pero algunos legisladores demócratas y defensores de los consumidores dicen que el estado debería intervenir. La asambleísta Mia Bonta, quien preside el Comité de Salud de la Asamblea, dijo que está trabajando en una solución presupuestaria legislativa para incluir en Medi-Cal 鈥� la versión estatal de Medicaid 鈥� a los inmigrantes que perderán su cobertura, incluidos los adultos mayores.

La demócrata de East Bay está especialmente preocupada por personas como Carranza, “que han vivido aquí durante décadas y han contribuido a esta economía, que han aportado a nuestro tejido cultural y a nuestras comunidades, que han formado familias y vidas y que ahora quieren tener la posibilidad de retirarse con dignidad y vivir con dignidad y tener la atención médica que necesitan”.

Una señal del futuro

En abril pasado, Carranza vislumbró lo que podría significar perder su cobertura de salud y beneficios de jubilación, después de que la Administración del Seguro Social le enviara una carta informándole que ya no calificaba para beneficios de jubilación porque no tenía presencia legal en el país, aunque sí la tenía. Luego Medicare dejó de pagar a su plan de salud, que como resultado la dio de baja.

Como beneficiaria de TPS con permiso de trabajo, sabía que se trataba de un error. Aun así, sin su cheque, Carranza no tuvo dinero para pagar la renta durante un mes. Compensó ese pago cuidando a los hijos de sus arrendadores. En mayo pasado, la oficina de la representante federal Lateefah Simon (demócrata de Oakland) ayudó a Carranza a recuperar sus beneficios de jubilación, pero tomó meses recuperar su seguro de salud.

La experiencia la dejó afectada.

“Es como recibir una bofetada en la cara después de más de 30 años trabajando para el sistema aquí”, dijo Carranza. “Y a cambio, esto es lo que tenemos ahora”.

Por las noches permanece despierta imaginando el futuro: aquí, donde ha pasado la mitad de su vida, sin seguro de salud y posiblemente sin beneficios del Seguro Social; o en El Salvador, donde están dos de sus tres hijos. Su hija, residente permanente que vive en Texas, espera convertirse en ciudadana para poder solicitar la residencia permanente para Carranza, pero el proceso puede tardar años.

También está la posibilidad que más teme: la detención indefinida o la deportación.

En una mañana reciente en su estudio en el sótano en Oakland, Carranza sacó una caja del fondo de su clóset. Dentro había una pila alta de tarjetas de identificación que incluían licencias de conducir antiguas, su tarjeta del Seguro Social y decenas de permisos de trabajo emitidos por el gobierno federal.

“Mi vida está en esta caja”, dijo.

Este artículo fue producido en colaboración con , una organización cívico-mediática que sirve y cubre a las comunidades inmigrantes latinas y mayas del Área de la Bahía.

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 .

USE OUR CONTENT

This story can be republished for free (details).

Dressed in hiking gear and beaded necklaces, Carranza, 67, maneuvered between trees and children on a sunny morning in December. “Hold on to that branch,” she said in Spanish. “You can do it, my love!”

Carranza, a child development professional who grew up swinging through trees and swimming in rivers in El Salvador, said she feels at home in the forest at the outdoor preschool she co-founded. She has worked with children and teens as a caregiver and educator for more than three decades, long enough to know when to lean in and when to step back to let her students find their own footing.

When she transitioned to working part-time last year, Carranza counted on getting Medicare and Social Security checks 鈥� benefits given to American workers and lawfully present immigrants when they retire, work history and age or disability requirements. She’s contributed tens of thousands of dollars into Medicare and Social Security over 24 years, according to her Social Security Administration earnings record, reviewed by El Tímpano and 麻豆女优 Health News. But Carranza and an estimated immigrants will soon be cut out of Medicare.

The GOP’s One Big Beautiful Bill Act, signed last July by President Donald Trump, barred certain categories of lawfully present immigrants 鈥� including temporary protected status holders, refugees, asylum-seekers, survivors of domestic violence, trafficking victims, and people with work visas 鈥� from Medicare.

Those already in the program, like Carranza, will be disenrolled by Jan. 4 鈥� a move by Republican lawmakers to rein in Medicare spending, as they and Trump have argued that taxpayer dollars should not be used to pay for the health care of immigrants in the U.S. without authorization.

“The Democrats want Illegal Aliens, many of them VIOLENT CRIMINALS, to receive FREE Healthcare,” Trump two months after he signed the bill into law. “We cannot let this happen!”

However, the categories of immigrants now losing coverage do have legal status. Neither the White House nor the Department of Health and Human Services responded to a question about whether it was fair to disenroll legal residents from Medicare.

Immigrants without legal status were already ineligible for Medicare or most other federally funded public benefits.

Carranza is worried that she could also lose legal permission to live in the United States if the Trump administration ends temporary protected status for Salvadorans, as it sought to do during .

If that happened, Carranza would lose legal residency, risking time in an immigration detention center or deportation.

“This is like a horror movie, a complete nightmare,” Carranza said. “This is not how I imagined getting old.”

鈥楿nder Constant Attack’

Carranza left El Salvador in 1991 during a brutal civil war, leaving behind three young children, to earn money to send home to her family. She overstayed her visa until 2001, when she qualified for temporary protected status, after two earthquakes struck El Salvador, and displacing 1.3 million.

Temporary protected status, or TPS, was passed by Congress and signed into law by Republican President George H.W. Bush in 1990.

It allows people such as Carranza, from select nations undergoing armed conflict, civil war, and climate disasters, to live and work in the United States if being in their home country poses a risk.

Carranza missed her youngest daughter’s graduation from kindergarten and first medal-winning performance in track. She worked overnight shifts babysitting newborns and later substitute-taught in public schools in the San Francisco Bay Area to pay for her children’s schooling in El Salvador, and for her own classes at City College of San Francisco, where she earned a degree in child development.

And she cared for dozens of 3-, 4-, and 5-year-olds who gazed in awe as they uncovered little treasures buried in the redwood forest of the Oakland park where she co-founded Escuelita del Bosque, a Spanish immersion preschool that teaches children outdoors.

The trade-off was supposed to be a peaceful retirement. But Congress narrowed Medicare eligibility to citizens, lawful permanent residents, Cuban and Haitian nationals, and people covered under the Compacts of Free Association, agreements between the United States and Pacific island nations.

The move followed Trump’s efforts to bar some lawfully present immigrants from Medicaid, marketplace insurance subsidies, and social support services, such as food assistance, housing subsidies, and medical visits in federally funded health centers. Altogether, 1.4 million lawfully present immigrants were projected to lose health insurance, according to 麻豆女优, a health information nonprofit that includes 麻豆女优 Health News.

A spokesperson for House Speaker Mike Johnson, Taylor Haulsee, did not respond to requests for comment.

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank, said Republicans wanted to enact tax cuts and eliminate health insurance for immigrants because it wouldn’t upset their base.

“They don’t want to turn the United States into a welfare magnet,” he said. “And they resent the government for making them pay for a welfare state.”

While data on lawfully present immigrants is not available, immigrants without legal status and $25.7 billion into Social Security in 2022, according to the Institute on Taxation and Economic Policy. The Congressional Budget Office estimated that the Medicare restrictions alone would reduce federal spending by 2034.

Health experts say eliminating coverage for immigrants with legal status .

“This is actually the first time that Congress has taken away Medicare from any group,” said Drishti Pillai, director of immigrant health policy at 麻豆女优. “This change is impacting immigrants who have lawful presence in the U.S., and many of whom have already worked and paid into the system for decades.”

As older adults like Carranza lose their Medicare coverage, clinicians anticipate that they will delay their care, leading to an increase in severely ill patients, especially in hospital emergency rooms.

