[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, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, June 4, 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. 

Margot Sanger-Katz: Hello, everybody. 

Rovner: Alice Miranda Olstein of Politico. 

Alice Miranda Ollstein: Hi, there. 

Rovner: And we welcome to our podcast panel this week Liz Essley Whyte of The Wall Street Journal. Happy to have you join us. 

Liz Essley Whyte: Thanks for having me, Julie. 

Rovner: Later in this episode, we’ll have my interview with my colleague Lauren Sausser, who wrote the latest 麻豆女优 Health News “Bill of the Month.” It’s about a woman with a temporary memory problem who probably wishes she could forget about a $59,000 hospital bill. But first, this week’s news. 

So, it’s been almost a full year since President [Donald] Trump signed the big budget bill that would reduce Medicaid spending by nearly a trillion dollars over the next decade, and this week we got the much-anticipated regulation outlining what states have to do in order to implement the new Medicaid work requirements for low-income adults on the program by next Jan. 1. And it’s safe to say that these rules 鈥� which are interim final rules, by the way, so that means they technically take effect immediately 鈥� are not what states were expecting. I want to break this down in pieces, but first, let’s talk about what a heavy lift this was going to be for the 43 states that are required to put these rules into effect.  before the rules came out, right? 

Ollstein: Yes, this is being pitched as a massive money saver, that was how it was framed. It’s being scored that way in the original bill in order to pay for a bunch of other things: tax cuts, etc. 

Rovner: I would say it is a money saver for the federal government, right? 

Ollstein: Well, that is the promise, that it will save money by reducing the number of people covered by Medicaid. And so proponents of this frame it as cracking down on waste, fraud, and abuse, arguing that the only people who are going to get booted off of Medicaid are the people who deserve to be booted off of Medicaid, because in this piece of it they’re not working or volunteering or going to school or caring for a sick relative. We looked at, yes, this is aimed at saving federal money, but it is currently costing states millions or tens of millions of dollars to implement. It is extremely expensive to implement. States are having to hire a lot of people, they’re having to create, you know, brand-new tech systems that, or upgrade their old tech systems that they didn’t have before. And a lot of state officials told us that this is coming at really the worst time for them. They’re already losing other federal funding, they are really struggling, they’re having to make lots of cuts to social services. And so there just isn’t a lot of extra money to go around. And yet they have to spend all this money to implement these rules. And, especially, Democratic officials were telling us that, Look, we wouldn’t mind having to invest this money if it were going to lead to covering more people or offering people better, more comprehensive coverage. But they really resent having to spend this money in order to cover fewer people in the future.  

Rovner: So, let’s get to the rules themselves. As I like to explain, there are two big things that states are going to have to do here: first, to determine which Medicaid recipients are exempt from that community engagement requirement 鈥� to work, volunteer, or attend school 80 hours per month 鈥� and second, to determine if those who are not exempt are actually meeting the requirements. And these new rules make both of those harder for states, right, Margot? 

Sanger-Katz: Yeah, I think it’s been like this huge freak-out among states over these last few weeks, because there were a lot of rumors flying around, but I think there was just this concern, like, Whoa, if they make major changes right now, it’s going to be even harder for us to implement. And for states that were, as Alice said, some of these blue states that were trying to minimize the coverage losses under the Medicaid work requirement, I think they were worried, Well, they’re only going to make it stricter; they’re only going to make it harsher. Why would they be changing things now? And so, , it turns out that is, in fact, what they did, that there were a number of policy choices where they decided to apply a stricter standard than what states had been told before this week. 

So what are the biggest examples of this? I think there are two. One is that the work requirement doesn’t apply to everyone. The Republicans in Congress basically said we want people, adults without young children and without disabilities, to be engaged in their communities 鈥� to work, volunteer, go to school a minimum number of hours each month if they want to stay eligible for Medicaid. But we understand that there are certain people who are going to have trouble doing that, and so we want to have exceptions for those people. So not everyone has to do the work requirement, a bunch of people don’t have to. And the biggest category of this was a category that Congress called “medical frailty.” The idea was these are people who have medical problems that, like, might make it hard for them to work, or who might really suffer if they lost their health insurance. So, depending on who you talk to, that was what Congress was trying to protect with that exception. And what CMS [the Centers for Medicare & Medicaid Services] had been telling states over these last few months is: Put together a list of diagnoses of serious illnesses, and you can data match, you know, you have people in your Medicaid system already. OK, if they had cancer, if they have HIV, if they have Parkinson’s disease, that’s a serious illness. Those people are medically frail. You can just automatically exempt them, and then you don’t have to check their work hours. 

Rovner: That’s what Nebraska is already doing, right? Because they’re one of the states that have started this early. 

Sanger-Katz: Correct. Yeah, so Nebraska is already live with its work requirement. And, again, Nebraska, even more so than these other states, got tons of guidance from CMS, because they were so excited to go first, and they wanted to do everything right. They wanted to be a good example. And I think CMS wanted them to demonstrate, OK, you can like do this policy. Yeah, they had a list, I think they had like 300 pages of diagnostic codes, you know, like all these diseases. If you have these diseases, we’re gonna exempt you, then you don’t have to demonstrate work hours. If you don’t, OK, like, then you’re gonna have to prove that you’re working or volunteering or going to school. 

So what the rule said is, like, that’s not good enough. It is not good enough to have cancer 鈥� that in order to be exempted from having to demonstrate that you are working, you have to prove that you have cancer, and that your cancer is creating a problem that would make it hard for you to work. And the rule creates a standard where states are going to have to evaluate not just what diseases people have, which might be easy to do using medical records, for at least people who are already enrolled and who have been getting medical care, but instead that they have to make something like a disability determination, which is something that the states were really not ready for, that they don’t really have the staff to do or the training to do, and that cannot be easily automated on the back end right now. I think there’s not an easy way for them to go into the medical record and decide whether or not someone’s illness is serious enough that it would impair their ability to work. And the language that they use in the rule, the standard, is not actually really like the standard in other programs that have work requirements, so the states have no experience with the standard.  

And, as it turns out, doctors don’t really have any experience with this standard either. So, you know, when you are making a workman’s comp claim, for example, like the doctors have forms, there’s a system, they understand what it means to be too sick to work because of an injury that would preclude you from workman’s comp. And in SNAP [Supplemental Nutrition Assistance Program], it turns out, there’s also a standard if you’re unable to work, you could get out of the work requirements. But that is slightly different. And so I think there is this real concern by states that they just like actually don’t know how to do this. There might be some AI [artificial intelligence] solution where they’re data mining in the medical records and trying to figure out if they have these codes, and these codes, like, maybe there’s a way to prove that someone is sick enough. What most people that I’ve talked to said is that basically this is going to be a system that’s largely going to be achieved with doctors’ notes. Doctors have to be willing to do this thing that they’ve never done before, and they’re, you know, having to sign that someone can’t work, and that’s going to be a lot of frictions in that process. And then there’s going to have to be a caseworker on the other end who is going to have to look at those doctors’ notes and is going to have to read them and decide whether the doctor has specified the impairment such that it is in compliance with the work requirement. 

So this is just a lot of like administrative headache. I think there are reasonable arguments for wanting to have this standard given what Congress’ intent was, that they wanted to have a work requirement. The point was they wanted people who could work to work, and they wanted people to be exempted who could not work. I think not everyone in Congress agrees with that, but I think some of them do. But I think the reality of how you actually do this in real life is much, much more complicated than that. There is no, like, godlike state that can just see how sick you are and can make these determinations. And so I think that states are really worried about this. They’re worried about how they’re going to get in compliance with this, they’re worried about all the changes they’re going to have to make to the systems that they’ve already built. And I think that a lot of advocates for people with Medicaid, and a lot of disease groups, advocates for people with serious illnesses, are very worried that many, many more people are going to lose coverage, and particularly people who are medically frail. You know, if you think about, say, a person with HIV, they may be in treatment and getting their medicines, and they might even have undetectable levels of HIV in their blood, and they are perfectly capable of working right now. But if they lose their health insurance and they lose their access to their prescription drugs, they fall out of treatment, their health condition could worsen pretty substantially. And I think we can all think of lots of other diseases that are like that. I think cancer is a good example. You know, some people are living with cancer, and it’s kind of like a chronic disease, but it’s because they’re getting regular care. If they lose their treatment&苍产蝉辫;鈥�&苍产蝉辫;they lose their treatment for many other diseases we can think of that are like this. Depression, you know, certain kinds of mental health problems, if people fall out of treatment, that actually could impair their ability to work, and that causality could run in the opposite direction. So, I think this is a big change. 

And then the other change that they made is more technical, but it was like, how are people going to prove various things under this law? And a lot of states were just expecting people would be able to sign a statement and say, I am caring for a disabled relative&苍产蝉辫;鈥�&苍产蝉辫;you can trust me, I’m signing under penalty of perjury. This is what I’m doing. Or I volunteered 12 hours last month, you know, I’m just going to sign this under penalty of perjury. Because there’s not a good way to check. 

Rovner: And for the first year, that’s OK, right? They’re taking these attestations&苍产蝉辫;鈥�&苍产蝉辫;

Sanger-Katz: For the first year, they’re going to allow it. And then after the first year, they’re going to allow it for medical frailty only 鈥� once. So if you sign up for Medicaid in 2028 and you claim that you’re too sick to work, you can sign a form that says that, but then, within the next six months, before you renew your coverage, you’re going to have to come back with some kind of medical record with some kind of doctor’s note that proves it. So you know these are some pretty big changes, and Trump administration officials said, you know, our view is this is consistent with [what] the law is for, which is to ensure that people are working and are engaged in their communities if they’re capable of doing it. They also said that this prohibition on people just signing statements is a way to avoid fraud, because why wouldn’t people just sign a statement saying that they didn’t have to do this work requirement if they could? But I think this is going to have real implications in the real world. It’s going to create a huge administrative headache for states. It’s probably going to impair a lot of people from getting coverage who would have otherwise been covered if CMS had stayed the course with what it had been telling states before. 

Rovner: So, I know my inbox is full of reactions from groups across the medical spectrum. Alice and Liz, I assume you guys are hearing lots of feedback about this, too. 

Ollstein: Absolutely. I mean, just like Margot said, there just isn’t really a good way to do this, trying to automate it and base it on medical claims, like 1) States don’t have that built yet, the different systems don’t, quote unquote, “talk to each other” in that way. But also, you know, just because someone used a certain number or kind of health services in a year doesn’t necessarily tell you whether they can work or not. You know, lots of people who are too sick to work maybe haven’t had the medical services, and someone who had a lot of medical services maybe can work fine. But then again, leaving it up to individual doctors who are not trained to make this determination, who don’t have the time to have a bunch of extra appointments just to do this, and who are more used to doing this for 鈥� Margot gave a few examples, but something some doctors brought up to me was like short-term disability, like evaluating, like, this is the number of weeks someone needs to recover from X surgery. So like that’s a determination a doctor feels qualified to make. Whether someone can work any job, I mean, that’s just not really something they can confidently say. I mean, working a job in a factory is not the same as working an email job, and what kind of jobs are available in this person’s area? It’s just a huge mess. 

Rovner: So, is there any chance the administration is going to back off? There is public comment being taken now until, I think, July. Or will Congress perhaps step in and say this is not what we intended, or does somebody get to sue here? I mean, or this is what’s called an interim, I’m saying, an interim final rule, so it’s not set in concrete yet. 

Sanger-Katz: I mean, I would not be at all surprised if we see lawsuits, but I think we’ll see something else happen first, which is: The law says the states have to get ready to go by&苍产蝉辫;鈥�&苍产蝉辫;Dec. 31, 2026, to be ready to go live in January. But it says if they encounter a hardship, if they’ve been making good-faith effort towards getting ready for the work requirement, and they’ve encountered some hardship, and they, like, can’t make the deadline, they can apply for a waiver, basically a two-year extension from CMS. The Trump administration has been extremely clear to states about this all the way along, basically saying, You are not going to get these, we are not going to grant them, like, you know, maybe if there’s like a volcano that goes off in your state and the entire mainframe that holds your Medicaid enrollment system is melted, like, we’ll talk. But I think a lot of states now, especially some of these blue states that are really concerned about this stuff, I think that they are going to apply now, which they might not have done before. And I think if they are denied, I could see some lawsuits around that waiver process to just say, Look, like, you just changed the rules very late. There’s no practical way that we can get this done in time. We have been proceeding in good faith, and, you know, we need more time. So, I think that there could be litigation. I also think they did have this temporary policy for 2027 around self-attestation, which I think does help states get out of some of these, like, really tricky technical issues in the first year. I don’t know, like maybe there could be some further extension of that. But I don’t know. I’m curious, Alice, what, or Liz, what you think. But I am not holding out much expectation that Congress is going to make major changes here. 

Ollstein: Well, and because of the January deadline, making changes could solve one problem and create another. Because states already feel like they don’t have enough time, and they already feel like the rules of the game are being changed in the middle of the game. You know, what they had been spending months preparing for now has to change because of this guidance. If it changes yet again, and they have even less time to adapt and make a new change&苍产蝉辫;鈥�&苍产蝉辫;like you said, they’re making hires, they’re trying to make contracts based on this, and so even as advocacy groups, and even states ask for additional changes, additional changes could make it even harder to implement in time. 

Rovner: All right, well, let us move on, because there’s lots more news. Speaking of new regulations, a proposed rule from the Office of Management and Budget would basically make all grant funding from the U.S. Treasury subject to political appointee approval. Currently, most grant-level awards are determined by career scientists and peer reviewers, who make decisions based on scientific merit. Under this new policy, grants would have to, quote, “demonstrably advance the president’s policy agenda.” At the same time, the new 400-page document includes many new rules for grant recipients, including universities and other entities, including limiting their ability to engage in so-called issue advocacy and allowing the revocation of grant funds if recipients take actions that are not deemed by administration political officials to be in, quote, “the public interest.” Now, all this isn’t totally new. Office of Management and Budget Director Russell Vought has been talking about this literally for years. It was laid out in Project 2025 as well as in several executive orders that have been issued by President Trump, which is why I think it’s getting relatively little attention, given the pretty earth-shaking changes that it envisions. Still, putting it out in an actual proposed regulation raises the stakes here, doesn’t it? 

Whyte: Yeah, I would echo that. This has been on Russ Vought’s radar for many years. If you talk to folks, you know, who know him and know his thinking, this all comes down to this thinking about the executive branch and its role in the Constitution, and how there shouldn’t really be independent agencies or branches of the executive branch that aren’t doing what the president wants. And so that is manifested in this regulation that says you can’t promote anti-American values, contribute to illegal immigration, things like that, that are policy priorities of this administration, and a new filter that’s going to be applied to all federal grant-making, once this is finalized. And it’s a distillation of that theory about the executive branch that is now coming out in practice. 

Rovner: Although going back to what we were just talking about with the Medicaid work requirements, I mean, the idea of having to have a political appointee involved at this extremely micro level in the hundreds of thousands of grants that the federal government issues every year. I mean, some of it is the ideology, but some of it is just the logistics. I know that this has been part of the problem of getting money out the door at the National Institutes of Health 鈥� is that normally money that just sort of flowed when it was approved by career workers now has to wait for the approval of a political appointee, and there are not enough political appointees to approve all of these things, and people aren’t getting their money. So, I mean, this is a logistical logjam, as well as an ideological one, right? 

Sanger-Katz: And we’ve seen some evidence of this. The Department of Homeland Security has had an informal policy like this, where the director was personally approving any expenditure, I think, more than 100 鈥攏ow, I’m forgetting. 

Rovner: $100,000, yeah, I think it was. 

Sanger-Katz: There was some threshold, and it did lead to this huge backlog, because you know this is a busy person who has a lot of other things to do. And it was leading to a lot of money not getting spent that had been authorized by the staff members who thought it was appropriate. And I think there’s also potential for corruption with this kind of system, where you have these bottlenecks where very few people are making all the decisions about where money goes, because then there is an obvious focus on where you send your lobbying efforts to try to get favorable outcomes in contracting and in grant-making. 

Whyte: Yeah, the concern from the science and public health organizations is that the merit of the scientific grant will no longer matter, that how good the science is won’t be the chief thing. 

Rovner: Yeah, that this is all about, you know, promoting the president’s agenda. I’m just wondering what Republicans will feel about this when Democrats, you know, take back the administration and try to do the same thing. 

Whyte: I think that’s exactly the concern that a lot of conservatives on the Hill have, which is, you know, all of this is fine and well, but you’re not going to like it when the tables turn. 

Rovner: Yeah, that was 鈥� that’s what I said, you know, when the Affordable Care Act passed, I said, there’s an awful lot of places where it says the secretary shall, or the secretary may, or the secretary will. I said, you know, the secretary’s not always going to be somebody who supports this. That&苍产蝉辫;鈥�&苍产蝉辫;turned out to be a correct prediction.  

Moving on, the idea of this administration playing down its vaccine skepticism was so last month. Last Friday, President Trump issued an executive order basically endorsing Health and Human Services Secretary [Robert F.] Kennedy [Jr.]’s revamp of the childhood vaccine schedule, and ordering the CDC [Centers for Disease Control and Prevention] to review it and, quote, “take any appropriate steps to update said schedule.” What happened to “This isn’t popular, so we’re not going to push it,” or is doing this on a Friday afternoon how the administration is trying to placate the MAHA [Make America Healthy Again] movement, but not really make big headlines here? I also 鈥� this is another story that I think kind of flew below the radar. 

Whyte: Yeah, it’s funny because HHS can’t really say anything about this executive order due to their litigation ongoing, and so it’s just kind of out there. But it’s totally unclear to everybody why or what it’s expected to do, given that the court has put everything regarding the Advisory Committee on Immunization Practices on hold, and there currently is no ACIP. So what exactly the White House was intending with this remains pretty opaque, I think. 

Rovner: Like a lot of things, although I have started to, you know, like, pay attention on Friday afternoons again. Meanwhile, our podcast colleague  about how the anti-vax movement is trying to achieve its goal through the courts by arguing that vaccine mandates that lack religious exemptions are unconstitutional. And one of those cases is likely to reach the Supreme Court at some point in the not-too-distant future. What would it mean to public health if the court were to actually strike down the ability of states to impose vaccine mandates, which is one of the possible outcomes here? Or, as the groups claim, is this just about getting the five states that don’t have religious exemptions from vaccines into alignment with the rest of the states? 

Sanger-Katz: I think there is pretty strong evidence from the studies of state policies over the years that having really limited exemptions on mandatory vaccination really increases the number of kids who get vaccinated, that the more ways there are to kind of wiggle out of the requirement, the more parents will choose one of those options. And the narrower the exceptions, the fewer will. So, there are clearly some parents who really, really care about this issue and who do qualify for one of these exemptions. But I think there’s a larger number of parents who are maybe ambivalent or have kind of weakly held preferences not to vaccinate; if they’re not really being forced to do it, they won’t do it. If they are really being forced to go through a lot of administrative burden to prove that they need an exception, then they tend to vaccinate. And so I think this is an exception that almost every state already has, but I think that the evidence is relatively clear that opening up more exceptions in those states that don’t have them now, probably on the margin, will lead to fewer kids getting vaccinated in those states. 

Whyte: Yeah, the five states that don’t allow religious exemptions to vaccine mandates are West Virginia, California, New York, Connecticut, and Maine. So that would be, you know, an immediate effect there. But then I think we can expect from a Supreme Court precedent, if one is set, that other states, state legislatures, local school districts would perhaps expand the religious exemptions they have now, or make them easier. We’ve seen that how much friction there is when you get a religious exemption really matters. So, like, do you have to just sign a form, click a box, or do you have to go meet with someone and prove that you, you know, have sincerely held beliefs on this matter? And those kind of friction points matter a lot too. 

Rovner: Yeah, I just, I couldn’t help thinking, as I was reading this story, about going back to the Dobbs case, the abortion case, which was not originally intended or filed as one that was going to overturn Roe, and makes me wonder what the Supreme Court might do, even if the question that’s raised is, you know, about these religious exemptions, could they go on and overturn 鈥� I think that precedent was from 1905 that said that states can have vaccine mandates 鈥� and wondering whether a) that’s possible, and b) that’s likely. 

Sanger-Katz: It’s always hard to predict what the Supreme Court is going to do. 

Rovner: Always. 

Sanger-Katz: It’s really up to them. They’re an idiosyncratic group of people who get the final say on a lot of things. 

Whyte: I thought it was interesting, Lauren’s story was great, and one of the things it pointed out is that what the Supreme Court did is specifically give instructions to this lower court to go back and look at this question about religious exemptions for vaccine mandates using a case that happened in Maryland, where the Supreme Court found that the school district could not mandate that kids participate in lessons with LGBTQ content that would conflict with their parents’ religious beliefs. So in other words, the families had a religious right to not have to participate into that in school. And the Supreme Court is asking, is there a similar right that a family would have to not have to participate in vaccination to attend school? So that’ll be an interesting question, and it could, as we said, you know, have big impacts across the states and how school districts handle vaccine mandates for kindergartners. 

Rovner: Although I think this will take a while to play out. And before we leave the subject of vaccines, an update to our discussion from a couple of weeks back about the global vaccine alliance known as Gavi, which the U.S. owes some $600 million appropriated by Congress. That’s money that’s been held up by HHS Secretary RFK Jr. At a hearing of the Senate Foreign Relations Committee on Tuesday, Secretary of State Marco Rubio said his agency, which has historically been in charge of Gavi for the U.S. government, said that it is, quote, “sort of at a stage where we are going to re-engage. We need to drive this to an outcome.” Was that his polite way of saying that he plans to give Gavi the money that Congress allocated to it, and RFK Jr.’s concerns be damned? 

Whyte: I think a lot of people are reading it that way. You know, the State Department has a very practical view on these things. I also thought the way that Rubio phrased how they were giving Secretary Kennedy a large amount of deference because of his strongly held views on this matter was a very interesting insight into how the Cabinet works and how Trump has instructed his top officials to work together. And I think part of the problem here is that they’re just running into the practicalities of not having an Ebola vaccine. And so the State Department is going to have to do what it feels must be done. 

Rovner: Yeah, it was just a little peek behind the curtain of this intra-agency squabble that’s going on. We’ll wait and see if that happens. 

Whyte: I should say that they don’t have a vaccine for this newest outbreak that is going on. They, you know, the older Ebola vaccine, it was not appropriate to treat this one or to prevent this. 

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

All right. Our theme this week seems to be federal rulemaking. So, here’s another one. The Trump administration has issued final rules attempting to fix the arbitration system created in the, quote, “No Surprises Act” 鈥� that it is safe to say has not worked as it was designed by Congress. Margot, remind us what went haywire with the process that’s actually in practice [to] dramatically increase what providers get paid, and will these new rules make it all better?  

Sanger-Katz: So this is a system supposed to solve the problem of surprise medical billing when you, say, go to the emergency room and some doctor treats you, and it turns out that that doctor didn’t take your insurance and sends you a huge bill. So the law did away with that, basically said no one is allowed to send you a huge bill in that situation, and then it created a system on the back end for the insurance company and the doctor to kind of fight it out and figure out what the doctor was going to get paid if they didn’t have a contract with that insurance company. And the expectation of Congress was that this is a system that would be used fairly rarely, that most of the time this would be negotiated between the parties; they would just decide on a price and work it out, but every once in a while there would be a rare case where they would need to litigate their dispute. And it would go, they set up this arbitration system where a neutral arbiter, usually a lawyer, but not always, would hear arguments from each side and decide who had the more reasonable position, and would have to choose between the two bids. They couldn’t negotiate any further, but, you know, the doctor would say, This was a very complicated case, I deserve $10,000. And the insurance company would say, No, no, no, like, normally for this kind of visit we pay $500. And the arbitrator would have to decide which is more reasonable: $10,000 or $500. 

What’s happened, I think, to the surprise of a lot of people, is that instead of 17,000 of these cases going to arbitration, which is what CMS expected when the law passed, more than a million are going through a year. There has just been an explosion of cases coming through the system. Lots and lots of medical disputes are now being decided using this process, and the doctors are winning almost all of the time. I think in the last quarter for which there is data, 88% of these arbitration claims are being decided in favor of doctors. And because of that, the doctors, in many cases, have started getting more aggressive in what they ask for. Because they keep winning, there is not really an incentive to say that price is normally $500. They’re much more likely now to ask for $10,000 than early on in the system, where maybe they were asking for $1,000. And so we’re seeing some really eye-popping awards. Not all of them; there are a fair number of awards that are, you know, within a reasonable number of multiples of what the normal price is. But there are an increasing number where doctors are just getting huge, huge, huge increases over what you would expect. And my colleague Sarah Kliff and I wrote a story a few weeks ago about a plastic surgeon in New York and New Jersey who was routinely collecting fees of hundreds of thousands of dollars for breast reduction surgeries that he had previously accepted payments of around $10,000 from the same insurer prior to this law going into place. So big problems. Lots of complaints from insurers, as you can imagine, and also from employers who, in many cases, are actually paying the bills for their workers’ health insurance directly, because they have these self-insured ERISA [Employee Retirement Income Security Act of 1974] plans. 

This rule that just came out is not getting at the real, like, meat of the system, how the arbitration works, and what&苍产蝉辫;鈥�&苍产蝉辫;how the arbitrators make their decisions. But it’s dealing with, like, a lot of, like, technical issues about, you know, how do you submit paperwork? What kind of information do you provide? Is it all in one computer system? How can you make sure that you have identified the right insurance company? And what are the administrative fees that you pay when you want to initiate one of these claims? And so this is a very hot issue. I wrote this one story, and, like, everyone is just really worked up about it. The doctors are really worked up about it, the insurers are really worked up about it, the arbitrators are really worked, you know, everyone feels strongly about this law, and whether it’s going well or not well, or what changes or they want or don’t want. Everybody loved this rule. As far as I can tell, there have been, like, basically no complaints about this rule. The one complaint I’ve seen is that they lowered the fee to file a new case, and so I think people who feel like there are too many of these cases would like it to be a little harder to file a new case. But, in general, it seems like these were expected, helpful, technical upgrades that are just going to make the process work a little bit more smoothly and deal with some of the annoying administrative headaches. 

Rovner: But not address the deeper problem. 

