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

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

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

Panelists

Among the takeaways from this week’s episode:

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

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

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

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

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

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

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

Also mentioned in this week’s podcast:

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

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

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

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

Rachel Cohrs Zhang:听Hi,听everybody.听

Rovner:听Shefali Luthra听of听The听19th.听

Shefali Luthra:听Hello.听

Rovner:听And Lizzy Lawrence of Stat News.听

Lizzy Lawrence:听Hello.听

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cohrs Zhang:听I听don’t听think so.听

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

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

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

Cohrs Zhang:听Yeah.听

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Luthra:听That’s听true.听

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Keith:听Thanks,听Julie.听

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

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

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

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

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

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

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

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

Luthra:听I am on听Bluesky听.听

Rovner:听Rachel.听

Cohrs Zhang:听On听X听, or听.听

Rovner:听Lizzy.听

Lawrence:听I’m听on听X听听and听听and听.听

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

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This story can be republished for free (details).

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

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

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

Panelists

Among the takeaways from this week’s episode:

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

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

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

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

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

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

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

Also mentioned in this week’s podcast:

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

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

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

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

Anna Edney:听Hi, everyone.听

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

Alice Miranda听Ollstein:听Hello.听

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

Joanne Kenen:听Hi, everybody.听

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

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

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

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

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

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

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

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

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

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

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

Ollstein:听Exactly.听

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

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

Rovner:听Yeah.听

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

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

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

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

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

Rovner:听It’s听$5.3 trillion.听

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

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

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

Rovner:听Right.听

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner:听Puberty blockers!听

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

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

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

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

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

Edney:听Yeah.听

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

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

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

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

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

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

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

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

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

Elisabeth Rosenthal:听Thanks for having me back.听

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

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

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

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

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

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

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

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

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

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

Rovner:听I know the feeling.听

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner:听Joanne.听

Kenen:听I’m听mostly on听听or on听听.听

Rovner:听Anna.听

Edney:听听or听X听.听

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

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In 2026, the Trump administration will require U.S. cancer registries that receive federal funding to classify patients’ sex as male, female 鈥� or not stated/unknown. That last category is for when a “patient’s sex is documented as other than male or female (e.g., non-binary, transsexual), and there is no additional information about sex assigned at birth,” the new standard says.

LGBTQ+ health advocates say that move in effect erases transgender and other patients from the data. They say the data collection change is the latest move by the Trump administration that restricts health care resources for LGBTQ+ people.

麻豆女优 Health News correspondent Rachana Pradhan appeared on WAMU’s Health Hub on Dec. 10 to explain why LGBTQ+ health advocates worry this change could hurt public health and the care patients receive.

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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Weiser spoke with 麻豆女优 Health News on the evening before World AIDS Day, which the U.S. government, for the first time since 1988, didn’t acknowledge this year. That was only the latest blow to efforts to combat HIV. The Trump administration has to provide lifesaving HIV care abroad, withheld money to prevent and treat HIV in the U.S., and fired HIV experts at the Centers for Disease Control and Prevention.

Weiser was fired from the CDC during mass layoffs in April, was rehired in June, and then resigned. He continues to treat patients at Grady Memorial Hospital in Atlanta. In November, he published an against complying with presidential orders to censor data about transgender people.

The following conversation has been condensed and edited for clarity.

LISTEN: Former CDC official John Weiser speaks with 麻豆女优 Health News correspondent Amy听Maxmen听about his resignation from the agency and why听he thinks complying with听President Donald Trump’s orders to erase transgender people is bad for science and society.听

In the first weeks of his presidency, Donald Trump issued with implications for HIV programs. One directed federal employees to exclude gender identities that didn’t correspond to a person’s biological sex assigned at birth.

On how this played out at the CDC:

We were told to scrub any mention of gender or transgender people from dozens of research papers and surveillance reports that had already been published or were going to be published, and to stop collecting information from participants about their gender identity. For example, we had to recalculate our numbers on HIV among men who have sex with men, or MSM, a category that the CDC changed to “males who have sex with males.”

The CDC had no director at the time. The order came from on high. And there was no discussion about whether we wanted to comply with the directive.

On how this directive has affected his research:

Using data from the Medical Monitoring Project, we found that people with HIV who misused opioids were more likely to engage in behaviors that could pass on HIV to another person 鈥� through unprotected sex or shared injection. And we found that very few people who misused opioids were receiving treatments for substance misuse. This information could have been useful to change clinical practice and boost funding to treat people with HIV who misuse opioids.

We were getting ready to publish this study, but when I put the paper through CDC’s clearance process, I was told to remove data about the prevalence of opioid misuse among transgender people.

I thought carefully about that, and I decided not to do that, because it’s bad science to suppress data for ideologic reasons and because erasing people from the story harms actual people. I thought about my transgender patients and how I would face them, and what I would say to them while I’m sitting with them in the exam room, knowing that I had erased their existence from CDC.

I withdrew the paper. It remains unpublished.

On how removing data harms people:

Purging data about transgender people has the effect of erasing them from the real world, pretending that they don’t exist. This group of people is heavily affected by HIV, and this type of information informs improvements in treatment. My transgender patients struggle with poverty, with unstable housing, with food insecurity, with mental health disorders, with substance misuse, and face a huge amount of stigma and discrimination in their daily lives.

My transgender patients are trying to get by, day by day. They’re trying to survive. I think it’s important to realize that somebody who is transgender needs to feel comfortable in their own body to be healthy 鈥� and denying them recognition compounds their challenges.

After the executive order came down, one of my patients said she felt even more afraid of being in public and not passing, and so she was considering having additional surgical treatment to feel safer. Her concern was not about politics. It was about survival.

On why the CDC went along with orders to remove transgender data:

I think the hope was that by complying with the directive, other work at the CDC would be spared. And unfortunately, that hasn’t proved to be the case. Funding for the Medical Monitoring Project was terminated after 20 years, and the concern within CDC is that the president will eliminate all HIV prevention and surveillance funding.

One of my concerns while there was that if it’s OK to comply with a directive to remove information about gender, what if the next demand is that we don’t report about people who emigrated from other countries, or on people who are experiencing homelessness? What if there’s a directive to suppress data about a particular racial or ethnic group that’s unpopular? How far would we go?

Some HIV clinics and organizations have considered curtailing their work with transgender people and undocumented immigrants, or on equity initiatives, because they fear the loss of federal funds.

His advice on these decisions:

People making these decisions are in a really tough spot. They want to do what’s best for their programs. They want to do what’s best for their employees. They want to do what’s best for the people they’re charged with taking care of. Those are careful decisions that need to be made weighing all of the considerations. What I want these leaders to do is also consider how a decision to essentially throw one group of people under the bus undermines scientific integrity and harms everyone.

鈥夾nd I think that it’s also necessary for the rise of autocracy to go along, to compromise, to acquiesce. While all of this was going on, I heard an interview with M. Gessen, who is a Russian American journalist who writes about the rise of autocracy. Gessen explained that decisions to go along are not made because people are unethical or heartless. They’re rational choices. They’re made in order to protect something that’s important 鈥� institutions, families, jobs 鈥� even if it means sacrificing principles. Gessen’s point is that this gradual process of compromising ultimately is what solidifies an autocrat’s power.

On why he resigned from the CDC:

As a physician working at the CDC, numbers have always described individual people, people whose suffering I witness. When you know somebody, they’re no longer just a concept that you make a judgment about.

I realized that I could do more good by spending more time with my patients than I could working for the CDC under this administration.

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).

Médicos y activistas por los derechos de las personas trans aseguran que esta modificación dificultará enormemente la comprensión de los diagnósticos y las tendencias del cáncer en esta población.

Algunos estudios han demostrado que entre las personas transgénero es más frecuente el consumo de tabaco y menos habitual los controles de detección del cáncer, factores que podrían aumentar su riesgo de desarrollar la enfermedad.

Investigadores del cáncer explicaron que este cambio es consecuencia de que la administración Trump solo reconoce los sexos “masculino” y “femenino”.

Los científicos opinan que la medida impactará a todos los registros de cáncer del país 鈥攅n cada estado y territorio鈥� ya que todos reciben fondos federales.

A partir de 2026, los registros financiados por los Centros para el Control y Prevención de Enfermedades (CDC) y el Instituto Nacional del Cáncer (NCI) . Y las agencias federales de salud solo recibirán datos de pacientes clasificados de esa manera.

Actualmente, los registros si el sexo de un paciente de cáncer es “hombre”, “mujer”, “otro”, ofrece diferentes opciones para “transexual”, y si el sexo no ha sido indicado o se desconoce.

En enero, el presidente Donald Trump firmó una en la que se estableció que el gobierno federal solo reconocerá los sexos masculino y femenino. Autoridades de los registros oncológicos informaron que se les ordenó modificar la manera en que recolectan los datos de pacientes con cáncer.

“En Estados Unidos, a los que estamos recibiendo fondos federales prácticamente no nos dieron otra opción”, le dijo a 麻豆女优 Health News Eric Durbin, director del Kentucky Cancer Registry y presidente de la North American Association of Central Cancer Registries (NAACCR). Esta institución, que recibe dinero federal, establece los estándares para informar casos de cáncer a lo largo de Estados Unidos y Canadá.