Seniors can become sick suddenly and quickly, and they are more vulnerable to cardiovascular diseases such as heart disease and high blood pressure, especially if they put off routine care, said Theresa Cheng, an emergency physician at Zuckerberg San Francisco General Hospital and assistant clinical professor of emergency medicine at the University of California-San Francisco.

“It’s quite easy for them to fall off the cliff,” Cheng said.

Carranza hikes and considers herself healthy, but she acknowledges that she is aging and starting to struggle to keep up with the kids in the forest.

Late last year she was diagnosed with high blood pressure, and in January she woke up with a tight chest and went to urgent care because it had spiked to dangerous levels. A few weeks later, she tripped on a curb while walking and fell to the ground. She woke up the next day with a swollen foot. A doctor at the local hospital told her she had arthritis.

These were scary moments, she said, but she was grateful to have to pay only $10 for the urgent care visit and $5 to see her primary care doctor. However, that will change when she loses Medicare by early next year.

The stress of knowing she will lose health insurance coverage, and potentially her legal status, all while masked federal agents are detaining immigrants like her across the country, has taken a toll on her mental health, she said. She is searching for a therapist and acupuncture services to treat her insomnia and anxiety 鈥� and the feeling that she is “under constant attack.”

Nowhere To Turn

In California, home to the largest number of , Carranza could have enrolled in state-sponsored insurance, but this year the state for adults 19 and older who are a TPS holder, in the U.S. without authorization, or an asylum-seeker. Other states with Democratic governors such as have also scaled back their health programs for immigrants amid budget pressures.

In January, California Gov. Gavin Newsom proposed a state budget that would not backfill federal health care cuts to about 200,000 lawfully present immigrants, noting the $1.1 billion annual price tag and state budget shortfalls.

“Given these fiscal pressures, the administration cannot backfill for this change in federal policy,” California Department of Finance spokesperson H.D. Palmer said.

But some Democratic lawmakers and consumer advocates say the state should step in. State Assembly member Mia Bonta, who chairs the Assembly’s health committee, said she is working on a legislative budget solution to bring immigrants who will lose health coverage, including older adults, into Medi-Cal, the state’s version of Medicaid.

The East Bay Democrat is especially concerned for people like Carranza, “who have lived here for decades and contributed into this economy, who have given into our cultural fabric and into our communities and who built families and lives and who are now wanting to be able to retire with dignity and live with dignity and have the health care that they need.”

A Sign of the Future

Last April, Carranza got a glimpse of what losing her health coverage and retirement benefits could look like, after the Social Security Administration sent her a letter informing her that she no longer qualified for retirement benefits because she was not lawfully present in the U.S. 鈥� even though she was. Then Medicare stopped payments to her health plan, which disenrolled her as a result.

As a TPS holder with a work permit, she knew a mistake had been made. Yet, without her check, Carranza didn’t have money to pay her rent for a month. She worked off her rent by babysitting her landlords’ children. Last May, the office of U.S. Rep. Lateefah Simon, an Oakland Democrat, helped Carranza recover her retirement benefits, but it took months for her to get her health insurance back.

The experience left her reeling.

“It’s like getting slapped on the face after more than 30 years working for the system here,” Carranza said. “And in return, this is what we have now.”

She lies awake at night imagining the future: here, where she’s spent half her life, without health insurance and possibly Social Security benefits; or in El Salvador, where two of her three children remain. Her daughter, a green-card holder who lives in Texas, hopes to become a citizen so she can petition for permanent residency for Carranza, but the process can take years. Then there’s the possibility she fears most: indefinite detention or deportation.

On a recent morning in her basement studio in Oakland, Carranza pulled a box from the back of her closet. In it was a thick stack of identification cards that included old driver’s licenses, her Social Security card, and dozens of work IDs issued by the federal government.

“My life is in that box,” she said.

This article was produced in collaboration with听, a civic media organization serving and covering the Bay Area’s Latino and Mayan immigrant communities.

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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This story can be republished for free (details).

Recent polling finds that health costs are a top worry for much of the American public, while Republicans in Congress are considering still more cuts to federal health spending on programs such as Medicaid and the Affordable Care Act.

Meanwhile, the Supreme Court ruled that Colorado cannot ban mental health professionals from using “conversion therapy” to treat LGBTQ+ minors, a decision that’s likely to affect other states with similar laws.

This week’s panelists are Julie Rovner of 麻豆女优 Health News, Jessie Hellmann of CQ Roll Call, Alice Miranda Ollstein of Politico, and Sandhya Raman of Bloomberg Law.

Panelists

Among the takeaways from this week’s episode:

• Republicans reportedly are weighing still more cuts to federal health spending. With the war in Iran draining military coffers, GOP leaders in Congress are eying a drop in health funding 鈥� a decision that could exacerbate problems following the passage of legislation expected to lead to major reductions in Medicaid spending, as well as the expiration of enhanced ACA premium subsidies that were not renewed by lawmakers last year. And President Donald Trump’s budget could include another sizable reduction in funding to the National Institutes of Health.
• The Supreme Court this week struck down a Colorado law prohibiting licensed professionals from practicing a form of therapy that tries to change the sexual orientation or gender identity of LGBTQ+ minors. States have long had the power to regulate medical care, with the goal of restricting treatments that can be harmful. Also, the Idaho Legislature passed a bill requiring teachers and doctors to out transgender minors to their parents.
• Meanwhile, the Department of Health and Human Services is studying whether to make private Medicare Advantage plans the default option for seniors enrolling in Medicare, a change that would seem to conflict with the Trump administration’s scrutiny of overpayments to the private insurance plans. And a tech nonprofit’s lawsuit seeks to reveal more about the administration’s pilot program testing the use of artificial intelligence in prior authorization in Medicare.

Also this week, Rovner interviews 麻豆女优 Health News’ Elisabeth Rosenthal, who wrote the last two 麻豆女优 Health News “Bill of the Month” stories. If you have a medical bill that’s outrageous, infuriating, or just inscrutable, you can submit it to us here.

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

Julie Rovner: New York Magazine’s “,” by Helaine Olen.听听

Jessie Hellmann: The Texas Tribune’s “,” by Colleen DeGuzman, Stephen Simpson, Terri Langford, and Dan Keemahill.听

Sandhya Raman: Science’s “,” by Jocelyn Kaiser.听听

Alice Miranda Ollstein: The New York Times’ “,” by Ed Augustin and Jack Nicas.听听

Also mentioned in this week’s podcast:

• 麻豆女优 Health News’ “States Pay Deloitte, Others Millions To Comply With Trump Law To Cut Medicaid Rolls,” by Samantha Liss and Rachana Pradhan.
• 麻豆女优 Health News’ “Trump’s Hunt for Undocumented Medicaid Enrollees Yields Few Violators,” by Phil Galewitz.
• The Colorado Sun’s “,” by John Ingold.
• Politico’s “,” by Alice Miranda Ollstein, Erin Doherty, Marcia Brown, and Carmen Paun.
• The New York Times Magazine’s “,” by Coralie Kraft.
• NOTUS’ “,” by Margaret Manto.
• The Dallas Morning News’ “,” by Emily Brindley.

