Big swings in federal vaccine policy are creating confusion for some parents and clinicians. A federal judge recently struck down Health and Human Services Secretary Robert F. Kennedy Jr.’s new, for all kids. But with the Trump administration likely to appeal, the situation is in flux. Meanwhile, cases of such as measles, mumps, and whooping cough continue to accumulate nationwide and in the Washington, D.C., area.

Julie Rovner, 麻豆女优 Health News chief Washington correspondent and host of the podcast What The Health?, appeared on WAMU’s “Health Hub” on April 1 to break down what’s changed, what hasn’t, and what’s still unclear.

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).

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

Credits

Click here to find all our podcasts.

And subscribe to “What the Health? From 麻豆女优 Health News” on , , , , , or wherever you listen to podcasts.

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).

According to a recording obtained by 麻豆女优 Health News, Bhattacharya at one point suggested to CDC staff that Trump could name a new leader for the agency as soon as Thursday. “But if not, I don’t think much will change,” he said.

Though his official position as acting director was set to expire Wednesday, Bhattacharya will continue to lead the agency until the top spot is filled. Meanwhile, news outlets including and reported that the administration was postponing filling the permanent director job amid the challenges of gaining Senate confirmation and other political pressures.

Bhattacharya opened the meeting by acknowledging the struggles the beleaguered agency has gone through over the past year. Workers faced waves of job losses, and a gunman attacked the CDC’s Atlanta campus in August, killing a police officer and causing significant property damage. “I want to acknowledge very honestly that I know that it has been such a difficult year for the CDC and for every single one of you here,” Bhattacharya said.

He said the agency has begun to fill its leadership gaps. During his first meeting with the agency’s top leaders, he said, “I noticed almost every single one of them is acting.”

“We’ve made progress in filling key roles across the agency,” he said. “Leadership stability is essential to delivering our mission.”

The aim, he said, is to leave the agency in “a solid, secure place” so it can do its work “without so much of the turmoil that we’ve seen the last year.”

Bhattacharya invited questions from the CDC staffers, who repeatedly asked about staffing losses, morale, and their job security, as well as Trump’s decision to withdraw from the World Health Organization.

“The politics of WHO withdrawal are above my pay grade,” Bhattacharya said. “What I do know is that without the CDC, the world will be in much worse health.”

Workforce Concerns

One employee told Bhattacharya the agency had lost a “huge amount” of “internal capacity and expertise in the past year” and it “continues to be very challenging for staff to do their jobs,” adding that “certain conditions are a bit demoralizing.”

The CDC can “function without leaders,” another speaker said. “We function without directors. And this entire team will make CDC run without you if you’re not here.”

Schedule F, an effort to reclassify certain federal employees in policy-related roles and reduce their civil service protections, drew some of the strongest statements from the staff. While it’s not fully implemented, the policy could make it easier for Trump to fire thousands of federal workers.

“What’s scaring the hell out of us right now is Schedule F,” an employee said. “We are terrified that 鈥榓t will’ means you’re gone, you’re not here, you’re fired.”

“The Schedule F fight’s above my level,” Bhattacharya replied. He said his focus is on making sure the “work is supported.”

He said the agency should seek to “depoliticize what we do fundamentally” so that “every American sees us as working for their benefit.”

“When I say 鈥榙epoliticize,’ I don’t mean you can’t say the hard or talk about the hard things,” he added. “I mean that you’re free to talk about the hard things without fear that you’re gonna be retaliated against.”

On hiring and operations, he pointed to ongoing efforts but acknowledged delays. The Department of Health and Human Services, which oversees the CDC, is “moving at the speed of bureaucracy,” he said, adding that he’s trying his best. “We have to move past the last year, and I think we now have an opportunity really to do that.”

Vaccine Policy

On vaccines, Bhattacharya said one of the first things he did in his role as acting CDC director was to record a video “strongly encouraging parents to vaccinate their kids from measles.”

He said rebuilding trust requires engagement. That means working with communities without denigrating them, and respecting how “they think and their values,” he said.

Bhattacharya said he would like the NIH and CDC to coordinate more, particularly on HIV prevention. He described his approach as “an implementation science strategy so that we can use these two pieces of the HIV tool kit to actually end the HIV pandemic.”

The search for a permanent CDC director is being led by HHS officials on behalf of the White House and Health and Human Services Secretary Robert F. Kennedy Jr.

Bhattacharya said he’s friends with Kennedy and called “the caricature of him that I’ve seen in the press” unfair. Kennedy “really does have a deep desire to make America healthy,” he said.

For now, Bhattacharya said, he expects to stay in place at the CDC, as “either acting director or acting in the capacity of the director, whatever the heck that means.”

He joked about the ambiguity: “It’s like an Office episode, you know?”

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).

• (starts at 21:03).
• Read Rayasam’s “When Health Insurance Costs More Than the Mortgage.”

麻豆女优 Health News rural health reporter Andrew Jones discussed the spread of measles across the Carolinas on WUNC’s Due South on March 17.

• Read Jones’ “Hospitals Fighting Measles Confront a Challenge: Few Doctors Have Seen It Before.”

Céline Gounder, 麻豆女优 Health News’ editor-at-large for public health, discussed on CBS News 24/7’s The Daily Report on March 16 how U.S. hospitals and insurers are turning to AI to settle disputes over medical claims and payments. On March 17, she outlined the court ruling blocking the Trump administration’s vaccine policy changes for children on CBS News’ CBS Mornings. Gounder also discussed Susie Wiles’ decision to stay on as White House chief of staff amid breast cancer treatment on CBS News 24/7’s The Takeout on March 16.

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).

Health and Human Services Secretary Robert F. Kennedy Jr.’s effort to change how the federal government recommends vaccines against childhood diseases was dealt at least a temporary setback in federal court this week. A judge in Massachusetts sided with a coalition of public health groups arguing that changes to the vaccine schedule violated federal law. The Trump administration said it would appeal the judge’s ruling.

Meanwhile, some of the same public health groups continue to worry about the slow pace of grantmaking at the National Institutes of Health, which, for the second straight year, is having trouble getting money appropriated by Congress out the door to researchers.

This week’s panelists are Julie Rovner of 麻豆女优 Health News, Alice Miranda Ollstein of Politico, Margot Sanger-Katz of The New York Times, and Lauren Weber of The Washington Post.

Panelists

Among the takeaways from this week’s episode:

• The latest decision on potential changes to the federal childhood vaccine schedule, even if ultimately reversed by a higher court, may re-elevate the vaccine issue as midterm campaigns kick into gear 鈥� and just as the Trump administration is trying to downplay it.
• A new survey of Affordable Care Act marketplace enrollees from 麻豆女优, a health information nonprofit that includes 麻豆女优 Health News, illuminates how many people are struggling to afford health insurance after the expiration of the enhanced premium tax credits. A large majority of respondents say their costs are higher this year, with half saying their costs are “a lot higher.”
• A dip in the number of health care jobs last month could suggest medical facilities and other providers are bracing for the impact of federal funding cuts. A reduction in the number of people with health insurance 鈥� an expected outcome of the expiration of enhanced ACA tax credits and, soon, stricter eligibility limits for Medicaid 鈥� would probably mean more unpaid bills that hospitals and others must absorb.
• And clinics that rely on Title X funding to provide care are in a bind, with funding set to expire at the end of the month and the federal government only just recently releasing guidance about applying. Many clinics are bracing for a gap in funding.

Also this week, Rovner interviews 麻豆女优 President and CEO Drew Altman to kick off a new series on health care solutions, called “How Would You Fix It?”

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 Rebecca Robbins.

Lauren Weber: The Atlantic’s “,” by McKay Coppins.

Margot Sanger-Katz: Stat’s “,” by Tara Bannow.

Alice Miranda Ollstein: The New York Times’ “,” by Stephanie Nolen.

Also mentioned in this week’s podcast:

• 麻豆女优’s “,” by Lunna Lopes, Isabelle Valdes, Grace Sparks, Mardet Mulugeta, and Ashley Kirzinger.
• The Washington Post’s “,” by Lauren Weber, Caitlin Gilbert, Dylan Moriarty, and Joshua Lott.
• 麻豆女优 Health News’ “Trump’s Cuts to Medicaid Threaten Services That Help Disabled People Live at Home,” by Tony Leys.
• Politico’s “,” by Alice Miranda Ollstein.
• States Newsroom’s “,” by Kelcie Moseley-Morris.
• ProPublica’s “,” by Amy Yurkanin.

Episode Title:听RFK Jr.’s Vaccine Schedule听Changes Blocked 鈥� For Now听Episode Number:听438听Published:听March 19, 2026听

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

Julie Rovner:听Hello from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C.听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,听March 19, at 10:30听a.m.听As always, news happens fast, and things might have changed by the time you hear this. So here we go.听

Today,听we are joined via video conference by Margot听Sanger-Katz听of听The New York Times. Welcome back, Margot.听

Margot Sanger-Katz:听Thanks.听It’s听good to see听you guys.听

Rovner:听Lauren Weber听of听The Washington Post.听

Lauren Weber:听Hello, hello.听

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

Alice Miranda听Ollstein:听Hi,听there.听

Rovner:听Later in this episode,听we’ll听kick off our new series,听“How听Would听You听Fix听It?”听The idea is to let experts from across the ideological spectrum offer their ideas for how to make the U.S.听health听care system function at least better than it does right now.听We’ll听post the entire discussions on our website and social channels, and听we’ll听include a shortened version here on听What the Health?听And to help me set the stage for the series,听we’ll听have one of the smartest people I know in health care policy听鈥斕齛lso my boss听鈥斕槎古盘齈resident and CEO听Drew Altman. But first,听this week’s news.听

We’re听going to start this week with vaccine policy. On Monday, a federal judge in Massachusetts sided with a coalition of public health groups and blocked the new childhood vaccine schedule recommendations from the Department of Health and Human Services, at least for now.听The judge ruled that HHS violated the law governing federal advisory committees when HHS Secretary Robert F Kennedy Jr.听summarily fired all 17 members of the Advisory Committee on Immunization Practices and replaced them,听largely with听people who share his anti-vaccine views. The judge also blocked the January directive from then-acting Centers for Disease Control and Prevention Director Jim O’Neill, formally changing the vaccine recommendations. The administration is听appealing听the decision, so it could change back any minute now听鈥斕齳ou should check.听What’s听the public health impact of this ruling, though?听