Sanger-Katz: The bigger issues, I think, really do require the involvement of Congress. If Congress wants to revisit the law and change the way that this overall system is structured, they’re probably going to have to write new legislation. And I’m not sure how large the appetite is for that right now. 

Rovner: Yeah, I’m not going to hold my breath on that one. All right, that’s as much news as we have time for this week. Now, we will play my “Bill of the Month” interview with Lauren Sausser, 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’ Lauren Sausser, who reported and wrote the latest “Bill of the Month.” Hi, Lauren. 

Lauren Sausser: Hi. 

Rovner: So, this month’s patient got caught in one of those fights between the insurance company and the hospital, and, of course, it turned out to be harder to untangle it than it should have been. Tell us who she was, what happened to her, what kind of care she needed. 

Sausser: Sure, so Jan Anderson is a 65-year-old woman who splits her time between Arizona and Washington state. And Jan was hiking with her husband about a year ago in Arizona. They were in Sedona. And later that afternoon 鈥� it might have even been pushing into early evening 鈥� she started repeating herself. So she asked her husband, Did we hike today? And he said, Yes, we hiked. And then a few seconds later she asked the exact same question, Did we hike today? And it was clear almost immediately that Jan needed to be seen. So her husband drove her to a freestanding ER in the Sedona area, and that facility assessed her but was not equipped to deal with patients who might be experiencing stroke. They didn’t know what was happening with Jan at this point, so she was airlifted to a hospital in the Phoenix area, where she was admitted. And they ran a bunch of different tests and images, and it turns out she wasn’t having a stroke, she was having, she was experiencing an episode of something that’s called temporary [transient] global amnesia 鈥� which, the good news is, is benign, and as the name suggests, temporary. But her hospital bill ended up being quite a lot, even though it was less of an emergency than they originally thought. 

Rovner: Well, of course, that’s what they always tell you: If you’re having symptoms, you should go to the emergency room. So, she did have insurance, right? So, why did the hospital in Phoenix think that she didn’t? And how much was the bill? 

Sausser: OK, so the total bill was $59,181. That’s just for the care she received at the hospital in the Phoenix area. She did have insurance. She was insured through Molina [Healthcare], and it was a plan that she had purchased through the federal healthcare.gov marketplace. For some reason, though, her insurance information was not transferred from that freestanding ER in Sedona to the facility where she was airlifted in the Phoenix area. So it was a mistake, but that second facility billed her as if she was a self-pay patient with no health insurance. 

Rovner: Now, once the hospital did figure out that she had insurance, why did the insurance company then still reject the claim? 

Sausser: It took a while to get some answers on this, but eventually Jan learned that Molina was not going to cover the cost of that care she received in Phoenix, because the Phoenix hospital had not sought prior authorization for her to be admitted. Now, under the federal No Surprises Act, emergency services are supposed to be paid for in-network without prior authorization. In this case, the insurer was saying Yes, we do cover emergency services without prior authorization, but in this case her care team was recommending that she be admitted. And the insurer argued that the insurance company needed to be notified before that happened. 

Rovner: So, I know I ask this question all the time: Why didn’t the No Surprises bill [Act] get the patient out of the middle of this obvious insurance company hospital dispute?  

Sausser: This&苍产蝉辫;鈥�&苍产蝉辫;in this case, the No Surprises Act kind of worked. Jan received a bill pretty early on saying she owed about $15,000 of that $59,000 total charge. After she told the hospital that she did indeed have coverage, that bill was suspended. There was no one technically knocking on her door pressuring her to pay any amount of the charges she had accumulated in the Phoenix hospital. But every time she would log on to her patient portal, she would see these outstanding charges. The hospital didn’t understand why the insurance company wouldn’t pay. The insurance company was saying she needed to have had prior authorization, and these charges just weren’t disappearing, and so eventually she started reaching out to insurance commissioners, lawmakers, trying to get someone to pay attention, because she was worried at some point she might owe the hospital $59,000. She couldn’t get these charges resolved, and didn’t understand why. 

Rovner: And what eventually happened? 

Sausser: Well, she eventually contacted us. And, as is often the case when journalists get involved with these health insurance issues, the ball started moving. So Molina started talking to the hospital in the Phoenix area, the Phoenix-area hospital has assured Jan that she will not be billed for any of the $59,000. Even if Molina doesn’t pay, the hospital has assured her that they will write off the balance and that she will not be billed. Jan has asked for that assurance in writing. As of the last time I spoke to her, she hasn’t gotten that, but she has been told she will not have to pay any of it. 

Rovner: So, what’s the takeaway here? I mean, it sounds like, you know, she did everything right, and it seems to be resolved. 

Sausser: It seems to be resolved, although the last I heard the $59,000 in charges haven’t necessarily gone away. I spoke with a patient billing expert about this, and the advice that she gave in a situation like this, you know, when you have a hospital stay, you get all sorts of paperwork in the mail afterward. You get paperwork from the insurer, you get paperwork from the provider. This billing expert recommends that you look at the patient responsibility portion of your explanation of benefits. Now that’s a document that you will get from your insurance company. It should list the charges that the hospital has billed, but it should also list the portion of those charges that the patient is responsible for. In Jan’s case, her explanation of benefits clearly stated that she was not responsible for any of it. Now, that didn’t mean that those $59,000 in charges was automatically disappearing, as this story shows. More than a year later, it’s still not resolved. But it shows you that the insurance company is saying you are not responsible for this bill, in this case. The billing expert that I spoke to recommended that the patient mail or email the explanation of benefits from the insurer to the hospital and show that the patient responsibility is zero, in order to get that balance cleared.  

Rovner: We’ll see if this happens. Lauren Sausser, thank you so much. 

Sausser: Of course, thanks for having me. 

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. Alice, why don’t you start us off this week? 

Ollstein: Yeah, I have a very interesting piece from The New York Times by Simar Bajaj, and it’s called “.” And it is about the trend we’re seeing under the MAHA movement, largely, you know, expressed by Secretary Kennedy, back towards putting a lot of focus on personal responsibility, personal lifestyle choices, and less focus on policy and environmental factors. And it’s, you know, digging into the history of that on a few different fronts, both with, you know, infectious diseases, but also with things like obesity. And it is talking about basically how we’re seeing a return to a system that didn’t really work before, which is, you know, basically browbeating and shaming people into healthier behaviors that did not work in the past. And yet we are sort of attempting to revive that, and part of that is a reaction to the fact that trying to move away from that also hasn’t seemed to work either. So it really explores these, the different history of these approaches in public health. 

Rovner: That’s why public health will continue to be studied. Margot. 

Sanger-Katz: I want to suggest an article in ProPublica from Alec MacGillis called “.” I’ve been interested in the public health problem of gun deaths for many years, and I have to admit that Alec in the story has tackled an issue that I just wasn’t watching. I think it’s, like, one of these other things that has a little bit slipped beneath the radar, because the Trump administration makes so much news. But they, through the ATF [Bureau of Alcohol, Tobacco, Firearms and Explosives], which regulates firearms and firearms dealers, has really loosened up a lot of the restrictions that the Biden administration had put in place to try to prevent the trafficking of illegal guns onto the streets of American cities, where a lot of crime happens. And the story sort of looks at those policy changes and what it means for gun dealers and for people who buy guns. And I think it is too soon to tell whether these policy changes will have an effect on violence and gun deaths on the streets. I think it takes, in many cases, a long time for illegal guns to kind of get out there and be used for crimes. But we have been in this period of really merciful reduction in the crime rate and the murder rate in many American cities for the last few years, and I do think that Alec raises the question that if we are seeing more guns on the streets of the future, whether those declines can be sustained.  

Rovner: Liz. 

Whyte: My choice is from my colleagues Anna Wilde Mathews and Christopher Weaver at The Wall Street Journal, and it’s entitled “.” And it’s a really great look at how there are all these providers that have really exploited this new and growing segment of therapy for kids with autism, which is obviously a growing diagnosis, such that you have, you know, this mom in New Jersey who hears that she can get a no-out-of-pocket-cost treatment for her son and has someone come a few days a week, three or four hours of therapy, and winds up with a bill for more than $900,000, which is obviously a nightmare. So we had previously looked, The Wall Street Journal had, [at] Medicaid billing abuse with these autism therapy services, and found that it was a huge issue. And then this is a look at kind of the private insurance sector, where all these providers are charging private insurance a lot, and when an insurer says, No, we’re not going to pay that, some of these bills end up falling on the families, which is really tragic. About 40 large employers, covering 3.5 million people, their expenses for autism therapy doubled from 2021 to 2025, to $108 million. The Wall Street Journal looked at a bill that was $30,000 for one kid to get autism therapy for one day; it’s actually quite insane. So, kudos to my colleagues for writing about this.  

Sanger-Katz: Can I share one fact from this article that really struck me? 

Rovner: Sure. 

Sanger-Katz: One of the things that these reporters did that I thought was so smart is they documented the growth in the autism services workforce. So, the number of people who are providing this kind of behavioral therapy to children with autism is now larger than the workforce of the U.S. Postal Service. That’s according to a tweet from Derek Thompson, who compared the numbers. But it is kind of astonishing, the growth, not just in the Medicaid spending, not just in private insurance spending, not just in some of these unjustifiable bills that individuals have faced, but also that this is now a huge part of the American workforce is serving in this specific industry right now.  

Rovner: And if this story sounds familiar, it’s because we had a different autism therapy abuse story last week as one of our extra credits. It was written by Margot here, and Sarah Kliff. Yeah, a burgeoning source for reporters to plumb. My extra credit this week is a joint investigation between my colleagues here at 麻豆女优 Health News and the AP. It’s called “Festering Infections to Untreated Cancer: ICE Detainees Describe Medical Neglect Across US.” The team of six reporters and analysts dug through court records to document that hundreds of immigration detainees in 33 states have filed suit, charging that they were denied adequate medical care. Quoting from the story, “Requests for help went unanswered for weeks, blood sugars rose, infections festered, cancers remained untreated, detainees collapsed and had seizures.” And there’s not even anyone to complain to. Officially, the administration shut down the office of the Immigration Detention Ombudsman earlier this year. The story is really infuriating and worth reading in its entirety. 

OK, that is this week’s news. Thanks to our editor this week, Stephanie Stapleton, and our producer-engineer, Francis Ying. We also had production help this week from Taylor Cook. 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 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? Alice. 

Ollstein: I am on Bluesky , and on X . 

Rovner: Liz. 

Whyte: I am , and on X , and Signal: JournoLiz.80. 

Rovner: Margot. 

Sanger-Katz: I am @sangerkatz at , and on Signal. If you want to send me tips, I’m @sangerkatz.01. 

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

[Editor’s note: This transcript was generated using 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, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, May 28, 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 Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Great to be here. 

Rovner: And Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: Later in this episode, we’ll have my interview about the ongoing Ebola outbreak with Céline Gounder, 麻豆女优 Health News’ public health editor-at-large and, conveniently for us, an infectious disease specialist. But first, this week’s news. I want to start this week with more of a trend than actual news, and that is the continued decline in health insurance coverage in the U.S.  on the number of children falling off the Medicaid rolls. It’s down about 1.75 million from the beginning of Trump 2.0 through this past January. Now, I thought we were told that none of the Medicaid cuts that Congress made last year would affect the core Medicaid constituencies: pregnant women, children, seniors, and people with disabilities. What’s happening here? 

Goldman: So, the law does exempt kids and parents of young kids from the eligibility and enrollment changes, work requirements, more frequent eligibility checks. That doesn’t mean that there aren’t going to be spillover effects, and we’re seeing that already, Absolutely, even though most of these provisions haven’t gone into effect. And there are a couple of reasons for that, including chilling effects from immigration enforcement and people who are in mixed-status households maybe not feeling comfortable enrolling their children in public benefits, even though their children would qualify, or also just confusion around who’s eligible for what. Often kids are eligible for Medicaid and Children’s Health Insurance Program 鈥� its sister program, CHIP 鈥� at a much higher income level than their parents, and that’s not communicated well to parents very often. And so one theory&苍产蝉辫;鈥�&苍产蝉辫;is that this year, when a lot of parents maybe saw how much their ACA [Affordable Care Act] premiums were going up and decided that they couldn’t afford health coverage anymore, they were just pulling their whole family out of health insurance, even though their kids might still actually be eligible for Medicaid. And&苍产蝉辫;鈥�&苍产蝉辫;there are a lot of other trends percolating in this, but I think it’s concerning to see this, these figures, even before this has really started. 

Rovner: Yeah, it’s funny, when you’re applying for health insurance, they’ve set it up so that you get funneled to the right place for which you’re eligible. But when you’re dropping your health insurance, there’s no funnel to say, hey, your kids might still be eligible for this, even though you’re no longer going to be getting Affordable Care Act insurance. 

Goldman: Exactly, and navigators for ACA coverage have also 鈥� funding for those programs have been cut, and so that’s harder, even harder for that process to actually work. 

Rovner: Yeah, I’ve also noticed in the states that are starting things like their work requirements early, there was kind of a shocking anecdote  鈥� one of the states that’s starting early 鈥� who’s blind, has multiple health problems, and a chemotherapy port, who was told that she might be required to work under these rules and was seeing about getting her port taken out when finally another person told her, No, you’re exempt. So, I mean&苍产蝉辫;鈥�&苍产蝉辫;in some of the states that are speeding this up, there’s a lack of knowledge among the state workers, which I think was one of the big concerns about people who are going to be dropped off the rolls, not because they’re no longer eligible, but because of mistakes. 

Weber: We also know that, in general, Medicaid enrollment is a tricky process. Typically, there’s paper forms that may get lost in the mail. Parents may not get the forms for their kids. This was very eloquently actually described on The Pitt 鈥� which, shoutout for getting this part of health policy correct. Although I’m still irritated about their Medicare-Medicaid mix-up in one of the other episodes, but we’ll get over it. 

Rovner: Yeah, me too. There were two of those. 

Weber: Yes, but very eloquently show[ed] how a mom who had moved and missed some Medicaid paperwork was now really in a hole financially. And so, as Maya has reported out, you know, more of these children falling off the rolls really could lead to some dire consequences for the families to which they belong. 

Goldman: Yeah, and I think one important thing to mention is that a lot of these kids that are uninsured are still eligible, and when they go to the hospital, the hospital can help them enroll in retroactive Medicaid coverage, but they’re not getting their yearly checkup, or maybe, like in The Pitt, they miss their asthma medication, and so now they’re in the hospital, and costs are just going up for the whole health system. 

Rovner: Well, along those same lines, we have another story in our 麻豆女优 Health News series called “Priced Out” about how people who can no longer afford comprehensive coverage are patching together other forms of insurance, or in some cases not even actual insurance, that leaves them on the hook for thousands of dollars if they end up needing actual medical care, which kind of raises the perennial question with our health system: Is it better to have bad insurance and not know it, or to have no insurance, so at least you know that you’re not prepared if something happens. 

Weber: I thought what was so striking in that story was it led off with a retired teacher who said, I recognize I am gambling. I mean, that’s what she said, she’s very clear. But to her, I think her cost had risen something like $900-something a month, and the other plans that she cobbled together were $300 a month, and so to her the short-term risk was worth it. But as we all know, hospital stays can run you several thousand dollars and, you know, you can get hit by a car. You may be a very healthy person, but something bad can happen, and you are left with large, large medical debt. And I think it seemed like the folks interviewed in the story were at least clear that these plans were less favorable, but I do think there is also this submarket where a lot of folks think that the health ministry plan that they’re in is going to save them in case of an issue. And we have found over and over again, and 麻豆女优, in particular, has found over and over again in reporting, that’s just not the case. And so this whole question of Is a bad plan better than no plan? I don’t know, but it’s striking to see people say I’m willing to take the gamble, because this is just what these increases in premiums have meant for me. 

Luthra: I just think what’s so interesting about these, these health shares, in particular, is when I’ve talked to people who’ve used them or considered them, they know these are not insurance, but I don’t think they always fully understand just how restrictive they are, and how often medical needs will be dismissed as lifestyle choices. I mean, obviously, often contraception is not covered, but something related to drug or alcohol use might not be covered, because that’s immoral, right? Let’s say the ministry says, “Oh, well, this accident you got into, maybe that’s because of alcohol use.” That’s a huge expense that you just might not have realized wouldn’t be covered at all. And the other thing that I was just so struck by is very often childbirth isn’t covered. Or you have to be enrolled for a very long time before childbirth is covered, which health insurance is required to cover childbirth. It is very, very expensive. It’s fascinating, also, because a lot of these [sharing ministries] are so religiously aligned and ostensibly pro-family, etc. And yet this, in particular, is just something where people will opt for this instead because it looks more affordable than insurance. But very often you end up paying a not-zero amount of money, and ultimately getting basically nothing for very expensive, even bankrupting medical needs. 

Rovner: Or you’re gambling, you know, maybe, maybe you’ll get reimbursed, and maybe you won’t. Although these days people feel that way about their health insurance. Maya, you want to say something? 

Goldman: I think a lot of young people also take for granted that health insurance will cover preexisting conditions. If you’ve come up, you know, post-ACA, and certainly I do. I’m 28, and that’s, like, something that never even crossed my mind that I would need to consider, and that really struck me in this article. A lot of these alternative plans are not bound to those requirements. 

Rovner: Well, Shefali, I wanted to ask you in particular about  about how abortion rights supporters are trying to adapt reproductive health to fit under the bigger affordability umbrella that seems to be the theme of this year’s midterm campaigns 鈥� that things like whether or not to get pregnant or whether to get unpregnant, that those are all wrapped up in all sorts of financial issues, as you just mentioned. Is this a natural fit, or do you think they’re kind of forcing it here? 

Luthra: I think it really depends on how you talk about it, and the context of where you are. And after the mifepristone case was before the Supreme Court, I spent a lot of time looking at different Senate campaigns and examining how they’re talking about it. And one example is Jon Ossoff in Georgia actually has a really interesting example where he talks about access to abortion and healthcare as part of this larger argument around the state of reproductive healthcare, talking about hospital closures, talking about Medicaid cuts, and putting all of this together as this broader policy ecosystem that is making your healthcare harder to come by and ultimately threatening your life. I think that’s very interesting. It could work. It makes sense logically to me. The other one that does come to mind 鈥� and this is not abortion, but it’s related 鈥� is in Maine, Graham Platner talking about IVF [in vitro fertilization] in the lens of affordability, saying, Oh, I couldn’t afford it in America. I traveled to Norway to try and get fertility treatments. Those are fascinating approaches, and a lot of people who work in abortion rights advocacy will say this has long been an economic argument, and many of them will look at polling and put it out that says when you frame this as an economic story, voters really, really do appreciate it and resonate with it. I think sort of the question is whether we actually see these candidates 鈥� and it’s not lost on me the two who I mentioned are both men 鈥� actually talk about the word “abortion” specifically, rather than saying “reproductive healthcare” more broadly. And you know those are very different, and they just register with voters differently when you single out something as specific as abortion versus whether you don’t. 

Rovner: And Graham Platner, for those who don’t know, is going to be the Democratic candidate running against Susan Collins in Maine. Jon Ossoff is the incumbent Democrat in Georgia, which always feels weird to say. There haven’t been a lot of Democratic senators from Georgia, but right now there’s two. 

So, moving on, the Trump administration says the declines in health insurance coverage are fine because they’re more about fraud and kicking people off of public health insurance rolls who aren’t actually eligible or 鈥� in the case of Affordable Care Act broker fraud 鈥� who don’t even know they’re covered. But a lot of the tools in last year’s big budget bill are pretty blunt, and they’re going to impact both those who maybe shouldn’t be there and those the administration says it wants to keep serving. This week’s example is a newly proposed rule to implement that law’s cap on something called state-directed payments, which is, in fact, a key way many states help ensure adequate funding for hospitals, nursing homes, and other healthcare providers. Now, this isn’t fraud, but it is what analysts like to call creative funding, and Congress has every right to limit it. But that’s not to say that it won’t have an impact on healthcare at the delivery level, right? It’s not just going to impact people that the administration says don’t deserve to be covered. 

Goldman: Yeah, this came up when I was talking to children’s hospitals for the story on children’s coverage that I wrote this week. They’re saying, you know, this is going to affect all kids that we can care for. This is going to mean less money into our funds, and, you know, a lot of people argue that hospitals have enough money, but hospitals will say, “No, we don’t, not to take care of all the people that we need to take care of.” And this is going to be less money. And then it’s not just kids who are on Medicaid who are struggling, it’s all kids. And I think another interesting thing about this proposed rule is that it’s significantly more federal savings than was estimated originally. I think CBO, Congressional Budget Office, originally estimated that the state-directed payments provision would save about $150 billion, and this rule would save about $510 billion in federal funding. So hospitals are concerned. 

Rovner: Yes, this is always the issue. Are we overpaying hospitals? But when you take money out of it, what does that mean for the health system writ large? Which I imagine is going to continue to be a theme as we go forward. Well, the Trump administration is also going very high-profile in its health fraud-fighting effort. The president has put Vice President JD Vance in charge. Earlier this month, he announced that the administration will be withholding $1.3 billion in federal Medicaid funding from California, because, said the vice president, the state has not taken fraud very seriously. This is the second Democrat-led state the administration is taking the nearly unprecedented step of withholding funding from in advance, after Minnesota. California has responded that one reason the state’s home health bill has gone up is that it has raised wages for home healthcare workers, and it has expanded eligibility. It’s not because of fraud. Again, while there obviously is fraud 鈥� not just in Medicaid, but in all health programs, public and private, because there is so much money there 鈥� these blunt tools, I think, will probably punish more than just those who are defrauding the program. Right? 

Weber: I mean, absolutely. At the end of the day&苍产蝉辫;鈥�&苍产蝉辫;look, it’s no coincidence that California is a blue state that seems to be getting targeted with that amount of cash. But let’s be very honest, there is a lot of fraud. I mean, all of us here have written stories about healthcare fraud. There is a lot of fraud to root out. So, to be very clear, I don’t think anyone should be upset about actual fraud being targeted. But there’s also a question of: What are the numbers? [Centers for Medicare & Medicaid Administrator Mehmet] Oz has gotten the numbers wrong before. The AP [Associated Press] had a great story on that a couple weeks ago. Show us the fraud, like, I want to see the actual fraud that we’re talking about. And, in addition, this reminds me of how the administration continuously says that they’re investing the most money in rural healthcare when they have this $50 billion rural healthcare fund. Well, the Medicaid cuts that [President Donald] Trump led is going to cut like triple that almost out of rural areas. So is this a talking point? Show us the money. I need to better understand what’s behind it. 

Rovner: Yeah, so far they’re doing well with a lot of very high-profile news events. We’ll see how much fraud they are actually able to ferret out. All right, we’re going to take a quick break, we will be right back. 

Let’s talk about Ebola. As you will hear later in this episode from our in-house expert, Dr. Céline Gounder, this is not likely to become the next covid or even a pandemic. But this administration, having hollowed out the Centers for Disease Control and Prevention and obliterated the U.S. Agency for International Development, is addressing this outbreak with many fewer arrows in its quiver. Lauren,  about someone close to this outbreak. Tell us about it. 

Weber: Yes, I was able to speak with an American missionary physician who was exposed to Ebola and actually evacuated to Prague and is sitting in basically like a bubble room waiting to see if he tests positive for Ebola. And what traumatizes him, as he was telling me, was that he’s sitting there, there’s all these people with endless gloves that are tending to him, he’s been evacuated, and stretchers with all this plastic and all these measures, and his colleagues that he worked alongside in the Congo are 鈥� you know, one died while we are in the middle of an interview, he learned of their death. And, in addition, they’re filling the hospitals themselves, that they say they don’t have enough gloves, they don’t have enough PPE [personal protective equipment]. There’s no vaccine to fight this current form of Ebola, and they’re in an environment in which people are very mistrustful. Ebola looks like malaria until it’s Ebola. And so you could send a family member into the hospital thinking it’s malaria, which is common in this part of the world, and then suddenly be told your relative has Ebola and died. A lot of people don’t believe it, and it’s leading to violence. And the usual public health measures and efforts by the international community to get in there are somewhat hampered. And Part Two, by the fact that this outbreak is happening in a really insecure region, where there’s roving militias and other violence. And there’s just a lot of concern that they caught this late, this could continue to explode, and case counts could really go up. But it was very humanizing to speak with this American missionary who obviously really put himself on the line to help these folks and is heartbroken to kind of be watching from afar as this continues to go poorly. 

Rovner: Well, meanwhile, the U.S. is banning foreign nationals who’ve been in any of these countries from entering the U.S. and also U.S. green-card holders who’ve been in countries where the virus is spreading. Not only that, but they’re not allowing exposed U.S. citizens to return, even though the U.S. has multiple facilities to care for exactly these types of patients. We have seen this before, just in the last 15 years. What happened to the medical freedom that this administration has been touting so much? 

Weber: It’s a real plot twist. I mean, these are the folks that said that they were the contrarians that oppose quarantine and mask mandates, and they are strictly having the hantavirus folks in Nebraska. They’re signing off on travel bans that go further than other administrations, and not allowing Americans back in and sending them to Kenya if they’re exposed. My colleague Lena Sun and I had a report a week ago about how the White House didn’t want exposed Americans back in the U.S., but the Kenya step is another step in that direction. Is really could have huge ramifications for the response as a whole, because it will likely limit the number of people that want to go. If you know that you’re not going to be able to be sent back, we saw, I think, yesterday the State Department union was like, look, our foreign service officers were sent here under the impression that they would be able to come back. I mean, this is somewhat completely uncharted territories in the vein of how they’re handling this. So we’ll see. 

Goldman: I’m very curious to see what the MAGA [Make America Great Again] base and the MAHA [Make America Healthy Again] base that were so anti-mask mandates and things like that during covid, like, what are they going to say? Are they going to say anything? Is it partially our responsibility as the media to point out this contradiction? 

Rovner: Yeah, and obviously there’s also so much else happening right now. It’s interesting that the hantavirus, which turned out to not be such a big deal, got so much play, and yet this, which could be a much bigger deal, is getting so much less attention. 

Weber: Do we think there’s maybe a reason for that? Let’s all be honest. The hantavirus cruise was a lot of wealthy, some Americans on a cruise sailing around Argentina and Antarctica. And then this outbreak is happening in Africa, and I think there’s less interest from the general public, as they feel like hantavirus is novel, whereas Ebola, they’ve heard about it before, so a depressing reality of some of that. 