[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 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听health听reporters covering Washington.听We’re听taping this week on Thursday,听April 2, 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.听

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

Alice Miranda听Ollstein:听Hello.听

Rovner:听Jessie Hellmann听of CQ听Roll Call.听

Jessie Hellmann:听Thanks for having me.听

Rovner:听And Sandhya听Raman,听now at Bloomberg Law.听

Sandhya Raman:听Hello, everyone.听

Rovner:听Later in this episode,听we’ll听have my interview with听麻豆女优 Health News’听Elisabeth Rosenthal, who reported and wrote the last听two听麻豆女优 Health News听“Bills of the听Month.”听One is about a patient who got caught in the crossfire over prices between insurers and drug companies. The other is about a woman who, and this is not an April Fools’听joke, got her insurance canceled for听failing to pay听a bill for听1听cent. But first,听this week’s news.听

So听Congress is on spring break, but when they come back,听health听policy will be waiting. A new Gallup poll out this week found 61% of those surveyed said they worry about the availability and affordability of health care, quote,听“a great deal.”听That was 10 percentage points more than the economy,听inflation,听and the federal budget deficit, and it topped a list of 15 domestic concerns. And while we are still waiting for final enrollment numbers for Affordable Care Act plans, we do know that the share of people paying more than $500 a month for their coverage doubled from last year to 2026.听Yet Axios this week is reporting that Republicans are considering still more cuts to the Affordable Care Act to potentially pay for a听$200 billion听war supplemental. What exactly are they thinking? And听it’s听looking more like Republicans are going to try for another budget reconciliation bill this spring. Isn’t that, right,听Jessie?听

Hellmann:听House听Budget听chair Jodey Arrington has kind of been pushing this idea听really hard听of going after what he says is fraud听in听mandatory programs like Medicare and Medicaid.听He’s听also talked about funding听cost-sharing听reductions, which is an idea that slipped out of the last reconciliation bill, and听it’s听a wonky kind of idea听鈥μ�

Rovner:听But听I think the best way to explain听it听is that it will raise premiums for many people.听That’s听how听I’ve听just been doing it.听听

Hellmann:听Yeah, exactly.听

Rovner:听Let’s听not get into the details.听

Hellmann:听It would听reduce spending for the federal government but听wouldn’t听really help people who buy insurance听on听the marketplace. He听hasn’t听been听very specific.听He’s听also talked about,听like,听site-neutral听policies听in听Medicare, but听it’s听hard to see how all of this could make a serious听dent in听a听$200 billion听Iran supplemental.听There’s听also a new development.听I think President听[Donald]听Trump threw a wrench in things yesterday when he said he wanted the reconciliation bill to focus on border spending and immigration spending to cover a three-year period, and now Senate Majority Leader John Thune is saying that there’s probably not room for much else in the bill. So,听unclear what the path forward is for all of that.听

Rovner:听Yeah, and of course, that was part of the deal to free up the Department of Homeland Security’s budget in the appropriation.听It’s听all one sort of big, tied-up mess at this point.听Alice, I see听you’re听nodding.听

Ollstein:听Yeah.听I mean, what often happens with these reconciliation bills is it starts out with a tight focus and everyone’s unified, and then, because it can often be the only legislative train leaving the station,听everybody gets desperate to get their pet issue on board, and then the more and more things get piled onto it, then they start losing votes, and people start disagreeing more. And听so听I think even though this is still in the ideas phase,听you’re听already seeing some signs of that happening. And when it comes to health care, it can be particularly fraught. And of course, you have lawmakers, especially in the听House, with wildly听different needs. Some of them need to fend off a primary from the right, and so they want to be as conservative as possible. Some are fighting to hang on in swing districts, and so they want to be more moderate. And these things are in conflict. And听so听these proposals to cut health spending, even more than the massive amount that was cut last year,听are already, you know, raising some red flags among some moderate Republican members.听And听it’s听very possible the whole thing falls apart.听

Rovner:听Well, along those lines,听we’re听supposed to get the听president’s budget on Friday, which is only two months late. It was due in February.听And while I听haven’t听seen much on it, Jessie, your colleagues at听Roll听Call听are reporting that the budget will seek a 20% cut to the National Institutes of Health.听That’s听only half the cut that the administration proposed last year. But given that Congress actually boosted the听agency’s听budget slightly this year, that feels kind of unlikely.听

Hellmann:听Yeah, I听don’t听think that the appropriators are likely to听go along with this.听They have really strong advocates, and Sen.听Susan Collins, who’s chair of the Senate Appropriations Committee.听And,听like听you听said, they rejected cuts last year.听Kind of surprised.听Twenty percent听is not as deep as the Trump administration went last year.听I was actually kind of surprised it wasn’t听a听bigger proposed cut.听But either way, I听don’t听think Congress is going to go along with that.听听

Rovner:听Meanwhile, I saw听a late headline that FDA is looking to hire back people after听DOGE [Department of Government Efficiency]听cut听thousands听of people last year. Sandhya,听HHS听[Department of Health and Human Services]听is just in this sort of personnel churn at this point, isn’t it?听

Raman:听Yeah, I think that HHS is kind of getting听bit听in the foot from, you know, we’ve had so many of these layoffs, and we’ve also had a lot of people just flee the various agencies over the past year because of some of this instability and all of these changes. And as听we’re听getting听closer and closer听to, you know, deadlines of things that they need to get done,听they’re听realizing that they do need more personnel to get some of those things done,听as听we’ve听been passing deadlines.听So听I听don’t听think听it’s听something听that’s听unique to just FDA.听But I think the way to solve this听鈥斕齣t’s听not an overnight thing for the federal government to staff up.听It’s听a longer process, but听it’s听really showing in a lot of areas right now.听

Rovner:听Yeah, I would say this is not like TSA听[Transportation Security听Administration], where you can, you know, hire new听people听and train them up in a couple of months. These are听鈥μ齧any of them scientists听who’ve听got years and years of training and experience at doing some of these jobs that,听you know,听the federal government is ordered to do by legislation.听

Raman:听Yeah, those听statutes are things that,听you know, if they听don’t听meet those听deadlines,听those听are things that are听going to be challenged, and just further tie things up in litigation.听And we already see so many of those right now that are making things more complicated.听听

Rovner:听Well, in news that is not from Congress or the administration, the Supreme Court this week said Colorado could not ban licensed mental health professionals from using so-called听conversion therapy aimed at LGBTQ individuals, at least not on minors.听What’s听the practical impact here? It goes well beyond Colorado,听I听would think.听

Ollstein:听Interesting,听because a lot of people think of this as regulating health care, restricting providers from providing health care that is not helpful and听maybe actively听harmful to the health of the patients.听

Rovner:听And that’s听鈥μ齀 would say听that’s听been a state听鈥μ�

Ollstein:听Power.听

Rovner:听鈥� power.听For generations.听听

Ollstein:听Absolutely.听Right,听I mean, you don’t want people selling sketchy snake oil pills on the street, etc. So many people view this as akin to that.听But it has morphed in the hands of conservative courts into a free speech issue, and that, you know, these laws are restricting the speech of mental health workers who are against people transitioning. And so, yes, it听definitely has听national implications. And of course, we are in a national wave right now of both state and federal entities, you know, moving in the direction of rolling back trans rights in the health care space and beyond.听

Rovner:听Yeah. In related news,听regarding听Colorado and minors and gender,听听that Children’s Hospital Colorado has not yet resumed providing gender-affirming care for transgender youth.听That’s听despite a federal judge in Oregon having struck down an HHS declaration that would have punished hospitals for providing such services.听Apparently, the听hospital in Colorado is concerned that the听judge’s听ruling听doesn’t听provide it with enough legal cover for them to resume that care.听I’m听wondering, is this the administration’s strategy here to get organizations to do what they want, even if they might lack the legal authority to do it?听Just by making them worry that they might come after them?听