Según la nueva normativa, se deberá clasificar a los pacientes como “sexo desconocido” cuando esté documentado como algo distinto a masculino o femenino (por ejemplo, no binario o transexual) y no haya información adicional sobre el sexo asignado al nacer.

Una visión incompleta

Investigadores señalaron que actualmente no se cuenta con datos poblacionales de calidad sobre la incidencia de cáncer en las personas transgénero. Si bien se estaban logrando avances importantes para mejorar esta información, ese trabajo ahora corre el riesgo de quedar en la nada.

“En lo que respecta al cáncer y las desigualdades en torno a esta enfermedad, se pueden usar los registros de cáncer para ver dónde se encuentra la mayor contaminación atmosférica, ya que las tasas de cáncer de pulmón son más altas en esas zonas. Se puede observar el impacto del almacenamiento de residuos nucleares debido a los tipos de cáncer que son más frecuentes en esos códigos postales, en esas zonas del país”, explicó Shannon Kozlovich, miembro del comité ejecutivo del California Dialogue on Cancer.

“Cuantos más sectores de la población dejemos fuera de esta base de datos, menos sabremos qué está ocurriendo”, agregó. “Y eso no significa que no esté ocurriendo”.

Durante décadas, los registros de cáncer fueron la herramienta de vigilancia más completa en el país para entender la incidencia del cáncer, las tasas de supervivencia y para identificar tendencias preocupantes.

Cada año, hospitales, laboratorios de patología y otros centros de salud notifican los casos de cáncer a registros regionales y estatales. Los datos compilados documentan las tasas de incidencia y mortalidad por región, raza, sexo y edad.

Dos programas federales son las principales fuentes de estadísticas sobre cáncer, con información sobre decenas de millones de casos. El National Program of Cancer Registries de los CDC financia organizaciones en 46 estados, el Distrito de Columbia, Puerto Rico, las Islas Vírgenes y territorios del Pacífico estadounidense. Su información representa del país.

Por su parte, el programa de Vigilancia, Epidemiología y Resultados Finales del Instituto Nacional del Cáncer, conocido como SEER, recopila y publica datos de registros que cubren del país.

La información que publican los registros de cáncer ha llevado a modificaciones en el tratamiento y en la prevención, además de impulsar otras políticas diseñadas para reducir las tasas de diagnóstico y de mortalidad.

Por ejemplo, esos datos permitieron identificar el entre personas . Como resultado, ahora las guías clínicas en Estados Unidos que los adultos comiencen los chequeos a los 45 años en vez de a los 50.

Varios estados también han aprobado sus propias medidas. Lara Anton, vocera del Departamento de Servicios de Salud de Texas, dijo que en 2018 los epidemiólogos del Registro Oncológico de Texas descubrieron que el estado tenía las tasas más altas del país de carcinoma hepatocelular, un tipo de cáncer de hígado más común en hombres que en mujeres.

A raíz de esto, el Instituto de Prevención e Investigación del Cáncer de Texas para revertir el aumento de casos. El Registro Oncológico de Texas se unió a SEER en 2021.

“Cuando se ingresa a un paciente con cáncer en un registro, lo seguimos durante el resto de su vida. Porque necesitamos saber si las personas sobreviven según el tipo y la etapa del cáncer”, señaló Durbin. “Eso es crucial para la formulación de políticas públicas”.

La NAACCR imparte los estándares nacionales que definen qué tipo de datos se deben recopilar con cada diagnóstico. Estos estándares son desarrollados junto a los CDC, el Instituto Nacional del Cáncer y otras organizaciones.

Según Durbin, los registros recopilan más de 700 datos por paciente, entre ellos información demográfica, diagnóstico, tratamiento y supervivencia. Los registros financiados por los CDC y el NCI deben especificar el sexo del paciente.

Las definiciones de NAACCR y sus estándares de datos garantizan una recolección uniforme en todo el país. “Todos seguimos esencialmente los estándares que desarrolla NAACCR”, dijo Durbin. Aunque los registros pueden agregar datos específicos a nivel estatal, deben seguir estos lineamientos cuando transfieren la información al gobierno federal.

En un comunicado enviado por correo electrónico, Andrew Nixon, vocero del Departamento de Salud y Servicios Humanos, afirmó: “HHS está utilizando la ciencia biológica para guiar sus políticas, no agendas ideológicas como lo hizo la administración Biden”.

Un retroceso

NAACCR publica periódicamente actualizaciones de sus lineamientos. Pero, según Kozlovich, el cambio en la categoría de “sexo” que eliminará las opciones transgénero a partir de 2026 fue una decisión de emergencia provocada por las políticas de la administración Trump.

Kozlovich formó parte de un grupo que impulsó la inclusión de datos sobre sexo y género como variables distintas en la recolección de información oncológica.

Según un realizado por el Williams Institute de la UCLA School of Law en Los Ángeles (UCLA), 2,8 millones de personas mayores de 13 años se identifican como transgénero en el país.

Científicos y defensores de los derechos de las personas trans manifestaron en entrevistas que hay señales preocupantes de que esta población podría tener mayor riesgo de desarrollar cáncer o enfrentar peores condiciones de salud en comparación con otras.

“Sin evidencia sobre nuestras desigualdades en salud, no hay ningún incentivo para corregirlas”, afirmó Scout, director ejecutivo de la LGBTQIA+ Cancer Network.

Un estudio publicado en 2022 concluyó que las personas transgénero y de género diverso eran entre más propensas que las personas cisgénero a consumir cigarrillos, cigarrillos electrónicos o habanos. El consumo de tabaco es una de las principales causas de cáncer y de muerte por cáncer.

Un publicado en 2019 concluyó que los pacientes trans tenían menos probabilidades de recibir los controles recomendados para detectar cáncer de mama, de cuello uterino y colorrectal. Y un realizado por investigadores de la Stanford Medicine encontró que los pacientes LGBTQ+ tenían casi tres veces más probabilidades de experimentar una recurrencia del cáncer de mama en comparación con personas cisgénero heterosexuales.

Scarlett Lin Gomez, epidemióloga de la Universidad de California-San Francisco y directora del Greater Bay Area Cancer Registry explicó que desde hace al menos 10 años el Instituto Nacional del Cáncer ha buscado mejorar su capacidad para monitorear la carga de cáncer en poblaciones con diferentes orientaciones sexuales e identidades de género. Los registros oncológicos son un punto de partida lógico, explicó.

“Se había avanzado lenta pero correctamente”, señaló Gómez. “Pero ahora, desde mi punto de vista, hemos retrocedido completamente”.

La decisión de no recopilar información sobre la identidad trans de los pacientes con cáncer es solo uno de los muchos cambios que han enfrentado los registros bajo la administración Trump, según científicos encargados de tareas de vigilancia y agencias estatales de salud.

Una orden del HHS para reducir gastos en contratos provocó recortes en el financiamiento a registros del programa SEER del NCI. Aunque los fondos de los CDC para registros no se han reducido, el presupuesto que propuso la Casa Blanca para el año fiscal 2026 plantea eliminar el financiamiento del National Program of Cancer Registries.

Otras acciones de la administración Trump contra personas trans incluyen la cancelación de subvenciones para investigaciones sobre salud LGBTQ+, el desmantelamiento de la oficina de salud para minorías sexuales y de género de los Institutos Nacionales de Salud, y la suspensión de servicios especializados para jóvenes LGBTQ+ en la línea nacional de prevención del suicidio 988.

Sin datos, los investigadores no pueden justificar el financiamiento de investigaciones que puedan beneficiar a pacientes trans, lamentó Gomez. “Es una forma de borrar su existencia”.

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Scientists and advocates for trans rights say the change will make it much harder to understand cancer diagnoses and trends among the trans population. Certain studies have shown that transgender people are more likely to use tobacco products or less likely to receive routine cancer screenings 鈥� factors that could put them at higher risk of disease.

The change is a consequence of Trump administration policies recognizing only “male” and “female” sexes, according to cancer researchers.

Scientists said the change will affect all cancer registries, in every state and territory, because they receive federal funding. Starting in 2026, registries funded through the Centers for Disease Control and Prevention and the National Cancer Institute as male, female, or not stated/unknown. And federal health agencies will receive data only on cancer patients classified that way.

Registries whether a cancer patient’s sex is “male,” “female,” “other,” various options for “transsexual,” or that the patient’s sex is not stated or unknown.

President Donald Trump in January issued an stating that the government would recognize only male and female sexes. Cancer registry officials said the federal government directed them to revise how they collect data on cancer patients.

“In the U.S., if you’re receiving federal money, then we, essentially, we weren’t given any choice,” Eric Durbin, director of the Kentucky Cancer Registry and president of the North American Association of Central Cancer Registries, told 麻豆女优 Health News. NAACCR, which receives federal funds, maintains cancer reporting standards across the U.S. and Canada.

Officials will need to classify patients’ sex as unknown when a “patient’s sex is documented as other than male or female (e.g., non-binary, transsexual), and there is no additional information about sex assigned at birth,” the new standard says.

Missing the Big Picture

Researchers said they do not have high-quality population-level data on cancer incidence in transgender people but had been making inroads at improving it 鈥� work now at risk of being undone.