Rovner: Yes, and also, you know, Americans and Europeans versus Africans. 

Weber: Yes, yes, exactly. 

Rovner: All right, moving on. I want to catch up on some drug price news, because there’s been a lot over the past few weeks. The Supreme Court earlier this month declined to hear a case challenging the Medicare drug price negotiation system that was implemented under the Biden administration, which ironically will probably redound to the credit of the Trump administration, even though it nominally opposed the Biden program. Also, earlier this month, the president announced a big expansion of his TrumpRx website, adding links to websites selling lower-cost generic drugs, including the site run by Mark Cuban, Cost Plus Drugs. But the most provocative drug price story I have seen this month came from my colleague Darius Tahir, noting that Trump himself was buying stock in drug companies just as he was negotiating with those companies to help bring drugs, particularly those GLP-1 medications that he likes to call “the fat drugs,” to more people. Now this isn’t technically illegal, although there are lots of efforts on Capitol Hill to outlaw individual stock trading by members. But I can’t help think if any other government official in any other administration ever did this, they would be out of a job instantly, if only for the appearance of the conflict of interest. This is just 鈥� Lauren, as you were saying 鈥� one in this whole long list of things that keeps happening, but every time I look at it, I’m like, he was doing what?! 

Weber: Julie, when I saw Darius’ story, I was blown away. First off, I feel like this should have been front-page news on every outlet. But secondly, it was a lot of money, it was like over $600,000. And now I understand they say that Trump himself, they don’t know whether he directed this or not. And in fairness, Trump’s not the only one. I mean, we’ve seen plenty of members of Congress that have done also questionable stock trades. But it is a very conflict-of-interest-looking-like thing, considering that CMS recently expanded massive access to these drugs. And so I do think conflicts of interest like this, especially in HHS [Department of Health and Human Services], which has constantly decried conflicts of interest, despite having many of them, are very important to highlight. And so, thank you to Darius for surfacing this. 

Rovner: Yes, we will never not have enough to do here as health reporters. Well, finally, this week I want to . President Trump this week had his third, quote, “annual” physical in the past 13 months 鈥� math does not math there 鈥� after which he said he checked out perfectly. But he is about to turn 80. He’s been caught on camera dozing off at public events in the Oval Office and has gone on hours-long social media rants in the wee hours of the night/morning. Now, much of this hasn’t been treated as news, because well, it’s pretty much par for the course for Trump, just more so. And therein lies the question: When does his increasingly aberrant behavior and obvious health issues, like visibly bruised hands and swollen ankles, become a public right-to-know issue? And is there a double standard for Trump compared to former President [Joe] Biden, when he began to show obvious signs of aging, and it was all over the news all of the time? I see raised eyebrows. 

Luthra: No, it’s such a good question. On the one hand, there was obviously a lot more scrutiny on Joe Biden’s age than there appears to be on Donald Trump’s. But part of it, I think, is that a lot of what you just highlighted, Julie, is out in the open. Everyone has seen the president dozing off on camera, whereas under the last administration, there were things that were not public that then became public, and that was obviously very important. That said, there’s certainly a level of focus on this issue that perhaps is lacking. Maybe it would be useful or newsworthy to put some more attention, even something that we already know, highlighting why it is important, putting together the fact that having this many physicals at this point in the presidency is actually more than normal. What could that mean, contextualizing it with everything we have seen publicly about the president’s sleep patterns, risk factors as you age, bruising, etc. But I think this kind of thing is complicated in terms of how you cover it appropriately and fairly, also just because you don’t want to assume things that you don’t have the evidence for. 

Rovner: And, in fair, I mean, Trump has not been transparent about his health, going back to when he was a candidate in 2016. He’s the only major presidential candidate, you know, he put out that, this famous letter from his personal doctor saying, you know, he’s the healthiest man I’ve ever seen. That’s pretty much what we get, having covered presidential health for a lot of administrations. We have much, much less information about Trump than we have had about previous presidents, which has been a continuing policy concern among doctors. I mean, this is not to single out Trump, who just happens to be president right now and turning 80. But this is, you know, an issue that goes back obviously to, you know, Dwight Eisenhower, to Woodrow Wilson, when he had a stroke, and they kept it a secret. Presidential health is a policy issue. 

Goldman: Yeah, I think that’s an important caveat, or note, I guess. Presidential health is not always as transparent as it claims to be, even going back, as you said. And so it’s not totally out of the ordinary that Trump wouldn’t be transparent about his health, even though, maybe ethically&苍产蝉辫;鈥�&苍产蝉辫;presidents in general should be. 

Rovner: Obviously something else we will continue to watch. All right, that is this week’s news. Now we’ll play my interview with Céline Gounder. Then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast my colleague, Dr. Céline Gounder, 麻豆女优 Health News’ editor-at-large for public health, a CBS News medical correspondent, and an internist, epidemiologist, and infectious disease doctor. I can’t think of anyone I trust more to explain what’s going on with Ebola than Céline. So, thank you very much for doing this. 

Céline Gounder: Oh, it’s my pleasure to be here, Julie. 

Rovner: So, when everybody was covering the hantavirus outbreak on that cruise ship a few weeks ago, experts like you were saying it was a cause for concern, but not likely to become a serious problem. All of those same experts seem much more concerned about this latest Ebola outbreak in Central Africa. How is this different from what we were just talking about with hantavirus, and how is it different from previous Ebola outbreaks? This is not the first one. 

Gounder: Yeah, so to give you a sense of perspective, when I first heard the reports of a viral respiratory illness out of Wuhan in very late 2019, early 2020, I was terrified by what I was hearing. When I heard the reports of the hantavirus outbreak on the cruise ship, I was concerned for the other people on the cruise ship. I was not worried about a larger outbreak, and I would be very surprised, especially at this point, if we see any further cases. With respect to this Ebola outbreak, I am very concerned about a very large, huge, regional epidemic, where we may have some sporadic spread to other countries outside of the region. I am not worried about a pandemic. So, this is one difference: An epidemic is usually within a certain region. Pandemic is when it goes worldwide. So, I think this is going to be an epidemic in Central, possibly also East, Africa, but not going beyond that. 

Rovner: So, how is this different from&苍产蝉辫;鈥�&苍产蝉辫;you worked in one of the past Ebola outbreaks. This one people seem to think is more serious than the last couple that we’ve seen. 

Gounder: Yeah, so I worked in Guinea during the 2014-2016 Ebola epidemic. I was there for two months. You have some of the same risk factors for a large epidemic, so you have urban areas affected, you have cross-border spread. There you had the epidemic start in Guinea, then move to Liberia, then Sierra Leone, then back to Guinea, and then you also had migrant workers that would go back and forth. And so you have those same, exact risk factors with this current outbreak, and then, secondly, you have large refugee populations in South Sudan. And so both of those issues also further complicate movement, both in and out of the area. Healthcare workers trying to get in to address issues. Healthcare workers being safe doing this kind of work, and also getting supplies, in particular, PPE 鈥� personal protective equipment 鈥� as well as tests into the area to help respond. 

Rovner: What about the U.S. pullback in foreign aid? We’ve obviously, you know, seen sort of the demise of USAID and a hollowing out of the CDC here. I imagine that’s impacting how we’re responding to this. 

Gounder: Yeah, so starting with USAID. So, USAID funded the people on the ground that would do the contact tracing, who might help set up Ebola triage, as well as treatment units. And that funding is gone. In fact, over the last week, I’ve been talking to some of the Congolese doctors who used to have jobs funded by USAID. And, in addition, USAID really supported the supply chain infrastructure for the area. So now you’ve seen a collapse of their ability to get personal protective equipment. There are shortages of this, which is also contributing to healthcare workers getting infected right now. And then also pharmaceutical supply chain. So, you know, even the most basic of medications is a challenge to get into the area. With respect to CDC, there have been tremendous layoffs related to the DOGE [Department of Government Efficiency] cuts from last year. We had the CDC shooting last August, and morale at the agency is&苍产蝉辫;鈥�&苍产蝉辫;it’s horrible, it’s horrible. And just in the last day or so, Dr. [Jay] Bhattacharya, who’s the NIH [National Institutes of Health] director, and also, I guess he’s calling himself something else, because he can’t technically be acting CDC director anymore. But 鈥�&苍产蝉辫;

Rovner: He’s nominally in charge of CDC, without being the acting director. 

Gounder: Right, exactly, whatever that means. But he has asked for CDC staff to volunteer to go over to Kenya, and staff a quarantine and, sounds like, treatment unit for any American healthcare workers who might get sick or be exposed while responding to the Ebola outbreak. And based on what we’re hearing, it sounds like they do not want anyone with Ebola coming back into the U.S., including the very people they’re asking right now to volunteer to go to this unit in Kenya. So I think that is also going to further complicate the response. You know, like, if you volunteer for the Marines, you enlist, and you get sent overseas, and you have an injury, you expect to be repatriated as quickly as is possible for treatment here in the United States, right? That is not the case. These are people who are similarly putting their lives on the line, who are responding to that call for help, and we are not seeing similar respect for that sacrifice. 

Rovner: And yet, I mean, the U.S. is set up to take care of people with seriously contagious diseases, right? 

Gounder: Oh, yeah, we have over a dozen units that were specifically created for this very purpose. Several of them have hands-on expertise, experience with this. So, in particular, Emory [University School of Medicine] in Atlanta, [NYC Health + Hospitals/] Bellevue in New York City, where I am, as well as University of Nebraska Medical Center. All three of those have experience with Ebola, not just having done preparations. And it’s really confounding why you would not want to make use of that. When somebody gets Ebola, particularly if you’re talking about an American, you know, who has put themselves in harm’s way 鈥� there are some real questions about fairness and equity of access to certain levels of care 鈥� but American aid workers, the expectation is that they would get the full-court press. And that might include being on a ventilator, that might include needing dialysis, for example, and to do those things when somebody has Ebola, and you need to do that in biosafety Level 4 conditions, I have a hard time seeing how they’re going to be able to put that together in Kenya on such short notice. 

Rovner: So we learned a lot of lessons from covid, not all of them good, obviously. You have a , which I will post a link to, about the psychology of pushback. Can you talk about that briefly? Because I think that has a lot to do with how the U.S. is responding to this. 

Gounder: Yeah, and I think a lot of people may actually identify with their own experiences during covid. You had a lot of people who didn’t want to wear a mask. In fact, we saw masks being burned, right? People not wanting to get vaccinated. And what happens is, when you have somebody who, for whatever reason, people don’t trust telling them to do something, they feel like they’ve been backed into a corner and they lash out. And so you tell them to do something, very often they want to do the exact opposite. And I saw this exact same thing when I was in Guinea over 10 years ago now. It was related to the presidential elections at the time, and it was a way of expressing dissent towards the current, at that time current, president and ruling party. And so, you know, for Ebola, the measures are pretty basic, particularly at that time: It really came down to contact tracing, testing, safe burials. And people would refuse to do some of those really basic things, and it was their way, what we called in Guinea and French, La réticence c’est la résistance, so reticence and resistance. And you saw that whole spectrum manifest there, and I think we’re seeing the same thing all over again, predictably so, in the DRC [the Democratic Republic of Congo] right now. 

Rovner: So, what could this administration be doing better, or be doing that they’re not doing that could maybe help us tamp this down, I mean, before it gets out of hand? 

Gounder: Well, I am concerned it’s already out of hand. They’re only following up on one out of every five contacts, so that means four out of every five contacts could be seeding new chains of transmission. So I think this is going to get a lot worse before things start to turn around. In fact, I would predict this is going to be a year or two to control. I mean, based on prior experiences with the 2018-2019 outbreak in the same area, as well as the 2014-2016 outbreak in West Africa. This has the potential to be even worse. What could the U.S. be doing? Well, we are currently adopting a very isolationist stance with respect to our public health policy. The dismantling of USAID is a big part of that, but it’s not the only thing. And I think what is happening now, frankly, gives me flashbacks to the 2014 Ebola news and midterm elections, and the way in which Ebola was politicized at that time. At that time, President Trump was not president; he wasn’t even a candidate yet, but he spoke very loudly about having travel bans. He called for President [Barack] Obama to resign because he allowed, in fact, facilitated the transport of infected Americans back to the U.S. for treatment. And so he’s on the record as having said he never wanted anybody with Ebola in this country. And I think the current policy that you’re seeing is consistent with that. We’re headed into midterm elections again. We’re seeing travel bans being instituted for real this time, not just talked about. And one of the other concerns around travel bans at that time, and again now, was what would it mean for healthcare workers and other aid workers, their willingness to volunteer to respond? And I remember Craig Spencer, a very good friend of mine, he was hospitalized at Bellevue with Ebola, and it was right around that time as well, Kaci Hickox, a nurse who had responded, she came back to Newark Airport. Chris Christie, as I recall&苍产蝉辫;鈥�&苍产蝉辫;

Rovner: Then the governor of New Jersey. 

Gounder: Yeah, right, governor of New Jersey, Chris Christie, at that time mandated that she be quarantined. So she did not have symptoms, but that she be quarantined due to her work on, I think, it was the tarmac at Newark Airport with a Porta Potty and a tent, something along those lines. And I had a lot of friends at that time who pulled out of volunteering 鈥� between Craig getting sick and Kaci and the mandated quarantine really under inhuman[e] and humiliating conditions. And I think this time it’s going to be even worse because not only are you having to face potentially getting sick, but you may not get to come home. And it’s really unclear at what stage, if you get sick, would you be allowed home. Do you have to wait until you recover? And what if you die? What happens then? Does your body get repatriated? Does your family, right, get to receive the body? That’s a big deal for a lot of families to have that closure. So I know, even among my friends who, like me, are Ebola veterans, there’s a lot of hesitance about stepping up again. 

Rovner: Well, I hope we can call on you as this continues, alas. Thank you so much. 

Gounder: Oh, of course, 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. Maya, why don’t you start us off this week? 

Goldman: My extra credit this week is a story in The Texas Tribune by Terri Langford and Colleen DeGuzman titled “.” And you know, I think it’s obviously a very important political story in the fight over transgender rights, and specifically rights for transgender kids, and the medical practice around gender-affirming care. But one of the things that’s especially interesting to me about this settlement is that there’s not really demand for detransition services, at least at the level of having a dedicated clinic at a children’s hospital for them. And so this is basically a children’s hospital is going to put resources towards creating something that, or presumably put resources towards creating something that may not be used. And as hospitals are talking about how stressed they are for dollars, and just in general overextended, you know, I think this is a very interesting use of resources. 

Rovner: That’s one way to put it. Lauren. 

Weber: I have the New York Times investigation by Sarah Kliff and Margot Sanger-Katz 鈥� which, you know, as soon as you see those two names, you have to read it 鈥� titled “.” And it’s a great look and also builds upon, you know, some great reporting by The Wall Street Journal, I’ll have to shout them out as well in this area. But it details how, amid this focus on autism clinic fraud how&苍产蝉辫;鈥�&苍产蝉辫;what that looks like on the ground. And it’s pretty terrible on the ground. A lot of these autism treatment clinics, the science is questionable on whether it really works. They’re encouraging people to send their kids there instead of to school.&苍产蝉辫;鈥�&苍产蝉辫;There’s this horrific anecdote in the lede about how a child is woken up from a nap that can only last almost seven minutes, so they can bill more. I mean, it’s pretty gut-wrenching and gets at the clear issue in a lot of healthcare, which is that a lot of this is done to maximize profit and not necessarily for the patient. So it’s very well done. 

Rovner: Yeah, it is really scary. Shefali. 

Luthra: Mine is in the New York Times opinion section by Dr. Sejal Hathi. The headline is “.” She herself is a new mom, in addition to running the Oregon Health Authority, and she writes about how our postpartum care system is terrible. We do not care about new moms. We only care about infant checkups. We have very little medical care for people when they are postpartum, and that is not good, because pregnancy is really hard. You can have complications. Most pregnancy-related deaths happen after giving birth, not during. Most of them are preventable, and yet we don’t treat this as something that could be addressed, even though it very well could be, because in other countries they actually do make an effort to care about new moms. I love that she wrote about this from a personal and professional standpoint. I think it’s great, and I hope that it inspires some states to think about ways to improve postpartum health. 

Rovner: Yeah, that story made me so angry. Well, my extra credit this week is also about reproductive health. It’s from ProPublica by Pulitzer Prize-winning reporter Kavitha Surana. It’s called “.” And it’s about yet another case of a mom pregnant with her second child, a college-educated healthcare worker, whose membranes ruptured early, putting her at high risk of sepsis, but who couldn’t get the pregnancy terminated at the hospital where she worked, because the doomed fetus still had a heartbeat. This was a well-connected family. The patient’s father is a doctor. She was in the same sorority at the same college as Arkansas Gov. Sarah Huckabee Sanders, and she enlisted one of the top reproductive health lawyers in the country to plead her case with hospital officials. I won’t spoil the end for you, because you really should read the entire piece, but it underscores yet again that abortion bans can endanger people who don’t think they will ever want or need an abortion. 

All right, that is this week’s show. As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. We also had production help this week from Taylor Cook. 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 your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X , and on Bluesky . Where are you guys hanging these days? Maya. 

Goldman: I am on LinkedIn under my name and on X . 

Rovner: Shefali. 

Luthra: On Bluesky . 

Rovner: Lauren. 

Weber: Still on  and  under @LaurenWeberHP. As I like to say, the HP is for health policy. 

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, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, May 21, 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 Sheryl Gay Stolberg of The New York Times. 

Sheryl Gay Stolberg: Hi, Julie. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: And Joanne Kenen of 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 Miranda Yaver, a health policy professor at the University of Pittsburgh and author of a cool new book all about insurance denials. But first, this week’s news. 

So, the biggest health policy news in Washington this week is the primary defeat of Senate Health, Education, Labor, and Pensions Committee Chairman Bill Cassidy, who finished third in a three-way Republican primary in Louisiana Saturday 鈥� not just to congresswoman Julia Letlow, the candidate endorsed by President [Donald] Trump, but to state treasurer and former representative John Fleming, who, like Cassidy, is also a medical doctor. Fleming and Letlow will now advance to a runoff next month to see who will make the general election ballot in November and likely advance to the Senate from very red Louisiana. 

Meanwhile, though, Cassidy still has the rest of this year at the helm of the HELP Committee, where he is still in charge of filling Trump administration vacancies for surgeon general, Food and Drug Administration commissioner, and director of the Centers for Disease Control and Prevention. And, just judging from the last few days, Cassidy appears to feel liberated from his former fealty to President Trump. He switched sides and voted with Democrats to limit Trump’s war powers. He questioned the legality of a $1.8 billion fund to pay people who claimed they were victims of unfair federal prosecutions, and he defended his vote to convict Trump in the impeachment trial after Jan. 6, which is what got him in hot water with the president in the first place. What does this portend for what might happen at the HELP Committee going forward the rest of this year? 

Stolberg: Well, I think we see Cassidy, as you said, “liberated,” unfettered. You know, Cassidy agonized over whether or not to confirm Bobby Kennedy. I recently reread his testimony, and at the end, he delivered this soliloquy, and he said, Man, you know, I don’t know, can a 71-year-old man, you know, change his tune after all this time? He said, I’m 71; Kennedy’s 71, and he wondered if Kennedy could, you know, really do the things that he promised Cassidy he would do. And in the end, Kennedy did not, and Cassidy was kind of humiliated in Washington. He may have been defeated by forces in Louisiana other than what he did in Washington, but at least here in Washington, Cassidy, you know, still has his perch. He was never comfortable with Bobby Kennedy. There’s nothing holding him back now. When I asked him before his primary, I said, Will we see a vote on Casey Means? She was still the nominee then, and he said, We’ll talk about that later. And I have a feeling that Cassidy will talk about a few things later. 

Rovner: I feel like two things happen when senators are, you know, become lame ducks like this, is they can either go rogue and do everything they always wanted to do and say everything they always wanted to say 鈥� which we’re kind of seeing with Sen. Thom Tillis from North Carolina 鈥� or they can actually hunker down because they’re worried about what they might do when their term is over, and they want to get a job, and they want to be able to lobby their former colleagues. Do we have a feel for which way Cassidy is going? 

Stolberg: Cassidy already gave us a feel. In 2021, he voted to convict Trump on a charge of incitement of insurrection. He said at the time I voted to convict Trump because he’s guilty. Now it is true that Trump is still in office now; Cassidy probably never expected him to come back, but I don’t know. Cassidy tried containing or constraining himself, and it didn’t work out. He lost, so no, why not let it rip now? 

Kenen: I was always sort of struck that once he cast that impeachment vote, which was a really defining vote, even, as Sheryl just pointed out, not expecting Trump to 鈥� I mean, [Sen. Mitch] McConnell didn’t expect him to, a lot of people didn’t expect him to 鈥� come back after that. But he had done it, and he can’t erase it once Trump did come back. So once you have that, sort of, you know, what for Trump is a mark of Cain on your forehead, then why&苍产蝉辫;鈥�&苍产蝉辫;like, we saw it was so visible, you could see Cassidy wrestling with the Kennedy nomination, you could see it. It was so visible, it was like [unintelligible]&苍产蝉辫;鈥�&苍产蝉辫;

Stolberg: It was like Hamlet. 

Kenen: And then vote against his conscience, probably, none of us are in his head or his heart, but you know it was not a vote he was completely comfortable with. And it wasn’t going to save him. Like, at that point, the politically smarter thing might have just gone, OK, I’m going to be an independent-minded guy, and if I lose, I’m going to lose if I do this, and take a gamble on doing that. I don’t think anyone expected him to come out ahead in this primary, although maybe he did. I never understood the Kennedy vote. I never&苍产蝉辫;鈥�&苍产蝉辫;

Rovner: I understood the Kennedy vote. What I never understood was what happened afterwards, when Kennedy did not keep all the promises that he made to Cassidy, that he would come and testify that he wasn’t going to change the vaccine schedule, all the things that he then did. And Cassidy sort of 鈥� you could see that he was disapproving of it, but he never really did anything about it. I think that was the part that surprised me much more than the actual vote. 

Ollstein: Cassidy also, throughout the course of his campaign, really tried to align himself with Trump and sort of tried to argue that, you know, forget about the impeachment vote a few years ago, you know, more recently we align on X policy and Y policy, and we both believe in border security, and we both believe in stopping fentanyl, and X, Y, and Z. And so, honestly, the entire primary was just about Trump. All three candidates tried to argue that they were the most aligned with Trump. Obviously, that was easiest for Letlow, who was endorsed by Trump, but all three tried to argue that they were carrying the MAGA [Make America Great Again] banner, including Cassidy, despite that impeachment vote, which was, I think, interesting. The RFK vote did not come up quite as much. It was really overshadowed by Trump. 

Stolberg: But you know what’s interesting? Cassidy did grow a little more vocal along the way. When I asked him in the early days how he thought Kennedy was responding to the measles outbreak, he said, Oh, it was, you know, OK. Like, he encouraged people to get vaccinated. And I said, No, he didn’t. He said&苍产蝉辫;鈥�&苍产蝉辫;vaccination was a personal choice. And Cassidy said, Well, it’s the gestalt of the thing. And then he slowly, you know, did speak out more. But what I found very striking was the way Kennedy spoke out against Cassidy right after Trump withdrew the Casey Means nomination. And he accused Cassidy of doing the bidding of, you know, the pharmaceutical industry and of forces that would thwart MAHA [Make America Healthy Again], which really tells you that the relationship was and is broken. 

Rovner: Well, to push the segue a little bit, one of the things that Cassidy has, the freed Cassidy, has done this week, as I mentioned, is criticized that $1.8 billion potential fund out there for people to collect who say that they’ve been unfairly taken to court and possibly convicted by the federal government. Alice, it looks like that could include people who broke into and blocked patients from abortion clinics. That would be something that Cassidy would presumably like, because he’s so anti-abortion. But is that really true? 

Ollstein: Yes. So the text of this settlement that was released, it was extremely broad. Really, it’s saying that anyone who feels they’ve been victimized by any administration, past or present, can apply for money from this fund. There really aren’t a lot of guardrails on it, but it did give a few specific examples of people who could apply for this money. And one of those examples was people convicted under the FACE Act, the Freedom of Access to Clinic Entrances Act, which is a law, since the 1990s, that is aimed at protecting abortion clinics but also anti-abortion crisis pregnancy centers and houses of worship. And it has these additional federal penalties. And so these are folks who the Trump administration pardoned last year, people who are serving felony sentences in many cases for breaking into abortion clinics, blocking the entrances of it, of them. And so , who have been documenting a rise in threats to clinics over the last couple years, since the pardons that came in 2025, at the beginning of Trump’s second term. And now they’re worried that this potential payout to these folks could serve as an increased incentive for that kind of behavior. 

Rovner: Yeah. Well, we will see if Sen. Cassidy, and maybe Sen. Tillis, and maybe some others who’ve expressed some doubts about this fund, manage to block it. Whatever happens for the rest of this year, though, come 2027, there will be a new chairman at the Senate Health, Education, Labor, and Pensions Committee. If the Republicans maintain control of the Senate, it’s likely to be one of the two other doctors currently on the committee, Roger Marshall of Kansas or Rand Paul of Kentucky. What could we expect from either of them? They have very different outlooks. 

Ollstein: Yeah, Roger Marshall is a big cheerleader of RFK Jr. and the MAHA movement. He is the head of a MAHA caucus in Congress, and so it would be a complete reversal of the criticisms we have been getting from Cassidy of the administration’s actions on that front 鈥� so, really, replacing one of the HHS secretary’s biggest critics with one of its biggest cheerleaders. 

Stolberg: I think Rand Paul wants to keep [his chairmanship of the ] Homeland Security [and Governmental Affairs Committee], I really do. Because I’m pretty sure he could have been 鈥� could he have been chairman this time around? 

Rovner: I think he, I think 鈥� no, Joanne is shaking her head no. 

Kenen: I might be wrong, but I think not. 

Rovner: But he definitely&苍产蝉辫;鈥�&苍产蝉辫;could be chairman, I think, if he wanted it. I think he’s senior to Marshall. 