Raman:听I think the chilling effect is definitely a big part of this broader issue.听I mean, we’ve seen it in other issues in the past, but just that if there is this worry that it’s a)听going to stop on the provider side, new folks taking part in providing care, and also just it’s going to make patients, even if there are opportunities,听even less likely to want to go because of the fears there. I mean, it goes broader than that.听We’ve听had FTC听[Federal Trade Commission]听complaints,听where they have gone and investigated听different places听that provide gender-affirming care or endorse it.听So听I think听it’s听broader than this, and really part of that chilling effect.听听

Rovner:听And Alice, as you were saying, I mean, the subject of transgender rights, or lack thereof,听remains听a political hot topic. The Idaho听Legislature this week passed a bill that now goes to the governor that would require teachers and doctors to out transgender minors to their parents. Parents could sue teachers, doctors,听and听child care听providers who, quote,听“facilitate the social transformation of the minor student.”听That includes using pronouns or titles that听don’t听align with their sex at birth.听I don’t know about teachers, but that definitely seems to violate patient privacy when it comes to听doctors, right?听

Ollstein:听There’s definitely patient privacy issues there. I also think, you know,听it’s听interesting that听this kind of nonmedical听transitioning听is now coming under attack. Because, you know, you would think that there would be some support for letting a kid, you know, go by a different name for a few weeks, test it out, see how it feels.听Maybe it’s a phase, then they discover that they don’t want to actually pursue taking medications and going through a medical transition.听But this is sort of shutting down that avenue as well.听You听can’t听even change your appearance, change how you present in the world, at a time when kids are really trying to figure out who they are.听So听I think the broad acceptance of hostility to medical transitioning for youth is now spilling over into this kind of social transitioning, and I wonder if听we’re听going to see more of that in the future.听

Rovner:听Yeah, I feel like we started with听minors听shouldn’t听have surgery.听They听shouldn’t听do anything听that’s听not easily reversible.听And now听we’ve听gotten down to,听in听the Idaho听law,听there’s听actually mention听of nicknames. You听can’t听鈥� a听kid听can’t听change his or her nickname. It feels like we’ve听sort of听reduced听this way, way, way down.听

Ollstein:听And I think听we’ve听seen these听laws,听laws related to bathrooms.听We’ve听seen these have negative impacts on people who are not trans at all, people who just are a tomboy or not looking like people’s stereotypes of what different genders may look like. And听so听there’s听a lot of policing of people who are not trans in any way. You know, there’s media reports of people being confronted by law enforcement for going into a bathroom that does align with their biological sex. And听so听it’s听important to keep in mind that these laws have an effect听that’s听much broader than just the听very small听percentage of people who do consider themselves trans.听

Rovner:听Yeah,听it’s听kind of the听opposite of not being听woke. All听right,听we’re听going to take a quick break. We will be right back.听听

So听while听we’ve听had lots of news out of the Department of Health and Human Services the past few weeks,听it’s听been mostly public听health-related.听But听there’s听a lot going on in the Medicare and Medicaid programs too. Item听A:听Stat News听is reporting听that HHS is studying whether to make the private Medicare Advantage program the default for seniors when they qualify for Medicare. Right now, you get the traditional fee-for-service plan that allows you to go to any doctor or hospital that accepts Medicare, which is most of them.听You have to affirmatively opt into Medicare Advantage, which often provides extra benefits but also much narrower networks.听What would it mean to make Medicare Advantage the default,听that people would go into private plans instead of the听government听plan, unless they affirmatively opted for the traditional fee-for-service?听

Hellmann:听Someone’s experience with听鈥μ齝an vary听greatly between听being on traditional Medicare and Medicare Advantage. If听you’re听in Medicare Advantage, you could be exposed to narrow networks. You can only see certain doctors that are covered by your plan. You can be exposed to higher cost sharing. A lot of people are听kind of fine听with their plans until they have a medical issue and need to go to the hospital or they need skilled nursing care.听So听making this the default could definitely be a challenge for some people, especially people that have complex health needs. Some people on the early side of their Medicare eligibility are fine with Medicare Advantage, and then they get听older听and听they’re听not fine with it anymore.听So听it’s听interesting that the administration would听kind of float听this听idea听because听they’ve听been critical听of Medicare Advantage.听

Rovner:听Thank you.听That’s听exactly what I was thinking.听

Hellmann:听Yeah,听they’ve听talked about the federal government听pays听these plans too much, and听it’s听not for better quality in a lot of cases, and听they’ve听talked about reforms in that area.听So听I was a little听surprised to see that.听

Rovner:听Yeah, Republicans have been super ambivalent. I mean, Medicare Advantage was their creation. They overpaid them at the beginning when they, you know,听sort of redid听the program in 2003.听And they purposely overpaid them to get people into Medicare Advantage. And then the Democrats pointed out that this is wasting money because听we’re听overpaying them. And now the Republicans seem to have joined a lot of their听鈥斕齛t least some Republicans听鈥斕齭eem to have joined a lot of the Democrats in saying,听Yes,听we’re听overpaying them.听We’re听paying听them too much. And you know, they talk about the big, powerful insurance companies, and yet听they’re听now听floating听this idea to make Medicare Advantage the default.听So听pick a side, guys.听

All right, well, in other Medicare news, the Electronic Frontier Foundation is suing Medicare officials to learn more about the pilot program听that’s听using artificial intelligence to oversee prior authorization requests in the traditional Medicare听fee-for-service听program.听The idea here is to cut down on,听quote,听“low-value services,”听things that doctors might be prescribing that aren’t either particularly necessary or shown to actually work.听But the fear, of course, is that needed care for patients will be delayed or denied, which is what听we’ve听seen with prior authorization in Medicare Advantage. This is the perennial push-pull of our health care system, right? If you do everything that doctors say,听it’s听going to be too expensive, and if you second-guess them,听it’s听going to be,听you know, it听might turn out to be too constraining.听

Hellmann:听Well, I was just going to say听this听is another issue that was听kind of a听little surprising to me, because听there’s听been so much criticism of the use of prior authorization and Medicare Advantage. And CMS听[Centers for Medicare & Medicaid Services]听looked at that and said,听Oh, what if we did it in traditional Medicare?听Like it was never going to go over well politically,听and听I think there听are even some Republican members of Congress who are not in support of this, but they听haven’t听really made a huge stink about it.听Yeah, this听wasn’t听something I really expected听to see.听

Rovner:听Yeah,听we’ll听see how听this one plays听out too.听Well, meanwhile,听regarding听Medicaid, two听really good听stories this week from my听麻豆女优 Health News colleagues Phil听Galewitz, Rachana Pradhan,听and Samantha Liss.听Phil’s story听found that efforts in multiple states to find enrollees who were not eligible for the program due to their immigration status turned up very few violators. While听Samantha and听Rachana听detailed听the hundreds of millions of dollars states and the federal government are spending to set up computer programs to track听Medicaid’s new work requirement, despite the fact that we already know that most people on Medicaid either already work or they are exempt from the requirements under the new law. Is it just me, or are we spending lots of time and effort on听both of these听policies that are going to听have not听a very big听return?听听

Ollstein:听Well,听that’s听what听we’ve听seen in the few states that have gone ahead and听attempted听this before,听that it costs a lot, and you insure fewer people. And听that’s听not because those people got great jobs with great health听care. You insure fewer people, and the level of employment does not meaningfully change.听

Rovner:听I would听say you insure fewer people who may well still be eligible. They just get caught in the bureaucratic red tape of all听of this.听