Ollstein:听I mean, I think听we’ve听seen that the more back-and-forth we have and the more clashing voices and shifting guidance, you know, trust听just continues听to听drop and drop and drop amongst the public. The average听person,听I’m听sure,听doesn’t听know what ACIP is, or how it functions, or how these decisions usually get made versus how听they’re听getting made under this administration.听And听so听all of that just makes people throw up their hands and not know who to trust.听

Rovner:听Lauren.听

Weber:听I think, to add to what Alice听said, I think when you inject so much confusion,听it’s听easier to choose not to get vaccinated. Several pediatricians have told me it’s, you know, when听they’re听like,听Oh, I听don’t听know, the听president’s saying one thing, and the pediatrician’s听saying something else.听And I’m just,听I’m听just going to walk away from this.听Because听that’s听almost easier than听to make听an active choice. And听so听there’s听a lot of concern among health professionals that even with all this, who knows what people will decide. And I do think听what’s听very interesting听about this is, obviously, you know,听it’s听getting appealed and so on. This is just a slew of vaccine headlines that the administration does not want right now.听And I am very curious to see how that continues to play out, as听there’s听been this concentrated effort to not talk about vaccines, after doing a lot on vaccines.听And this is going to put vaccines firmly in the headlines for quite听a period of time.听

Rovner:听Yeah, actually, you’ve anticipated my next question, which is one of the immediate things听the听ruling did is postpone the ACIP meeting that was scheduled for this week and,听with it, consideration of whether to recommend further changes to the covid vaccine policy. Margot, your colleagues got ahold of a听pretty provocative听working paper that suggested the creation of a whole new category of reported covid vaccine injuries,听basically putting听more focus on a subject the Trump administration is trying to get HHS to downplay.听Yes?听听

Sanger-Katz:听Yeah. I mean,听I just think that this issue听is becoming increasingly politicized.听As Lauren and Alice said,听I think that does affect the confusion around it, does affect people’s willingness to take up vaccine. But I do wonder also if听we’re听just going to see over time that there is not a kind of scientific expertise-based way that we make these decisions as a country. But instead听鈥μ齣t’s听going to become much more polarized along the lines that many other health policy areas are. I think this has historically been a rare area of听relatively broad听consensus across the parties. Not that there听haven’t听been disagreements among scientists or among听different groups听of Americans.听There’s听always been resistance to vaccines or concerns about vaccine safety in this country.听But I think there was a sense that it’s not听鈥斕齮hat one party is for and one party is against, and I think all of this debate and the ping-ponging and the desire to highlight vaccine injury in ways that haven’t been done before,听I think,听risks this becoming a much bigger kind of partisan political issue going into the next election.听

Rovner:听And yet, the backdrop of this is this continuing听seemingly spread听of outbreaks of measles. I mean,听we’ve听seen big outbreaks in Texas and,听particularly,听South Carolina.听But now听we’re听seeing听鈥� smaller outbreaks in听lots and lots of听places.听I’m听wondering if听there’s听going to come a point where complications from vaccine-preventable diseases are going to听maybe push听people back into the听oh,听maybe we听actually should听get our kids vaccinated听camp.听

Ollstein:听I think听we’ve听seen that start to bubble up. I think听there’s听been reporting about a surge in parents wanting to get their kids vaccinated, like in Texas, for instance, in places where outbreaks have gotten听really big听already.听And I think news coverage of those outbreaks, you know, helps raise that awareness.听It’s听not just word听of mouth.听So听I don’t know whether that will vary from place to place that trend, but it’s definitely something you see.听听

Rovner:听Apparently, public听health requires us to relearn things.听Before we leave this听鈥μ齳es, Lauren, you want to add something?听听

Weber:听My colleagues and I had听听at the end of last year that found that, you know,听in order to听be protected against measles, your county or area or school needs to be above 95% vaccinated.听And we found in December that the numbers on that are pretty bad around the country.听According to our analysis of state school-level and county-level records, we found that before the pandemic only about 50% of counties in the U.S.听could meet that herd immunity status from among kindergartners. After the pandemic, that number dropped to about a quarter,听to 28%.听That’s听not great. That does mean, obviously,听there are still places that could be vaccinated at 94% or so on.听But听there’s听a lot more that are also vaccinated at 70% and really risk high outbreak spread. And听so听I think amid this confusion, and听it’s听important to note that vaccine rates have been dropping for some time as the anti-vaccine movement has gained power. And听it听remains to be seen how much this confusion continues to contribute to that.听

Rovner:听Speaking of long-running stories,听let’s听revisit the grant funding slowdown at the National Institutes of Health.听Again听this year, grants, particularly grants for early career scientists, are slow leaving the agency, which is one of the few HHS subsidiaries that听actually got听a boost in appropriations from Congress for this fiscal year. According to researchers at Johns Hopkins, the NIH has awarded 74% fewer new awards than the average for the same听time period, from 2021 to 2024.听Last year, only a gigantic speed-up at the very end of the fiscal year prevented the NIH听from not听disbursing all the funding ordered by Congress. Coincidentally, or maybe not so coincidentally, the Office of Management and Budget removed one hurdle just this week, approving NIH’s funding apportionment the night before NIH Director Jay Bhattacharya appeared before a House Appropriations Subcommittee. But,听much as with vaccines, public health groups are worried about the impact of this sort of closing funding funnel on biomedical research, which, as we have pointed out, is not听just important听to medical advancement, but to a large chunk of the entire U.S.听economy. Biomedical听research is听a very, very large听export of the United States.听

Sanger-Katz:听Yeah, the NIH has just been giving out this money in a very weird way.听It’s听not just that they gave it all out at the end of the fiscal year before it was too late, but they听didn’t听distribute it in the way that they normally distribute the funding. So,听normally, the way that these things work听is听people听submit听applications for multiyear grants, or for these shorter grants for early researchers, they get a multiyear grant, and they get one year of money at a time. And听so听over the course of, say, the four or five years of their grant, they get money out of the NIH’s appropriation in each of those years. And then听鈥μ齣t’s听kind of rolling听so new grants come in. What the Trump administration did last year is they got all the money out the door, but they actually funded much fewer research projects than in a typical year, because instead of funding the first year of lots of new grants, what they did is they paid for all the years of a much smaller number of grants. They听sort of prepaid听for the whole thing. And听so听my colleague听Aatish Bhatia听did a wonderful story on this around the end of the fiscal year,听sort of pointing听this out.听And I think this is the kind of pattern that will result in NIH actually funding a lot less research.听I mean, over time, presumably,听they’re听going to, I guess they could,听catch up.听But I think in the short term, what听it’s听allowing them to do is to fund many fewer scientists and many, many fewer research projects. And I听think听that听that does听have an effect on听the kind of reach and diversity of the projects that are getting funded by听NIH听and that听are听the kind of scientific research听that’s听being conducted. And听it’s听also, of course, extremely destabilizing to universities and other institutions that depend on this money to pay for the bills of not just the salaries of their researchers, but also for their facilities and their students. And there’s just much less money going to much fewer people, because even those prepaid grants, they听can’t听all be spent in the first year.听So听it’s听kind of like,听almost like, the money is no longer with the NIH,听but听it’s听kind of like听sitting in a bank account somewhere.听It’s听not actually out there in the economy, in the university, in the researcher’s pocket funding research in each of those years.听

Rovner:听And as we pointed out,听it’s听also听sort of听impacting听the pipeline of future researchers, because why do you want to go into a line of work where there might not be jobs?听听

Sanger-Katz:听And not just that.听A lot of these universities are really tightening their belts, and听they’re听bringing in fewer PhD students because听they’re听concerned that they听won’t听be able to听support them.听So听there’s less听potentially听interest in pursuing听science, because听it听doesn’t听seem like听as听valuable career. But there’s also just fewer slots for even those scientists who want to move forward in their careers.听They听can’t听get jobs,听they听can’t听get spots as PhD students, they听can’t听get slots as post-docs听because all these universities are really tightening their belts.听

Rovner:听Yeah, this is one of those stories that I feel like would be a much bigger story if there听weren’t听so many other big stories going on at the same time. Congress is听kind of busy听these days not figuring out how to end the funding freeze for the Department of Homeland Security and not having much say over the ongoing war with Iran. Something else that Congress is not doing right now is continuing the debate over the Affordable Care Act.听At least听right听not at the moment. But that听doesn’t听mean听it’s听not still听a big political issue looming for the midterms. Just today, my colleagues in our听麻豆女优听polling unit are听听that finds 80% say their health care costs are up this year, and 51% say their costs are, quote,听“a lot higher.”听More than half report they have or plan to cut spending on food or other basic expenses to pay for their health care, including more than 60% of those with chronic health conditions. I saw a random tweet this week that kind of summed it up perfectly. Quote,听“Health insurance is cool because you get to pay a bunch of money each month for nothing, and then if something happens to you, you pay a bunch more.”听So where are we in the ACA debate cycle right now?听听

Sanger-Katz:听I think as far as the ACA debate,听as like听a policy matter,听we’re听a little bit nowhere.听I think there听is no one in Congress currently who is actively discussing some kind of bipartisan compromise that might make major reforms to the law or might bring more of this funding back that expired at the end of the year.听But there is some regulatory action by the Trump administration, who, I think, officials there are sensitive to the idea that insurance is so expensive, and they want to think about how to address that. And then听we’re听starting to see, just today, some green shoots from the Democrats in the Senate that听they’re听looking to explore kind of听big ideas听in this space.听So听I think we shouldn’t think of this as some kind of legislation or policy debate that’s going to happen right now. But I think听they’re听thinking about what would happen in a future where Democrats controlled the government again, what would they want to do about these issues? And they feel like they want to start getting ready, having these internal听debates听and having some hearings, maybe, and听talking to experts and doing听some of the kind of work I was thinking that they did before they debated and听passed听the ACA, right?听They听did a process like this.听So听we听don’t听know what听that’s听going to be.听听

