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

Mary Agnes Carey: Hello from 麻豆女优 Health News and WAMU radio in Washington, D.C. Welcome to What the Health? I’m Mary Agnes Carey, managing editor of 麻豆女优 Health News, filling in for Julie Rovner this week. And as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Friday, April 17, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So here we go. 

Today we’re joined via videoconference by Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

Carey: Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine. 

Joanne Kenen: Hi, everybody. 

Carey: And my 麻豆女优 Health News colleague Emmarie Huetteman. 

Emmarie Huetteman: Hey there. 

Carey: Later in this episode, we’ll play Julie’s interview with immigration attorney Michelle Canero about the impact the Trump administration’s immigration policies are having on the medical workforce. But first, this week’s news 鈥� and there is plenty of it. 

On Thursday, President [Donald] Trump nominated Dr. Erica Schwartz to lead the Centers for Disease Control and Prevention. Schwartz, a vaccine supporter, served as a deputy surgeon general in President Trump’s first term, and during the coronavirus pandemic she ran the federal government’s drive-through testing program. She’s also a Navy officer and a retired rear admiral in the Commissioned Corps of the U.S. Public Health Service. Her appointment requires Senate confirmation. President Trump also announced other changes to the agency’s top leadership: Sean Slovenski, a health care industry executive, as the agency’s deputy director and chief operating officer; Dr. Jennifer Shuford, health commissioner for Texas, as deputy director and chief medical officer, and Dr. Sara Brenner, who briefly served as acting commissioner of the FDA [Food and Drug Administration], as a senior counselor to Department of Health and Human Services Secretary Robert F Kennedy Jr. So we’ve discussed previously on the podcast several times that the CDC has lacked a permanent director for most of the president’s second term. Will Dr. Schwartz, if confirmed, and the other members of this new leadership team make the difference? 

Huetteman: I think that we’ve seen a CDC that’s been in a protracted period of turmoil, and this is going to be an opportunity for maybe a shift in that. Dr. Schwartz would actually be the agency’s fourth leader in a little more than a year, and we’ve talked on the podcast about how naming someone who could fit the bill to lead the CDC was a difficult task facing the Trump administration. They needed someone who could support the MAHA [Make America Healthy Again] agenda while not embracing some of the more anti-vaccine views, and that person needed to be able to win Senate confirmation, which isn’t a given, even with this Republican-controlled Senate. 

Edney: And I think we’ve seen that there have been some people already in the MAHA coalition that have come out and been upset about this pick. So I think what that shows is a calculated decision by the administration to, kind of, as they’ve been doing for this year, is kind of not focus on the vaccine part of Secretary Kennedy’s agenda and to, as Emmarie said, try to get someone that can get through Senate confirmation. We’ve already seen the surgeon general nominee be held up in the Senate because she was not as strong on vaccines as I think some would have liked to see when she had her confirmation hearing. 

Kenen: So this happened late yesterday, and I’ve been traveling this week, but I did have a chance to talk to some public health people about her, and there was sort of this audible sigh of relief. The Senate is a very unpredictable place, and we live in very unpredictable times. At this point, my initial gut reaction is she’s got a pretty good chance of confirmation. The other thing, I think some of the other appointees, there’s a little bit more concern about, but what really matters is who is the face of the CDC, and she would be the face of the CDC. She would be in charge, and people like her. Also, this is an administration that has not had a lot of minorities, and she will be, she’s a Black woman. respected in her field. And that also is going to 鈥� she needs to be able to speak to all Americans about their health, and I think that people welcome that as well, both her credentials and her life experience. So, yeah, I think that MAHA is sort of in this funny moment now, because clearly Kennedy isn’t doing everything that people wanted or expected. And so we’ll sort of see how the 鈥� I think if he had his ideal CDC director, this, we can probably surmise that this would not, she would not be the first on his list. But there’s a certain amount of adaptation going on at the moment. So I think many, many people will be relieved to see somebody get through, confirmed pretty quickly. People can get held up for things that have absolutely nothing to do with the CDC or public health. The Senate has all sorts of peculiarities. But I think there’s probably going to be a desire to get this done pretty quickly. 

Carey: All right. Well, we’ll see what happens, and we will go back to the MAHA folks a little bit later in the podcast. But right now I want to shift to Capitol Hill. Thursday was a very big day on the Hill for HHS Secretary Kennedy. He kicked off a series of appearances before Congress. This week he’s testifying before three House committees before he heads over to the Senate next week. This is the first time that the secretary has visited some of these House panels, and while the purpose of the latest congressional visit is to talk about President Trump’s HHS budget request, this also was the first time that a lot of lawmakers ever had an opportunity to talk to Kennedy, and what they asked him sometimes deviated, maybe quite a bit, from that subject of federal funding. The topics included Medicaid fraud, measles outbreaks, the birth-dose recommendation for the hepatitis B vaccine, peptides, unaccompanied minors, and more 鈥� actually, much more when you look at the hearings from yesterday, and I’m sure that will also happen with today’s session. What stood out to you about Kennedy’s testimony this week? 

Edney: I think it was the mix of questions, and you sort of alluded to this, but they wanted, the members of Congress wanted to talk about so many things. And I feel like in the earlier hearing, which was in the House Ways and Means Committee, that it was, there was a lot of focus in the beginning on fraud, and that sort of surprised me, and then we saw maybe one or two questions on vaccines. And so I thought the mix of questions, the things that members were interested in, were really interesting. And it did 鈥� there were some fiery moments, but for his first time on the Hill in a while, for such a controversial Cabinet member, I thought they were pretty tame. 

Kenen: Yeah, I watched a fair amount of the morning. I did not see the afternoon, but I read about the afternoon, and I totally agree with Anna’s take. This administration and Kennedy did what this administration has been doing. They blame all problems on [former president Joe] Biden and the prior administration. And to be fair, Democrats, when they’re in power, they, I don’t think they do it quite to this extreme, but Democrats spend, when they have the chance, they blame things on Republicans. So that’s sort of Washington as usual. The emphasis on fraud has been a hallmark of this administration, particularly in health and social services. And you’ve seen, of course, in the way they’ve gone after blue states in particular. And a lot of their justification for the changes in Medicaid that are coming in the coming year are supposedly because of massive fraud and they’re cracking down. It was not dominated by vaccines, and I was watching Kennedy’s face really carefully. When he was asked about the first child to die of measles in Texas last year, and a Democrat asked him could the vaccine have saved her life, and you could sort of see him just, you just sort of watch his facial expressions, and he knew he had to say this, and he came out with the word “possibly,” and, which is a change. And then in the afternoon 鈥� where I did not, as I said, I did not watch the afternoon, but I read about it 鈥� he was much more certain. He was much stronger about the measles vaccine and said it’s, the measles vaccine, is safer than measles, which is a big signal shift there. 

Huetteman: It’s true, although I will point out, though, that he did stand by the decision to remove the recommendation for the birth dose of the hepatitis B vaccine when he was pressed on that. So it was, I agree it was a softening, I’d say. At least it wasn’t a dramatic turnaround from what he’d said or not said in the past. But for him, it was at least a softening. 

Kenen: In the hepatitis B recommendation, he said that the biggest threat to infection was at, through birth, at, through the mother, and if you test the mother, the baby is not at risk. And that’s partially true, and that is a significant factor to eliminate risk. It doesn’t 鈥� it minimizes risk. It does not eliminate risk. Babies can and have been infected in the first weeks of life in other ways. The recommendation was not to totally eliminate that vaccine. It was to postpone it. But there’s, public health, still believe that, in general, many public health leaders would still say that the vaccine at birth is the better way of doing it. 

Carey: The focus was, theoretically, on the budget request from the administration. Did the secretary shed any light on those priorities or their impacts? I was taken, I think in the afternoon hearing I read about various lawmakers, including Rosa DeLauro from Connecticut, who sort of just said: A CDC cut of 30%? We’re not gonna do that. And there were also some Republican members who jumped in to sort of say, I don’t think we’re going to do the cuts you envision. But did the secretary defend them? Did he bring any new clarity to them? 

Edney: I don’t feel like I gained any new clarity on it. I think to bring it back to Budget 101, I guess, is like when the president, when the administration, sends down their budget, I think a lot of people already assume it’s dead on arrival. And maybe even though Kennedy is there to talk about the budget, it does become this broader hearing, because they don’t get him on the Hill that often and people go there to talk about all kinds of things, and I think that he probably knew that he didn’t have to defend it in the same way, because it’s not going to happen. 

Carey: Sure. As they say, the president proposes and Congress disposes. But Joanne, you want to jump in? 

Kenen: Yeah, there’s something significant about this administration, which is Congress has repeatedly authorized more money for various health programs and science programs, and the administration doesn’t spend it, so that there’s a different dynamic. Traditionally, yes, Congress 鈥� the president proposes, Congress legislates, and then people go off and spend money. That’s what people like to do. And in this case, when Congress has, in a bipartisan way, differed with the administration and restored funding, it hasn’t all gone, those dollars haven’t gone out the door. So the entire sort of checks-and-balances system has been askew in terms of funding. I agree with everybody here. I do not think that Congress is going to accept these extreme cuts across the board in health care and health policy, in public health and science and NIH [the National Institutes of Health] and everything, but I don’t know what they’re actually going to spend at the end of the day. 

Carey: Emmarie, you wanted to jump in. 

Huetteman: Yeah, there was one striking exchange to me where the secretary acknowledged he wasn’t happy with the cuts that were proposed. I think those were his words. But he pretty quickly added, and neither is President Trump, and he framed it as a matter of making hard decisions when faced with federal budget shortfalls. 

Carey: All right. Well, we’ll keep watching this as it moves through Congress. Also during yesterday’s House Ways and Means hearing, some Democrats took issue with past statements from Secretary Kennedy and President Trump that linked Tylenol use during pregnancy to autism in children. released this week in JAMA Pediatrics found that the use of Tylenol by women during pregnancy was not associated with autism in their children. This nationwide study from Denmark followed more than one and a half million kids born between 1997 and 2002, including more than 31,000 who were exposed to Tylenol in the womb. in another medical journal examining community water fluoridation exposure from childhood to age 80 found no impact on IQ or brain function. Kennedy has claimed that fluoride in water has led to IQ loss in children. These studies clearly debunk medical claims that have gotten a lot of attention. Will these findings have an impact now? 

Kenen: I think we’ve seen over and over and over again that there are people who are very deeply wedded to certain beliefs, and new science, new research, does not deter them from those beliefs. We also see some people who are sort of in the middle, who are uncertain, and new findings can shift their beliefs, right? And then, of course, there’s a lot of 鈥� these are not new studies. I mean these are new studies but they are not the first of their kind. The reason we’ve been using fluoride for, what, 60 years now in the water. Tylenol has been around a long time. So is it going to change everybody’s belief? No. Is it going to perhaps slow the push to ban fluoridation? Perhaps. But I just don’t think we know, because we’re sort of on these dual-reality tracks regarding a lot of science in this country, where once people sort of buy into disinformation, they’re very, it’s very hard to change 鈥� or misinformation 鈥� it’s hard to change people’s minds. 

Edney: I do think, on the Tylenol front 鈥� I absolutely agree with what Joanne said overall. And I think on the Tylenol front that it’s possible that this study will give pediatricians something to give and talk about with parents that are asking. I think there still is some confusion among some people. It’s not a huge, I don’t think, widespread thing, but I think there are some new parents who are wondering. And if you are able to take this study that is published in 2026 鈥� it just happened, it was after Trump made his statements 鈥� I think maybe that would give them something to talk about with their patients. 

Kenen: I agree with Anna. I think the Tylenol one is easier to change than some of the fluoridation stuff going on, partly because so many of us 鈥� and we should just say, it’s not just the Tylenol, the brand. It’s acetaminophen, which I’ve never pronounced right. I think those of us who have been pregnant, we’ve taken that in our life before and we don’t think of it as a big, dangerous, heavy prescription drug. I think we’ve, it’s something we feel comfortable with. And I think there’s also the counterinformation, which is, a fever in a pregnant woman can, a pregnant person can be dangerous to the fetus. So I think that one’s a little 鈥� and I don’t, also, I don’t think it’s as deep-rooted. The fluoridation stuff goes back decades, and the Tylenol thing is sort of new. And it might be, I’m not sure that the course of these arguments 鈥� I think that Tylenol is easier to counter than some other things, because partly just we do feel safe with it. 

Carey: All right. We’re going to take a quick break. We’ll be right back. 

We’re back and talking about how the Trump administration is managing the voters behind the Make America Healthy Again, or MAHA, movement, which helped President Trump win the 2024 election. My colleagues Stephanie Armour and Maia Rosenfeld wrote about the administration’s recent decision to give coke oven plants in the U.S. a one-year exemption from tougher environmental standards. And that was a move that angered some MAHA activists who wondered if the GOP is more beholden to industry than the MAHA agenda. President Trump, HHS Secretary Kennedy, and other top administration officials met recently at the White House with a group of MAHA leaders to calm concerns that the administration is moving too slowly on food policy changes, and they are concerned about the president’s recent support of the pesticide glyphosate. According to press reports, the MAHA folks seem to feel their concerns were heard during that session. But is this ongoing conflict between the president and this key political constituency, will it be one that keeps brewing as the midterm elections approach? 

Edney: Yes, 100%. I think it will continue to brew. I think that meeting was thrown together so quickly that some members of the MAHA movement who were invited couldn’t even make it. So it wasn’t exactly a long-planned, seemingly deep desire to fix everything. But it was, as you’ve said, an effort to kind of hear them out and make them feel heard. No one that I’ve talked to has said everything is fixed now. It’s more of a to-be-determined We will see what the administration will do moving forward, if they will listen to any of our plans 鈥� which we will not share with you, by the way 鈥� to make us happy. And I think that that’s going to continue. There’s a rally planned in front of the Supreme Court on glyphosate later this month where a lot of those people will be, and so I think that they’re upset and they’re stirring up, that concern is only going to get stirred up more. 

Carey: Emmarie. 

Huetteman: It’s a small thing, but our fellow podcast panelist Sheryl Stolberg at The New York Times during this White House meeting where President Trump was meeting with MAHA leaders, one of the leaders made a joke about how this is not a group that’s going to be, quote, “Team Diet Coke,” and the president apparently took that as a cue to press that Diet Coke button he famously has on his desk and summon a server who apparently brought him a Diet Coke. Supporters of MAHA have been clear that they want not just for the Trump administration to promote policies supporting priorities like healthy eating and removing food dyes, but also they want them to rein in or end policies they don’t support. And that weed-killer executive order, that really was a big example of that. The MAHA constituency made it clear that they felt betrayed by that order, and they’re going to have to do some work to walk that back. 

Carey: We’ll also see how, with their concerns about the new CDC director nominee, which they’re already voicing, we’ll see how that plays out. 

Kenen: No, I just think that we are, as we mentioned at the beginning, we’re seeing cracks, right? We’re seeing 鈥� none of us are privy to any conversations that President Trump has had privately with Secretary Kennedy. But his, Secretary Kennedy’s, public statements have been a little different than they were a few months ago. There’s certainly been reports that he’s been told to soft-pedal vaccines and talk about some of the things that there’s more unanimity across ideological and party lines. Healthier food 鈥� there’s debate about how to, whether, there’s debate about how Kennedy defines healthier food. But in general, should we eat healthier? Yes, we should eat healthier. Should our kids get more exercise? Yes, our kids should get more exercise. Do we have too much chronic disease? Yes, we have too much chronic disease. So they’re sort of this, trying to move a little bit more, sort of this sort of top line, very hazier agreement. But at the same time, the people who are sort of really the core of MAHA, as Kennedy has sort of created it or led it, there’s cracks there. 

Carey: All right, we’ll see. We’ll see where that goes. But let’s go ahead and move on to ACA enrollment. A found that 1 in 7 people who signed up for an Affordable Care Act plan failed to pay their first month’s premium. The analysis from Wakely consulting group found that nationally around 14% of those who enrolled in ACA plans didn’t pay their first bill for January coverage. Now we know the elimination of the enhanced ACA tax credits and higher premium costs led to lower enrollment in the ACA exchanges, with sign-ups for 2026 falling to 23 million from 24 million a year ago. But how do you interpret this finding that 14% of enrollees didn’t pay their January premium? Is it a sign of more trouble ahead? 

Edney: I think it could be a sign of more trouble ahead. Some 鈥� what we’re seeing is sticker shock. And there may be some people who are trying to deal with that and won’t be able to as the months go on. And so, yeah, I think it could mean that even more drop out, and that means more people lose coverage and are uninsured. 

Kenen: I think there was sort of a general, initial, misleading sigh of relief when in December, when the enrollment figures, the drop wasn’t as bad as some feared. But at the same time, people said: Wait a minute. This doesn’t really count. Signing up isn’t the same thing as staying covered. The drop in January was significant, we now know. And I agree with Anna. I think we don’t know how many more people will decide they can’t afford it. Or we don’t know whether the big drop is January. Probably a lot of it is, because you get that first bill. But can, will more people drop? Probably. We have no way of knowing how many. And it also depends on the economy, right? If more people lose jobs, right now it’s still pretty, kind of still pretty stable, but we don’t know what’s ahead. We don’t know what’s going to happen with the war. We don’t know many, many, many 鈥� we don’t know anything. So the future is mysterious. I would expect it to drop more. I don’t think, I don’t know whether this is the big drop or February will be just as bad. I suspect January will be the biggest. But who knows? It depends on other outside factors. 

Huetteman: We’re also seeing a drop-off in the kind of coverage that people are choosing. That analysis that you referenced, Mac, showed that there was a 17% drop in silver plan membership, with most of those folks switching to bronze plans, which, in other words, that means they switch to plans that have lower monthly premiums but they have higher deductibles. And that means that when you get sick, you owe more, in some cases much more, before your insurance starts picking up the tab. And I think really what this means is people are more exposed to the high charges for medical services, bigger bills when you get sick. I think that 

Kenen: I think that the Republicans were seen as having pushed back a lot of the health impacts of the so-called One Big Beautiful Bill and that it would be after the election. And I and others wrote: No, no, no, no, no. We’re going to see this playing out before the election. This is a really big political red flag, right? This is a lot more people becoming uninsured, which makes other people worried about their insurance and stability. So I think this is definitely going to 鈥� it may not be. There are other things going on in the world. Health care may not be the dominant theme in this year’s election. But yes, this is going to be, the off-year elections are going to be health care elections, like almost every one else has been for鈥� 

Carey: Oh yeah. 

Kenen: 鈥攕ince the Garden of Eden, right? 

Carey: Absolutely, it’s a perennial. All right, we’ll keep our eye on that. That’s this week’s news. Now we’re going to play Julie’s interview with immigration attorney Michelle can arrow, and then we’ll be back with our extra credits. 

Julie Rovner: I am pleased to welcome to the podcast Michelle Canero. Michelle is an immigration attorney from Miami and a member of the board of Immigrants’ List, a bipartisan political action committee focused on immigration reform. Michelle, thanks for joining us. 

Michelle Canero: Thank you for having me. 

Rovner: So, we’ve talked a lot about immigration policy on this podcast over the past year, but I want to look at the big picture. How important to the U.S. health care system are people who originally come from other countries? 

Canero: I think the statistics speak for themselves. One in three residency positions can’t be filled by American graduates alone. That means 33% of these residency positions are being filled by immigrant workers. Twenty-seven percent of physicians are foreign-born. Twenty percent of hospital workers are immigrants. And, at least in Florida, a large percentage of our home health care workers happen to be immigrants. And we depend on this population heavily in the health care sector. 

Rovner: Now, we talk a lot about the Trump administration’s crackdown on illegal immigration, but we talk a little bit less about their sort of messing with the legal immigration system. And there’s a lot going on there, isn’t there? 

Canero: There is. And I think that the campaign talking points were illegal immigration but what we’re actually seeing is a little more sinister. I think that the goal of leadership at the head of DHS [the Department of Homeland Security] and DOS [the State Department], or really Stephen Miller, is pushing something called reverse migration, which is really not about limiting illegal immigration but reducing the immigrant population in the United States. And I think that’s where the real concern is and why you’re seeing these policies that directly affect legal immigrants. 

Rovner: We talk a lot about doctors and nurses and skilled, the top skilled, medical professionals who make up a large chunk of the United States health care workforce. We don’t talk as much about the sort of midlevel professional workers and the support staff. They’re also overwhelmingly immigrant, aren’t they? 

Canero: Yeah, and whether it’s your IT- and technical-knowledge-based workers in hospitals who facilitate all the technology 鈥� we rely on an immigrant workforce for a lot of the technology sector. And then you’ve got research professionals. A lot of clinical researchers, medical researchers, are foreign-born. So it’s not just about the doctors. It’s also the critical staff that keep the hospitals operating. And I’m from Florida. For us, it’s the home health care workers. We have an aging population, and a large percentage of the home health care workers, particularly in Florida, happen to be Haitians on TPS [temporary protected status] or people with asylum work authorizations. And when we lose that, our aging population is left with no resources, because that’s not something AI or technology can fix. You can’t turn someone over in a bed with a robot yet, and we’re probably decades away from that. 

Rovner: So what’s the last year been like for you and your clients? 

Canero: I think it’s a lot of uncertainty. A lot of these policies are percolating, and we’re assuming that they’ll be resolved in litigation, but the damage is being done in real time. So we’re seeing hospitals turning away from hiring foreign workers, because of the H-1B penalty now. The suspension of J-1 processing created backlogs. These visa bans that affect 75 countries on certain visas and 39 countries on others. You’ve got thousands of health care workers that are stuck outside the U.S. So what’s happening, really, is that hospitals and medical providers are just shutting down, and they’re cutting back services, and that means that there are less available services and resources for the same population and the same demand. People are waiting longer for doctor’s appointments. People are finding that they’re not able to get to the specialist that they need to get to in time. And so for us as practitioners, I think, we’re trying to navigate as best we can, but we’re just seeing a lot of people, employers that traditionally would rely on our services, give up and foreign workers looking to go elsewhere. 

Rovner: I noticed during the annual residency match in March that it worked out, I think, fairly well for most graduating medical students. But the big sort of sore thumb that stuck out were international medical graduates. That’s going to impact the pipeline going forward, isn’t it? 

Canero: From what I understand, it takes like seven to 15 years to get to that level, and we just don’t have the student body to meet the demand of residency positions. From my understanding, there’s a gap between American graduates and the demand for residents that’s usually filled by foreign workers. And if we don’t have those foreign workers, those residency positions just don’t get filled. And that becomes more expensive for hospitals, and that transfers to our medical bills. 

Rovner: And people assume that, Oh well this doesn’t impact me. But it really impacts all patients, doesn’t it? And I would think particularly those in rural areas, which are less desirable for U.S.-born and -trained medical professionals and tend to be overrepresented by immigrants. 

Canero: Yeah, I think a lot of the J-1 doctors and H-1B doctors are what facilitate, are working at, our veterans hospitals and our rural medical facilities. And what’s ending up happening is the very same people that this administration touts to support their interests are being forced to travel farther for specialists, right? If there isn’t an endocrinologist in your area, you may have to drive 100 miles to go see that specialist, and you may forgo necessary medical care because of the inconvenience or the cost. And I think that’s hitting at our health. 

Rovner: So you’re on the board of Immigrants’ List, which is working to change things politically. What’s one change that could really make a big difference in what we’re starting to see in terms of immigration and the health care workforce? 

Canero: Well, asking Congress to actually do something. It’s been a problem for decades. So I don’t really know, but I think there’s a couple of things, whether it’s just policymakers supporting our fight against some of these illegal policy changes in courts, organizations supporting us with amicus briefs. For example, there’s a lot of lawsuits challenging these visa bans and these adjudicative holds and the H-1B fine. The more support that the plaintiffs in the litigation get, the more likely we are to resolve that through the court system. And then I hope that there’s enough pressure from hospitals and organizations that have real dollars that impact these elected officials to get them to start seeing, Hey, we need to pass reasonable immigration reform to address some of the loopholes that this administration is using to cause chaos in the system, right? They’re able to do this because we have a gap. We allow them to terminate TPS. We don’t have a structure to ensure that a community that’s been on TPS for 20 years gets grandfathered into some sort of more stable visa. We don’t have a system that precludes the administration from just putting a hold or a visa ban on nationalities. So it’s something that Congress is going to have to step up and do something about. 

Rovner: What worries you most about sort of what’s going on with the immigration system and health care? What keeps you up at night? Obviously you, I know you work on more than just health care. 

Canero: I think my concern is that the American people aren’t seeing what’s happening, or they’re sort of turning a blind eye to it, and by the time it starts to actually impact them and they start asking, Wait, wait, wait. Why is this happening? I don’t understand, it’s going to be too late. Because it’s not hitting their pocket, because it’s not their suffering at this point, they’re not standing up and saying, Hey, this needs to stop, at the level that we need, opposition, to make it stop. And by the time it does hit their pocket and it does affect them directly, I think, it’ll be a little too late. I think people will be scared off from coming here, people that we needed will be gone, and to reverse the system is going to take decades. 

Rovner: Michelle Canero, thanks again. 

Canero: No, you’re very welcome. Thank you for your time. 

Carey: OK, we’re back. Now it’s time for our extra-credit segment, and that’s where we each recognize a story we read this week and we think that you should read it, too. Don’t worry if you miss it. We’ll post the links in our show notes. Joanne, why don’t you start us off this week? 

Kenen: Well, this is by Teddy Rosenbluth in The New York Times. The headline is “” This is one of those stories where you know exactly how it’s going to end in the first paragraph, and yet it was so compellingly and beautifully written that you kept reading until the last word. It is, as the headline suggested, a young man who is an expert on AI and cognitive science named Ben Riley discovered that his father had been lying about a controllable, treatable form of leukemia. He had denied treatment, he’d refused treatment, he had ignored his oncologist because he was relying on AI. And as we all know, AI has its up moments and its down moments. And he was getting incorrect information, distrusted the diagnosis, refused treatment, getting sicker and sicker and sicker as the oncologist and the family got increasingly desperate. And the son, Ben Riley, had, like, skills. He knew how to find scientific evidence, and his father just would not believe it. And by the time his father finally consented to treatment, it was too late, and he did die. And his father was a neuroscientist, a retired neuroscientist, but he found a neuroscience rabbit hole. 

Carey: That’s amazing. Anna, what’s your extra credit? 

Edney: Mine, I’m highlighting a story that I wrote in Bloomberg called “.” And this is, I wanted to dive into this policy that the FDA had implemented. The commissioner has long talked about and felt that perimenopausal and menopausal women were not getting access to the treatments that maybe they really needed, because there had been sort of this two-decade-old study that had showed there were some safety issues regarding breast cancer and cardiovascular disease, but the issue being that those studies had looked at older forms of the medication and also at women who were much older than those who might benefit from taking it. And so they, the agency, asked the companies to remove those warning labels, at least the strongest ones. And what we’ve seen, why 鈥� I wanted to dive into the numbers specifically. Bloomberg has some prescription data that was able to help me out here and just look at when this started rising. You could see that the prescriptions started going up around 2021. I feel like a lot of influencers, a lot of celebrities, were talking about this. And then in 2024 to 2025 when the FDA started talking about this, it really just goes, the prescription numbers just go straight up on the scale. And so there were about 32 million prescriptions written last year, which is a huge increase. And I just dove into some of this, some of the companies, what kind of drugs there are out there, and talked to some women who are benefiting but also, because of this pop, experiencing shortages, because the companies aren’t quite keeping up with the products. 

Carey: Wow, that sounds like an outstanding deep dive. Thank you. Emmarie. 

Huetteman: Yeah, my extra credit is from my colleague at 麻豆女优 Health News who covers health technology. That’s Darius Tahir. The headline is “Your New Therapist: Chatty, Leaky, and Hardly Human.” The story looks at the proliferation of AI chatbot apps that offer mental health and emotional support, particularly the ones that market themselves as, quote-unquote, “therapy apps.” Darius counted 45 such apps in Apple’s App Store last month, and he uncovered in some cases that safety and privacy concerns existed, such as minimal age protections. Fifteen of the apps that he looked at said they could be downloaded by users who were only 4 years old. His story also explored the tension between the risks of sharing sensitive data and the interests of app developers and collecting that data for business purposes. It’s a good read. All right, 

Carey: All right. Thanks so much. My extra credit is from Politico, and it’s written by Alice Miranda Olstein, and she’s a frequent guest here on What the Health? The headline is, quote, “,” close quote. The headline kind of says it all. Alice writes that Nebraska is racing to implement Medicaid work requirements by May 1, and that’s eight months ahead of the national deadline that was set by the One Big Beautiful Bill Act. Nebraska state officials plan to do this without hiring additional staff, even as other health departments in other states prepare to bring in dozens, if not hundreds, of new employees. Alice writes that advocates for people on Medicaid fear that this rush timeline and lack of new staff will cause many problems for Medicaid beneficiaries who are just trying to meet those new work requirements. 

All right. That’s this week’s show. Thank you so much for listening. Thanks, as always, to our editor and panelist Emmarie Huetteman, to this week’s producer and engineer, Taylor Cook, and to my 麻豆女优 colleague Richard Ho, who provided technical assistance. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. Also, as always, you can email us with your comments or questions. We’re at whatthehealth@kff.org. Or you can find me on X, . Joanne, where can people find you these days? 

Kenen: and , @joannekenen. 

Carey: OK. Anna? 

Edney: and and , @annaedney. 

Carey: And Emmarie. 

Huetteman: You can find me on . 

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

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

Julie Rovner: Hello, from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, April 9, at 9:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

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

Lauren Weber: Hello, hello. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, everybody. 

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

Maya Goldman: Go, Blue. 

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

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

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

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

Rovner: Lauren, you want to add something? 

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

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

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

Rovner: I will point out, as a person who covered the entirety of the fight to have emergency contraception 鈥� which is not the abortion pill 鈥� made over the counter, it took like, 15 years. It shortened my life covering that story. Lauren, did you want to add something?  

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

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

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

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

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

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

Ollstein: Right.  

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

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

Rovner: Lauren, you want to add something? 

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

Rovner: Absolutely.  

Weber: 鈥� glad we are able to have her explain it to us. But just wanted to throw out a kudos for breaking all the news on that front.  

Goldman: Yeah, great coverage. 

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

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

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

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

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

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

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

Rovner: Which we will get to. 

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

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

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

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

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

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

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

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

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

Goldman: The money has got to come from somewhere. 

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

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

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

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

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

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

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

Rovner: Lauren, you wanted to add something? 

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

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

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

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

Rovner: Oh, absolutely. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: As it were. 

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

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

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

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

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

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

Rovner: Yeah 鈥� this was quite a scoop. Really, really interesting story. Lauren. 

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

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

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

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

Rovner: Alice. 

Ollstein: I’m on Bluesky  and on X . 

Rovner: Lauren. 

Weber: Still @LaurenWeberHP on both  and . 

搁辞惫苍别谤:听We will be back in your feed next week.聽Until then, be healthy.

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

Julie Rovner: Hello, from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, April 2, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

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

Alice Miranda Ollstein: Hello. 

Rovner: Jessie Hellmann of CQ Roll Call. 

Jessie Hellmann: Thanks for having me. 

Rovner: And Sandhya Raman, now at Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

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

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

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

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

Hellmann: Yeah, exactly. 

Rovner: Let’s not get into the details. 

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

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

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

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

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

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

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

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

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

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

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

Rovner: And that’s 鈥� I would say that’s been a state 鈥� 

Ollstein: Power. 

Rovner: 鈥� power. For generations.  

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Yeah, Republicans have been super ambivalent. I mean, Medicare Advantage was their creation. They overpaid them at the beginning when they, you know, sort of redid the program in 2003. And they purposely overpaid them to get people into Medicare Advantage. And then the Democrats pointed out that this is wasting money because we’re overpaying them. And now the Republicans seem to have joined a lot of their 鈥� at least some Republicans 鈥� seem to have joined a lot of the Democrats in saying, Yes, we’re overpaying them. We’re paying them too much. And you know, they talk about the big, powerful insurance companies, and yet they’re now floating this idea to make Medicare Advantage the default. So pick a side, guys. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Elisabeth Rosenthal: Thanks for having me.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: And what happened with this case? 

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

Rovner: One cent. 

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

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

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

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

Rosenthal: Thanks, Julie, for having me. 

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

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

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

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

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

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

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

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

Raman: On  and on  . 

Rovner: Alice. 

Ollstein: On Bluesky  and on X . 

Rovner: Jessie. 

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

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

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

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

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

Rachel Cohrs Zhang: Hi, everybody. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: And Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hello. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Lawrence: Yeah, is there another deadline to miss? 

Cohrs Zhang: I don’t think so. 

Lawrence: I think this was the only one. 

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

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

Cohrs Zhang: Yeah. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Luthra: That’s true. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Keith: Thanks, Julie. 

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

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

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

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

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

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

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

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

Luthra: I am on Bluesky . 

Rovner: Rachel. 

Cohrs Zhang: On X , or . 

Rovner: Lizzy. 

Lawrence: I’m on X  and  and . 

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

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

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

Julie Rovner: Hello from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, March 19, at 10:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

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

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

Rovner: Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: And Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, there. 

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

We’re 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. The judge ruled that HHS violated the law governing federal advisory committees when HHS Secretary Robert F Kennedy Jr. summarily fired all 17 members of the Advisory Committee on Immunization Practices and replaced them, largely with 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 appealing the decision, so it could change back any minute now 鈥� you should check. What’s the public health impact of this ruling, though? 

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

Rovner: Lauren. 

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

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

Sanger-Katz: Yeah. I mean, I just think that this issue is becoming increasingly politicized. As Lauren and Alice said, I think that does affect the confusion around it, does affect people’s willingness to take up vaccine. But I do wonder also if we’re 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 鈥� it’s 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 relatively broad consensus across the parties. Not that there haven’t been disagreements among scientists or among different groups of Americans. There’s always been resistance to vaccines or concerns about vaccine safety in this country. But I think there was a sense that it’s not 鈥� that 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, I think, risks this becoming a much bigger kind of partisan political issue going into the next election. 

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

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

Rovner: Apparently, public health requires us to relearn things. Before we leave this 鈥� yes, Lauren, you want to add something?  

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

Rovner: Speaking of long-running stories, let’s revisit the grant funding slowdown at the National Institutes of Health. Again this year, grants, particularly grants for early career scientists, are slow leaving the agency, which is one of the few HHS subsidiaries that actually got 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 time period, from 2021 to 2024. Last year, only a gigantic speed-up at the very end of the fiscal year prevented the NIH from not 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, 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 just important to medical advancement, but to a large chunk of the entire U.S. economy. Biomedical research is a very, very large export of the United States. 

Sanger-Katz: Yeah, the NIH has just been giving out this money in a very weird way. It’s not just that they gave it all out at the end of the fiscal year before it was too late, but they didn’t distribute it in the way that they normally distribute the funding. So, normally, the way that these things work is people submit 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 so 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 鈥� it’s kind of rolling 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 sort of prepaid for the whole thing. And so my colleague Aatish Bhatia did a wonderful story on this around the end of the fiscal year, sort of pointing this out. And I think this is the kind of pattern that will result in NIH actually funding a lot less research. I mean, over time, presumably, they’re going to, I guess they could, catch up. But I think in the short term, what it’s allowing them to do is to fund many fewer scientists and many, many fewer research projects. And I think that that does have an effect on the kind of reach and diversity of the projects that are getting funded by NIH and that are the kind of scientific research that’s being conducted. And it’s 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 can’t all be spent in the first year. So it’s kind of like, almost like, the money is no longer with the NIH, but it’s kind of like sitting in a bank account somewhere. It’s not actually out there in the economy, in the university, in the researcher’s pocket funding research in each of those years. 