Ollstein:听Exactly.听These tech systems that are being set up are challenging to navigate, if people even have a means to do it, if they even have a smartphone or a computer or access to Wi-Fi.听There are not that many physical offices they can听go听to听to听work it out if they need to. And some of those are听very far听from where they live. And听so听you see some of these tech vendors,听you know, are set to make off very well out of this system, and people who need the care not so much. And then, of course, you know,听it’s听not just the patients who will feel the impact. You have these hospitals around the country that are on the brink of closure. And if they have people who used to be insured听鈥斕齮hey used to be able to bill and get reimbursed for their services, suddenly they’re uninsured听鈥斕齛nd they’re coming in for emergency care that they can’t pay for, that the hospital has to throw out-of-pocket for, that puts the strain that some of these facilities can barely cope with.听And听so听you’re听seeing a lot of state hospital associations听sounding听the alarm as well.听

Raman:听I would also say the timing is interesting. You know, we spent so much time and energy last year going through the reconciliation process to tighten these areas, to get in the work requirements, to reduce immigrant eligibility for Medicaid. And then, you know, as they’re gearing up to possibly do this again, to defer their crackdown on health care as part of that, instead of it saving money听鈥斕齮hat it’s not having as much of an effect and costing so much, in the case of the work requirements, where we’re not expected to see the return of it.听

Rovner:听Yeah, that may be, although听I guess the return听is that people will not have insurance anymore, and so the federal government,听the states,听won’t听be spending money听for听their medical care.听They’ll听be spending money on other things. All right, of course,听there’s听more news from HHS than just Medicare and Medicaid听this week.听We also have a lot of news about the Make America听Healthy听Again movement, which is a sentence听that 2023听me听would听definitely not听recognize.听听about a new poll that finds the MAHA vote听isn’t听necessarily locked in with Republicans. Tell us about it.听

Ollstein:听Yeah,听that’s听right.听So听Politico did our own polling on this, because we听hadn’t听really seen good data out there on who identifies as MAHA听and what do they even believe about the different parties and about different issues. And听so听we found that,听OK, yes, most people associate MAHA听with the Republican Party听鈥斕齧ost, but not all. But a lot of voters who identify as MAHA, and a lot of voters who voted for Trump in 2024听don’t听think that the Trump administration has done听a good job听making America healthy again.听And they rank the Democratic Party above the Republican Party on a lot of their top priority issues, like standing up to influence from the food industry and the pharmaceutical industry. They rank Democrats as caring more about health. So, you know, we found this very fascinating, and it supports what we’ve been hearing anecdotally, where Democratic candidates, a handful of them, and听Democratic electoral groups, are really seeing a lot of opportunity to go after MAHA听voters and win them over for this November. And you know, we should remember that even if you听don’t听see听a big swing of people听voting for Democrats, even if MAHA听voters are disillusioned and stay home, that alone could decide races. You know, midterms are decided by very narrow margins.听

Rovner:听Well, two other really interesting MAHA听takes this week.听.听It’s听about the tension in and among medical groups, about how to deal with HHS Secretary听[Robert听F.]听Kennedy听[Jr.]听and the MAHA movement. The American Medical Association seems to be trying to play nice, at least on things it agrees with the听secretary about, lest it risk things like its giant contract to supply the CPT billing codes to Medicare. On the other hand, the American Academy of Pediatrics and the American College of Physicians have been more confrontational to the point of going to court.听The other story,听from听听pushing MAHA.听One thing I noticed is that听all of听the teens in the story seem to suffer from physical problems that are not well understood by the mainstream medical community, and so they turned online to seek advice instead, which is understandable in each individual case. But then they turn around and try to influence others. And you can see how easily misinformation can spread. It makes me not so much wonder听鈥斕齣t makes me see how, oh, this is how this stuff sort of gets out there, because you see so much听鈥� and Alice, this听goes back to what you were saying about MAHA听is not a movement that’s allied with one particular political party.听It’s听more of sort听of a mindset that听doesn’t听trust听expertise.听

Ollstein:听I think it听spans people who identify as Democrats, identify as Republicans. And, you know,听we’re听not really interested in politics until the rise of Robert F Kennedy Jr., and so I think it does show a lot of malleability. And there is a fight for this, for this cohort right now, on the airwaves, on the internet, etc.听听

Rovner:听And,听as听The New York Times pointed out, you know,听we’ve听thought of this as being听sort of a听young men cohort.听It’s听now also a young woman cohort,听too.听So听there’s听lots of people out there to听go and get,听for these people who are pursuing votes.听听

Well, turning to reproductive health, we have a couple of follow-ups to things we covered earlier. The big one is听Title听X, the federal family planning program, whose grants were set to end as of April 1. Sandhya, it looks like the federal government is going to fund the program after all?听

Raman:听Yeah, the family planning grantees in this space have been on edge for so long, you know, waiting to see would they finally just issue the grant applications.听And then it was such a short timeline for them to get them done. And then everyone that I talked to in the听lead-up听was expecting some sort of delay, just because it was such a short听timeframe听before they were set to run out of money. And听so听I think that they听were all pleasantly surprised that HHS was able to turn things around when they confirmed that the money听is听going to go out the day before the deadline. It does take a couple听of听days to go through the process and get that done. But I think the new worry now is also that in the statements that the White House and HHS have made is just that they are still at work on getting听Title听X听rulemaking out so that a lot of these groups would be ineligible if they also听provide听abortions.听Or we also听don’t听know what will be in the rule听鈥斕齣f it will be broader than what was under the last听Trump administration, if it encompasses other restrictions.听So听a little bit of both there.听听

Rovner:听Yeah. And I also was听gonna听say, I mean, we know that anti-abortion groups are unhappy with the administration, so this would be one place where they could听presumably throw听them a bone, yes?听

Ollstein:听So听people on both sides have been a little mystified why we听haven’t听seen a new听Title听X听rule yet.听They were expecting that near the beginning of last year, especially if the administration was just planning to reimpose his 2019 version, that would be pretty straightforward and simple.听And yet, here we are, more than a year into the administration, and we听haven’t听really seen this yet. The administration did confirm to me听鈥斕齱e put this in our newsletter听鈥斕齮hat a new rule is coming.听And they said it will听align with pro-life values. And the White House’s comments to some conservative media outlets were very explicit that this will be the last time Planned Parenthood can get funding. Now I wonder if that statement will come back to bite them in court, because the rule previously was听very careful听not to name Planned Parenthood or name any specific organization. It just imposed criteria that applied to a lot of Planned Parenthood facilities, and听in order to听make them ineligible for听Title听X听funding. And听so听I wonder if that will help Planned Parenthood听sue听later on.听But听we’ll听put a pin in that and come back to it.听But we have confirmed that some sort of new rule is coming, but we don’t know when, and we don’t know what it would entail.听There’s听a lot of speculation that this could go way beyond an attempt to kick Planned Parenthood out. There’s speculation it could involve restrictions on听particular forms听of birth control. There’s speculation that it could entail restrictions on gender-affirming care. There’s speculation that it could involve rules around parental consent, stricter parental consent requirements, which are currently something that’s not part of听Title听X. And听so听we just听don’t听know, you know,听in order to听mollify the anti-abortion groups that are upset, they are saying,听Don’t听worry, new rule is coming.听But again, we don’t know when, and we don’t know what’s going to be in it.听

Rovner:听Well,听we’ll听be here when it happens. Another topic听we’ve听talked about at some length is crisis pregnancy centers, which are anti-abortion organizations that sometimes offer some medical services.听听who was told after an ultrasound at a crisis pregnancy center that she had a normal pregnancy, and three days later, ended up in emergency surgery because the pregnancy was not normal, but rather ectopic听鈥斕齣n other words, implanted in her fallopian tube rather than her uterus, which could have been fatal if not caught. This is not the first such case, but it again raises this question of whether these centers should be treated as medical facilities, which听we’ve听talked about many states听do.听听