Rovner:听Exactly.听That’s听sort of the听origin of our series of听“How听Would听You听Fix听It?”听鈥� that听we’re听in that stage where people are starting to think about the big picture.听And in order to think about the big picture, you have to do an enormous amount of planning and stakeholder discussions and all kinds of stuff before you even get to a point where you can have legislative proposals.听

Sanger-Katz:听Which is听鈥μ齛ll of which is fine, except, I think it is important to say, like, this is not close to a concrete policy proposal, that even if the Democrats had the votes that they could, you know, there’s not like they’re听gonna听come forward with,听OK, here’s what we’re听gonna听do about this.听I think this听is:听Let’s听do some studies,听let’s听talk,听let’s听debate,听let’s听think.听Let’s听get ready for the future.听听

Rovner:听Let’s听be ready in case we get the White House back in听2028听is basically where we are right now.听听

Sanger-Katz:听What the Trump administration has proposed for ACA is some听pretty radical听changes to the kind of nature and structure of health insurance for people who are buying in this market. And I think听it’s听tied to their concern that premiums are really听high听and people听can’t听afford coverage.听So听they’re听trying to think about, like,听OK, what are some things that we could do that would make insurance more affordable for people? And one of the things that they propose is making the availability of what are called catastrophic plans.听This is something that was created by the ACA听鈥斕齪lans that have really high deductibles, but, you know, still have comprehensive coverage after the deductible.听Could they make those available to more people, and could they听kind of jack听up the deductible even more?听So those would be plans,听still pretty expensive, and you would end up with, you know, having to pay听tens听of听thousands听of dollars before your insurance kicked in, but you would have insurance if something really bad happened to you.听That’s听one of their ideas. They also have some other ideas that听are actually,听like,听really new, including having a kind of insurance where you听don’t听actually have听a guaranteed network of doctors and hospitals, but there is听a sort of a听payment rate that your insurance will pay for certain services. And then you,听as听the听patient,听have to go around and say,听Will听you take this amount for my knee replacement or for my pneumonia hospitalization?听or whatever.听And then you might be on the hook for the difference if no one wants to accept that price.听So听it听鈥斕�

Rovner:听I call this听“the really fancy discount card.”听

Sanger-Katz:听The really fancy discount card.听That’s听good. And,听you know, the idea is not that different听than what some employer plans do,听but generally, these听kinds of bundled, capped payments听are in听relatively discreet听services, and听they’re听being overseen by HR professionals. And I do think the idea that individual people are going to be able to navigate a system like this is it seems a little extreme.听So听I think that’s听sort of where听we are on ACA,听is that enrollment is down. People are really struggling with the affordability of it, and it just听doesn’t听look like anyone is going to come forward, at听least in听this year, and do anything听that’s听going to听substantially change听that. Even these Trump proposals, whether you think听they’re听a good idea听or a bad idea, are proposals for next year.听

Rovner:听The听general consensus听is,听by next month,听we’re听going to have a better handle on how many people dropped coverage because their costs went up too much, and听I’m听wondering if that may restart some of the debate.听

Weber:听Again,听to talk about midterms conversations,听I mean the folks that are often hit hardest by this, as I understand, are听middle-income earners, early retirees, or folks that live in expensive states.听And听that’s听a voting bloc. I mean,听early retirees听鈥μ齱ho else is voting? I mean听that’s听who’s听voting.听So听I’m听very curious how this will continue to animate a conversation around the election, as there’s so much conversation around how folks are forgoing medical care or forgoing other expenses听in order to听make up the difference of what听we’re听seeing.听听

Rovner:听Well, meanwhile, in news that I think counts as both bad and good:听Health care jobs took a dip in February,听according to the Labor Department, the first such decline in four years. On the one hand, every new health care job means more health care spending, which contributes to health care unaffordability, at least听in the aggregate. But I wonder if this dip is an听anomaly听or it听represents听the health care sector bracing both for people dropping their insurance that they can no longer afford or bracing for the Medicaid cuts that we know are coming. Alice,听you wanted听to add something?听听

Ollstein:听Yeah. I mean,听I think that these things听have a cascading effect, and it can take years to really see,听like,听the full damage of something. And听so听we’re听just starting to see the very beginning of a trend of people dropping their insurance because they听can’t听afford it. But then听it’ll听take a while to see when people have emergencies or get sick and need care. And then is that uncompensated care? And are hospitals that are already on the brink of closure having to cover that uncompensated care? And does that lead to more closures, and that leads to health deserts? And so, you know, there could be this domino effect, and听we’re听just at the very beginning of it, and we can听sort of infer听what could happen based on听what’s听happened in the past. But听that’s听a challenge for the political cycle, because听it’s听hard to talk about things that听haven’t听happened yet, both good and bad. I mean, you see that听also with听promising to lower drug prices;听if voters don’t actually see lower prices by the time they go to cast their votes, it feels like an empty promise, even if you know it pays听off down听the line.听

Rovner:听Well, speaking of things that听weren’t听supposed to happen yet, a shoutout to my听麻豆女优听Health听News colleague Tony听Leys for a听wrenching story he did last week听about a family in Iowa facing a cut in home care through Medicaid for their adult son with severe autism and deafness.听It appears that Iowa听is not the only state cutting back on expensive but optional Medicaid services like听home and听community-based听care in anticipation of the Medicaid cuts to come. But this was not what Republicans were hoping were going to happen before the midterms, right?听听

Sanger-Katz:听Yeah, I think there was this idea that a lot of Republicans were saying that, because most of the Medicaid cuts are not scheduled to take place until after the midterms, I think there was an expectation that there would be no reason for states to start making changes to their program in the short term. And that just really听hasn’t听happened. States听kind of went听into this budget cycle already a little bit in the hole, and then they looked ahead and saw that, you know, their finances and their Medicaid program are not going to get any better听next year.听And so we’re seeing, like,听a pretty large number of states that have been making substantial cutbacks, either to, as you say, some of these benefits that are optional to the payments that they make to doctors, hospitals,听and other kinds of health care providers.听It’s pretty ugly out there.听听

Rovner:听It is. All right. Well, finally, this week,听still听more news on the reproductive health front. Alice,听you’ve听been following some last-minute scrambling on yet another federal program that’s technically听funded听but the听federal government’s not actually passing the money to those who are supposed to receive it.听That’s听the nation’s听Title X听family planning program. What is happening there?听听

Ollstein:听Well, nothing happened for a while. The things that were supposed to happen听didn’t听happen, and now they may be happening, but it may be too late to avoid some problems happening. So to break that all down:听The way it normally works is that all of these clinics around the country that provide subsidized or entirely free birth control and other reproductive health services, you know, things like STI听[sexually transmitted infections]听testing and treatment, cancer screenings, etc., to millions of low-income people, men and women, they were supposed to get guidance last fall or winter in order to know how to apply for the next year of funding.听So that funding runs out at the end of this month, March, and they only just got the guidance a few days ago.听And I will say there was no guidance for听months and months and months. I听;听a couple听days听later, the guidance came out.听Not saying that was the reason, but that was the timing.听听

Rovner:听But a lot of people are thanking you.听

Ollstein:听The issue is,听all of听the clinics now have only one week to apply for the next round of funding. Normally,听they have听months.听And then HHS only has like a week or so to process听all of听those applications and get the money out the door. And they usually take months to do that. And听so听people are听anticipating听a gap between when the money runs out and when the new money comes in, unless there’s some sort of last-minute emergency extension, which听there’s听been no mention of that yet.听And听so听they’re听bracing for听this funding shortfall, and, you know, are worried that they听won’t听be able to offer a sliding scale, or听they’ll听have to curtail certain services they offer, or have fewer hours that the clinics are open. And听we’ve听already seen,听based on what happened last year where some听Title听X听clinics had their funding formally withheld for听months and months and months, and even though they got it back later, that came too late for a lot of听places;听they closed. You know, these clinics are sometimes hanging on by a thread, and even a short funding gap can really do them in.听And听so听at a time when demand for birth control is up and the stakes are high, this is really worrying a lot of people.听

Rovner:听Well, speaking of federal funding on reproductive-related health care,听听found that most of the money that Missouri is giving to crisis pregnancy centers听鈥斕齮hose are the anti-abortion alternatives to Planned听Parenthoods and other clinic听鈥μ齮hat the crisis pregnancy centers provide neither abortions nor, in most cases, contraceptives听鈥斕齢as been coming from TANF听[Temporary Assistance for Needy Families]听鈥斕齮hat’s the federal welfare program that’s supposed to pay for things like housing and job training. It turns out that at least eight states are using TANF money for these crisis pregnancy centers, and this is just the听tip of the iceberg听in public money going to these often overtly religious organizations, right?听听

Ollstein:听Yeah, I think听we’ve听seen that听more and more听over the last few years.听These centers were,听by conservative activists and politicians,听have held them up as an alternative to reproductive health clinics that are closing around the country, and these centers can really vary. Some of them employ trained health care providers. Some of them听don’t. Some of them offer real health services. Some of them听don’t.听And there’s听very little听oversight and regulation.听There’s been some really strong reporting by ProPublica about this money going to them in Texas and other states with very little accountability and being spent on, you know, things that arguably don’t help the people that they should be helping.听And听so听I think that we听haven’t听yet seen that on the federal level, but听we’re听absolutely seeing it on the state level. And听I think this听is just contributing to the national听patchwork of, you know, where听you live听determines听what kind of services you can access, because we do not see blue states funneling money to these centers. And听so听you’re听going to see a real split there.听

Rovner:听And I will point out,听before people complain, that some of these centers do provide social services, and, you know, even things like diapers and car seats, but many of them听don’t.听So听it’s听a very mixed bag,听from what听we’ve听been able to see.听听

Well, lastly, ProPublica, speaking of ProPublica, has听听about women in labor in Florida who听are required to听undergo court-ordered C-sections, even if they听don’t听want them,听in order to听protect the fetus. It turns out a lot of states have these laws that let the state intervene to protect fetal life, even if it means further threatening the life of the pregnant patient. Is this听“fetal personhood”听quietly taking hold without听our even听really noticing it? It seems these laws, some of them, have been challenged, and the courts have听sort of gone听different ways听on it, but mostly just left it to the states.听听