“When it comes to cancer and inequities around cancer, you can use the cancer registries to see where the dirtiest air pollution is, because lung cancer rates are higher in those areas. You can see the impact of nuclear waste storage because of the types of cancers that are higher in those ZIP codes, in those areas of the country,” said Shannon Kozlovich, who is on the executive committee of the California Dialogue on Cancer.

“The more parts of our population that we are excluding from this dataset means that we are not going to know what’s happening,” she said. “And that doesn’t mean that it’s not happening.”

For decades, cancer registries have been the most comprehensive U.S. surveillance tool for understanding cancer incidence and survival rates and identifying troubling disease trends. Each year, cancer cases are reported by hospitals, pathology labs, and other health facilities into regional and statewide cancer registries. The compiled data documents cancer and mortality rates among regions, races, sexes, and age groups.

Two federal programs serve as the top authorities on cancer statistics, with information on tens of millions of cases. The CDC’s National Program of Cancer Registries provides funding to organizations in 46 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the U.S. Pacific Island territories. Its data represents . The National Cancer Institute’s Surveillance, Epidemiology, and End Results program, known as SEER, collects and publishes data from registries covering the U.S. population.

The information published by cancer registries has led to changes in treatment and 听prevention, and the enactment of other policies designed to reduce diagnosis rates and mortality.

For example, data collected by cancer registries was essential in identifying among people . As a result, U.S. guidelines that adults start screenings at age 45 rather than 50.

States have enacted their own measures. Lara Anton, spokesperson for the Texas Department of State Health Services, said epidemiologists with the Texas Cancer Registry in 2018 found that the state had the nation’s highest incidence rates of hepatocellular carcinoma, a liver cancer more common in men than women. aimed at reversing rising rates of liver cancer. The Texas Cancer Registry joined SEER in 2021.

“Once a cancer patient is entered into a cancer registry, we follow those patients for the rest of their lives. Because we really need to know, do patients survive for different types of cancer and different stages of cancer?” Durbin said. “That’s incredibly important for public policies.”

The North American Association of Central Cancer Registries maintains national standards outlining what kind of data registries collect for each diagnosis. It develops the list in partnership with the CDC, the National Cancer Institute, and other organizations.

For any given patient, under NAACCR’s standards, Durbin said, registries collect more than 700 pieces of information, including demographics, diagnosis, treatment, and length of survival. CDC and NCI-funded registries must specify the sex of each patient.

The NAACCR definitions and accompanying data standards are designed to ensure that registries collect case data uniformly. “Everyone essentially follows the standards” that NAACCR develops, Durbin said. Although registries can collect state-specific information, researchers said they need to follow those standards when sending cancer data to the federal government.

In an emailed statement, Department of Health and Human Services spokesperson Andrew Nixon said, “HHS is using biological science to guide policy, not ideological agendas that the Biden administration perpetrated.”

鈥楤ackwards’ Progress

NAACCR routinely publishes updated guidelines. But the change to the “sex” category to remove transgender options in 2026 was an emergency move due to Trump administration policies, Kozlovich said. She was among a group that had pushed for changes in cancer data collection to account for sex and gender identity as separate data points.

According to an by the Williams Institute at the UCLA School of Law, 2.8 million people age 13 and older identify as transgender.

Scientists and trans rights advocates said in interviews that there are troubling signs that may make transgender people more likely to develop cancer or experience worse health outcomes than others.

“Without evidence of our health disparities, you take away any impetus to fix them,” said Scout, executive director of the LGBTQIA+ Cancer Network.

A study published in 2022 found that transgender and gender-diverse populations were as likely as cisgender people to report active use of cigarettes, e-cigarettes, or cigars. Tobacco use is a leading cause of cancer and death from cancer.

A concluded in 2019 that transgender patients were less likely to receive recommended screenings for breast, cervical, and colorectal cancers. And a from researchers at Stanford Medicine found that LGBTQ+ patients were nearly three times as likely to experience breast cancer recurrence as cisgender heterosexual people.

Scarlett Lin Gomez, an epidemiologist at the University of California-San Francisco and the director of the Greater Bay Area Cancer Registry, said that for at least 10 years the NCI had been interested in improving its ability to monitor cancer burden across patient populations with different sexual orientations and gender identities. Cancer registries are a logical place to start because that is what they’re set up to do, she said.

There’s been “slow but good progress,” Gomez said. “But now we’ve completely, personally, I think, regressed backwards.”

The decision not to capture transgender identity in cancer patients is just one change registries have confronted under the Trump administration, according to scientists leading surveillance efforts and state health agencies. An HHS mandate to reduce spending on contracts led to funding cuts for cancer registries in NCI’s SEER program. Scientists said CDC funds for registries haven’t been cut; however, the White House’s proposed fiscal 2026 budget aims to eliminate funding for the National Program of Cancer Registries.

Among the Trump administration’s other actions targeting trans people are canceling research grants for studies on LGBTQ+ health, dismantling the National Institutes of Health’s office for sexual and gender minority health, and stopping specialized services for LGBTQ+ youth on the 988 national suicide prevention hotline.

Without data, researchers can’t make a case to fund research that may help trans patients, Gomez said. “It’s erasure.”

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The longest federal government shutdown in history is over, after a handful of House and Senate Democrats joined most Republicans in approving legislation that funds the government through January. Despite Democrats’ demands, the package did not include an extension of the expanded tax credits that help most Affordable Care Act enrollees afford their plans 鈥� meaning most people with ACA plans are slated to pay much more toward their premiums next year.

Also, new details are emerging about the Trump administration’s efforts to use the Medicaid program 鈥� for low-income and disabled people 鈥� to advance its immigration and trans health policy goals. And President Donald Trump has unveiled deals with two major pharmaceutical companies designed to increase access to weight loss drugs for some Americans.

This week’s panelists are Emmarie Huetteman of 麻豆女优 Health News, Anna Edney of Bloomberg News, Shefali Luthra of The 19th, and Sandhya Raman of CQ Roll Call.

Panelists

Among the takeaways from this week’s episode:

• Though the shutdown deal did not include an extension of the enhanced ACA subsidies, it came with a plan for a Senate vote by next month 鈥� on what exactly, it is unclear. Senate Republicans appear to be coalescing around providing money via health savings accounts rather than through the subsidies, while House Republicans seem more fragmented. The clock is ticking; the existing credits expire on Jan. 1, and open enrollment has begun.
• Even as the Trump administration is likely to be tied up in court over its efforts to use Medicaid to crack down on health care for immigrants and trans people, they’ve had a real chilling effect. Immigrants, for instance, are skipping medical care, and hospitals are cutting back on offering gender-affirming care for trans people for fear of losing federal funding.
• Trump’s newly announced GLP-1 price deals could help Medicare enrollees afford the weight loss drugs, potentially opening up access to a new population of patients 鈥� and customers. And a steady stream of policy reversals, unexplained dismissals, and negative news coverage is leading to worries that the FDA’s credibility is being undermined by internal drama. Also in question is whether it’s interfering with the agency’s work. Drug companies would likely say yes, and some within the FDA are trying to combat these concerns.
• A major anti-abortion group is leaning into the current electoral moment, targeting key states and preparing for sizable political contributions ahead of next year’s midterm elections. Abortion opponents see an opportunity to capitalize on voters’ changing motivations and reposition themselves to fit into the post-Trump Republican Party.

Also this week, 麻豆女优 Health News’ Julie Rovner interviews 麻豆女优 Health News’ Julie Appleby, who wrote the latest “Bill of the Month” feature, about a doctor who became the patient after a car accident sent her to the hospital 鈥� and $64,000 into debt. Do you have an outrageous medical bill? Tell us about it!

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

Emmarie Huetteman: 麻豆女优 Health News’ “Immigrants With Health Conditions May Be Denied Visas Under New Trump Administration Guidance,” by Amanda Seitz.

Anna Edney: Bloomberg News’ “,” by Tim Loh, Hayley Warren, and Julia Janicki.

Shefali Luthra: The 19th’s “,” by Orion Rummler.

Sandhya Raman: BBC’s “,” by Nadine Yousif.

Also mentioned in this week’s episode:

• 麻豆女优’s “,” by Audrey Kearney, Alex Montero, Mardet Mulugeta, Ashley Kirzinger, and Liz Hamel.
• 麻豆女优 Health News’ “Trump’s HHS Orders State Medicaid Programs To Help Find Undocumented Immigrants,” by Phil Galewitz.
• NPR’s “,” by Selena Simmons-Duffin.
• Stat’s “,” by Lizzy Lawrence and Adam Feuerstein.
• Stat’s “,” by Lizzy Lawrence.