Raman:听And I think a lot of the rationale that people have for trying to do some of these听mandatory ultrasounds, you know, encouraging people to go to this is because the talking point is that听you don’t know if you have an ectopic pregnancy, you don’t have another complication, so you should go here to instead of just taking a medication abortion. So听鈥μ齱e’re听coming full circle here, where this is also not helping the听case, if听you’re听not finding the full information there.听So听I think that听was an interesting point to me听鈥μ�

Rovner:听Yeah,听it’s听going on both听sides听basically.听It is fraught, and we will continue to cover it.听

All right, that is this week’s news. Now听we’ll听play my interview with Elisabeth Rosenthal at听麻豆女优 Health News, and then we will come back and do听our听extra credits.听

I am pleased to welcome back to the podcast听麻豆女优 Health News’听Elisabeth Rosenthal, who reported and wrote the last听two听“Bills of the听Month.”听Libby, thanks for coming back.听

Elisabeth Rosenthal:听Thanks for having me.听听

Rovner:听So听let’s听start with our drug copay card patient.听Before we get into the particulars,听what’s听a听drug copay card?听

Rosenthal:听Well, copay cards, or听copayment programs, are things that the drug companies give patients. You know,听when it says you could pay as little as $0,听where they听pay听your copayment, which is usually听pretty big听鈥斕齱hen you see a copay card, it means听the听price is big, and听they’ll听bill your insurance for the rest.听So听for patients, it sounds like a good deal, and it is a good deal when they work.听

Rovner:听So听tell us about this patient, and what drug did he need that cost so much that he听required听a copay card?听

Rosenthal:听Well, the funny thing is听鈥斕齢is name is Jayant Mishra, and he has听a psoriatic听arthritis. And the doctor told him, you know,听there’s听this drug called Otezla that would really help you.听And he was, he was a little cautious, because he knew it could be expensive, so he did wait a few months, and his symptoms, his joint pain, in particular, got worse.听He was like,听OK,听I’ll听start it.听So听he started it the first month, and it worked听really well.听听

Rovner:听“It”听the drug, or听“it”听the copay card, or both?听

Rosenthal:听Both seemed to work very well.听So听the copay card covered his copay of over $5,000 and he was like,听Oh, this is great. And then what happened was, the next month, he tried to fill听it,听and it was like,听Wait, the copay card听didn’t听work!听And really what happens is copay听cards,听they are often limited in time and in the amount of money that’s on them.听So听depending on how much the copay is,听they can run out,听basically expire. You used all the money, and you have a drug that听you’ve听used that is working听really well听for you, and then suddenly听you’re听hit with a big bill.听So听they听kind of get听people addicted to drugs,听which they then听can’t听afford.听听

Rovner:听And what happened听in this case was the insurance company charged more than expected, right?听

Rosenthal:听Well, Otezla, you know,听there’s听so many things about this, and many听“Bill of the听Month”听stories that,听you know,听are eye-rollers. Otezla听鈥斕齮here are biosimilars that were approved by the FDA in听鈥μ�2021?听鈥μ齱hich听everyone’s听talking about, faster approval of biosimilars. Well, this was approved, but the drugmaker filed multiple suits and patent infringement, and so in the U.S., it听won’t听be on the market, the听biosimilar,听until 2028,听so听that’s听a problem too.听

Rovner:听So听if you want this drug,听it’s听going to be expensive.听

Rosenthal:听It’s听going to be expensive. And the other problem is copay cards. Insurers used to say,听OK, that will count towards your deductible, right?听So听you听didn’t听really feel it,听right?听Because you got a $5,000 copay card,听and you had a $5,000 deductible if you had a high-deductible plan.听And everything was good. Now, insurers听kind of said,听Whoa,听we’re听not sure we like these things.听So听yeah, you can use them, but it听won’t听count towards your deductibles.听So听they’re听not听nearly as听useful as they might have been in the past. But patients are really stuck, because these are听really expensive听drugs that most people听couldn’t听afford without copay cards.听

Rovner:听So听what eventually happened to this patient, and how can other people avoid falling into the copay card trap?听

Rosenthal:听So basically, because he had used up the amount on the copay card, which was听$9,400 for the year,听by the second month, he tried for the third month to kind of ration his drugs to take half as much, and his symptoms came back. And then the lucky thing for him was then it was January,听right,听copay cards听are usually done for the year.听So听he got a new copay card for another $9,400 and he was good for January, and he paid with his health savings account for the first month’s听copay,听with the copay card the second month, with the copay card and his health savings account. And when this went to press, he听wasn’t听sure how he was going to pay for the rest of the year. And for him,听it’s听not a huge problem, because he has a very听well-funded听health savings account, which few of us do, but he was听really up听in the air for the rest of the year when we wrote about this.听

Rovner:听So听sort of moral of this story, be careful if you want to take an expensive drug, and the theory that when the drugmaker promises,听Oh, you can have this for as little as听$0听copay.听

Rosenthal:听Well, I听think it’s听you have to understand what a particular card does.听You have to understand what’s the limit on how much is on the copay card.听You have to understand how many months it’s good for.听You听have to听understand, from your insurer’s point of view,听if听that will count as your deductible or not. And then, man, you know,听you’re听kind of on听your own,听right?听Sometimes your copay card will work great for you, and at other times it will work for a shorter amount of time. And you听got听to figure out what to do. I think the third,听bigger lesson is getting biosimilars, which are these听very expensive听drugs approved,听is not really the big problem in our country. The problem is the patent thickets that surround so many of these drugs that prevent them from getting to the patients who need them.听听

Rovner:听In other words,听you can make a copy of this drug, but you might not be able to get it onto the market.听听

Rosenthal:听Right.听You can make a听copy听this drug听鈥斕齣t听[a generic]听was approved in 2021听鈥斕齜ut that won’t help patients until 2028,听which is really terrible. You know,听it’s听available in other countries, but not here.听

Rovner:听So听moving听on,听our March patient had insurance through the Affordable Care Act exchange and was听benefiting听from one of those zero-premium plans until she got caught in a听literally Kafkaesque听mess over a听1-cent bill that turned into a听5-cent bill. Who is she and what happened here?听

Rosenthal:听Yeah, her name in this wonderful, terrible story is听Lorena Alvarado Hill. And what happened here is she was on one of these $0 insurance plans through the Obamacare exchanges with that great subsidy, the Biden-era subsidy, and she and her mother were on the same plan, and her mother went on to Medicare,听turned 65.听So听Lorena听didn’t听need听the family听coverage and told the insurer that. And the insurance, of course, automatically recalculates your subsidy, and her premium went from being zero to听1听cent. Now,听no human would make that, you know, would say,听Oh, that makes sense. And to Lorena, it听didn’t听really make sense either. She was like,听I’m听not sure how to pay听1听cent, like, will it work on my credit card? And some of the bills said, you听know,听you understand that this could听impact听the continuation of your insurance, but, you know, she was like,听1听cent,听I听don’t听think so. And then she kept going to doctors, and the insurance still worked, and then at some point, four months later, she听got听a letter in November saying,听Oh, your insurance was canceled in July, and you owe money for all these bills.听