Ollstein:听So听I thought the article did听a good job听of pointing out that this听isn’t听a phenomenon caused by the overturning of听Roe听v.听Wade. This was an issue before that.听So听I think听that’s听really important for people to remember. Obviously,听these personhood laws that have been on the books or are newly on the books have taken on a heightened significance after听Dobbs. But this is not a brand-new phenomenon, and this tension between whose life and health should be prioritized in these situations is not new.听But听it’s听important that听it’s听getting this new scrutiny, and the details in the article were just horrifying. I mean, having to听participate听in a court hearing when听you’re听in active labor on your back in听the bed听is just a nightmare.听听

Rovner:听And without legal representation. I mean,听there’s听a court hearing with the judge, and,听you know, a woman who’s 12 hours into her labor, so it would,听yeah, it is quite a story. I will definitely post听the听link to it. Anybody else?听Lauren, you looked like you wanted to say something.听听

Weber:听Yeah. I mean, I just wanted to add听鈥斕齀 think you all听covered it.听But, I mean, the story is absolutely worth reading for its dystopian details.听I just听don’t听think anyone realizes that in America, you could be in your hospital bed听鈥斕齣n active labor with all that entails听鈥斕齛nd then a听Zoom screen with a judge and a bunch of other people appears. I mean, I had no idea that could even happen.听So听kudos to ProPublica for continuing to really charge forward on this coverage.听

Rovner:听Yeah, all right.听That is this week’s news. Now听we’ll听play my interview with听麻豆女优 President and CEO听Drew Altman, and then听we’ll听come back with our extra credits.听

I am so pleased to welcome back to the podcast Drew Altman, president and CEO of 麻豆女优. And yes, Drew is my boss, but since long before I worked here, Drew has been one of the people I turn to regularly to help explain the U.S. health system and its politics.听So听I听can’t听think of anyone better to help launch our new interview series called “How Would You Fix It?”听

Here is the premise. I think听it’s听pretty clear听that the U.S. is heading for another major debate about health care. It’s been 16 years since the Affordable Care Act passed and, once again, we’re looking at increasing numbers of Americans without health insurance, increasing numbers of Americans with insurance who are still having trouble paying their bills and just navigating the system, and just about everyone, from patients to doctors to听hospitals to employers, pretty frustrated with the status quo. The idea behind the series is to start to air 鈥� or, in some cases, re-air 鈥� both old and new ideas about how to reshape the health care “system” 鈥� I put that in air quotes 鈥� that we have now into something that works, or at least works better than what we currently have. In the months to come, we plan to interview experts and decision-makers from a variety of backgrounds and perspectives and ask each of them: How would听you听fix it?听You’ll听hear a condensed version of each interview here on the podcast, and you can find the full versions on the 麻豆女优 Health News website and our YouTube page.听

So听Drew, thank you for helping us kick off the series. What do you see as the big听signs听that听it’s听time for another major debate about health care?听

Drew Altman:听Well, first of all, Julie, I’m thrilled to be here, and we’re very proud of听What听the Health?听And听I’m听always happy to join you on this program.听There’s听no question that health care is going to be a big issue in the midterms.听We’re听seeing something now that we听haven’t听seen听maybe ever听before, but听we’ve, certainly, seldom seen it before. And that is when we ask people what their top economic concerns听are,听their health care costs are actually at the very top of the list.听It’s听a real problem for people, and so it will be front and center in the midterms.听

Rovner:听And this is bigger even than it was, as I recall, before the Affordable Care Act debate, before the Clinton debate even?听

Altman:听No, health care has always been a hot issue. Sometimes听it’s听been a voting issue. So now听it’s听a hot issue and a voting issue. And we just听don’t听see that a lot.听

Rovner:听I feel like every time the U.S. goes through one of these major political throwdowns over health care,听it’s听because the major stakeholders are so frustrated听they’re听ready to sue for peace 鈥� the hospitals, the insurance companies, the doctors. In other words, as painful as change is,听it’s听better than the current pain that everyone is experiencing. Are we there yet, in this current cycle?听

Altman:听No, I听don’t听think so. I mean,听I’ve听seen听this many times听before. The country has never had either the courage or the political system capable of mounting a significant effort on health care costs. We neither have a competitive health care system 鈥� the industry is too听consolidated听鈥� or the political chemistry to regulate health care costs or health care prices鈥� the two big answers.听So听we fumble around the edges. We are about to enter a stage of more significant fumbling around the edges, what we political scientists would call incremental reforms. But听it’s听unlikely to be more than that. We have made, as a country,听very significant听progress on coverage. Now 92% of the American people听[are]听covered; that [is] now endangered by big cutbacks, unprecedented cutbacks. But we made听very little听progress on health care costs. And there are two big problems. The big one that is really driving the debate are the concerns that the American people have about their own health care costs, which impinges on their family budgets and their ability to pay for everything they need to pay for their lives. And that is what has made this a voting issue, and听that’s听what’s听really driving this debate. And the other one is the one that we experts talk about, and that’s just overall national health care spending as a share of gross national product, and how that affects everything else we can do in the country, almost one-fifth of the economy.听But we’re pretty much nowhere on that one and going backwards on the other one.听So, without being the captain of doom and gloom here, I think what听we’re听looking at is an interest in incremental changes at the margin that will be blown all out of proportion as bigger changes than they really are.听

Rovner:听You had a column earlier this year about how the fight to reduce health care spending is more about everyone trying to pass costs to someone else than about lowering costs in general. In other words,听I spend less, so you spend more. Can you explain that a little bit?听

Altman:听Well, I think in the absence of some kind of a global solution, every other nation, wealthy nation, has a way to control overall health care spending.听How they do it differs from country to country. But they have a way to control the spigot. We听don’t. And so instead, we micromanage everything to听death, and听make ourselves听pretty miserable听in the health care system in the process. Nobody likes the prior authorization review or narrow networks or all the other things that we do. But what it has resulted in is what I called, in that column, a “Darwinian approach” to health care costs.听Kind of every听payer on their own. And听so听the federal government tries to reduce their own health care costs, as they just did galactically, in the so-called Big Beautiful Bill, reducing federal health spending by about a trillion dollars. What happens?听That burden then falls to the states, which have to try and deal with that.听Or employers have only so much they can do to try and control their own health care costs, so a lot of that burden gets shifted onto working people.听And on and听on and on.听That’s听not a strategy听on听health care costs.听And if you think about it, we don’t actually have a national strategy on health care costs.听The Congress has never mandated that someone听come up with听a strategy on that. There are parts of agencies that have pieces of it. There are places in the government that track spending, but we听don’t听actually have听anyone responsible for an overall strategy on health care costs. And it shows.听

Rovner:听So, if anything, the politics of health care have become more partisan over the years. We are both old enough to remember when Democrats and Republicans听actually agreed听on more things than they disagreed on when it came to health care. Is there any hope of coming together, or is this going to be one more red-versus-blue debate?听

Altman:听It’s听red versus blue right now. There is hope听for coming听together. What is important, and what the media struggles with a lot, is what I call proportionality, or recognizing proportionality. They can come together听on听small things.听They might come together on site-neutral payment, not paying more for the same thing, you know, in a hospital-affiliated place than a free-standing place. They might come听together on听juicing up transparency. These are not solutions to the health cost problem, but听they’re听helpful. And, you听know, so听there听are听a broad range of areas.听AI [artificial intelligence] is another area which, of course, is going to demand tremendous attention, where there’s potential for tremendous good and also tremendous harm.听And that discussion is important, and听that’s听a part of it that 麻豆女优 will focus on.听

Rovner:听Are there some lessons from past major health debates that 鈥� some of which have been successful, some of which听haven’t听鈥� that policymakers would be smart to heed from this go-round?听

Altman:听Well, you know, the biggest lesson,听maybe in听the history of all these debates,听is听people听don’t听like to change what they have very much. And听it’s听hard to sell them on that.听A second听lesson is: Ideas seem听very popular. And听you’ll听see a lot of polls:听Would you like this?听And 90% of people like everything.听That听doesn’t听mean that they will still like it when you get to an all-out debate about legislation, with ads and arguments about the pros and cons, because the other horrible lesson of health policy is absolutely everything has trade-offs. And听so听when you get to actually听discussing听the trade-offs, support falls. It becomes a much, much tougher debate. And the fate of legislation turns on a set of other issues, like, who wins, who loses? How much does it cost? Which听states are听affected? Not听just on听public opinion. So those are a couple of lessons. There is also a silent crisis, I think, in health care costs that听doesn’t听get enough recognition. And that is the crisis facing people with chronic听illness听and serious medical problems. They are the people who use the health care system the most, who face the biggest problems with health care costs.听So听we may see that 25%, sometimes it gets up to听30%,听of the American people tell us听they’re听really struggling with their health care costs. They听have to听put off care. They may be splitting pills, whatever it may be. But those numbers for people who have cancer, diabetes, heart disease, a听long-term chronic illness can go up to 40% or 50%, and it听truly affects听their lives. I听don’t听think that problem gets enough attention.听So听you could say, OK, Drew, well, that’s just obvious. They use the most health care. You could also say, yes, but听that’s听the reverse of how any functioning health care system should work;听it should听first of all听take care of people who are sick, and we are not doing that in our health insurance system.听

Rovner:听Well, that seems听like听as听good a place听to leave our starting point as anything. Drew Altman, thank you so much.听

Altman:听Great, Julie. Thank you,听appreciate听it.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 a 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. Margot, why don’t you go first this week?听听