[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.]鈥�听

Emmarie Huetteman:听Hello and welcome to “What the Health?” from 麻豆女优 Health News and WAMU.听I’m听Emmarie Huetteman, a senior editor for 麻豆女优 Health News, filling in for host Julie Rovner this week.听I’m听joined by some of the best and smartest health reporters in Washington.听We’re听taping this week on Thursday, Nov.听13,听at 10听a.m.听As always, news happens fast,听and things听might’ve听changed听by the time you hear this. So,听here we go.听

Today,听we’re joined听via video conference by Sandhya Raman of CQ Roll Call.听

Sandhya Raman:听Good morning.听

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

Anna Edney:听Hi, everyone.听

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

Shefali Luthra:听Hello.听

Huetteman:听Later in this episode,听we’ll听have Julie’s interview with 麻豆女优 Health News’听Julie Appleby, who wrote our latest听“Bill of the听Month”听story about a doctor who became the patient after a car accident sent her to the hospital and $64,000 into debt. But first, this week’s news.听

The longest federal government shutdown in history is over. Late Wednesday, six听House Democrats joined most Republicans in approving legislation that funds the government through January. That vote came after a handful of Senate Democrats broke ranks with their party last weekend and brokered a deal to end the shutdown. Although the Trump administration was still fighting earlier this week听not听to fully fund food stamps, the White House has said those benefits would be fully restored within hours of the shutdown’s end. That said, food banks and other safety-net programs have warned the听shutdown’s听consequences could linger, especially for those who were forced to redirect rent money, dip into savings, and make other sacrifices to feed their families. Notably, despite Democrats’听demands, the deal does not include an extension of the expanded tax credits that help people afford Affordable Care Act plans. That means those enhanced subsidies are still slated to expire at the end of the year. Sandhya, you were on Capitol Hill last night. What was included in the deal? And now that the shutdown’s听over,听can we expect a vote on extending the tax credits?听

Raman:听So听part of that deal was that sometime in the middle of next month, the Senate is going to be able to vote on a health bill of Democrats’听choosing听to extend the Affordable Care Act enhanced subsidies that are set to expire at the end of the year.听There’s听been a decent amount of talk already in听both chambers about what a health听care bill could look听like, because听it would need to be bipartisan to pass.听There’s听some multiple camps right now.听

I think in the Senate, Republicans are coalescing around putting money into flexible savings accounts instead of doing an extension of the credits as something that they would want to do instead. There are other Republicans that are still open to extending the credits with some reforms attached. The听House,听we figured out last听night,听was a little bit more fragmented.听They’re听less united in the way the House is around doing something with听the flexible听spending accounts.听So听a lot of them are still anti-extending the credits at all. They are working on a health package, but听it听remains to be seen what they want to do with that, given the short amount of time they have. But I think a lot of them are also looking for the same reforms that the Senate is on the Republican side, if they do sign on to extend them.听

Huetteman:听Yeah, short is right.听We’re听already looking at that听Dec.听31 deadline听to extend the existing credits. And of course,听we’re听already in the open enrollment period at this point. People are already听getting their plans听for next year. Polls show that most Americans blamed Republicans for the shutdown. A tracking poll from my 麻豆女优 colleagues out last week showed most Americans听want听Congress to extend the tax credits. Republicans are aware of this heading into the midterms next year, no?听

Raman:听I think that’s听definitely been听a big factor when talking to folks, especially ones that I think have been more interested in extending the credits听are set听up for our competitive races next year. There has been talk at听different times听of听doing a one-year extension.听But that puts us听pretty close听to the midterms, which might not be in everyone’s best interest depending on how things shake out.听So,听I think it’s听definitely in听a lot of folks’听minds, just because it is a lot more popular than it has been in previous years.听But there are a lot of the more conservative folks that just have been anti-ACA for so听long,听that they听don’t听want to extend something that was 鈥� The enhanced subsidies were started by Democrats during听covid. They think听it’s听a听covid-era thing that needs to be phased out.听

Huetteman:听Yeah,听and also听notably, you听might’ve听noticed I said that they only funded the government through January. Does that mean听we’re听getting ready to do this again in a couple of months?听

Raman:听There’s听a chance.听So听part of the听deal听got done this week is that they听did听three of the 12 spending bills that they do every year to fund the government. But they usually do them in order听of听which ones are easiest to get done.听So听we still听have to听come to听agreements听on some of the bigger ones,听including Labor,听HHS听[Health and Human听Services].听Education is what funds most of the health activities, and听that’s听usually a tougher one. So,听I think it听depends on a few things. Are folks sticking to their听word? Do they get that health听care vote that they听were promised? Do other things shake out that make people at odds with each other over the next bit? But we could听possibly be听in the same situation if we听don’t听make inroads on funding the government for a听yearlong听situation before then.听

Huetteman:听Oh goodness. Well, it sounds like听we’ll听be back again having this conversation soon. Meanwhile, months after the president听[Donald Trump]听signed into law the One Big Beautiful Bill with听big changes听to Medicaid,听new details听are听emerging听about how the Trump administration is using the Medicaid program to promote its policy goals.听My 麻豆女优 Health News colleague Phil Galewitz recently reported on how听the Trump administration has ordered state Medicaid agencies to investigate the immigration status of certain enrollees听鈥斕齪roviding states with lists of names to re-verify听鈥斕齛nd effectively roping the health program into the president’s immigration crackdown.听

Also, NPR reports the Trump administration plans to dramatically restrict access to medical care for transgender youth. New proposals that could be released as soon as this month would block federal money from being spent on trans care. Policy experts say that would make it difficult, if not impossible, to access that care, in large part because government funding is a huge source of听revenue, and听losing it could force hospitals to end the programs entirely.听Both of these听programs are听pretty striking:听enlisting Medicaid to perform spot checks of immigration status,听and also听potentially blocking funding for trans care. Have we seen other presidential administrations use Medicaid like this? And since听we’re听talking about funding, is there a role for Congress here?听

Luthra:听My understanding is that this approach, specifically with gender-affirming care and with immigration,听doesn’t听really have a precedent. And what I think is听really important听about these听is听these are decisions that will be litigated, challenged, argued in court. But, even if and as that happens,听there’s听a real chilling effect that I think is听really important. Already, we know that a lot of immigrants are very afraid to sign up even for benefits they are entitled to, because听they’re听worried it could count against them. We already know that a lot of immigrants with health needs are skipping their health听care because they are so worried about what happens if ICE听[Immigration and Customs Enforcement]听shows up at a hospital.听This only threatens to add to that. On the vantage of gender-affirming care,听already we have听seen some major hospitals and health providers drop the offering, even in anticipation of this policy coming into effect.听So听I think what’s听really important听is to understand that no matter what happens, already, people’s health is really being affected,听and people are suffering as a result.听

Raman:听I think听we’ve听seen little sprinkles of some of these things that have happened in the past, but this is elevated at such a level that听it’s听different. Even in the first Trump administration, there were some things put in place with the public charge to crack down on what benefits immigrants could be entitled to. But I think,听as with a lot of the things that听we’re听seeing,听it’s听really been amped up. I think one thing that Shefali was saying that made me think of was,听we’ve听already seen a lot of this chilling effect with a lot of things in abortion and reproductive care, where even if laws or regulations听don’t听go into effect,听they’re听being talked about or litigated. It already has that effect of people not wanting to show up or not knowing听what’s听available to them.听So听we have a little bit of that to look at as well.听

Huetteman:听Yeah, absolutely. All right, well,听we’re听going to take a quick break.听We’ll听be right back with more health news.听

We’re听back. In an Oval Office announcement last week,听President Trump unveiled agreements with the pharmaceutical giants Eli Lilly and Novo Nordisk to offer听some Americans lower prices on their weight loss drugs. Under the deals, the Trump administration says, most eligible patients on Medicare and Medicaid, or those who use the planned听TrumpRx听website, would pay a few hundred dollars a month for some of the most popular GLP-1 drugs.听That’s听compared to current price tags, which can be听$1,000听or more. Anna, these are only some of the most recent deals between the Trump administration and drugmakers. What does this mean for Americans who take these weight loss drugs, and what do the companies get in exchange?听

Edney:听Yeah, I think for Americans who take these or are hoping to take these, I think,听is probably where it really听opens up. Because 鈥� Medicare was not covering these. Now that听they’ve听come to the table and made a deal, it might open it up to some Medicare beneficiaries. I听don’t听think听you’re听going to see everyone on Medicare who wants it听be听able to get it. I think听it’ll听be a little stricter on what BMI听[body mass index]听and comorbidities and things that they need to meet, but it will听open access听to some Americans. Medicaid, I think,听it听might not听be as听beneficial for people’s pocketbooks because听they’re听already paying extremely low out-of-pocket prices, and Medicaid already negotiates听very low听prices. That might not be the听big change听that it was听hyped听up to be.听

But on the Medicare side, certainly, the companies听benefit听from that,听too, because that opens a new patient population to them.听And through听TrumpRx听鈥斕齮hat’s听the other place where they made this deal for lowered听prices on the听GLP-1s听鈥斕齛听lot of people have employer coverage that they might be trying to already get these drugs through,听and then听they’re听not paying a whole lot out-of-pocket.听But there听are听employer coverage plans that听aren’t听covering GLP-1s because听they’re听just so expensive.听So听it could be a place where some people might go to try to comparison听shop听and get their GLP-1s that they听didn’t听have access to before.听

Huetteman:听I also noticed,听in looking at the Trump administration’s fact sheet on this, that they were heralding that the companies had agreed to some extra American manufacturing.听Let’s听say concessions. Am I correct about that? Is this connected to tariffs by any chance?听