Rovner:听And what happened with this case?听

Rosenthal:听Well, you know, like many of our听“Bill of the听Month”听patients, I celebrate them for being real fighters, because her bill, since her premium was听1听cent a month, went from听1听cent to听2听cents to听3听cents to听4听cents to听5听cents,听when they sent her the note saying your insurance has been canceled for the last four months.听And what turns out, which is really interesting,听is this is a known glitch in the way the subsidies were calculated, were administered.听There’s听a recalculation of subsidies every time听there’s听a life event, a kid goes off the plan, you change jobs, get married, you听get divorced.听So听the recalculation听happens automatically.听And the Biden administration, understanding that this glitch could exist, they gave the insurers the听option听not to cancel insurance if the amount owed was less than $10.听And there were听apparently 180,000听people caught in this situation where their insurance could have been canceled for under $10听of a听recalculated premium. The Trump administration revoked that rule because their feeling was, you owe something, you pay something.听So听it’s听part of their听“stamp out fraud and abuse,”听and this was, in their view, abuse of a system when people听didn’t听pay what they owed.听听

Rovner:听One cent.听

Rosenthal:听One cent,听right.听So听what happened听with听her is, you know,听a听good bill-paying听citizen sending her daughter to college with loans. She wrote her insurers, she wrote to the state, she wrote to everyone. And as a last resort, of course, someone said,听Well,听there’s听this thing called听Bill of the听Month you could write to.听So听when we听looked into听this,听at first听HealthFirst, which was her insurer in Florida, said,听Oh,听she’s听not insured through us.听And I was like,听Yeah, because you canceled her insurance. And then I gave them her insurance number, and they said,听Well, yes, according to law, we did the right thing.听She听didn’t听pay,听so it was canceled. Somehow, through all of this,听word got back to the hospital and the insurer,听and they worked together, and her bills were suddenly zero on her portal. So听that’s听the good news for Lorena Alvarado听Hill. It听doesn’t听really help all those other people whose insurance may have been canceled for premiums that were under $10.听

Rovner:听So,听basically, if you get a bill for听5听cents, you should pay it.听

Rosenthal:听Yeah, you know, it was funny when this story went up, many听people were sympathetic, but other commenters said,听Well, she should have just paid $1 because you can pay that.听And听maybe there听was a way to pay听1听cent. And听I’m听kind of with听her, like, if I got a bill for听1听cent, life is busy. This is a woman who is a teacher’s aide and works on weekends at a store to help pay for her daughter’s college. Life is busy. You just听can’t听sweat over听1-cent bills and spend a lot of time figuring out how to pay them. And听I guess the lesson听is,听what’s听the worst that can happen in a very dysfunctional system where so much is automated听now?听The听worst听that can happen is always really bad. Your insurance could be canceled.听

Rovner:听So basically, stay听on top of it, I guess,听is the message for听both of these听stories this month. Elisabeth Rosenthal, thank you so much.听

Rosenthal:听Thanks,听Julie,听for having me.听

Rovner:听OK, we听are back.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. Jessie, why don’t you go听first this week?听

Hellmann:听My story is from听The Texas Tribune, from a group of reporters who I听can’t听name individually.听There’s听too many of them. But it is听听in Texas after the governor issued an executive order a few years ago requiring that hospitals check patients’听citizenship.听So听the story found that hospital visits by undocumented people dropped by about a third, and the story also got into how this is bleeding into other types of health care at other facilities, free vaccine clinics are not being attended as widely anymore. People听aren’t听attending their preventive care appointments,听like cancer screenings or prenatal care checkups. Some of these other health facilities听are required to听check citizenship status, but听it’s听definitely a听chilling effect over the broader health听care landscape in Texas.听

Rovner:听Yeah. There have been a lot of good stories about that. Sandhya.听

Raman:听My extra credit is from听Science, and听it’s听by Jocelyn Kaiser, and the story is听“.”听In her story, she talks about how last year, you know, the administration cut a lot of staff at the Agency for Healthcare Research and Quality. They’ve canceled all of the open grants, but Congress still appropriated $345 million for the agency this year, and so supporters kind of want to revive what should be going on听at听the agency, which hasn’t been issuing any of the grants since the start of the fiscal year, and just kind of make progress on some of the things that this agency does do, like running the U.S.听Preventive Services Task Force, which has been, you know, something that has been talked about this year. So thought it was an interesting piece.听听

Rovner:听Yeah,听I’m听old enough to remember when听AHRQ听was bipartisan. Alice.听

Ollstein:听So听a听very harrowing story in The New York Times titled听“.”听And I will say, since this piece ran, we have seen that an oil shipment from Russia is going through to the island, but I don’t think that will be sufficient to completely wipe away all of the upsetting conditions that this piece really gets into,听what is happening as a result of the ramped-up U.S.听embargo and blockade of the island. People听can’t听get food, they听can’t听get medicine, they听can’t听get electricity, and that is having a devastating effect on health听care. The Cuban health听care system has been听really miraculous听over the years, just the pride of the government.听It has meant,听prior to this blockade,听that their life expectancy was better than ours, and a lot of their outcomes were better. And听so听this has been really devastating. There’s, you know, harrowing scenes of people on ventilators having to be hand-pumped when the electricity cuts out,听babies听in听incubators, you know, losing power.听You know, people听having听to skip medications, etc. And听so听this is really shining a light on a foreign policy situation that this administration听is behind.听

Rovner:听Yeah,听that’s听really been an under-covered story, too,听I think, you know, right off our shores.听My extra credit this week is one I simply could not resist.听It’s听from New York Magazine, and听it’s听called听“,”听by听Helaine Olen. And as the headline听rather vividly听points out, we are听witnessing听the rise of pet medical tourism, along with human medical tourism, which has been a thing for a couple of decades听now.听It seems that veterinary medicine听is getting听nearly as听expensive as human medicine, and that one way to find cheaper care is to cross the border, which is obviously easier if you live near the border.听I’m听not sure how much cheaper veterinary care is in Canada, but as the owner of two corgis, I may have to do some investigating of my own.听听

OK, that is this week’s show.听As always, thanks to our editor,听Emmarie Huetteman,听and our producer-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,听as always, you can email听us听your comments or questions.听We’re听at 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Sandhya.听

Raman:听On听听and on听听.听

Rovner:听Alice.听

Ollstein:听On Bluesky听听and on X听.听

Rovner:听Jessie.听

Hellmann:听I’m听on LinkedIn under Jessie Hellmann听and on X听.听

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

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Who Really Collects in the Wage Garnishment Game?

I was a consumer bankruptcy attorney for years during the global financial crisis of 2008 (pre-Affordable Care Act). Around 40% of the bankruptcies were caused by medical debts uncovered by insurance. With the effectiveness of the ACA, the number of bankruptcies in Colorado plummeted.

My comment on “State Lawmakers Seek Restraints on Wage Garnishment for Medical Debt” (Feb. 20)? BC Services acts as if it is garnishing these wages to keep rural hospitals, medical providers, etc. in business. The likely reality is that BC Services (and other collection operations) takes “90-day-overdue” bills 鈥� which may or may not have ever been delivered to the patient; usually disregards whether the hospital has offered the patient a reasonable repayment schedule; and then keeps 50% or more of the debt, along with its attorneys’ fees and costs. The medical provider receives very little of the money sent to collections.

鈥� Bill Myers, Denver

On Work Requirements: Working Out Solutions

Eighty hours a month works out to about 20 hours a week, and I think if people can work or study from home, they should be able to meet the requirements (“New Medicaid Work Rules Likely To Hit Middle-Aged Adults Hard,” Feb. 11). More importantly, though, “navigators” will help people get exemptions if they qualify. I wonder why there is so much moaning about the law and nothing about the means to fix the problems it creates. It seems like a lot of hot air. We know it’s a problem. So how about exploring solutions?

鈥� Therese Shellabarger, North Hollywood, California

The Flip Side of a Drug’s Benefits

I read Phillip Reese’s report on anti-anxiety medications, adults who take them, and their concerns about this administration’s policies regarding them (“As More Americans Embrace Anxiety Treatment, MAHA Derides Medications,” Feb. 23). If the anti-anxiety medications provide solace to adults such as Sadia Zapp 鈥� a 40-year-old woman who survived cancer 鈥� then she should be able to continue them. Unfortunately, the same is not true for many other people, particularly patients such as myself.