Stolberg: But I do think he wants to keep Homeland Security. But I think if we saw a Rand Paul chairmanship, we would see a lot of going after the NIH [National Institutes of Health] and investigating [Anthony] Fauci. Rand Paul has repeatedly said he thinks Fauci should be in prison. And&苍产蝉辫;鈥�&苍产蝉辫;I think he’s kind of like a dog with a bone there. I don’t think he’s going to let that go. 

Rovner: No, he’s sort of the biggest iconoclast, I think, on that committee. 

Kenen: But there’s also two quite moderate, among the most moderate, Republicans on that committee, which [is] Susan Collins, who obviously has a tough race, and we’re not sure if she’ll be there next year, and Lisa Murkowski. Both of them have other committee assignments on Approps [Appropriations], they’re not being talked about so much in the in the mix for succeeding Cassidy. But it’s an odd committee. It’s always been an interesting committee for years to watch because of the mix of who wants to be on it and what they can do. But the speculation right now is Marshall. 

Stolberg: And if they lose, Bernie Sanders will be the chair, and we’re going to hear a lot about drug prices. 

Rovner: Yes, I think that’s fair. Well, meanwhile, this year, there are still more vacancies happening at a Department of Health and Human Services that never seems to get settled, in the wake of the departure of FDA Commissioner Marty Makary last week. Was it really just last week? Also out is Tracy Beth Høeg, who was running FDA’s drug center and was a vaccine critic and a favorite of the MAHA movement. But, meanwhile, the acting FDA chief, Kyle Diamantes, did some “kiss and make up” with anti-abortion activists who helped lead to Makary’s ouster. Alice, did this work? 

Ollstein: Depends what you mean by “work.” So we reported this a couple weeks ago, and it was really notable that he spent his first couple days in power making personal phone calls to several anti-abortion groups, trying to reassure them that he is on their side, that he has been personally anti-abortion for a while. He was trying to calm a storm that had been brewing when court records came to light showing that he had, as a private attorney a decade ago, represented Planned Parenthood in a legal case in Florida. 

Rovner: It was a real estate case. It had nothing to do with abortion. 

Ollstein: Sort of. It sort of had to do with abortion. It was about what is a surgery, and can a building at this site, you know, be approved for surgery, and is abortion a surgery or just a procedure? So it sort of had to do with abortion. But obviously defending Planned Parenthood in any capacity is verboten in the anti-abortion community, and so that was seen as sort of a black mark on his record that he was rushing to reassure these groups that he did that against his will, that he tried to leave the case, etc. I will say that blitz of outreach did not completely alleviate concerns. We heard from both anti-abortion folks on Capitol Hill and in the advocacy community that they remain concerned. But since he is rumored to not be in the running to be the leader of the agency on a more long-term basis, I think that those concerns are sort of just simmering for now. 

Kenen: Didn’t he represent Planned Parenthood for three full years? 

Ollstein: His name&苍产蝉辫;鈥�&苍产蝉辫; 

Kenen: I mean, the case might not have been active, but his name was on there for three&苍产蝉辫;鈥�&苍产蝉辫; 

Ollstein: Right. His name was on the documents. 

Kenen: It’s hard to talk about three years and say, Well, I withdrew because I’m morally opposed to abortion. You know, if his name was on there for a week, it would be a more easier case to make, but three years is a lot of days. 

Ollstein: Yeah, and that’s what some folks told us. They said they still have questions, basically, that it’s not clear when he asked to be removed from the case, what his involvement was, etc. And so, yes, people do remain concerned. But because he seems to not be in consideration to be the FDA leader more permanently, then it’s sort of a moot point. 

Rovner: But the immediate concern is this purported study of the safety of mifepristone, which was one of the things that the anti-abortion movement said Makary was sitting on and not doing. Sheryl, I see you nodding 鈥� you guys had some reporting [on] this. What the heck is the status of this study? 

Stolberg: So this is what we reported this week, my colleague Christina Jewett and I. First of all, this study hasn’t even started. 

Rovner: Surprise! 

Stolberg: The basic issue here: There’s a court case going on. The FDA left intact a Biden policy that broadened access to mifepristone, an abortion pill. The state of Louisiana is suing, saying that that policy undermines its ability to enforce its abortion restrictions, which are some of the strictest in the nation, no exceptions for rape or incest. So the FDA has been saying, We will study this issue, we’re studying it, and when we have a determination about the safety of mifepristone, we will reconsider this policy. And they’ve been saying this for months, since last fall. But the fact of the matter is, as we reported, this study has not even begun. And the reason it hasn’t begun, at least according to our sources, is not that Marty Makary was sitting on it. Makary is actually anti-abortion. It is because the FDA wanted to use this database, called the Sentinel Initiative, which is [a] vast database of medical records and insurance billing claims, but they needed an updated version, and it’s been caught up in the bureaucracy by the higher-ups at the somewhat dysfunctional headquarters of the Department of Health and Human Services. So, absent having this database, our sources said the FDA couldn’t begin the study. 

Now, it is true that the delay conveniently coincides with pushing this study past the midterm elections. And Trump and his White House, and Republicans more generally, really want this issue of abortion to go away by the time of the midterms, because they saw what happened in 2022 right after Dobbs. In those midterms, nobody thought abortion was going to be an issue in 2022. Then Dobbs came along, and it really benefited Democrats, and they regained control of the Senate, and they only lost a few seats in the House, where they were supposed to, you know, get slaughtered. So Trump does not want a repeat of that, and they just want this whole thing to go away. 

Rovner: We will keep watching that space. So it’s not just the FDA where the Department of Health and Human Services is seeing changes. Secretary Kennedy has now fired the two leaders of the U.S. Preventive Services Task Force, which is in charge of determining what preventive services are covered by health insurance. The deadline to nominate new members is this Saturday. It’s unclear as of this morning what will happen. But this is an important group that’s now headless and looks likely to remain that way for some time. And this is not Kennedy’s first strike at the USPSTF. He canceled the panel’s last several meetings and appears to be looking to sideline it completely? I mean, this could create havoc in a lot of other places&苍产蝉辫;鈥�&苍产蝉辫;there’s 150 million Americans who are in plans that are covered basically by USPSTF recommendations. 

Kenen: Right, I mean, we should make clear that, in addition to saying, certifying this is a good thing to do for preventive care, it’s also&苍产蝉辫;鈥�&苍产蝉辫;creates what certain health plans have to cover legally. 

Rovner: Right, under the Affordable Care Act. 

Stolberg: Such as mammograms, right? 

Kenen: Right, so it’s not just like a recommendation, it’s whether people really do have coverage to follow through on these recommendations. So it’s incredibly important. It hasn’t been, like, compared to a lot of things that are always controversial, and they flip back and forth in different administrations, and they come and go. There’s been controversy sometimes about a specific recommendation changing or causing confusion, but sort of&苍产蝉辫;鈥�&苍产蝉辫;there hasn’t been an existential crisis before about it, at least that I remember. 

Rovner: Right. What age should mammograms start, I think, has been the biggest controversy. 

Kenen: That one, yeah, there’s like, and prostate cancer. There are things that like that, which there’s scientific debate, and things change, and&苍产蝉辫;鈥�&苍产蝉辫;but that’s different. Like, the fact that this agency that most Americans don’t know exists, but benefit from, it has never been a hot potato, the way you know various other alphabet soup things that people may not be familiar with, but have constantly been, you know, in Congress, you know, AARP, for instance, or&苍产蝉辫;鈥�&苍产蝉辫;but this one has just sort of been, Oh yeah, you know, it’s how I get my shots free. 

Rovner: Do we know why Kennedy has had knives out for this? Is it because of the vaccine recommendations? 

Kenen: Probably a factor, but also he does have a lot of control over this agency, and it does shape what he regards as preventive care. I mean, some things are not controversial, some things we would all agree are preventive care, and there’s some things that, you know, we’ve said before that there are things that he’s, he believes&苍产蝉辫;鈥�&苍产蝉辫;certain things that there’s broad consensus about. But I think that the whole shift in how he thinks about health and the health industry, or the health industrial complex, as he might call it, and maybe has called it. This is one of the sort of obscure to normal people, but it’s one of the battlegrounds for what is preventive care? Who pays for it, and who gets access? So, I think it’s potentially&苍产蝉辫;鈥�&苍产蝉辫;recommending coverage of some unproven supplements, or something like that. 

Stolberg: Right. That’s exactly what I was gonna say. I 鈥�&苍产蝉辫;

Kenen: Peptides. 

Stolberg: Kennedy is fixated on prevention, right? He’s always saying that America has a sick care system, not a healthcare system. We need to focus on prevention. It’s kind of curious to me, then, why he is decimating the CDC, which has the word “prevention” in its name. But I do wonder if he wants to reshape this committee in a way that will cover other things that he sees as prevention 鈥� like supplements, like wearables, like peptides, or all of these other things that are unproven, but that are part of what public health people would call the wellness industrial complex. You know, he rails against the medical industrial complex, but public health people complain about the wellness industry. That’s the only thing that I can think about as to why he might have done this, but I confess I don’t have direct insight into his thinking about this, and just talking about it kind of makes me want to know more. 

Rovner: Well, we will keep watching this space. 

Stolberg: So stay tuned. Maybe Alice knows. 

Rovner: Alice, you have&苍产蝉辫;鈥�&苍产蝉辫;you would like to add something? 

Ollstein: Yeah, so we got some foreshadowing that this was coming more than a year ago, because this issue was before the Supreme Court, and the administration surprised some people by technically defending the Affordable Care Act. But, in its argument in defense of this panel, said that it is legal and its folks were legally appointed because they really stressed that the HHS secretary has the power to fire and replace these people or ignore their recommendations or override them. And so the fact that they wanted to make it clear to the court that they had the power to do this 鈥� and, lo and behold, now they’re doing it 鈥� should surprise no one. But, like Sheryl said, exactly why they want to do it and what they plan to do next, we still don’t know. 

Rovner: Well, there could still be even more big personnel changes to come. Department of Health and Human Services last Friday announced that it is moving hundreds of senior career staff to a new civil service classification that strips them of many protections and makes it easier to fire them. This is a new version of the so-called Schedule F that the president floated at the end of his first term, and then was included in Project 2025. Now, if this really happens, and apparently it still requires a separate executive order from the president, it would give Kennedy power to oust even more career HHS workers than have already either been pushed out or forced to retire, or, you know, whatever. I mean, really remake the department in his image, right? 

Stolberg: I’m hearing from a lot of HHS employees who are really worried about this. They’re worried that it’s a de facto system of expanding political appointees 鈥� that, basically, once you serve at will, you’re not really a career servant anymore, you’re serving the whims of your boss, maybe the NIH director or the CDC director, or whomever. And there’s a lot of fear that this will diminish independence at these agencies, especially in the scientific agencies: the NIH, the FDA, and the CDC. 

Rovner: And also just, I mean, discourage people from speaking out, many of them, as scientists, to talk about what the evidence shows, not what a political appointee might desire. 

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

OK, we are back. Moving on to public health, the hantavirus outbreak from that cruise ship was apparently just our warm-up. Now we have an outbreak of Ebola in Africa that seems to have all those public health experts who said not to worry about hantavirus, now they’re really worried about Ebola. What’s different about this Ebola outbreak? We’ve had them before, and it’s never really affected us here. 

Stolberg: It’s a novel strain, and, Joanne, you should talk in a minute, but what I think is different, frankly, is that the Trump administration has really injured the public health infrastructure around the world to prevent and track and respond to infectious disease outbreaks. So we’ve withdrawn from the World Health Organization, we’ve dismantled USAID [the United States Agency for International Development], which I noticed was founded in 1961 under President John F. Kennedy, in part to combat the spread of disease. And funding is withering, and people in [the Democratic Republic of] Congo, public health people in Congo, are saying, like, this outbreak got out of hand before they even knew it was happening. And the question is, did all of these cuts hinder our response? 

Rovner: Yeah, which, I mean, if we’d had people on the ground, we probably would have known about it sooner. 

Kenen: Yeah, I agree with everything Sheryl said. The other thing is, I mean, this is one of the poorest countries in the world, and yet they’ve had a bunch of Ebola outbreaks, and they’re actually pretty good at handling them, for a low-resource country. This is much worse for where it broke out. There’s conflict in parts of the country. There’s refugee camps, where sanitation and people are very close. And it’s just a worst-case scenario. And because it is the rare strain, the standard, most commonly used tests don’t pick it up. So it’s not like they didn’t notice something bad was going on, but when they tested, the locally available tests came out negative, because it was not the most common Zaire strain they were most used to seeing, and that were best at fighting. So this is already spread undetected. It wasn’t like they thought, Oh, this couldn’t be Ebola, and then it had already spread before they knew it, not just in that country, but in, at least, to Uganda. And the real bad thing is the vaccine doesn’t work, as far as they know. And most of the treatments that have been developed for Ebola, which is not an easily treatable or curable disease, even with the advances that have been made, they don’t work for this one, or at least they’re not believed to work very well. Every time I look it up, the number’s gone up by like another 100. I think there’s 600 confirmed cases now, something in that range. And by tomorrow, as the disease spreads and as they detect more, we’re looking at a really terrible scenario of late detection and a hard-to-treat, really lethal version of this disease that’s already in a geopolitical bad place for a bad disease. 

Rovner: And possible spread. 

Kenen: Yes, and plus, as Sheryl said, you know, the global public health infrastructure 鈥� combination of the cutting of&苍产蝉辫;鈥�&苍产蝉辫;the wood chipping of AID, plus the U.S.’s intent of leaving WHO, and we’re a big source of funding 鈥� and it’s just really a diminished capacity. 

Rovner: We will clearly have more on this next week. Moving on to news about the Affordable Care Act, my colleagues here at 麻豆女优 have a  out projecting that marketplace enrollment could fall by 5 million by the end of the year. And that even those who have managed to hang on to coverage have much higher deductibles, with the average of nearly $4,000 before their insurance kicks in for most things. That’s up $1,000 from the year before, and the biggest increase in the history of the program. And in its final rule for 2027, the Trump administration is proposing even more big changes to the ACA, including making it easier for people to sign up for those so-called catastrophic plans with even bigger deductibles, and to sign up for something called non-network plans, which, as far as I can tell, basically say we, the insurance company, will pay a set fee for services, and if you can’t find a healthcare provider to accept that fee, that’s too bad for you. Am I misreading this? Is that how these plans seem to work? 

Kenen: Your guess is as good as mine, Julie. We haven’t seen this before, and we don’t know&苍产蝉辫;鈥�&苍产蝉辫;like many things this administration proposes, and we don’t always know exactly what they mean at the beginning, and then when it becomes&苍产蝉辫;鈥�&苍产蝉辫;presumably it will become somewhat clearer. But I’d never heard of this before. 

Stolberg: I would just say this is&苍产蝉辫;鈥�&苍产蝉辫;not what Congress intended when it passed the ACA, and Obama signed it into law in 2010. 

Rovner: I think that is definitely fair. I will say, when the ACA passed, I spent a lot of time reading it, and all the places that it gave, quote-unquote, “secretarial discretion,” I thought to myself, The secretary isn’t always going to be somebody who supports this. I think this is a good example of it, that the secretary of HHS has a lot of discretion to do stuff like this, and they seem to be doing it. And you know, unlike some of the other things that they’re doing, this does not seem to be against the rules.&苍产蝉辫;鈥�&苍产蝉辫;It seems fairly clear that they can. Alice, did you want to add something? 

Ollstein: Yeah, I mean, I think it just helps us to keep in mind that, you know, while there’s always a lot of attention on the numbers of uninsured and the recent numbers of people dropping their insurance because they can’t afford it anymore, there’s a whole other category of people who are newly becoming underinsured, who are moving from comprehensive plans that’ll be there for them when they need them, when they get sick, when they have facing a major health crisis, and plans that are very skimpy and won’t really cover what they need, or they’ll be facing such a huge deductible that they can’t afford to pay that either, and so I think it helps us keep a broader scope in terms of assessing, you know, the health of the marketplace. The uninsured numbers aren’t the only thing to pay attention to. 

Rovner: Yeah, and I think it’s important that&苍产蝉辫;鈥�&苍产蝉辫;the 麻豆女优 analysis said that the numbers of people losing insurance were smaller than had originally been predicted, because so many people moved from affordable deductible plans to basically unaffordable deductible plans. So they still have insurance, sort of in name, even if most people don’t have $10,000 hanging around that they can use to pay their deductible if something happens. 

Kenen: The first Trump administration, obviously, you know, he got elected on “repeal and replace,” which was a failure. Spent a lot of political capital and didn’t repeal&苍产蝉辫;鈥�&苍产蝉辫;or certainly didn’t replace it. But from the very beginning, from like the very, very beginning, they were always trying to undermine the ACA, and in a variety of ways. And uninsurance 鈥� those numbers did rise after the first few years of the ACA. There was a steady increase in coverage and in comprehensive coverage. It deteriorated in the Trump administration the first time around, but what we’re seeing this time is much, much larger projections of lost coverage. And that’s not even counting 鈥� that’s just in the ACA. That doesn’t count what’s going to happen with Medicaid and the private insurance market in general, and whatever they’re going to do with discussions about changes in Medicare. People aren’t going to lose Medicare completely, but there could be 鈥� no one’s talking about repealing Medicare, but there are a lot of levers to change how people get care. So this is a pretty aggressive approach without using the politically difficult traumatic memories of repeal and replace. 

Rovner: Yeah, we’re just gonna go in and change it a lot. 

Stolberg: I was gonna say it suggests that we need to start tracking people who have catastrophic plans, because to call them insured is really not the case. And you know, this really plays out in people’s lives. I actually know someone who fell and injured both legs, and the doctors wanted to do MRIs on each, and this person said, “No, I can only afford one.” And you know, you think about the choices that people are forced to make. 

Rovner: And that they’re not forced to make in any other industrialized country. I think that’s sort of the thing that people miss. It’s like we are the only country where you can fall down the stairs and go broke. You will get care, we&苍产蝉辫;鈥�&苍产蝉辫;have EMTALA [the Emergency Medical Treatment and Active Labor Act], we have other laws. You will be taken to a medical facility, and care will be delivered, and then you will be broke. I mean, that’s kind of where we are in the United States right now. 

Kenen: But we should also point out a version of catastrophic plans, or bronze plans, has existed. It’s always been options for people who truly want that option, right? For some individuals, that might be the best choice, and the original version of ACA had it. But it’s being changed because the end of the enhanced subsidies and other factors, the other options are less affordable for many people. There’s a lot of nudges in capital letters pushing people into these flimsier plans. So it’s been around for a while in various forms. Some people want them. But they’re looming now as like a big part of coverage, as opposed to an option that some people might want to choose. 

Rovner: And originally catastrophic plans were supposed to be accompanied by medical savings accounts 鈥� they were originally called, now they’re called health savings accounts. The idea is that you would, you, the consumer, would be given some money, so that you would be able to pay for these things before you got to your deductible, and that’s kind of going away. I mean, rich people now have health savings accounts because they’re a good tax shelter. But most people with high-deductible plans don’t. They’re just expected to be able to come up with this money on their own. That was not even the original conservative idea: Give people more control over their money. This is simply, We’re going to give you cheaper insurance by saying that we’re not going to pay for the first however many thousands dollars’ worth of care that you need. 

Kenen: We’re going to give you great cheap insurance as long as you don’t get sick or injured. 

Rovner: Exactly. All right. Well, that is this week’s news. Now we will play my interview with Miranda Yaver. Then we will come back and do our extra credits.  

I am pleased to welcome to the podcast Miranda Yaver, who I have followed for some years now. She’s an assistant professor of health policy and management at the University of Pittsburgh, and the author of a timely new book called Coverage Denied: How Health Insurers Drive Inequality in the United States. Miranda Yaver, welcome to What the Health? 

Miranda Yaver: Thanks so much for having me. I appreciate it. 

Rovner: So, you came to health policy less because of initial academic interest than because of need, right? How did you end up here [rolling] in the muck with us other health policy nerds? 

Yaver: Yeah, we’d been really interested in health policy, and I’d been writing on the ACA repeal efforts, but my work had been pretty separate. And then I ran into some health issues, and the great American experience is running into health issues often means running into insurance issues. And I just kept sort of stepping back and realizing I have so much privilege in terms of health literacy, job flexibility. If I’m struggling, what do other people who don’t have the education and the stamina to be able to do it, how did they navigate healthcare access? And so I just really wanted to take this opportunity to bring my social science skills to this health policy space that felt rather understudied. 

Rovner: So, there are a lot of things that are wrong with our healthcare system. How did you come to focus on insurance company denials, and what does that tell us about the greater dysfunction of the U.S. healthcare system? 

Yaver: Yeah, so one of the things that I was really struck by as I was experiencing denials of my own, was that 麻豆女优 had done such great work to catalog the number of claim denials and the infrequency of appeals. But no one had really gotten under the hood to get a feel for who these people are, and how does this reshape lives? And so people can get denied in a couple of different ways, it can be prior to treatment 鈥� or, which is to say prior authorization, or required health insurer preapproval 鈥� or it can happen on the other end. And those are going to have very different experiences for the patient, where prior authorization may mean that healthcare is going to be out of reach for a while in a country where healthcare is exceedingly expensive. Whereas with claim denials, where we will have received the care, but then we’re dealing with the financial repercussions of the insurer not picking up at least part of the tab. And so thinking about this through the lens of burden and equity felt like a really important story here. So I really look at this insurance complexity through this lens of administrative burden, because these are these really big bureaucracies that we often have to navigate when we’re not having our best day. 

Rovner: I mean, it’s not just education, often it’s just time. I mean, one of the things that insurers love to do is make you sit on hold forever. If you have not a desk job, basically you can’t do that. 

Yaver: Yeah, absolutely. I’m fortunate 鈥� in academia, I work a lot, but it is sufficiently flexible that I can be on hold between 2 and 4 on a Tuesday and make up my work later, and that isn’t something that everyone can do. And so Annie Lowrey has this great piece in The Atlantic called “The Time Tax,” which I cite in this book. And it really is laborious, and it becomes easy once you’ve started to navigate this oneself to realize why so many appeals are ultimately abandoned by patients. 

Rovner: So, in many cases, insurers deny coverage because healthcare providers have incentives to provide too much care, often care that’s not necessary, or maybe more expensive than necessary, in order to pad their own pocketbooks, or serve their own private equity owners, or whatever. Doesn’t some of the blame for this problem fall on providers? 

Yaver: Yeah, these tools didn’t originate without any underlying purpose. So we see prior authorization come up amid concerns about greater healthcare spending, health inflation, but also overutilization 鈥� overtesting and overtreatment. And so my book doesn’t so much aim to dispel that argument so much as raise the question of: Do we address this with a hammer or a scalpel? And essentially thinking about, yes, there is overutilization, and there’s a really great book called Unhealthy Politics that also really dives into what accounts for this. Some of it is financial incentive, some of it is just practices get really entrenched, and we don’t update our beliefs very quickly, based on, you know, a latest study, potentially, and a lot of other factors. And so there is this overutilization. There’s some question about exactly how much there is. And then, you know, medical malpractice raises defensive medicine concerns on top of all of that. And so there are a lot of reasons why we have overutilization, but then there’s this question that I raise, which is essentially: Is the answer to this utilization to impose broad-based barriers to care and administrative burdens that are borne by both patients as well as their physicians, as opposed to going after the overprescribers? 

Rovner: So what surprised you most in researching and writing this book? 

Yaver: So I was really initially coming at this book from the patient perspective. So I did a survey, I did interviews, and I wasn’t actually thinking about the physician side quite as much when I was writing this. And I realized I was wrong, that even though we do have these challenges of overprescribing prior auth works to mitigate, I also really got a better appreciation of the immense staffing support and broader burdens that this causes for physicians, which I’ve also argued elsewhere can contribute to inequities among physicians’ experience of this. Because Black and Hispanic physicians are more likely to work in smaller solo practices, where we can’t have all that staffing support. And mental health providers are more likely to operate in small and solo practices, where it’s just harder to shift that burden to administrative support. And so I really enjoyed getting to dive into that side of things. And then, you know, I was just really felt grateful that so many patients just trusted me with their stories. And some of them were infuriating, some were heartbreaking, and some really just highlighted that there’s also administrative error that can be costly to both patients and their physicians. 

Rovner: So is there a way to address this without tearing the entire system down and rebuilding it all at once, which I know we’re probably moving towards at some point. 

Yaver: So one of the ways that I argue that this can be addressed&苍产蝉辫;鈥�&苍产蝉辫;is through a shift to an audit-based model. So if overprescribing is an issue, and it is an issue to some extent, why not target those who are prescribing outliers? And then maybe do random audits of everyone else with the idea that prior authorization could potentially be a penalty for overprescribing 鈥� a watchful eye when someone seems to be ordering a tremendous number of lower lumbar spine MRIs, which is a sign of overprescribing. And then for people who seem to be doing appropriate prescribing, allow them to have the greater professional autonomy in doing so. And so I think that this would bring prior authorization closer to its original purpose of an appropriate guardrail, whereas right now I think a lot of the pain and frustration that my book works to illuminate is that it has just seeped into every corner of healthcare delivery, even areas where there isn’t evidence of abuse. I mean, PrEP can have prior authorization 鈥� we’re not taking that for fun. Insulin is a huge source of frustration to get covered. 

Rovner: One would think that doctors are not prescribing insulin for profit. 

Yaver: No, exactly. And especially in a country where insulin is so expensive, this is not something that people are taking for a rainy day. So I think that that is a real illustration of how prior auth has evolved. And I think that then, when I was really diving into insulin in the book, I kept wondering, like, if you don’t give someone a continuous glucose monitor, aren’t they going to get sicker and costlier to treat? And I think that the surprising factor that I hadn’t really appreciated until writing this was the fact that people changing insurance companies can often reshape the incentives to cover these things. 

Rovner: Well, dare I say it, this sounds like something that Congress would actually have to address. 