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

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

Rovner: Yeah, this is one of those stories that I feel like would be a much bigger story if there weren’t so many other big stories going on at the same time. Congress is kind of busy 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. At least right not at the moment. But that doesn’t mean it’s not still a big political issue looming for the midterms. Just today, my colleagues in our 麻豆女优 polling unit are  that finds 80% say their health care costs are up this year, and 51% say their costs are, quote, “a lot higher.” 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, “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.” So where are we in the ACA debate cycle right now?  

Sanger-Katz: I think as far as the ACA debate, as like a policy matter, we’re a little bit nowhere. I think there 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. 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 we’re starting to see, just today, some green shoots from the Democrats in the Senate that they’re looking to explore kind of big ideas in this space. So 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 they’re 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 debates and having some hearings, maybe, and talking to experts and doing some of the kind of work I was thinking that they did before they debated and passed the ACA, right? They did a process like this. So we don’t know what that’s going to be.  

Rovner: Exactly. That’s sort of the origin of our series of “How Would You Fix It?” 鈥� that we’re in that stage where people are starting to think about the big picture. 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. 

Sanger-Katz: Which is 鈥� all 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 gonna come forward with, OK, here’s what we’re gonna do about this. I think this is: Let’s do some studies, let’s talk, let’s debate, let’s think. Let’s get ready for the future.  

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

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

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

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

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

Weber: Again, to talk about midterms conversations, I mean the folks that are often hit hardest by this, as I understand, are middle-income earners, early retirees, or folks that live in expensive states. And that’s a voting bloc. I mean, early retirees 鈥� who else is voting? I mean that’s who’s voting. So I’m 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 in order to make up the difference of what we’re seeing.  

Rovner: Well, meanwhile, in news that I think counts as both bad and good: Health care jobs took a dip in February, 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 in the aggregate. But I wonder if this dip is an anomaly or it represents 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, you wanted to add something?  

Ollstein: Yeah. I mean, I think that these things have a cascading effect, and it can take years to really see, like, the full damage of something. And so we’re just starting to see the very beginning of a trend of people dropping their insurance because they can’t afford it. But then it’ll 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 we’re just at the very beginning of it, and we can sort of infer what could happen based on what’s happened in the past. But that’s a challenge for the political cycle, because it’s hard to talk about things that haven’t happened yet, both good and bad. I mean, you see that also with promising to lower drug prices; 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 off down the line. 

Rovner: Well, speaking of things that weren’t supposed to happen yet, a shoutout to my 麻豆女优 Health News colleague Tony Leys for a  about a family in Iowa facing a cut in home care through Medicaid for their adult son with severe autism and deafness. It appears that Iowa is not the only state cutting back on expensive but optional Medicaid services like home and community-based 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?  

Sanger-Katz: 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 hasn’t happened. States kind of went 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 next year. And so we’re seeing, like, 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, and other kinds of health care providers. It’s pretty ugly out there.  

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

Ollstein: Well, nothing happened for a while. The things that were supposed to happen didn’t happen, and now they may be happening, but it may be too late to avoid some problems happening. So to break that all down: 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 [sexually transmitted infections] 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. So that funding runs out at the end of this month, March, and they only just got the guidance a few days ago. And I will say there was no guidance for months and months and months. I ; a couple days later, the guidance came out. Not saying that was the reason, but that was the timing.  

Rovner: But a lot of people are thanking you. 

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

Rovner: Well, speaking of federal funding on reproductive-related health care,  found that most of the money that Missouri is giving to crisis pregnancy centers 鈥� those are the anti-abortion alternatives to Planned Parenthoods and other clinic 鈥� that the crisis pregnancy centers provide neither abortions nor, in most cases, contraceptives 鈥� has been coming from TANF [Temporary Assistance for Needy Families] 鈥� that’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 tip of the iceberg in public money going to these often overtly religious organizations, right?  

Ollstein: Yeah, I think we’ve seen that more and more over the last few years. These centers were, by conservative activists and politicians, 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 don’t. Some of them offer real health services. Some of them don’t. And there’s very little oversight and regulation. 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. And so I think that we haven’t yet seen that on the federal level, but we’re absolutely seeing it on the state level. And I think this is just contributing to the national patchwork of, you know, where you live determines what kind of services you can access, because we do not see blue states funneling money to these centers. And so you’re going to see a real split there. 

Rovner: And I will point out, 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 don’t. So it’s a very mixed bag, from what we’ve been able to see.  

Well, lastly, ProPublica, speaking of ProPublica, has  about women in labor in Florida who are required to undergo court-ordered C-sections, even if they don’t want them, in order to 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 “fetal personhood” quietly taking hold without our even really noticing it? It seems these laws, some of them, have been challenged, and the courts have sort of gone different ways on it, but mostly just left it to the states.  

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

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

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

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

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. So I can’t think of anyone better to help launch our new interview series called “How Would You Fix It?” 

Here is the premise. I think it’s pretty clear 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 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 you fix it? You’ll 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. 

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

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

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

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

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

Altman: No, I don’t think so. I mean, I’ve seen this many times 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 consolidated 鈥� or the political chemistry to regulate health care costs or health care prices鈥� the two big answers. So 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 it’s unlikely to be more than that. We have made, as a country, very significant progress on coverage. Now 92% of the American people [are] covered; that [is] now endangered by big cutbacks, unprecedented cutbacks. But we made very little 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 that’s what’s 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. But we’re pretty much nowhere on that one and going backwards on the other one. So, without being the captain of doom and gloom here, I think what we’re 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. 

Rovner: 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, I spend less, so you spend more. Can you explain that a little bit? 

Altman: 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. How they do it differs from country to country. But they have a way to control the spigot. We don’t. And so instead, we micromanage everything to death, and make ourselves pretty miserable 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. Kind of every payer on their own. And so 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? That burden then falls to the states, which have to try and deal with that. 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. And on and on and on. That’s not a strategy on health care costs. And if you think about it, we don’t actually have a national strategy on health care costs. The Congress has never mandated that someone come up with 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 don’t actually have anyone responsible for an overall strategy on health care costs. And it shows. 

Rovner: 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 actually agreed 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? 

Altman: It’s red versus blue right now. There is hope for coming together. What is important, and what the media struggles with a lot, is what I call proportionality, or recognizing proportionality. They can come together on small things. 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 together on juicing up transparency. These are not solutions to the health cost problem, but they’re helpful. And, you know, so there are a broad range of areas. 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. And that discussion is important, and that’s a part of it that 麻豆女优 will focus on. 

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

Altman: Well, you know, the biggest lesson, maybe in the history of all these debates, is people don’t like to change what they have very much. And it’s hard to sell them on that. A second lesson is: Ideas seem very popular. And you’ll see a lot of polls: Would you like this? And 90% of people like everything. That doesn’t 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 so when you get to actually discussing 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 states are affected? Not just on public opinion. So those are a couple of lessons. There is also a silent crisis, I think, in health care costs that doesn’t get enough recognition. And that is the crisis facing people with chronic illness 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. So we may see that 25%, sometimes it gets up to 30%, of the American people tell us they’re really struggling with their health care costs. They have to put off care. They may be splitting pills, whatever it may be. But those numbers for people who have cancer, diabetes, heart disease, a long-term chronic illness can go up to 40% or 50%, and it truly affects their lives. I don’t think that problem gets enough attention. So you could say, OK, Drew, well, that’s just obvious. They use the most health care. You could also say, yes, but that’s the reverse of how any functioning health care system should work; it should first of all take care of people who are sick, and we are not doing that in our health insurance system. 

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

Altman: Great, Julie. Thank you, appreciate it. 

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

Sanger-Katz: Sure. So I’m so excited to encourage everyone to read this wonderful story from Tara Bannow at Stat called “.” And I say that it’s a wonderful story, but it’s not necessarily good news. This is a story about a Texas couple of entrepreneurs who have figured out how to exploit the system that was set up by the No Surprises Act in order to get extremely rich. As you guys may remember, this was the bill that ended most surprise medical billing, so you would never go to an emergency room and suddenly end up with a doctor that was out-of-network that was sending you an extra bill. And the law, since it was passed a few years ago, has been extremely effective in preventing those bills from getting sent to individuals. But it created this very complicated and 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. 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 the insurance companies might not be fast enough to reply if they came in these huge batches. So they were sending hundreds of thousands 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, Alla and Scott LaRoque, were personally very colorful. She was a former contestant on The Apprentice, and they had a sort of crazy wedding where they gave everyone luxury gifts. And, anyway, I thought that the story was extremely good, both because the details about these people were very interesting, but also because I think it shows how the No Surprises Act, which I covered at the time of its passage, you know 鈥� 

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

Sanger-Katz: I think in a lot of ways, it was like a, 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. It was a real problem in the health care system that Congress came together to try to solve, and yet, and yet, the work is never done. And there are always unanticipated problems.  

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

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

Rovner: Oh, this is a huge public health problem, particularly for young men. I mean 鈥� it’s the vaping of this decade, I call it. Alice. 

Ollstein: So I have , 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. So a completely unrelated economic and infrastructure priority, and they’re using this health funding as a bargaining chip. And so 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. by 2030? Because, as we learned during covid, we live in a global society, and things that impact other countries impact us as well. And [Jay] Bhattacharya answered, you know, oh, I think we can still eliminate HIV in the U.S., not necessarily in the whole world. So really, really urge people to check out this piece. 

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

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

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

Rovner: Lauren? 

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

Rovner: Margot. 

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

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

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

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

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

Shefali Luthra: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

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

Joanne Kenen: Hi, everybody. 

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

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

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

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

Rovner: That’s a fair assessment. Anna. 

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Yes. 

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

Rovner: Right. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Oh, it is. 

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

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

Kenen:&苍产蝉辫;础苍诲&苍产蝉辫;迟丑别苍鈥�&苍产蝉辫;

Rovner: And then maybe cut it back later. 

Kenen: No, but it’s exceeded expectations. 

Rovner: Absolutely. 

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

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

Kenen: Right. Right. 

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

Kenen: Right.  

Rovner:&苍产蝉辫;鈥�&苍产蝉辫;颈苍&苍产蝉辫;1997.&苍产蝉辫;

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

Rovner: They made it fail. 

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

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

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

Rovner: The ones that passed by voters. 

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

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

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

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

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

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

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

Andy Schneider: Thanks for having me, Julie. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Schneider: Julie Rovner, thank you very much. 

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

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

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

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

Rovner: That’s what it was for. 

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

Rovner: It is not. Shefali. 

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

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

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

Luthra: I am at Bluesky, . 

Rovner: Anna. 

Edney:  and , @annaedney. 

Rovner: Joanne. 

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

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

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

Julie Rovner: Hello from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News. Usually we’re joined by some of the best reporters covering Washington, but today we’re bringing you something special. I hope you enjoy it. We’re taping this episode on Friday, Feb. 27, at 4 p.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

I have two special guests today, who I will introduce in a moment. But first I’m going to explain why I chose them. I started reporting on health policy in 1986, covering health and welfare on Capitol Hill and at the Department of Health and Human Services for what was then the Congressional Quarterly “Weekly Report.” This month marks my 40th anniversary on the health beat, and as anniversaries so often do, it got me thinking about everything I’ve seen and covered, including a half a dozen major health reform fights, a dozen budget reconciliation bills, years-long fights over everything from the Patients’ Bill of Rights and human cloning to bioterrorism and a pandemic. It also got me thinking about where I thought the U.S. health system would be four decades after I began, and where it actually is. And I thought it might be fun to reminisce with a couple of people who not only were there when I started, but who also taught me a lot of what I know. So without further ado, let me introduce my guests. Chip Kahn just stepped down as president and CEO of the Federation of American Hospitals after 25 years in that post. Chip previously worked in both the House and the Senate for the major health committees and also headed the Health Insurance Association of America, the industry group now known as AHIP. I’m pleased to announce that Chip is not actually retiring 鈥� that, among other activities, he’s going to be a colleague of mine here at 麻豆女优 as a senior fellow. Chip will also host a podcast starting later this spring on the business of health care. Chip, thanks for being here, and welcome. 

Chip Kahn: Really happy to be here and celebrate with you. 

Rovner: Joining Chip is Chris Jennings, who not only worked in the Senate for a decade, but also worked in the White House as a senior health staffer for Presidents [Bill] Clinton and [Barack] Obama and advised President [Joe] Biden as well. Today, Chris is president of the health care consulting firm Jennings Policy Strategies. Chris, welcome and thanks for playing along. 

Chris Jennings: Julie, it’s been great to age together. 

Rovner: So let’s start with a little bit of a tour of each of your careers. Chip, you go first. How did you first get started in shaping health policy, and what was your trajectory to today? 

Kahn: It was a scary long time ago. I guess I got started in politics in 1968, actually, when I met Newt Gingrich in New Orleans and then managed his two congressional campaigns. But then I went to graduate school in public health, and finally broke into the Hill in 1983 and worked for a year for Dan Quayle, and then worked in the Senate, worked in the House, went out and worked for the health insurers, came back and worked in the House again during the ’90s 鈥� many, many years of health policy. And then, as you said, for almost 25 years, worked at the Federation of American Hospitals, representing 20% of the hospital industry and all the health policy battles. 

Rovner: And behind your head it says “AEI,” so in your not-retirement, you’re going to be here at 麻豆女优, and you’re also going to be at AEI [American Enterprise Institute]. What else are you planning on doing? 

Kahn: Well, other than being a think tanker 鈥� and a podcaster, I’m looking at a number of areas where I’d like to do some writing on the health policy issues that I’ve been involved with over the years, and maybe try to impact their future by some of the things I have to say. That’s my, will be primary, although I’m also working with the dean of the School of Public Health at Tulane on developing a health policy center there. And I do photography, street photography, and I’ve got a project there too. So I’m not retiring. I’m just moving on. 

Rovner: You are busier than I am, and I thought I was busy. Chris, how did you come to health policy? 

Jennings: Well, I know you’re a Michigan gal, Julie, but I’m from Ohio. And I came, actually, the same year that Chip came in, in 1983. John Glenn hired me as a very, very young assistant. I don’t think I got to know you until 鈥� 1986, shortly behind. But I remember in ’86 I was hired by the chairman of the Aging Committee, the then-chairman of the agency committee [Special Committee on Aging], John Melcher, and he held the first hearing in a blizzard on the Medicare Catastrophic [Protection] illness coverage Act, and I worked through 鈥� that was ’88-’89, we repealed the policy, as you will recall. By that time, you may have moved on to the National Journal. I can’t even remember when you were there and in NPR, but I followed you as you followed me. And I worked on another chairman, David Pryor, on the Pepper Commission, where I got to know Chip 鈥� love, hate, mostly respect Chip 鈥� on the Pepper Commission, which both succeeded and immediately failed.  

Rovner: And we’ll get to that.  

Jennings: And it set the stage, really, and that’s where I think people started to know me on the Aging Committee, on the Finance Committee, on the Pepper Commission. And then, I’d go on and on. But, of course, I was eventually tapped to help Hillary Clinton do the Health Security Act, where we spectacularly failed, but learned our lessons, and we moved on. And I was there for all eight years of the Clinton administration, set up my own consulting firm, went back into the White House, as you said, and have been proud to be involved with some, you know, both extraordinary successes and failures, but progress that I think sometimes people don’t acknowledge in this debate. So hopefully we get to talk about that as well. 

Kahn: You know, Julie, one thing I think you can say about both of us is that there hasn’t been anything congressionally in delivery or financing, over your entire 40 years, that Chris and I were not involved in in one way or another. 

Rovner: That was why I decided I wanted you guys. I well know that you’ve had your fingers in everything this entire time. Well, let’s go back to the spring of 1986, when I first started covering health care on Capitol Hill. Congress was just finishing the COBRA [Continuation of Health Coverage] budget reconciliation bill, for which the health care continuation provisions that everybody knows are named, even though that was just one of literally hundreds of provisions, of different health care provisions in that bill. And from the “Some Things Never Change” file, that bill was very late. It had been kicking around since the middle of the year before one of the first big feature stories I wrote that spring was about how the U.S. had no real program to pay for long-term care for the elderly, something that is still true today. What were you guys focused on in 1986? 

Kahn: I think in 1986, as you said, every year during the ’80s and into the early ’90s, almost like clockwork, there was a budget bill, although some of those budget bills, like COBRA, lapped over. And I could, I could recite, until about 1990, I think, all the key provisions of every one of those bills. So whether it was Medicare in terms of payment modifications and payment improvements, or payment reforms, or whether it was Medicaid in terms of incrementalism, in terms of expanding to different populations. You know, we sort of saw it all. 

Jennings: There were notable reforms. In fact, it’s important to remember back then, health care really was the domain of the Congress. Presidents, barely, you know, they were for technical assistance, they provided information. But the big players in health care in the ’80s were 鈥� and it’s a very impressive group of people, both members and staff. And I don’t want to sound like an old person, but those were days when you actually did get bipartisan policies done. They weren’t easily done, but they were done, and I think it’s important to recognize that. I go 鈥� you’re saying ’86, so I’m going to stick with ’86. But ’86 was a big year 鈥� I think that was also 鈥� when did we do COBRA? ’85-’86 we were implementing COBRA.  

Kahn: It was done in ’86. 

Jennings: Yeah, ’86. 

Rovner: It was in COBRA. 

Jennings: Yeah, yeah. So, you know, that is, again, a policy that a number of people actually do utilize and it’s very, very important. 

Rovner: And EMTALA was in that bill. 

Jennings: EMTALA was in that bill, yes. 

Kahn: But besides these bills, and you brought it up, Medicaid Catastrophic, which was started a little bit after that, actually was a Reagan administration initiative. Dr [Otis] Bowen, the secretary of HHS [Department of Health and Human Services], was the major proponent. Then it became, obviously, very congressional. And so the major piece of health legislation that was just a health bill that wasn’t connected to one of these big budget bills, these big reconciliations, it passed, and it passed overwhelmingly in both chambers. After a lot of work, we could talk about that, if you want. And then within a year, you know, it was repealed. And one of the weird experiences of my life, was that, on the one hand, Bill Gradison in the House was one of the original framers of that legislation. 

Rovner: Your boss at the time. 

Kahn: One of my bosses at the time. But the day before repeal was considered in the House, I had to write for Bill Gradison a draft of a statement for him. And I, but I also worked for Bill Archer, who was one of the authors of the Archer-Donnelly amendment, which would repeal Medicare Catastrophic. So I also had to write a draft of a statement for him. Actually, let me say, I didn’t write them on the same day because I couldn’t bring myself to. But I was really sort of 鈥� I got to be careful here 鈥� “schizophrenic” on the issue, because I worked both on the legislation and then on its repeal. 

Jennings: Julie, also, I just have to say there’s another irony that I think no one knows really about, but the lead sponsor of the repeal was John McCain. John McCain, who raised all the issue of the so-called surtax, OK? Do you remember this? 

Rovner: I do. I wrote a big story about John McCain. 

Jennings: People think John McCain is Mr. Savior of the Affordable Care Act, but he also repealed the most significant, at the time, bipartisan, bicameral health care reform bill that actually, we should also say, did include an incremental Medicare prescription drug benefit. 

Rovner: John McCain was very sorry. He actually felt bad that he ended up 鈥� he tried to undo the repeal that he led. 

Kahn: And also, there was a secret weapon in there, which actually was very expensive, which was a Bill Gradison initiative, which was to change the skilled nursing facility benefit so that Medicare would basically cover six months without three days prior hospitalization.  

Jennings: Yeah. 

Kahn: And that was something that CBO said, the Congressional Budget Office said would just cost a few 100 million dollars. It was actually costing billions almost immediately, because all the states immediately changed those dual-eligible patients, dual eligible for Medicare and Medicaid, and made them Medicare patients because of the six months. So there was even a long-term care provision in there, despite the fact that some felt that Medicare Catastrophic didn’t touch long-term care. 

Rovner: Well, while we’re on the subject of the poor, be-knighted, repealed Medicare Catastrophic bill, which we all experienced, that led to the Clinton health reform bill. Chris, you were instrumental in that. What had you learned from the passage and repeal of catastrophic that you tried to put into place when you were working on the Clinton plan? 

Jennings: Sure. Well, first, Julie, I think we learned from all of our mistakes, and you learn more from your mistakes than you learn from your successes. And sometimes you mislearn your successes in major ways. But I do want to say the one thing that we did not repeal in the Medicare Catastrophic [Protection] coverage Act was the Pepper Commission. And the Pepper Commission was the first attempt to do the comprehensive reform proposal, and it was reported out, but in a really humorous, terrible scene, which I won’t bore people with, but 鈥� Chip was there, and I was there, and it was painful, and that people actually almost came to blows over that policy. Physical, physical blows between my boss, David Pryor, and Pete Stark, of all people. So that’s another story. But yes, after that, there was a[n] election in Pennsylvania 鈥� and this is sort of interesting historical context 鈥� it was a special election by [Sen.] Harris Wofford, who won, and it was all about health reform. And his political advisers, interesting, was James Carville and Paul Begala, and health care suddenly became, comprehensive health care reform became, oh, this is a big issue. And every candidate who was running at that time 鈥� really, people who 鈥� no one even knew the people running, because no one wanted to run against George W. Bush 鈥� but Bill Clinton was running against it, and he, he ended up winning, as you know, and then he chose 鈥� 

Rovner: It was George H.W. Bush. 

Jennings: George H. 鈥� George H. was so popular that the primary Democratic candidates didn’t want to run against him. So people just said, I’ll just try. And, long story short, Bill Clinton wins. And he designates Hillary Clinton. And Hillary Clinton, because I had done some work for their campaign and helped in the transition, I was asked to become the congressional liaison. So now, what did I learn from that? Well, there’s so many things to learn, and we applied them almost all to the Affordable Care Act. And of course, we’re going to have to give Chip his 鈥� you know, Chip’s the star of “Harry and Louise,” and proudly contributed to 鈥� 

Rovner: We’ll get to that. 

Jennings: 鈥� the demise. But I will say, even if we had perfectly executed the Health Security Act policy, because of the time and the delay of it and how in the environment in which it was in, it probably would have been very, very difficult to pass and enact at that time. We can talk about that. But one thing we learned is it’s really important for presidential candidates to have a vision and a way to finance their vision, but not to micromanage exactly the specific policies you need to get congressional investment in those policies. And if you impose details, the details will get, will be picked apart before you get the momentum to pass legislation. And you won’t have time to get both members of Congress and stakeholders, who inevitably you can’t pick, you can’t have everyone be your enemy if you’re going to pass health care reform, and we succeeded in getting most everyone against us. That wasn’t completely my fault, but sure, I’ll take whatever responsibility there is. But those are two big reasons. You know me, Julie. I could go on forever, but I’m going to stop with that and let Chip take his victory lap or whatever. 

Rovner: Yeah, because Chip, at that point, you were with the health insurers, who were not thrilled with the Clinton plan. 

Kahn: Well, let me say this. I always have to say this when I talk about the Health Insurance Association of America. Bill Gradison went over there in early ’93, and he took me with him. I was his executive vice president at that point. And the health insurers that we represented were for some kind of universal coverage structure. They weren’t for the model that was developed by the Clinton administration that they took to Congress. But I think Chris made a very important point: All the noise from the campaign around “Clinton Care,” pro and con, there were a lot of things going on. First, a new administration only gets so many bites at the apple, even if they’ve got big majorities in Congress. And they chose to do their big budget bill and a gun bill, which were very difficult votes for many members of Congress, before starting, in September, on the Hill with the presidential speech to lead into health reform. So I think they went in with a clock that was against them, in terms of how much a new administration has. Second, I don’t think everybody completely understood it at the time, but we had congressional control by the Democrats of the House for 40 years, and in some ways, they were a bit bankrupt, and there were a lot of issues around, you know, their unity. And we didn’t know it until the election in ’94 鈥� and Clinton Care had had some effect on that election 鈥� but we were about to see the Republican revolution taking place. But the soundings of that and the effects of that played out in Clinton Care. But, all that being said, if you believe that campaigns make a difference in policy process and elections, there were campaigns that said Clinton Care, as proposed, needs to change. And the Health Insurance Association of America did the Harry and Louise campaign, which I managed. And actually there was one point 鈥� 

Rovner: I would say, for those who don’t remember, Harry and Louise were a couple of actors. Those were their names, actually, Harry and Louise, who sat around their kitchen table wondering how they were going to pay for their health insurance if the Clinton plan passed. 

Kahn: And that concept came from over the summer, leading into that August, before the Clinton Care process began in Congress. Bill Gradison had been going around giving speeches, saying that health reform was going to be decided around the kitchen tables of America. So I told our advertising firm, First Tuesday [Strategies], go test that. And that’s how it all got started. And they came up with the concept, and we spent a lot of time on scripts. And our whole point was not to defeat but to raise questions and actually just get a seat at the table. Well, I could give anecdotes about why we didn’t get a seat at the table, and thus we began a campaign that was one of the components of the opposition to health reform that really defeated Clinton Care. 

Jennings: And Julie, I’ll just say I think it’s important to note that we also played into it by complaining so much about [how] it got lot of free airtime, too. So then the media covered it even more than the other one. And so it was the amount of money they paid for those ads versus the amount of ads people who see that ads was an extraordinary ROI [return on investment] for Chip Kahn and Bill Gradison. But I do feel it’s important to note that a lot of the predicate for rationale behind and policy underpinning the Affordable Care Act, you’ll find a lot in the seeds of the Health Security Act, and then you’ll see them again in the debate between Barack Obama and Hillary Clinton. And in many ways, Hillary Clinton’s policy is more like what ultimately was passed and enacted in 2008 and 2009. So it’s a very interesting circle of the process. And the other thing that I think people don’t understand, is, right after that we had another health care debate, which was the “Contract With America” and, or on America, as we used to call it, and, and that was a huge Medicare-Medicaid fight, which didn’t, which also failed. But I think you almost had to have these two attempts to have an attempt to make some progress. That led to things like the Children’s Health Insurance Program and beyond, so all of which 鈥� and by the way, HIPAA, insurance reforms beyond that 鈥� which began to lay the predicate for it. Yes. 

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

OK, we’re back. In the 1990s, after the death of the Clinton health reform plan, there was this huge sort of flow of big, important health bills: the Children’s Health Insurance Program; like you say, HIPAA, the Health Insurance Portability and Accountability Act, which was a whole lot more than just the confidentiality provisions. In fact, my favorite piece of trivia is that there were no medical records confidentiality provisions because it was a requirement for Congress to write them, which they never bothered to do.  

Kahn: If you want an anecdote on that, I’ll give you an anecdote.  

Rovner: OK. 

Kahn: That’s there because of me. But I can only take credit for a few things: diabetic shoes and HIPAA confidentiality. 

Rovner: I do remember diabetic shoes, but I will not make you explain that. But do explain how the confidentiality 鈥� because HIPAA was actually about being able to change jobs without losing your health insurance 鈥� it was literally about portability of health insurance, and the confidentiality stuff got tacked on at the last minute. 

Kahn: No, no, no. It didn’t. It didn’t. No, the point of HIPAA 鈥� and, frankly, I wasn’t the author of this; I sort of stole this idea 鈥� but HIPAA was either the seven-point plan or the nine-point plan. And the idea of the way we structured HIPAA in the House was to take four or five different things 鈥� and it was, it was much more than just insurance reform 鈥攁nd build out aspects of health reform, sort of small-ball health reform. And the confidentiality was one part of it. And we thought at the time that there was an administrative simplification portion of the bill, which came from a congressman from Ohio that, frankly, as a staffer, I was the one in the House that put that in the bill, and I and our expectation was that Congress would come back and do confidentiality, but we needed to require it, to set a framework for it. And there was one day when the bill was in conference, when Dean Rosen, who was working for Ms. [Sen. Nancy] Kassebaum 鈥�  

Jennings: Yeah, it was Kassebaum. 

Kahn: 鈥� called me and said, Do we really have to leave those lines in the bill? And I said, Boy, it’s really, really important. And the congressman from Ohio feels strongly about it, and Mr. [Rep. Bill] Thomas feels strongly about it. And so that’s why we got HIPAA, and then, then they couldn’t legislate on it because it was too sensitive, but we put language in, and HHS wrote the rules. 

Jennings: I think it’s really important to note that in the olden days, when we started this, Congress actually gave much more explicit guidance to the executive branch as to how they implemented. HIPAA was a good example as a bridge to where we are today, which was we will do something. This is what we were saying in HIPAA. But if we fail to do so, we authorize you, executive branch, to implement the provisions of HIPAA, which is what ultimately the Clinton administration had to do. And a lot of that is because the Congress couldn’t agree on the details, as they often can’t, but they still want to be associated with the underlying policy. But anyway, it’s just another lesson of the life that we were at and where we are now. 

Kahn: And when you say, wouldn’t agree on the details, the trouble is that the poison pills, those cultural issues, frequently come into issues here. I mean abortion and other issues, which are extremely important issues, but they’re cultural issues, and people are not generally willing to compromise on those. And those are the issues that ended up holding up things like confidentiality, which Congress should have acted on. 

Rovner: Yeah, I want to get to the Affordable Care Act, but before I do, Chip, I want to talk about the strange bedfellows. Because I want 鈥� you were talking about in the context of the Clinton reform, that the stakeholders weren’t really against it. They were only against parts of it. I think I wrote in a monograph on this that everybody wanted to cut off just one finger, but, in the end, the patient bled to death. You wanted to prevent that from happening when there was the next round that became the Affordable Care Act, and you got together with Ron Pollack, who was, you know, a very liberal, also outside group. And you guys tried to put together a framework, right? 

Kahn: Well, when I went to back to the Health Insurance Association of America in 1998, Ronnie Pollack and I got together and wanted to see what we could do. I mean, in a sense, we both really agreed that we needed various kinds of coverage expansions. We started incremental. And as part of that, the Rob[ert] Wood Johnson Foundation came in with a major initiative to fund us and to fund the conversations we began, and to fund other groups coming in and joining us in a big coalition. And, frankly, we were very close on some subsidization. We had a Republican and Democratic senator right before 9/11 and then 9/11 happened, and it just 鈥� killed us. And 鈥� we got put on the back burner. And so then we went through many years of Ronnie and I doing a lot of different efforts with many other stakeholders 鈥� around either doing small-ball expansions or pushing for the ultimate 鈥� and that, ultimately, I think, at least helped fuel what happened in ’09. I mean, a lot of things led to ’09, but at least, I think, our effort laid a base of commonality across stakeholders that made ’09 very different from ’93. 

Rovner: Chris, you said that, you know, one of the things that you learned from the failed Clinton health reform is it 鈥� you’ve got to have at least some of the stakeholders inside the tent, right? 鈥� That seemed to me one of the big changes between 1993 and 2009. 

Jennings: Yes, I mean, like every story that sounds black-and-white, there’s grays in those. But yes, for sure, and I do agree that the larger insurers knew the market couldn’t 鈥� at least the individual, non-group market had to be reformed so that they didn’t 鈥� they’d make their money on avoiding sick people. They needed to have a pool of people that they could insure, and it wasn’t an irrational, expensive, immoral health care system. So I felt, and to Chip’s credit a lot, and others, they wanted to have. 鈥� And actually, the other argument that happened in 2008 and ’09, there’s a lot of different things that came together. Bipartisan Policy Center was there. There was interest in doing comprehensive reforms that were very consistent with what the Affordable Care Act ended up happening. But there was also this notion of all the stakeholders were just tired of fighting, and it was like, Let’s get something together. There’s one last point that I think people neglect to cite, and I know Chip would agree. At the time, there was a concern that a lot of the savings from health care would go to something like deficit reduction or tax cuts, but not reinvested in health care for coverage expansion. And so when, you know, if you’re a stakeholder and you’re going to contribute something to the offsets, you want to be reinvested in your system so you have paying customers, and that’s why I think the hospitals and the physicians and the insurers all came together to say, let’s figure out a way that this can work. So that at least helps paint the picture about how you could tie it together. 

Kahn: And one experience that I had was that I brought 鈥� I was then working by the early 2000s for the hospital association, the Federation of American Hospitals. And at that point, you know, obviously my members were supportive of the work I was doing with Ronnie. But there came a point, I can remember it to this day, in October 2006 we were having a meeting, and a number of the CEOs of the systems I work for came to me in a meeting and said, This isn’t good enough. There are just too many patients that we’re treating that don’t have insurance, where their finances are getting in the way of the care they need, and we got to have something comprehensive. So they moved away from, not that they didn’t support incremental changes, but they wanted to see the big picture done, and that led the Health Insurance Association 鈥� we were a small group 鈥� to develop our own plan, the health care passport. And there were other plans out there. And the increment, the very important thing about that plan and the others and the way that ’09 worked was that in the administration and in Congress, they wanted to build on what works in the system, and reform the individual market and lay in enough subsidization and expansion of Medicaid so that we could say everybody has the opportunity for coverage. Now we could say that was not that different from ’93 and ’94, but it was handled completely differently. And I think it was more sensitive to all the concerns of all those that were stakeholders, that were players. And that was the framework, but it was building on what exists with those kinds of playing with the knobs that really made the difference, that you could say everybody could have access to coverage. 

Rovner: So as we’ve kind of talked about, up to 2009 health care was pretty bipartisan. I mean, you know, there were partisan fights. There are obviously fights that Chip, you noted, that were going to be perennial, like fights over abortion. But, generally, big things that got done got done with Democratic and at least some Republican votes, or, you know, Republican 鈥� in the case of the Medicare prescription drug bill, Republican and some Democratic votes. And yet, you know, in 2009, it just suddenly became partisan in a way that it still is today. I mean, what happened? 

Kahn: Well, let me say it’s very, very important to think of the broader context and not just focus on health care for a second. A lot was changing. The Tea Party, we go on and on about how we got to where we are today, and the great divide. So there was a great political divide. There was no more getting 鈥� there was much less getting to yes in Congress. And I think that health reform, in a sense, suffered from that. And the other dilemma that health reform had, I think, which was it was successful because of the vast Democratic majorities. They didn’t need the Republicans. On the other hand, the fact that 鈥� and the Republicans wouldn’t play, so I’m not saying there was a possibility there 鈥� but the fact that it got done in a partisan fashion, you know, fit into a larger context that made it part of the divide. And, frankly, after it passed 鈥� and, obviously, hospitals were very supportive of it 鈥� there were a lot of Republicans that would never speak to me again. 

Jennings: Yeah. And Julie, I think it’s important to recall that even back in ’93-’94, around the Health Security Act, there were Republicans who wanted to do this, but 鈥� and I’m sure Chip will yell at me about this 鈥� but Speaker Gingrich was not interested in having a health care achievement signed into law by Bill Clinton. He made that very, very explicit. So I think different people will say, When did partisanship around health care really start? But I would say there was a big one. Then we had the big fight around the “Contract With America,” and from then on, even though there were significant reforms that were bipartisan, I would call them important, but incremental, you know. And Chip’s right. I don’t think you could have gotten anything close to the Affordable Care Act on a bipartisan bill. Maybe he’d disagree, but I just, I don’t think there are some Republicans 鈥� I’ll tell, I can even tell you 鈥� who would say, Oh, if you’d only tried or whatever 鈥� I think [Sen.] Max Baucus [the Finance Committee chairman] really wanted, you may recall this. He worked for a long time. He desperately wanted to have bipartisanship. I don’t think that was going 鈥�  

Rovner: Yes. And I sat in the hall during those meetings for weeks at a time. I remember. 