When I was 16, I went through an unnecessarily painful and traumatic year. I was sent away from home three times, sent to a wilderness therapy “troubled teen industry” camp that has now been shut down, sent to a new boarding school that I hated, and was away from my family for many months. Of course, I felt depressed and anxious, so my psychiatrist at Kaiser prescribed citalopram. At first, it caused extreme agitation and violent ideation, stuff that is commonly reported to the point it has an . Thankfully, it calmed down. And when I lowered the dose, my life was calm, stable, and productive.

Unfortunately, that did not last long. Over time, the effects wore out, so I tried to go off. I was not given any safety instructions on how to taper slowly and safely, so I went off multiple times. Each time caused extreme withdrawal symptoms, including self-harm, crying spells, and worse depression than ever before. Also, the sexual “side effects” persisted and even worsened upon cessation to this day. It is a , and it is very rarely covered. While the worst symptoms of withdrawal went away, I still live with a worsened sexuality than a young adult my age is supposed to have.

Back to the article, which seems to focus on adults. Its only named profile is Zapp, and when it cites statistics, it begins at age 18. Solely showing statistics of adults is unethical because it obscures the high and rising prescription rates among minors. Minors are also more likely to suffer permanent developmental damage to their sexualities and experience suicidal ideation. This is a major problem that warrants further conversations.

When covering the downsides of SSRIs, the article mentioned only mild side effects, like upset stomach, decreased libido, and mild discontinuation effects, without covering the major concerns of suicidal ideation, akathisia, PSSD, and severe withdrawal. I believe that framing antidepressants as an unequivocal good is equivalent to framing them as an unequivocal evil; both misguide patients through harm and deception.

Lastly, I want to finish on this by the brilliant psychiatrist Awais Aftab.

鈥� Eli Malakoff, San Francisco

A Rigged System?

Insurers pay these exorbitant amounts because they set them in the first place (Bill of the Month: “Even Patients Are Shocked by the Prices Their Insurers Will Pay 鈥� And It Costs All of Us,” March 3). They have been doing this for years. I learned this over 15 years ago, when I dislocated and broke my elbow. I had no insurance and, as a “self-pay” patient, paid the surgeon, hospital, and radiology center myself. They set the prices high enough that people will buy insurance out of fear, ensuring they make a profit.

The first thing I learned was that there is not a set price for all; for the insured, it is a fixed system controlled by contracts and codes. As a self-pay patient, the cost may vary.

It was late in the evening and I tripped over a snow shovel, slammed my arm up against a gate post, and it was hanging like a puppet without a string! I called an ambulance and, at the hospital, they strapped me up and told me that I must see the orthopedic surgeon the next day. He sent me to a radiology facility for an X-ray; I paid for it and took it to the surgeon. When I received a bill from the radiology center, I called to say that I had paid. They said it was for the radiologist (who, as far as I knew, never analyzed it). The contract with the insurance company required that every patient had to be billed, whether or not a radiologist reviewed scans. If not, they would lose their contract.

My elbow was dislocated, with a fracture, and I needed surgery. The surgeon’s office called the hospital for pricing, and he told me it would be about $2,000 for outpatient surgery. I called the hospital to confirm the appointment for outpatient surgery, and they wanted $8,000! When I objected, and told them what the surgeon had quoted, they checked. “Oh, you are a self-pay!” Cost would be $2,000. I gave them my card number and prepaid it before they could change their minds.

I had a friend in New Jersey who had the very same injury and surgery. She had insurance through her employer, and she paid more in copays than I paid when paying directly.

Insurance companies are SHARKS!

鈥� Stephanie Hunt-Crowley, Chamberet, Nouvelle Aquitaine, France (formerly Frederick, Maryland)

US vs. Canada

Re: the article about nurses moving to Canada (“鈥榊ou Aren’t Trapped’: Hundreds of US Nurses Choose Canada Over Trump’s America,” Feb. 26). You neglect the “rest of the story” 鈥� or maybe you don’t know it? I had my medical office in Los Angeles for about 30 years and had dozens of Canadians come to L.A., where some had to self-pay for care, but chose to because of the superior level of medicine available. One man, a son of a gynecologist in Canada, had a draining abscess from a years-old appendectomy. The reason was, after investigation, that the Canadian practice had used silk suture (organic material), which can harbor microbes and carry a greater risk of infection. The trend has been to discontinue silk in favor of nylon. The Canadians were obliged to “use up” the silk suture they had before switching to nylon. The surgeons at my hospital were astounded.

鈥� Kathryn Sobieski, Jackson, Wyoming

On the NET Recovery Device’s Track Record 鈥� And Detractors

I read your piece about the NET Recovery device with interest (Payback: Tracking Opioid Cash: “Maker of Device To Treat Addiction Withdrawal Seeks Counties’ Opioid Settlement Cash,” March 18), and I am grateful to you for pointing to one of our many success stories 鈥� the story of Michelle Warfield, whom the NET device helped get off opioids.

I also wanted to note a couple of instances where I see the facts differently than they were portrayed in your piece. Your piece seemed to imply that the NET device is new, and I wanted to note that the device has been around for decades (it helped Eric Clapton and members of The Who and the Rolling Stones get sober back in their heyday), and is based on a proven technology that stimulates both the brain and the vagus nerve to help patients with their cravings and withdrawal. There are countless studies that prove the power of neurostimulation, including that showed significant reductions in opioid and stimulant use without medication for a polysubstance population receiving at least 24 hours of stimulation.

I also noted you quoted detractors of our device, and I’d simply urge anyone looking at the issue of opioid addiction abatement to consider who those detractors are; organizations that now find themselves competing for grant dollars from counties increasingly choosing to fund innovation. It is not surprising that those with the most to lose financially would prefer the status quo. But the counties and jails leading this charge are doing so because they have seen what works, and their constituents, real patients, are the proof.

The success stories of our patients speak for themselves, and our only motivation at NET Recovery is to help as many people as possible get truly clean and sober by helping to break that initial grip the opioids have on them. When the NET device works, and it works an astounding 98% of the time (producing a clinically meaningful reduction in opioid withdrawal symptom severity in one hour), our patients are experiencing the return of choice and true freedom.

Thank you for your interest in our work and for the coverage you provide.

鈥� Joe Winston, NET Recovery CEO, Costa Mesa, California

Education Is the First Step in Lowering Health Care Prices

After reading this article about making hospital prices more transparent, I realized the information alone could help drive medical prices down (“Trump Required Hospitals To Post Their Prices for Patients. Mostly It’s the Industry Using the Data,” Feb. 17). Your publication shows good use of evidence-based research 鈥� it’s timeless and informative.

As a student at Thomas Jefferson University on the path to serving in the health care arena, I understand the struggles and complexities of medical decision-making. In the medical setting, the topic of price is always overshadowed by patient care and clear communication on the part of both professionals and patients, and it does not reflect how patients would navigate comparison-shopping for care. Almost every patient relies on the help of a physician or gets help from an insurance network and not from online price matching.

I believe that many people should engage with this article even if they aren’t entering the health profession; it would benefit everyone. Although price transparency may help insurers and care providers more than patients, if their goal is to lower prices, they must look beyond the simple posting or sharing of prices. I appreciate the effort to try to bring awareness to this major issue and encourage thoughtful policy discussion about lowering medical prices.

鈥� Jan Rodriguez, Philadelphia

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 .

USE OUR CONTENT

This story can be republished for free (details).