Edney:听Yeah, I听think that听that’s听been going on in conjunction with some of these deals. As you usually hear the companies say,听And听we’re听opening a new factory in Virginia听or somewhere.听And听certainly听they’re听trying to avoid the tariffs. As with a lot of these things, some of听it,听in some cases, they听have been factories that the companies were already planning to open,听and then they just pumped up for this purpose. I think for so many of this听鈥斕齛nd even for the prices, the lower prices that these companies are negotiating听鈥斕齱e just haven’t seen the details that will matter on what the company’s got,听and what the American people听actually benefit听from for all of this, and what these factories will mean or will be making.听These are things that might not come online for several years.听So听you can say听you’re听building something, but will we see it once Trump is out of office?听

Huetteman:听Exactly. And a lot of the framing has been:听We’re听helping Americans by bringing this work back to America, so that Americans can do the work, so that Americans can听benefit听from the drug prices.听But it seems like听there’s听at best a lag听on听that sort of benefit.听Right?听

Edney:听Definitely.听Definitely a听lag听on听being able to bring some of that stuff online. I think with a lot of the Trump administration’s health policies听鈥斕齛nd I use that word loosely听鈥斕齣t is that it is a lot of negotiation and handshakes. And听so听we don’t really know how solid those efforts will be in the years to come.听

Huetteman:听Well, we can听definitely keep听an eye on that.听In other news:听Drama, drama, drama at the Food and Drug Administration. With a steady stream of controversial policy reversals, unexplained dismissals, and听just plain听unflattering stories, concerns are growing that mismanagement at the FDA is undermining the usually cautious agency’s credibility. In some of the latest developments, Stat reported the FDA’s top drug regulator resigned after being accused of using his position to punish a former associate.听Stat also reported that dozens of scientists are considering leaving the already diminished FDA office that regulates vaccines, biologics,听and the blood supply听to get away from a toxic work environment. What are the ramifications of problems at the FDA?听Is the internal drama interfering with business there?听

Edney:听I think the pharmaceutical industry would say听yes, definitely.听They’re听feeling like their applications for new drugs听aren’t听getting reviewed in time.听They’re听worried that听they’re听not going to be reviewed in time. And this starts with the administration letting go hundreds of workers in those offices,听but also,听is听now 鈥μ齌here’s听just been such chaos at the top. You had Vinay Prasad,听who is the head of vaccines and biologic drugs there, who has been let go and then brought back. And then now we have the head of the drug center, George Tidmarsh, who resigned under investigation for听basically using听his position to fulfill a vendetta against an old colleague who pushed him out of some companies. And听so听I think,听certainly,听there’s听a lot of potential for disruption, as people are trying to avoid retaliation, avoid getting in the crosshairs of all of this.听

And recently, the FDA has now put Rick听Pazdur, who was the head of their cancer center, in charge of the drug center to try to show some stability to encourage the pharmaceutical industry. Because he is someone who’s really pushed for innovation, pushed for trying to get drugs to the market faster. And听he’s听been at the FDA for,听I think,听26 years. So,听they’re听trying to show some stability with that. But听we’ll听have to see how that goes because听he’s听also been highly criticized in the past by Prasad,听and听they’ll听be working closely together at the head of those two centers.听

Huetteman:听Well, finally, in reproductive health news, a federal judge ruled late last month that the FDA violated federal law by restricting access to mifepristone. While the government’s restrictions听remain听in place for the politically controversial medication, which is used to manage miscarriages as well as abortions, the judge did order the FDA to consider the relevant evidence听in order to听“provide a reasoned explanation for its restrictions.”听And a听major anti-abortion group, Susan B. Anthony Pro-Life America, announced plans for it and its super PAC听[political action committee]听to spend about $80 million in at least four states to support anti-abortion candidates in the midterm elections next year. Shefali, what does this say about how abortion opponents see this moment? What are they looking to gain in the midterms and beyond?听

Luthra:听It’s听so interesting to me to see how听much听anti-abortion groups are really听鈥斕齛nd,听in particular,听SBA听鈥斕齦eaning into this moment. And they really see this as a reversal of last year’s election, where Trump certainly won. But we do know from polling that voters听largely opposed听abortion restrictions, supported abortion rights.听I think some听really useful听context听is to consider that the president, despite being backed by听abortion听opponents, has not really been the champion many of them听would’ve听hoped for. He听hasn’t听actually done听very much on abortion, has not taken the very meaningful steps that you听might’ve听expected in a post-Dobbs听landscape听[Dobbs v. Jackson Women’s Health Organization]听to remarkably restrict it, beyond the normal things any Republican president does. And听so听I think what听we’re听seeing here is an effort to reposition the anti-abortion movement beyond this presidential administration. Thinking ahead to听what does it look like if there is a post-Trump GOP?听

How do you听build out听a movement that is a听more staunch听ally to the anti-abortion movement going forward? One other thing that I think is听really noteworthy听is: A听lot of abortion opponents are looking at polling that says that voters who support abortion rights听aren’t听prioritizing it in the same way they might have a year ago. And听they’re听really hoping that things can revert to how they used to be.听Or the voters who were these single-issue abortion voters were on their side, were supportive of restrictions, and then might be mobilized by these kinds of听really seismic听investments in elections.听

Huetteman:听Yeah, absolutely.听I’m听thinking about now how there was such a reaction about a month ago听鈥斕齝heck me on the timing听鈥斕齱hen a generic version of the abortion pill was put out. What was the reaction like then,听and what does that say about how they feel the Trump administration is reacting to their needs?听

Luthra:听A lot of abortion opponents were听really livid听about this,听and approving this generic was听pretty standard. It was not that complicated of a process. This drug has been available for so long in other forms. But it听underscored听that a lot of people who oppose abortion feel like they’re听really just听waiting. The HHS and the FDA have promised this review of mifepristone that they say could听ultimately lead听to restrictions. But all it has really听been听has听been听a promise听this review is ongoing, is coming.听There will eventually be results, but there听haven’t听been any.听So听to be waiting for some kind of policy that people keep telling you is coming, and then at the same time, to see听actually the听FDA moving to make abortion medication more available听鈥斕齨ot less听鈥斕齣s really frustrating for a lot of people who hope that this administration听would听be an ally to them.听

Huetteman:听Absolutely. OK.听That’s听it for听this week’s news. Now,听we’ll听have Julie’s interview with 麻豆女优 Health News’听Julie Appleby. And then听we’ll听do our extra credits.听

Julie Rovner:听I am pleased to welcome back to the podcast, 麻豆女优 Health News’ other Julie, Julie Appleby, who reported and wrote the latest 麻豆女优 Health News听“Bill of the听Month.”听Julie, welcome back.听

Julie Appleby:听Thanks for having me.听

Rovner:听So听this month’s patient is听actually a听doctor, so she knows how the system works.听But,听as so often happens, she was in a car accident and ended up in an out-of-network hospital. Tell us who she is and what kind of care she听needed.听

Appleby:听OK. Her name is Lauren Hughes,听and she was heading to see patients at a clinic about 20 miles from where she lives in Denver back in February when another driver T-boned her car, totaling it. She was taken by ambulance to the closest hospital, which turned out to be Platte Valley Hospital, where she was diagnosed with bruising, a deep cut on her knee,听and a broken ankle. Physicians there recommended immediate surgical repair because they wanted to wash out that wound on her knee.听And also, she needed some screws in her ankle to hold it in place.听

Rovner:听So then after the surgery and an overnight stay, she goes home,听and then the bills start to come. How much did it end up听costing?听

Appleby:听Well, she was billed $63,976 by the hospital.听

Rovner:听And the insurance company denied her claim. What was their argument?听

Appleby:听Yeah, this is where it gets complicated, as many of these things often do. Her insurer, Anthem, fully covered the听nearly $2,400听ambulance ride and some smaller radiology charges from the ER. But it denied the surgery and the overnight stay charges from the hospital,听which did happen听to be out-of-network. Four days after her surgery, Anthem听notified Hughes听in a letter that after consulting clinical guidelines for her type of ankle repair, its reviewer听determined听that it听wasn’t听medically necessary for her to be fully admitted for an inpatient hospital stay. So,听the note said that if听she’d听needed听additional听surgery or had other problems such as vomiting or fever, an inpatient stay听might’ve听been听warranted. But they听didn’t听have that in this case.听And generally, people听don’t听stay overnight in the hospital after broken ankle surgery.听

Rovner:听Of course, she had no car and she听鈥μ�

Appleby:听Right?听Her听car听was听totaled. She had no way to get home. She had nobody to pick her up. And it turns听out,听there’s a couple more little quirks.听So听the surgery charges were denied听because听this quirk that under Anthem’s agreement with the hospital, all claims for services before and after a patient are approved or denied together. So,听since the hospital stay was听generally not听required听after the ankle surgery, the听surgery charges听itself听were听denied as well. Even though Anthem said they always felt that that was medically necessary听鈥斕齮hat she needed the ankle surgery听鈥斕齣t all came down to this overnight hospital stay.听

Rovner:听So,听isn’t this exactly what the federal surprise billing law was supposed to eliminate听鈥斕齜eing in an accident, getting taken to an out-of-network hospital for emergency care? How did it not apply here?听