Jennings: Yeah, yes. You remember? I mean 鈥� and to the criticism of a lot of the Democrats, what are you holding up for? So unfortunately, there are elements of health care, and I think a lot have to do with coverage 鈥� Medicare, Medicaid, marketplace, the three M’s, if you will 鈥� that are very hard not to politicize. And unfortunately, public health has now become very politicized, too. So we’re having a smaller [unintelligible] of elements of health care that you can see bipartisanship. But 鈥� there are some, and I’m sure we were going to talk about that, but I look back and reflect about that debate, and I don’t see a possibility of where it would have worked and Barack Obama would have been able to achieve what he said he was going to achieve. 

Kahn: Well, let me say a couple of things. First, I think, to modify your history. I think that in the House 鈥� 

Jennings: Yes. 

Kahn: 鈥� Newt wasn’t speaker at the time, he was minority leader. Clearly, there was nowhere to go with Clinton Care. I mean, the Republicans just were not going to go. I think you saw something quite different in the Senate. And there were many Republicans in the Senate, probably not a majority of the conference, but a very large minority who were willing to at least try 鈥� but I think the environment completely changed over time, and by the time you got to 2009, 2010, despite some kabuki theater on the part of some Republican senators, who I won’t name, who sort of played along, they were not going to cooperate. But let me say, one of the turns in history that’s important is that you’ll remember the Democrats had 60 votes in the Senate until the end, when, unfortunately, Sen. [Ted] Kennedy died. But actually, I would argue that it was his death, in a sense, that ultimately led to health reform passing, because a conference report on health reform between the House and the Senate probably wouldn’t have gotten all the Democratic senators. I don’t think Sen. [Ben] Nelson [D-Neb.] could have done it, so you would have had a filibuster against it. But by [Kennedy] dying, the House was forced to take on, for the bulk of health reform, the Senate bill, and they passed the Senate bill. Yes, there was a reconciliation later, but it was really, that was the framework for health reform, and in a bizarre way, it was the contribution of his death and the 鈥� House having to accept the Senate bill that led to health reform really passing, you know, by the skin of its teeth, even though there were these vast majorities of Democrats in the House and Senate. 

Jennings: Yes, I think that’s a very insightful comment, and I rarely say that about Chip. [Kahn laughs.] So, no, I do all the time. It is, but Kennedy, the sacrifices Kennedy would make to become the ultimate legislator, even to go so far as to die. But I will say, I think that’s right, because there was a very significant frustration amongst the House Democrats, and they desperately wanted to have a true conference, and that would have made it very hard in the Senate. It would 鈥� have been hard to clear through reconciliation rules in the Senate. And there would have been lots of challenges, and, ultimately, this is why Nancy Pelosi gets most of the credit, and so too should Harry Reid. They brought it home in a way that probably was the only way to get it done. And subsequently, one of the problems was it probably wasn’t drafted as cleanly as we would have liked it to be. You know what I’m saying? 

Rovner: Yes, I know what you’re saying. For those who, for those of us who had to follow this sort of ins and outs of the not being able to make technical corrections to it for its entire history 鈥� which, flash-forward to today, is there any chance of ever getting back to bipartisanship on health care? 

Kahn: I don’t think on anything regarding delivery and financing that’s major is there much likelihood of consensus. Now, if you remember, not too long ago, there were bills on, you know, FDA processes and the such, and they were done in a bipartisan manner. And maybe some of those things at the edges. I think there are some hospital issues and others that still could be dealt with in a bipartisan manner. But that gets back to context. You’ve got to have the sun and the moon come together on political context that would allow some 鈥� I won’t call them marginal, but 鈥� relatively small changes to be legislated. Other than that, we’re in an environment right now where I just don’t see compromise on anything big, because the divide that we saw coming out of ’10 is still there. And if anything, it’s just deeper than ever. 

Jennings: Right, and 鈥� although I don’t think Chip would disagree with 鈥� what I’m about to say, is, there are issues that are not so much ideological in coverage: biomedical research, transparency, even physician payment reform, rural health, telemedicine, community health centers. I’m just mentioning these out loud, because you’ll see bipartisan agreements on some of those things. But in terms of real structural reform, and particularly when you’re talking about where people get coverage and how much you subsidize it, boy, is that tough. In fact, I would even argue, and this is really unbelievable to say out loud, that cost containment in some fields, which is almost always impossible, is easier than how you spend the money. Because people don’t, can’t agree on the structure by which you would reallocate the savings to make health care work. So it is a frustrating time, which is why it’s hard to make the argument against people who say, then we need to have all one party or the other party to get something big done. 

Kahn: Now, let me say I think there could be some surprises next year if the Democrats took over in the House. You know, is there some possibility that there could be a big compromise with a Trump administration in the future on drug negotiation or drug costs? So I don’t want to say that there’s nothing that can be done. And I agree with, and I think I said, with Chris that there are these issues around the edges that could be dealt with, and the ones he outlined are the ones that I would agree with. I think the one big one is there is some possibility around drugs. But I think, other than that, I don’t see the Republicans being willing to help on Medicaid. 

Jennings: And that is a cost containment as opposed to kind of a coverage, you know. And it’s sort of a one-off. It isn’t, you know, big, big reform. But I agree with Chip that there you could see Democrats in the House push something that [President Donald] Trump would endorse, that Republicans in the Senate wouldn’t like to pass but would. 鈥� They probably would want to have come up with an excuse not to. But that’s, that is a target area that could happen. Although, you know, I’m 鈥� Democrats aren’t catching, counting our chickens just yet, Chip. 鈥� We’re knocking on wood here. [knocks] 

Kahn: Yeah, let me say, if the Congress doesn’t change, in terms of who has the majorities in both House and Senate, I don’t see anything major, other than some of the things, you know, transparency and some of these other issues, getting attached to something bigger. And then you’ve got to have context, as I said, the right context to have it. But I don’t see anything big unless we get split government. I think split government could lead to some interesting things in some of these areas. But what we think of as health reform writ large, right now, it’s just politically charged. 

Rovner: We’re going to have to wrap up. But one thing that I’ve been sort of thinking about a lot is that we seem to be getting to this place that we were in in 1993 again, and in 2008 again, where everybody is unhappy with the system 鈥� that, particularly patients, even people with insurance, are unhappy with the way the system is working. Doctors are unhappy, hospitals are unhappy, insurance companies are unhappy. Is it possible that that’s going to push this big divide a little bit back together, at least in an effort to do something? I mean, clearly President Trump knows that people are unhappy with the cost of drugs, if nothing else in health care. Do you think we’re heading for another round of major health reform debate? 

Jennings: It feels like that, Julie, for sure, ’91-’92-ish, or, you know. It does not feel like in any way. 鈥� I think people are really frustrated with costs, really frustrated with complexity, really frustrated with how they think the system is not necessarily responsive. They’re pretty good at kind of defining the problems, but in terms of developing a consensus around how best to do that, which is, you know, typically what people say, I want comprehensive reform that doesn’t disrupt me, you know, which is a hard nut to crack sometimes. But 鈥� it feels like we’re seeing it. And you’re going to hear a lot about talk, but I think you’re 鈥� the big thing will happen around a ’27-’28 period, when the two open electorates for presidency come up, and 鈥� this issue will be absolutely debated. But the big, big thing probably isn’t going to happen until the next president is elected. 

Kahn: So let me say this, and I’m going to give a plug to 麻豆女优’s Business of Health With Chip Kahn, a podcast that will come sometime in April. 

Rovner: Absolutely. 

Jennings: He’s shameless. 

Kahn: We’re going to 鈥� focus on AI [artificial intelligence] for the first three or four months. And I don’t want to say it’s going to change the world. It’s going to change the world. I don’t want to say it’s going to change health care. It’s going to change health care. Is it going to solve all these problems? I don’t know, but I think many of these issues could be different five years from now because of the effect of AI, and will doctors be practicing the same way they are now? Will all these issues of thousands of people working with green eyeshades in hospitals to make sure the claims are done right, they go to insurance companies. With respect to those thousands of people, it’s going to be AI. 鈥� They’re not going to have jobs anymore, and it’s going to change a lot. Now, is it going to solve any of these problems, or is it going to raise risks and challenges we can’t even foresee? I don’t know, but I think we’re going through, about to go through, an evolutionary period, and I don’t know what it’s going to look like on the other end. 

Rovner: Well, I think that’s as good a place as any to leave it. I want to thank both of you. I could definitely go on for another hour, but we won’t. Chip Kahn, soon to be a fellow at 麻豆女优. Chris Jennings, Jennings Policy Strategies. Thank you very much.  

Kahn: Thanks a lot. 

Rovner: OK, that is this week’s show. As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer this week, Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org. We’ll be back in your feed next week with all the health news. Until then, be healthy.

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

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

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

Alice Miranda Ollstein: Hello. 

Rovner: Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: And Sheryl Gay Stolberg of The New York Times. 

Sheryl Gay Stolberg: Hi, Julie. 

Rovner: No interview this week, but more than enough news, so we will jump right in. So we watched all the nearly two hours of President [Donald] Trump’s longest ever State of the Union address, so you wouldn’t have to. And if you’re interested in what he had to say about health, you really only needed to tune in for about five minutes, during which he took a victory lap for lowering drug prices, which he kind of did and mostly didn’t, and announced that Vice President JD Vance will henceforth be in charge of fighting fraud in health and social programs, which we’ll talk more about in a moment. Yet, just last month, President Trump told House Republicans at their retreat that health should be front and center as an issue for the midterms. What happened to that strategy? 

Weber: I gotta be honest, I was shocked. I mean, 麻豆女优 recently had a poll saying that health care costs are top of mind for voters, so the fact that he spent only five minutes of the longest State of the Union talking about health care, I think, is quite notable. And he had stuff he could have talked more about, on affordability, that he did mention when he got to it. I think some of it was a lot of the State of the Union did focus a lot on, you know, the hockey team and other various awards. 

Rovner: Yes, the Olympic hockey team came marching in through the press gallery. That was something I’ve not seen in my 38-something years as a State of the Union watcher 鈥� 

Weber: As a former high school field hockey goalie, I’m a big fan of the goalie getting the medal. But it did take away from some of the more policy topics. So again, health care costs 鈥� top of mind for people 鈥� seems like a missed opportunity. 

Stolberg: Here’s my take on that. First of all, I think we know why Trump said he was going to let Bobby [Health and Human Services Secretary Robert F. Kennedy Jr.] go wild on health. Because Trump doesn’t really care that much about health care. He finds it complicated. He has said so. I’m sure you remember from the first term, Who knew health care was so complicated? In addition, TrumpRx, I think, OK, he can point to that. Gonna say, he can trumpet that, no pun intended. But his health care plan is barely a concept of a plan. He doesn’t have a plan. His notion of directing money into health savings accounts to help people buy health care, quote-unquote “outright,” you know, is just not workable, and it’s vague. Republicans on Capitol Hill have a number of thoughts about how to achieve that, but he doesn’t really have anything to offer, and he’s got to deal with these Obamacare subsidies having been replaced. So I think this has always been a weakness for Republicans. And if there’s one strength that Trump has, it’s kind of the MAHA [“Make America Healthy Again”] movement, which is itself, and we’ll talk about this later, you know, fractured. And he didn’t mention that at all. 

Ollstein: Not only did he not spend a lot of time on this, but he exaggerated and sort of misrepresented the few things he has done. And I think there is a big political danger in that, if you say, We solved drug pricing, we brought down your drug prices, and the voters don’t feel that, when they go to pick up their drugs, they cost just as much. There could be a backlash there. And so I think there’s a risk to not focusing on this overriding issue enough, but I think there’s also a risk in overpromising and underdelivering to voters. 

Rovner: Yeah, you’ve anticipated my next question, which is to do a quick fact check on some of those claims, particularly the one that he lowered drug prices more than any previous president. He has indeed negotiated deals that have lowered some drug prices for some people, mostly those who buy their drugs without insurance coverage. But I think you could argue that Presidents [Bill] Clinton, [Barack] Obama, [Joe] Biden, and even George W. Bush, who signed the big Medicare prescription drug benefit bill 鈥� all those presidents signed legislation that had a much bigger impact on what Americans pay for their drugs than Trump has at least so far produced, even though he talks about it a lot. 

Stolberg: I think that’s a really good point. Medicare Part D was huge. You know, it had its flaws. It inserted the provision barring Medicare from negotiating directly with companies, which Joe Biden, you know, with the Inflation Reduction Act, partially overturned, or at least dug into. But I think that was an inflated statement, to say the least. 

Rovner: Yeah, and I think Alice is right. This is going to be lived experience for a lot of Americans. It’s like, Wait, I thought you said you lowered drug prices. I’m not seeing my drug prices much lower yet. 

Ollstein: Well, the Democrats found that as well when, you know, they passed meaningful things, but things that didn’t kick in before the election. And so the message didn’t line up with the lived experience, and it didn’t have the political benefit that they were hoping it would. 

Rovner: Yeah. Now, Trump also said, and I quote, that “I want to stop all payments to big insurance companies and instead give that money directly to the people.” Now I think he was talking about the Affordable Care Act subsidies, which have been the topic of much debate since last year. But the fact is that the federal government gives lots and lots of payments to big insurance companies through Medicare and Medicaid, particularly Medicare Advantage, which was part of that big bill that George W. Bush signed in 2003. I imagine this is giving health insurers some pretty major heartburn right now. 

Stolberg: It’s always easy to beat up on the insurance companies, right? Like, they’re a very easy target. But, you know, we had a fact-check team at the State of the Union address the other night. I was on it, and I fact-checked this statement, and I wrote, “This is misleading.” I said he’s, you know, proposed redirecting insurance subsidies into health savings accounts, which people could use to purchase health care services directly. And then, as I just stated earlier, it doesn’t offer specifics. And I quoted your analysis, at 麻豆女优, which says the president’s plan is vague, and without knowing more, it is impossible to say what the implications would be for people with preexisting conditions who rely on the ACA markets. So I think what’s bedeviling Trump is the expiration of these ACA extended tax credits, and he doesn’t have an answer for it. 

Ollstein: And the remarks at the State of the Union, I think, never say an issue is over, because we know in health care, things always come back in some form. Nothing’s ever over, but it could be read as the final nail in the coffin for the negotiations around reviving the ACA subsidies, if you have the president getting out there and saying no more money for big insurers, that doesn’t exactly help the few Republicans who are trying to negotiate something on Capitol Hill, get something done. 

Rovner: Although he has been on all sides of this issue. 

Ollstein: Oh, certainly. But in terms of messaging and the bully pulpit and where the energy is going, it’s not going into, hey, let’s cut a deal to bring down people’s rates, even if that includes giving money to the insurers, which, you know, of course, they’ve also misrepresented this issue. And, you know, where the money goes and what it’s used for has been, you know, sort of misrepresented. So it’s just a mess. 

Stolberg: If they called Obamacare “Trumpcare,” he’d give the money to the insurers. 

Rovner: That’s true. Maybe they should have done that at the time. Well, finally, about the speech about that fraud announcement on Wednesday, the day after the speech, HHS announced again that they plan to withhold Medicaid money from Minnesota based on fraud allegations. This is the latest in a series of efforts going after Minnesota and its Democratic governor and 2024 vice presidential candidate Tim Walz over what actually is a continuing Medicaid fraud problem that the state and the federal government have been working on for over a year. But now it’s complicated by the fact that, apparently, every single member of the federal task force that was working on the fraud cases from the U.S. Attorney’s Office in Minnesota have resigned over the feds’ immigration work. So they were working on fraud, but they’ve left for other reasons. When we talked about this last month, about the federal government withholding Medicaid funding from Minnesota, I asked the panel when other blue-state governors were going to start paying attention to feds’ withholding federal Medicaid funds from blue states. I guess that would be now. 

Weber: I mean, yeah, it’s a lot of money. I mean, Medicaid money would be a huge problem if a bunch of blue states lost it. We’ve seen selective targeting of blue states for public health funds. It seems reasonable to expect that to be coming for the Medicaid fraud. I think it’s important to note there is a fair amount of Medicaid fraud, and CMS [Centers for Medicare & Medicaid Services] has announced what looks to be a somewhat promising fraud initiative about stopping “pay and chase.” So, I mean, I think there’s a lot of story left on spool here on that front. 

Rovner: You have to say what pay and chase is. 

Weber: Oh, yes, so pay and chase. This is one of my one of my soapboxy things. I did an investigation with Sarah Jane Tribble back when I was at Kaiser Health News [麻豆女优 Health News] all about this. But essentially, the way the fraud system works here in the United States, which is kind of wild, is that people just pay the fraudsters money, and then the feds have to chase to get the money back, which is kind of crazy. It’s a system that many experts have explained to me is incredibly broken and leaves the taxpayer holding the bag, because often they don’t get the money back. So there is this new effort by CMS to utilize AI in a way that could really revolutionize how fraud is fought, but the selectiveness of which this seems to be being applied to Minnesota, or at least highlighted in Minnesota, leads to some political concerns. 

Rovner: I will add that part of this big new fraud effort is also going after fraud in durable medical equipment, which made me both smile and roll my eyes, because this has been a continuing problem ever since I started covering health care in the 1980s. Indeed, fraud is perennial. There’s a lot of money, some people are going to cheat to find it, and there’s always going to be an effort to work to ferret it out. 

Well, it was a busy news week beyond the State of the Union. Also on Capitol Hill this week, Casey Means, President Trump’s nominee to serve as surgeon general, finally got her confirmation hearing before the Senate Health, Education, Labor & Pensions Committee after she had to bow out of an earlier scheduled date last fall because she went into labor with her first child. Lauren, remind us who Casey Means is, and how’d the hearing go? Is she going to be our next surgeon general? 

Weber: So Casey Means is a health tech entrepreneur and someone with a large social media following who really got her bona fides from condemning the medical establishment, from leaving her residency and rising on podcasts and other talk shows, and through her entrepreneurship to promote this idea that the medical system is broken, and here’s how we can fix it. And when she finally got her hearing on the Hill, I think it’s really interesting, because she and her brother, Callie Means, really wrote the MAHA bible. They wrote this book called Good Energy, which a lot of MAHA principles are based off of. And what’s fascinating about a confirmation hearing for her is you see how MAHA, as a coalition, really doesn’t have a political home. There’s parts of it that Democrats really like, there’s parts of it that Republicans obviously really like, and there’s this awkward confrontation of that when you see this MAHA figure then questioned by both sides of the aisle. Something that she really exposed is a current deep issue in the MAHA movement, which I know Sheryl’s also , and she got a bunch of questions from both sides of the aisle on that. But the big takeaway, I think, a lot of people were focused on, as they should as surgeon general, was that she dodged a lot of questions about vaccination. She refused to explicitly say she would recommend the measles or flu vaccine, which is pretty shocking coming from a potential surgeon general candidate, but also in line with the MAHA movement and her political patron, Robert F Kennedy Jr. 

Rovner: And also, I mean, Sheryl, you and I were talking before we started taping that, I mean, she did, compared to some of the nominees for some of these jobs, she did a pretty good job. She was really smooth. She ducked questions in a way that one does duck questions, you know, saying thank you for asking that good question. But I know you were saying also, there’s some talk about whether or not she’s actually qualified to be surgeon general. 

Stolberg: That’s what I’m hearing today. I agree with you, Julie, that she was very smooth, and I was actually struck by how much her appearance reminded me of what confirmation hearings used to look like in the pre-Bobby Kennedy era, when nominees, you know, tried to entice politicians, tried to, you know, be engaging. She thanked Democrats. Thank you so much, Sen. [Patty] Murray, for engaging so deeply with these issues, you know, I want to thank you for our meeting that we had. I really enjoyed getting to talk with you, you know. And she is very knowledgeable, and she’s a smooth speaker, and she was, I think I told Lauren last night, she was like the Artful Dodger. Or maybe I should, I might have said that on social media. But there are questions about her credentials. So, her medical license is inactive. She has a license with the Oregon Medical Board. It is inactive. This means that she cannot prescribe medication, and she can’t treat patients right now. And there’s some question about whether or not one has to have an active medical license, not necessarily to be a surgeon general, but to be head of the Commissioned Corps of the [U.S.] Public Health Service, which the surgeon general is. 

Rovner: And which is basically the only 鈥� the surgeon general used to have a lot of line authority at HHS, and the only thing that’s left is being head of the Commissioned Corps. 

Stolberg: That’s exactly right, and the bully pulpit. And, you know, I looked at the statute last night. The statute also says that the surgeon general has to have, quote, I think, “experience in public health programs.” But it’s ill-defined. Like, what does that mean? But you are seeing some folks today, including, as you mentioned earlier, Julie, Jerome Adams, President Trump’s surgeon general, who are raising questions about her qualifications. And I think we may see more of this. 

Ollstein: I also thought it was notable that  this morning and said they find her unqualified, and raised concerns that her equivocation on vaccines could further contribute to the already diminishing trust, public trust in public health. And so the Wall Street [Journal] editorial board remains pretty influential among conservatives, so I think that is an interesting sign of where things could go. And, of course, raises the question if her nomination does collapse for lack of votes, who else could be nominated? 

Rovner: And I guess Jerome Adams doesn’t want to come back for the second term. 

Ollstein: I don’t know if he’d be welcomed back. 

Rovner: He’s burned his bridges. 

Weber: He’s not welcome back, if I had to guess, yeah, no. 

Stolberg: No, he doesn’t want to come back. He’s hawking his book. 

Rovner: Lauren, you wanted to add something? 

Weber: Yeah. I just wanted to add, I mean, it was interesting. She did get a couple stronger questions. [Sen. Lisa] Murkowski from Alaska, obviously, a Republican moderate who could be a potential “no” vote of the group, did question her pretty strongly on her stance on hepatitis B vaccines. She did get a question from [Sen. Jon] Husted about her thoughts on pesticides. That said, you know, [Sen. Bill] Cassidy also peppered her with some questions, but Cassidy also peppered Kennedy with a lot of questions, and then he was confirmed. So I think there is some chatter today about her credentials, but no Republicans brought up her credentials yesterday. The person who did was a Democratic senator, Sen. [Andy] Kim, I believe, and so, you know, we’ll have to see in this political moment what shakes out. 

Rovner: Before we leave this subject, Alice, like most of the high officials at HHS of late, she rather deftly ducked Chairman Cassidy’s question about whether the abortion pill mifepristone should be available without an in-person visit with a doctor. What did you take away from her answer? 

Ollstein: So, her comments on birth control got more attention, which we can talk about in a sec, but on mifepristone, it was very much in line with this administration just not wanting to talk about it and saying, Everybody shut up. We’re studying it behind closed doors. Just wait for us to do that, and then you can say something. So she very much kept in line with that. Didn’t want to tip her hand. 

Rovner: I would say it felt like she’d been given the talking points. 

Ollstein: Yes, exactly. And she was not really, like, free in sharing her personal views on the matter, because she was, you know, seemingly told to stick with the administration line. But I think Lauren can talk more about the birth control piece, and she’s researched that a lot. 

Weber: Yeah, I could chime in on that. And I also, just on the mifepristone piece, I think it was notable that [Sen. Josh] Hawley didn’t go after her for it. I felt like that was Hawley toeing the line, because, obviously, he, notably, in some of the RFK hearings, really went after that, and also has publicly, recently stated that he’s very disappointed in the FDA on mifepristone. So the fact that he had a pretty chummy exchange with her, some softball questions about AI chatbots, I mean, it was, I thought, notable in terms of toeing the line, on Hawley towing the mifepristone line. When it comes to birth control, Means does have a history of disparaging birth control and highlighting some of the known side effects and speaking about wanting more natural forms of contraception, which is, you know, somewhat common in the right-wing and wellness influencer space that she currently finds herself in. 

Rovner: Sheryl, do you want to add something before we move on? 

Stolberg: Abortion also is not a good issue for this administration. It’s not a good political issue. President Trump didn’t bring it up during his State of the Union. They don’t want to talk about it. It’s a loser for them. So I think that probably accounts for Hawley’s reticence in asking her about it, and, you know, sort of the muted answers that she gave, and she was very careful to say, I believe birth control should be available to all women, and she kind of said that her previous remarks, where she had said that it had horrific side effects, etc., were taken out of context. 

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

Well, while we were on the subject of abortion, to follow up on what Sheryl just noted, President Trump did not mention it during the State of the Union, a speech where he touched on lots of other things that were important to his base. He has been hinting that he wants to downplay abortion for a while now, but could this come back to bite him and other anti-abortion Republicans in the midterms, where some of his most motivated voters might just not turn out? 

Ollstein: So that’s the argument that anti-abortion advocacy groups have been, you know, shouting from the rooftops for months now. And you know, they recently put together their own polling to try to make that argument. And I think that different wings of the Republican Party are making different calculuses here. And you could argue that not doing enough on the issue is risking the votes of the conservative base, who are really fired up about this. You know, these voters are very motivated. They turn out. They knock on doors, these anti-abortion voters. But the administration seems to be making a calculus that there are a lot more people out there who are uncomfortable with the kind of national restrictions that the anti-abortion movement is demanding from the FDA, and so they, like Sheryl said, have calculated that this is a loser issue for them and they should lean away from it. And it’s just interesting because a midterm year is not the same as a presidential year in terms of who turns out, who gets fired up. And of course, there’s the primary versus general election dilemma, where doing one thing could really help you in a primary, but doing the opposite could really help you in the general, and so something you say on the campaign trail could come back to bite you later. 

Rovner: Sheryl, you want to add something? 

Stolberg: Yeah, I think it’s fascinating to look at Trump I versus Trump II. So when Trump was running for office in 2016, he made a deal with Marjorie Dannenfelser, one of the big leaders of the anti-abortion movement, that he was going to work to overturn Roe. And the anti-abortion movement just embraced Trump and said, you know, he was the most anti-abortion candidate ever, the most anti-abortion president ever. Well, now Roe has been overturned, and it’s a completely different climate, where we are seeing the effects of what it looks like in states where women do not have access to abortion. And it’s a dark picture out there. I mean, women are being injured, and this struggle is, it’s a different debate, and it’s a much harder debate. It was easier for Trump when Roe was intact. 

Rovner: Yeah, and we’ve, I mean, what we’re seeing, it’s also, it’s not just people, it’s not just women who want to get abortion. It’s women who can’t get care during pregnancy complications. 鈥� I think that’s the piece that’s upsetting so many people. And, you know, shoutout to ProPublica, who’s just continuing to do an amazing job with this. Lauren, you want to add something? 

Weber: Yeah, I think it’s notable that he didn’t talk about abortion in the State of the Union, but he did bring up fertility drugs, and how his TrumpRx can reduce the cost for fertility drugs. And obviously that could agitate some members of the anti-abortion 鈥� some of the more hard-core members of the anti-abortion movement who have issues with fertility treatments like IVF. But I think also, Trump’s making a calculus, as we’ve talked about: Are the anti-abortion voters gonna go vote for the left? Probably not. I don’t think so. So 鈥� 

Rovner: It’s just a question of whether they stay home. 

Weber: It’s 鈥� a question of whether they stay home. But I think he’s just playing to the fact that he thinks he has them in the bag to some extent. 

Rovner: Maybe they won’t stay home because they’d rather have him than 鈥� his candidates, those who would like to restore abortion. Well, also this week 鈥� I said there was a lot of news 鈥� while the administration isn’t moving very fast to try to rein in availability of the abortion pill, states are. There was a hearing in federal court this week in Louisiana about that state’s lawsuit calling for the FDA to rescind its rule allowing the mailing of mifepristone from out of state. Alice, I imagine the administration would much prefer this decision to ultimately be made by judges and take it out of their hands, right? 

Ollstein: Well, what they’re asking the court is to not make a decision at all. They’re asking them to hold it in abeyance, which is fancy judicial language for hit pause. Put it on freeze. Don’t do anything right now, like the messaging we were talking about in the confirmation hearing. What they are telling courts is: We’re working on this issue. You should defer to us and stop these states from suing us, and let us work on reviewing the abortion pill behind closed doors, and we will issue some sort of a decision at some point. And so that is, you know, what came up in court in Louisiana. The only other notable thing is that the judge did allow the makers of the pill, Danco and GenBioPro, to intervene in the case. So that happened because the Justice Department is not defending the regulations on the pill on the merits. They’re not saying, you know, the FDA went through a fair scientific process, and we are defending the decision they made to allow telemedicine and mail delivery of the pills. They’re not doing that. They’re saying, Hit pause. So the drug companies are the ones now in court, allowed to make the argument that the FDA should be, you know 鈥� their decision was based on science and not ideology, and that should be left alone. 

Rovner: Well, we’ll see how this all plays out. All right, moving on to news from the Department of Health and Human Services. Last week, we mentioned that Jay Bhattacharya, the director of the National Institutes of Health, has now also become the acting head of the Centers for Disease Control and Prevention. That’s awkward for a lot of reasons, not least of which is that the NIH is headquartered in Bethesda, Maryland, just outside Washington, D.C., and CDC is in Atlanta, Georgia. Bhattacharya is also the third interim director of the CDC in seven months, after the first interim chief, Susan Monarez, was confirmed by the Senate to lead the agency, then summarily let go when she refused to rubber-stamp the recommendations of the anti-vaxxers appointed to CDC’s vaccine advisory panel by Secretary RFK Jr. Monarez was replaced by HHS Deputy Secretary Jim O’Neill. He’s now been relieved of both jobs and is off to head the National Science Foundation. Adding to the confusion, the No. 2 at the CDC, Ralph Abraham, stepped down this week, effective immediately, citing, quote, “unforeseen family obligations.” Lauren, you said last week that this is all about the White House wanting to rein in HHS, in general, and its anti-vaccine activities, in particular, in advance of the midterms. But what might this continued churn mean for CDC, and are we ever going to see someone nominated to, you know, run the agency? 

Weber: Julie, I wish I had the answer to that question, because I would certainly have written that story if I had an answer to what will happen to the leadership at CDC. I don’t know. I mean, I think the bottom line is, is that this is an agency that has not had a steady leader for a very long time. It has certainly made some quite shocking moves for the CDC. Obviously, they overhauled the vaccine schedule at the beginning of January, and it remains to be seen how this will be going forward. I think it’s very difficult. Running a federal agency is a huge task. I mean, assuming that someone can run both equally is a tough sell. I do think he’s limited in terms of time, of how much time he would be interim. But the reality is, and I think , and it seems like there’s not a lot of people running the top of the CDC these days. 

Rovner: Yeah. Well, remember when Monarez quit, most of the career leadership also quit. So, I mean 鈥� 

Weber: Right. The agency was also gutted when RFK Jr., you know, got rid of about a quarter of HHS at the beginning of his term. So the CDC is, certainly, is a very changed and in mangled shape currently. So I think it remains to be seen who ends up taking the reins of it. 

Rovner: Sheryl, how are things at CDC? 

Stolberg: They’re really difficult. I talk to people inside the agency, you know, they’re feeling really dispirited. A lot of the top leadership is gone, as we just said. The idea that Jay Bhattacharya could run the NIH and the CDC, two massive federal agencies with complementary missions 鈥� the NIH is the nation’s biomedical research agency; the CDC, public health 鈥� in two locations, Atlanta and Bethesda, is, honestly, I don’t know who came up with this idea. I heard 鈥� I don’t have evidence to back this up, but I heard that this was actually Trump’s idea, which kind of makes sense, if that is true, because maybe only President Trump would think up such a crazy thing that you could [laughs] 鈥� I think they recognized that they needed to put someone Kennedy trusts in there. That has really been kind of the big issue. And it is all about the midterms. It’s all about the pivot. The White House wants Kennedy to turn away from vaccines and toward healthy eating. That’s why we’re seeing him do this national “Eat Real Food” tour. And, you know, wearing the Mike Tyson tattoo and social media, etc. It’s a very, very difficult situation for a storied agency, and many, many people are worried that it is going to take a long time for the CDC to rebuild, if ever. 

Rovner: Lauren, you want to add something? 

Weber: Yeah, I just wanted to echo that, I think, what gets lost in a lot of D.C. circles and, frankly, around the country, is this is an agency that also was pocked with bullet holes just a couple months ago. I mean, if that had happened in D.C., I think you would see a very different response, to be quite honest. I was very taken aback and shaken to see the bullet holes when I went down after that happened. And I think the visuals of that got a bit lost in some of the conversation. But so this is an agency that not only is suffering with utter leadership turmoil, but has, frankly, been shot at. And so 鈥� 

Rovner: Right, they were physically attacked, their building was physically attacked. 

Weber: Physically attacked. And so the folks that are still left, I think, it’s a tough deal. And to Sheryl’s point on the midterms, and I have a , led by Rachel, you know, we found out that the MAHA piece of this is, look, I mean, they’re telling Kennedy to focus on foods because they see it as more popular. And honestly, MAHA is saying they’re gonna throw some cash. Tony Lyons 鈥� I mean, who knows that this will happen 鈥� but Tony Lyons told me they’re hoping to raise $100 million for midterm spending for Republicans. So, you know, there is that element of the coalition that I think they’re trying to make happy with this whole piece of it. 

Stolberg: One interesting note about the cash. Tony Lyons has already committed a million dollars to Cassidy’s primary challenger, which is really interesting. I mean, Cassidy voted reluctantly for RFK to be secretary, you know, and he fell on his sword for the administration, and now Kennedy’s people are working actively to unseat him. 

Rovner: Let us move to MAHA. I have a segment that I’m calling “MAHA Is Mad-Ha.” The Make America Healthy Again movement is big mad about RFK Jr.’s seeming reversal on the use of weed killers by Big Farm, not to be confused with Big Pharma. The HHS secretary Sunday night put out a lengthy statement arguing that while pesticides and herbicides used on crops are poisons, that U.S. agriculture is also dependent on them, and their use needs to be phased out, rather than cut off, in order to protect the nation’s food supply. MAHA advocates, though, see this as a complete betrayal. Sheryl, I want you to start 鈥� start by telling us where you are and why. 

Stolberg: So I’m in Austin, [Texas,] where there is a MAHA Action rally tonight, interestingly, an “Eat Real Food” rally. They’re not going to be talking about glyphosate, as far as I know, and they’re not going to be talking about vaccines. So, just an interesting sort of personal perspective: Last Wednesday, when Trump issued the executive order on glyphosate after business hours, right? Shocker, I was like 鈥�  

Rovner: And glyphosate is the weed killer that’s used in Roundup, which has been the subject of many, many lawsuits that it’s a carcinogen. And some of those lawsuits were brought by RFK Jr., right? 

Stolberg: That’s right, who won a massive judgment in 2018, a $289 million judgment. And this weed killer, Roundup, this has really been an animating force behind a lot of the MAHA movement, the Moms Across America, led by Zen Honeycutt, is really wrapped up in this issue, in getting glyphosate out of American food. As Vani Hari, who calls herself the Food Babe, said to me, What good is it if you eat real food, if it’s sprayed with pesticides? So I was, you know, minding my own business that Wednesday night, Trump issues the executive order, and I sent a text to Kennedy’s spokesman, and I said, Does the secretary have any response? And I got a three-sentence reply, basically saying that, you know, Kennedy was supporting Trump. This was a matter of national security. That is how Trump framed his order. He said, We need to ramp up production of this weed killer because we have only one domestic producer, and we don’t want to rely on foreign nations to keep our food supply running in the event of a crisis. That three-sentence statement from Kennedy obviously did not sit well. His MAHA moms exploded. I can’t even begin to tell you the anger. My headline of the story that I wrote said “,” and then it quoted someone I interviewed from Turning Point USA, Charlie Kirk’s organization, saying, women feel like they were lied to. So the anger is very deep and real. And I guess Kennedy felt that he had to address it in some lengthier way to, you know, try to assuage this part of his movement that really helped power him to the position that he is in right now, and also aligned itself with Trump, perhaps foolishly, and helped, you know, they threw their weight behind a Republican. And now, I think, Lauren said earlier, they really kind of have no political home. 