Sanger-Katz:听Sure.听So听I’m听so excited to encourage everyone to read this wonderful story from听Tara Bannow听at听Stat called听“.”听And I say that听it’s听a wonderful story, but听it’s听not necessarily good news. This is a story about听a听Texas couple of entrepreneurs who听have figured out how to exploit the system that was set up by the听No听Surprises听Act听in order to听get extremely rich. As听you guys听may remember, this was the bill that ended most听surprise听medical billing, so you would never go to an emergency room and suddenly end up with a doctor that was听out-of-network that was sending you an extra bill. And the law,听since it was passed a few years ago, has been extremely effective in preventing those bills from getting sent to individuals.听But it created this听very complicated听and听Byzantine arbitration system on the back end so that the insurers and the health care providers could figure out what everyone should get paid. And this company has very effectively exploited that system.听And the story just does a really interesting job of laying out what their strategies have been, of just kind of flooding the system with tons and tons of claims, some of which are bogus, recognizing that the system didn’t have a good mechanism for differentiating between valid and invalid claims, and recognizing that some of them would just be paid even though they were invalid, recognizing that听the insurance companies might not be fast enough to reply if they came in these huge batches.听So听they were sending hundreds听of thousands听at the same time, so that someone would have to respond to all of them by a deadline or lose by default. And this couple that they wrote about,听Alla and Scott听LaRoque, were personally very colorful. She was a former contestant on听The Apprentice, and they had a sort of crazy wedding where they gave everyone luxury gifts. And,听anyway, I thought that the story was extremely good, both because the details about these people were听very interesting, but also because听I think it听shows how the听No听Surprises Act, which I covered at the time of its passage, you know听鈥斕�

Rovner:听We听talked about听it听at great length on the podcast.听听

Sanger-Katz:听I think in a lot of ways, it was like听a,听it was a kind of health policy triumph. It was a bipartisan bill. There was a lot of cooperation. There was a lot of this kind of discussion and planning we were talking about earlier in the podcast, about how to do this right.听It was a real problem in the health听care system that Congress came together to try to solve, and yet, and yet, the work is never done.听And there are always unanticipated problems.听听

Rovner:听It also illustrates the continuing point of because there’s so much money in health听care,听grifters are going to find it, even if it seems unlikely. Lauren.听

Weber:听I had a little bit of a different plot twist this time.听It’s听called听“,” by McKay Coppins听at听The Atlantic.听And it is just a gut-wrenching tale of how Coppins,听who it talks about how he’s Mormon, and so gambling听isn’t听really a part of his religion. That special dispensation from religious authorities to gamble.听For听The Atlantic to learn, you know, how one can kind of fall into a gambling rabbit hole or not. And despite thinking that听maybe he听would be above the fray, that this听wasn’t听something that would really catch him. He finds himself utterly sucked in and听exhibiting听incredibly addictive tendencies, and听basically talking听about how听鈥斕齟ssentially,听the moral of the story is, I cannot believe the guardrails are听off of听American gambling, and a lot of people will suffer.听If听he’s听not able to really survive being given $10,000 by听The Atlantic to gamble away.听It’s听a great piece. I highly recommend it. And I also recommend as a follow-up, one of my friends from college just听wrote听a book called听. That kind of gets into the history of why this has happened and why it matters now. And听I think this听is going to end up being a health policy issue that we end up talking about a lot, because this is an addiction problem that now is accessible from your pocket,听and that you can constantly be on. And you know,听we’re听all women on this podcast right now. And the article听actually gets听into how gambling is not as,听psychologically,听as enticing to women, at least for sports gambling.听But听it’s听very enticing to men, it appears,听from the science that he points out. And听so听I think听there’s听a lot听that’s听going to come out on this in the next couple of years. And听it’s听a great piece to read.听听

Rovner:听Oh, this is a huge public health problem, particularly for young men. I mean听鈥μ齣t’s听the vaping of this decade,听I call it. Alice.听

Ollstein:听So听I have听, and it is about how the Trump administration is trying to use HIV funding for Zambia as a lever to coerce them to grant minerals access.听So听a completely unrelated economic and infrastructure priority, and听they’re听using this health funding as a bargaining chip. And听so听this caught my attention. It came up in a recent hearing with the head of the NIH on Capitol Hill, and lawmakers were pressing him, saying, you know, if the United States is doing things like this and threatening to cut HIV funding abroad, how are we supposed to meet our goal of eliminating HIV in the U.S.听by 2030?听Because, as we learned during covid, we live in a global society, and things that听impact听other听countries impact us听as well. And听[Jay]听Bhattacharya answered, you know,听oh, I think we can still听eliminate听HIV in the U.S.,听not necessarily听in the听whole world. So really,听really听urge people to check out this piece.听

Rovner:听Yeah, it was听a听really good story.听My extra credit is also from听The New York Times.听It’s听by Rebecca Robbins, and听it’s听called听“.”听And,听spoiler, the听TrumpRx听website does not offer the best prices for medications in the world. The Times, along with three German news organizations,听sent secret shoppers to pharmacies in eight cities around the world,听and also听compared听TrumpRx’s听prices to Germany’s publicly published prices. It seems that while听TrumpRx, at least for the few dozen drugs that it sells right now, has narrowed the gap between what the U.S.听and European patients pay.听“But,”听quote from the story,听“the gap persists.”听I will note that the administration disputes the Times’听reporting and says that when you factor in economic conditions in every country that听TrumpRx听prices can count as cheaper.听You can read the story and judge for yourself.听

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

Ollstein:听I am mostly on听Bluesky听听and still on听X听.听

Rovner:听Lauren?听

Weber:听On听听and听听as听LaurenWeberHP;听the HP is for听health听policy.听

Rovner:听Margot.听

Sanger-Katz:听At all the places听听and at听Signal听.听

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

Credits

Click here to find all our podcasts.

And subscribe to “What the Health? From 麻豆女优 Health News” on , , , , , or wherever you listen to podcasts.

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).

Quizás, pensaron, se trataba de unos zapatos que no le quedaban bien.

Los familiares describían a la niña amante de los unicornios como inteligente, cariñosa y a veces un poco traviesa. Antes de aprender el alfabeto, ya había descubierto cómo encontrar su programa favorito, Blippi, en un teléfono. También era conocida por sacar mantequilla del refrigerador a escondidas para disfrutarla lamiéndose los dedos.

Pero luego sus extremidades empezaron a sacudirse. Una punción lumbar reveló sarampión en su líquido cefalorraquídeo. El virus que probablemente tuvo cuando era bebé había llegado en secreto a su cerebro. Ahora, con 8 años, Deepanwita está paralizada y no puede hablar.

El sarampión causa complicaciones 鈥攓ue van desde diarrea hasta la muerte鈥� en infectadas, según la Sociedad de Enfermedades Infecciosas de América (IDSA, por sus siglas en inglés). Algunas aparecen de inmediato, mientras que otras tardan semanas o meses en manifestarse. La que está experimentando Deepanwita es la encefalitis esclerosante subaguda (PEES); por lo general, tarda años en aparecer.

“Muchas personas piensan: 鈥楽i nos da sarampión, estaremos bien, porque conozco a un vecino que lo tuvo y está bien’”, dijo , quien dirige la Sociedad de Neurología Infantil (Child Neurology Society) a nivel nacional, pero habló con 麻豆女优 Health News en su papel como doctora en Nueva York con experiencia en enfermedades neurológicas.

Porque el sarampión puede ser peligroso. Un tendrá que volver a aprender a caminar después de sufrir una de las complicaciones más inmediatas: inflamación del cerebro.

Y, a veces, el virus deja una bomba de tiempo en el sistema nervioso.

Una persona puede recuperarse del sarampión y continuar con su vida normal, ya no contagiar y no presentar síntomas identificables 鈥攁 veces durante una década o más鈥� antes de que aparezcan problemas. Aunque algunos pacientes quedan gravemente discapacitados por un tiempo, Khakoo dijo que la enfermedad casi siempre es mortal.

Antes de la aparición de vacunas eficaces y de uso masivo, esta complicación ocurría con suficiente frecuencia en Estados Unidos como para que, en la década de 1960, un doctor creara un de pacientes con PEES.

Los que aproximadamente 1 de cada 10.000 personas que contraen sarampión desarrollará PEES, pero el riesgo es mucho mayor para quienes se infectan antes de los 5 años. En países muy poblados donde el virus es endémico, como India, los casos se ven con regularidad.

Ahora, doctores e investigadores temen que, a medida que bajan las tasas de vacunación y el sarampión se propaga en Estados Unidos, los casos de esta complicación debilitante también aumenten.

Desde el inicio de 2025, los Centros para el Control y la Prevención de Enfermedades (CDC) 鈥攎ás que en toda la década anterior鈥� en su mayoría en personas no vacunadas. Muchos eran niños.

El año pasado, doctores en Connecticut y, en California, otro en edad escolar que había tenido sarampión cuando era bebé .

“Es probable que veamos más casos de PEES en el futuro, especialmente si no controlamos esto”, dijo , miembro del Comité de Enfermedades Infecciosas de la Academia Americana de Pediatría y autor del libro .

La preocupación por la PEES fue lo suficientemente grande como para que en enero la Child Neurology Society para educar a los médicos estadounidenses sobre la enfermedad. Los doctores que han visto estos casos también están advirtiendo a sus colegas.

“No tenemos una forma de saber quién la va a desarrollar, ni una manera muy efectiva de tratarla”, señaló , profesor de neurología en la Escuela de Medicina de la New York University Grossman. “Lo mejor que podemos hacer, idealmente, es evitar que los niños tengan que pasar por esto en primer lugar”.

La vacuna contra el sarampión recomendada en dos dosis reduce el riesgo de que una persona expuesta contraiga el virus contagioso del听听y, por lo tanto, disminuye la posibilidad de desarrollar PEES.

Las vacunas tienen pequeños riesgos de y un , pero el sarampión tiene un riesgo mayor de causar ambos.

Casos en Estados Unidos

Un sobre niños en California que desarrollaron PEES después de un brote de sarampión ocurrido años antes determinó que se diagnostica 1 caso por cada aproximadamente 1.400 casos conocidos de sarampión en niños menores de 5 años, y 1 por cada 600 bebés infectados.

Los investigadores también encontraron que, con los años, los doctores habían pasado por alto algunos casos en pacientes que murieron con enfermedades neurológicas no diagnosticadas.

La posibilidad de que casos futuros pasen desapercibidos llevó a y a sus colegas a publicar un comunicado en septiembre cuando un niño del condado de Los Ángeles .

“Hemos tenido muy pocos casos de sarampión en los últimos 25 años en este país”, dijo Yeganeh, directora médica del Vaccine Preventable Disease Control Program del departamento de salud pública del condado de Los Ángeles, quien ha tenido dos pacientes con PEES. “Desafortunadamente, eso está cambiando y queríamos asegurarnos de que todos supieran de esta complicación a largo plazo”.

El niño de California que murió había contraído sarampión cuando era bebé, dijo Yeganeh, antes de que pudiera recibir la vacuna.