Yaver: Yeah, I mean that’s one of the challenging things is that this big gnarly law called ERISA [the Employee Retirement Income Security Act of 1974] 鈥� which I’m now writing a book about, because I have some masochistic tendencies, it turns out 鈥� really limits what states can do with respect to the majority of employer-sponsored health insurance. And so in so many areas of health policy, we’re pretty accustomed to saying, OK, well, D.C. is really gridlocked, but at least California and Massachusetts 鈥� and take your pick of other states 鈥� can move the needle. And ERISA, preempting state policymaking that relates to so much of health insurance, really limits that. And so this really is an area where national reform is needed, but, of course, politics is pretty fraught right now, to say the least. 

Rovner: We will come back when maybe politics is a little bit less fraught. But Miranda Yaver, thank you. Thank you for contributing to the knowledge base here, and thanks for coming on. 

Yaver: Thanks so much. It’s been a real pleasure. 

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. Alice, why don’t you start us off this week? 

Ollstein: Yes, so I have a very grim story that is part of Stat’s ongoing series on alcohol and its many healthcare consequences. And this latest installment is by Isabella Cueto [“”], and it is about drinking during pregnancy, which is unfortunately, despite decades of public health efforts to stop it, is still fairly prevalent and really damaging. It has lots of physical and neurological impacts on developing fetuses. It got worse during the pandemic, and there is a lot of misinformation. And so, to be clear, this article stresses that the medical evidence is that no amount of drinking in pregnancy is considered safe. And that comes as people are getting mixed messages, even from doctors, about whether that’s the case. So, definitely something I recommend reading. 

Rovner: Yeah, the whole series is really good. Joanne. 

Kenen: This is a story from The Associated Press by Tiffany Stanley: “.” It was interesting because this is 鈥� he’s a reproductive endocrinologist working on IVF [in vitro fertilization], and he’s anti-abortion, deeply religious, and has been wrestling, you know, with the destruction of the excess embryos, or the perpetual storage of them. But he also believed, you know, he found value in helping couples have babies, and his 鈥� I don’t want to use the word “compromised” in any kind of negative way, I mean 鈥� his solution for him was to start a sort of a Christian-guided IVF practice, where they’re basically using fewer embryos. Now that makes some of the religious couples more comfortable. It can raise the cost, because IVF is not 100% certain by any means, so if you have fewer embryos, you might have to go through even more cycles. It also made me think, and I’m not an expert on this, and one of you might know, I mean, there is such things as egg freezing now. The technology is not fabulous yet. It is better than it was a few years ago. I mean, I’m sort of wondering, do we get 鈥� IVF technology is much better. Success rates are better. There are fewer multiple births. There’s&苍产蝉辫;鈥�&苍产蝉辫;they were able to bring the embryos out to six or seven days after fertilization. It’s very different than it was 20 or 30 years ago. But if you got to the point where egg freezing was really viable and that they really worked well, it would eliminate this whole issue of the stored embryos. But I just thought it was interesting in that this was a man with two competing sets of values, right? He was against the destruction of embryos, and he was for the creation of embryos, and as a doctor, he had the power to address both in a way that probably some Christians would still find ethically problematic, but it does give religious couples some new choices too. 

Rovner: Yeah, it was a really interesting story. Sheryl, you also have a reproductive health story. Oh, go ahead. 

Stolberg: I do, but I just want to say about Joanne’s story, that is so interesting to me because 25 years ago, when George W. Bush was considering stem cells, I wrote about an adoption agency, a Nightlight Christian Adoptions that&苍产蝉辫;鈥�&苍产蝉辫;

Rovner: Snowflake babies! 

Stolberg: 鈥�&苍产蝉辫;had these quote-unquote “snowflake babies,” right. And they were adopting out frozen embryos with the argument was that, see, we don’t have to destroy these embryos for stem cells, we can adopt them out to religious couples. 

Kenen: That’s mentioned in this story too, that is&苍产蝉辫;鈥�&苍产蝉辫;but it’s never&苍产蝉辫;鈥�&苍产蝉辫;I wrote about them too, and Julie did, but it’s never really caught on on a super 鈥� and we all know people have gone through IVF, and even people who aren’t deeply religious, or the whole thing of those leftover frozen embryos does bother people. And the science is changing, and&苍产蝉辫;鈥�&苍产蝉辫;you don’t need as many embryos as you might have, or they freeze better, you could have one IVF cycle, and two kids. But I just thought it was a thoughtful article about an interesting phenomenon. 

Rovner: It was. OK, Sheryl, your extra credit. 

Stolberg: My extra credit is 麻豆女优 Health News by Jazmin Orozco Rodriguez. It’s called “Religious Anti-Abortion Center Finds Opportunity in Town Without OB-GYNs.” And the story is set in Idaho, where crisis pregnancy centers are flourishing, as they are across the country in the wake of Dobbs. And one reason I really like this was because, in 2023, I traveled to Idaho and I , and maternity care was suffering as a result. And this story really shows what’s happening three years on, which is that local hospitals are shuttering their maternity wards and their labor and delivery units. And in towns with very limited maternity care, these crisis pregnancy centers, often run by religious organizations, are basically the replacement. But in this particular case, this center that they focused on was not medically licensed, not required to meet regulatory standards for medical facilities, and has an agenda that discourages pregnant women from terminating their pregnancies. And there have been a lot of investigations of these kind of centers saying that they mislead patients by drawing them in with offers that, you know, you’ll get free pregnancy care, etc., etc. And so this is really kind of the upshot of Dobbs and how it’s playing out and in small towns and rural places across America. 

Rovner: Yeah, it is. All right, my extra credit this week is from The Wall Street Journal. It’s called “” It’s by Josh Dawsey, C. Ryan Barber, and Liz Essley Whyte, who, by the way, will be joining our podcast panel soon. It’s quite the eye-opener to follow on our tobacco discussion of the past few weeks about how yet another source of nicotine, in addition to cigarettes and vapes, nicotine pouches have become hugely popular in Trump administration circles as a way to get that nicotine buzz without inhaling stuff into your lungs. Now, these are not harmless products. Nicotine is addictive, and scientific evidence on the pouch’s safety is relatively thin, although they’ve been growing rapidly in popularity, particularly among young men, pushed by some of the biggest tobacco companies. It’s yet another piece of the puzzle of why this administration, which purports to be so health-conscious, seems to have kind of a blind spot when it comes to tobacco-related substances. 

All right, that is this week’s show. As always, thanks to our editor this week, Stephanie Stapleton, 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, 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? Alice? 

Ollstein:  on Bluesky and  on X. 

Rovner: Joanne. 

Kenen: I’m Joanne Kenen on  and I’m on . 

Rovner: Sheryl. 

Stolberg: And I’m at @SherylNYT on  and also on . That’s Sheryl with an S. 

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, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, May 14, 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 Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Rachel Cohrs Zhang of Bloomberg News. 

Rachel Cohrs Zhang: Hi, everybody. 

Rovner: And Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi. 

Rovner: Later in this episode, we’ll have my interview with Wisconsin Democratic Sen. Tammy Baldwin. But first, this week’s news. 

Well, as we foreshadowed last week, Marty Makary’s tenure as commissioner of the Food and Drug Administration has come to an end. It’s not entirely clear whether he was fired or whether he resigned or whether he was forced to resign, but what is clear is that his 13-month tenure at the helm of the agency that regulates $1 of every $5 worth of consumer products in the U.S. was chaotic, to say the least. Quoting from the excellent  on his exit, “He had upset advocates for vaping and rare-disease patients, antiabortion groups, and some drug-industry leaders 鈥� as well as other officials in the administration.” Rachel, you’ve been following this story very closely and breaking a lot of news on it. Who didn’t Marty Makary piss off? And tell us more about that Wall Street Journal ticktock of his last few days, since it’s your “extra credit” this week. 

Cohrs Zhang: It is my extra credit. Truly nothing scares me more than seeing Josh Dawsey’s byline on a story on my beat. So I think the tension with Dr. Makary had been going on for months. I think there was kind of an effort that bubbled up, kind of last fall, in November, about 鈥� that raised some questions about his future and just his ability to cooperate. But he was able to keep his job at that point in time. But I think there have been a lot of changes at HHS [the Department of Health and Human Services] this calendar year, and I think there’s been an effort to kind of stabilize things, start to get people in place for some of these other positions, at surgeon general and at CDC [the Centers for Disease Control and Prevention]. And once those personnel searches started wrapping up, I think it shifted the focus back, I think, to FDA a little bit more, and there’s a lot of drama coming out of there. 

And I think there is certainly a desire from the White House to get wins out of their agencies to tout, and especially ahead of the midterms, they just want people to be on message and to not have distractions. And I think the FDA, under Dr. Makary’s tenure, just continued to produce distractions. And there was personnel issues. There were certain policy issues that he was not necessarily aligned with the White House on. But there’s also just internal dynamics. When you’re leading an organization, you’re coming in after DOGE [the Department of Government Efficiency], it takes a lot of work to build trust back with career staff who saw their bosses fired, their colleagues retiring. It’s 鈥� there was so much turnover. 

Rovner: And I was going to say, FDA took a big hit from DOGE, didn’t it? 

Cohrs Zhang: It did take a big hit. 

Rovner: This was before Makary came in. 

Cohrs Zhang: Yes, technically before he came in. But I think we’ve seen other agencies 鈥� certainly not the level of turnover we saw at FDA 鈥� but try to build bridges and speak positively about career staff and really make an effort to value their expertise and bring them in the room. And I think we just didn’t really see that at the FDA. I think there was just mistrust and genuinely a view that we hear in public sometimes that career staff, or the “deep state,” weren’t supportive of the administration’s goals. And I think ultimately just the culture becomes toxic enough, and it’s just a difficult work environment for people doing really important work. 

Rovner: And people, the stakeholders at FDA, are really important people, many of them. 

Rachel Cohrs Zhang: They are. It cuts across so many different industries, like tobacco, food, medical devices, drugs, Big Pharma, small biotech. Truly, it’s a tough job to balance all the stakeholder interest. But I think if there had been a sense that he was really taking on industry and pursuing needed reforms, I think that would have been OK. But I think it was just communication issues, unpredictability. It’s just investors, companies don’t like unpredictability. They don’t like surprises, especially kind of a regulator that usually is pretty 鈥� has a lot of continuity from one administration to another. 

Julie Rovner: Well, it seems like the last straw, as we discussed last week, was this fight over vaping 鈥� in particular, fruit-flavored vapes, which might help adults quit more-dangerous tobacco products but also might attract children to start vaping. Makary was against the fruit-flavored vapes. [President Donald] Trump had promised the vaping industry during the 2024 campaign that he would protect them. Is there going to be more fallout from this whole vaping fight? I did see that a top HHS spokesman quit this week, also citing approval of the fruit-flavored vapes. But there’s more to that story, too. Right, Rachel? 

Cohrs Zhang: Yeah, I think personnel issues are really hard to cover, and the context that I would want to provide is that these resignations, both of Dr. Makary and the , Rich Danker, were not resignations where these individuals had the possibility of a long and robust career at these agencies. I think they both kind of reached the end of the line. And certainly, are there policy disagreements that occurred about fruity-flavored vapes? Absolutely, yes. But those dynamics have been ongoing for a long time. I think it’s also important to point out that the agency did approve these before the exit of both of these officials. And I think there’s just, the timeline, it’s a little complicated. Personnel issues are complicated, but I think, again, the Wall Street Journal story by Liz [Essley Whyte] and Josh did a really good job of trying to get that 360 view and kind of explain it in a fair and balanced way as to how that all went down. 

Rovner: So the question that this keeps leaving in my mind is: How is tobacco not a bigger piece of MAHA? If we’re going to “Make America Healthy Again,” isn’t the first thing we want to do is get people to stop using tobacco products? Why is this out in this sort of little island by itself, when [Health and Human Services Secretary] RFK [Robert F. Kennedy] Jr. is beating up on pretty much everything else? 

Cohrs Zhang: That is an interesting point. Calley Means at the White House also did a conversation with Harvard this morning and just kind of mentioned that they’re not trying to ban anything in the administration. That was kind of the talking point they were using: We’re not banning cigarettes. We’re not banning ultraprocessed food. We’re just trying to educate people on what’s good or bad for you. So that’s kind of the line they’re taking. 

Rovner: So it’s like vaccines? It’s like everything should be up to your choice about what you put in your body? 

Weber: I just wanted to add that, Julie, I feel like you’re asking a question of the MAHA movement the MAHA movement is unable to answer, which is: What is the MAHA movement? If we care so much about chronic disease, why aren’t we looking at one of the things that kills people a lot, which is tobacco? So, which leads also, and we’ll get to it later, to my extra credit, which is on Stat’s excellent series on alcohol, which the administration is also not really looking at. So I think when MAHA talks about these underlying pillars of combating the chronic disease epidemic, that’s all great. But what are they defining as the chronic disease epidemic? Because a lot of their attention has been focused on vaccines, which scientists have very clearly stated are not causing the chronic disease epidemic. So, we’ll see how this continues to unfold. 

Rovner: And reversing the food pyramid, to emphasize things that science has shown do contribute to chronic disease, like lots of animal products. So it’s a little bit curious, let us say. Well, the person who is now installed to replace Dr. Makary, at least on an interim basis, isn’t even a doctor. He’s a former corporate lawyer at the firm Jones Day and a hunting partner of Donald Trump Jr.’s. What else do we know about Kyle Diamantas, who’s been heading up FDA’s food division? 

Ollstein: So the anti-abortion groups that were demanding Makary’s ouster, some of them, over accusations that Makary was not doing enough to restrict access to abortion pills, are already worried about the acting replacement because records surfaced showing that he represented Planned Parenthood as a private attorney a decade ago, and so 鈥� 

Rovner: In a real estate case, right? 

Ollstein: In a real estate case, in a dispute between a clinic and its landlord. So clearly this was a concern, because within hours of his appointment as acting FDA leader, he was on the phone with anti-abortion groups, and he’s been talking to them on Tuesday, on Wednesday, on Thursday, different groups, trying to reassure them that he personally opposes abortion and will work with them going forward. But I think if he is nominated to lead the agency on a more permanent basis, that could potentially become a flash point. 

Rovner: And of course, we do know, Rachel, I think you were breaking this morning that the idea of him replacing Makary on a more permanent basis is already not going over very well in the Senate. 

Cohrs Zhang: Yeah, I think Sen. Bill Cassidy made some comments about Kyle. And I think there is absolutely a permanent search. I am not under the impression that they are planning to nominate Kyle Diamantas to be the permanent leader. I think they are searching for somebody with more robust expertise. But I think he’s just made a lot of allies. He’s been a pretty predictable and rational actor in the FDA. He got promoted earlier this year to be an adviser. He’s been doing public appearances, conferences, and on podcasts and television. So I think they just see him as a kind of a steady hand to guide the agency and not cause a lot of drama going into the midterms, because there’s a big backup of nominations in the Senate. So this could drag on for a while. 

Rovner: Right. That is my next question. Who is likely to get this job permanently? And, wow, the nominations are stacking up at the Senate HELP [Health, Education, Labor, and Pensions] Committee, where chairman and troubled Trump ally Bill Cassidy now has to oversee the confirmations of a new FDA commissioner, a new CDC director, and a surgeon general. And Cassidy himself is facing a primary election this weekend in which the president has endorsed one of his opponents. Awkward much? 

Cohrs Zhang: Yeah, it’s an interesting test of some of this proof of concept. Secretary Kennedy’s political operation has backed congresswoman Julia Letlow and so has the president. So there are these bigger macro issues of loyalty to the president and kind of where the Republican Party is headed. But there is a distinct healthcare flavor to this, given Sen. Cassidy’s influence over health policy in the Senate, and also just the involvement of a sitting Cabinet secretary’s political operation, which is pretty unusual, especially countering a sitting senator from his own party. So, yeah. It’ll be interesting to watch on Saturday. 

Rovner: Lauren, you want to add something. 

Weber: I want to call out again that Trump and RFK and Calley Means went pretty scorched-earth on Cassidy when they pulled Casey Means out, too. It’s not just that Trump has opposed him. It’s that this is like blow-everything-up-on-the-field oppose Bill Cassidy. So it is very curious to hear how this goes over, considering that Cassidy was the vote that got RFK his secretary post. So the weekend will be one to watch. 

Rovner: Yeah, it will. Well, the other big story from last week that continues this week is also FDA-related. It’s the fate of the abortion pill mifepristone and whether it will continue to be available via telehealth prescribing. The Supreme Court last week put a temporary hold on a 5th Circuit Court of Appeals ruling that would have rolled back the tele-prescribing option. We were supposed to get a decision on whether or not that appeals court ruling would take effect by the end of the day Monday. But, as we so often say in Washington, that did not happen. Alice, where are we with this case? 

Ollstein: We’re in a real hurry-up-and-wait situation. I had all my pre-writes ready to go on Monday, and I still have them ready to go for today. Look, the Supreme Court could punt again. They could say we need even more time. That’s happened before. They could say that the nationwide restrictions that the 5th Circuit put into effect that would cut off telehealth access to abortion pills and mail delivery of abortion pills and reinstate a prior rule saying patients can only get the drugs in person from a doctor, they could let that go into effect. Or they could say, Look, we’re going to maintain the status quo for now while this case makes its way through the courts. Those are sort of the three options. There could be a secret fourth thing. This is the Supreme Court. They kind of do what they want. One possibility is some parties in the case have asked the Supreme Court to leapfrog the 5th Circuit and just deal with this themselves once and for all. So that could happen, or they could send it back down to the 5th Circuit. 

We can sort of take some clues from what they did when a different case challenging abortion pills came before them in 2023, which is: They maintained the status quo. They maintained nationwide telehealth access while sending the case back to the 5th Circuit. And then it eventually came back to the Supreme Court, and they eventually sort of dodged the heart of the issue and decided it based on standing. That could happen again here, too. We have no idea. But this is really a major case because if these nationwide restrictions on telehealth go into effect, it’ll be really the biggest rollback of access since Roe v. Wade was overturned in 2022. And it will really go after access in blue states with protections on the books for abortion access in a way that people in those states really haven’t experienced before now, which could have very big political as well as healthcare implications. 

Rovner: And which those states have also sued. 

Ollstein: Yes. Yes, yes, yes. 

Rovner: The blue states. So there’s more to come. What role if any did the anti-abortion movement have in Dr. Makary’s losing his job? As we discussed last week, they blamed him for the FDA’s slow-walking of a review of mifepristone safety, even though it’s pretty clear that that delay came from the White House, not from Makary himself. And I know there was a White House meeting just last Friday with anti-abortion groups, just as the Makary-is-on-his-way-out rumors began to fly in earnest. Connected? 

Ollstein: So the administration is definitely trying to reassure the anti-abortion movement and keep them in their good graces leading up to the midterms. But that’s not entirely been successful. The anti-abortion groups are still upset. They still want to see these policy actions. They want the FDA or the DOJ [Department of Justice] or the EPA [Environmental Protection Agency] or some agency to do something to cut off access to abortion pills. They have not gotten that yet. They’re also really upset that the current ban on Planned Parenthood receiving Medicaid funding is set to expire in July, and it’s not totally clear Congress is going to manage to extend that defunding provision at all or in time for its expiration. And so these are two big priorities of theirs that they are very upset about. And so it’s not clear that all of this access that the administration is extending to them in these meetings and these phone calls, if that’s not followed up by concrete policy action, they’re not going to be satisfied. They’re going to keep complaining, loudly, as we’ve already seen this week. 

Rovner: Well, meanwhile the Trump administration used Mother’s Day this week to unveil a new regulation aimed at making it easier for employers to offer IVF [in vitro fertilization] coverage to their workers, though not making it free, as Trump had promised on the campaign trail in 2024. And at a maternal health event on Monday in the White House, administration officials continued to press their pro-natal push for more people to procreate. Here’s how [Centers for] Medicare & Medicaid [Services] chief Dr. Mehmet Oz put it at the event. 

Mehmet Oz: One in 3 Americans are under-babied. What does under-babied mean? That means that you either don’t have any children or you have less children than you would normally want to have. 

Rovner: Um, OK then. This event also featured the unveiling of a new federal website, moms.gov, which HHS says is a, quote, “user-friendly, one-stop digital hub providing new and expectant mothers with essential resources.” But it also links users to an anti-abortion group site that collects lots of sensitive personal information that can apparently be used any way the group, Heartbeat International, sees fit. Alice, this has prompted some concern in the reproductive health community. Has it not? 

Ollstein: It has, and it’s also a good example of how the administration is both working to appeal to anti-abortion activists while also continuing to piss them off, disappoint them. And so there was just a lot of mixed reaction to the unveiling of this website, because the anti-abortion folks were thrilled that it was steering people, using government resources to steer people to these often faith-based, anti-abortion crisis pregnancy centers. But at the same time, it was promoting IVF, which many of them oppose. They see it as akin to abortion. They 鈥� some see it as even worse than abortion, because it’s creating all these embryos and discarding them. And so it’s this real sort of push and pull where they’re not happy and, as you mentioned, the pro-abortion-rights camp is really not happy, either. 

Rovner: So we will have more of this as we go forward. All right, we’re going to take a quick break. We will be right back. 

So back in February 鈥擨 looked this up 鈥� we talked about the Trump administration threatening to withhold millions of dollars appropriated to the global childhood vaccine group called Gavi, because it wouldn’t promise to phase out the use of the preservative thimerosal, which, by the way, has long since been cleared of accusations that it causes autism. The U.S., which helped create Gavi, now owes it $600 million 鈥� $300 million each for the last fiscal year and the current fiscal year. And last week, a bipartisan group of senators, led by Senate Appropriations Chairwoman Susan Collins of Maine, sent a letter to Secretary of State Marco Rubio asking him to, you know, spend the money that Congress appropriated. Now, Gavi says it has specific reasons for using vaccines with preservatives, because it mostly operates in poor countries, where refrigeration can be spotty, and it has to make the best use of limited funds. My bigger question is: How does the secretary of Health and Human Services get to stop the State Department from spending money appropriated by Congress? 

Weber: I think that’s a great question, Julie. At the end of the day, Kennedy, for years 鈥� this is not something he came up with overnight. This is something he’s been harping on for years. He wrote a book about thimerosal. He has linked it to autism, which is a claim that has been disproven by scientists and even folks at his own agency, before his handpicked advisory committee voted to get rid of it, in a decision that now is on ice with the federal court. But he also has railed against the sending of these vaccines abroad for years. I’ve listened to him talk about it. He really dislikes Bill Gates for his involvement in some of this. And so on. So it was a personal issue for him that he’s held tightly. I’m not sure how you get ahold of State Department funds, but I’m not sure of a lot of things these days. So, here we are. 

Rovner: Neither is Congress, apparently. We will watch the Gavi space, too. Well, meanwhile, we are also still watching this hantavirus outbreak that apparently came from Dutch tourists in Argentina, who caught it and spread it on a cruise ship in the Atlantic. So far, there are nine confirmed cases and two more people showing symptoms. Public health experts, including what’s left of the Centers for Disease Control and Prevention here in the U.S., seem fairly united in the view that while this is an odd outbreak, since hantavirus rarely spreads from person to person, they’re still not super worried about it morphing into another pandemic. But it does underscore just how unprepared the U.S. is should another outbreak of this or something else prove more dangerous, now that the nation has basically cut public health capacity to the bone, cut ties with international public health organizations like the World Health Organization, and defunded much of the federal public health infrastructure. Although, I have to add, there is at least a little bit of karma in watching all these officials who rose to prominence criticizing the nation’s covid response trying to respond to a public health emergency of their own. What are you guys watching for? Lauren, you must be on this one. 

Weber: Yeah, no, I had  earlier in the week about: What’s it like to be in the Nebraska national quarantine unit? Which it was kind of fascinating to me. So basically there’s this whole setup in the middle of the country 鈥� and as a Midwesterner, I obviously love a Midwest shout-out 鈥� where they repatriated all these people off the cruise ship and sent them to Nebraska. And you end up, basically, if you’re in the quarantine unit, in what’s essentially a souped-up hotel room. There’s an exercise bike. Apparently, the staff is very nice. But you can’t leave, really, unless 鈥� there is some talk about letting some of the people that seem to really have no symptoms potentially leave to stay at home, but it’s a little unclear what’s happening there. Staff comes in in protected masks. And you don’t get to see people for a while, so that’s kind of a tough go after you were on a cruise ship sailing the world. That really went awry. So 鈥� 

Rovner: And it’s a long incubation period for this particular strain of hantavirus. 

Weber: It’s a long 鈥� 42 days! That’s a long time to be stuck in a room. But again, officials 鈥� as you said, Julie, I think which was smart to point out 鈥� have said this is not covid. This does have very low risk of spreading to the general public. I do think there is some question about this question of prolonged contact and what that means 鈥� it seems like it’s being debated a little bit about how exactly this spreads and how exactly many people may end up coming down with it 鈥� that we’ll have to continue to watch as well. 

Rovner: And of course, we’re already seeing people online, like, selling more ivermectin. And, this sort of thing does bring out the less-than-scrupulous actors in public health, shall we say? 

Weber: Nothing like a crisis. But, in general, I think it’s a good reminder. As you pointed out, we’re watching the contrarians run the ship. I was fascinated. In the Oval Office, basically, RFK Jr. said there’s nothing to worry about, Nothing to see here kind of thing. And that is, it’s interesting, the public health messaging, which has varied from person to person in the administration, because they have litigated how covid was messaged for such a long time. Now, again, this is not covid. But it’s very fascinating to see players that had such strong opinions deal with some of the same terms, like “quarantine,” “6-feet isolation,” the uncertainty of what’s happening, and, again, deal with it in a backdrop of: We’ve withdrawn from the WHO. There have been CDC cuts. And what happens now? 

Rovner: Yeah, and also the fact, and we talked about this a little bit last week, that the U.S. didn’t even know that some of the people who were exposed had already gotten off the ship and gone home. And those people are not in quarantine in Nebraska. Those people are apparently being watched by their individual state health departments. So the coordination effort here was not great, either. 

Weber: Well, it does sound like the CDC was on the horn with state health officials. But yeah, I mean, some of these people kind of flew into the wind, so to speak, and they haven’t found everyone. But that said, you know, I talked to the Virginia state health official who was like, Look, we’re in talks with the patient in Virginia who&苍产蝉辫;鈥�&苍产蝉辫;they check in for daily monitoring of temperature checks and so on. The California state health official that I listened to said, Look, these people that we’re watching were either a row behind or a row in front of, or two seats next to, for at least 15 minutes a suspected ill passenger on a plane. That’s why we’re watching them. And that’s interesting to me, too, because that speaks to the level: Is that prolonged contact? What does prolonged contact mean? is my underlying question I continue to ask. So we’ll have to continue to see what we learn more on this front. 