Rovner: Yes, Lauren, did you want to add to that? 

Weber: Yeah, no. I mean, Sheryl hit all the points. I think it’s important to note that these people are mad, as she said. And, you know, Glyphosate Girl, Kelly Ryerson, who’s big on social media, told me some version of We feel lied to in the sense that we, you know, we showed up, we voted for this, and we’re seeing no results, and we may change our minds in the next election. Because a lot of these people were independents or Democrats or so on. And I think what’s really fascinating about that is it kind of goes back to when Kennedy was going to be in consideration to be a health czar or something else. I mean, the bottom line is, the man does not have control over the EPA [Environmental Protection Agency]. I mean, that’s not his jurisdiction. And I think that a lot of his followers really got on board with the MAHA movement under the pretense that he was going to come in, he was going to do all this stuff. But the political realities are just very different. And this MAHA coalition, you know, as I talked about earlier, is so fascinating because it talks all about “real food,” which is, as we’ve talked about on this podcast, was Michelle Obama, a Democrat-led issue 10, you know, a decade or more ago. It talks about glyphosate. Typically, you see that as often being a lefty issue that is now under this right tent. And then, obviously, vaccines, which kind of is a political horseshoe issue, which you often see on the far left and far right. And I think you see this fracture in MAHA, because it just does not fit very neatly within the partisan lines that D.C. is so accustomed to. 

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

Weber: Yeah. So I wanted to highlight an article that I did with my colleague Lena [H.] Sun and Caitlin Gilbert, and it’s titled “.” We did a deep dive into how Kennedy feels about the flu vaccine, and it turns out that he, in several instances, has linked it to his spasmodic dysphonia, which is a type of dystonia. It’s a neurological voice condition that causes his raspy voice. But the catch is, is that all the scientific experts that we spoke to said there’s no scientific evidence to support that. And as Kennedy has gone around saying this about his voice, he’s also disparaged the flu vaccine while in office on, you know, the day after he took office, last February, he moved to kill a national flu vaccine awareness campaign. And this January, he downgraded the recommendation for the flu vaccine for children. And public health officials that I spoke to are horrified. They’re very worried this could lead to more cases, more misery, potentially even deaths from the flu. And some of the otolaryngologists that I spoke to also pointed out that while Kennedy had linked this condition, which was also known as a dystonia, to his voice, and there was no scientific evidence to link it to vaccines, however, there is evidence of some association between drug use and dystonias. And they pointed out that that is an association. And as has been well reported in the past, Kennedy has spoken very openly about his heroin addiction. And so, you know, we spoke to a bunch of folks who just marked this sea change that we’ve seen. You know, Kennedy obviously has, has gone after vaccines, but the flu vaccine in particular appears to be personal. 

Rovner: It does. Really interesting story. Thank you for writing it. Sheryl.  

Stolberg: I was just going to say, if Lauren hadn’t written that story and wanted to talk about it, I’d have wanted to talk about it because it was such a good story. So the story that I think people need to read this week is by ProPublica, and it’s headlined, “.” And this is a really fascinating and troubling story about what’s happening in South Carolina. There are 973 reported cases of measles there. But because hospitals aren’t required to disclose it, doctors have no idea, and ordinary people have no idea where it’s happening. The story opened with a man who went to a meeting to talk about what happened to his wife. His wife was a schoolteacher, and she was vaccinated against measles, like pretty much all American adults are. But one of her kids in her class had measles, and she had a rare breakthrough infection, and she got very, very sick. And there was no way to foresee this. And I think that this is like a canary in a coal mine issue, where we’re seeing sort of a downgrading of the importance of knowing about infectious disease, especially measles, under this Trump-Kennedy health regime. And it’s putting people in danger. 

Rovner: Yeah. It was quite an interesting story. Alice. 

Ollstein: So I have a piece from Stat [“”] by my former colleague Daniel Payne and our co-podcast friend Lizzy Lawrence. And it is about how the FDA has become politicized and become a much bigger lobbying target than ever before. And they go into how a lot of decisions are being made by the White House. And so that has, you know, emerged as the center of power in FDA-related decisions. And thus, you know, companies that have business before the FDA feel that it’s worth it for them to pour lobbying efforts into this in order to influence processes that previously they felt they couldn’t influence. And so that’s raising a lot of concerns. So I highly recommend the piece. 

Rovner: Yeah, really interesting story. My extra credit this week is from my 麻豆女优 Health News colleague and sometime podcast panelist Julie Appleby, and it’s called “When It Comes to Health Insurance, Federal Dollars Support More Than ACA Plans.” Now, this is something we have talked about before, and I have talked about a lot since the debate over the expiring ACA subsidies heated up. But it bears repeating: Just about everyone who gets health insurance in the U.S. gets some sort of federal subsidy. It’s not just people who buy it on the ACA marketplaces. Medicare and Medicaid are both paid for in large part through taxpayer dollars. Employers get a tax break from offering health insurance, and employees who get health benefits don’t pay taxes on them, which is one of the biggest subsidies in the federal budget. So the next time somebody complains about why people who buy their own health insurance should get federal help with the costs, remember that, in all likelihood, you do, too. 

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

Stolberg: I’m at @SherylNYTon both  and . 

Rovner: Lauren. 

Weber: I’m @LaurenWeberHP 鈥� the HP is for health policy 鈥� at  and . 

Rovner: Alice. 

Ollstein: I’m on Bluesky  and on X at . 

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

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

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

Lauren Weber: Hello, hello. 

Carey: Tami Luhby of CNN. 

Tami Luhby: Glad to be here. 

Carey: And Shefali Luthra of The 19^th. 

Shefali Luthra: Hello. 

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

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

Carey: Of course. 

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

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

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

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

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

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

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

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

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

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

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

Weber: And will he stay on message? 

Carey: Exactly. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Carey: Yes, great story. 

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

Carey: Sure. 

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

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

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

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

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

Luhby: Many comments. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Carey: All right. Shefali. 

Luthra: On Bluesky:  

Carey: And Tami. 

Luhby: You can find me at . 

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

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

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

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

Alice Miranda Ollstein: Hello. 

Rovner: Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hi.  

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

Jackie Fortiér: Hey, everyone. 

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

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

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

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

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

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

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

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

Rovner: Is this over? What happens now? 

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

Rovner: Yeah. And I would think others in the drug space, too. It’s not just 鈥� that’s the point of this 鈥� it’s not just vaccines. Alice, you wanted to say something. 

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

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

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

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

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

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

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

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

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

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

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

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

Lawrence: Yeah. 

Ollstein: You have chemicals. 

Lawrence: We are chemicals. 

Ollstein: We are chemicals. 

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Jackie, you wanted to add something. 

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

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

Fortiér: Right. But when you’re president and you want credit for it, it’s going to be a little more 鈥� it’s harder in order to make that connection. Sorry. 

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

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

Rovner: Not in United’s favor. 

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

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

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

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

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

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

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

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

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

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

Rovner: Tell us again what it does. 

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

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

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

Rovner: Jackie. 

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

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

Fortiér: Yeah, it reminded me鈥� 

Rovner: It’s hard to, right, it’s hard to import another country’s 鈥� part of another country’s 鈥� policies without importing all of them. It is really good story. Lizzy. 

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

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

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

Fortiér: Bluesky mainly, . 

Rovner: Alice. 

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

Rovner: Lizzy. 

Lawrence: On X, . On Bluesky, . 

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

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

Mary Agnes Carey: Hello from 麻豆女优 Health News and WAMU radio in Washington, D.C. Welcome to What the Health? I’m Mary Agnes Carey, managing editor of 麻豆女优 Health News, filling in for Julie Rovner this week. And as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Friday, April 17, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So here we go. 

Today we’re joined via videoconference by Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

Carey: Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine. 

Joanne Kenen: Hi, everybody. 

Carey: And my 麻豆女优 Health News colleague Emmarie Huetteman. 

Emmarie Huetteman: Hey there. 

Carey: Later in this episode, we’ll play Julie’s interview with immigration attorney Michelle Canero about the impact the Trump administration’s immigration policies are having on the medical workforce. But first, this week’s news 鈥� and there is plenty of it. 

On Thursday, President [Donald] Trump nominated Dr. Erica Schwartz to lead the Centers for Disease Control and Prevention. Schwartz, a vaccine supporter, served as a deputy surgeon general in President Trump’s first term, and during the coronavirus pandemic she ran the federal government’s drive-through testing program. She’s also a Navy officer and a retired rear admiral in the Commissioned Corps of the U.S. Public Health Service. Her appointment requires Senate confirmation. President Trump also announced other changes to the agency’s top leadership: Sean Slovenski, a health care industry executive, as the agency’s deputy director and chief operating officer; Dr. Jennifer Shuford, health commissioner for Texas, as deputy director and chief medical officer, and Dr. Sara Brenner, who briefly served as acting commissioner of the FDA [Food and Drug Administration], as a senior counselor to Department of Health and Human Services Secretary Robert F Kennedy Jr. So we’ve discussed previously on the podcast several times that the CDC has lacked a permanent director for most of the president’s second term. Will Dr. Schwartz, if confirmed, and the other members of this new leadership team make the difference? 

Huetteman: I think that we’ve seen a CDC that’s been in a protracted period of turmoil, and this is going to be an opportunity for maybe a shift in that. Dr. Schwartz would actually be the agency’s fourth leader in a little more than a year, and we’ve talked on the podcast about how naming someone who could fit the bill to lead the CDC was a difficult task facing the Trump administration. They needed someone who could support the MAHA [Make America Healthy Again] agenda while not embracing some of the more anti-vaccine views, and that person needed to be able to win Senate confirmation, which isn’t a given, even with this Republican-controlled Senate. 

Edney: And I think we’ve seen that there have been some people already in the MAHA coalition that have come out and been upset about this pick. So I think what that shows is a calculated decision by the administration to, kind of, as they’ve been doing for this year, is kind of not focus on the vaccine part of Secretary Kennedy’s agenda and to, as Emmarie said, try to get someone that can get through Senate confirmation. We’ve already seen the surgeon general nominee be held up in the Senate because she was not as strong on vaccines as I think some would have liked to see when she had her confirmation hearing. 

Kenen: So this happened late yesterday, and I’ve been traveling this week, but I did have a chance to talk to some public health people about her, and there was sort of this audible sigh of relief. The Senate is a very unpredictable place, and we live in very unpredictable times. At this point, my initial gut reaction is she’s got a pretty good chance of confirmation. The other thing, I think some of the other appointees, there’s a little bit more concern about, but what really matters is who is the face of the CDC, and she would be the face of the CDC. She would be in charge, and people like her. Also, this is an administration that has not had a lot of minorities, and she will be, she’s a Black woman. respected in her field. And that also is going to 鈥� she needs to be able to speak to all Americans about their health, and I think that people welcome that as well, both her credentials and her life experience. So, yeah, I think that MAHA is sort of in this funny moment now, because clearly Kennedy isn’t doing everything that people wanted or expected. And so we’ll sort of see how the 鈥� I think if he had his ideal CDC director, this, we can probably surmise that this would not, she would not be the first on his list. But there’s a certain amount of adaptation going on at the moment. So I think many, many people will be relieved to see somebody get through, confirmed pretty quickly. People can get held up for things that have absolutely nothing to do with the CDC or public health. The Senate has all sorts of peculiarities. But I think there’s probably going to be a desire to get this done pretty quickly. 

Carey: All right. Well, we’ll see what happens, and we will go back to the MAHA folks a little bit later in the podcast. But right now I want to shift to Capitol Hill. Thursday was a very big day on the Hill for HHS Secretary Kennedy. He kicked off a series of appearances before Congress. This week he’s testifying before three House committees before he heads over to the Senate next week. This is the first time that the secretary has visited some of these House panels, and while the purpose of the latest congressional visit is to talk about President Trump’s HHS budget request, this also was the first time that a lot of lawmakers ever had an opportunity to talk to Kennedy, and what they asked him sometimes deviated, maybe quite a bit, from that subject of federal funding. The topics included Medicaid fraud, measles outbreaks, the birth-dose recommendation for the hepatitis B vaccine, peptides, unaccompanied minors, and more 鈥� actually, much more when you look at the hearings from yesterday, and I’m sure that will also happen with today’s session. What stood out to you about Kennedy’s testimony this week? 

Edney: I think it was the mix of questions, and you sort of alluded to this, but they wanted, the members of Congress wanted to talk about so many things. And I feel like in the earlier hearing, which was in the House Ways and Means Committee, that it was, there was a lot of focus in the beginning on fraud, and that sort of surprised me, and then we saw maybe one or two questions on vaccines. And so I thought the mix of questions, the things that members were interested in, were really interesting. And it did 鈥� there were some fiery moments, but for his first time on the Hill in a while, for such a controversial Cabinet member, I thought they were pretty tame. 

Kenen: Yeah, I watched a fair amount of the morning. I did not see the afternoon, but I read about the afternoon, and I totally agree with Anna’s take. This administration and Kennedy did what this administration has been doing. They blame all problems on [former president Joe] Biden and the prior administration. And to be fair, Democrats, when they’re in power, they, I don’t think they do it quite to this extreme, but Democrats spend, when they have the chance, they blame things on Republicans. So that’s sort of Washington as usual. The emphasis on fraud has been a hallmark of this administration, particularly in health and social services. And you’ve seen, of course, in the way they’ve gone after blue states in particular. And a lot of their justification for the changes in Medicaid that are coming in the coming year are supposedly because of massive fraud and they’re cracking down. It was not dominated by vaccines, and I was watching Kennedy’s face really carefully. When he was asked about the first child to die of measles in Texas last year, and a Democrat asked him could the vaccine have saved her life, and you could sort of see him just, you just sort of watch his facial expressions, and he knew he had to say this, and he came out with the word “possibly,” and, which is a change. And then in the afternoon 鈥� where I did not, as I said, I did not watch the afternoon, but I read about it 鈥� he was much more certain. He was much stronger about the measles vaccine and said it’s, the measles vaccine, is safer than measles, which is a big signal shift there. 

Huetteman: It’s true, although I will point out, though, that he did stand by the decision to remove the recommendation for the birth dose of the hepatitis B vaccine when he was pressed on that. So it was, I agree it was a softening, I’d say. At least it wasn’t a dramatic turnaround from what he’d said or not said in the past. But for him, it was at least a softening. 

Kenen: In the hepatitis B recommendation, he said that the biggest threat to infection was at, through birth, at, through the mother, and if you test the mother, the baby is not at risk. And that’s partially true, and that is a significant factor to eliminate risk. It doesn’t 鈥� it minimizes risk. It does not eliminate risk. Babies can and have been infected in the first weeks of life in other ways. The recommendation was not to totally eliminate that vaccine. It was to postpone it. But there’s, public health, still believe that, in general, many public health leaders would still say that the vaccine at birth is the better way of doing it. 

Carey: The focus was, theoretically, on the budget request from the administration. Did the secretary shed any light on those priorities or their impacts? I was taken, I think in the afternoon hearing I read about various lawmakers, including Rosa DeLauro from Connecticut, who sort of just said: A CDC cut of 30%? We’re not gonna do that. And there were also some Republican members who jumped in to sort of say, I don’t think we’re going to do the cuts you envision. But did the secretary defend them? Did he bring any new clarity to them? 

Edney: I don’t feel like I gained any new clarity on it. I think to bring it back to Budget 101, I guess, is like when the president, when the administration, sends down their budget, I think a lot of people already assume it’s dead on arrival. And maybe even though Kennedy is there to talk about the budget, it does become this broader hearing, because they don’t get him on the Hill that often and people go there to talk about all kinds of things, and I think that he probably knew that he didn’t have to defend it in the same way, because it’s not going to happen. 

Carey: Sure. As they say, the president proposes and Congress disposes. But Joanne, you want to jump in? 

Kenen: Yeah, there’s something significant about this administration, which is Congress has repeatedly authorized more money for various health programs and science programs, and the administration doesn’t spend it, so that there’s a different dynamic. Traditionally, yes, Congress 鈥� the president proposes, Congress legislates, and then people go off and spend money. That’s what people like to do. And in this case, when Congress has, in a bipartisan way, differed with the administration and restored funding, it hasn’t all gone, those dollars haven’t gone out the door. So the entire sort of checks-and-balances system has been askew in terms of funding. I agree with everybody here. I do not think that Congress is going to accept these extreme cuts across the board in health care and health policy, in public health and science and NIH [the National Institutes of Health] and everything, but I don’t know what they’re actually going to spend at the end of the day. 

Carey: Emmarie, you wanted to jump in. 

Huetteman: Yeah, there was one striking exchange to me where the secretary acknowledged he wasn’t happy with the cuts that were proposed. I think those were his words. But he pretty quickly added, and neither is President Trump, and he framed it as a matter of making hard decisions when faced with federal budget shortfalls. 

Carey: All right. Well, we’ll keep watching this as it moves through Congress. Also during yesterday’s House Ways and Means hearing, some Democrats took issue with past statements from Secretary Kennedy and President Trump that linked Tylenol use during pregnancy to autism in children. released this week in JAMA Pediatrics found that the use of Tylenol by women during pregnancy was not associated with autism in their children. This nationwide study from Denmark followed more than one and a half million kids born between 1997 and 2002, including more than 31,000 who were exposed to Tylenol in the womb. in another medical journal examining community water fluoridation exposure from childhood to age 80 found no impact on IQ or brain function. Kennedy has claimed that fluoride in water has led to IQ loss in children. These studies clearly debunk medical claims that have gotten a lot of attention. Will these findings have an impact now? 

Kenen: I think we’ve seen over and over and over again that there are people who are very deeply wedded to certain beliefs, and new science, new research, does not deter them from those beliefs. We also see some people who are sort of in the middle, who are uncertain, and new findings can shift their beliefs, right? And then, of course, there’s a lot of 鈥� these are not new studies. I mean these are new studies but they are not the first of their kind. The reason we’ve been using fluoride for, what, 60 years now in the water. Tylenol has been around a long time. So is it going to change everybody’s belief? No. Is it going to perhaps slow the push to ban fluoridation? Perhaps. But I just don’t think we know, because we’re sort of on these dual-reality tracks regarding a lot of science in this country, where once people sort of buy into disinformation, they’re very, it’s very hard to change 鈥� or misinformation 鈥� it’s hard to change people’s minds. 

Edney: I do think, on the Tylenol front 鈥� I absolutely agree with what Joanne said overall. And I think on the Tylenol front that it’s possible that this study will give pediatricians something to give and talk about with parents that are asking. I think there still is some confusion among some people. It’s not a huge, I don’t think, widespread thing, but I think there are some new parents who are wondering. And if you are able to take this study that is published in 2026 鈥� it just happened, it was after Trump made his statements 鈥� I think maybe that would give them something to talk about with their patients. 

Kenen: I agree with Anna. I think the Tylenol one is easier to change than some of the fluoridation stuff going on, partly because so many of us 鈥� and we should just say, it’s not just the Tylenol, the brand. It’s acetaminophen, which I’ve never pronounced right. I think those of us who have been pregnant, we’ve taken that in our life before and we don’t think of it as a big, dangerous, heavy prescription drug. I think we’ve, it’s something we feel comfortable with. And I think there’s also the counterinformation, which is, a fever in a pregnant woman can, a pregnant person can be dangerous to the fetus. So I think that one’s a little 鈥� and I don’t, also, I don’t think it’s as deep-rooted. The fluoridation stuff goes back decades, and the Tylenol thing is sort of new. And it might be, I’m not sure that the course of these arguments 鈥� I think that Tylenol is easier to counter than some other things, because partly just we do feel safe with it. 

Carey: All right. We’re going to take a quick break. We’ll be right back. 

We’re back and talking about how the Trump administration is managing the voters behind the Make America Healthy Again, or MAHA, movement, which helped President Trump win the 2024 election. My colleagues Stephanie Armour and Maia Rosenfeld wrote about the administration’s recent decision to give coke oven plants in the U.S. a one-year exemption from tougher environmental standards. And that was a move that angered some MAHA activists who wondered if the GOP is more beholden to industry than the MAHA agenda. President Trump, HHS Secretary Kennedy, and other top administration officials met recently at the White House with a group of MAHA leaders to calm concerns that the administration is moving too slowly on food policy changes, and they are concerned about the president’s recent support of the pesticide glyphosate. According to press reports, the MAHA folks seem to feel their concerns were heard during that session. But is this ongoing conflict between the president and this key political constituency, will it be one that keeps brewing as the midterm elections approach? 

Edney: Yes, 100%. I think it will continue to brew. I think that meeting was thrown together so quickly that some members of the MAHA movement who were invited couldn’t even make it. So it wasn’t exactly a long-planned, seemingly deep desire to fix everything. But it was, as you’ve said, an effort to kind of hear them out and make them feel heard. No one that I’ve talked to has said everything is fixed now. It’s more of a to-be-determined We will see what the administration will do moving forward, if they will listen to any of our plans 鈥� which we will not share with you, by the way 鈥� to make us happy. And I think that that’s going to continue. There’s a rally planned in front of the Supreme Court on glyphosate later this month where a lot of those people will be, and so I think that they’re upset and they’re stirring up, that concern is only going to get stirred up more. 

Carey: Emmarie. 

Huetteman: It’s a small thing, but our fellow podcast panelist Sheryl Stolberg at The New York Times during this White House meeting where President Trump was meeting with MAHA leaders, one of the leaders made a joke about how this is not a group that’s going to be, quote, “Team Diet Coke,” and the president apparently took that as a cue to press that Diet Coke button he famously has on his desk and summon a server who apparently brought him a Diet Coke. Supporters of MAHA have been clear that they want not just for the Trump administration to promote policies supporting priorities like healthy eating and removing food dyes, but also they want them to rein in or end policies they don’t support. And that weed-killer executive order, that really was a big example of that. The MAHA constituency made it clear that they felt betrayed by that order, and they’re going to have to do some work to walk that back. 

Carey: We’ll also see how, with their concerns about the new CDC director nominee, which they’re already voicing, we’ll see how that plays out. 

Kenen: No, I just think that we are, as we mentioned at the beginning, we’re seeing cracks, right? We’re seeing 鈥� none of us are privy to any conversations that President Trump has had privately with Secretary Kennedy. But his, Secretary Kennedy’s, public statements have been a little different than they were a few months ago. There’s certainly been reports that he’s been told to soft-pedal vaccines and talk about some of the things that there’s more unanimity across ideological and party lines. Healthier food 鈥� there’s debate about how to, whether, there’s debate about how Kennedy defines healthier food. But in general, should we eat healthier? Yes, we should eat healthier. Should our kids get more exercise? Yes, our kids should get more exercise. Do we have too much chronic disease? Yes, we have too much chronic disease. So they’re sort of this, trying to move a little bit more, sort of this sort of top line, very hazier agreement. But at the same time, the people who are sort of really the core of MAHA, as Kennedy has sort of created it or led it, there’s cracks there. 

Carey: All right, we’ll see. We’ll see where that goes. But let’s go ahead and move on to ACA enrollment. A found that 1 in 7 people who signed up for an Affordable Care Act plan failed to pay their first month’s premium. The analysis from Wakely consulting group found that nationally around 14% of those who enrolled in ACA plans didn’t pay their first bill for January coverage. Now we know the elimination of the enhanced ACA tax credits and higher premium costs led to lower enrollment in the ACA exchanges, with sign-ups for 2026 falling to 23 million from 24 million a year ago. But how do you interpret this finding that 14% of enrollees didn’t pay their January premium? Is it a sign of more trouble ahead? 

Edney: I think it could be a sign of more trouble ahead. Some 鈥� what we’re seeing is sticker shock. And there may be some people who are trying to deal with that and won’t be able to as the months go on. And so, yeah, I think it could mean that even more drop out, and that means more people lose coverage and are uninsured. 

Kenen: I think there was sort of a general, initial, misleading sigh of relief when in December, when the enrollment figures, the drop wasn’t as bad as some feared. But at the same time, people said: Wait a minute. This doesn’t really count. Signing up isn’t the same thing as staying covered. The drop in January was significant, we now know. And I agree with Anna. I think we don’t know how many more people will decide they can’t afford it. Or we don’t know whether the big drop is January. Probably a lot of it is, because you get that first bill. But can, will more people drop? Probably. We have no way of knowing how many. And it also depends on the economy, right? If more people lose jobs, right now it’s still pretty, kind of still pretty stable, but we don’t know what’s ahead. We don’t know what’s going to happen with the war. We don’t know many, many, many 鈥� we don’t know anything. So the future is mysterious. I would expect it to drop more. I don’t think, I don’t know whether this is the big drop or February will be just as bad. I suspect January will be the biggest. But who knows? It depends on other outside factors. 

Huetteman: We’re also seeing a drop-off in the kind of coverage that people are choosing. That analysis that you referenced, Mac, showed that there was a 17% drop in silver plan membership, with most of those folks switching to bronze plans, which, in other words, that means they switch to plans that have lower monthly premiums but they have higher deductibles. And that means that when you get sick, you owe more, in some cases much more, before your insurance starts picking up the tab. And I think really what this means is people are more exposed to the high charges for medical services, bigger bills when you get sick. I think that 

Kenen: I think that the Republicans were seen as having pushed back a lot of the health impacts of the so-called One Big Beautiful Bill and that it would be after the election. And I and others wrote: No, no, no, no, no. We’re going to see this playing out before the election. This is a really big political red flag, right? This is a lot more people becoming uninsured, which makes other people worried about their insurance and stability. So I think this is definitely going to 鈥� it may not be. There are other things going on in the world. Health care may not be the dominant theme in this year’s election. But yes, this is going to be, the off-year elections are going to be health care elections, like almost every one else has been for鈥� 

Carey: Oh yeah. 

Kenen: 鈥攕ince the Garden of Eden, right? 

Carey: Absolutely, it’s a perennial. All right, we’ll keep our eye on that. That’s this week’s news. Now we’re going to play Julie’s interview with immigration attorney Michelle can arrow, and then we’ll be back with our extra credits. 

Julie Rovner: I am pleased to welcome to the podcast Michelle Canero. Michelle is an immigration attorney from Miami and a member of the board of Immigrants’ List, a bipartisan political action committee focused on immigration reform. Michelle, thanks for joining us. 

Michelle Canero: Thank you for having me. 

Rovner: So, we’ve talked a lot about immigration policy on this podcast over the past year, but I want to look at the big picture. How important to the U.S. health care system are people who originally come from other countries? 

Canero: I think the statistics speak for themselves. One in three residency positions can’t be filled by American graduates alone. That means 33% of these residency positions are being filled by immigrant workers. Twenty-seven percent of physicians are foreign-born. Twenty percent of hospital workers are immigrants. And, at least in Florida, a large percentage of our home health care workers happen to be immigrants. And we depend on this population heavily in the health care sector. 

Rovner: Now, we talk a lot about the Trump administration’s crackdown on illegal immigration, but we talk a little bit less about their sort of messing with the legal immigration system. And there’s a lot going on there, isn’t there? 

Canero: There is. And I think that the campaign talking points were illegal immigration but what we’re actually seeing is a little more sinister. I think that the goal of leadership at the head of DHS [the Department of Homeland Security] and DOS [the State Department], or really Stephen Miller, is pushing something called reverse migration, which is really not about limiting illegal immigration but reducing the immigrant population in the United States. And I think that’s where the real concern is and why you’re seeing these policies that directly affect legal immigrants. 

Rovner: We talk a lot about doctors and nurses and skilled, the top skilled, medical professionals who make up a large chunk of the United States health care workforce. We don’t talk as much about the sort of midlevel professional workers and the support staff. They’re also overwhelmingly immigrant, aren’t they? 

Canero: Yeah, and whether it’s your IT- and technical-knowledge-based workers in hospitals who facilitate all the technology 鈥� we rely on an immigrant workforce for a lot of the technology sector. And then you’ve got research professionals. A lot of clinical researchers, medical researchers, are foreign-born. So it’s not just about the doctors. It’s also the critical staff that keep the hospitals operating. And I’m from Florida. For us, it’s the home health care workers. We have an aging population, and a large percentage of the home health care workers, particularly in Florida, happen to be Haitians on TPS [temporary protected status] or people with asylum work authorizations. And when we lose that, our aging population is left with no resources, because that’s not something AI or technology can fix. You can’t turn someone over in a bed with a robot yet, and we’re probably decades away from that. 

Rovner: So what’s the last year been like for you and your clients? 

Canero: I think it’s a lot of uncertainty. A lot of these policies are percolating, and we’re assuming that they’ll be resolved in litigation, but the damage is being done in real time. So we’re seeing hospitals turning away from hiring foreign workers, because of the H-1B penalty now. The suspension of J-1 processing created backlogs. These visa bans that affect 75 countries on certain visas and 39 countries on others. You’ve got thousands of health care workers that are stuck outside the U.S. So what’s happening, really, is that hospitals and medical providers are just shutting down, and they’re cutting back services, and that means that there are less available services and resources for the same population and the same demand. People are waiting longer for doctor’s appointments. People are finding that they’re not able to get to the specialist that they need to get to in time. And so for us as practitioners, I think, we’re trying to navigate as best we can, but we’re just seeing a lot of people, employers that traditionally would rely on our services, give up and foreign workers looking to go elsewhere. 

Rovner: I noticed during the annual residency match in March that it worked out, I think, fairly well for most graduating medical students. But the big sort of sore thumb that stuck out were international medical graduates. That’s going to impact the pipeline going forward, isn’t it? 

Canero: From what I understand, it takes like seven to 15 years to get to that level, and we just don’t have the student body to meet the demand of residency positions. From my understanding, there’s a gap between American graduates and the demand for residents that’s usually filled by foreign workers. And if we don’t have those foreign workers, those residency positions just don’t get filled. And that becomes more expensive for hospitals, and that transfers to our medical bills. 

Rovner: And people assume that, Oh well this doesn’t impact me. But it really impacts all patients, doesn’t it? And I would think particularly those in rural areas, which are less desirable for U.S.-born and -trained medical professionals and tend to be overrepresented by immigrants. 

Canero: Yeah, I think a lot of the J-1 doctors and H-1B doctors are what facilitate, are working at, our veterans hospitals and our rural medical facilities. And what’s ending up happening is the very same people that this administration touts to support their interests are being forced to travel farther for specialists, right? If there isn’t an endocrinologist in your area, you may have to drive 100 miles to go see that specialist, and you may forgo necessary medical care because of the inconvenience or the cost. And I think that’s hitting at our health. 

Rovner: So you’re on the board of Immigrants’ List, which is working to change things politically. What’s one change that could really make a big difference in what we’re starting to see in terms of immigration and the health care workforce? 

Canero: Well, asking Congress to actually do something. It’s been a problem for decades. So I don’t really know, but I think there’s a couple of things, whether it’s just policymakers supporting our fight against some of these illegal policy changes in courts, organizations supporting us with amicus briefs. For example, there’s a lot of lawsuits challenging these visa bans and these adjudicative holds and the H-1B fine. The more support that the plaintiffs in the litigation get, the more likely we are to resolve that through the court system. And then I hope that there’s enough pressure from hospitals and organizations that have real dollars that impact these elected officials to get them to start seeing, Hey, we need to pass reasonable immigration reform to address some of the loopholes that this administration is using to cause chaos in the system, right? They’re able to do this because we have a gap. We allow them to terminate TPS. We don’t have a structure to ensure that a community that’s been on TPS for 20 years gets grandfathered into some sort of more stable visa. We don’t have a system that precludes the administration from just putting a hold or a visa ban on nationalities. So it’s something that Congress is going to have to step up and do something about. 

Rovner: What worries you most about sort of what’s going on with the immigration system and health care? What keeps you up at night? Obviously you, I know you work on more than just health care. 

Canero: I think my concern is that the American people aren’t seeing what’s happening, or they’re sort of turning a blind eye to it, and by the time it starts to actually impact them and they start asking, Wait, wait, wait. Why is this happening? I don’t understand, it’s going to be too late. Because it’s not hitting their pocket, because it’s not their suffering at this point, they’re not standing up and saying, Hey, this needs to stop, at the level that we need, opposition, to make it stop. And by the time it does hit their pocket and it does affect them directly, I think, it’ll be a little too late. I think people will be scared off from coming here, people that we needed will be gone, and to reverse the system is going to take decades. 

Rovner: Michelle Canero, thanks again. 

Canero: No, you’re very welcome. Thank you for your time. 

Carey: OK, we’re back. Now it’s time for our extra-credit segment, and that’s where we each recognize a story we read this week and we think that you should read it, too. Don’t worry if you miss it. We’ll post the links in our show notes. Joanne, why don’t you start us off this week? 

Kenen: Well, this is by Teddy Rosenbluth in The New York Times. The headline is “” This is one of those stories where you know exactly how it’s going to end in the first paragraph, and yet it was so compellingly and beautifully written that you kept reading until the last word. It is, as the headline suggested, a young man who is an expert on AI and cognitive science named Ben Riley discovered that his father had been lying about a controllable, treatable form of leukemia. He had denied treatment, he’d refused treatment, he had ignored his oncologist because he was relying on AI. And as we all know, AI has its up moments and its down moments. And he was getting incorrect information, distrusted the diagnosis, refused treatment, getting sicker and sicker and sicker as the oncologist and the family got increasingly desperate. And the son, Ben Riley, had, like, skills. He knew how to find scientific evidence, and his father just would not believe it. And by the time his father finally consented to treatment, it was too late, and he did die. And his father was a neuroscientist, a retired neuroscientist, but he found a neuroscience rabbit hole. 

Carey: That’s amazing. Anna, what’s your extra credit? 

Edney: Mine, I’m highlighting a story that I wrote in Bloomberg called “.” And this is, I wanted to dive into this policy that the FDA had implemented. The commissioner has long talked about and felt that perimenopausal and menopausal women were not getting access to the treatments that maybe they really needed, because there had been sort of this two-decade-old study that had showed there were some safety issues regarding breast cancer and cardiovascular disease, but the issue being that those studies had looked at older forms of the medication and also at women who were much older than those who might benefit from taking it. And so they, the agency, asked the companies to remove those warning labels, at least the strongest ones. And what we’ve seen, why 鈥� I wanted to dive into the numbers specifically. Bloomberg has some prescription data that was able to help me out here and just look at when this started rising. You could see that the prescriptions started going up around 2021. I feel like a lot of influencers, a lot of celebrities, were talking about this. And then in 2024 to 2025 when the FDA started talking about this, it really just goes, the prescription numbers just go straight up on the scale. And so there were about 32 million prescriptions written last year, which is a huge increase. And I just dove into some of this, some of the companies, what kind of drugs there are out there, and talked to some women who are benefiting but also, because of this pop, experiencing shortages, because the companies aren’t quite keeping up with the products. 

Carey: Wow, that sounds like an outstanding deep dive. Thank you. Emmarie. 

Huetteman: Yeah, my extra credit is from my colleague at 麻豆女优 Health News who covers health technology. That’s Darius Tahir. The headline is “Your New Therapist: Chatty, Leaky, and Hardly Human.” The story looks at the proliferation of AI chatbot apps that offer mental health and emotional support, particularly the ones that market themselves as, quote-unquote, “therapy apps.” Darius counted 45 such apps in Apple’s App Store last month, and he uncovered in some cases that safety and privacy concerns existed, such as minimal age protections. Fifteen of the apps that he looked at said they could be downloaded by users who were only 4 years old. His story also explored the tension between the risks of sharing sensitive data and the interests of app developers and collecting that data for business purposes. It’s a good read. All right, 

Carey: All right. Thanks so much. My extra credit is from Politico, and it’s written by Alice Miranda Olstein, and she’s a frequent guest here on What the Health? The headline is, quote, “,” close quote. The headline kind of says it all. Alice writes that Nebraska is racing to implement Medicaid work requirements by May 1, and that’s eight months ahead of the national deadline that was set by the One Big Beautiful Bill Act. Nebraska state officials plan to do this without hiring additional staff, even as other health departments in other states prepare to bring in dozens, if not hundreds, of new employees. Alice writes that advocates for people on Medicaid fear that this rush timeline and lack of new staff will cause many problems for Medicaid beneficiaries who are just trying to meet those new work requirements. 