El sarampión es altamente contagioso, por lo que al menos el 95 % de la población debe ser inmune para proteger a las personas vulnerables de la infección, incluidos bebés demasiado pequeños para vacunarse y personas con sistemas inmunológicos debilitados.

“Este es un ejemplo de alguien que hizo todo bien, que quería proteger a su hijo contra esta infección y, lamentablemente, terminó perdiendo a su hijo porque no teníamos inmunidad colectiva”, agregó Yeganeh.

Poco después de que el grupo de Yeganeh publicara el comunicado en California, Nelson también estaba tratando de difundir la información.

Recientemente había visto a un niño de 5 años cuya familia había viajado a Estados Unidos para recibir atención médica después de que el pequeño empezara a tropezar, a tener sacudidas, a alucinar con insectos y animales y a sufrir convulsiones. El niño había contraído sarampión cuando era bebé, cuando todavía era demasiado pequeño para vacunarse. Nelson le diagnosticó PEES.

“Imagínese: tener un hijo sano y feliz que empieza a hablar cada vez menos y finalmente ya no puede caminar”, dijo Nelson. “Es algo muy triste”.

Pensó que solo encontraría esta enfermedad en los libros de texto de la escuela de medicina, como una reliquia del pasado. Sin embargo, en octubre terminó presentando el caso en la conferencia nacional de la Child Neurology Society y participó en el video de la organización sobre la enfermedad.

“Ahora he visto algo que nunca debería haber visto en toda mi carrera”, dijo.

Señales de advertencia desde India

A nivel mundial, el número de brotes de sarampión en los últimos años, y médicos en lugares como el e han visto recientemente grupos de casos de PEES.

El alto costo humano de la propagación del sarampión es especialmente evidente en India. Aunque el número total de casos no se registra, alrededor de 200 familias que cuidan a personas con PEES, incluida la familia de Deepanwita, participan en un mismo grupo de chat en el área de Bangalore.

En Nueva Delhi, Sheffali Gulati estudia y atiende a unos 10 nuevos pacientes al año con esta enfermedad, lo que ella llama el “eco tardío” de los brotes de sarampión. El paciente más joven que ha visto tenía 3 años.

“Las edades y la muerte o un estado vegetativo pueden desarrollarse entre seis meses y cinco años después del inicio”, dijo Gulati, quien dirige el programa de neurología pediátrica del y hasta hace poco dirigía la .

Gulati no ha encontrado tratamientos que reviertan el curso de la SSPE, solo algunos que pueden ralentizar su progreso. A menudo termina aconsejando a los padres: es una situación catastrófica, no es culpa de ellos y no pueden hacer nada más que aceptarlo.

Los familiares de Deepanwita tratan de encontrar momentos de alegría donde pueden. Creen que la niña sonrió cuando su primo favorito la llamó recientemente. Anindita Dasgupta, su madre, dijo que Deepanwita mueve las manos y los pies por sí sola y a veces gira la cabeza, especialmente cuando su padre entra a la habitación.

La niña se comunica con sus padres con los ojos y algunos sonidos.

Pero está muy lejos de cómo estaba en 2022. En el cumpleaños de un primo, unos meses antes de que empezaran los síntomas evidentes, Deepanwita fue quien cantó la canción de cumpleaños más fuerte.

En su propia fiesta de cumpleaños número ocho el año pasado, Deepanwita, con un vestido rosa y un tubo nasal, solo podía parpadear y mover los ojos mientras estaba sentada frente a dos pasteles que no podía comer. Ya no puede tragar, así que su mamá le puso un poco de glaseado en la lengua.

Investigación que no debería ser necesaria

, biólogo molecular de la Clínica Mayo en Rochester, Minnesota, ha estudiado la PEES durante años. Recientemente utilizó tejido cerebral obtenido después de la muerte para mapear cómo el virus del sarampión puede propagarse desde la corteza frontal hasta colonizar todo el cerebro.

Aun así, dijo que sigue siendo una “caja negra” entender exactamente qué hace el virus durante los años en que permanece inactivo entre la infección inicial y la aparición de síntomas de daño neurológico.

Es posible que el virus se replique en el cerebro durante todo ese tiempo sin ser detectado y vaya destruyendo neuronas. Pero con tantas neuronas en el cerebro humano 鈥�10 veces más que el número de personas que viven en el planeta鈥� el cerebro puede encontrar formas de adaptarse, dijo Cattaneo, hasta que finalmente ya no puede.

Ahora ha solicitado financiamiento para continuar investigando la enfermedad y posibles tratamientos, aunque en realidad desearía no tener que hacerlo. Las herramientas para eliminar esta enfermedad ya existen.

“El problema podría resolverse con la vacunación”, dijo Cattaneo. “Estados Unidos no debería tener ningún caso de PEES. Es simplemente doloroso”.

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).

Relatives described the unicorn-loving child as smart, affectionate, and occasionally rascally. Before she learned the alphabet, she had figured out how to find her favorite show, Blippi, on a phone. She was known to sneak butter from the fridge to enjoy a few finger licks.

But then her limbs started jerking. A spinal tap revealed measles in her cerebrospinal fluid. The virus she probably had as an infant had secretly made its way to her brain. Now 8 years old, Deepanwita is paralyzed, unable to talk.

Measles causes complications 鈥� ranging from diarrhea to death 鈥� in , according to the Infectious Diseases Society of America. Some are immediate, while others take weeks or months to appear. The one Deepanwita is experiencing, subacute sclerosing panencephalitis, or SSPE, typically takes years to rear its head.

“People think, 鈥極h, you know, if we get measles, then we’ll be fine, because I know my neighbor had it and they’re fine,’” said , who leads the national Child Neurology Society but spoke to 麻豆女优 Health News in her capacity as a New York City doctor with expertise in neurologic conditions.

Measles, though, can be dangerous: A will have to relearn how to walk after enduring one of the more immediate complications, brain swelling. And every so often, the virus plants a ticking time bomb in the nervous system. A person can recover from measles and continue life as usual, no longer contagious and without any identifiable symptoms 鈥� sometimes for a decade or more 鈥� before problems appear. While some patients end up severely disabled for a while, Khakoo said, the condition is almost always fatal.

Before the advent of widespread and effective vaccines, the complication occurred enough in the U.S. that in the 1960s a doctor created of SSPE patients. Researchers about 1 in 10,000 people who get measles will develop SSPE, but the risk is significantly higher for those who contract measles before age 5. Populous nations where the virus is endemic, including India, see cases routinely.

Now, doctors and researchers fear that as vaccination rates drop and measles spreads in the U.S., cases of this debilitating complication will also rise here. Since the start of 2025, the over 3,500 measles cases 鈥� more than in the entire preceding decade 鈥� mostly people who were unvaccinated. Many were children. Last year, Connecticut doctors with SSPE, and in California, a school-age child who’d had measles as an infant .

“We are likely to see SSPE cases going forward, especially if we don’t get this under control,” said , a member of the American Academy of Pediatrics’ Committee on Infectious Diseases and author of the book .

Concern about SSPE was great enough that in January, the Child Neurology Society to educate U.S. clinicians about the condition, and doctors who have seen such cases are warning their peers.

“We don’t have a way of knowing who’s going to get it, and we don’t have a way of very effectively treating it,” said , a professor of neurology with the New York University Grossman School of Medicine. “The one best thing that we can do, ideally, is to prevent children from having to go through it in the first place.”

The recommended two-dose measles vaccine slashes an exposed person’s risk of getting the contagious virus from 鈥� and thus reduces the chance of SSPE. The vaccines carry small risks of and a , but measles itself has a higher risk of causing both.

Cases in the U.S.

A of California children who developed SSPE after a measles outbreak there years ago determined that 1 case is diagnosed for about every 1,400 known cases of measles in children under age 5, and 1 for every 600 infected babies.

The researchers also found that, over the years, doctors had missed some cases among patients who had died with undiagnosed neurologic illness.

The possibility that future cases could go undiagnosed spurred and her colleagues to publish a news release in September when a Los Angeles County child .

“We’ve had very few cases of measles in the last 25 years in this country,” said Yeganeh, who is the medical director with the Vaccine Preventable Disease Control Program at the Los Angeles County public health department and has had two patients with SSPE. “Unfortunately, that’s changing, and so we wanted to make sure that everyone was aware of this long-term complication.”

The California child who died had gotten measles as an infant, Yeganeh said, before the child could receive the vaccine. Measles is highly contagious, so at least 95% of the population must be immune to it to protect vulnerable people 鈥� including babies too young to vaccinate and people who are immunocompromised 鈥� from infection.

“This is an example of someone who did everything right, wanted to protect their child against this infection, and unfortunately ended up losing their child because we didn’t have herd immunity for them,” Yeganeh said.

Shortly after Yeganeh’s group published the news release in California, Nelson was working to get the word out, too.

He had recently seen a 5-year-old whose family had traveled to the U.S. for medical care after the child started stumbling, jerking, hallucinating about bugs and animals, and having seizures. The child had contracted measles as an infant and had been too young to be vaccinated. Nelson diagnosed the child with SSPE.

“Imagine that: Having a child who is healthy and happy, moving to talking less and less, eventually not able to walk,” Nelson said. “It’s a very sad thing.”

He thought he would encounter the condition only in medical school textbooks, as a relic of the past. Instead, in October he found himself presenting the case at the Child Neurology Society’s national conference and participating in the society’s video about the condition. “I’ve now seen something I shouldn’t have ideally seen ever in my career,” he said.

Warning Signs From India

Globally, the number of measles outbreaks in recent years, and physicians in places including and have recently seen clusters of SSPE.

The high human cost of measles’ spread is especially evident in India. While total cases aren’t tracked, about 200 families caring for people with SSPE, including Deepanwita’s, are in a single chat group in the Bangalore area.

In New Delhi, Sheffali Gulati and sees about 10 new patients a year with the condition, what she calls the “delayed echo” of measles outbreaks. The youngest she has seen was 3 years old.

“The ages are , and a death or a vegetative state can develop as soon as in six months to five years of onset,” said Gulati, who leads the pediatric neurology program at the and until recently led India’s .