Appleby:听Right. Well,听that’s听where听it’s听so interesting because initially,听that’s听what everybody thought:听The No Surprises Act听would cover it. And听the听No Surprises Act听from听2022,听it’s听aimed at preventing these so-called surprise bills, which come when you go to an out-of-network hospital or provider. And in those cases, it limits your financial liability for emergency care to the exact same听cost听sharing as if you had been听in听an in-network hospital.听

So听in this case, it applies to emergency care,听and we saw that it did听actually cover听some of her emergency room charges, and that kind of thing. But听generally听though, emergency care is defined as treatment needed to stabilize a patient.听So听once she was stabilized before the surgery, she听enters听this post-stabilization situation. And if your provider听determines听that you can travel using听nonmedical听transport to an in-network facility, you might lose those No Surprises Act protections.听Generally, you’re听asked to sign some paperwork saying you want to stay at the out-of-network facility,听and you want to continue treatment,听and you waive your rights in that case. Hughes does not remember getting anything like that. And this case听didn’t听come down to the No Surprises Act. It was a question of medical necessity. Your insurer has broad power to听determine听medical necessity.听And if they review a situation and听determine听that听it’s听not medically necessary, and听you’re听post-stabilization, that trumps any No Surprises Act protections.听

Rovner:听So听what eventually happened with this bill?听

Appleby:听So听what eventually happened was that the hospital resubmitted the charges as outpatient services. And that听seemed to be听the crux of the matter here. It was听that听inpatient overnight hospital听stay. If she was听kept听[on]听an observation status听鈥斕齱hich is a lower level of care, hospitals get paid a little bit less听鈥斕齮hat听would’ve听seemed to solve the problem. And听that’s听what happened here. Platte Valley resubmitted the bill,听and her insurer paid about $21,000听of听that bill. There was another听$40,000 that was knocked off by an Anthem discount.听And in the end, Hughes only owed a $250 copayment.听

Rovner:听Wow.听

Appleby:听Yeah.听

Rovner:听Of course, you left out the part where we听actually called听and made it听鈥μ�

Appleby:听Well, there was that,听too. And she was very savvy, as you mentioned. She also got her HR department at听her employer听involved. She wrote letters. She was not going to give up on this.听That’s听one of the听advice听that she gave is not to wait听鈥斕齨ot to delay too long if you get a notice of not medical听necessity听鈥斕齜ut to听quickly and aggressively question insurance denials听once听they’re听received.听Make sure you understand听what’s听going on.听Try to get it escalated to the insurers and the hospital’s leadership.听All of听those things. And I think another takeaway for folks is听鈥� and this is harder because,听look,听you’re听in the emergency听room,听you听don’t听know听what’s听going on听鈥斕齜ut it might be worth asking,听Hey, am I post-stabilization? Am I being admitted as an听inpatient? Am I being held for an observation stay?听Is there some kind of difference with that in terms of my insurance coverage?听And you could听perhaps try听to put this听to听the听hospital听billing department. But听it’s听even better if听there’s听a way you can call your insurer. But听that’s听not always realistic in these kinds of emergency situations.听

Rovner:听Yeah, and just out of curiosity, if somebody totals my car and I end up听[in]听an ambulance needing surgery,听I’m听going to assume that the other driver’s insurance is going to pay my medical bills. Why didn’t that happen?听

Appleby:听Well, in this case, the way it was explained to me is the other driver had the minimum coverage needed in the state of Colorado. And听so听it did pay听nearly $5,000听toward some of these charges. But听that’s听about all it paid.听

Rovner:听Wow. Well, now,听obviously,听as you said, Lauren Hughes is a doctor. Savvy about the way the system听works, or听doesn’t听in this case. Even then, it took her months and called us to work this all out. How should somebody with less听expertise听handle a situation like this?听Is there somebody they can turn to help,听assuming that听they’re not cognizant enough to start asking questions about their admission status while they’re still in the emergency room waiting for surgery?听

Appleby:听Right. Again, that is so complicated. If you can, call your听insurer听and see what they have to say. And again, it may be after hours.听It may听be not听possible. Perhaps see if you can chat with the hospital billing department. But again, some of this is going to be after听the听fact. And remember, the billing in this situation came down to how the hospital coded the billing. They coded it as an inpatient hospital stay, and听that’s听after the fact. And听there’s听not a lot you can do about it. But in the end, it was resubmitted as an outpatient service, and that made all the difference in this case.听

Rovner:听Wow. Another complicated one. Or听I guess听you can just write to us. Julie Appleby, thank you very much.听

Appleby:听Thanks for having me.听

Huetteman:听All right, now听it’s听time for our听extra-credit听segment.听That’s听where we each recognize听a听story we read this week that we think you should read,听too.听Don’t听worry if you miss it.听We’ll听put the links in our show notes on your phone or other mobile device. Anna, how about you听go first听this week?听

Edney:听Sure. This听story is from a few of my colleagues听at听Bloomberg.听“.”听And I thought this was an interesting story, not just because there is the possibility that the world’s听most-used听weed killer could be going away because听it’s听just folding under so many legal challenges related to cancer. But听it’s听also just a deep dive to look at this herbicide that has affected听all of听our lives and how it came to be,听what’s听going on with it now, why听it’s听not working.听And also听at this company, Bayer, that in the middle of these legal challenges, bought the company that owned Roundup.听So听I just think it’s an interesting look at听the听whole situation and something that we’ve听probably all consumed before in certain ways, through just fruits and vegetables and different seeds and things.听

Huetteman:听Definitely. Shefali, how about your story?听

Luthra:听Sure.听So听I picked a four-part series by my colleague听at听The听19th, Orion Rummler. The headline for the piece I picked is听“”听I think this is a听really smart听package of stories because,听as Orion notes, people who have听“detransitioned”听鈥斕齮ransitioned听and then transitioned back听鈥斕齛re a听really central听part of the modern conservative movement’s efforts to target trans health and,听in particular, trans听health for young people. Saying, look at these people who transitioned and then came back and regretted it.听But there hasn’t been a lot of journalism听actually looking听at people who navigate this experience beyond those who are these political tokens.听So听Orion does exactly that. He talked to people who have had听the experience听of transitioning and then听detransitioning听in some way.听

He notes that this is a听pretty rare听experience to have this journey with one’s gender, but that the people he interviewed, he profiled, said that they felt really frustrated with how the conversation has unfolded.听In fact, their transitioning was an important part of their journey to discover their gender, and that they are deeply concerned that restrictions on trans health could be harmful to them and their loved ones as well.听I think this is听really valuable听journalism, and I’m so excited that Orion did it, and I hope everyone reads it.听

Huetteman:听That’s听really interesting.听Thank you for sharing that one. Sandhya, what听do听you听have听this week?听

Raman:听So听I pick,听“,”听and听it’s听by Nadine Yousif for the BBC.听So听this week, the Pan-American Health Organization, Canada is no longer measles-free.听And so that means that the Americas region听as a whole has听lost its elimination status.听I thought this was important because in the U.S.,听we’re听at a 33-year high with measles. And Mexico has also seen a surge in cases. And just an interesting way to look at听what’s听happening a little broader than just the U.S. lens, as all these places are seeing fewer people vaccinated against measles.听

Huetteman:听Thanks for sharing that story, Sandhya. My extra credit this week is a great scoop from my 麻豆女优 Health News colleague Amanda Seitz. The headline is,听“Immigrants听With听Health听Conditions听May听Be听Denied听Visas听Under听New Trump听Administration听Guidance.”听Amanda got her hands on a State Department cable that expands the list of reasons that would make visa applicants ineligible to enter the country, including now age or the likelihood they might rely on government benefits. And it gives visa officers quite a bit of power to make those calls.听听

Now immigrants,听they’re听already screened for communicable diseases and mental health problems.听But the new guidance goes further and emphasizes that chronic diseases should be considered. And it calls on those visa officers to assess whether applicants can pay for their own medical care, noting that certain medical conditions can听“require hundreds of thousands of dollars’听worth of care.”听

All right, that’s this week’s show.听Thanks听this week to our editor,听Stephanie Stapleton,听and our producer-engineers, Taylor Cook and听Francis Ying.听“What the Health?”听is available on WAMU platforms, the NPR app, and wherever you get your podcasts. And,听as always, on听kffhealthnews.org. Also, as always, you can听email听us听your comments or questions.听We’re听at听whatthehealth@kff.org.听Or you can find me on听. Where are you folks these days? Sandhya?听

Raman:听I’m听on听听and on听听@SandhyaWrites.听

Huetteman:听Shefali?听

Luthra:听I’m听on Bluesky听.听

Huetteman:听And Anna?听

Edney:听听or听听@AnnaEdney.听

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

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Sin embargo, hubo una omisión importante que, según defensores de la comunidad LGBTQ+ y estrategas políticos, forma parte de una situación cada vez más compleja que enfrenta el demócrata mientras delinea un perfil más ubicado en el centro para una posible candidatura presidencial.

Newsom听听que habría obligado a las aseguradoras a cubrir y a las farmacéuticas a dispensar 12 meses de terapia hormonal de una sola vez a pacientes transgénero y a otras personas.