Rovner: Well, at very least, they’re getting an idea that covid was not so easy to deal with 鈥� these people who’ve been criticizing the covid response. OK, that is this week’s news. Now we’ll play my interview with Sen. Tammy Baldwin of Wisconsin, and then we’ll come back and do our extra credits. 

I am so pleased to welcome to the podcast U.S. Sen. Tammy Baldwin, Democrat of Wisconsin. Sen. Baldwin is a senior member of both the Health, Education, Labor, and Pensions Committee and the Senate Appropriations Committee, where she’s the top Democrat on the subcommittee that funds the Department of Health and Human Services. Sen. Baldwin, thank you so much for joining us. 

Sen. Tammy Baldwin: Thank you for having me. 

Rovner: So we spend a lot of time on the podcast talking about health issues that are divisive, and often divisive by party, but one feel-good story of the past few months comes from a study showing that the new 988 suicide prevention hotline has, in fact, reduced youth suicides. That was a very bipartisan effort in Congress that you were, I know, a big part of. How satisfying has it been to see that succeed, and is there a chance that you could repeat that work on other health issues, or was this kind of a one-off? 

Baldwin: Look, I knew when we wrote the bill to establish the 988 hotline that it was going to save lives. But to have this study showing that there was 10% to 11% reduction in youth suicide and attributable to this 988 hotline 鈥� it’s heartwarming to know that this work matters. And it was very bipartisan legislation to establish the 988 hotline. You know, we’ve long had a mental health crisis suicide prevention hotline. It was a 10-digit number that no one would remember at a time of crisis and need. And so now people remember it and can use it, and it’s also modern in that you can also chat or text as well as call. And with the young generation, sometimes that’s their preferred way of reaching out and communicating. But again, heartwarming to hear what I always believed would be true about 988 鈥� that it is saving lives and people are using it. 

Rovner: I know that as much of a success as this has been, you’ve been critical of HHS Secretary RFK Jr. for eliminating the part of the hotline that provided a separate option for LGBTQ+ youth. What’s the status of your effort to get that restored? 

Baldwin: Yeah, and I’ll focus on that. And there’s some other concerns that I have about the way in which we support 988. But let me start with that. There are certain populations in the United States that have higher rates of suicide. I think we all immediately think of our military veterans. And so when you call the 988 hotline, one of the first screening questions is: “Are you a military veteran? Press 1.” And if you are, you have the option then of getting your call or inquiry responded to by somebody in the VA [Department of Veterans Affairs] system who, I might say, has walked in your boots before and understands the experiences that you might have had while serving in the military. Another population with a very high rate of suicide is LGBTQ youth, and so the “Press 3” option made sure that youth who were in the LGBTQ community and reaching out for help in crisis were getting their calls and texts responded to by somebody who was specially trained and understood their situation. And you know, again, it promotes use of the line because you don’t think when you call that you’re likely to be judged. And by the way, the study that showed this was having a very positive impact on reducing suicide said that 1 in 10 calls to the 988 hotline, people utilize the “Press 3” option. But what happened there is the Trump administration last year abruptly ended the service and defended that by saying, Well, we want to treat everyone the same. We don’t want to discriminate. Well, they kept the “Press 1” option for veterans, and understanding that specialized response for veterans would be important to keep, but they eliminated the service “Press 3” for LGBTQ youth. Very unfortunate. But fortunately, there was a bipartisan pushback to that 鈥攐n two fronts for that, one successful and the other still in progress. We wanted to make sure that the administration restored the “Press 3” option and restored the contracts with nonprofits that are able to provide the response to those calls. And that was written into our appropriations law for the fiscal year 2026. Now we’re chasing down the administration and Secretary Kennedy, saying, It’s in the law. Let’s get it done. It hasn’t happened yet, but we have his public commitment to make sure it does. And so we’re pressing him for expeditious restoration of the “Press 3” option. That said, we also want to make this permanent law. And so I have a bill that is bipartisan with Sen. Lisa Murkowski that would write into statute that a “Press 3” option has to exist and so that it doesn’t become political football in the future. 

Rovner: Well, I’m so glad you mentioned things that have been written into the appropriations law, because one of the continuing issues that we’ve chronicled over this last year has been this administration just refusing to spend money as appropriated by Congress. Now, I’ve been covering Congress in general 鈥� and the Labor-HHS appropriation, in particular 鈥� for four decades now, and a 25-year-old or 35-year-old me could not imagine appropriators standing for any administration, ignoring their power of the purse, which this one seems to be doing. Why has there been so little pushback, and is that going to change? 

Baldwin: Yeah, in answer to your question, I want to say that in this most recently passed bill that Donald Trump signed into law, we had to put guardrails that we’ve never had to put into our appropriations laws before to enforce our spending bills. And those laws have made it clear that we expect that they must spend what we have appropriated, and not just, you know, all of it at the end of the fiscal year, but in a timely manner throughout the year. And we also are more specific about staffing requirements, because we saw last year these incredible numbers of people fired, RIF’d, as well as really heavy pressure to get people to sign up to early retirements, etc., but just a big push to get people out of the agencies. And so we had to write into the appropriations law that they have to maintain staffing sufficient for their mission. And I can give you any number of examples where people needed to reach out to divisions within the CDC, for example, and no one was there. 

Rovner: Is there going to be more pushback, do you think, if the administration tries this year to avoid spending money in the way that they tried to avoid spending money last year 鈥� and, as you kind of mentioned, dumped a lot of money out the door at the very end of the fiscal year? 

Baldwin: Yeah, so one of the areas in which they did that in a significant way was NIH [the National Institutes of Health]. We saw thousands fewer grants awarded last fiscal year, and we’re very worried that they would continue to act in that vein. And part of that battle is still ongoing. There’s something 鈥� we’re going to get in the weeds here for a second 鈥� but there’s something they call forward funding, where instead of just annually funding one year of grant research activity, you actually fund multiyear grants all at once up-front. And the administration has wanted to move into doing that more and more and more, but if you have a finite number of dollars, that simply means fewer grants will be awarded each year. And the way I liken it, if you’re thinking about NIH and curing cancer or finding a better treatment for Alzheimer’s, these are more shots on goal. We need to not just invest in a few research endeavors to try to cure cancer, to try to treat Alzheimer’s, to deal with all of the things that NIH is trying to advance, you have to have as many shots on goal as you can. And so this forward funding is really tying up a lot of resources in fewer and fewer research endeavors. 

Rovner: And that 鈥� which leads me to my last question, which is&苍产蝉辫;鈥�&苍产蝉辫;concerns the other thing we’ve talked about a lot, is that future health care and research worker pipeline having fewer grants means fewer jobs for students and PhDs. And this administration has also made it more difficult for medical students and other health profession students to take out loans by capping the loan amount. How big a concern is this? And what can you do from your posts, either on the HELP Committee or on the Appropriations Committee, to make sure that there is a future workforce for healthcare and research? 

Baldwin: Yes. Well, especially in research, I was proud to&苍产蝉辫;鈥�&苍产蝉辫;lead bipartisan legislation called the Next Generation Researchers Act that passed many years ago but is definitely in threat under this administration. I represent the state of Wisconsin. We have a couple of academic research centers that are exceptional. And I remember visiting on so many occasions and seeing these bright postdocs looking forward to their opportunity to advance treatments and cures for devastating illnesses and learn about the basic mechanisms of biology. And knowing each year that the average age of the first-time grant awardee is getting older and older and older, and the opportunities for a career in research 鈥� which is such an investment by the individual to their education and postdoc work 鈥� their opportunities are shrinking and shrinking. And some are leaving research and going into private industry. Some are leaving the country and are actually being lured by other nations who want to take advantage of this neglect here in the United States. This is something we’ve got to turn around. And forward funding is one of the things that is making it harder, but also the lack of commitment to just increasing the overall research enterprise in the United States, which is something we are known for globally. You have to keep up with it. Costs increase, and so you can’t just flat-fund, that means less. You can’t forward-fund, that means less. So we’re going to have some bipartisan pushback, but we also are going to have a very limited amount of resources to deal with, especially 鈥� just to drop a big topic at the very end here 鈥� especially with a Defense Department that is seeking $1.5 trillion in funding 鈥� that, just the math doesn’t work out. 

Rovner: Well, we will be watching the appropriations process closely as it moves forward. 

Baldwin: Yes, indeed. 

Rovner: Sen. Baldwin, thank you so much for joining us. 

Baldwin: Thank you 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. Rachel, you have already done yours. Lauren, why don’t you go next? 

Weber: Yeah, I wanted to highlight Stat’s series, the first of which is titled “,” by Lev Facher and Isabella Cueto. And it’s just a fabulous step-back look at how this administration, in particular, which would seem to be primed to look into alcohol as an addiction, considering that Trump himself is a teetotaler and RFK Jr. has publicly spoken about his recovery from addiction to alcohol, is not seizing the moment. And this is happening at a time that ER visits for alcohol are going up, and that alcohol does, speaking of chronic diseases, contribute to quite a large amount of American healthcare costs. And it’s a real bracing look at an issue that, you know, oftentimes people don’t want to look at in this way, as alcohol is such an inherent part of America’s social fabric. So kudos to them for the look. 

Rovner: Yeah, I would point out that both alcohol and tobacco are, you know, two of those vices that have been bipartisan over the years. Republicans and Democrats in Congress have worked on, but this administration seems to be sort of downplaying both of them. Alice. 

Ollstein: Yes, I have a piece by my colleague Katherine Tully-McManus titled “.” Now we’ve been hearing a lot about the threats to medical privacy with everything being in these electronic records, and, you know, being shared from company to company. And turns out, even being a member of Congress does not protect you from this brave new world that we live in. And there was a data breach this week that lawmakers were informed of, and potentially their prescription history was unveiled. And so that is information I am sure they do not want out there. So it just really shows that if even they can be at risk, then, you know, what’s going to happen to the rest of us? 

Rovner: Yeah, that was some story. And I would add that TMZ is looking for members of Congress who smoke weed. That’s a separate story. Not my extra credit. My extra credit this week is from ProPublica. It’s called “,” by Rob Davis. It’s about a state law that gave Oregon officials the power to stop mergers and acquisitions that were deemed not in the best interest of patients. The idea was to, if not stop them, then at least slow the consolidation push that was cutting access and driving up healthcare costs 鈥� except it hasn’t worked, at least not yet. Quoting from the story: “Of the nine healthcare deals for which regulators have done follow-up reviews, at least three had outcomes the law was meant to forestall.” As always, complicated healthcare problems defy simple solutions, but I assume they’ll keep trying. 

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 鈥� 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? Lauren. 

Weber: I am still on X  and the same thing on . 

Rovner: Rachel. 

Cohrs Zhang: I’m on X  and on . 

Rovner: Alice. 

Ollstein: I am  on Bluesky 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, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, May 7, 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 Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Good morning, everyone. 

Rovner: And Jessie Hellmann of CQ Roll Call. 

Jessie Hellmann: Thanks for having me. 

Rovner: Later in this episode, we’ll have my interview with Andrew Jones, who reported and wrote the latest 麻豆女优 Health News “Bill of the Month,” about an emergency room bill for what turned out not to be an emergency but could have been. But first, as always, this week’s news. 

Let’s start this week with the continuing fight over the abortion pill mifepristone. Last month, it appeared that the court fight over the pill was put on the back burner. That was after the Trump administration, to the consternation of abortion opponents, asked a federal district court judge to postpone proceedings while it finished a new safety review of the pill by the Food and Drug Administration. Well, the state of Louisiana, which had brought the suit to roll back the pill’s availability, wasn’t satisfied with that, and appealed the delay to the 5th Circuit Court of Appeals. Last Friday, right before dinner, a three-judge appeals court panel ruled in favor of Louisiana and basically ordered a rollback of abortion pill availability to the rules that were in place before 2021. That’s when doctors had to literally hand the pill to patients, meaning no telehealth and no pharmacy distribution. Shefali, you’re one of our abortion experts. Pick up the story from there. What happened over the weekend, and where are we now? 

Luthra: Over the weekend, there was a lot of confusion. I spent a lot of time talking to abortion providers and people who track abortion law quite closely. And providers were prepared to switch regimens, if they had to, to change to what’s misoprostol-only 鈥� using larger doses of the other drug in medication abortions, which is safe, is effective 鈥� is less safe, less effective? 鈥� but still good, though not gold standard. Meanwhile, we saw an appeal from the manufacturers of medication abortion to the Supreme Court. They also saw a stay from the 5th Circuit. While they might get some more time to figure things out, they never heard from the 5th Circuit. But then, on Monday, the Supreme Court weighed in and said, We are blocking this 5th Circuit ruling for a week. You have a few days 鈥� so, until Thursday, today actually 鈥� to submit arguments from both sides. And then, by the end of the day Monday, they are supposed to say whether this stay will be extended, whether they will be ruling, whether they might take up this case. And there’s a lot that could happen, right? They could try and make a ruling now, they could send this back to the lower courts. They could say, We want to hear arguments before this term ends, which would be at the end of June. They could say, We want to hear arguments on this in the fall, right before the midterm elections. But what they do could have real significance for whether mifepristone is available by telehealth, and, as a result, how people in states with abortion bans 鈥� but also where abortion is legal 鈥� get abortions. Because telehealth abortion is increasingly popular. One in 4 abortions are done by telehealth. About half of those are for people in states with bans, but half of them are for people in states where abortion is legal and protected. But going to a clinic and getting a pill handed to you is simply much more inconvenient and often impractical or not really possible, compared to having it mailed to you 鈥� if you have child care, if you can’t get off work, if you live really far from a clinic. And so access to this gold-standard regimen of abortion care is now possibly going to be very much in limbo for all these people across the country. 

I don’t know if we have seen much to indicate that this is going to be a campaign issue. We haven’t really heard as much chatter from Democrats as one might expect. But it is possible that if this becomes more of a live issue, if the Supreme Court makes those restrictions more permanent, or if they, in fact, do take this case up in a manner of timing that would be very influential, that this could, in fact, become a meaningful campaign issue, because most voters don’t like abortion restrictions, especially national ones. 

Rovner: Yeah, among the people who are sort of put in a difficult situation here is the Trump administration. The anti-abortion movement clearly wants more action on this issue. Trump was pretty clear, even on the campaign trail in 2024, that he doesn’t want to further restrict abortion; he’s already getting hammered for not following through on his promise to make in vitro fertilization more available. And now anti-abortion groups are planning to put not just money but their large volunteer power up against those candidates who won’t vow to take more aggressive federal action. How angry are they? And what impact could that have on the midterms, where Republicans are already on defense? 

Luthra: They are furious with the Trump administration. I mean, you have the head of SBA Pro-Life America : Trump is the problem. That’s quite blatant for what is ostensibly a close ally to the White House, an organization that has tried to influence policy, that has hoped for those influences to be translated into actual policy. It’s clear that they’ve given up on that. And many of them were very, very frustrated that the administration took on this purported review of mifepristone and kept saying, We will have more information for you later, probably after the elections. And that they, in fact, argued against Louisiana in the courts, and they defended their policy of having mifepristone available for now. And so I think what you’re seeing politically is this real possibility of schisms in the conservative movement. The people who oppose abortion and, right, are an important part of that base, but also, Trump may be unpopular nationally, but he still carries a lot of influence in a large part of the Republican Party. We just saw that in the primaries in Indiana this week. And so I think we really don’t know who wins. Do anti-abortion voters simply stay home? Do they say, Well, this is still our best option. It’s the Republican Party. And also, in the meantime, how much does the movement start thinking instead about trying to pick a possible successor to Trump? And a lot of them really are focusing now on the midterms, but also on 2028. And so do they just say, Well, we’re done with this. We’re not going to win and move on. Or is there something that they might be able to get if they keep threatening to withhold money and voter influence? Open question. I think we’ll see. 

Rovner: Jessie, Sandhya, you guys are on the Hill. I mean, you know, there’s been a lot written this week: Oh, Democrats haven’t said anything about this. I think this came as a bit of a surprise. I think we, most of us, thought that this was going to be kind of back-burnered until after the election. Do you see Democrats picking this up and running with it at some point? It has, it has been, it’s been an effective political issue, but maybe not so much in terms of votes, right?  

Hellmann: I don’t know if Democrats really saw much gain from focusing on abortion in the last round of elections, which feels like such a weird way to talk about it. But they might think that other campaign issues, like the affordability issue, healthcare costs, more generally, might be more of an issue that they want to hit on&苍产蝉辫;鈥�&苍产蝉辫;especially after the ACA tax credits expired. But we might see more from them as this issue continues to play out in the courts. 

Rovner: And I’m just wondering if, you know, if Republicans start&苍产蝉辫;鈥�&苍产蝉辫;I mean, we’ve seen people like Bill Cassidy, the chairman of the HELP [Senate Committee on Health, Education, Labor and Pensions] Committee, who’s been very outspoken, you know, and has long anti-abortion bona fides, I mean, going back pretty much his whole career. But it’s interesting that he’s been hammering on this. I’ve seen Republicans on the Hill hammering on this in a way that separates them from the president, which is a little bit surprising. It makes me wonder if Democrats are going to try to exploit that difference or not, or if they can figure out how, or if just, as you say, affordability is so much a bigger issue right now. 

Hellmann: I think the Bill Cassidy race is really interesting. He’s in a heated primary against Julia Letlow, and he seems to think that this mifepristone issue is going to be, like, a wedge issue in that race. He’s the chairman of the HELP Committee, so he spends so much time talking about this. Even when HHS [Department of Health and Human Services] Secretary RFK [Robert F. Kennedy] Jr. was on the Hill a few weeks ago, this is one of the first things that he asked him about, and he didn’t even get to the vaccine issue until later. But I think that maybe in those more conservative primaries, it could be an issue. But then it’ll be interesting to see how he’ll talk about it later on, if he does win that primary. 

Luthra: I think one thing to note about the Cassidy primary that I’m really surprised by 鈥� and I think speaks to the complicated state of things, and maybe the fact that people thought this was a resolved issue 鈥� is he talks about it a lot on the Hill. If you go through his TV ads that he is running in this very close primary, they’re not about abortion. He has not had a single TV ad about abortion, and it is largely instead about trying to assert his bona fides as a true partner to Donald Trump. And I think that’s really interesting because, again, as we’ve discussed, Trump is not really interested in this issue, and Louisiana primary voters certainly are. But there’s a calculation, right? Do you want to situate yourself as the partner to the president, or do you want to talk about abortion? And maybe you can do both, but maybe it’s actually really difficult to do both of those things. 

Rovner: Well, one thing I haven’t seen mentioned in this latest round of debate over abortion is the potential impact on the rest of the drug industry. Once again, justices are being asked to step in and override the presumably evidence-based findings of the Food and Drug Administration. The last time we got this close to a Supreme Court ruling on an FDA approval of mifepristone was in 2024, when the justices were able to punt by pointing out that the doctors group that brought the suit didn’t have standing. But it doesn’t look like that’s as viable an out this time, because it’s the state that’s suing. Why haven’t we heard more from drugmakers, who we know are freaking out about not being able to rely on FDA decisions to make, you know, business plans worth billions of dollars? 

Raman: I think we will. I think it really depends on what we see in the next week, in terms of is this getting escalated, that the Supreme Court would hold arguments, or where we are? If I think back to 2024, I feel like a lot of more of the involvement from the pharmaceutical industry 鈥� when they were speaking out more, holding briefings, maybe submitting those briefs 鈥� was when we got to the Supreme Court stage. So I think it’s a matter of time. And right now it’s, you know, kind of figuring out their options and what they’re going to do. But a ruling could have a huge impact on so many other drugs. So I doubt that they’d be quiet as we get further along. 

Rovner: Yes, I would expect, I mean, we’re going to see a flurry of briefs by the end of the day today, and I would expect that the drug industry would be among those who are going to be filing those briefs. So we will know more. 

Luthra: In fact, we actually already have a brief from PhRMA [. 

Rovner: Oh good. 

Luthra: It came in either last night or this morning, and it says exactly what you’d say, that they are concerned that pharmaceutical development will suffer if Louisiana wins, that this is really problematic for drug research and development. And we are seeing some op-eds from biotech CEOs, etc., in places like Stat just highlighting that they are very concerned about the ramifications for the industry. So I think so I’m just totally right, like, as this case picks up steam, that chorus will get louder and louder, because this is just too consequential for the industry to not talk about. 

Rovner: Right, this is about much, much more than abortion. All right. Well, speaking of the FDA, Commissioner Marty Makary’s job is, quote, “on thin ice” 鈥� that was, were the exact words used in stories from Bloomberg, NOTUS, and The Wall Street Journal, all in the past few days. On the one hand, we’ve heard these rumors before, as things at FDA have been chaotic, to say the least, but this week’s flurry of rumors appears to be over Makary’s overruling of FDA scientists who recommended approval of mango- and blueberry-flavored vapes. Makary was reportedly concerned about attracting children to vaping by approving fruit flavors. This has been a long-standing argument. While the scientists who recommended approval wanted to help adults actually quit smoking, which is demonstrably worse for their health than vaping. As it turns out, the flavored vapes were approved on Tuesday, apparently after President Trump intervened personally by calling Makary. So this raises two questions. First, is this more politicization of FDA policy? It certainly looks like it, even if the ultimate decision here was what the FDA scientists actually wanted. 

Raman: I mean, if you look back to when President Trump was on the campaign trail, he did talk about wanting to save vaping and how that was a big issue for certain voters and stuff. So it has been something that’s been in the back burner. These kind of approvals and authorizations take a very long time. And they’ve, you know, a lot of folks have been complaining for a long time about how long some of these things take. They can be backlogged for years. And we had very different opinions with some of the appointees during the Biden administration about how to handle flavored nicotine and tobacco products. I do think that the short turnaround between some of those conversations over the weekend and then suddenly this getting authorized is a little unusual, but it’s kind of hard to say where they were in the process before that, if they were dotting the i’s, crossing the t’s, or if this shoved things forward a lot more. So it’s hard to tell, but I think it really does build into your earlier point about how folks are just not sure for how long that he remains as FDA commissioner. I mean, there have been things building for months, but it really has heated up in the last couple weeks or so. And I think something that raises for me there is just if he does get out at some point soon, that would make another thing that the Senate has to get through and, you know, find agreement on which could get even more complicated if, depending on what happens with&苍产蝉辫;鈥�&苍产蝉辫;

Rovner: 鈥� with the abortion case. 

Raman: Yeah, and Cassidy’s race! 

Rovner: Oh, Cassidy’s primary! That’s right. Yes. 

Raman: Yeah. So I think there’s a lot of interconnected things that will be really interesting to watch here as this plays out. 

Rovner: Well, there’s also, before we get off of this, there’s a broader question here about harm reduction. Sandhya, we just talked about this a few weeks ago, after the federal government said it would stop paying for test strips to detect fentanyl and other potentially fatal substances added to illicit drugs. So harm reduction is bad when it comes to fentanyl strips, but good for flavored vapes? 

Raman: I think we’ve had a lot of conflicting messaging on this. Flavored vapes, I guess, are a little bit more complicated, because you could be an adult and just go straight into flavored vapes, and it is a little bit more complicated than that. 

Rovner: And it is a legal product. 

Raman: Yes, it is a legal product. You know, it’s regulated very differently. But I think, since you did bring up harm reduction, the interesting thing there that has been happening is just that there’s been so much differences of opinion, despite that guidance. You know, we had the Office of National Drug Control Policy this week put out their drug control strategy plan for the year, and that had language in favor of the testing strip. So we’ve had a lot of conflicting messages between different parts of the administration over the same issue, which is really confusing folks on the ground. 

Rovner: It is. Well, in other news from the FDA this week,  that the agency blocked the publication of several studies that found very few serious side effects from vaccines for covid-19 and shingles. This included top FDA officials ordering the withdrawal of studies that had already been accepted by medical journals. This is far from the first that we’ve heard of this sort of thing from the FDA and from the Centers for Disease Control and Prevention. But it does increase the doubts that this administration is, quote, “following the science,” does it not? 

Raman: I mean, we saw the same kind of reaction in terms of why this happened from HHS, you know, saying that the studies were making really broad claims, and they were not supported by whatever the underlying data that they had was. I think that this and the CDC vaccine study getting pulled are both highly unusual, but the fact that they’re both happening in a short period of time, you know, kind of increases that. I think it’ll be interesting, you know, we saw with the CDC study that it ended up getting leaked, and then people were able to look at it and make their own conclusions. What happens with this? But having these studies about vaccine efficacy being pulled when the administration is trying to pull back on their vaccine messaging is, like, a less salient issue for the midterms is interesting. So I’m curious what happens next there. 

Rovner: Yeah, me too. OK, we’re going to take a quick break. We will be right back. 

OK, we’re back, and of course, we have more personnel news. Last Thursday, just after we taped, thank you very much, President Trump pulled the nomination of Casey Means to become the next surgeon general after it had become clear she did not have the votes to even move out of committee. In her place, the president nominated Dr. Nicole Saphier, a Fox News contributor who did finish her medical residency and is a practicing radiologist specializing in breast imaging, and 鈥� apparently this is now a requirement for a high job at the Department of Health and Human Services 鈥� she’s a podcast host. Just this week, there’s been a  that were critical of some of the health stances taken by President Trump and HHS Secretary RFK Jr. But I imagine that might actually help her nomination, which has generally been pretty well received, by making her look like she’s at least as interested in accurate medical advice as she is in currying favor. Or am I misreading this? 

Raman: I don’t know that the tweets are going to have a huge effect either way, when there’s so many other things going on. And I feel like it’s so interesting that her book from, you know, long before this administration, was called Make America Healthy Again. So it seems like if anyone is committed to this movement, it would be someone with a book titled that six years ago. 

Rovner: Although she’s not really a MAHA person, right? 

Raman: Yeah, yeah. But it just is such a funny coincidence. But I think that right after they pulled the Means nomination, it was interesting 鈥� kind of goes back to what Jessie said was that 鈥� we had the president; we had her brother, Calley Means; and then we had Secretary Kennedy as well digging in on Cassidy and blaming him for that nomination falling through. But they did back the new nominee. So it’s interesting what is going to happen there. But just how political just getting this across is, even though there weren’t other votes in the Senate to get Casey across the finish line. 