Gulati hasn’t found any treatments that reverse SSPE’s course, only some that slow its progress. She’s found herself counseling parents: It’s catastrophic, it’s not their fault, and they can do nothing but accept it.

Deepanwita’s relatives try to find joy where they can. They think they noticed the girl smiling when her favorite cousin called recently. Anindita Dasgupta, her mother, said Deepanwita moves her hands and feet on her own and sometimes turns her head, especially when her father enters the room. The girl communicates with her parents through her eyes and a few sounds.

But it’s far from where she was in 2022: At a cousin’s birthday, a few months before noticeable symptoms started, Deepanwita started the birthday song and sang the loudest.

At her own 8th-birthday gathering last year, Deepanwita, wearing a pink eyelet dress and a nasal tube, could only blink and move her eyes as she sat propped up before two cakes that she would not be able to eat. She can no longer swallow, so her mom dabbed a bit of icing on her tongue.

Research That Shouldn’t Be Needed

, a molecular biologist at the Mayo Clinic in Rochester, Minnesota, has been for years. He recently used postmortem brain tissue to map how the measles virus can spread from the frontal cortex to colonize the entire brain. Still, he said it’s a “black box” what exactly measles is doing in those dormant years between the initial infection and when the symptoms of neurologic damage crop up.

It’s possible the virus replicates in the brain that whole time, undetected, killing off neurons. But with so many neurons in the human brain 鈥� 10 times as many as people living on the planet 鈥� the brain may find a way to adjust, Cattaneo said, until finally it can’t anymore.

He’s applying for funding to continue research on the disease and possible treatments, though ultimately, he wishes he didn’t have to. The tools to obliterate the condition already exist.

“The problem could be solved with vaccination,” Cattaneo said. The U.S. should have no cases of SSPE, he said. “It’s just painful.”

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).

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

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

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

Panelists

Among the takeaways from this week’s episode:

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

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

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

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

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

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

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

Also mentioned in this week’s podcast:

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

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

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

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

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

Shefali Luthra:听Hello.听

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

Anna Edney:听Hi,听everybody.听

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

Joanne Kenen:听Hi,听everybody.听

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner:听Yes.听

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

Rovner:听Right.听

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner:听Oh, it is.听

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

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

Kenen:听And听then鈥斕�

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

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

Rovner:听Absolutely.听

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

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

Kenen:听Right.听Right.听

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

Kenen:听Right.听听

Rovner:听鈥斕齣n听1997.听

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

Rovner:听They made it听fail.听

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

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

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

Rovner:听The ones that passed by voters.听

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner:听That’s听what it was for.听

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

Rovner:听It is not.听Shefali.听

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

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

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

Luthra:听I am at Bluesky,听.听

Rovner:听Anna.听

Edney:听听and听,听@annaedney.听

Rovner:听Joanne.听

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

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

Credits

Click here to find all our podcasts.

And subscribe to “What the Health? From 麻豆女优 Health News” on , , , , , or wherever you listen to podcasts.

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).

The tensions risk fraying Kennedy’s dynamic MAHA coalition, potentially driving away critical supporters who helped fuel President Donald Trump’s 2024 election win.

The movement’s grassroots membership includes suburbanites, women, and independents who are generally newer entrants to the GOP and laser-focused on achieving certain results around the nation’s food supply and vaccines.

Promoting healthy foods tops their list and will be at the center of the White House’s pitch to voters during the midterm election cycle.

“President Trump’s mass appeal partly lies in his willingness to question our country’s broken status quo,” White House spokesperson Kush Desai said in a statement. “That includes food standards and nutrition guidelines that have helped fuel America’s chronic disease epidemic. Overhauling our food supply and nutrition standards to deliver on the MAHA agenda remains a key priority for both the President and his administration.”

At the same time, with most Americans , the White House has cooled on Kennedy’s aggressive policies to curb vaccines and MAHA’s interest in tamping down environmental chemicals that are linked to disease.

The result: Republicans are realizing just how demanding the MAHA vote can be. Moms Across America leader Zen Honeycutt warned that Republicans are facing their biggest setback yet with the MAHA movement, after Trump signed an executive order to support production of glyphosate, a herbicide the World Health Organization has .

“It has caused the biggest uproar in MAHA,” Honeycutt said during a CNN interview in late February.

A White House Warning

Trump’s top pollster, Tony Fabrizio, cautioned in December that an embrace of Kennedy’s anti-vaccine policies could cost politicians their jobs this year.

Eight in 10 MAHA voters and 86% of all voters believe vaccines save lives, his poll of 1,000 voters in 35 competitive districts found.

“In the districts that will decide the control of the House of Representatives next year, Republican and Democratic candidates who support eliminating long standing vaccine requirements will pay a price in the election,” on the poll stated.

The White House has since shaken up senior staffing at HHS, including removing from the deputy secretary role and his job as acting director of the Centers for Disease Control and Prevention, in which he curtailed the agency’s childhood vaccination recommendations. Ralph Abraham, a vaccine skeptic who as Louisiana’s surgeon general suspended its vaccination promotion program last year, stepped down as the CDC’s principal deputy director in late February.

, a doctor who said in congressional testimony that he doesn’t believe vaccines cause autism, is now running the CDC in addition to directing the National Institutes of Health.

Though Trump himself has frequently espoused doubts and mistruths about vaccines, polling around anti-vaccine policy has undoubtedly shaken the White House’s confidence during a tough midterm election year, said former , an Indiana Republican and retired doctor who left Congress last year.

Bucshon said Republicans can’t risk alienating voters, especially parents of young children who might be moved by Democratic attack ads on the topic at a time when hundreds of measles cases are popping up across the U.S.

“That’s the reason you’re seeing the White House get nervous about it,” Bucshon said. “This is just the political reality of it.”

Kennedy built some of his MAHA following with calls to end federal approval and recommendations for the covid vaccines during the pandemic. The Advisory Committee on Immunization Practices, a federal panel of outside experts who were handpicked by Kennedy to develop national vaccine recommendations, is expected to review and possibly withdraw its recommendation for covid shots. Its February meeting was postponed and is now scheduled for March 18-19, when the panel plans to discuss injuries from covid vaccines, HHS spokesperson Andrew Nixon confirmed on March 11.

“I’m not deaf to the calls that we need to get the covid vaccine mRNA products off the market. All I can say is stay tuned and wait for the upcoming ACIP meeting,” ACIP Vice Chair Robert Malone , a conservative account on the social platform X, before the meeting was postponed. “If the FDA won’t act, there are other entities that will.”

No Fury Like Scorned MAHA Moms

Bipartisan support is also extremely high 鈥� above 80% 鈥� for another core tenet of the MAHA agenda: eliminating the use of certain pesticides on crops.

But MAHA leaders were incensed when Trump issued a Feb. 18 promoting the production of glyphosate, a chemical used in weed killers sprayed on U.S. crops and which Kennedy has railed against and sued over because of its reported links to cancer.

“There’s gonna be ups and downs, and there is zero question that this week was a down,” Calley Means, a senior adviser to the health secretary and a former White House employee, told a MAHA rally in Austin, Texas, on Feb. 26. “I am not going to gaslight or sugarcoat it: This glyphosate thing was extremely disappointing. Bobby’s disappointed.”

Despite deep unhappiness from MAHA followers, Kennedy endorsed Trump’s executive order defending access to such pesticides.

“I support President Trump’s Executive Order to bring agricultural chemical production back to the United States and end our near-total reliance on adversarial nations,” Kennedy .

Without offering policy changes, Kennedy promised a future agricultural system that “is less dependent on harmful chemicals.”

White House officials are now trying to downplay the executive order.

“The President’s executive order was not an endorsement of any product or practice,” Desai said in a statement.

But that’s done little to dampen criticism from leading MAHA influencers who had hoped, with Kennedy’s influence in the administration, that the chemical would be banned.

Some Democrats see an opening.

of Maine earned cheers from MAHA loyalists for co-sponsoring legislation with Rep. Thomas Massie (R-Ky.) to undo the executive order.

“The Trump Admin. cannot keep paying lip service to while propping up Big Chemical like this and choosing corporate profits over Americans’ health,” .

, a prominent MAHA influencer who promotes healthy eating, responded on X with a “HELL YES.”

鈥楨at Real Food’

The White House and Kennedy are refocusing their messaging to emphasize one of the most popular elements of the MAHA platform: food.

At the start of the year, Kennedy unveiled new dietary guidelines that emphasize vegetables, fruits, and meats while urging Americans to avoid ultraprocessed foods.

Kennedy has leaned into his new “Eat Real Food” campaign, launching a nationwide tour in January. Ahead of the late-February MAHA rally, he stopped at a barbecue joint in Austin where he took photos with stacks of smoked ribs and grilled sausages. Large “Eat Real Food” signs have been provided for crowds of supporters to hold up during major announcements at HHS’ headquarters this year.

Focusing on nutrition will please MAHA moms, suburban swing voters, and conservatives alike, said , a physician and former Republican representative from Texas.

“They keep them happy by talking about the food pyramid,” Burgess said. “That’s an area where there is broad, bipartisan support.”

Indeed, Fabrizio’s poll shows equal support 鈥� 95% 鈥� among respondents who voted for former Vice President Kamala Harris and those who voted for Trump for requiring labeling of harmful ingredients in ultraprocessed foods.

Trump is keenly aware that Kennedy’s MAHA movement is key to his political survival. At a Cabinet meeting in January, Kennedy rattled off a list of his agency’s efforts researching autism and tackling high drug prices.

Trump leaned in at the table.

“I read an article today where they think Bobby is going to be really great for the Republican Party in the midterms,” , “so I have to be very careful that Bobby likes us.”

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).

Después de que Robert F. Kennedy Jr., secretario del Departamento de Salud y Servicios Humanos (HHS, por sus siglas en inglés), despidiera a Susan Monarez, directora de los Centros para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglé), por negarse a lo que sus abogados calificaron , Newsom para ayudar a modernizar el sistema de salud pública de California.

También dio trabajo a Debra Houry, ex directora científica y médica de la agencia, quien había renunciado en protesta pocas horas después del despido de Monarez.

Newsom también se asoció con los gobernadores demócratas Tina Kotek, de Oregon; Bob Ferguson, de Washington; y Josh Green, de Hawaii para formar la , una agencia regional de salud pública.