All right. That’s this week’s show. Thank you so much for listening. Thanks, as always, to our editor and panelist Emmarie Huetteman, to this week’s producer and engineer, Taylor Cook, and to my 麻豆女优 colleague Richard Ho, who provided technical assistance. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. Also, as always, you can email us with your comments or questions. We’re at whatthehealth@kff.org. Or you can find me on X, . Joanne, where can people find you these days? 

Kenen: and , @joannekenen. 

Carey: OK. Anna? 

Edney: and and , @annaedney. 

Carey: And Emmarie. 

Huetteman: You can find me on . 

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

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

Julie Rovner: Hello, from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, April 9, at 9:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

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

Lauren Weber: Hello, hello. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, everybody. 

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

Maya Goldman: Go, Blue. 

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

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

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

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

Rovner: Lauren, you want to add something? 

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

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

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

Rovner: I will point out, as a person who covered the entirety of the fight to have emergency contraception 鈥� which is not the abortion pill 鈥� made over the counter, it took like, 15 years. It shortened my life covering that story. Lauren, did you want to add something?  

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

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

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

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

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

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

Ollstein: Right.  

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

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

Rovner: Lauren, you want to add something? 

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

Rovner: Absolutely.  

Weber: 鈥� glad we are able to have her explain it to us. But just wanted to throw out a kudos for breaking all the news on that front.  

Goldman: Yeah, great coverage. 

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

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

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

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

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

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

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

Rovner: Which we will get to. 

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

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

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

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

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

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

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

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

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

Goldman: The money has got to come from somewhere. 

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

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

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

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

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

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

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

Rovner: Lauren, you wanted to add something? 

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

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

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

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

Rovner: Oh, absolutely. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: As it were. 

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

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

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

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

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

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

Rovner: Yeah 鈥� this was quite a scoop. Really, really interesting story. Lauren. 

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

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

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

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

Rovner: Alice. 

Ollstein: I’m on Bluesky  and on X . 

Rovner: Lauren. 

Weber: Still @LaurenWeberHP on both  and . 

搁辞惫苍别谤:听We will be back in your feed next week.聽Until then, be healthy.

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

Julie Rovner: Hello, from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, April 2, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

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

Alice Miranda Ollstein: Hello. 

Rovner: Jessie Hellmann of CQ Roll Call. 

Jessie Hellmann: Thanks for having me. 

Rovner: And Sandhya Raman, now at Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

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

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

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

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

Hellmann: Yeah, exactly. 

Rovner: Let’s not get into the details. 

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

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

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

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

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

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

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

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

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

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

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

Rovner: And that’s 鈥� I would say that’s been a state 鈥� 

Ollstein: Power. 

Rovner: 鈥� power. For generations.  

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Yeah, Republicans have been super ambivalent. I mean, Medicare Advantage was their creation. They overpaid them at the beginning when they, you know, sort of redid the program in 2003. And they purposely overpaid them to get people into Medicare Advantage. And then the Democrats pointed out that this is wasting money because we’re overpaying them. And now the Republicans seem to have joined a lot of their 鈥� at least some Republicans 鈥� seem to have joined a lot of the Democrats in saying, Yes, we’re overpaying them. We’re paying them too much. And you know, they talk about the big, powerful insurance companies, and yet they’re now floating this idea to make Medicare Advantage the default. So pick a side, guys. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Elisabeth Rosenthal: Thanks for having me.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: And what happened with this case? 

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

Rovner: One cent. 

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

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

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

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

Rosenthal: Thanks, Julie, for having me. 

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

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

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

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

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

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

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

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

Raman: On  and on  . 

Rovner: Alice. 

Ollstein: On Bluesky  and on X . 

Rovner: Jessie. 

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

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

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

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

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

Rachel Cohrs Zhang: Hi, everybody. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: And Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hello. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Lawrence: Yeah, is there another deadline to miss? 

Cohrs Zhang: I don’t think so. 

Lawrence: I think this was the only one. 

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

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

Cohrs Zhang: Yeah. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Luthra: That’s true. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Keith: Thanks, Julie. 

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

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

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

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

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

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

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

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

Luthra: I am on Bluesky . 

Rovner: Rachel. 

Cohrs Zhang: On X , or . 

Rovner: Lizzy. 

Lawrence: I’m on X  and  and . 

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

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

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

Julie Rovner: Hello from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, March 19, at 10:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

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

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

Rovner: Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: And Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, there. 

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

We’re 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. The judge ruled that HHS violated the law governing federal advisory committees when HHS Secretary Robert F Kennedy Jr. summarily fired all 17 members of the Advisory Committee on Immunization Practices and replaced them, largely with 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 appealing the decision, so it could change back any minute now 鈥� you should check. What’s the public health impact of this ruling, though? 

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

Rovner: Lauren. 

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

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

Sanger-Katz: Yeah. I mean, I just think that this issue is becoming increasingly politicized. As Lauren and Alice said, I think that does affect the confusion around it, does affect people’s willingness to take up vaccine. But I do wonder also if we’re 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 鈥� it’s 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 relatively broad consensus across the parties. Not that there haven’t been disagreements among scientists or among different groups of Americans. There’s always been resistance to vaccines or concerns about vaccine safety in this country. But I think there was a sense that it’s not 鈥� that 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, I think, risks this becoming a much bigger kind of partisan political issue going into the next election. 

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

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

Rovner: Apparently, public health requires us to relearn things. Before we leave this 鈥� yes, Lauren, you want to add something?  

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

Rovner: Speaking of long-running stories, let’s revisit the grant funding slowdown at the National Institutes of Health. Again this year, grants, particularly grants for early career scientists, are slow leaving the agency, which is one of the few HHS subsidiaries that actually got 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 time period, from 2021 to 2024. Last year, only a gigantic speed-up at the very end of the fiscal year prevented the NIH from not 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, 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 just important to medical advancement, but to a large chunk of the entire U.S. economy. Biomedical research is a very, very large export of the United States. 

Sanger-Katz: Yeah, the NIH has just been giving out this money in a very weird way. It’s not just that they gave it all out at the end of the fiscal year before it was too late, but they didn’t distribute it in the way that they normally distribute the funding. So, normally, the way that these things work is people submit 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 so 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 鈥� it’s kind of rolling 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 sort of prepaid for the whole thing. And so my colleague Aatish Bhatia did a wonderful story on this around the end of the fiscal year, sort of pointing this out. And I think this is the kind of pattern that will result in NIH actually funding a lot less research. I mean, over time, presumably, they’re going to, I guess they could, catch up. But I think in the short term, what it’s allowing them to do is to fund many fewer scientists and many, many fewer research projects. And I think that that does have an effect on the kind of reach and diversity of the projects that are getting funded by NIH and that are the kind of scientific research that’s being conducted. And it’s 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 can’t all be spent in the first year. So it’s kind of like, almost like, the money is no longer with the NIH, but it’s kind of like sitting in a bank account somewhere. It’s not actually out there in the economy, in the university, in the researcher’s pocket funding research in each of those years. 

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

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

Rovner: Yeah, this is one of those stories that I feel like would be a much bigger story if there weren’t so many other big stories going on at the same time. Congress is kind of busy 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. At least right not at the moment. But that doesn’t mean it’s not still a big political issue looming for the midterms. Just today, my colleagues in our 麻豆女优 polling unit are  that finds 80% say their health care costs are up this year, and 51% say their costs are, quote, “a lot higher.” 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, “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.” So where are we in the ACA debate cycle right now?  

Sanger-Katz: I think as far as the ACA debate, as like a policy matter, we’re a little bit nowhere. I think there 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. 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 we’re starting to see, just today, some green shoots from the Democrats in the Senate that they’re looking to explore kind of big ideas in this space. So 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 they’re 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 debates and having some hearings, maybe, and talking to experts and doing some of the kind of work I was thinking that they did before they debated and passed the ACA, right? They did a process like this. So we don’t know what that’s going to be.  

Rovner: Exactly. That’s sort of the origin of our series of “How Would You Fix It?” 鈥� that we’re in that stage where people are starting to think about the big picture. 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. 

Sanger-Katz: Which is 鈥� all 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 gonna come forward with, OK, here’s what we’re gonna do about this. I think this is: Let’s do some studies, let’s talk, let’s debate, let’s think. Let’s get ready for the future.  

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

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

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

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

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

Weber: Again, to talk about midterms conversations, I mean the folks that are often hit hardest by this, as I understand, are middle-income earners, early retirees, or folks that live in expensive states. And that’s a voting bloc. I mean, early retirees 鈥� who else is voting? I mean that’s who’s voting. So I’m 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 in order to make up the difference of what we’re seeing.  

Rovner: Well, meanwhile, in news that I think counts as both bad and good: Health care jobs took a dip in February, 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 in the aggregate. But I wonder if this dip is an anomaly or it represents 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, you wanted to add something?  

Ollstein: Yeah. I mean, I think that these things have a cascading effect, and it can take years to really see, like, the full damage of something. And so we’re just starting to see the very beginning of a trend of people dropping their insurance because they can’t afford it. But then it’ll 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 we’re just at the very beginning of it, and we can sort of infer what could happen based on what’s happened in the past. But that’s a challenge for the political cycle, because it’s hard to talk about things that haven’t happened yet, both good and bad. I mean, you see that also with promising to lower drug prices; 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 off down the line. 

Rovner: Well, speaking of things that weren’t supposed to happen yet, a shoutout to my 麻豆女优 Health News colleague Tony Leys for a  about a family in Iowa facing a cut in home care through Medicaid for their adult son with severe autism and deafness. It appears that Iowa is not the only state cutting back on expensive but optional Medicaid services like home and community-based 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?  

Sanger-Katz: 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 hasn’t happened. States kind of went 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 next year. And so we’re seeing, like, 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, and other kinds of health care providers. It’s pretty ugly out there.  

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

Ollstein: Well, nothing happened for a while. The things that were supposed to happen didn’t happen, and now they may be happening, but it may be too late to avoid some problems happening. So to break that all down: 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 [sexually transmitted infections] 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. So that funding runs out at the end of this month, March, and they only just got the guidance a few days ago. And I will say there was no guidance for months and months and months. I ; a couple days later, the guidance came out. Not saying that was the reason, but that was the timing.  

Rovner: But a lot of people are thanking you. 

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

Rovner: Well, speaking of federal funding on reproductive-related health care,  found that most of the money that Missouri is giving to crisis pregnancy centers 鈥� those are the anti-abortion alternatives to Planned Parenthoods and other clinic 鈥� that the crisis pregnancy centers provide neither abortions nor, in most cases, contraceptives 鈥� has been coming from TANF [Temporary Assistance for Needy Families] 鈥� that’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 tip of the iceberg in public money going to these often overtly religious organizations, right?  

Ollstein: Yeah, I think we’ve seen that more and more over the last few years. These centers were, by conservative activists and politicians, 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 don’t. Some of them offer real health services. Some of them don’t. And there’s very little oversight and regulation. 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. And so I think that we haven’t yet seen that on the federal level, but we’re absolutely seeing it on the state level. And I think this is just contributing to the national patchwork of, you know, where you live determines what kind of services you can access, because we do not see blue states funneling money to these centers. And so you’re going to see a real split there. 

Rovner: And I will point out, 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 don’t. So it’s a very mixed bag, from what we’ve been able to see.  

Well, lastly, ProPublica, speaking of ProPublica, has  about women in labor in Florida who are required to undergo court-ordered C-sections, even if they don’t want them, in order to 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 “fetal personhood” quietly taking hold without our even really noticing it? It seems these laws, some of them, have been challenged, and the courts have sort of gone different ways on it, but mostly just left it to the states.  

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

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

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

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

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. So I can’t think of anyone better to help launch our new interview series called “How Would You Fix It?” 

Here is the premise. I think it’s pretty clear 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 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 you fix it? You’ll 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. 

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

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

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

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

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

Altman: No, I don’t think so. I mean, I’ve seen this many times 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 consolidated 鈥� or the political chemistry to regulate health care costs or health care prices鈥� the two big answers. So 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 it’s unlikely to be more than that. We have made, as a country, very significant progress on coverage. Now 92% of the American people [are] covered; that [is] now endangered by big cutbacks, unprecedented cutbacks. But we made very little 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 that’s what’s 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. But we’re pretty much nowhere on that one and going backwards on the other one. So, without being the captain of doom and gloom here, I think what we’re 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. 

Rovner: 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, I spend less, so you spend more. Can you explain that a little bit? 

Altman: 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. How they do it differs from country to country. But they have a way to control the spigot. We don’t. And so instead, we micromanage everything to death, and make ourselves pretty miserable 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. Kind of every payer on their own. And so 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? That burden then falls to the states, which have to try and deal with that. 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. And on and on and on. That’s not a strategy on health care costs. And if you think about it, we don’t actually have a national strategy on health care costs. The Congress has never mandated that someone come up with 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 don’t actually have anyone responsible for an overall strategy on health care costs. And it shows. 

Rovner: 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 actually agreed 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? 

Altman: It’s red versus blue right now. There is hope for coming together. What is important, and what the media struggles with a lot, is what I call proportionality, or recognizing proportionality. They can come together on small things. 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 together on juicing up transparency. These are not solutions to the health cost problem, but they’re helpful. And, you know, so there are a broad range of areas. 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. And that discussion is important, and that’s a part of it that 麻豆女优 will focus on. 

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

Altman: Well, you know, the biggest lesson, maybe in the history of all these debates, is people don’t like to change what they have very much. And it’s hard to sell them on that. A second lesson is: Ideas seem very popular. And you’ll see a lot of polls: Would you like this? And 90% of people like everything. That doesn’t 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 so when you get to actually discussing 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 states are affected? Not just on public opinion. So those are a couple of lessons. There is also a silent crisis, I think, in health care costs that doesn’t get enough recognition. And that is the crisis facing people with chronic illness 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. So we may see that 25%, sometimes it gets up to 30%, of the American people tell us they’re really struggling with their health care costs. They have to put off care. They may be splitting pills, whatever it may be. But those numbers for people who have cancer, diabetes, heart disease, a long-term chronic illness can go up to 40% or 50%, and it truly affects their lives. I don’t think that problem gets enough attention. So you could say, OK, Drew, well, that’s just obvious. They use the most health care. You could also say, yes, but that’s the reverse of how any functioning health care system should work; it should first of all take care of people who are sick, and we are not doing that in our health insurance system. 

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

Altman: Great, Julie. Thank you, appreciate it. 

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

Sanger-Katz: Sure. So I’m so excited to encourage everyone to read this wonderful story from Tara Bannow at Stat called “.” And I say that it’s a wonderful story, but it’s not necessarily good news. This is a story about a Texas couple of entrepreneurs who have figured out how to exploit the system that was set up by the No Surprises Act in order to get extremely rich. As you guys may remember, this was the bill that ended most surprise medical billing, so you would never go to an emergency room and suddenly end up with a doctor that was out-of-network that was sending you an extra bill. And the law, since it was passed a few years ago, has been extremely effective in preventing those bills from getting sent to individuals. But it created this very complicated and 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. 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 the insurance companies might not be fast enough to reply if they came in these huge batches. So they were sending hundreds of thousands 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, Alla and Scott LaRoque, were personally very colorful. She was a former contestant on The Apprentice, and they had a sort of crazy wedding where they gave everyone luxury gifts. And, anyway, I thought that the story was extremely good, both because the details about these people were very interesting, but also because I think it shows how the No Surprises Act, which I covered at the time of its passage, you know 鈥� 

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

Sanger-Katz: I think in a lot of ways, it was like a, 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. It was a real problem in the health care system that Congress came together to try to solve, and yet, and yet, the work is never done. And there are always unanticipated problems.  

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

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

Rovner: Oh, this is a huge public health problem, particularly for young men. I mean 鈥� it’s the vaping of this decade, I call it. Alice. 

Ollstein: So I have , 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. So a completely unrelated economic and infrastructure priority, and they’re using this health funding as a bargaining chip. And so 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. by 2030? Because, as we learned during covid, we live in a global society, and things that impact other countries impact us as well. And [Jay] Bhattacharya answered, you know, oh, I think we can still eliminate HIV in the U.S., not necessarily in the whole world. So really, really urge people to check out this piece. 

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

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

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

Rovner: Lauren? 

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

Rovner: Margot. 

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

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

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

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

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

Shefali Luthra: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

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

Joanne Kenen: Hi, everybody. 

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

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

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

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

Rovner: That’s a fair assessment. Anna. 

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Yes. 

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

Rovner: Right. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Oh, it is. 

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

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

Kenen:&苍产蝉辫;础苍诲&苍产蝉辫;迟丑别苍鈥�&苍产蝉辫;

Rovner: And then maybe cut it back later. 

Kenen: No, but it’s exceeded expectations. 

Rovner: Absolutely. 

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

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

Kenen: Right. Right. 

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

Kenen: Right.  

Rovner:&苍产蝉辫;鈥�&苍产蝉辫;颈苍&苍产蝉辫;1997.&苍产蝉辫;

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

Rovner: They made it fail. 

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

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

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

Rovner: The ones that passed by voters. 

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

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

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

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

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

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

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

Andy Schneider: Thanks for having me, Julie. 

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

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

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

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

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

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

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

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

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

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

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

Schneider: So the only letters that we’ve seen from the administration have been to California, New York, and Maine. There may be other letters out there. We only access the public record. So so far, based on what we know, it’s just been Democratically run states. 

Rovner: As long as I’ve been covering this, which is now a long time, fraud-fighting has been pretty bipartisan. It’s been something that Congress has worked on, Democrats and Republicans in Congress, Democrats and Republicans in the states. What’s the danger of politicizing fraud-fighting, which is what certainly seems to be going on right now? 

Schneider: Yeah, that’s a terrific point. So it always has been bipartisan, because money is green. It’s not red. It’s not blue. It’s green. And trying to keep bad actors from ripping it off from Medicaid or Medicare has always been a bipartisan undertaking. The reason that’s important, particularly in a program like Medicaid, where the federal government and the state have to talk to one another when they are flagging potential fraud, when they’re investigating it, when they’re prosecuting it, you don’t want the agencies tripping all over one another. You want them sharing information as necessary, etc. When that gets politicized, it’s very bad for the results and for the effective operation of the program. 

Rovner: Well we will keep watching this space, and we’ll have you back to explain it more. Andy Schneider, thank you very much. 

Schneider: Julie Rovner, thank you very much. 

Rovner: OK, we’re back. Now it’s time for our extra-credit segment. That’s where we each recognize the story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Anna, why don’t you start us off this week? 

Edney: Sure. Mine is in The Wall Street Journal. It’s [“”]. This is a look at the booming business of providing therapy to children with autism. And that’s particularly been big in the Medicaid program. And I don’t want to give away too much, because there are just so many jaw-dropping details in this. So I guess the reporters were able to kind of go through the data and billing records in a way that showed some of these companies and what they were doing and how they were becoming millionaires, people who had never done anything in autism before. So if you enjoy a sort of jaw-dropping read, I think you should take a look at it. 

Rovner: Yeah, jaw-dropping is definitely the right description. Joanne. 

Kenen: So I sort of rummaged around the internet to the less widely read sources, and I came across this great story from the Idaho Capital Sun by Laura Guido. It has a long headline. Reminder that 988 is the mental health crisis line and suicide help. The headline is: “” The story is that a 15-year-old boy named Jace Woods called two years ago 鈥� so this still hasn’t been fixed after two years 鈥� and they cut him off. They sort of gently cut him off. But they can’t talk to these kids who have, who are in crisis, without parental consent. They do a quick assessment. If they think someone’s life is immediately in danger right then and there, they can stay on. But a kid who’s what they call suicidal ideation, seriously depressed and at risk, and knows he’s at risk or she’s at risk, and made this phone call, they don’t talk to them unless they think it’s imminent. So it also affects, these parental, it affects sexual health and STDs and abortion and whole lot of other things. 

Rovner: That’s what it was for. 

Kenen: That was the initial reason, but it got bigger. So a kid who calls in a crisis can get no help at all. And even in those emergency situations where they can stay on the line and try to get emergency help if they do think a kid’s in imminent danger, they’re not allowed to make a follow-up call to make sure they’re OK. So this kid has been trying for two years. There’s a state lawmaker. They’re refining a law. They say it’s, they’re refining a bill. They say it’s going to go through. But really this, talk about unintended consequences. We have a national mental health crisis, particularly acute for teens. This is not solving any problems. 

Rovner: It is not. Shefali. 

Luthra: My story is in The New York Times. It is by Apoorva Mandavilli. The headline is “.” And it’s just a good story about what is happening with the Ryan White AIDS Drug Assistance Programs, which people use to get their HIV medications paid for or for free. They get insurance support. And these are really important. Funding has been pretty flat for quite some time because they’re funded by Congress. And what the story gets into is that with growing financial pressure on these programs, there is more-expensive drugs, there are more-expensive insurance premiums, more people might be losing Medicaid. States are having to make very difficult choices, and they are cutting benefits. They are changing who is eligible, because it’s getting more expensive and there is more need and there is no support coming. And I wasn’t really on top of this and did not know what was going on, and I just thought it was interesting and a very useful look at some of the consequences of the policy choices that are making all of these health programs more expensive and health care, in general, harder to afford. 

Rovner: My extra credit this week is from The Marshall Project. It’s called “.” It’s by Shannon Heffernan and Jesse Bogan and Anna Flagg. It answers the question that I’ve been wondering about since the whole immigration crackdown began, which is: What happens to the people who are snatched off the streets or out of their cars or homes, flown to a distant state, and then someone says: Oops, sorry. You can go. How do you get home from Texas or Louisiana to Minnesota or Massachusetts? Authorities don’t give you plane or even bus tickets to get back to where you were picked up, even though that’s where most of those being released are required to go to report back to immigration authorities. It turns out there’s a small network of charities that is helping. But as the story details pretty vividly, the harm to these families doesn’t end when their detention does./ 

OK. That’s this week’s show. As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer. Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X, , or on Bluesky, . Where are you guys hanging these days? Shefali? 

Luthra: I am at Bluesky, . 

Rovner: Anna. 

Edney:  and , @annaedney. 

Rovner: Joanne. 

Kenen: A little bit of  and more on , @joannekenen. 

Rovner: We will be back in your feed next week. Until then, be healthy. 

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Julie Rovner: Hello from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News. Usually we’re joined by some of the best reporters covering Washington, but today we’re bringing you something special. I hope you enjoy it. We’re taping this episode on Friday, Feb. 27, at 4 p.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

I have two special guests today, who I will introduce in a moment. But first I’m going to explain why I chose them. I started reporting on health policy in 1986, covering health and welfare on Capitol Hill and at the Department of Health and Human Services for what was then the Congressional Quarterly “Weekly Report.” This month marks my 40th anniversary on the health beat, and as anniversaries so often do, it got me thinking about everything I’ve seen and covered, including a half a dozen major health reform fights, a dozen budget reconciliation bills, years-long fights over everything from the Patients’ Bill of Rights and human cloning to bioterrorism and a pandemic. It also got me thinking about where I thought the U.S. health system would be four decades after I began, and where it actually is. And I thought it might be fun to reminisce with a couple of people who not only were there when I started, but who also taught me a lot of what I know. So without further ado, let me introduce my guests. Chip Kahn just stepped down as president and CEO of the Federation of American Hospitals after 25 years in that post. Chip previously worked in both the House and the Senate for the major health committees and also headed the Health Insurance Association of America, the industry group now known as AHIP. I’m pleased to announce that Chip is not actually retiring 鈥� that, among other activities, he’s going to be a colleague of mine here at 麻豆女优 as a senior fellow. Chip will also host a podcast starting later this spring on the business of health care. Chip, thanks for being here, and welcome. 

Chip Kahn: Really happy to be here and celebrate with you. 

Rovner: Joining Chip is Chris Jennings, who not only worked in the Senate for a decade, but also worked in the White House as a senior health staffer for Presidents [Bill] Clinton and [Barack] Obama and advised President [Joe] Biden as well. Today, Chris is president of the health care consulting firm Jennings Policy Strategies. Chris, welcome and thanks for playing along. 

Chris Jennings: Julie, it’s been great to age together. 

Rovner: So let’s start with a little bit of a tour of each of your careers. Chip, you go first. How did you first get started in shaping health policy, and what was your trajectory to today? 

Kahn: It was a scary long time ago. I guess I got started in politics in 1968, actually, when I met Newt Gingrich in New Orleans and then managed his two congressional campaigns. But then I went to graduate school in public health, and finally broke into the Hill in 1983 and worked for a year for Dan Quayle, and then worked in the Senate, worked in the House, went out and worked for the health insurers, came back and worked in the House again during the ’90s 鈥� many, many years of health policy. And then, as you said, for almost 25 years, worked at the Federation of American Hospitals, representing 20% of the hospital industry and all the health policy battles. 

Rovner: And behind your head it says “AEI,” so in your not-retirement, you’re going to be here at 麻豆女优, and you’re also going to be at AEI [American Enterprise Institute]. What else are you planning on doing? 

Kahn: Well, other than being a think tanker 鈥� and a podcaster, I’m looking at a number of areas where I’d like to do some writing on the health policy issues that I’ve been involved with over the years, and maybe try to impact their future by some of the things I have to say. That’s my, will be primary, although I’m also working with the dean of the School of Public Health at Tulane on developing a health policy center there. And I do photography, street photography, and I’ve got a project there too. So I’m not retiring. I’m just moving on. 

Rovner: You are busier than I am, and I thought I was busy. Chris, how did you come to health policy? 

Jennings: Well, I know you’re a Michigan gal, Julie, but I’m from Ohio. And I came, actually, the same year that Chip came in, in 1983. John Glenn hired me as a very, very young assistant. I don’t think I got to know you until 鈥� 1986, shortly behind. But I remember in ’86 I was hired by the chairman of the Aging Committee, the then-chairman of the agency committee [Special Committee on Aging], John Melcher, and he held the first hearing in a blizzard on the Medicare Catastrophic [Protection] illness coverage Act, and I worked through 鈥� that was ’88-’89, we repealed the policy, as you will recall. By that time, you may have moved on to the National Journal. I can’t even remember when you were there and in NPR, but I followed you as you followed me. And I worked on another chairman, David Pryor, on the Pepper Commission, where I got to know Chip 鈥� love, hate, mostly respect Chip 鈥� on the Pepper Commission, which both succeeded and immediately failed.  

Rovner: And we’ll get to that.  

Jennings: And it set the stage, really, and that’s where I think people started to know me on the Aging Committee, on the Finance Committee, on the Pepper Commission. And then, I’d go on and on. But, of course, I was eventually tapped to help Hillary Clinton do the Health Security Act, where we spectacularly failed, but learned our lessons, and we moved on. And I was there for all eight years of the Clinton administration, set up my own consulting firm, went back into the White House, as you said, and have been proud to be involved with some, you know, both extraordinary successes and failures, but progress that I think sometimes people don’t acknowledge in this debate. So hopefully we get to talk about that as well. 

Kahn: You know, Julie, one thing I think you can say about both of us is that there hasn’t been anything congressionally in delivery or financing, over your entire 40 years, that Chris and I were not involved in in one way or another. 

Rovner: That was why I decided I wanted you guys. I well know that you’ve had your fingers in everything this entire time. Well, let’s go back to the spring of 1986, when I first started covering health care on Capitol Hill. Congress was just finishing the COBRA [Continuation of Health Coverage] budget reconciliation bill, for which the health care continuation provisions that everybody knows are named, even though that was just one of literally hundreds of provisions, of different health care provisions in that bill. And from the “Some Things Never Change” file, that bill was very late. It had been kicking around since the middle of the year before one of the first big feature stories I wrote that spring was about how the U.S. had no real program to pay for long-term care for the elderly, something that is still true today. What were you guys focused on in 1986? 

Kahn: I think in 1986, as you said, every year during the ’80s and into the early ’90s, almost like clockwork, there was a budget bill, although some of those budget bills, like COBRA, lapped over. And I could, I could recite, until about 1990, I think, all the key provisions of every one of those bills. So whether it was Medicare in terms of payment modifications and payment improvements, or payment reforms, or whether it was Medicaid in terms of incrementalism, in terms of expanding to different populations. You know, we sort of saw it all. 

Jennings: There were notable reforms. In fact, it’s important to remember back then, health care really was the domain of the Congress. Presidents, barely, you know, they were for technical assistance, they provided information. But the big players in health care in the ’80s were 鈥� and it’s a very impressive group of people, both members and staff. And I don’t want to sound like an old person, but those were days when you actually did get bipartisan policies done. They weren’t easily done, but they were done, and I think it’s important to recognize that. I go 鈥� you’re saying ’86, so I’m going to stick with ’86. But ’86 was a big year 鈥� I think that was also 鈥� when did we do COBRA? ’85-’86 we were implementing COBRA.  

Kahn: It was done in ’86. 

Jennings: Yeah, ’86. 

Rovner: It was in COBRA. 

Jennings: Yeah, yeah. So, you know, that is, again, a policy that a number of people actually do utilize and it’s very, very important. 

Rovner: And EMTALA was in that bill. 

Jennings: EMTALA was in that bill, yes. 

Kahn: But besides these bills, and you brought it up, Medicaid Catastrophic, which was started a little bit after that, actually was a Reagan administration initiative. Dr [Otis] Bowen, the secretary of HHS [Department of Health and Human Services], was the major proponent. Then it became, obviously, very congressional. And so the major piece of health legislation that was just a health bill that wasn’t connected to one of these big budget bills, these big reconciliations, it passed, and it passed overwhelmingly in both chambers. After a lot of work, we could talk about that, if you want. And then within a year, you know, it was repealed. And one of the weird experiences of my life, was that, on the one hand, Bill Gradison in the House was one of the original framers of that legislation. 

Rovner: Your boss at the time. 

Kahn: One of my bosses at the time. But the day before repeal was considered in the House, I had to write for Bill Gradison a draft of a statement for him. And I, but I also worked for Bill Archer, who was one of the authors of the Archer-Donnelly amendment, which would repeal Medicare Catastrophic. So I also had to write a draft of a statement for him. Actually, let me say, I didn’t write them on the same day because I couldn’t bring myself to. But I was really sort of 鈥� I got to be careful here 鈥� “schizophrenic” on the issue, because I worked both on the legislation and then on its repeal. 

Jennings: Julie, also, I just have to say there’s another irony that I think no one knows really about, but the lead sponsor of the repeal was John McCain. John McCain, who raised all the issue of the so-called surtax, OK? Do you remember this? 

Rovner: I do. I wrote a big story about John McCain. 

Jennings: People think John McCain is Mr. Savior of the Affordable Care Act, but he also repealed the most significant, at the time, bipartisan, bicameral health care reform bill that actually, we should also say, did include an incremental Medicare prescription drug benefit. 

Rovner: John McCain was very sorry. He actually felt bad that he ended up 鈥� he tried to undo the repeal that he led. 

Kahn: And also, there was a secret weapon in there, which actually was very expensive, which was a Bill Gradison initiative, which was to change the skilled nursing facility benefit so that Medicare would basically cover six months without three days prior hospitalization.  

Jennings: Yeah. 

Kahn: And that was something that CBO said, the Congressional Budget Office said would just cost a few 100 million dollars. It was actually costing billions almost immediately, because all the states immediately changed those dual-eligible patients, dual eligible for Medicare and Medicaid, and made them Medicare patients because of the six months. So there was even a long-term care provision in there, despite the fact that some felt that Medicare Catastrophic didn’t touch long-term care. 

Rovner: Well, while we’re on the subject of the poor, be-knighted, repealed Medicare Catastrophic bill, which we all experienced, that led to the Clinton health reform bill. Chris, you were instrumental in that. What had you learned from the passage and repeal of catastrophic that you tried to put into place when you were working on the Clinton plan? 

Jennings: Sure. Well, first, Julie, I think we learned from all of our mistakes, and you learn more from your mistakes than you learn from your successes. And sometimes you mislearn your successes in major ways. But I do want to say the one thing that we did not repeal in the Medicare Catastrophic [Protection] coverage Act was the Pepper Commission. And the Pepper Commission was the first attempt to do the comprehensive reform proposal, and it was reported out, but in a really humorous, terrible scene, which I won’t bore people with, but 鈥� Chip was there, and I was there, and it was painful, and that people actually almost came to blows over that policy. Physical, physical blows between my boss, David Pryor, and Pete Stark, of all people. So that’s another story. But yes, after that, there was a[n] election in Pennsylvania 鈥� and this is sort of interesting historical context 鈥� it was a special election by [Sen.] Harris Wofford, who won, and it was all about health reform. And his political advisers, interesting, was James Carville and Paul Begala, and health care suddenly became, comprehensive health care reform became, oh, this is a big issue. And every candidate who was running at that time 鈥� really, people who 鈥� no one even knew the people running, because no one wanted to run against George W. Bush 鈥� but Bill Clinton was running against it, and he, he ended up winning, as you know, and then he chose 鈥� 

Rovner: It was George H.W. Bush. 

Jennings: George H. 鈥� George H. was so popular that the primary Democratic candidates didn’t want to run against him. So people just said, I’ll just try. And, long story short, Bill Clinton wins. And he designates Hillary Clinton. And Hillary Clinton, because I had done some work for their campaign and helped in the transition, I was asked to become the congressional liaison. So now, what did I learn from that? Well, there’s so many things to learn, and we applied them almost all to the Affordable Care Act. And of course, we’re going to have to give Chip his 鈥� you know, Chip’s the star of “Harry and Louise,” and proudly contributed to 鈥� 

Rovner: We’ll get to that. 

Jennings: 鈥� the demise. But I will say, even if we had perfectly executed the Health Security Act policy, because of the time and the delay of it and how in the environment in which it was in, it probably would have been very, very difficult to pass and enact at that time. We can talk about that. But one thing we learned is it’s really important for presidential candidates to have a vision and a way to finance their vision, but not to micromanage exactly the specific policies you need to get congressional investment in those policies. And if you impose details, the details will get, will be picked apart before you get the momentum to pass legislation. And you won’t have time to get both members of Congress and stakeholders, who inevitably you can’t pick, you can’t have everyone be your enemy if you’re going to pass health care reform, and we succeeded in getting most everyone against us. That wasn’t completely my fault, but sure, I’ll take whatever responsibility there is. But those are two big reasons. You know me, Julie. I could go on forever, but I’m going to stop with that and let Chip take his victory lap or whatever. 

Rovner: Yeah, because Chip, at that point, you were with the health insurers, who were not thrilled with the Clinton plan. 