La propuesta era para los líderes de los derechos de las personas trans, quienes afirmaron que era crucial preservar la atención médica mientras las clínicas de afirmación de género bajo la presión de la Casa Blanca.

Expertos políticos afirman que el pone de relieve la carga que ha adquirido la atención médica para las personas transgénero para y, en particular, para Newsom, quien, como alcalde de San Francisco, cometió actos de desobediencia civil al permitir que las parejas homosexuales .

El veto, junto con su tibia respuesta a la retórica antitrans, argumentan, forma parte de un patrón alarmante que podría dañar su credibilidad ante su base de votantes clave.

“Aunque no hubiera ninguna motivación política tras la decisión de Newsom, sin duda existen ramificaciones políticas de las que es muy consciente”, declaró Dan Schnur, ex estratega político republicano que ahora es profesor de política en la Universidad de California-Berkeley. “Es lo suficientemente inteligente como para saber que este es un tema que va a enojar a su base, pero que, a cambio, podría hacerlo más aceptable para un gran número de votantes indecisos”, agregó.

A principios de este año, en el podcast de Newsom, el gobernador le dijo al difunto activista conservador Charlie Kirk que la participación de atletas trans en deportes femeninos era , lo que desencadenó una reacción negativa entre la base de su partido y los líderes LGBTQ+. Y ha descrito la como un “problema grave para el Partido Demócrata”, afirmando que los anuncios de campaña de Donald Trump fueron “devastadores” para su partido en 2024.

Aun así, en una conversación con el streamer de YouTube ConnorEatsPants en octubre,听: “Como alguien que ha arriesgado su vida política por la comunidad durante décadas, ha sido un defensor y un líder”.

“No quiere enfrentar las críticas como alguien que, estoy segura, intenta postularse para la presidencia, cuando la retórica antitrans actual es tan fuerte”, dijo Ariela Cuellar, vocera de la Red de Salud y Servicios Humanos LGBTQ de California.

Caroline Menjivar, la senadora estatal que presentó la medida, la describió como la “más tangible y efectiva” de este año para ayudar a las personas trans en un momento en que están siendo señaladas por lo que describió como una “discriminación selectiva”.

En una legislatura donde los demócratas cuentan con supermayoría en ambas cámaras, los legisladores enviaron el proyecto de ley a Newsom mediante una votación partidista. A principios de este año, Washington se convirtió en en promulgar una ley que extiende la cobertura de la terapia hormonal a un suministro de 12 meses.

En un sobre el proyecto de ley de California, Newsom mencionó su potencial para aumentar los costos de la atención médica, impactos que, según un , serían insignificantes.

“En un momento en que las personas se enfrentan a aumentos de dos dígitos en las tarifas de sus primas de atención médica en todo el país, debemos tener mucho cuidado de no promulgar políticas que aumenten aún más el costo de la atención médica, por muy bien intencionadas que sean”, escribió Newsom.

, se ha ordenado a las agencias federales a la atención de afirmación de género para niños, a lo que Trump se ha referido como “mutilación química y quirúrgica”, y se han a las instituciones que la brindan.

En los últimos meses, , el y han reducido o eliminado la atención médica de afirmación de género para pacientes menores de 19 años, una muestra del efecto persuasivo que las órdenes ejecutivas de Trump han tenido en la atención médica, incluso en uno de los estados más progresistas del país.

California una amplia cobertura de atención médica de afirmación de género, incluyendo la terapia hormonal, pero actualmente las farmacias solo pueden dispensar un suministro para 90 días. El proyecto de ley de Menjivar habría permitido suministros para 12 meses, siguiendo el modelo de que permitía a las mujeres recibir un suministro anual de anticonceptivos.

Luke Healy, quien en una audiencia en abril que era “un joven de 24 años que ya no se identificaba como transgénero” y que ya no se consideraba mujer, criticó el intento de aumentar la cobertura de servicios que, dijo, resultó “irreversiblemente perjudicial” para él.

“Creo que proyectos de ley como este obligan a los médicos a convertir cuerpos sanos en problemas médicos perpetuos en nombre de una ideología”, testificó Healy.

La Asociación de Planes de Salud de California se opuso al proyecto de ley debido a las disposiciones que limitarían el uso de ciertas prácticas, como la autorización previa y la terapia escalonada, que requieren la aprobación de la aseguradora antes de ofrecer la atención, y obligan a pacientes y médicos a probar primero otras terapias.

“Estas salvaguardas son esenciales para aplicar estándares de prescripción basados en la evidencia y gestionar los costos de forma responsable, garantizando que los pacientes reciban la atención adecuada y manteniendo las primas bajo control”, declaró la vocera Mary Ellen Grant.

Un análisis del Programa de Revisión de Beneficios de Salud de California, que revisa de forma independiente las facturas relacionadas con los seguros médicos, concluyó que los aumentos anuales de las primas resultantes de la implementación de la ley serían insignificantes y que no se esperaban “impactos a largo plazo en la utilización ni en los costos”.

Shannon Minter, director legal del Centro Nacional para los Derechos LGBTQ, afirmó que el argumento económico de Newsom no era plausible. Aunque afirmó considerar a Newsom un firme aliado de la comunidad transgénero, Minter señaló estar “profundamente decepcionado” al ver el veto del gobernador. “Entiendo que intenta responder a este momento político y desearía que respondiera con un lenguaje y políticas que realmente puedan impulsar el cambio”.

La oficina de prensa de Newsom no quiso hacer más comentarios.

Luego de la entrevista en el podcast de Kirk, Cuellar afirmó que los grupos de defensa que apoyaban la SB 418 comenzaron a preocuparse cada vez más por un posible veto y se esforzaron por destacar las voces de otros pacientes que se beneficiarían, como mujeres en la etapa de menopausia y pacientes con cáncer. Fue una estrategia radicalmente distinta a la que podrían haber seguido antes de que Trump asumiera el cargo.

“Si hubiéramos presentado este proyecto de ley en 2022-2023, el mensaje habría sido totalmente distinto”, dijo otro defensor queien pidió que su no se revelara su nombre por no estar autorizado a hablar públicamente sobre el tema. “Nos habría hecho estar muy orgullosos. En 2023, podríamos haber tenido una ceremonia de firma”.

Los defensores de los derechos de las personas trans se mostraron tan recelosos del clima político actual que algunos también sintieron la necesidad de evitar promover un proyecto de ley independiente que habría ampliado la cobertura de la terapia hormonal y otros tratamientos para la menopausia y la perimenopausia.

Ese , redactado por la asambleísta Rebecca Bauer-Kahan, quien ha hablado conmovedoramente sobre sus dificultades con la atención médica para la perimenopausia, .

Mientras tanto, Jovan Wolf, un hombre trans y veterano militar, dijo que pacientes como él tendrán que sufrir.

Wolf, quien había tomado testosterona durante más de 15 años, intentó reiniciar la terapia hormonal en marzo, tras una pausa de dos años en la que contempló tener hijos.

Los médicos del Departamento de Asuntos de Veteranos le dijeron que era demasiado tarde. Días antes, la administración Trump que eliminaría gradualmente la terapia hormonal y otros tratamientos para la disforia de género.

“Tener estrógeno bombeando por mi cuerpo no me hace sentir bien, ni física ni mentalmente. Y cuando tomo testosterona, me siento equilibrado”, dijo Wolf, quien finalmente recibió atención en otro lugar. “Debería ser mi decisión y solo mía”.

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But there was one glaring omission that LGBTQ+ advocates and political strategists say is part of an increasingly complex dance the Democrat faces as he curates a more centrist profile for a potential presidential bid.

Newsom that would have required insurers to cover, and pharmacists to dispense, 12 months of hormone therapy at one time to transgender patients and others. The proposal was a for trans rights leaders, who said it was crucial to preserve care as gender-affirming services under White House pressure.

Political experts say highlights how charged trans care has become and, in particular, for Newsom, who as San Francisco mayor engaged in civil disobedience by allowing gay couples to marry . The veto, along with his lukewarm response to anti-trans rhetoric, they argue, is part of an alarming pattern that could damage his credibility with key voters in his base.

“Even if there were no political motivations whatsoever under Newsom’s decision, there are certainly political ramifications of which he is very aware,” said Dan Schnur, a former GOP political strategist who is now a politics lecturer at the University of California-Berkeley. “He is smart enough to know that this is an issue that’s going to anger his base, but in return, may make him more acceptable to large numbers of swing voters.”

Earlier this year on Newsom’s podcast, the governor told the late conservative activist Charlie Kirk that trans athletes competing in women’s sports was “,” triggering a backlash among his party’s base and LGBTQ+ leaders. And he has as a “major problem for the Democratic Party,” saying Donald Trump’s were “devastating” for his party in 2024.

Still, in a conversation with YouTube streamer ConnorEatsPants this month, Newsom “as a guy who’s literally put my political life on the line for the community for decades, has been a champion and a leader.”

“He doesn’t want to face the criticism as someone who, I’m sure, is trying to line himself up for the presidency, when the current anti-trans rhetoric is so loud,” said Ariela Cuellar, a spokesperson for the California LGBTQ Health and Human Services Network.