Los gobernadores que sus recomendaciones “defenderán la integridad científica en la salud pública mientras Trump destruye” la credibilidad de los CDC. Newsom argumentó que crear la alianza independiente era vital mientras Kennedy lidera el retroceso de las recomendaciones nacionales de vacunación de la administración Trump.

Más recientemente, California se convirtió en el primer estado en de respuesta a brotes coordinada por la Organización Mundial de la Salud (OMS), seguido por Illinois y Nueva York. Colorado y Wisconsin indicaron que planean unirse.

Esto ocurrió después de que el presidente Donald Trump a Estados Unidos de la agencia, argumentando que la OMS “se ha desviado de su misión principal y ha actuado en contra de los intereses de Estados Unidos para proteger al público estadounidense en múltiples ocasiones”.

Newsom dijo que unirse al consorcio liderado por la OMS permitirá a California responder más rápido a brotes de enfermedades contagiosas y a otras amenazas a la salud pública.

Aunque otros gobernadores demócratas y líderes de salud pública han criticado abiertamente al gobierno federal, pocos han sido tan directos como Newsom, quien considera postularse a la presidencia en 2028 y está en su segundo y último mandato como gobernador.

Miembros de la comunidad científica han elogiado su esfuerzo por construir una defensa de salud pública frente a los recortes de financiamiento y la reducción de las recomendaciones de vacunas por parte del gobierno federal.

Lo que está haciendo Newsom “es una gran idea”, dijo Paul Offit, crítico de Kennedy y experto en vacunas que anteriormente formó parte del comité asesor de vacunas de la Administración de Alimentos y Medicamentos (FDA, por sus siglas en inglés), pero fue removido bajo la administración Trump en 2025.

“La salud pública se ha puesto de cabeza”, dijo Offit. “Tenemos a un activista antivacunas y negador de la ciencia al frente del Departamento de Salud y Servicios Humanos. Es peligroso”.

La Casa Blanca no respondió a preguntas sobre la postura de Newsom y el HHS rechazó solicitudes para entrevistar a Kennedy.

En cambio, funcionarios federales de salud criticaron a los demócratas en general y argumentaron que los estados gobernados por demócratas están participando en fraude y mala administración de fondos federales en programas de salud pública.

Emily Hilliard, vocera del HHS, dijo que la administración está actuando contra “estados gobernados por demócratas que impulsaron confinamientos sin base científica, mandatos de máscaras para niños pequeños y estrictas tarjetas de vacunación durante la era del covid”. Señaló que esas medidas “han erosionado completamente la confianza del pueblo estadounidense en las agencias de salud pública”.

Salud pública guiada por la ciencia

Desde que Trump regresó al poder, Newsom ha criticado al presidente y a su administración por impulsar políticas que considera una amenaza para la salud y la seguridad públicas. Ha calificado a los líderes federales como “extremistas” que intentan “usar los CDC como arma y difundir desinformación”.

También a funcionarios federales por vincular erróneamente a las vacunas con el autismo y que la administración está poniendo en peligro la vida de bebés y niños pequeños al reducir las recomendaciones de vacunas infantiles. Además, argumentó que la Casa Blanca está generando “caos” en el sistema de salud pública de Estados Unidos al retirarse de la OMS.

El gobernador rechazó una solicitud de entrevista. Marissa Saldivar, vocera de Newsom, dijo que es una prioridad del gobernador “proteger la salud pública y brindar a las comunidades orientación basada en ciencia y evidencia, no en política ni conspiraciones”.

Las acciones de la administración Trump han generado incertidumbre financiera que, según funcionarios locales, ha reducido la moral dentro de los departamentos de salud pública y ha dejado a los estados menos preparados para brotes de enfermedades y .

El año pasado, la Casa Blanca propuso recortar el gasto del HHS en , incluidos . En enero, el Congreso rechazó en gran medida esos recortes, aunque para programas centrados en determinantes sociales de la salud, como el acceso a alimentos, vivienda y educación.

La administración Trump anunció que retiraría en fondos de salud pública de California, Colorado, Illinois y Minnesota, argumentando que los estados liderados por demócratas financiaban iniciativas “woke” que no reflejaban las prioridades de la Casa Blanca.

En cuestión de días, y un juez el recorte.

“De repente siguen cancelando subvenciones y luego se revierte en los tribunales”, dijo Kat DeBurgh, directora ejecutiva de la Asociación de Oficiales de Salud de California. “Gran parte del daño ya está hecho porque los condados ya dejaron de hacer el trabajo”.

Según un análisis de 2025 de 麻豆女优, una organización sin fines de lucro de información sobre salud que incluye a 麻豆女优 Health News, el financiamiento federal representa de los presupuestos de los departamentos de salud estatales y locales en todo el país. Ese dinero se destina a combatir el VIH y otras infecciones de transmisión sexual, prevenir enfermedades crónicas y fortalecer la preparación en salud pública y la respuesta a enfermedades contagiosas.

Los fondos federales representan $2.400 millones del presupuesto de salud pública de $5.300 millones de California, lo que dificulta que Newsom y los legisladores estatales compensen posibles recortes. Ese dinero ayuda a financiar operaciones estatales y es vital para los departamentos de salud locales.

Los recortes afectan a todos

Barbara Ferrer, directora de salud pública del condado de Los Ángeles, dijo que si el gobierno federal logra recortar esos $600 millones, el condado 鈥攃on casi 10 millones de residentes鈥� perdería unos $84 millones en los próximos dos años, además de otras subvenciones para la prevención del VIH y otras infecciones de transmisión sexual.

Ferrer señaló que el condado depende de casi $1.000 millones en financiamiento federal al año para rastrear y prevenir enfermedades contagiosas y combatir problemas crónicos de salud, incluidos la hipertensión y la diabetes. El condado el cierre de que ofrecían vacunación y pruebas de enfermedades, en gran parte por pérdidas de financiamiento relacionadas con recortes a subvenciones federales.

“Es una estrategia mal informada”, dijo Ferrer. “La salud pública no se preocupa por si tu afiliación política es republicana o demócrata. No se preocupa por tu estatus migratorio ni por tu orientación sexual. La salud pública tiene que estar disponible para todos”.

Un solo caso de sarampión requiere que los trabajadores de salud pública rastreen a unas 200 personas que pudieron haber estado en contacto con el paciente, dijo Ferrer.

Estados Unidos , pero está cerca de perder ese estatus debido al escepticismo sobre las vacunas y a la desinformación difundida por sus críticos. El año pasado hubo , la mayor cifra desde 1991, con un 93% en personas no vacunadas o cuyo estado de vacunación era desconocido.

Este año, la enfermedad altamente contagiosa se ha reportado en , y en .

Funcionarios de salud pública esperan que la West Coast Health Alliance ayude a contrarrestar las políticas de Trump al generar confianza mediante recomendaciones de salud pública basadas en evidencia.

“Lo que estamos viendo del gobierno federal son políticas partidistas en su peor forma y represalias por diferencias sobre políticas públicas; esto pone en un riesgo extraordinario la salud y el bienestar del pueblo estadounidense”, dijo Georges Benjamin, director ejecutivo de la Asociación Estadounidense de Salud Pública (APHA, por sus siglas en inglés), una coalición de profesionales de salud pública.

Un calendario de vacunación más sólido

Erica Pan, principal funcionaria de salud pública de California y directora del Departamento de Salud Pública de California, dijo que la West Coast Health Alliance está defendiendo la ciencia al recomendar un calendario de vacunación más sólido que el del gobierno federal.

California forma parte de una coalición que por su decisión de retirar las recomendaciones de siete vacunas infantiles, incluidas las de la hepatitis A, la hepatitis B, la influenza y covid-19.

Pan expresó una profunda preocupación por la situación de la salud pública, especialmente por el aumento de casos de sarampión.

“Estamos retrocediendo”, dijo Pan sobre las inmunizaciones.

Sarah Kemble, epidemióloga estatal de Hawaii, dijo que el estado se unió a la alianza después de escuchar a residentes que apoyan las vacunas y quieren tener la seguridad de que seguirán teniendo acceso a ellas.

“Recibíamos muchas preguntas de personas con ansiedad que sí entendían las recomendaciones basadas en la ciencia, pero se preguntaban: 鈥樎縏odavía voy a poder ir a ponerme mi vacuna?’”, dijo Kemble.

Otros estados liderados principalmente por demócratas también han formado alianzas. Pennsylvania, Nueva York, Nueva Jersey, Massachusetts y varios otros estados de la costa este se unieron para crear el .

Hilliard, del HHS, dijo que aunque los gobernadores demócratas establezcan coaliciones asesoras sobre vacunas, el Comité Asesor sobre Prácticas de Inmunización federal “sigue siendo el organismo científico que guía las recomendaciones de vacunación en este país, y el HHS garantizará que la política se base en evidencia rigurosa y ciencia de alto nivel, no en la política fallida de la pandemia”.

Influencia en estados republicanos

Por su parte, Newsom aprobó una asignación anual recurrente de casi $300 millones para apoyar al Departamento de Salud Pública de California, así como a las 61 agencias locales de salud pública en el estado. El año pasado también que autoriza al estado a emitir sus propias recomendaciones de inmunización.

La ley exige que las aseguradoras de salud en California cubran las vacunas recomendadas por el estado, incluso si el gobierno federal no las recomienda.

Jeffrey Singer, doctor y investigador principal del Cato Institute, un centro de pensamiento libertario, dijo que la descentralización puede ser beneficiosa. Esto se debe a que las campañas informativas locales que reflejan distintas ideologías políticas y prioridades comunitarias pueden tener más posibilidades de influir en el público.

Un análisis de 麻豆女优 encontró que algunos estados republicanos se están sumando a estados demócratas para desvincular sus recomendaciones de vacunación del gobierno federal. Singer dijo que doctores en su estado natal de Arizona están mirando a California, más liberal, para guiarse sobre consejos de vacunación.

“La ciencia nunca está completamente establecida y hay muchas áreas de este país donde existen diferencias de opinión”, dijo Singer. “Esto puede ayudarnos a cuestionar nuestras suposiciones y aprender”.

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).