Kahn: Well, let me say this. I always have to say this when I talk about the Health Insurance Association of America. Bill Gradison went over there in early ’93, and he took me with him. I was his executive vice president at that point. And the health insurers that we represented were for some kind of universal coverage structure. They weren’t for the model that was developed by the Clinton administration that they took to Congress. But I think Chris made a very important point: All the noise from the campaign around “Clinton Care,” pro and con, there were a lot of things going on. First, a new administration only gets so many bites at the apple, even if they’ve got big majorities in Congress. And they chose to do their big budget bill and a gun bill, which were very difficult votes for many members of Congress, before starting, in September, on the Hill with the presidential speech to lead into health reform. So I think they went in with a clock that was against them, in terms of how much a new administration has. Second, I don’t think everybody completely understood it at the time, but we had congressional control by the Democrats of the House for 40 years, and in some ways, they were a bit bankrupt, and there were a lot of issues around, you know, their unity. And we didn’t know it until the election in ’94 鈥� and Clinton Care had had some effect on that election 鈥� but we were about to see the Republican revolution taking place. But the soundings of that and the effects of that played out in Clinton Care. But, all that being said, if you believe that campaigns make a difference in policy process and elections, there were campaigns that said Clinton Care, as proposed, needs to change. And the Health Insurance Association of America did the Harry and Louise campaign, which I managed. And actually there was one point 鈥� 

Rovner: I would say, for those who don’t remember, Harry and Louise were a couple of actors. Those were their names, actually, Harry and Louise, who sat around their kitchen table wondering how they were going to pay for their health insurance if the Clinton plan passed. 

Kahn: And that concept came from over the summer, leading into that August, before the Clinton Care process began in Congress. Bill Gradison had been going around giving speeches, saying that health reform was going to be decided around the kitchen tables of America. So I told our advertising firm, First Tuesday [Strategies], go test that. And that’s how it all got started. And they came up with the concept, and we spent a lot of time on scripts. And our whole point was not to defeat but to raise questions and actually just get a seat at the table. Well, I could give anecdotes about why we didn’t get a seat at the table, and thus we began a campaign that was one of the components of the opposition to health reform that really defeated Clinton Care. 

Jennings: And Julie, I’ll just say I think it’s important to note that we also played into it by complaining so much about [how] it got lot of free airtime, too. So then the media covered it even more than the other one. And so it was the amount of money they paid for those ads versus the amount of ads people who see that ads was an extraordinary ROI [return on investment] for Chip Kahn and Bill Gradison. But I do feel it’s important to note that a lot of the predicate for rationale behind and policy underpinning the Affordable Care Act, you’ll find a lot in the seeds of the Health Security Act, and then you’ll see them again in the debate between Barack Obama and Hillary Clinton. And in many ways, Hillary Clinton’s policy is more like what ultimately was passed and enacted in 2008 and 2009. So it’s a very interesting circle of the process. And the other thing that I think people don’t understand, is, right after that we had another health care debate, which was the “Contract With America” and, or on America, as we used to call it, and, and that was a huge Medicare-Medicaid fight, which didn’t, which also failed. But I think you almost had to have these two attempts to have an attempt to make some progress. That led to things like the Children’s Health Insurance Program and beyond, so all of which 鈥� and by the way, HIPAA, insurance reforms beyond that 鈥� which began to lay the predicate for it. Yes. 

Rovner: All right. Well, we’re going to take a quick break. We will be right back. 

OK, we’re back. In the 1990s, after the death of the Clinton health reform plan, there was this huge sort of flow of big, important health bills: the Children’s Health Insurance Program; like you say, HIPAA, the Health Insurance Portability and Accountability Act, which was a whole lot more than just the confidentiality provisions. In fact, my favorite piece of trivia is that there were no medical records confidentiality provisions because it was a requirement for Congress to write them, which they never bothered to do.  

Kahn: If you want an anecdote on that, I’ll give you an anecdote.  

Rovner: OK. 

Kahn: That’s there because of me. But I can only take credit for a few things: diabetic shoes and HIPAA confidentiality. 

Rovner: I do remember diabetic shoes, but I will not make you explain that. But do explain how the confidentiality 鈥� because HIPAA was actually about being able to change jobs without losing your health insurance 鈥� it was literally about portability of health insurance, and the confidentiality stuff got tacked on at the last minute. 

Kahn: No, no, no. It didn’t. It didn’t. No, the point of HIPAA 鈥� and, frankly, I wasn’t the author of this; I sort of stole this idea 鈥� but HIPAA was either the seven-point plan or the nine-point plan. And the idea of the way we structured HIPAA in the House was to take four or five different things 鈥� and it was, it was much more than just insurance reform 鈥攁nd build out aspects of health reform, sort of small-ball health reform. And the confidentiality was one part of it. And we thought at the time that there was an administrative simplification portion of the bill, which came from a congressman from Ohio that, frankly, as a staffer, I was the one in the House that put that in the bill, and I and our expectation was that Congress would come back and do confidentiality, but we needed to require it, to set a framework for it. And there was one day when the bill was in conference, when Dean Rosen, who was working for Ms. [Sen. Nancy] Kassebaum 鈥�  

Jennings: Yeah, it was Kassebaum. 

Kahn: 鈥� called me and said, Do we really have to leave those lines in the bill? And I said, Boy, it’s really, really important. And the congressman from Ohio feels strongly about it, and Mr. [Rep. Bill] Thomas feels strongly about it. And so that’s why we got HIPAA, and then, then they couldn’t legislate on it because it was too sensitive, but we put language in, and HHS wrote the rules. 

Jennings: I think it’s really important to note that in the olden days, when we started this, Congress actually gave much more explicit guidance to the executive branch as to how they implemented. HIPAA was a good example as a bridge to where we are today, which was we will do something. This is what we were saying in HIPAA. But if we fail to do so, we authorize you, executive branch, to implement the provisions of HIPAA, which is what ultimately the Clinton administration had to do. And a lot of that is because the Congress couldn’t agree on the details, as they often can’t, but they still want to be associated with the underlying policy. But anyway, it’s just another lesson of the life that we were at and where we are now. 

Kahn: And when you say, wouldn’t agree on the details, the trouble is that the poison pills, those cultural issues, frequently come into issues here. I mean abortion and other issues, which are extremely important issues, but they’re cultural issues, and people are not generally willing to compromise on those. And those are the issues that ended up holding up things like confidentiality, which Congress should have acted on. 

Rovner: Yeah, I want to get to the Affordable Care Act, but before I do, Chip, I want to talk about the strange bedfellows. Because I want 鈥� you were talking about in the context of the Clinton reform, that the stakeholders weren’t really against it. They were only against parts of it. I think I wrote in a monograph on this that everybody wanted to cut off just one finger, but, in the end, the patient bled to death. You wanted to prevent that from happening when there was the next round that became the Affordable Care Act, and you got together with Ron Pollack, who was, you know, a very liberal, also outside group. And you guys tried to put together a framework, right? 

Kahn: Well, when I went to back to the Health Insurance Association of America in 1998, Ronnie Pollack and I got together and wanted to see what we could do. I mean, in a sense, we both really agreed that we needed various kinds of coverage expansions. We started incremental. And as part of that, the Rob[ert] Wood Johnson Foundation came in with a major initiative to fund us and to fund the conversations we began, and to fund other groups coming in and joining us in a big coalition. And, frankly, we were very close on some subsidization. We had a Republican and Democratic senator right before 9/11 and then 9/11 happened, and it just 鈥� killed us. And 鈥� we got put on the back burner. And so then we went through many years of Ronnie and I doing a lot of different efforts with many other stakeholders 鈥� around either doing small-ball expansions or pushing for the ultimate 鈥� and that, ultimately, I think, at least helped fuel what happened in ’09. I mean, a lot of things led to ’09, but at least, I think, our effort laid a base of commonality across stakeholders that made ’09 very different from ’93. 

Rovner: Chris, you said that, you know, one of the things that you learned from the failed Clinton health reform is it 鈥� you’ve got to have at least some of the stakeholders inside the tent, right? 鈥� That seemed to me one of the big changes between 1993 and 2009. 

Jennings: Yes, I mean, like every story that sounds black-and-white, there’s grays in those. But yes, for sure, and I do agree that the larger insurers knew the market couldn’t 鈥� at least the individual, non-group market had to be reformed so that they didn’t 鈥� they’d make their money on avoiding sick people. They needed to have a pool of people that they could insure, and it wasn’t an irrational, expensive, immoral health care system. So I felt, and to Chip’s credit a lot, and others, they wanted to have. 鈥� And actually, the other argument that happened in 2008 and ’09, there’s a lot of different things that came together. Bipartisan Policy Center was there. There was interest in doing comprehensive reforms that were very consistent with what the Affordable Care Act ended up happening. But there was also this notion of all the stakeholders were just tired of fighting, and it was like, Let’s get something together. There’s one last point that I think people neglect to cite, and I know Chip would agree. At the time, there was a concern that a lot of the savings from health care would go to something like deficit reduction or tax cuts, but not reinvested in health care for coverage expansion. And so when, you know, if you’re a stakeholder and you’re going to contribute something to the offsets, you want to be reinvested in your system so you have paying customers, and that’s why I think the hospitals and the physicians and the insurers all came together to say, let’s figure out a way that this can work. So that at least helps paint the picture about how you could tie it together. 

Kahn: And one experience that I had was that I brought 鈥� I was then working by the early 2000s for the hospital association, the Federation of American Hospitals. And at that point, you know, obviously my members were supportive of the work I was doing with Ronnie. But there came a point, I can remember it to this day, in October 2006 we were having a meeting, and a number of the CEOs of the systems I work for came to me in a meeting and said, This isn’t good enough. There are just too many patients that we’re treating that don’t have insurance, where their finances are getting in the way of the care they need, and we got to have something comprehensive. So they moved away from, not that they didn’t support incremental changes, but they wanted to see the big picture done, and that led the Health Insurance Association 鈥� we were a small group 鈥� to develop our own plan, the health care passport. And there were other plans out there. And the increment, the very important thing about that plan and the others and the way that ’09 worked was that in the administration and in Congress, they wanted to build on what works in the system, and reform the individual market and lay in enough subsidization and expansion of Medicaid so that we could say everybody has the opportunity for coverage. Now we could say that was not that different from ’93 and ’94, but it was handled completely differently. And I think it was more sensitive to all the concerns of all those that were stakeholders, that were players. And that was the framework, but it was building on what exists with those kinds of playing with the knobs that really made the difference, that you could say everybody could have access to coverage. 

Rovner: So as we’ve kind of talked about, up to 2009 health care was pretty bipartisan. I mean, you know, there were partisan fights. There are obviously fights that Chip, you noted, that were going to be perennial, like fights over abortion. But, generally, big things that got done got done with Democratic and at least some Republican votes, or, you know, Republican 鈥� in the case of the Medicare prescription drug bill, Republican and some Democratic votes. And yet, you know, in 2009, it just suddenly became partisan in a way that it still is today. I mean, what happened? 

Kahn: Well, let me say it’s very, very important to think of the broader context and not just focus on health care for a second. A lot was changing. The Tea Party, we go on and on about how we got to where we are today, and the great divide. So there was a great political divide. There was no more getting 鈥� there was much less getting to yes in Congress. And I think that health reform, in a sense, suffered from that. And the other dilemma that health reform had, I think, which was it was successful because of the vast Democratic majorities. They didn’t need the Republicans. On the other hand, the fact that 鈥� and the Republicans wouldn’t play, so I’m not saying there was a possibility there 鈥� but the fact that it got done in a partisan fashion, you know, fit into a larger context that made it part of the divide. And, frankly, after it passed 鈥� and, obviously, hospitals were very supportive of it 鈥� there were a lot of Republicans that would never speak to me again. 

Jennings: Yeah. And Julie, I think it’s important to recall that even back in ’93-’94, around the Health Security Act, there were Republicans who wanted to do this, but 鈥� and I’m sure Chip will yell at me about this 鈥� but Speaker Gingrich was not interested in having a health care achievement signed into law by Bill Clinton. He made that very, very explicit. So I think different people will say, When did partisanship around health care really start? But I would say there was a big one. Then we had the big fight around the “Contract With America,” and from then on, even though there were significant reforms that were bipartisan, I would call them important, but incremental, you know. And Chip’s right. I don’t think you could have gotten anything close to the Affordable Care Act on a bipartisan bill. Maybe he’d disagree, but I just, I don’t think there are some Republicans 鈥� I’ll tell, I can even tell you 鈥� who would say, Oh, if you’d only tried or whatever 鈥� I think [Sen.] Max Baucus [the Finance Committee chairman] really wanted, you may recall this. He worked for a long time. He desperately wanted to have bipartisanship. I don’t think that was going 鈥�  

Rovner: Yes. And I sat in the hall during those meetings for weeks at a time. I remember. 

Jennings: Yeah, yes. You remember? I mean 鈥� and to the criticism of a lot of the Democrats, what are you holding up for? So unfortunately, there are elements of health care, and I think a lot have to do with coverage 鈥� Medicare, Medicaid, marketplace, the three M’s, if you will 鈥� that are very hard not to politicize. And unfortunately, public health has now become very politicized, too. So we’re having a smaller [unintelligible] of elements of health care that you can see bipartisanship. But 鈥� there are some, and I’m sure we were going to talk about that, but I look back and reflect about that debate, and I don’t see a possibility of where it would have worked and Barack Obama would have been able to achieve what he said he was going to achieve. 

Kahn: Well, let me say a couple of things. First, I think, to modify your history. I think that in the House 鈥� 

Jennings: Yes. 

Kahn: 鈥� Newt wasn’t speaker at the time, he was minority leader. Clearly, there was nowhere to go with Clinton Care. I mean, the Republicans just were not going to go. I think you saw something quite different in the Senate. And there were many Republicans in the Senate, probably not a majority of the conference, but a very large minority who were willing to at least try 鈥� but I think the environment completely changed over time, and by the time you got to 2009, 2010, despite some kabuki theater on the part of some Republican senators, who I won’t name, who sort of played along, they were not going to cooperate. But let me say, one of the turns in history that’s important is that you’ll remember the Democrats had 60 votes in the Senate until the end, when, unfortunately, Sen. [Ted] Kennedy died. But actually, I would argue that it was his death, in a sense, that ultimately led to health reform passing, because a conference report on health reform between the House and the Senate probably wouldn’t have gotten all the Democratic senators. I don’t think Sen. [Ben] Nelson [D-Neb.] could have done it, so you would have had a filibuster against it. But by [Kennedy] dying, the House was forced to take on, for the bulk of health reform, the Senate bill, and they passed the Senate bill. Yes, there was a reconciliation later, but it was really, that was the framework for health reform, and in a bizarre way, it was the contribution of his death and the 鈥� House having to accept the Senate bill that led to health reform really passing, you know, by the skin of its teeth, even though there were these vast majorities of Democrats in the House and Senate. 

Jennings: Yes, I think that’s a very insightful comment, and I rarely say that about Chip. [Kahn laughs.] So, no, I do all the time. It is, but Kennedy, the sacrifices Kennedy would make to become the ultimate legislator, even to go so far as to die. But I will say, I think that’s right, because there was a very significant frustration amongst the House Democrats, and they desperately wanted to have a true conference, and that would have made it very hard in the Senate. It would 鈥� have been hard to clear through reconciliation rules in the Senate. And there would have been lots of challenges, and, ultimately, this is why Nancy Pelosi gets most of the credit, and so too should Harry Reid. They brought it home in a way that probably was the only way to get it done. And subsequently, one of the problems was it probably wasn’t drafted as cleanly as we would have liked it to be. You know what I’m saying? 

Rovner: Yes, I know what you’re saying. For those who, for those of us who had to follow this sort of ins and outs of the not being able to make technical corrections to it for its entire history 鈥� which, flash-forward to today, is there any chance of ever getting back to bipartisanship on health care? 

Kahn: I don’t think on anything regarding delivery and financing that’s major is there much likelihood of consensus. Now, if you remember, not too long ago, there were bills on, you know, FDA processes and the such, and they were done in a bipartisan manner. And maybe some of those things at the edges. I think there are some hospital issues and others that still could be dealt with in a bipartisan manner. But that gets back to context. You’ve got to have the sun and the moon come together on political context that would allow some 鈥� I won’t call them marginal, but 鈥� relatively small changes to be legislated. Other than that, we’re in an environment right now where I just don’t see compromise on anything big, because the divide that we saw coming out of ’10 is still there. And if anything, it’s just deeper than ever. 

Jennings: Right, and 鈥� although I don’t think Chip would disagree with 鈥� what I’m about to say, is, there are issues that are not so much ideological in coverage: biomedical research, transparency, even physician payment reform, rural health, telemedicine, community health centers. I’m just mentioning these out loud, because you’ll see bipartisan agreements on some of those things. But in terms of real structural reform, and particularly when you’re talking about where people get coverage and how much you subsidize it, boy, is that tough. In fact, I would even argue, and this is really unbelievable to say out loud, that cost containment in some fields, which is almost always impossible, is easier than how you spend the money. Because people don’t, can’t agree on the structure by which you would reallocate the savings to make health care work. So it is a frustrating time, which is why it’s hard to make the argument against people who say, then we need to have all one party or the other party to get something big done. 

Kahn: Now, let me say I think there could be some surprises next year if the Democrats took over in the House. You know, is there some possibility that there could be a big compromise with a Trump administration in the future on drug negotiation or drug costs? So I don’t want to say that there’s nothing that can be done. And I agree with, and I think I said, with Chris that there are these issues around the edges that could be dealt with, and the ones he outlined are the ones that I would agree with. I think the one big one is there is some possibility around drugs. But I think, other than that, I don’t see the Republicans being willing to help on Medicaid. 

Jennings: And that is a cost containment as opposed to kind of a coverage, you know. And it’s sort of a one-off. It isn’t, you know, big, big reform. But I agree with Chip that there you could see Democrats in the House push something that [President Donald] Trump would endorse, that Republicans in the Senate wouldn’t like to pass but would. 鈥� They probably would want to have come up with an excuse not to. But that’s, that is a target area that could happen. Although, you know, I’m 鈥� Democrats aren’t catching, counting our chickens just yet, Chip. 鈥� We’re knocking on wood here. [knocks] 

Kahn: Yeah, let me say, if the Congress doesn’t change, in terms of who has the majorities in both House and Senate, I don’t see anything major, other than some of the things, you know, transparency and some of these other issues, getting attached to something bigger. And then you’ve got to have context, as I said, the right context to have it. But I don’t see anything big unless we get split government. I think split government could lead to some interesting things in some of these areas. But what we think of as health reform writ large, right now, it’s just politically charged. 

Rovner: We’re going to have to wrap up. But one thing that I’ve been sort of thinking about a lot is that we seem to be getting to this place that we were in in 1993 again, and in 2008 again, where everybody is unhappy with the system 鈥� that, particularly patients, even people with insurance, are unhappy with the way the system is working. Doctors are unhappy, hospitals are unhappy, insurance companies are unhappy. Is it possible that that’s going to push this big divide a little bit back together, at least in an effort to do something? I mean, clearly President Trump knows that people are unhappy with the cost of drugs, if nothing else in health care. Do you think we’re heading for another round of major health reform debate? 

Jennings: It feels like that, Julie, for sure, ’91-’92-ish, or, you know. It does not feel like in any way. 鈥� I think people are really frustrated with costs, really frustrated with complexity, really frustrated with how they think the system is not necessarily responsive. They’re pretty good at kind of defining the problems, but in terms of developing a consensus around how best to do that, which is, you know, typically what people say, I want comprehensive reform that doesn’t disrupt me, you know, which is a hard nut to crack sometimes. But 鈥� it feels like we’re seeing it. And you’re going to hear a lot about talk, but I think you’re 鈥� the big thing will happen around a ’27-’28 period, when the two open electorates for presidency come up, and 鈥� this issue will be absolutely debated. But the big, big thing probably isn’t going to happen until the next president is elected. 

Kahn: So let me say this, and I’m going to give a plug to 麻豆女优’s Business of Health With Chip Kahn, a podcast that will come sometime in April. 

Rovner: Absolutely. 

Jennings: He’s shameless. 

Kahn: We’re going to 鈥� focus on AI [artificial intelligence] for the first three or four months. And I don’t want to say it’s going to change the world. It’s going to change the world. I don’t want to say it’s going to change health care. It’s going to change health care. Is it going to solve all these problems? I don’t know, but I think many of these issues could be different five years from now because of the effect of AI, and will doctors be practicing the same way they are now? Will all these issues of thousands of people working with green eyeshades in hospitals to make sure the claims are done right, they go to insurance companies. With respect to those thousands of people, it’s going to be AI. 鈥� They’re not going to have jobs anymore, and it’s going to change a lot. Now, is it going to solve any of these problems, or is it going to raise risks and challenges we can’t even foresee? I don’t know, but I think we’re going through, about to go through, an evolutionary period, and I don’t know what it’s going to look like on the other end. 

Rovner: Well, I think that’s as good a place as any to leave it. I want to thank both of you. I could definitely go on for another hour, but we won’t. Chip Kahn, soon to be a fellow at 麻豆女优. Chris Jennings, Jennings Policy Strategies. Thank you very much.  

Kahn: Thanks a lot. 

Rovner: OK, that is this week’s show. As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer this week, Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org. We’ll be back in your feed next week with all the health news. Until then, be healthy.

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Julie Rovner: Hello from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Feb. 26, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

Today, we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: And Sheryl Gay Stolberg of The New York Times. 

Sheryl Gay Stolberg: Hi, Julie. 

Rovner: No interview this week, but more than enough news, so we will jump right in. So we watched all the nearly two hours of President [Donald] Trump’s longest ever State of the Union address, so you wouldn’t have to. And if you’re interested in what he had to say about health, you really only needed to tune in for about five minutes, during which he took a victory lap for lowering drug prices, which he kind of did and mostly didn’t, and announced that Vice President JD Vance will henceforth be in charge of fighting fraud in health and social programs, which we’ll talk more about in a moment. Yet, just last month, President Trump told House Republicans at their retreat that health should be front and center as an issue for the midterms. What happened to that strategy? 

Weber: I gotta be honest, I was shocked. I mean, 麻豆女优 recently had a poll saying that health care costs are top of mind for voters, so the fact that he spent only five minutes of the longest State of the Union talking about health care, I think, is quite notable. And he had stuff he could have talked more about, on affordability, that he did mention when he got to it. I think some of it was a lot of the State of the Union did focus a lot on, you know, the hockey team and other various awards. 

Rovner: Yes, the Olympic hockey team came marching in through the press gallery. That was something I’ve not seen in my 38-something years as a State of the Union watcher 鈥� 

Weber: As a former high school field hockey goalie, I’m a big fan of the goalie getting the medal. But it did take away from some of the more policy topics. So again, health care costs 鈥� top of mind for people 鈥� seems like a missed opportunity. 

Stolberg: Here’s my take on that. First of all, I think we know why Trump said he was going to let Bobby [Health and Human Services Secretary Robert F. Kennedy Jr.] go wild on health. Because Trump doesn’t really care that much about health care. He finds it complicated. He has said so. I’m sure you remember from the first term, Who knew health care was so complicated? In addition, TrumpRx, I think, OK, he can point to that. Gonna say, he can trumpet that, no pun intended. But his health care plan is barely a concept of a plan. He doesn’t have a plan. His notion of directing money into health savings accounts to help people buy health care, quote-unquote “outright,” you know, is just not workable, and it’s vague. Republicans on Capitol Hill have a number of thoughts about how to achieve that, but he doesn’t really have anything to offer, and he’s got to deal with these Obamacare subsidies having been replaced. So I think this has always been a weakness for Republicans. And if there’s one strength that Trump has, it’s kind of the MAHA [“Make America Healthy Again”] movement, which is itself, and we’ll talk about this later, you know, fractured. And he didn’t mention that at all. 

Ollstein: Not only did he not spend a lot of time on this, but he exaggerated and sort of misrepresented the few things he has done. And I think there is a big political danger in that, if you say, We solved drug pricing, we brought down your drug prices, and the voters don’t feel that, when they go to pick up their drugs, they cost just as much. There could be a backlash there. And so I think there’s a risk to not focusing on this overriding issue enough, but I think there’s also a risk in overpromising and underdelivering to voters. 

Rovner: Yeah, you’ve anticipated my next question, which is to do a quick fact check on some of those claims, particularly the one that he lowered drug prices more than any previous president. He has indeed negotiated deals that have lowered some drug prices for some people, mostly those who buy their drugs without insurance coverage. But I think you could argue that Presidents [Bill] Clinton, [Barack] Obama, [Joe] Biden, and even George W. Bush, who signed the big Medicare prescription drug benefit bill 鈥� all those presidents signed legislation that had a much bigger impact on what Americans pay for their drugs than Trump has at least so far produced, even though he talks about it a lot. 

Stolberg: I think that’s a really good point. Medicare Part D was huge. You know, it had its flaws. It inserted the provision barring Medicare from negotiating directly with companies, which Joe Biden, you know, with the Inflation Reduction Act, partially overturned, or at least dug into. But I think that was an inflated statement, to say the least. 

Rovner: Yeah, and I think Alice is right. This is going to be lived experience for a lot of Americans. It’s like, Wait, I thought you said you lowered drug prices. I’m not seeing my drug prices much lower yet. 

Ollstein: Well, the Democrats found that as well when, you know, they passed meaningful things, but things that didn’t kick in before the election. And so the message didn’t line up with the lived experience, and it didn’t have the political benefit that they were hoping it would. 

Rovner: Yeah. Now, Trump also said, and I quote, that “I want to stop all payments to big insurance companies and instead give that money directly to the people.” Now I think he was talking about the Affordable Care Act subsidies, which have been the topic of much debate since last year. But the fact is that the federal government gives lots and lots of payments to big insurance companies through Medicare and Medicaid, particularly Medicare Advantage, which was part of that big bill that George W. Bush signed in 2003. I imagine this is giving health insurers some pretty major heartburn right now. 

Stolberg: It’s always easy to beat up on the insurance companies, right? Like, they’re a very easy target. But, you know, we had a fact-check team at the State of the Union address the other night. I was on it, and I fact-checked this statement, and I wrote, “This is misleading.” I said he’s, you know, proposed redirecting insurance subsidies into health savings accounts, which people could use to purchase health care services directly. And then, as I just stated earlier, it doesn’t offer specifics. And I quoted your analysis, at 麻豆女优, which says the president’s plan is vague, and without knowing more, it is impossible to say what the implications would be for people with preexisting conditions who rely on the ACA markets. So I think what’s bedeviling Trump is the expiration of these ACA extended tax credits, and he doesn’t have an answer for it. 

Ollstein: And the remarks at the State of the Union, I think, never say an issue is over, because we know in health care, things always come back in some form. Nothing’s ever over, but it could be read as the final nail in the coffin for the negotiations around reviving the ACA subsidies, if you have the president getting out there and saying no more money for big insurers, that doesn’t exactly help the few Republicans who are trying to negotiate something on Capitol Hill, get something done. 

Rovner: Although he has been on all sides of this issue. 

Ollstein: Oh, certainly. But in terms of messaging and the bully pulpit and where the energy is going, it’s not going into, hey, let’s cut a deal to bring down people’s rates, even if that includes giving money to the insurers, which, you know, of course, they’ve also misrepresented this issue. And, you know, where the money goes and what it’s used for has been, you know, sort of misrepresented. So it’s just a mess. 

Stolberg: If they called Obamacare “Trumpcare,” he’d give the money to the insurers. 

Rovner: That’s true. Maybe they should have done that at the time. Well, finally, about the speech about that fraud announcement on Wednesday, the day after the speech, HHS announced again that they plan to withhold Medicaid money from Minnesota based on fraud allegations. This is the latest in a series of efforts going after Minnesota and its Democratic governor and 2024 vice presidential candidate Tim Walz over what actually is a continuing Medicaid fraud problem that the state and the federal government have been working on for over a year. But now it’s complicated by the fact that, apparently, every single member of the federal task force that was working on the fraud cases from the U.S. Attorney’s Office in Minnesota have resigned over the feds’ immigration work. So they were working on fraud, but they’ve left for other reasons. When we talked about this last month, about the federal government withholding Medicaid funding from Minnesota, I asked the panel when other blue-state governors were going to start paying attention to feds’ withholding federal Medicaid funds from blue states. I guess that would be now. 

Weber: I mean, yeah, it’s a lot of money. I mean, Medicaid money would be a huge problem if a bunch of blue states lost it. We’ve seen selective targeting of blue states for public health funds. It seems reasonable to expect that to be coming for the Medicaid fraud. I think it’s important to note there is a fair amount of Medicaid fraud, and CMS [Centers for Medicare & Medicaid Services] has announced what looks to be a somewhat promising fraud initiative about stopping “pay and chase.” So, I mean, I think there’s a lot of story left on spool here on that front. 

Rovner: You have to say what pay and chase is. 

Weber: Oh, yes, so pay and chase. This is one of my one of my soapboxy things. I did an investigation with Sarah Jane Tribble back when I was at Kaiser Health News [麻豆女优 Health News] all about this. But essentially, the way the fraud system works here in the United States, which is kind of wild, is that people just pay the fraudsters money, and then the feds have to chase to get the money back, which is kind of crazy. It’s a system that many experts have explained to me is incredibly broken and leaves the taxpayer holding the bag, because often they don’t get the money back. So there is this new effort by CMS to utilize AI in a way that could really revolutionize how fraud is fought, but the selectiveness of which this seems to be being applied to Minnesota, or at least highlighted in Minnesota, leads to some political concerns. 

Rovner: I will add that part of this big new fraud effort is also going after fraud in durable medical equipment, which made me both smile and roll my eyes, because this has been a continuing problem ever since I started covering health care in the 1980s. Indeed, fraud is perennial. There’s a lot of money, some people are going to cheat to find it, and there’s always going to be an effort to work to ferret it out. 

Well, it was a busy news week beyond the State of the Union. Also on Capitol Hill this week, Casey Means, President Trump’s nominee to serve as surgeon general, finally got her confirmation hearing before the Senate Health, Education, Labor & Pensions Committee after she had to bow out of an earlier scheduled date last fall because she went into labor with her first child. Lauren, remind us who Casey Means is, and how’d the hearing go? Is she going to be our next surgeon general? 

Weber: So Casey Means is a health tech entrepreneur and someone with a large social media following who really got her bona fides from condemning the medical establishment, from leaving her residency and rising on podcasts and other talk shows, and through her entrepreneurship to promote this idea that the medical system is broken, and here’s how we can fix it. And when she finally got her hearing on the Hill, I think it’s really interesting, because she and her brother, Callie Means, really wrote the MAHA bible. They wrote this book called Good Energy, which a lot of MAHA principles are based off of. And what’s fascinating about a confirmation hearing for her is you see how MAHA, as a coalition, really doesn’t have a political home. There’s parts of it that Democrats really like, there’s parts of it that Republicans obviously really like, and there’s this awkward confrontation of that when you see this MAHA figure then questioned by both sides of the aisle. Something that she really exposed is a current deep issue in the MAHA movement, which I know Sheryl’s also , and she got a bunch of questions from both sides of the aisle on that. But the big takeaway, I think, a lot of people were focused on, as they should as surgeon general, was that she dodged a lot of questions about vaccination. She refused to explicitly say she would recommend the measles or flu vaccine, which is pretty shocking coming from a potential surgeon general candidate, but also in line with the MAHA movement and her political patron, Robert F Kennedy Jr. 

Rovner: And also, I mean, Sheryl, you and I were talking before we started taping that, I mean, she did, compared to some of the nominees for some of these jobs, she did a pretty good job. She was really smooth. She ducked questions in a way that one does duck questions, you know, saying thank you for asking that good question. But I know you were saying also, there’s some talk about whether or not she’s actually qualified to be surgeon general. 

Stolberg: That’s what I’m hearing today. I agree with you, Julie, that she was very smooth, and I was actually struck by how much her appearance reminded me of what confirmation hearings used to look like in the pre-Bobby Kennedy era, when nominees, you know, tried to entice politicians, tried to, you know, be engaging. She thanked Democrats. Thank you so much, Sen. [Patty] Murray, for engaging so deeply with these issues, you know, I want to thank you for our meeting that we had. I really enjoyed getting to talk with you, you know. And she is very knowledgeable, and she’s a smooth speaker, and she was, I think I told Lauren last night, she was like the Artful Dodger. Or maybe I should, I might have said that on social media. But there are questions about her credentials. So, her medical license is inactive. She has a license with the Oregon Medical Board. It is inactive. This means that she cannot prescribe medication, and she can’t treat patients right now. And there’s some question about whether or not one has to have an active medical license, not necessarily to be a surgeon general, but to be head of the Commissioned Corps of the [U.S.] Public Health Service, which the surgeon general is. 

Rovner: And which is basically the only 鈥� the surgeon general used to have a lot of line authority at HHS, and the only thing that’s left is being head of the Commissioned Corps. 

Stolberg: That’s exactly right, and the bully pulpit. And, you know, I looked at the statute last night. The statute also says that the surgeon general has to have, quote, I think, “experience in public health programs.” But it’s ill-defined. Like, what does that mean? But you are seeing some folks today, including, as you mentioned earlier, Julie, Jerome Adams, President Trump’s surgeon general, who are raising questions about her qualifications. And I think we may see more of this. 

Ollstein: I also thought it was notable that  this morning and said they find her unqualified, and raised concerns that her equivocation on vaccines could further contribute to the already diminishing trust, public trust in public health. And so the Wall Street [Journal] editorial board remains pretty influential among conservatives, so I think that is an interesting sign of where things could go. And, of course, raises the question if her nomination does collapse for lack of votes, who else could be nominated? 

Rovner: And I guess Jerome Adams doesn’t want to come back for the second term. 

Ollstein: I don’t know if he’d be welcomed back. 

Rovner: He’s burned his bridges. 

Weber: He’s not welcome back, if I had to guess, yeah, no. 

Stolberg: No, he doesn’t want to come back. He’s hawking his book. 

Rovner: Lauren, you wanted to add something? 

Weber: Yeah. I just wanted to add, I mean, it was interesting. She did get a couple stronger questions. [Sen. Lisa] Murkowski from Alaska, obviously, a Republican moderate who could be a potential “no” vote of the group, did question her pretty strongly on her stance on hepatitis B vaccines. She did get a question from [Sen. Jon] Husted about her thoughts on pesticides. That said, you know, [Sen. Bill] Cassidy also peppered her with some questions, but Cassidy also peppered Kennedy with a lot of questions, and then he was confirmed. So I think there is some chatter today about her credentials, but no Republicans brought up her credentials yesterday. The person who did was a Democratic senator, Sen. [Andy] Kim, I believe, and so, you know, we’ll have to see in this political moment what shakes out. 

Rovner: Before we leave this subject, Alice, like most of the high officials at HHS of late, she rather deftly ducked Chairman Cassidy’s question about whether the abortion pill mifepristone should be available without an in-person visit with a doctor. What did you take away from her answer? 

Ollstein: So, her comments on birth control got more attention, which we can talk about in a sec, but on mifepristone, it was very much in line with this administration just not wanting to talk about it and saying, Everybody shut up. We’re studying it behind closed doors. Just wait for us to do that, and then you can say something. So she very much kept in line with that. Didn’t want to tip her hand. 

Rovner: I would say it felt like she’d been given the talking points. 

Ollstein: Yes, exactly. And she was not really, like, free in sharing her personal views on the matter, because she was, you know, seemingly told to stick with the administration line. But I think Lauren can talk more about the birth control piece, and she’s researched that a lot. 

Weber: Yeah, I could chime in on that. And I also, just on the mifepristone piece, I think it was notable that [Sen. Josh] Hawley didn’t go after her for it. I felt like that was Hawley toeing the line, because, obviously, he, notably, in some of the RFK hearings, really went after that, and also has publicly, recently stated that he’s very disappointed in the FDA on mifepristone. So the fact that he had a pretty chummy exchange with her, some softball questions about AI chatbots, I mean, it was, I thought, notable in terms of toeing the line, on Hawley towing the mifepristone line. When it comes to birth control, Means does have a history of disparaging birth control and highlighting some of the known side effects and speaking about wanting more natural forms of contraception, which is, you know, somewhat common in the right-wing and wellness influencer space that she currently finds herself in. 