Rovner: Yeah. Shefali, you were going to add something? 

Luthra: Oh, I just think that the tweets, I mean, they are really striking, and I think you’ve hit on something that is a fascinating tension. This is someone who has criticized the president’s talking points around Tylenol in pregnancy; who has said that, you know, maybe there is not a link between Tylenol and pregnancy and autism. Maybe I don’t want to be told just tough it out when I am in pain. She also, fascinatingly, is quite anti-abortion, and has talked about that a lot as well. And I think there’s just a lot of really complicated worldviews that she brings. And on the one hand, like, maybe some of that ends up being appealing to lawmakers because, as we’ve discussed many times on this podcast, the stances that are more anti-vax, anti-medicine, anti-science are not necessarily that popular with voters, and lawmakers are reacting to that. That’s why it’s been so difficult to confirm a surgeon general nominee. And maybe this finally changes that. Maybe deleting those tweets does suggest that someone would rather remain in good standing with the president. I don’t think we really know until&苍产蝉辫;鈥�&苍产蝉辫;if she gets the job and then see what happens. But it is really fascinating to see the third person picked, where there’s still an unfilled position, possibly being someone a bit more aligned with some things that are, in fact, conventionally accepted medicine. 

Rovner: Well, we will see. And of course, this is&苍产蝉辫;鈥�&苍产蝉辫;yet another nomination that has to go through Bill Cassidy’s HELP Committee. And regardless of what happens in his primary, even if he loses his primary, he’s going to be the chairman of that committee until the end of this year. So we will have to see. 

All right. Moving on to the Affordable Care Act, we have more evidence this week about the impact of last year’s big budget bill and the expiration of those covid-era additional premium subsidies that they’re having on enrollment.  that analysts and state officials are expecting a drop of about 20%, dropping from 24 million in 2025 to about 19 million. Insurance company Cigna announced last week that it’s dropping out of the ACA marketplace. It currently sells in 11 states. And hospitals are reporting their first-quarter results that are already experiencing the fallout 鈥� from lower admissions to more uncompensated care. That includes not just people who’ve dropped insurance, but people who had to buy insurance with higher deductibles that they may not be able to pay. Republicans in the Trump administration have tried to downplay the reductions, but as the year wears on and the results get more obvious, aren’t they going to have to have some counterargument to this? 

Hellmann: A 20% decrease in enrollment could be really bad for the marketplaces, especially if the people who are leaving are healthy. It’s going to lead to a sicker risk pool, which is going to possibly lead to higher premiums in the future. So you would think that the administration would have to respond to that. But they have also showed that they’re not really a friend to the ACA, and the first Trump administration also did a lot of things to undermine it. So I’m not sure that they’re going to try to find a way to fix these problems. And they also had a recent marketplace rule that some experts actually think could weaken the health of the marketplaces even more.  

Rovner: Yeah&苍产蝉辫;鈥�&苍产蝉辫;I know the Republicans&苍产蝉辫;鈥�&苍产蝉辫;one of the big Republican talking points is that a lot of these people were what they call phantom enrollees. They didn’t even know they were enrolled. They didn’t file any claims. But, as you point out, a lot of people have insurance and don’t file any claims because they are healthy. Those are kind of the people that the insurers want. Obviously, not phantom people who don’t know they’re enrolled. That’s fraud. But people who&苍产蝉辫;鈥�&苍产蝉辫;have insurance and don’t use it are a good thing for the insurance industry. Shefali, you’re nodding. 

Luthra: No, I was just thinking about all the years I’ve had health insurance and didn’t file a claim. Like, of course you would want that. That’s awesome. It doesn’t mean I wasn’t covered. It meant that I relied on the peace of mind of having health insurance. And I would be very sad if I started filing claims for insurance and suddenly all the healthy people were gone. That would be terrible. 

Rovner: Yeah, we will 鈥� again, I think we’re going to get more evidence as the year wears on, and this is going to become a big, I think, campaign issue, obviously. 

Well, I want to talk about global health, at least briefly. A lot of people are watching that Dutch-flagged cruise ship with passengers sickened and some dying of hantavirus. Now, hantavirus is not normally spread person-to-person, but it is fairly clear that that’s what’s happening in this case, and it appears the outbreak is being fairly effectively handled by the World Health Organization. But of course, the U.S. left the WHO when Trump returned to office, so the U.S. is not only not helping with this, it’s out of the loop, even though there are more than a dozen Americans who’ve been on board, and reportedly seven who could have been exposed to this who have disembarked and already returned to the U.S. This is kind of why the U.S. was part of the WHO, right? When you have an international incident like this? 

Raman: Yeah, and I was just listening in to [an] infectious disease briefing this morning, where they were detailing how this situation is unusual. Usually, at this point in a crisis like this, we would have had more communication from the CDC, from the NIH [National Institutes of Health], just about the state of play, different briefings, or just going and helping with the situation. And we haven’t seen that, and just how striking that is right now. 

Rovner: And of course, I mean, so many people are having PTSD [post-traumatic stress disorder] from covid, and remembering, you know, cruise ships with people with covid. Public health experts say that’s not going to happen here with hantavirus. It’s just this one strain of hantavirus that spreads person to person. It’s hard to spread it. But with so little trust in science and so much misinformation, you got to wonder whether even this incident that shouldn’t cause a panic might anyway. 

Raman: Yeah, I think that has been kind of the concern is that this is something that the experts are worried about, and they’d like to learn more about, because there is a new case that they can learn from, to provide more public health information. But to not panic over this, just because the things that you said: This is not likely to cause another major pandemic in the same way as covid. 

Rovner: Well. Finally, this week, HHS Secretary RFK Jr. has struck out on another cause. Now he wants to get people off of their antidepressants. At a MAHA meeting on Monday, he unveiled a series of steps for doing that, from encouraging non-drug interventions for mental health conditions, to paying doctors to counsel patients for how to taper off the medications. He says he doesn’t want to tell people to stop taking their drugs, which can be lifesaving in many cases, although he’s also said he doesn’t want people not to be allowed to take vaccines, too. So where is this headed? Is this 鈥� this is a big, I guess, some MAHA people think people are overmedicated with antidepressants and ADHD [] drugs. 

Raman: I think it has a lot of the same playbook that we’ve seen with vaccines. He’s talked about over-medicalization as an issue for a while now. It was in the last MAHA report about a year ago, and even before that, he’s brought it up. My sense from attending that event this week was not that they were really looking at changing prescription guidelines, but I guess it’s hard to tell where we’ll see further along down the line. But it was more of just like an exploratory stage, you know, training physicians about different things related to tapering and things like that. But sometimes that’s the start of things changing down the line, and it is interest[ing], that kind of brings back his focus to very much the psychiatric drugs, the ADHD, depression, anxiety, and just wanting to lessen the medications there. So. 

Rovner: I can’t help but wonder if, because he’s been told to back off of the vaccine issue, because it doesn’t play that well with the public, that he’s going to pick this up as his next crusade.  

Raman: There was a huge emphasis on informed consent, which is, I feel, another big talking point with vaccine. So there is a lot of similarities in how it’s approached. So, I would look for more of those kind of clues there. 

Luthra: I think it’s also worth noting, even if this is early rhetoric that we know from research that rhetoric does influence prescribing behavior. We saw that study that showed after the “don’t take Tylenol when you’re pregnant” kerfluffle, prescriptions of Tylenol went down for people who are pregnant. And this is not really the first time RFK has talked about SSRIs, specifically. He’s talked about them with regard to pregnancy, in particular, and that’s already a very stigmatized, very fraught time for people, even though the consensus is, if you are depressed, stay on your medications. And I think this is something absolutely worth keeping an eye on, even if this is largely rhetorical, discouraging use of medications. Does that translate into changes, especially around something that is fraught and is often stigmatized and misunderstood, like antidepressants, which, as you mentioned, Julie, are lifesaving and very important for people with severe depression. 

Rovner: Indeed, and for people with severe anxiety. All right, that’s this week’s news. Now we’ll play my “Bill of the Month” interview with Andrew Jones, and then we’ll come back with our extra credits. 

I am pleased to welcome to the podcast 麻豆女优 Health News’ Andrew Jones, who reported and wrote the latest “Bill of the Month.” Andrew, welcome. 

Andrew Jones: Thank you so much for having me. 

Rovner: So tell us about this month’s patient 鈥� who she is, where she’s from, and what happened that landed her in the emergency room. 

Jones: Silvana Toska. She’s from Davidson, North Carolina. It’s just north of Charlotte. She’s a professor of political science there, and a mom of two. And while she was outdoor at an event last fall, she got bit by an insect, and she ended up with such a bad systemic allergic reaction that she got anaphylaxis. What anaphylaxis means is that her lungs began to be difficult to breathe. And so she broke out in hives, and she immediately decides, with her husband, to go to an urgent care, where she gets treated with two doses of epinephrine. And then the doctor says you need to be under watch for a couple of hours, so you need to go to the ER, which is kind of where our story starts. 

Rovner: So she doesn’t drive off to the ER, she goes in an ambulance to the ER, right? 

Jones: That’s correct. Yeah. They put her in the back of an ambulance, and they ship her off to the ER. Her husband and her two kids follow. 

Rovner: So by the time she got to the ER, she was already feeling better from the medication that they gave her at the urgent care. That’s what’s in an EpiPen, right? 

Jones: That’s correct, yeah. 

Rovner: The epinephrine. So what happened when she got to the ER? 

Jones: So, not a whole lot, actually. Like you said, she’s feeling fine at that point. A doctor comes in. The doctor sees her for less than five minutes, asks her about her condition, does a quick checkup, doesn’t actually make physical contact with her, which I thought was very interesting. And then the doctor steps out. And she basically spends an hour and a half doing nothing, trying to keep her kids entertained. And she gets a dose of Pepcid to keep the allergic reaction at bay. But after the doctor came in again, just to say that she could leave, she left, and it was an incredibly uneventful ER visit. 

Rovner: And then, as we say, the bill came. So how much is the ER charge for her couple of hours of follow-up&苍产蝉辫;鈥�&苍产蝉辫;at which not very much happened? 

Jones: Yeah. So that empty hour and a half, essentially, for that time, she was charged $6,746.50. And at the end of the day, she was responsible for a $150 copay and $3,100.24 鈥� a bill that she got on Christmas Day that year. 

Rovner: Awesome. So what was the justification for such a big bill for such 鈥� I won’t say “little care,” but what seemed to be little care? 

Jones: Yeah, well, she was actually charged for something that wasn’t little. It was called “critical care.” She was coded for critical care, her time there was. And the experts that I spoke to said that while Toska had every right to think that it was an outrageous price to charge, it was probably an appropriate charge for the situation, those codes were. And that’s partly because of a coding system that really isn’t hyper-specific to individual cases. Toska needed to be in the ER setting because of the anaphylaxis. It can return and cause a critical situation. And while she was coded based on what might have happened, rather than what did happen, it ended up not working in her favor as far as the bill went. And so people all over the U.S. experience this. Another expert I spoke to said that people are brought on that train of care when they arrive to the ER. There’s really no way to get off once it starts moving. And you don’t know what it’s going&苍产蝉辫;鈥�&苍产蝉辫;what the dreaded bill is going to be once it stops. And there definitely could be reform in the way that U.S. healthcare system does ER coding, although there would have to be some, you know, pretty titanic changes for that to happen. But I’ll say that if listeners ever find themselves concerned about a bill, they should definitely call their insurance company, ask if there was an attempt to negotiate, and they should call the hospital to check the accuracy of the coding. Toska did do both of those things and, unfortunately, nothing changed. But I can say that that was the right thing to do. There was some great back-and-forth. There was a letter that explained why they did that and, ultimately, what happened to her comes down to a coding system that did not work in her favor. And she told me that recently she experienced another allergic reaction, but instead of going to the ER, she just took some Benadryl instead. 

Rovner: And you know, I guess the takeaway here is that when a medical professional tells you to go to the ER, it’s not usually because they’re going to make money from sending you to the ER. It’s because something could happen that you should be in the ER for it. I guess that’s sort of why we have medical insurance, right? 

Jones: Absolutely, absolutely. Yeah. I mean, she really had no other choice. It was the right thing for her to do. But again, because of a coding system that wasn’t specific to her situation, it ended up 鈥� I see, you know, testimonies all the time from people who see this very outrageous bill for a little care. Toska is the first time I’ve seen a bill where there was essentially no care that she could see. And so I think it’s fair for her to have this discussion in her mind and with her family, and here in this article about: Is our coding system fair? But ultimately, when a provider says you need to go to the ER to make sure that you know your situation is taken care of, that’s what you have to do. 

Rovner: Andrew Jones, thank you very much. 

Jones: Julie, thank you. 

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 links in our show notes on your phone or other mobile device. Jessie, why don’t you go first this week? 

Hellmann: My extra credit is from Nature. It’s titled “.” They [Max Kozlov, Alexandra Witze, and Dan Garisto] did an analysis showing that more than 100 independent advisory panels have been terminated. These are panels that advise agencies on biomedical environmental policy and other types of health policy. They’re typically staffed by researchers and other experts from outside of the government. And now so many of these groups are being canceled, there’s concern that this could result in less transparency and more of agencies making decisions within their own ranks. And then they also found that groups that are still in existence are meeting less and less. They’re not issuing public reports. An example of this that we all know about is the Advisory Committee on Immunization Practices, which is tied up in a big legal dispute right now. And the White House defended all of this, is saying that these panels are a waste of taxpayer dollars that don’t meaningfully inform policymaking. So I thought that was a good read on something that doesn’t get a ton of attention. 

Rovner: Yeah. Well&苍产蝉辫;鈥�&苍产蝉辫;of course, these panels are intended to bring in the public to make public policy. That’s kind of why they’re there. They’ve always been sort of a bipartisan thing. Anyway, really interesting story. Sandhya. 

Raman: So my extra credit is from The Cut, and it’s called “,” and it’s by Juno DeMelo. And this was a story that, you know, they talked to a lot of pediatricians about how their jobs have changed given the increasing vaccine skepticism. And some of these pediatricians are talking about having to really sell to their patients and their families why pediatric vaccines are necessary, or just devoting a lot more time, having a longer appointment just to explain why this is necessary. Sometimes it takes multiple appointments, which is just different with what they’ve had to do from the past. And, you know, the fatigue from having to go into all the science, instead of just presuming the child will get the vaccine and being able to discuss other things 鈥� safety and signs to watch and growth, and all of that. And so I think it was a good look at some of the things that drilled down on that. 

Rovner: Yeah, it was. These policy changes have impacts way down the line. Shefali. 

Luthra: My story is from ProPublica. It is by Duaa Eldeib. The headline is “.” It’s about families opting out of vitamin K shots, which are useful for blood clotting for newborns, and babies dying. And I think the story is remarkable for several reasons. It’s really got remarkable examples, and we see who these children are who are dying. We know how old they are, we know the color of their hair. We know what their symptoms were and what happened to them. There isn’t government data tracking vitamin K shots and whether they are rejected, but the story does a really good job painting a picture anyway. It has interviews with hospitals who have seen more and more parents saying we don’t want this because we are concerned. And it contextualizes this within the rising anti-establishment approach to medicine, more skepticism around well-researched and appropriate interventions. There is data showing how many children die from this spontaneous bleeding that can often happen if you’re deficient in vitamin K. And together, it uses those different points to create a picture of a troubling and avoidable public health trend that’s resulting in kids dying. 

Rovner: Yeah, more fallout from the anti-vax movement. My extra credit this week is from my 麻豆女优 Health News colleague Stephanie Armour, and it’s called “HHS’ Healthy Food Agenda Puts Hospitals on Notice About Patients’ Meals.” It’s a story about something that we’ve talked about before in the podcast, the new HHS policy that threatens hospitals’ Medicare and Medicaid reimbursement for facilities that don’t conform to last year’s new dietary guidelines. But there’s some pretty vivid detail here about how those guidelines actually fail to address the needs of many hospitalized patients who may be limited in their ability to eat or drink and might actually need Jell-O or ginger ale or Ensure, all of which are now at least theoretically banned. And the administration is also asking patients to report hospitals that are violating the new rules. Again, another thing that was not on my 2026 bingo card. 

All right, 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 鈥� 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 . Sandhya, where are you hanging these days? 

Raman: I’m on  and on  @SandhyaWrites. 

Rovner: Jessie. 

Hellmann:  on  and  and also on . 

Rovner: Shefali. 

Luthra: 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.] 

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. As always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, April 30. 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: Rachel Roubein of The Washington Post. 

Rachel Roubein: Happy to be here.  

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

Joanne Kenen: Hi, everybody.  

Rovner: No interview this week, but lots of news. So let’s dive right in. I want to start with politics this week. The House Ways and Means Committee held a kind of remarkable hearing with some large hospital chain CEOs, at which members from both parties took great public umbrage at hospital pricing practices. The headline on the Ways and Means GOP chair Jason Smith’s opening statement was, quote, “,” and that was among the milder charges that he and other committee members lobbed at the witnesses. Yet Ways and Means members have been talking about things like site-neutral payments for Medicare and reining in the 340B Drug Pricing Program for literally years now without actually doing anything about them. Was this all just for show? Or might we actually see some action on hospital pricing this year?  

Kenen: They did take a bite at this, about the site-neutral payments, in a limited 鈥� on certain things. I looked it up last night because I figured Julie would know it by heart but I couldn’t remember. It was 2015. So they did a little bit of it, and they 鈥� it was bipartisan. And they did not solve the problem. They sort of nibbled around the edges. Consolidation of hospitals and acquisition of physician practices, etc., have intensified in the last decade. So there is a bipartisan willingness to nibble. We don’t know if there’s a bipartisan or even either side really having the stick-to-itness to get something done. I wasn’t in that room. Some of you may have been on the Hill more than I get there. I don’t feel that action is imminent, but I do think that the conversation is returning to hospitals in a way we haven’t seen it for a while. And hospitals are a lot of money.  

Rovner: That was my point is that hospitals are where the money is in healthcare. Rachel, you wanted to add something.  

Roubein: Oh yeah, and we saw in Trump 1 [President Donald Trump’s first term] some efforts around site-neutral at the Centers for Medicare & Medicaid Services. But just sort of politically speaking, why the rhetoric is interesting, it used to historically be a little harder for lawmakers to take aim at their friendly neighborhood hospital. They’re major employers in their districts, particularly rural areas, and they also support lawmakers. 

Rovner: Yes, and I would say for those who don’t follow this as weedily as we do, site-neutral payment is when hospitals who own outpatient clinics charge more for the same service in the hospital than they do in the clinic. The art justification is, Well, we have to help support the rest of the hospital facility, so we have to charge more. And this has been a point of contention for some time. 

Kenen: But that playing field has changed. So it’s more, there are more of them now than there were when there were more independent medical practices and more independently owned, either small chains or non-chain hospitals. The whole hospital industry has changed. And if I can add just one other quick fact why, I think politically, the targets have been insurers and drug companies, right? And that’s what the conversation’s been about for quite 鈥� the dominant conversation. And I think it’s because insurance prices are really high, and they go up every year, and you see it in your paycheck week after week. And drugs, most of us do go to a pharmacy or have a mail order. So many of us are confronted with paying out-of-pocket for a drug, and people who don’t have great insurance might pay a lot out-of-pocket for a drug, or they’re on a drug that’s not in their formulary, etc. It can be confusing. Most of us in any given year are not in a hospital. And sometimes, when we are in a hospital, we’re grateful for it. It’s not that everybody gets perfect care and there are no bad outcomes. Of course, there are. But if the hospital I gave birth at saved my kid, I’m grateful for that. And it was a long time ago. Eighth grade wasn’t so great, but the rest of his life is right. So we have a different relationship in terms of how we interact and how often we interact with our hospitals. 

Rovner: So building on that one hint of why Republicans might be feeling freer to criticize hospitals 鈥� who have long been, as Rachel points out, the most protected of all the healthcare stakeholders in Washington 鈥� came from . Quoting 麻豆女优 President and CEO Drew Altman’s , which I will link to, quote: “What jumped out from the poll is the value voters place on villainizing health care’s big interests now. It’s like serving up a big fat slow curveball for every candidate to hit.” Putting on my cynical hat, maybe the message that politicians are taking here is to talk a big game on healthcare but don’t do things that will actually impact negatively the people who fund your campaigns. In other words, it is all for show and they’re not planning on doing it. 

Luthra: That’s kind of the interesting question, right? I was thinking a lot this morning about the really great  in The [New York] Times that Margot Sanger-Katz and Sarah Kliff wrote, and one of the points that they make is there’s less political pressure when people aren’t seeing firsthand the consequences for reform. And so if there isn’t really vocal outcry from consumers directly at hospitals as an institution, where does that political pressure come from? I don’t know that we have an answer that suggests it would be strong enough to outweigh what an important interest hospitals are. 

Rovner: Yeah. I want it noted that, in addition to going after Big Insurance and Big Pharma, members of Congress are now going after Big Hospital, which, as Joanne points out, is pretty rare. We will see if anything comes of it. 

Well, one of the reasons that healthcare is such a hard subject to, you know, legislate on is that there are almost always unintended consequences. Lawmakers want to give people stuff, and they want to give healthcare providers stuff, but they don’t want to figure out how to pay for it or who should pay for it. Case in point 鈥� those very popular weight loss drugs known as GLP-1s. The Trump administration last year announced a deal that would make the drugs made by Eli Lilly and Novo Nordisk 鈥� those are the two big makers of these popular drugs 鈥� would make those drugs available through a Medicare pilot program provided by insurers. But even with the drugmakers agreeing to dramatically slash the drugs’ prices, insurers have balked at the added cost, causing the pilot to be canceled. Now, Medicare plans to pay for the drugs itself, apparently, at least temporarily. But of course, that’s going to pile new costs on a program that itself is not financially stable, and run the risk of doing to Medicare what many employers are doing to their workers, cutting off coverage for these drugs after they’ve already started it. There’s no easy solution to giving people new, modern, even working technologies that are expensive, right? 

Kenen: As more and more research about the potential benefits of these drugs 鈥� and also they are still relatively new. We could be having a whole different conversation about long-term use in a few years. But right now, one finding after another shows that it’s not just weight loss and diabetes, that there may be a lot of other benefits which still have to be studied or understood better, and who would benefit, and all those questions for the scientists. But these could be, end up being as common as statins down the road, and very expensive. So then the question is: Who gets the savings? Is it going to be worth it if Medicare pays for the drugs and ends up with fewer hospitalizations for advanced diabetes complications and amputations and kidney failure and all the terrible things that can come from advanced, uncontrolled diabetes? Is an insurer 鈥� insurers don’t like to always pay long-term. They don’t like to spend something tomorrow where the benefits may be 10 years down the road, because that person might not be your customer anymore in 10 years. So you’re investing in their long-term health, but they’re gonna be paying their premiums to your competitor in 10 or 20 or 30 years. So I just see this is getting more and more and more expensive, or at least the demand, the more and more people. How are we defining 鈥� diabetes has a clinical definition, but obesity is a little fudgier, right? No pun intended. 

Rovner: Two points. One is that the one thing we know about prevention and people who are not children is that it doesn’t pay for itself. So if you keep these people from dying from their diabetes complications and other complications of obesity, they’re going to live longer and eventually are going to die of something else, and that’s going to be expensive. So probably not a savings from CBO’s [the Congressional Budget Office’s] point of view. But the other thing is that other countries aren’t having this issue, because they have price controls on drugs, and we don’t. And try as hard as President Trump seems to be doing to piggyback off of other countries’ price controls, at some point 鈥� and I guess this harkens back to the hospital conversation 鈥� at some point Congress, the president, could just bite the bullet and say: Hey, we’re not going to let you charge 鈥� we’re not going to buy your drugs if you’re going to charge this much. So charge us less. I don’t see that anytime soon, but it is a possibility, yes? 

Luthra: Certainly. And I think one thing we’re not thinking about as well is what happens 鈥� right? 鈥� when people have had access to these drugs and then suddenly they are no longer covered. And with GLP-1s in particular, it’s actually kind of complicated and fascinating, because we are seeing all of these compounding pharmacies, some 鈥� right? 鈥� more in compliance with regulations than others, developing knockoffs. And people, I’ve talked a lot of them, will just go to those places instead, buy those products at a price they can afford, but the safety, the quality, may or may not be guaranteed. And there’s just a very large conversation that we’re not having about all of these consequences and trade-offs that we can’t quantify, by nature of us kicking the can down the road on dealing with the pricing problem. 

Rovner: Yeah, there’s a lot of PhD theses that are going to come out of this. There are just so many tentacles of it to study. And Joanne’s right. We don’t know. 

Kenen: Right. Particularly, to combine PhDs. The sweet spot is going to be like an AI analysis of GLP spending, or some 20 years out or whatever. That’s going to be what all the PhD theses are. 

Rovner: Yes, well, going from insoluble problems, most of what we talk about is kind of by necessity, bad news or divisive news. So this week I wanted to highlight an actual good-news story in health policy. According to  in the Journal of the American Medical Association, youth suicides have dropped markedly in the two years following the implementation of the 988 suicide prevention hotline. And while it’s hard to attribute all of the improvement to the hotline’s existence, the researchers were able to tease out that suicides decreased most in states with higher volumes of answered 988 calls and that suicides didn’t change much in peer countries that didn’t implement a hotline, like in England. And even more good news, while the Trump administration ended a specific part of the program that was aimed at helping LGBTQ+ callers last year, HHS [Department of Health and Human Services] Secretary Robert F. Kennedy Jr. testified during his marathon of hearings last week that the department would reinstate that option. Now all of this was the result of a bipartisan push in Congress over several years. What are the chances that seeing something good come from working together might prompt more cooperation that things, that lawmakers might agree on? This is my non-cynic hat. 

Kenen: Maybe in an alternative universe. 

Rovner: Go head, Rachel. 