Caroline Menjivar, the state senator who introduced the measure, described her bill as “the most tangible and effective” measure this year to help trans people at a time when they are being singled out for what she described as “targeted discrimination.” In a legislature in which Democrats hold supermajorities in both houses, lawmakers sent the bill to Newsom on a party-line vote. Earlier this year, Washington to enact a state law extending hormone therapy coverage to a 12-month supply.

In a on the California bill, Newsom cited its potential to drive up health care costs, impacts that an found would be negligible.

“At a time when individuals are facing double-digit rate increases in their health care premiums across the nation, we must take great care to not enact policies that further drive up the cost of health care, no matter how well-intended,” Newsom wrote.

, federal agencies have been to gender-affirming care for children, which Trump has referred to as “chemical and surgical mutilation,” and from or of institutions that provide it.

In recent months, , , and have reduced or eliminated gender-affirming care for patients under 19, a sign of the chilling effect Trump’s executive orders have had on health care, even in one of the nation’s most progressive states.

California wide coverage of gender-affirming health care, including hormone therapy, but pharmacists can currently dispense only a 90-day supply. Menjivar’s bill would have allowed 12-month supplies, modeled after that allowed women to receive an annual supply of birth control.

Luke Healy, who at an April hearing that he was “a 24-year-old detransitioner” and no longer believed he was a woman, criticized the attempt to increase coverage of services he thought were “irreversibly harmful” to him.

“I believe that bills like this are forcing doctors to turn healthy bodies into perpetual medical problems in the name of an ideology,” Healy testified.

The California Association of Health Plans opposed the bill over provisions that would limit the use of certain practices such as prior authorization and step therapy, which require insurer approval before care is provided and force patients and doctors to try other therapies first.

“These safeguards are essential for applying evidence-based prescribing standards and responsibly managing costs 鈥� ensuring patients receive appropriate care while keeping premiums in check,” said spokesperson Mary Ellen Grant.

An analysis by the California Health Benefits Review Program, which independently reviews bills relating to health insurance, concluded that annual premium increases resulting from the bill’s implementation would be negligible and that “no long-term impacts on utilization or cost” were expected.

Shannon Minter, legal director for the National Center for LGBTQ Rights, said Newsom’s economic argument was “not plausible.” Although he said he considers Newsom a strong ally of the transgender community, Minter noted he was “deeply disappointed” to see the governor’s veto. “I understand he’s trying to respond to this political moment, and I wish he would respond to it by modeling language and policies that can genuinely bring people along.”

Newsom’s press office declined to comment further.

Following the podcast interview with Kirk, Cuellar said, advocacy groups backing SB 418 grew concerned about a potential veto and made a point to highlight voices of other patients who would benefit, including menopausal women and cancer patients. It was a starkly different strategy than what they might have done before Trump took office.

“Had we run this bill in 2022-2023, the messaging would have been totally different,” said another proponent who requested anonymity because they were not authorized to speak publicly on the issue. “We could have been very loud and proud. In 2023, we might have gotten a signing ceremony.”

Advocates for trans rights were so wary of the current political climate that some also felt the need to steer clear of promoting a separate bill that would have expanded coverage of hormone therapy and other treatments for menopause and perimenopause. , authored by Assembly member Rebecca Bauer-Kahan, who has spoken movingly about her struggles with health care for perimenopause, .

In the meantime, said Jovan Wolf, a trans man and military veteran, patients like him will be left to suffer.

Wolf, who had taken testosterone for more than 15 years, tried to restart hormone therapy in March, following a two-year hiatus in which he contemplated having children.

Doctors at the Department of Veterans Affairs told him it was too late. Days earlier, the Trump administration it would phase out hormone therapy and other treatments for gender dysphoria.

“Having estrogen pumping through my body, it’s just not a good feeling for me, physically, mentally. And when I’m on testosterone, I feel balanced,” said Wolf, who eventually received care elsewhere. “It should be my decision and my decision only.”

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Through a data network connecting its records system with other providers, the health center receives not just X-ray and lab results but real-time alerts when hospitals on the network admit or discharge its patients who have diabetes or asthma, enabling care teams to troubleshoot and significantly drive down emergency room visits.

But Christine Park, the community health center’s chief medical officer, said that even with those achievements, data sharing is far from seamless: The hospitals visited by the center’s patients aren’t all on the same network, and it’s often necessary to exchange records via fax.

“You know the patient went there, and you know there’s got to be a note,” Park said, “but you keep bumping up against that glass door.”

Despite and of effort invested in improving health care data sharing, , Americans’ medical records often remain siloed, leading to duplicate testing, increased costs, and wasted time for patients and care teams. And as the Trump administration and lawmakers from several states aim to bolster health data sharing, they face financial and operational hurdles that have stymied previous efforts.

Further complicating these efforts is whether providers and other stakeholders 鈥� facing the prospect of reduced Medicaid revenue after the passage of President Donald Trump’s major tax-and-spending law this summer 鈥� will invest the time and money needed to improve data sharing. And in some states, lawmakers and privacy advocates have heightened concerns about information sharing because of instances in which patient data has been used by and agencies.

In July, the Trump administration launched a voluntary, tech-focused initiative aimed at modernizing health data sharing and giving patients better access to their information. The announced that over 60 technology and health care companies had pledged to “kill the clipboard.” Health data networks and digital health records systems agreed to follow common information-sharing rules, providers pledged to share data through these networks, and tech companies agreed to enable patients to pull their data from these networks or apps.

applauded the focus on patient access, while skeptics questioned whether the voluntary plan would sufficiently motivate health care providers to participate.

“There’s not really a carrot here,” said venture capitalist Bob Kocher, who was a health official in the Obama administration.

Previous initiatives have run into data sharing’s bleak economics for providers: It requires investment and carries risks given privacy and security issues, and the financial return is often limited.

are paid primarily for the volume of services they render, limiting the incentive to share data and reduce unnecessary care, despite years of and to move toward a system that rewards providers financially for improving health outcomes. And health systems, Kocher said, can lose patients to business rivals when they share data.

In a statement, Amy Gleason, a strategic adviser to CMS, acknowledged that data sharing requires investment and that “some providers face financial pressures.” She added that CMS uses all available levers to encourage health care providers to share data, including testing new payment models. New federal initiatives are also aimed at enforcing regulations and at .

The federal government has long tried to streamline the sharing of health records. After the passage of the 2009 Health Information Technology for Economic and Clinical Health Act 鈥� or HITECH Act 鈥� during the Obama administration, federal subsidies were used successfully to push most hospitals and doctors to and to get most states to establish or enable a type of data network known as a health information exchange.

Subsequent administrations worked to make these systems more interoperable. The first Trump administration required providers to promptly share electronic records with patients and other providers, and the Biden administration to connect national, state-level, and other types of data networks.

But hospitals with fewer resources struggle with sharing data, and federal health IT efforts have historically left out many behavioral health and long-term care providers, said Julia Adler-Milstein, a professor of medicine at the University of California-San Francisco. especially those who treat underserved patients, find accessing information on health record systems other than their own difficult. Patients, too, struggle to consolidate their records.

States have forged ahead with medical data sharing in myriad ways, some using monetary incentives or, less frequently, penalties to get providers to share data with their exchanges.

Melissa Kotrys, chief executive of Contexture, the state-designated health information exchange in Arizona and Colorado, said most hospitals in both states connect to the exchange. To encourage participation, annual Medicaid incentives to providers that join and achieve specific milestones, while Colorado offers incentives to rural providers.

For many years, New York state 鈥� which requires hospitals, nursing homes, and other providers regulated by the state to join a regional network 鈥� with federal support. The state continues to fund the platform that connects them, also with the U.S. government’s support. in the state participate.

This year, lawmakers in at least seven states introduced bills largely aimed at enhancing digital record sharing and bolstering privacy protections, according to Alan Katz, a policy leader at Civitas Networks for Health, a national group representing health information exchanges. Some of these bills, , propose expanding the capabilities of already robust, existing exchanges.

In California, Democratic state Sen. Caroline Menjivar that would lay groundwork for the state to better enforce its that health care organizations share health and social services data in real time.

Supporters say the state needs more enforcement authority to ensure compliance and to support priorities such as better integrating health care and social services.

“I wouldn’t say this is the last step by any means, but it’s a necessary next step,” said Timi Leslie, executive director of Connecting for Better Health, the nonprofit that sponsored the bill, SB 660.

Amid the Trump administration’s restrictive stance on and are sharing patient data with deportation officials, the bill would exempt data on gender-affirming care and immigration status, as well as other sensitive information, from being shared.

The California Hospital Association opposes the bill, saying to the state Assembly that it would impose enforcement and costs on hospitals at a time when they face federal and state cuts.

Claudia Williams, a former health information exchange leader, said she doubts the bill can drive meaningful data sharing without providing ongoing funding for incentives and infrastructure.

In a statement, Menjivar said the state had already granted to hospitals and other organizations to help them meet the mandate’s requirements and has . The bill passed both chambers and is on its way to the governor for approval.

There’s broad agreement amid the numerous federal and state efforts to improve health record sharing that the endpoint should be data being at the right place at the right time, said UCSF’s Adler-Milstein. “But the actual process of getting an entire health care system’s IT, incentives, and policies to align behind that is extremely hard.”

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