Rovner: Sheryl, do you want to add something before we move on? 

Stolberg: Abortion also is not a good issue for this administration. It’s not a good political issue. President Trump didn’t bring it up during his State of the Union. They don’t want to talk about it. It’s a loser for them. So I think that probably accounts for Hawley’s reticence in asking her about it, and, you know, sort of the muted answers that she gave, and she was very careful to say, I believe birth control should be available to all women, and she kind of said that her previous remarks, where she had said that it had horrific side effects, etc., were taken out of context. 

Rovner: All right. Well, we’re going to take a quick break, and we will be right back. 

Well, while we were on the subject of abortion, to follow up on what Sheryl just noted, President Trump did not mention it during the State of the Union, a speech where he touched on lots of other things that were important to his base. He has been hinting that he wants to downplay abortion for a while now, but could this come back to bite him and other anti-abortion Republicans in the midterms, where some of his most motivated voters might just not turn out? 

Ollstein: So that’s the argument that anti-abortion advocacy groups have been, you know, shouting from the rooftops for months now. And you know, they recently put together their own polling to try to make that argument. And I think that different wings of the Republican Party are making different calculuses here. And you could argue that not doing enough on the issue is risking the votes of the conservative base, who are really fired up about this. You know, these voters are very motivated. They turn out. They knock on doors, these anti-abortion voters. But the administration seems to be making a calculus that there are a lot more people out there who are uncomfortable with the kind of national restrictions that the anti-abortion movement is demanding from the FDA, and so they, like Sheryl said, have calculated that this is a loser issue for them and they should lean away from it. And it’s just interesting because a midterm year is not the same as a presidential year in terms of who turns out, who gets fired up. And of course, there’s the primary versus general election dilemma, where doing one thing could really help you in a primary, but doing the opposite could really help you in the general, and so something you say on the campaign trail could come back to bite you later. 

Rovner: Sheryl, you want to add something? 

Stolberg: Yeah, I think it’s fascinating to look at Trump I versus Trump II. So when Trump was running for office in 2016, he made a deal with Marjorie Dannenfelser, one of the big leaders of the anti-abortion movement, that he was going to work to overturn Roe. And the anti-abortion movement just embraced Trump and said, you know, he was the most anti-abortion candidate ever, the most anti-abortion president ever. Well, now Roe has been overturned, and it’s a completely different climate, where we are seeing the effects of what it looks like in states where women do not have access to abortion. And it’s a dark picture out there. I mean, women are being injured, and this struggle is, it’s a different debate, and it’s a much harder debate. It was easier for Trump when Roe was intact. 

Rovner: Yeah, and we’ve, I mean, what we’re seeing, it’s also, it’s not just people, it’s not just women who want to get abortion. It’s women who can’t get care during pregnancy complications. 鈥� I think that’s the piece that’s upsetting so many people. And, you know, shoutout to ProPublica, who’s just continuing to do an amazing job with this. Lauren, you want to add something? 

Weber: Yeah, I think it’s notable that he didn’t talk about abortion in the State of the Union, but he did bring up fertility drugs, and how his TrumpRx can reduce the cost for fertility drugs. And obviously that could agitate some members of the anti-abortion 鈥� some of the more hard-core members of the anti-abortion movement who have issues with fertility treatments like IVF. But I think also, Trump’s making a calculus, as we’ve talked about: Are the anti-abortion voters gonna go vote for the left? Probably not. I don’t think so. So 鈥� 

Rovner: It’s just a question of whether they stay home. 

Weber: It’s 鈥� a question of whether they stay home. But I think he’s just playing to the fact that he thinks he has them in the bag to some extent. 

Rovner: Maybe they won’t stay home because they’d rather have him than 鈥� his candidates, those who would like to restore abortion. Well, also this week 鈥� I said there was a lot of news 鈥� while the administration isn’t moving very fast to try to rein in availability of the abortion pill, states are. There was a hearing in federal court this week in Louisiana about that state’s lawsuit calling for the FDA to rescind its rule allowing the mailing of mifepristone from out of state. Alice, I imagine the administration would much prefer this decision to ultimately be made by judges and take it out of their hands, right? 

Ollstein: Well, what they’re asking the court is to not make a decision at all. They’re asking them to hold it in abeyance, which is fancy judicial language for hit pause. Put it on freeze. Don’t do anything right now, like the messaging we were talking about in the confirmation hearing. What they are telling courts is: We’re working on this issue. You should defer to us and stop these states from suing us, and let us work on reviewing the abortion pill behind closed doors, and we will issue some sort of a decision at some point. And so that is, you know, what came up in court in Louisiana. The only other notable thing is that the judge did allow the makers of the pill, Danco and GenBioPro, to intervene in the case. So that happened because the Justice Department is not defending the regulations on the pill on the merits. They’re not saying, you know, the FDA went through a fair scientific process, and we are defending the decision they made to allow telemedicine and mail delivery of the pills. They’re not doing that. They’re saying, Hit pause. So the drug companies are the ones now in court, allowed to make the argument that the FDA should be, you know 鈥� their decision was based on science and not ideology, and that should be left alone. 

Rovner: Well, we’ll see how this all plays out. All right, moving on to news from the Department of Health and Human Services. Last week, we mentioned that Jay Bhattacharya, the director of the National Institutes of Health, has now also become the acting head of the Centers for Disease Control and Prevention. That’s awkward for a lot of reasons, not least of which is that the NIH is headquartered in Bethesda, Maryland, just outside Washington, D.C., and CDC is in Atlanta, Georgia. Bhattacharya is also the third interim director of the CDC in seven months, after the first interim chief, Susan Monarez, was confirmed by the Senate to lead the agency, then summarily let go when she refused to rubber-stamp the recommendations of the anti-vaxxers appointed to CDC’s vaccine advisory panel by Secretary RFK Jr. Monarez was replaced by HHS Deputy Secretary Jim O’Neill. He’s now been relieved of both jobs and is off to head the National Science Foundation. Adding to the confusion, the No. 2 at the CDC, Ralph Abraham, stepped down this week, effective immediately, citing, quote, “unforeseen family obligations.” Lauren, you said last week that this is all about the White House wanting to rein in HHS, in general, and its anti-vaccine activities, in particular, in advance of the midterms. But what might this continued churn mean for CDC, and are we ever going to see someone nominated to, you know, run the agency? 

Weber: Julie, I wish I had the answer to that question, because I would certainly have written that story if I had an answer to what will happen to the leadership at CDC. I don’t know. I mean, I think the bottom line is, is that this is an agency that has not had a steady leader for a very long time. It has certainly made some quite shocking moves for the CDC. Obviously, they overhauled the vaccine schedule at the beginning of January, and it remains to be seen how this will be going forward. I think it’s very difficult. Running a federal agency is a huge task. I mean, assuming that someone can run both equally is a tough sell. I do think he’s limited in terms of time, of how much time he would be interim. But the reality is, and I think , and it seems like there’s not a lot of people running the top of the CDC these days. 

Rovner: Yeah. Well, remember when Monarez quit, most of the career leadership also quit. So, I mean 鈥� 

Weber: Right. The agency was also gutted when RFK Jr., you know, got rid of about a quarter of HHS at the beginning of his term. So the CDC is, certainly, is a very changed and in mangled shape currently. So I think it remains to be seen who ends up taking the reins of it. 

Rovner: Sheryl, how are things at CDC? 

Stolberg: They’re really difficult. I talk to people inside the agency, you know, they’re feeling really dispirited. A lot of the top leadership is gone, as we just said. The idea that Jay Bhattacharya could run the NIH and the CDC, two massive federal agencies with complementary missions 鈥� the NIH is the nation’s biomedical research agency; the CDC, public health 鈥� in two locations, Atlanta and Bethesda, is, honestly, I don’t know who came up with this idea. I heard 鈥� I don’t have evidence to back this up, but I heard that this was actually Trump’s idea, which kind of makes sense, if that is true, because maybe only President Trump would think up such a crazy thing that you could [laughs] 鈥� I think they recognized that they needed to put someone Kennedy trusts in there. That has really been kind of the big issue. And it is all about the midterms. It’s all about the pivot. The White House wants Kennedy to turn away from vaccines and toward healthy eating. That’s why we’re seeing him do this national “Eat Real Food” tour. And, you know, wearing the Mike Tyson tattoo and social media, etc. It’s a very, very difficult situation for a storied agency, and many, many people are worried that it is going to take a long time for the CDC to rebuild, if ever. 

Rovner: Lauren, you want to add something? 

Weber: Yeah, I just wanted to echo that, I think, what gets lost in a lot of D.C. circles and, frankly, around the country, is this is an agency that also was pocked with bullet holes just a couple months ago. I mean, if that had happened in D.C., I think you would see a very different response, to be quite honest. I was very taken aback and shaken to see the bullet holes when I went down after that happened. And I think the visuals of that got a bit lost in some of the conversation. But so this is an agency that not only is suffering with utter leadership turmoil, but has, frankly, been shot at. And so 鈥� 

Rovner: Right, they were physically attacked, their building was physically attacked. 

Weber: Physically attacked. And so the folks that are still left, I think, it’s a tough deal. And to Sheryl’s point on the midterms, and I have a , led by Rachel, you know, we found out that the MAHA piece of this is, look, I mean, they’re telling Kennedy to focus on foods because they see it as more popular. And honestly, MAHA is saying they’re gonna throw some cash. Tony Lyons 鈥� I mean, who knows that this will happen 鈥� but Tony Lyons told me they’re hoping to raise $100 million for midterm spending for Republicans. So, you know, there is that element of the coalition that I think they’re trying to make happy with this whole piece of it. 

Stolberg: One interesting note about the cash. Tony Lyons has already committed a million dollars to Cassidy’s primary challenger, which is really interesting. I mean, Cassidy voted reluctantly for RFK to be secretary, you know, and he fell on his sword for the administration, and now Kennedy’s people are working actively to unseat him. 

Rovner: Let us move to MAHA. I have a segment that I’m calling “MAHA Is Mad-Ha.” The Make America Healthy Again movement is big mad about RFK Jr.’s seeming reversal on the use of weed killers by Big Farm, not to be confused with Big Pharma. The HHS secretary Sunday night put out a lengthy statement arguing that while pesticides and herbicides used on crops are poisons, that U.S. agriculture is also dependent on them, and their use needs to be phased out, rather than cut off, in order to protect the nation’s food supply. MAHA advocates, though, see this as a complete betrayal. Sheryl, I want you to start 鈥� start by telling us where you are and why. 

Stolberg: So I’m in Austin, [Texas,] where there is a MAHA Action rally tonight, interestingly, an “Eat Real Food” rally. They’re not going to be talking about glyphosate, as far as I know, and they’re not going to be talking about vaccines. So, just an interesting sort of personal perspective: Last Wednesday, when Trump issued the executive order on glyphosate after business hours, right? Shocker, I was like 鈥�  

Rovner: And glyphosate is the weed killer that’s used in Roundup, which has been the subject of many, many lawsuits that it’s a carcinogen. And some of those lawsuits were brought by RFK Jr., right? 

Stolberg: That’s right, who won a massive judgment in 2018, a $289 million judgment. And this weed killer, Roundup, this has really been an animating force behind a lot of the MAHA movement, the Moms Across America, led by Zen Honeycutt, is really wrapped up in this issue, in getting glyphosate out of American food. As Vani Hari, who calls herself the Food Babe, said to me, What good is it if you eat real food, if it’s sprayed with pesticides? So I was, you know, minding my own business that Wednesday night, Trump issues the executive order, and I sent a text to Kennedy’s spokesman, and I said, Does the secretary have any response? And I got a three-sentence reply, basically saying that, you know, Kennedy was supporting Trump. This was a matter of national security. That is how Trump framed his order. He said, We need to ramp up production of this weed killer because we have only one domestic producer, and we don’t want to rely on foreign nations to keep our food supply running in the event of a crisis. That three-sentence statement from Kennedy obviously did not sit well. His MAHA moms exploded. I can’t even begin to tell you the anger. My headline of the story that I wrote said “,” and then it quoted someone I interviewed from Turning Point USA, Charlie Kirk’s organization, saying, women feel like they were lied to. So the anger is very deep and real. And I guess Kennedy felt that he had to address it in some lengthier way to, you know, try to assuage this part of his movement that really helped power him to the position that he is in right now, and also aligned itself with Trump, perhaps foolishly, and helped, you know, they threw their weight behind a Republican. And now, I think, Lauren said earlier, they really kind of have no political home. 

Rovner: Yes, Lauren, did you want to add to that? 

Weber: Yeah, no. I mean, Sheryl hit all the points. I think it’s important to note that these people are mad, as she said. And, you know, Glyphosate Girl, Kelly Ryerson, who’s big on social media, told me some version of We feel lied to in the sense that we, you know, we showed up, we voted for this, and we’re seeing no results, and we may change our minds in the next election. Because a lot of these people were independents or Democrats or so on. And I think what’s really fascinating about that is it kind of goes back to when Kennedy was going to be in consideration to be a health czar or something else. I mean, the bottom line is, the man does not have control over the EPA [Environmental Protection Agency]. I mean, that’s not his jurisdiction. And I think that a lot of his followers really got on board with the MAHA movement under the pretense that he was going to come in, he was going to do all this stuff. But the political realities are just very different. And this MAHA coalition, you know, as I talked about earlier, is so fascinating because it talks all about “real food,” which is, as we’ve talked about on this podcast, was Michelle Obama, a Democrat-led issue 10, you know, a decade or more ago. It talks about glyphosate. Typically, you see that as often being a lefty issue that is now under this right tent. And then, obviously, vaccines, which kind of is a political horseshoe issue, which you often see on the far left and far right. And I think you see this fracture in MAHA, because it just does not fit very neatly within the partisan lines that D.C. is so accustomed to. 

Rovner: OK. That is this week’s news. Now it is time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Lauren, why don’t you go first this week? 

Weber: Yeah. So I wanted to highlight an article that I did with my colleague Lena [H.] Sun and Caitlin Gilbert, and it’s titled “.” We did a deep dive into how Kennedy feels about the flu vaccine, and it turns out that he, in several instances, has linked it to his spasmodic dysphonia, which is a type of dystonia. It’s a neurological voice condition that causes his raspy voice. But the catch is, is that all the scientific experts that we spoke to said there’s no scientific evidence to support that. And as Kennedy has gone around saying this about his voice, he’s also disparaged the flu vaccine while in office on, you know, the day after he took office, last February, he moved to kill a national flu vaccine awareness campaign. And this January, he downgraded the recommendation for the flu vaccine for children. And public health officials that I spoke to are horrified. They’re very worried this could lead to more cases, more misery, potentially even deaths from the flu. And some of the otolaryngologists that I spoke to also pointed out that while Kennedy had linked this condition, which was also known as a dystonia, to his voice, and there was no scientific evidence to link it to vaccines, however, there is evidence of some association between drug use and dystonias. And they pointed out that that is an association. And as has been well reported in the past, Kennedy has spoken very openly about his heroin addiction. And so, you know, we spoke to a bunch of folks who just marked this sea change that we’ve seen. You know, Kennedy obviously has, has gone after vaccines, but the flu vaccine in particular appears to be personal. 

Rovner: It does. Really interesting story. Thank you for writing it. Sheryl.  

Stolberg: I was just going to say, if Lauren hadn’t written that story and wanted to talk about it, I’d have wanted to talk about it because it was such a good story. So the story that I think people need to read this week is by ProPublica, and it’s headlined, “.” And this is a really fascinating and troubling story about what’s happening in South Carolina. There are 973 reported cases of measles there. But because hospitals aren’t required to disclose it, doctors have no idea, and ordinary people have no idea where it’s happening. The story opened with a man who went to a meeting to talk about what happened to his wife. His wife was a schoolteacher, and she was vaccinated against measles, like pretty much all American adults are. But one of her kids in her class had measles, and she had a rare breakthrough infection, and she got very, very sick. And there was no way to foresee this. And I think that this is like a canary in a coal mine issue, where we’re seeing sort of a downgrading of the importance of knowing about infectious disease, especially measles, under this Trump-Kennedy health regime. And it’s putting people in danger. 

Rovner: Yeah. It was quite an interesting story. Alice. 

Ollstein: So I have a piece from Stat [“”] by my former colleague Daniel Payne and our co-podcast friend Lizzy Lawrence. And it is about how the FDA has become politicized and become a much bigger lobbying target than ever before. And they go into how a lot of decisions are being made by the White House. And so that has, you know, emerged as the center of power in FDA-related decisions. And thus, you know, companies that have business before the FDA feel that it’s worth it for them to pour lobbying efforts into this in order to influence processes that previously they felt they couldn’t influence. And so that’s raising a lot of concerns. So I highly recommend the piece. 

Rovner: Yeah, really interesting story. My extra credit this week is from my 麻豆女优 Health News colleague and sometime podcast panelist Julie Appleby, and it’s called “When It Comes to Health Insurance, Federal Dollars Support More Than ACA Plans.” Now, this is something we have talked about before, and I have talked about a lot since the debate over the expiring ACA subsidies heated up. But it bears repeating: Just about everyone who gets health insurance in the U.S. gets some sort of federal subsidy. It’s not just people who buy it on the ACA marketplaces. Medicare and Medicaid are both paid for in large part through taxpayer dollars. Employers get a tax break from offering health insurance, and employees who get health benefits don’t pay taxes on them, which is one of the biggest subsidies in the federal budget. So the next time somebody complains about why people who buy their own health insurance should get federal help with the costs, remember that, in all likelihood, you do, too. 

OK, that is this week’s show. As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can find me still on X , or on Bluesky . Where are you guys hanging these days? Sheryl? 

Stolberg: I’m at @SherylNYTon both  and . 

Rovner: Lauren. 

Weber: I’m @LaurenWeberHP 鈥� the HP is for health policy 鈥� at  and . 

Rovner: Alice. 

Ollstein: I’m on Bluesky  and on X at . 

Rovner: We’ll be back in your feed next week. Until then, be healthy. 

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Mary Agnes Carey: Hello from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Mary Agnes Carey, managing editor of 麻豆女优 Health News, sitting in for your host, Julie Rovner. I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Feb. 19, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today, we’re joined via video conference by Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Carey: Tami Luhby of CNN. 

Tami Luhby: Glad to be here. 

Carey: And Shefali Luthra of The 19^th. 

Shefali Luthra: Hello. 

Carey: Let’s start today with the Food and Drug Administration. The FDA has now agreed to review Moderna’s application for a new flu vaccine, reversing the agency’s decision from just a week ago to reject the application because it said the company’s research design was flawed. What happened? 

Weber: I think we got to take a step back, and we got to think about this in the lens of the midterms, because, of course, we got to talk about the midterms on this podcast. 

Carey: Of course. 

Weber: But what we’ve seen, really, since the beginning of January, after [Health and Human Services Secretary] Robert F. Kennedy [Jr.] overhauled the vaccine schedule under Jim O’Neill, is a lot of changes. And part of that, I think, is due to a big poll that came out by a Republican pollster, the Fabrizio poll, that indicated that some of the vaccine changes were making voters nervous. Basically, it told the president, and it told Republicans, that maybe you shouldn’t mess with the vaccine schedule as much. And ever since that poll has kind of reached the ether, you’ve seen a lot more tamping down of conversation about vaccines. So you’ve seen Kennedy stay a lot more on message about food. And then you saw what happened this past week with the Moderna flu reversal. So what ended up happening is the FDA came out and said they were not going to review the Moderna flu vaccine, which was an mRNA vaccine, which, as we all remember, was the vaccine technology that became quite famous during the covid pandemic that [President Donald] Trump really championed in his first term. So the FDA came out and was like, You know what, we’re not going to review this 鈥� which was a huge issue. It caused massive shock waves through the vaccine industry. A lot of vaccine and pharma insiders said this could really dampen their ability to develop future vaccines, because they felt like this action was made without enough explanation. And after a week of pretty much bad headlines and bad press, the decision was reversed. And Lauren Gardner from Politico had a , along with a colleague [Tim Röhn], where she pointed out that this reversal happened after a meeting with the FDA head in the White House, where Trump expressed some concern over the handling of vaccines. So I think this reversal that you’re seeing fits into the broader picture of the unpopularity of Kennedy’s push around vaccines, and I expect that, considering their hesitancy, along with a really contentious midterms race, we may see more pushback to whether or not Kennedy is able to continue on his push against vaccines. 

Carey: So, what are the implications for drug and vaccine manufacturers in the months ahead? How will this impact them? Does it provide stability and reassurance that if you spend billions of dollars on drug development, you’re not going to be stopped by federal agencies? 

Weber: I think the reversal maybe does, but, I mean, certainly they’re still spooked. I mean, the reality is that it’s a little unclear. Obviously, there was a pressure campaign to reverse this, and it has been reversed. But the current makeup of the FDA, with Vinay Prasad, has led many to be unclear on what will and will not get approved. Under this HHS administration, there’s been a big push for placebo-controlled trials and so on, and somewhat a shifting of expectations. And I think that while the reversal will settle feelings a bit, you also 鈥� this is on a backdrop of hundreds of millions of dollars being canceled in mRNA vaccine contracts. So I think there’s a lot of unease, and there’s a lot of fear that this could continue to [dampen] vaccine development. 

Luthra: I think, to add to what Lauren’s saying, it’s just pretty hard to imagine that after the past year and change that anything could really feel predictable if you are in the business of developing biopharmaceuticals in any form. It’s just so much has changed, and so much really seems to depend on the whims of where the politics are and where the different players are and who’s carrying influence. It’s just hard to really think about how you would want to invest 鈥� right? 鈥� a lot of money in developing these products, where you may or may not have success. But one other thing that I am just so struck by in this whole episode is there is a lot of tension in different parts of the health policy community groups around how the FDA is approaching different policies. And one area I’ve been thinking about a lot is where the FDA has been on abortion is a source of real frustration for a lot of abortion opponents, and seeing this episode play out if the White House did get involved, I think it raises a really interesting question for people who oppose abortion and want the FDA to take a harder look at it. Are they going to expect similar movement from the president, similar intervention, or conversations from the White House? And if they don’t get that, how does that affect, again, just another issue that feels really salient as we head into a midterm election that gets closer and closer. 

Carey: And I think you know, this is a sign of what health care might mean and play in the fall election, so we’ll keep our eye on that. Lauren, you just mentioned recently some changes at the Department of Health and Human Services. We’re going to shift from the FDA to HHS, where there’s been a shake-up in top leadership. Jim O’Neill, who had served as the HHS deputy secretary and as acting director for the Centers for Disease Control and Prevention, is leaving those positions. Other agency changes include Chris Klomp, who oversees Medicare, being named chief counselor at HHS, where he will oversee agency operations. And National Institutes of Health. Director Dr. Jay Bhattacharya will also serve as acting director of the CDC. Clearly, there is a lot going on here. Why are these changes happening now? 

Weber: So our understanding from reporting is that the White House wanted to shake things up before the midterms. I mean, if you know 鈥� kind of what I alluded to in my last comments is, you know, Jim O’Neill was the person who signed off on the childhood vaccine schedule. I mean, his name was plastered all over that in January, and now he’s been shipped off to be head of the National Science Foundation, but certainly not as high profile of an HHS deputy role or CDC acting director. From our understanding, that’s because the White House wants a bit tighter control over messaging and overall thrust of HHS heading into the midterms. And I think it’s noticeable 鈥� you mentioned Chris Klomp, I mean, let’s note where he came from. He came from CMS. You know, you’re seeing a fair amount of folks from CMS, from “Oz Land,” come into HHS and exert seemingly, it looks like, more power, based on the White House’s judgment, along with Kennedy. Kennedy is said to have also signed off on these changes. But it remains to be seen how this will impact HHS focus going forward. 

Carey: So while we’re talking about HHS, let’s look at Secretary Robert F. Kennedy Jr.’s first year in office. There’s so much we could talk about: the firing of members of the Advisory Committee on Immunization Practices, also known as ACIP, and the addition of several members who oppose some vaccines; major changes in the childhood vaccine schedule, changes that the American Academy of Pediatrics has called “dangerous and unnecessary”; pullbacks of federal funding for vaccination programs at local departments that were later reversed by a federal judge; the firing of Senate-confirmed CDC director Susan Monarez, who had only served in that position for less than a month; new dietary guidelines aimed at getting ultra-processed foods out of our diets, but adding red meat and whole milk 鈥� foods that many nutritionists have steered people away from. This is an open question for the panel: What do you make of Kennedy’s tenure so far? 

Luhby: I mean, he’s certainly been changing the agency in ways that we somewhat expected and, you know, other ways that we didn’t. I will let the others speak to some of the vaccine and others. But one thing that’s also notable is the makeup of the agency. They’ve laid off or prompted many people to quit or retire. You know, there’s major staffing changes there as well, and there’s a large brain drain, which has concerned a lot of people. 

Weber: Yeah, I’ll chime in and say, I mean, I think public health officials have been horrified by his first year in office. There is a growing fear that, obviously, his many vaccine changes could have long-term consequences for vaccine [uptake] and an increase in vaccine hesitancy. There’s been a lot of concern among public health officials and experts that Congress really has not stepped in to stop any of this. That said, there are currently 鈥� there’s a lawsuit the AAP has brought against these changes, which could have an outcome in the coming days that may or may not impact whether or not they’re going forward. You mentioned how he reconstituted ACIP, the federal advisory committee on vaccination. You know, what’s really interesting is, right now, we’re unclear if that ACIP meeting is still happening at the end of February. And again, it goes back to my point of vaccines seem to be, after this polling, not where Republicans want to be talking. And so a lot of Kennedy’s primary concern, even though he talked a lot about food in his first year in office,  of his social media, and he talked way more about food than he talked about vaccines. But his focus, and ultimately, what he was able to upend a lot of, was vaccine infrastructure. And I think this year we will see. More of the impacts of that, and also whether or not he’s allowed to make some of these changes, if there is enough backlash, or if there is enough pushback, or if there is enough political detriment that pushes back on what he has done.  

Luthra: And I think a really important thing for us to think about, that Lauren just alluded to, is a lot of the consequences of this first year are things we will be seeing play out for many years to come. There has been this dramatic upending of the vaccine infrastructure. We have seen medical groups try and step in and try and offer independent forms of authority and expertise to give people useful medical information. But that’s a very big role to fill in the context of this tremendous brain drain. And I think what we are waiting to see is, how does that translate to decision-making on the individual level and on the aggregate level? Do people feel like they can trust the information they’re given? Do they get the vaccines they would have gotten in the past for their families, for their children? Is it easier? Is it harder? Does those difficulties matter in the end? And that’s the kind of impact and consequence that we can talk about now, but that we’ll only really understand in years to come when we look at whether and how population health outcomes shift. 

Carey: Sure. And so we’re talking about, you know, Lauren and the full panel has made this clear, talking about some of the shifts in the messaging out of HHS as we head into the fall elections. Lauren, if I heard you correctly, you were saying on Secretary Kennedy’s social media feeds, he had talked a lot more about food than vaccines, but yet, the vaccine message seems to have resonated more. So, as you look towards the fall elections, right? We’re talking about affordability, in a moment we’re going to be talking about the Affordable Care Act. We’ve read a lot 鈥� and folks have talked on this podcast about drug prices. Are the steps enough that are happening here on the messaging? Is it enough to focus the message, and is it going to land with voters, or will they be looking at it in a different way? 

Weber: And will he stay on message? 

Carey: Exactly. 

Weber: I’ve watched, I’ve watched hundreds of hours of Kennedy speaking, and the man, when let rip 鈥� I mean, recently he said in a podcast, he talked about snorting cocaine off a toilet seat. I mean, that was something that came up in a long-form conversation. Obviously, there’s more context around it. But he is known for speaking off the cuff. And so, I think it remains to be seen if, if they are able to see how that messaging 鈥� in order to talk about drug prices, talk about affordability 鈥� if that continues to play for the midterms, and if it doesn’t, what the consequences of that may be. I think it’s important too 鈥� I mean, last night, Trump issued an executive order that is aimed at encouraging the domestic production of glyphosate, which is a really widely used weed killer that has been key in a bunch of health lawsuits around Roundup and other pesticides, is a real shot against, across the bow for the MAHA [“Make America Healthy Again”] crowd, and it puts Kennedy in a tough position. I mean, he’s issued a statement saying he supports the president, but I mean, this is a man who’s advocated against glyphosate and pesticides for years and years and years, and it’s really divided the MAHA movement that, you know 鈥� many folks who said they joined MAHA, many MAHA moms, pesticides are a huge issue, and this could fracture this movement, you know, that , just as they’re starting to try to get on message. 

Luhby: One thing also that my colleague, I wanted to talk about, my colleague Meg Tirrell did a fantastic piece last week about Kennedy’s first year, and it’s headlined “.” So I think that that’s one thing that also we have to look at is that Trump had said that there would be historic reforms to health and public health, and that, you know, it would bring back people’s trust and confidence in the American health care systems after covid 鈥� and you know, after what he criticized the Biden administration for. But also it shows that actually, if you look at recent polling from 麻豆女优, it shows that trust in government health agencies has plummeted over the last year. So that’s going to be something that they also will have to contend with, both in the midterms and going forward. 

Carey: We’ll keep our eye on those issues now and in the months ahead. And right now, we’re taking a quick break. We’ll be right back. 

All right, we’re back and returning to the upcoming confirmation hearing for Dr. Casey Means. She’s President Trump’s nominee to be surgeon general. The Senate Health, Education, Labor & Pensions, or HELP, Committee, as it is known, will consider that nomination next Wednesday, Feb. 25. You might remember that Means’ confirmation hearing was scheduled for late October, but it was delayed when she went into labor. She was expected then to face tough questions about her medical credentials and her stance on vaccines, among other areas. Means is known as a wellness influencer, an entrepreneur, an author, and a critic of the current medical system, which she says is more focused on managing disease than addressing its root causes. If confirmed as surgeon general, she would oversee the more than 6,000 members of the U.S. Public Health Service, which includes physicians, nurses, and scientists working at various federal agencies. What do you expect from the hearing, and what should people look for? 

Weber: So I did a  last fall. And what we learned, in really digging into reading her book, going through her newsletters, going through her public comments, is that this is someone who left the medical establishment. She left her residency near the end of it, and has really promoted and become central in MAHA world due to her book, Good Energy, which, you know, some folks in politics referred to as the bible of MAHA. So if confirmed, I think she could play a rather large role in shepherding the MAHA movement. But I think she’ll face a lot of questions from folks about her medical license and practicing medicine. So Casey Means currently has a medical license in Oregon that she voluntarily placed in inactive status, which, according to the Oregon State Medical Board, means she cannot practice medicine in the state as of the beginning of 2024. Additionally, she has received over half a million dollars in partnerships from various wellness products and diagnostic companies, you know, some of which in her disclosure forms talked about elixirs and supplements and so on. And I expect that will get a lot of scrutiny from senators as well. And I will just note, too, I think it’s important to look at a passage from her book that a lot of public health experts that we spoke to were a bit concerned about, because she wrote in her book that “the ability to prevent and reverse” a variety of ailments, including infertility and Alzheimer’s, “is under your control and simpler than you think.” And statements like that really worried a fair amount of the public health experts I spoke to. [They] said she would have this bully pulpit to speak about health, but they’re concerned that she doesn’t underpin it with enough scientific reasoning. And so we’ll see if those issues and, also obviously having to answer for Kennedy and the HHS shake-ups and Kennedy and vaccines 鈥� I’m sure a lot of that will come up as well. It should 鈥� I expect it to be a hearing with a fair amount of fireworks. 

Carey: Do you think the fact that 鈥� they’ve scheduled this hearing means that they have the votes for confirmation? Or is it simply a sign that the administration just wants to get moving on this, or shift a bit from some of the hotter issues that have happened recently? 

Weber: I mean, this is a long time for the American public to not have a surgeon general. So I mean, I think they were hoping to get this moving, to get her in the position. As I said, she could be a very strong voice for MAHA, considering her book underpins a lot of the MAHA movement. I think, in general, Republicans do have the votes to confirm her, but it just depends on how much they are agitated by her medical credentials and some of her past comments. I think we could see some fireworks, but, you know, we saw fireworks in the Kennedy hearing, and he got approved. So, you know, I think it remains to be seen what happens next week. 

Carey: Sure. Well, thanks for that. Let’s move on to the Affordable Care Act, or the ACA. More Americans than expected enrolled in ACA health plans for this year, even though the enhanced premium subsidies expired Jan. 1. But it’s unclear if these folks are going to keep their coverage as their health care costs increase. Federal data released late last month showed a year-over-year drop of about 1.2 million enrollments across the federal and state marketplaces. But these aren’t the final numbers, right? 

Luhby: No. What’s going to happen is people have time now, they still have to pay their premiums. The numbers that were being released were the number of people who signed up for plans. So what experts expect is that, over time, people who receive their bills may not pay them. A lot of people, remember, get automatically enrolled, so they may not be even aware of how much their premiums are going to increase until they actually get their bill. So they may not pay the bills, or they may try to pay the bills for a short time and find that they’re just too high. Remember that the premiums, on average, premium payments were expected to increase by 114% according to 麻豆女优. So that just may be unmanageable. The experts I’ve spoken to expect that we should get better numbers around April or so to see what the numbers of actual enrollees are. Because people, actually, if they don’t pay their premiums, can stay in the plants for three months, and then they get washed out. So we’re expecting to see if, hopefully, CMS will release it, but we’re hoping to see better numbers in April. 

Carey: Shefali, I know you closely follow abortion. How much has the abortion and the Hyde Amendment played in all these discussions about Congress trying to find, if they really want to find, a resolution to this subsidy issue? 

Luthra: It’s so interesting. A lot of anti-abortion activists have been quite firm. They say that there cannot be any permission that ACA-subsidized plans cover abortion if the subsidies are renewed. That, of course, would go against laws in some states that require those claims to cover abortion using state funds, not using federal funds, because of the Hyde Amendment. The president relatively recently, even though it feels like a lifetime, said, Oh, we should be flexible on this abortion restriction that anti-abortion activists want. They were, of course, furious with him and said, We can’t compromise on this. This is very important to our base. And they view it as the federal government making abortion more available. And so I think it’s still an open question as to whether this will ultimately be a factor. It’s, to your point, not really clear that lawmakers are anywhere close to coming to a deal on the subsidies. They very well may not, right? They still have to figure out funding for DHS [Department of Homeland Security]. They have many other things that are keeping them quite occupied. But this is absolutely something that abortion opponents will remain very firm on. And I mean, they haven’t had the victories they really would have hoped for in this administration so far, and I think it’d be very difficult for them to take another loss. 

Carey: So, Lauren, what’s going on with the discussions on Capitol Hill about potentially extending the enhanced ACA subsidies? We’re hearing reports from negotiators that the deal might be dead. How would that impact voters in November? 

Weber: I think people should be interested in getting a solution, because I think 鈥� talk about hitting voters’ pocketbooks and actual consequences. I mean, this seems like this is a thing that’s only going to continue to pick up speed. I was fascinated 鈥� I know you want to talk more about that great Politico piece that dives into the ticktock of how this all happened. But 鈥�  

Carey: Yes, great story. 

Weber: I think, in general, the ACA subsidies fall into a trap of most of the contentious two-party system that we’re in right now, where different issues that are issues that we can’t touch end up blowing up problems that affect everyday Americans in their day-to-day, and then no action gets made, and then we end up closer to the midterms, where people actually may or may not want to do something. So I’m not sure that people don’t want to do something. I’m just not sure that there’s enough consensus around what that would be, and in the meantime, actual people are feeling the pain. So we’ll see how that continues to play out.  

Carey: Sure. 

Luthra: I just wanna say, just to add one more point to what Lauren mentioned about political pressure and backlash. The  shows that health care costs are voters’ No. 1 affordability concern. And we know there was that brief moment when the president said, We should be the affordability party, not Zohran Mamdani and the Democrats. And so I think that’s really interesting, right? Are they able to stick to that? Are they able to address this policy that voters are saying is such a high priority for them, because it is so visceral, right? You know what you’re paying, and you know that your bills are higher than last year. And if they can’t, is that the kind of thing that actually does shape how voters react in November, especially given so many other cost-of-living concerns many of them have. 

Luhby: Right, well, one of  about how the Trump administration’s messaging, or what they’re suggesting that the GOP message for the midterms is lower drug prices, which is something that they have been very active on. So they don’t want to discuss the exchanges, and we’ll talk a little bit about the new rule that they’ve just proposed. But yeah, I think the administration is going to focus on health care. They’re aware of the concerns of health care, and their message is going to be “most favored nation,” TrumpRx, and the other efforts that they’ve made to lower drug prices, which is something, of course, Trump was also very focused on in his first term as well, but to less effect. 

Carey: Speaking of that rule, Tami, can you tell us more about that? 

Luhby: Sure. Well, CMS wants to make sweeping changes for ACA plans for 2027. It issued a proposed rule last week that would give more consumers access to catastrophic policies. Now these are policies that have very high deductibles and out-of-pocket costs, generally offer skimpier benefits, but, importantly for the administration, have lower premiums. The proposed rule would also repeal a requirement that exchanges offer standardized plans, which are designed to make it easier for people to compare options. It would ease network adequacy rules and require, as we were just talking about, require more income verifications to get subsidies and crack down on brokers and agents who, we’ve just discussed about, you know, have been 鈥� some of whom have been complicit in fraud. The goal is to lower the ACA premiums and give people more choice, according to CMS. Premiums, of course, have been a big issue, as we discussed 鈥� because of the increase in monthly payments due to the expiration of the subsidies. But notably, the agency itself says that up to 2 million people could lose ACA coverage because of this proposed rule. It’s a sweeping, 577-page rule, I think? And if you want to get more information, I highly recommend you read Georgetown’s Katie Keith’s , which was published in Health Affairs. 

Carey: All right, well, we’ll have to keep our eye on that rule and all the comments that I am sure will come in. 

Luhby: Many comments. 

Carey: Many. I’m also intrigued about some of the GOP talking points on potential fraud in the program. For example, the House Judiciary Committee has subpoenaed eight health insurers, asking for information on their subsidized ACA enrollees and potential subsidy-related fraud. It has been a Republican talking point that it’s their perception, for many Republicans, that there is a lot of fraud in the program that needs to be investigated. Is there any merit to the claim, and will this discussion of fraud shift away from this really critical affordability issue that we’re all talking about? 

Luhby: Well, we know that there has been fraud in the program, particularly after the enhanced subsidies went into effect. I mean, even the Biden administration released reports and information about brokers and agents that were basically switching people into different plans, switching them into low-cost plans, enrolling them in order to get the commissions. And it’s one that actually played also into the argument on Capitol Hill about extending the subsidies, whereas the Republicans were very forceful about not having zero-premium subsidies, because they felt that this helped contribute to the fraud. So you know, that’s not an issue anymore, because the subsidies were not renewed, but both CMS and Congress are still focused on this idea of fraud with the subsidies. 

Carey: All right, well, we’ll keep watching that now and in the months ahead.  

So that’s the news for this week. And before we get to our extra credits, we need to correct the name of the winner of our Health Policy Valentines contest. The winner is Andrew Carleen of Massachusetts, and thanks again to everyone who entered.  

All right, now it’s time for our extra-credit segment. That’s where we each recognize a story that we read this week and think you should read, too. Don’t worry if you miss it. We’ll post the links in our show notes. Lauren, why don’t you start us off this week? 

Weber: Yeah, I have two pieces, a piece from NiemanLab: “.” And then I also have one from my publication at The Washington Post. It’s from Scott Nover. The Atlantic’s essay about measles was gut-wrenching. And some readers feel deceived. And for a little bit of background for anyone who didn’t read it, Elizabeth wrote a very striking, beautifully written piece in The Atlantic from the perspective of a mom who lost her child to measles after a fatal complication that can happen for measles. But the way it was written, a lot of people did not realize it was fiction, or creative nonfiction, or creative fiction to some degree. And so it was written from the perspective like it was Bruenig’s story, but at the very end of the piece, and it turns out this was attached later, after publication, was an editor’s note saying this piece is based on interviews. I gotta say, as, when I initially read it, as a savvy consumer, I initially was like, Is this her story? until I got to the editor’s note at the end. The NiemanLab reporting says that that editor’s note wasn’t actually even on the piece when it started. I think this is a fascinating question, in general. I think that in an era where vaccine misinformation is rampant and the truth is important, it seems like having a pretty clear editor’s note at the top of this piece is essential. But that’s just my two cents on that, and I thought both the discussion and the online discussion about it was really fascinating this week. 

Carey: That’s fascinating. Indeed. Tami, what’s your extra credit? 

Luhby: My extra credit is titled “,” by Claudia Irizarry Aponte and Ben Fractenberg in The City, an online publication covering New York. We’ve been having a major nurses’ strike in New York City. It’s, you know, notable in the size and number of hospitals and length of the strike, which has been going on already for over a month. It’s affected several large hospitals 鈥� Mount Sinai, Montefiore, and NewYork-Presbyterian 鈥� with nurses demanding stronger nurse-to-patient staffing ratios, which, you know, has been a long-standing issue at many hospitals. Now, the interesting development is that the city uncovered a rift between NewYork-Presbyterian’s nurses union and their leadership. So what happened is the nurses at Montefiore and Mount Sinai have recently approved their contracts and are back to work, but the NewYork-Presbyterian nurses did not approve their contract because the language differed on the staffing-ratio enforcement and did not guarantee job security for existing nurses. And what actually apparently happened is that the union’s executive committee rejected the contract, but the union leaders still forced the vote on it, which was, actually, ended up voting down. So now the nurses have demanded a formal disciplinary investigation into the union leaders for forcing this vote. So more than 1,500 nurses at NewYork-Presbyterian signed the petition, and more than 50 nurses delivered it to the New York State Nurses Association headquarters. One nurse told The City they are overriding our voices. The union president urged members not to rush to judgment. Now, the NewYork-Presbyterian nurses remain on strike, which has lasted already for more than a month, and it’s going to be interesting to watch how this develops, especially because you have, obviously, the contentious negotiations between the hospital and the nurses union, but now you also have this revolt, and, you know, issues within the nurses union itself. 

Carey: Wow, that is also an amazing story. Shefali? 

Luthra: Sure. My piece is from NPR. It is by Jasmine Garsd. The headline is “.” And the story looks at something that we know from research happens, but on the ground in Minneapolis, of people concerned about ICE [Immigration and Customs Enforcement] and immigration presence at medical centers, delaying important health care that can be treatment for chronic ailments, it can also be treatment for acute conditions. And what I like about this story is that it highlights that this is something that is going to have consequences, even now with this surge of DHS law enforcement in Minnesota winding down. The consequences of missed health care can last for a very long time. And something I have heard often when just talking to immigrants and medical providers in the Minneapolis metropolitan area is exactly this fear that they actually don’t know what the coming weeks and months are going to bring. They don’t know when they will feel safe getting health care again, when it will feel as if the consequences of this really concentrated federal blitz will be ameliorated in any way. And I love that this story takes that longer view and highlights that we are going to be navigating the medical effects of something so seismic and frankly pretty unprecedented for quite some time. And I encourage people to read it. 

Carey: Thank you for that. My extra credit is from Politico by Robert King and Simon J. Levien, called “.” The piece is an inside look at why and how Congress failed to take action on extending the enhanced Affordable Care Act subsidies, which led to the longest government shutdown in U.S. history and higher ACA premiums for millions of Americans. 

OK, that’s this week’s show. As always, thanks to our editor, Emmarie Huetteman, and our producer and engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts 鈥� as well as, of course, kffhealthnews.org. Also, as always, you can email us with your comments or questions. We’re at whatthehealth@kff.org, or you can find me on X . Lauren, where can people find you these days? 

Weber: On  and on : @LaurenWeberHP. The HP stands for health policy. 

Carey: All right. Shefali. 

Luthra: On Bluesky:  

Carey: And Tami. 

Luhby: You can find me at . 

Carey: We’ll be back in your feed next week. Until then, be healthy. 

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Julie Rovner: Hello from 麻豆女优 Health News and WAMU public radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Feb. 12, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go. 

Today, we are joined via videoconference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hi.  

Rovner: And up early to join us from California, my 麻豆女优 Health News colleague Jackie Fortiér. Welcome, Jackie.  

Jackie Fortiér: Hey, everyone. 

Rovner: No interview this week, but plenty of news. So let’s jump right in. We will start this week at the Food and Drug Administration, where things are 鈥� why don’t we call it 鈥� newsmaking. The biggest FDA story that broke this week was controversial vaccine chief Vinay Prasad outright rejecting an application for a new flu vaccine from Moderna, maker of the mRNA covid vaccine that so many anti-vaxxers have criticized. Lizzy, you . Congratulations. What happened exactly? And why is this such a big deal beyond the flu vaccine? 

Lawrence: This is a big deal because to refuse to file is a pretty rare occurrence in general, because in general the FDA and industry like to have agreed-upon standards for clinical trials before companies embark on them and pour millions of dollars into them. So that was surprising. And then鈥� 

Rovner: And refuse to file means that they said that they’ve got the application and said: Yeah, we’re not accepting that. We’re not going to review this. Right? 

Lawrence: Yes, yes. And Prasad wrote that the grounds for this was that it wasn’t an adequate, controlled trial. Well, Moderna is saying that actually the FDA greenlit this trial back under the Biden administration in 2024. They acknowledged that there was basically a control vaccine that the FDA say they would prefer that Moderna use for the older population. But they said, however, it’s acceptable if you don’t do that. 

Rovner: And I want to make sure I understand this. The complication here is that this is supposed to be a better vaccine for older people, but right now there’s vaccines for older people that start at age 65 and this is a vaccine that’s supposed to start at age 50, right? So it was unclear who they were going to test it against, whether it was going to be the 50-to-64s or the 65s and older. Because there isn’t a vaccine right now that’s approved for 50 and up, right? 

Lawrence: Exactly, exactly. So it was there’s the high-dose vaccine, which is recommended for the above-65s, but that is not recommended for the 50-to-64, which is part of why Moderna didn’t use that high-dose vaccine, because the population that they were studying was broader than this over-65s. So anyway, so yeah, so refusing to file is already rare, and then for there to be an overriding refuse to file, where the, I was told, basically, while there may have been individuals who agreed with Dr. Prasad’s assessment, the review team, every discipline, thought that it was reviewable. And the head of vaccines wrote a memo explaining why he thought it was viable, so that the career staff kind of documented their thoughts here. It’s not clear whether this will be made public ever, but one would hope, with radical transparency, but we’ll see. Despite that, Dr. Prasad still refused to review Moderna’s application. 

Rovner: So obviously it’s a big deal for the flu vaccine, but it’s a big deal beyond this. Moderna’s CEO was on cable news this morning, said that, as you said, after consulting with the FDA officials about the trial, they spent a billion dollars on this trial. How do we expect companies to invest in new medicines like this if the FDA is basically acting on vibes? 

Lawrence: I don’t know. Yeah. And it’s interesting. It doesn’t seem like there’s a ton of sympathy from this administration. Even back last year, [FDA] Commissioner [Marty] Makary tweeted something 鈥� this was when they were limiting, wanted to require more data for covid vaccines for the under-65 crowd. And I think he said something like: Our goal is not to save companies money. That’s not something we 鈥� which of course that isn’t. The FDA’s goal is to promote public health. But it’s definitely a change in tune. I think that in the past, the FDA has understood that you’re really only going to get innovation if you have clear, consistent guidance and that it’s a really worst-case scenario for a company to spend a billion dollars on a clinical trial and then there’s nothing to show for it and nothing for it to benefit patients, either. So. 

Rovner: Is this over? What happens now? 

Lawrence: So now Moderna has requested a meeting to challenge this decision, and now there begins a kind of negotiation. It might be possible that the FDA would, in fact, would review at least the 50-to-64 cohort, because they don’t have any objections there, seemingly. But we’ll have to see. On a call yesterday, a senior FDA official talked about Moderna kind of coming to the agency with humility and acknowledging that the FDA had recommended this high-dose vaccine. And so I don’t know. I think companies are definitely 鈥� it’s a lesson that they’re, especially if you’re in the vaccine space, you have to tread very carefully. 

Rovner: Yeah. And I would think others in the drug space, too. It’s not just 鈥� that’s the point of this 鈥� it’s not just vaccines. Alice, you wanted to say something. 

Ollstein: Oh, yeah. Not only the monetary investment, which we’ve touched on a bunch, but companies spend years. So it’s the time investment as well. And why would you dedicate years of effort to something that you’re not sure if a political appointee is going to swoop in and override career scientific officials’ assessment, if you can’t trust the regulatory system to work as it’s always worked. There really is just a lot of risk there, and you might see people not making these submissions on all kinds of fronts. Of course, this is coming as we’ve had a really bad flu season. I’ve had people in my life get really sick and say it’s been really, really bad. So the prospect of having something that works better to prevent, or even just make it milder, not coming to fruition is rough. 

Rovner: Yeah. And this year, as we know, this year’s flu vaccine was not very well matched to the strains that ended up circulating. And that’s kind of the point of this Moderna vaccine, this mRNA vaccine, is that they say it would be much faster for them to match strains to what’s going around. If it works as the clinical trials suggest it would actually be a better flu vaccine than we have now. 

Well, meanwhile, cases of measles are also continuing to multiply, as they do when people aren’t vaccinated, and not just in the places we’ve talked about, like Texas and South Carolina, but also all around us here in the nation’s capital, apparently, as a result of people traveling here for the anti-abortion March for Life in January. There have been more than 730 confirmed cases of measles in the U.S. already this year. That’s four times more than have been typical for a full year, and it’s not yet the middle of February. Yet that doesn’t seem to be deterring the administration from its anti-vaccine activities. So now, the American Medical Association and the University of Minnesota Vaccine Integrity Project have announced they’ll convene a parallel group of experts to make vaccine recommendations, basically saying they are done following the Centers for Disease Control and Prevention. This has been brewing for a while. Right, Lizzy? 

Lawrence: Yes. As soon as the secretary fired all of the experts who served on the advisory panel to the CDC on vaccines, I think there’s been unease. And now, as you said, there’s an active parallel public health establishment that’s trying to spread credible information and provide an alternative resource, because it’s clear that HHS [the Department of Health and Human Services] has become compromised when it comes to vaccine recommendations. And yet, you’re seeing the spread of infectious diseases right now. 

Fortiér: Having kind of this rival court is not surprising, because they’ve refused to participate in any of the Advisory Committee on Immunization Practices meetings for months and months. I do wonder if this will maybe change some of the tone. We do have an upcoming ACIP meeting in February. Normally we would have a agenda out by now. Before Secretary [Robert F.] Kennedy [Jr.] we would have them weeks in advance, and we haven’t seen one yet, so we’re really not totally sure what they’re going to be talking about. But Dr. [Mehmet] Oz did say this week that he finally advised people 鈥� he’s the CMS [Centers for Medicare & Medicaid Services] director鈥� to take the vaccine. And there’s been over 933 cases in just South Carolina during this outbreak that started last October. And so when I talk to people on the ground who are treating folks in South Carolina and have been treating them for months, and they’ve been doing vaccine clinics and things like that, they were just so fed up with Dr. Oz and the administration, because they partially blame them for these various outbreaks. And I had one of them tell me, like, well, it’s like a band-aid on a bullet hole. Like, now they’re finally encouraging people to get vaccinated when we could have had this months ago. 

Rovner: And, of course, the CDC doesn’t have a director at the moment, because the Senate-approved director was summarily fired and/or quit, not clear which, after refusing to basically rubber-stamp the immunization panel’s recommendations that had not been made at the time. So the American Academy of Pediatrics is suing to stop this February ACIP meeting. I did not hear what the last decision was on that, but I know that there’s still a lot of movement around here. I guess the big worry is: Who should the public trust now? Is it going to be this sort of grouping of medical societies led by the AMA, or the CDC, which people and doctors are used to following the advice of? 

Ollstein: And there’s all these state alliances forming to do the same thing. And so I think, yeah, the more competing recommendations the average person hears, the more they just sort of throw their hands up and say: I don’t even know who to trust anymore. I’m not listening to any of these people. And the trust that’s eroded in the federal government, that’s going to be really hard to recuperate in the future. You can’t just flip a switch and say: OK, it’s a different government. We trust them again. Once those seeds of doubt are planted in people’s minds, it’s really hard to unearth. And so, if not permanent damage, all of this is doing at least very long-term damage to the idea of expertise and authoritative information. 

Rovner: And science, which this administration insists it wants to follow. Well, turning to FDA-related “MAHA” [“Make America Healthy Again”] news, the agency said last week it would relax enforcement of its food additive regulations to make it easier for manufacturers to say they’re not using artificial dyes. Now this was a huge deal when the agency announced the phaseout of artificial coloring. Looking at you, fancy-colored Froot Loops. Now the administration says it’s going to allow foodmakers to say they’re not using artificial colors as long as they’re not using petroleum-based dyes. Apparently, natural dyes are OK. But even that is controversial, and it appears that this whole effort really relies on manufacturers’ willingness to comply rather than, you know, actual regulation, which is kind of what the FDA does for a living. It’s a regulatory agency. 

Ollstein: Well, every time the word “natural” comes up, I always laugh because there is no definition of that. And there are plenty of things that are natural that could kill you or hurt you very badly. And there are plenty of things that are synthetically manufactured that are helpful and fine for you. And so it has this veneer of safety, veneer of health with no actual substance. So my red flags go up whenever I hear that word, and I think everyone should be skeptical. 

Rovner: But it goes with RFK Jr.’s quest now that you should, quote, “eat real food.” 

Lawrence: Right. Yeah. I was going to say same with “chemical.” I feel like, “chemical” abortion drug, “chemical.” And it’s like, a lot of things are chemicals. That’s not鈥� 

Ollstein: Yeah, like in your own body, naturally. 

Lawrence: Yeah. 

Ollstein: You have chemicals. 

Lawrence: We are chemicals. 

Ollstein: We are chemicals. 

Rovner: You guys are all too young to remember the Dow Chemical advertising line “Better Living Through Chemistry,” which at the time, in the ’60s and ’70s, was true. There was, there 鈥� we’ve had a lot of better living through chemistry. And some of it has turned out to be maybe not so good for us, but a lot of it has turned out to be pretty darn good for us. 

Well, finally, in FDA land, Commissioner Marty Makary this week met with anti-abortion senators about that ongoing review of the abortion pill mifepristone, which senators want the FDA to remove from the market. Alice, how’d that meeting go? 

Ollstein: Not great for the FDA, from what I was told. I got on the phone with Sen. Josh Hawley after it, and he was extremely frustrated. He said he didn’t get answers to any of the questions he’s been sending in public letters to the FDA for months and now asking in this briefing behind closed doors that they held on Capitol Hill this week. He said he didn’t get answers about what the timeline is for this review of the abortion pill mifepristone, what the review consists of, whether it’s even begun, really, whether it’s even underway. And so he is sort of concluding that this is not going anywhere, and he wants Congress to step in and take action. Now, Congress has tried to step in and take action before. They’ve tried to put restrictions on mifepristone in the FDA funding bill. That didn’t pass. So I don’t know if this is even plausible in this environment where Congress can’t really pass much of anything anymore. 

But Hawley is not just another Republican senator. He is very intertwined with the anti-abortion movement. His wife is an extremely prominent anti-abortion lawyer who’s led a lot of the major cases trying to restrict or ban mifepristone. They founded their own anti-abortion advocacy group. And so it really shows that the tensions, clashes, whatever we want to call them, between the anti-abortion movement and the Trump administration, so after backing the Trump administration for years and years, they’re really getting fed up. And they’re fed up that even after they achieved their grand goal of overturning Roe v. Wade, there are actually more abortions happening now than before, and that’s largely through these pills and people’s ability to get them. And so they’re getting increasingly impatient with the Trump administration, who has been sort of stringing them along and saying: Yeah, we’re working on it. We’re working on it. But they want to see results. Now, of course, if there were some sort of restrictions imposed, that could have a big political effect. And so a lot of Republicans are very torn about that. But not Sen. Hawley. Sen. Hawley wants to see it.  

Rovner: That’s right. Well, moving to what I call FDA-adjacent news, one of the many thorny issues that FDA has been dealing with is the compounding of those very popular and very pricey obesity drugs. When the drugs were in shortage, it was legal for compounders to make their own copies. But now the shortage for both of the leading medications 鈥� semaglutide, made by Novo Nordisk, and tirzepatide, made by Eli Lilly 鈥� is over, and those cheaper copycats were supposed to be pulled from the market. So it was a bit of a surprise when the company Hims, one of those direct-to-consumer drug sites, announced the unveiling of a semaglutide tablet just weeks after the first such drug was approved by the FDA, by Novo Nordisk. The FDA promptly referred the company to the Justice Department for possible violation of federal drug laws, after which Hims said, Oh, maybe we won’t start selling the drug after all. Oh, and Novo is suing for patent infringement. But I would think that the war over the “fat” drugs, as President [Donald] Trump likes to call them, is likely to lower prices just as effectively as government regulation might. Or am I misreading that? Lizzy, this has been quite the sideshow, if you will. 

Lawrence: Yeah. It might. I think that the compounding, the FDA’s crackdown on Hims was very interesting to me because I think before the commissioner had come into his role, there was some speculation. He had worked for a telehealth company that prescribed compounded drugs. And there’s also, I think compounders have tried to tap into a little bit of the MAHA medical freedom aspect. But clearly that’s not been the case, at least at the FDA. They are clearly very upset about this and mean business, and I think it’s tying into their crackdown on direct-to-consumer drug advertising as well. But as far as price, yeah. I think the deals that Trump has managed to strike with the companies could actually be reducing price for patients. I think we’ll have to see. I know there’s obviously drug pricing programs as well that they could pursue. So, yeah, we’ll have to see.  

Rovner: All right. Well, we’re going to take a quick break. We will be right back. 

OK. We’re back. And speaking of President Trump, there’s also drug news this week that’s not directly related to the FDA. That’s the official unveiling of TrumpRx, the website the president says will lower drug prices like no one’s “ever seen before.” That’s a direct quote, by the way. Except it turns out that’s not quite the case. First, these discounts are only for people who are paying out-of-pocket, not those with insurance, which makes them valuable mostly for people who have no coverage or people who take drugs that insurance often doesn’t cover, like those for obesity or infertility. Yet of the 43 drugs so far that are promoted on the TrumpRx website, about half already have cheaper generic copies available through sites like GoodRx and Mark Cuban’s Cost Plus Drugs. And really, the website just points people to already existing manufacturer websites that were already offering those lower prices. So what is the point of TrumpRx? 

Lawrence: Great question. Yeah. This administration has been very focused on, obviously, media and wins and attaching President Trump’s name to things. So it accomplishes that goal. Maybe it does raise awareness for these other sites that already exist. But that’s a theme of a lot of the movement on health care so far, has been 鈥� there’s been a lot of chaos, and then there’s also sometimes things that they announce as like a grand, brand-new, no-one’s-ever-thought-of-it-before policy, but then there are already, of course, existing programs or avenues for that. 

Rovner: And to be fair, Trump has jawboned down some prices, including some prices for the obesity drugs, by basically dragging in the CEOs of these companies and saying, You will lower prices. 

Lawrence: Yeah, yeah. The dealmaking has been effective. And I think the question is: Will this last beyond his administration? Will there be a legacy there? 

Ollstein: I think there’s also some danger in overpromising, because he’s out there saying things that don’t comport with how math works. He’s basically suggesting prices will come down so many percents that we’ll be getting paid to take drugs, because that’s what more than 100% is. And people who are hearing that, voters who are hearing that, if they aren’t seeing that show up in their bills, if they’re not actually seeing those drastic, drastic drops that they’re being promised by the president, are they going to get upset? And is that going to impact how they vote? So yes, there has been some, on the margins, improvements, but when you’re out there promising 600% reductions and not delivering, there’s a risk to that. 

Rovner: Jackie, you wanted to add something. 

Fortiér: Well, I was going to say, I think it’s also confusing for a lot of people, from a consumer perspective, because you log on and I think people, they hear these huge promises, like Alice is talking about, and then they think that they can, necessarily, buy the drugs through there and immediately get them shipped, what these third parties like Hims and Weight Watchers are doing a lot of with the GLP-1s. And that’s not how this works. You still have another step of getting a prescription and then going to the pharmacy and using these to potentially get discounts and lower prices, in the same way that these have been available from pharmaceutical manufacturers and other things like GoodRx for years. But it’s that disconnect between, even if you can get a discount, actually getting the discount and crediting the Trump administration for that that I think is going to be really difficult for a lot of voters to make that connection in the way that the administration wants them to. 

Rovner: And this was ever the case with rebates 鈥� for other consumer products, not just talking about drugs. We’ll give you a $15 rebate, but you have to fill out 87 forms and send it to this place and get it exactly right, do it before the end date, and we’ll send you back $15. Because they count on most people not being able or willing to follow all of the various steps. So instead of giving everybody the discounted price, they make you really basically work for your discount, which is a consumer thing, but it’s pretty popular in the drug space as well. Rather than just lowering prices, they’re going to say, We will give you a discount, but you’re going to have to do this, that, and the other thing in order to get it. 

Fortiér: Right. But when you’re president and you want credit for it, it’s going to be a little more 鈥� it’s harder in order to make that connection. Sorry. 

Rovner: Yes, that’s true. That is a good point. All right, moving on. We have talked a lot about consolidation in the health care industry, particularly companies like UnitedHealthcare, which used to be just an insurer, now owns its own PBM [pharmacy benefit manager], its own claims processing company, and thousands of medical practices around the country. Well, now an extremely unlikely pair in the Senate, Massachusetts Democrat Elizabeth Warren and Missouri Republican Josh Hawley, have joined to introduce something called the Break Up Big Medicine Act, which would basically outlaw so-called vertical integration, like that of United and, to a somewhat lesser extent, Cigna and CVS Health, which owns Aetna, the insurer. Some are referring to this as the health version of the 1932 Glass-Steagall Act, which separated commercial from investment banking 鈥� and, side note, whose repeal in 1999 is considered a major factor setting off the financial crisis of 2008. But that was a risk thing. It was done to prevent another stock market crash like the one in 1929. This is a cost thing. This is to go after high health care costs. Could it work? Could it pass? And is this the beginning of the next big thing in health reform? 

Lawrence: Perhaps. Yeah. Last year, I worked with my colleagues on  kind of examining UnitedHealth Group and the effects of consolidation on doctors and patients. And at the time, I think, there were some vocal lawmakers on either side of the aisle who were criticizing this, especially in the wake of the murder of the UnitedHealth CEO, and which had a surprising 鈥� the public sort of had this reaction and to鈥� 

Rovner: Not in United’s favor. 

Lawrence: Not in United’s favor. And so I think that there is, this is a political issue that affects everyone, Republican and Democrat, the, well, cost in general, but I think there’s a lot of resentment and anger, and it seems like that is bringing together these unlikely and pretty powerful senators. I’m not an expert on the Hill. I don’t know if this has a chance. Especially, it’s targeting massive, powerful companies with hands in every part of the health care system. So it’s something that you would imagine the entire health care industry would fight against. But, yeah, I don’t know. 

Rovner: And I will point out that Sen. Josh Hawley, in addition to all his anti-abortion activities, last year, when Congress was debating the Medicaid cuts, kept vowing not to vote for those Medicaid cuts. So he’s 鈥� which, of course, in the end, he did 鈥� but he’s been sort of on the consumer side of health care for a while now. It’s just this is not brand new to him. 

Lawrence: Right. And I’m not sure how many other Republican senators would follow him down this path. But it’s definitely a noteworthy development, and curious to see where it goes. 

Rovner: Yeah, I’m curious to see sort of if the populist part of health care costs sort of rises to the fore. We’ll have to, we will have to watch that space. Well, finally this week, more on the impact of the Trump administration’s immigration crackdowns and health. My 麻豆女优 Health News colleague Amy Maxmen has  about health professionals in the U.S. Public Health Service Commissioned Corps actually resigning rather than accepting postings to Guantánamo Bay, Cuba, where some immigrants are being detained in prisons that used to hold al-Qaida suspects. Another  by Claudia Boyd-Barrett describes how when people detained by ICE [Immigration and Customs Enforcement] end up in the hospital, often their immediate families and their lawyers aren’t even allowed to know where. And remember, last week we talked about cases of measles in some immigration detention facilities. Well, now there are two confirmed cases of tuberculosis at the ICE facility at Fort Bliss in El Paso, Texas. I’m thinking maybe the health part of this is starting to kind of get to people as much as the whole depriving-civil-liberties part. 

Fortiér: Yeah, and there’s also been cases of covid-19, which makes sense. You’re going to have respiratory viruses as you get hundreds of people grouped together. That makes sense. A judge in California a couple days ago ordered that there had to be adequate health provided to detainees in one specific California 鈥� it was a prison and now it’s an ICE detainee facility. That’s specific to there, but it’s 鈥� more and more senators, I think, are also looking at this and pointing out that they’re just not providing the health facilities that people need. And especially ongoing care 鈥� a lot of folks need diabetes treatment, and that treatment just isn’t really happening in many cases. 

Rovner: Yeah, we’ve talked about this at some length, over many weeks, that people in detention are not getting health care, even though it is required, that we keep hearing stories about people not getting needed health care. I didn’t know until I read this story that people who actually end up being hospitalized, that their family members are not allowed to know. That’s allegedly, well, it is because of security, because the idea is that if somebody who’s in detention is in a hospital, you don’t necessarily want bad people knowing that and being able to come to the hospital. But these are people often who are, as we have documented at length, do not have criminal records, and it’s hard to find out where they are. Alice, you wanted to add something. 

Ollstein: Yeah. So there was a recent GAO [Government Accountability Office] report about this, and it found that people were not getting evaluated when they entered a facility to see if they were medically vulnerable and at risk of having a really bad episode or emergency, and that even children, pregnant women, vulnerable populations weren’t getting that initial evaluation, which then led to problems down the road. And it also said that people upon their release 鈥� either deportation or release within the United States if that’s what a court ordered 鈥� they weren’t being given their medical records, their prescriptions. And so the continuity of care was disrupted. And it’s important to note that that GAO report was about a few years ago under the Biden administration. So this isn’t new. These problems aren’t new, but they’re getting much worse, because the number of people detained is at record levels and so everything’s just getting multiplied. 

Rovner: Yeah, it is. Well, we will keep watching that space. OK, that’s this week’s news. Before we get to our extra credits, I am pleased to present the winner of our annual 麻豆女优 Health News Health Policy Valentine contest. It’s from [Andrew Carleen] of Massachusetts, based on a story about Medicare Advantage overpayments. And it goes like this: “I thought it was love. My heart felt spring-loaded. Turns out our relationship was significantly upcoded.” Congratulations, and happy Valentine’s Day to all. 

OK, now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Alice, why don’t you start us off this week? 

Ollstein: Sure. So I have a kind of fun story [“”] from my co-worker Amanda Chu about how the Oura ring has taken over D.C. They have been heavily lobbying the Trump administration and Congress to prevent tough regulations. Basically, there’s a debate about whether it should be regulated as a medical device or not. 

Rovner: Tell us again what it does. 

Ollstein: It’s a ring you wear on your finger that monitors different health metrics. And so the Trump administration MAHA movement has gone all in on this. They love it. The Pentagon has a huge contract with them. Other government agencies are looking at it, too. I think it’s interesting because it is this very sort of conservative mindset of individual responsibility in health care and, oh, if you could just track your own metrics and do the right things. That’s an approach that is sort of counter to the idea of public health and government protecting your health through policy. 

Rovner: And we know HHS Secretary Kennedy is a big fan of wearables. 

Ollstein: Exactly, and this is one of the most popular ones right now. And so this story does a good job digging into all the lobbying and also into concerns about data privacy and pointing out that these technologies are moving much faster than government can regulate them. And that is leaving some lawmakers really concerned about who could have access to this data. 

Rovner: Jackie. 

Fortiér: Mine is by Ariana Hendrix. She’s a writer based in Norway. It’s entitled “.” It was published in Stat. And she writes eloquently about being a parent in Norway and knowing that her children wouldn’t go to day care until they were about 16 months old, because Norway has paid parental leave. And she points out, beyond the vaccine debate there’s a bigger issue, that the U.S. lacks universal health care and federal paid parental leave. So changes in infant vaccines in the U.S. have a large effect, because babies in the U.S. often go to day care, when they’re around a lot of other kids when they’re just a few weeks old. So she points to the, in January, the infant RSV [respiratory syncytial virus] vaccine was moved to the high-risk category of shots, so now it isn’t routinely recommended for all babies in the U.S. And RSV, of course, is the most common cause of hospitalizations for infants, and that’s due to the fact that they’re exposed to the virus in day care a lot earlier than other children in other countries like Norway and Denmark whose vaccine schedules U.S. officials are now kind of trying to emulate. So she does a really great job of laying out how families face greater health and financial risks in the U.S. without the same safety net that other countries have. 

Rovner: Or just the same social policies that other countries have. 

Fortiér: Yeah, it reminded me鈥� 

Rovner: It’s hard to, right, it’s hard to import another country’s 鈥� part of another country’s 鈥� policies without importing all of them. It is really good story. Lizzy. 

Lawrence: Yeah. So my piece is by Rachana Pradhan and 麻豆女优 Health News, and it’s about the “” And I thought this piece was very interesting, just because in general I’ve been fascinated by 鈥� politicization of medicine isn’t new 鈥� but just like right-wing-coded products and left-wing-coded products. And in this piece, Rachana talks about NIH [National Institutes of Health] Director Jay Bhattacharya kind of talking about how, It’s the people’s NIH and if a lot of people are using it, well, we want to investigate it. So she just, she does a really good job of kind of unpacking why this is problematic, that they’re kind of just choosing a random medication and there’s not really any scientific reason to be investing in it as much as they are. And she got a response from NIH after the fact as well, kind of where they were trying to defend this decision to pour this much investment. And so, yeah, I think it’s just a really interesting development in NIH land. 

Rovner: It is. My extra credit this week is from ProPublica, by Mica Rosenberg, and it’s called “.” It’s about what immigration detention looks like from the point of view of children being held at a family facility in Dilley, Texas. That’s the one where the two cases of measles were diagnosed earlier this winter. The story includes some pretty wrenching letters and video calls from kids who were living elsewhere in the U.S., while their parents were mostly working within the immigration system. And these kids had been ripped from their daily lives, their other parents and siblings in some cases, their schools and their classmates, and in many cases, from hope itself. Wrote one 14-year-old from Hicksville, New York, quote: “Since I got to this Center all you will feel is sadness and mostly depression.” It really is a must-read story. 

OK. That is this week’s show. As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, . Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me on X, , or on Bluesky, . Where are you folks hanging these days? Jackie. 

Fortiér: Bluesky mainly, . 

Rovner: Alice. 

Ollstein: Mainly on Bluesky, , and still on X, . 

Rovner: Lizzy. 

Lawrence: On X, . On Bluesky, . 

Rovner: We’ll be back in your feed next week. Until then, be healthy.