Roubein: I thought this was interesting, because, as you said, this was something that was rolled out with bipartisan support in 2022. And it came off of the heels of the pandemic, which really exposed issues with youth mental health. I remember writing about the time this number was replacing a 10-digit hotline number, and advocates, etc., weren’t sure how much people would know about it, how received it would be from that standpoint, because you really had to get the message out that this was out there. So I thought that these numbers a few years later were pretty striking. 

Rovner: Yeah, I thought it was striking how fast that we were able to sort of see a difference. 

Kenen: But also there’s a history going back at least 10-ish, and probably longer, years on mental health. There’s bipartisanship. There have been a number of bills, both on opioids and substance abuse and mental health in general, not just for kids. There’s several over, in recent years, about mobile clinics and just spending more money. And this is great news, right? It’s good. And I think it helps in this area. Like by, can you work on some youth issues? Or could you work on some, continue working in a bipartisan basis on mental health issues? Because this country has a lot of mental health challenges. So I think a success makes that lane broader and better lit, but I don’t think it necessarily spills over to fixing all the 800,000 other problems stacked up in Congress. But it’s good. It’s obvious, I think, not just good news but I also think it’s good news for moving ahead and doing something else good. 

Rovner: Yeah, I would say it’s good news on its own, but it’s also potentially good news on the Let’s make other policy and fix other problems in the healthcare system. All right, we’re going to take a quick break. We will be right back. 

OK, we are back 鈥� and back to divisive stuff. The Supreme Court on Monday heard arguments in a case surrounding glyphosate. That’s the pesticide sold under the brand name Roundup, which Make America Healthy Again supporters and many scientists say causes, or at least contributes to, multiple types of cancers, and which the U.S. Environmental Protection Agency has determined is not carcinogenic. The case at issue concerns whether or not the maker of Roundup, Monsanto, should have included a warning label on its packaging. I’m less interested in the details of the case here, which involve whether states have the right to require labeling that the EPA does not, than the split it’s causing in the MAHA movement as the Trump administration backs the EPA’s finding that glyphosate is not carcinogenic, which MAHA supporters find to be a complete betrayal of their cause. Does this potentially have as much political oomph as the dispute over vaccines? Certainly not helping the MAHA movement be happy with the Trump administration. 

Roubein: This has definitely opened fissures between the Make America Healthy Again movement and the Trump administration. On top of that, I think one of the things that people in the MAHA movement were particularly upset about was Trump’s executive order earlier this year to boost domestic manufacturing of glyphosate. But at the same time, we have seen the Trump administration try and make nice with some MAHA leaders, inviting them to the White House. Some of them even spoke to Trump a little bit. So you’re kind of seeing that kind of divide here with the administration also trying to placate as well. 

Rovner: Yeah, this is sort of a fascinating political alliance that they’re on the one hand trying to protect and on the other hand trying to not allow, particularly when it comes to things like vaccines, not let it alienate people who are outside the movement, which as we have seen has turned out to be an extremely delicate dance. 

Luthra: And we’ve talked about this before, but I think one thing we still don’t really know is just how amorphous vs. cohesive MAHA as a movement is, and also its political potency. And there are Senate primaries that are good tests of this, [Sen.] Bill Cassidy an obvious one, given his vote on RFK and his stance on vaccines broadly. But we are still many months out from knowing if Trump alienating MAHA, if Republican institutions alienating parts of the MAHA movement, actually matters. Clearly a lot of Democrats think it might. That’s why we’re seeing so many of them court this constituency. But, yeah, I just think we really need to get a better sense as to how much of this is an influence that has been maybe a little bit hyped up, even by us in the press, and how much of it is actually substantial and influential. 

Rovner: Yeah, we know that the anti-abortion movement is powerful and turns out their voters, and when they make endorsements, when they get behind somebody or when they go against somebody, they have the money and the power and the clout and the vote to back that up. We don’t really know that yet about MAHA. I think that’s a really fair point. Joanne you wanted to add something? 

Kenen: No I think we don’t know as much. I think that the Trump people think they’re voters and that they think they helped them in 2024. But MAHA, I agree with what both of you just said. It’s amorphous. There are people whose primary issue is vaccines, and that’s how many of us think of MAHA, but it is also about healthy food. And some things that people could find common ground are the pesticides, the chemicals. Those are things that actually had been identified more with Democratic causes or Democratic voters in the past, those, some of the environmental issues. But I think, Julie, the question you asked is right. It’s a political force, but is it a political force that’s gonna gain power or just sort of dissipate? And there’s so many other things right now changing the politics of the country. I don’t think we could possibly know, even if you took a terrific poll today and found out they were mad. We have a pretty short news cycle. 

Rovner: Yeah, we do. We’ll see. All right. Well, meanwhile, elsewhere in the Trump administration, scientific retribution continues apace. The Justice Department this week announced the indictment of a former aide to Dr. Anthony Fauci for using his personal devices and email addresses to skirt public record laws and keep official communications private. Now this isn’t really news. The scientist, named David Morens, testified before a House hearing in 2024 and basically admitted what he did. So the question here is whether this criminal indictment is the beginning of a new effort to publicly punish those who the Trump administration accuse of unspecified wrongdoing regarding their handling of the covid pandemic. I would note that this week, obviously, we also got the indictment, again, of former FBI director Jim Comey. It’s not clear how much of this is the Justice Department trying to please President Trump and how much is sort of a new effort on this scientific front. 

Luthra: That’s such a good question. 

Rovner: Thank you. 

Luthra: No, I just, I think you’re right. It’s just not clear, because the acting attorney general hasn’t been in his role for very long. We know one of the reasons he has this job is because of dissatisfaction with how Pam Bondi approached the president’s goal of going after political opponents and targets. And so maybe, in a way, the why of it doesn’t matter if it creates a perception that this war on science is, in fact, renewed or accelerated or regaining steam in some way. If that’s how people feel and what the consequences look like, then there’s obviously a chilling effect that could be even greater than what we’ve already seen. 

Rovner: Yeah, and I would point out, it is a crime to use your personal devices to avoid public records laws. It is pretty common, but the actual indictment came so long after this. And is this the beginning of a series of, We’re gonna go punish the people who we think wronged us during the pandemic using whatever power we can find, or is this a one-off? And I guess we’ll have to see. 

Kenen: But I think he was sort of easy pickings because he had publicly admitted it. It’s up to the courts to decide if he’s guilty of an actual crime or just not following the rules. That’s not our decision. But it’s also, he was an easy target because he had admitted it, but he had also 鈥� it’s a sore spot. It’s the China lab thing. It’s not just some study or something to do with covid. It was very specifically, there are people who believe it was engineered and a lab leak that鈥� 

Rovner: Oh, yeah, this clearly feeds into that. Right? 

Kenen: Into that conspiracy theory, which is unproven, and we may never know the full story of how covid emerged, but that’s a political button for a certain segment of Trump supporters. 

Rovner: Well, the administration’s ideologic purge continues as well. Late last week, the president fired all 22 members of the advisory board for the National Science Foundation. Now, the National Science Board is a bipartisan group that has advised the NSF since 1950. It is hardly full of political firebrands. Also this week, the Substance Abuse and Mental Health [Services] Administration announced it would no longer pay for test strips to see if drugs are adulterated with fentanyl or other potentially deadly substances, because it “facilitates,” air quotes, illegal drug use. Now there is a long and lively debate about whether such harm reduction policies protect lives or encourage illegal drug users to continue to use drugs, or both. But it does look kind of weird the week after the administration sought to loosen restrictions on both marijuana and hallucinogens. Yes? 

It doesn’t feel very consistent. Let’s put it that way. Though on the one hand, No more harm reduction, but we’re going to make it easier for you to use LSD and marijuana, because Joe Rogan thinks that it can help you with PTSD]. Which maybe it can 鈥� I’m not suggesting that was a wrong decision. I’m just suggesting that it does not look very consistent on a policy level. 

Kenen: That’s a good word, Julie. 

Luthra: No. You’re right, I think, to highlight the Joe Rogan maybe not manosphere but podcast-adjacent world where obviously you are trying to appeal to a very specific demographic by loosening regulations on marijuana or LSD in particular. And maybe it’s as simple as a lot of the party drug stimulants don’t fit into that demographic, at the risk of being incredibly reductive, like cocaine is associated with Brat summer. Brat summer is not 鈥� right? 鈥� the Joe Rogan-adjacent cultural force. I don’t know, maybe there’s something to there that this doesn’t fit into that same policy category because of who is seen as the people who end up sort of fitting into these different drug areas. 

Rovner: It does feel sort of overtly political, though, that going after particular groups of people who might or might not support you. Not that every, obviously, every administration is overtly political in some ways. They want to help the people who support them and not help the people who don’t support them. This just feels much more picking and choosing audiences. 

Kenen: I think you’re right, and it’s also a shift. I think that the country made a lot of progress in, again, that bipartisan mental health push we were talking about a few minutes ago. There was a greater understanding that addiction is a disease 鈥� there’s a criminal element, it’s an illegal drug, and there’s bad people involved in that market, obviously 鈥� but that this is not entirely a criminal justice issue. This is also a mental health and health issue, and that people need treatment. So we did sort of, not 100%, but we got much better at thinking about that. Chris Christie was one of the first appointees that Trump made in his first term on that initial opioid commission who really pressed that message. And this just seems to be a sort of demographic and class for subsectors of the population, who’s the Silicon Valley people who are into psychedelics vs. who’s using quote-unquote “street” drugs. So we’ll just have to see how this plays out. 

Roubein: Oh, I think with fentanyl strips, specifically, we’ve seen sort of a ping-pong with administrations, too. With, you’re talking about the politics, like Elinore McCance Katz, under Trump 1, who was the head of SAMHSA, opposed this. And then the Biden administration came in, and they had their drug strategy, which leaned heavily into harm reduction, which, as you mentioned duly, has been political. 

Rovner: Going back to needle exchanges in the early 2000s. It’s always been: Do you want to make it safer? And if you do make it safer, does that deter people from stopping using illegal drugs? That’s sort of the age-old debate about harm reduction. But you also don’t want when we had the overdose crisis, particularly when fentanyl first came on the scene. Do you really want people dying of fentanyl when they could have a test strip that costs a dollar and find out it’s, like: Ooh, this thing has been cut with fentanyl. Maybe I shouldn’t take it.  

Kenen: Right. Because if your goal is to get people into treatment and off of drugs, you can’t do that once they’re dead. 

Rovner: That is very true. All right. Finally, this week, there is vaccine news, because there is always vaccine news these days. The decision by the Department of Health and Human Services to drop the recommendation for the birth dose of the vaccine to protect against hepatitis B could result in hundreds of cases of the disease that could have been prevented and millions of dollars in additional healthcare costs to treat liver cancer and other complications. That’s according to   in this week’s JAMA Pediatrics journal. That’s partly because not every pregnant woman gets tested before giving birth, and also because there are other ways infants can contract the virus, that people keep saying, Oh, it’s only sexually transmitted. It’s not only sexually transmitted. There is such a thing as household transmission. I don’t suppose this study is going to change anybody’s mind who wanted the change on the hepatitis B vaccine in the first place, though, will it? 

Roubein: I think we’ve seen people in their camps on this one. The medical establishment, even some Republicans, Sen. Cassidy, etc., had been upset about this decision. 

Rovner: Yes, Sen. Cassidy, who is a liver specialist and is particularly unhappy with this decision, and yet, you know, science. So we will see if this also plays out. 

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. Shefali, why don’t you start us off this week? 

Luthra: Mine is from The Atlantic and 麻豆女优 Health News by the wonderful Elisabeth Rosenthal. The headline is “.” And I would very much say that you should read this in installments, because it is very, very difficult to get through. It’s about how her husband died in the emergency room, and just the quality of care that he got, and for how long he was just boarded and 鈥� right? 鈥� kept without really getting the appropriate care, and how they knew that this was going to happen, because it had happened so many times and they’d gone to the ER. And she uses her experience as a journalist to also highlight how the problem of boarding has actually gotten a lot worse, which I didn’t realize, and we’ve all known for a long time that boarding is terrible, and being in the emergency department is actually really bad for you a lot of the time, even though it’s supposed to be a place for people in the midst of health crises. And I think there’s just a really effective blend of what her family’s story is and what the policy problems are. And 鈥� right? 鈥� by the end she realizes the only way to get appropriate care for her husband is to call somebody who she knows and see if they can get special treatment, which it just kind of is the way it is, I think, in a lot of these emergency departments. And I hope that when people read this and think about the experiences of their loved ones getting emergency care, they bring us to something where actually we can fix this. Because it feels like it’s something that, speaking of things that are easy to fix, everyone should want to. 

Rovner: Yeah, absolutely. It is quite the story. Rachel. 

Roubein: My extra credit this week, the headline is “Big Companies Position Themselves for Payday From $50B Federal Rural Health Fund,” by 麻豆女优 Health News’ Sarah Jane Tribble. She writes about the $50 billion pot of money Congress earmarked for rural healthcare in America, which came amid Trump’s One Big Beautiful Bill last summer, which also cut money to Medicaid. And Sarah, she writes about the tussle to get funds, which is kind of a persistent problem that we see in healthcare, and how small community healthcare providers may find they are sharing the billions with, as she called it, “an army of corporate giants before it reaches their patients.” And she talks about sort of a lack of digital infrastructure, which is generally an issue at rural hospitals, but how some state plans showed that a “heavy dose” of spending will go to companies that “increase the use of electronic health records, strengthen cybersecurity, and improve state and health system technology platforms.” I liked the story because I think it’s really interesting to see this fight over how to get funding for your healthcare system. 

Rovner: And making the point that they’re taking money away from everybody. And they say they’re giving back. First of all, they’re taking a trillion, $900 billion out and giving $50 billion back, so it doesn’t make up for the cuts. But also that the money that they’re giving back isn’t going to the places where they’re doing the cutting, which I think is sort of the broader point. Sorry. Go ahead. Joanne. 

Kenen: This is from ProPublica, by Anna Clark: “.” Basically, there’s now a new thread of disinformation that solar power is bad for us, not the power but that the process of capturing the sun’s power, that radiation is blocking things, and the noise, that there’s sort of, quote, “visual pollution.” So anyway, it’s interfering with the growth of, the spread of solar power in Michigan, which is one of the states that had been sort of 鈥� pretty far north and pretty cold 鈥� I hadn’t realized it was one of the targeted states for a big push for solar energy, but it is. We’ve seen health disinformation about pretty much everything, and the latest is the sun. 

Rovner: Yeah, really interesting story. My extra credit this week is from The New York Times, by Christina Jewett and Benjamin Mueller, and it’s called “.” The aide in question, Calley Means, is the brother of the wellness influencer nominated to serve as surgeon general, Casey Means. And now Calley Means is a full-time regular employee in the federal government. But for most of last year, when he was advising HHS Secretary Kennedy as a, quote, “special government employee,” he also continued to hold a large stake in the health company Truemed, which profits from people using money in their health savings accounts to pay for medical expenses insurance doesn’t cover. According to the story, that includes things like $10,000 saunas and radiation-blocking underwear. And health savings accounts were dramatically expanded last year in the Republican budget bill. Now, Calley Means says he didn’t work on HSA policy, but it’s hard to ignore just all the appearances of conflicts in this administration. And just because there are so many of them, shouldn’t really normalize it. So this has been really good shoe leather reporting here. 

OK, that is this week’s show. Before we go, some well-deserved kudos to some of our podcast panelists. [Bloomberg’s] Anna Edney has been named a winner of the annual NIHCM [National Institute for Health Care Management] health awards for her work on  about the high cost and often limited benefit of new cancer drugs, and [The Washington Post’s] Lauren Weber and our own Shefali Luthra here have been named finalists for the University of Michigan’s Livingston Award for young journalists, along with 麻豆女优 Health News’ Aneri Pattani. I’m not kidding when I say we let you hear from the best and smartest reporters covering healthcare. 

As always, thanks to our editor this week, Stephanie Stapleton, and our producer-engineer, Francis Yang. 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? Joanne. 

Kenen: On  and . 

Rovner: Rachel. 

Roubein: On X, . Bluesky, . 

Rovner: Shefali. 

Luthra: On Bluesky, . 

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

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

Julie Rovner: 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, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, April 23, 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 Sheryl Gay Stolberg of The New York Times. 

Sheryl Gay Stolberg: Hi, Julie. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: And we welcome back to the podcast my former 麻豆女优 Health News colleague Victoria Knight, now at Bloomberg. 

Victoria Knight: Hi, everyone. Happy to be back. 

Rovner: Later in this episode, we’ll have the latest installment of our “How Would You Fix It?” series. This week with David Blumenthal, a physician, health policy expert, author, and former Obama administration official. He literally wrote the book on the history of presidents and health reform through George W. Bush, and he has a brand-new book on the last three presidents and their health care policies. But first, this week’s news.  

So, Health and Human Services Secretary Robert F Kennedy Jr. on Wednesday completed his tour of Capitol Hill, having appeared before seven separate House and Senate committees in four days of hearings. Ostensibly, Kennedy’s appearances were to answer questions about President [Donald] Trump’s budget proposal for the Department of Health and Human Services. But, as usual, there were lots of other topics as well, as this was the first time the secretary appeared before some of these panels, and the first time some of these members of Congress got to question him in person ever. Victoria, you sat through all of the hearings, right? Or at least all the hearings this week. What was your big takeaway? I guess, not as many fireworks as some of us might have been expecting? 

Knight: Yeah, definitely not as many fireworks. I mean, I think that it’s pretty clear Kennedy has gotten a mandate in some way from the administration to watch his rhetoric, basically, especially his vaccine rhetoric. And we even, at Bloomberg, we’ve had reporting directly saying that he’s&苍产蝉辫;鈥�&苍产蝉辫;there’s an internal memo that said, you know, he’d keep his messaging on chronic diseases and nutrition and health care affordability, you know, more palatable topics. So I think he definitely tried to stick to that messaging. But there were points where the Kennedy that has for years been anti-vaccine came back through. And so we saw that in certain lines of questioning. And also he really wasn’t able to justify the cuts. He was there on the Hill to testify about the HHS budget, which President Trump proposed putting in still significant cuts to HHS. It wasn’t as deep as proposed last year. But there wasn’t really any good justification that Kennedy provided, except that the U.S. is in a lot of debt, and they need to, we need to reduce it. But he kept being, like, The programs are still good. We need to do these programs.  

Rovner: I’m amused, because this, you know, goes back forever of when Cabinet secretaries come up to justify cuts to their departments that they clearly don’t want to make, and they’re not allowed to say, But it wasn’t my idea.  

Knight: Well, and also that they know Congress will reject it. And so it’s, it’s kind of all fake anyways. All these congressional appropriators are like, Yeah, this is not happening. 

Rovner: Yeah. Hence the reason why they get to talk about other things. I will say one thing that I noticed is that he was less rude to these committees than he had been in previous appearances on Capitol Hill.  

Stolberg: Really? 

Rovner: Yeah.  

Stolberg: I sat through all seven of them. Julie. I thought he was pretty rude. 

Rovner: I guess it’s all in how you look at it. I thought he wasn’t. Yes, he was definitely still rude, but I really thought there were times when he had now sort of taken the briefing that you get, which is to try and agree with something that a member of Congress says, and says, I will work with you, which he hasn’t done before. He’d just been combative before.  

Stolberg: That maybe is true, but he has a habit of addressing members of Congress by their first name, which is a serious violation of protocol. And he was rebuked in the House last week for doing that with Frank Pallone, the Democrat of New Jersey. He did apologize for that, which I thought was interesting. But that did not stop him from also accusing senators of, Democrats, of making stuff up, grandstanding, and, you know, fake indignation. And, you know, he yells at them. And then at one point, Diana Harshbarger, the Republican in the House that was chairing the committee, said to him, she just said, I think it’d be best if everybody would just simmer down.  

Rovner: Yeah, there were definitely moments.  

Stolberg: And I would add to what Alice [Victoria] said, I do think that the big takeaway was that vaccines really still dominate his tenure. That is the defining issue of his tenure. [Sen. Bill] Cassidy yesterday was very pointed in correcting Kennedy when Kennedy cited a study that he said showed that advances in or reductions in deaths from an infectious disease were largely due to hygiene and sanitation, which is actually true in the first half of the 20th century, before vaccines were introduced. And the second line in that study, which Kennedy did not cite, was that, you know, vaccines had made an incredible difference and were extremely important. And Cassidy had somebody look up that study in the middle of the hearing and came back to Kennedy and said, This is what you didn’t say. You took it out of context.  

Rovner: Yeah, I was actually very impressed, because first Cassidy couldn’t find the study, and then&苍产蝉辫;鈥�&苍产蝉辫;

Stolberg: I knew the study because I had cited it before. 

Rovner: I had a feeling you probably knew it. I was trying to find it, and I couldn’t find it. So I was glad that they did.  

Stolberg: It’s in the Journal of Pediatrics in 2000 by an author named Guyer, not David Geier, but G-U-Y-E-R. You can look it up.  

Rovner: We could. I will  in the show notes. OK. 

Knight: I did want to mention also, I do think Cassidy did press Kennedy on vaccines. Certainly, everyone was watching that very closely because of his hesitation last year to vote for Kennedy, and really talking about struggling with the vote, and extracting all these commitments from Kennedy, ostensibly to vote for him, for HHS secretary. Cassidy did not mention any of those, like Kennedy violating any of those commitments, which he clearly has. He was supposed to be in frequent contact with the HELP [Health, Education, Labor & Pensions Committee] chair, go up to the Hill quarterly. He hadn’t been to the 鈥� Kennedy had not been to the Hill since September. In some of the committees, he hadn’t been there since last year, the last budget proposal. So Cassidy also did not mention these childhood vaccine recommendation overhaul that Kennedy did, which is a huge deal. And he did not mention the Advisory Committee on Immunization Practices being completely overhauled as well, and all those members being fired, which are two things Cassidy said he extracted commitments from Kennedy on. So I just want to make that point. Yes. 

Stolberg: One quick on that. After the hearing, I asked Cassidy, “Do you think Kennedy has lived up to his promises to you?” And he looked at me and he said, “We’ll talk later.” 

Rovner: I would say, Alice, you wrote a separate story about the fix in which Chairman Cassidy finds himself. He’s being challenged in a primary by a Republican congresswoman endorsed by the Make America Healthy Again PAC. I thought Cassidy was actually more restrained than I expected him to be in yesterday’s hearings. Although I think I guess it was our colleagues at The [Washington] Post who thought he was pretty combative. I mean, what did you take away from the Cassidy-Kennedy relationship? 

Ollstein: Yeah, definitely. I mean, one thing I noticed with both Cassidy and a few other Republicans is one of the few topics where they feel comfortable really going after Kennedy and the Trump administration more broadly is abortion. They think that the administration has not done enough to restrict access to abortion pills, and so they felt more comfortable hammering Kennedy on that issue. You saw Cassidy do that. You saw [Sen. Steve] Daines and a couple of other very anti-abortion senators raise that. And I think that’s an area where they feel like they’re more aligned with the sort of activist GOP base than the administration is. And so whatever blowback they would get for questioning the administration is outweighed by their anti-abortion bona fides. So&苍产蝉辫;鈥�&苍产蝉辫;

Rovner: Although I would say, I will interrupt before you finish and say I thought it was interesting that the members kept doing that because I thought most of it was for show, because we knew early on, because he’s been to all of these committees, that Kennedy was not going to talk about the FDA study on the abortion pill because there’s pending litigation, which is an easy out. But they made, they all made their little speeches, and they knew exactly what he was going to say.  

Ollstein: Oh, absolutely, absolutely. I mean, they want to be seen fighting on the issue, for sure. I’ve talked to a lot of anti-abortion activists who say, you know, Look, the Trump administration keeps saying we got to go through the process with the study. We got to go through the process with the courts. We got to check all the boxes. And the anti-abortion activists point out, you know 鈥� correctly, I think 鈥� that the administration has been very willing to break with protocol, and even, you know, legal procedure on a bunch of other issues, and they’re saying&苍产蝉辫;鈥�&苍产蝉辫;

Rovner: Which we’ll get to in a moment.  

Ollstein: 鈥�&苍产蝉辫;Why not us? Why are they so careful when it comes to our issue when, clearly, they do whatever they want on other issues? And so, I mean, that is a fair point, and I think it’s going to be a continuing frustration. The  is the influence of the Make America Healthy Again, MAHA, as a political force. We’re going to really get a key test of that in Cassidy’s primary that’s coming up in just a few weeks. MAHA has put a big target on him and wants to knock him out. And my colleague and I took a really critical look at their influence in the race, and it’s sort of not living up to the hype, I would say. MAHA is not making a big impact financially in the race, and they are not making a big impact, really, in messaging. They haven’t succeeded in putting MAHA issues 鈥� like vaccines, like healthy food, chemicals in the environment 鈥� they haven’t made those the top issues in this race. It’s sort of the same bread-and-butter, cost-of-living Republican red meat stuff that you’re seeing in other states. And so, I think, you know, we talked to a lot of people, you know, close to the situation, who said, even if Cassidy loses, it’s not going to be because of MAHA. And so I don’t know if that makes him more willing to tangle with RFK in these hearings or not.  

Rovner: I did think, I thought that it was politics that made him lead with abortion, though, because he&苍产蝉辫;鈥�&苍产蝉辫;I mean, Louisiana, as we know, is one of the most anti-abortion of all the anti-abortion states. He’s been a longtime anti-abortion crusader. This is not a new position for him, and he’s got this primary, so he would like to bring out his supporters. I mean&苍产蝉辫;鈥�&苍产蝉辫;I saw that. It’s like, oh, aha, politically, that makes sense, even though he knew that Kennedy wasn’t going to respond to the question.  

Aside from the secretary’s continuing denial of the accusation that he is anti-vax, there was, in fact, considerable anti-vaccine-related news this week. First, over at the Defense Department, where Secretary Pete Hegseth has decreed that annual flu shots will no longer be required for active-duty and reserve military members. This is, according to Hegseth, “because your body, your faith, and your convictions are not negotiable.” Now, flu vaccines have routinely been given to members of the military since just after World War II for the fairly obvious reason that viral infections pass easily among people who are living together in close quarters, like, you know, members of the military. And vaccine requirements in the military, in general, date back to the Revolutionary War, when George Washington ordered troops to submit to the then fairly new smallpox vaccine. Sheryl, you’re our public health historian at the table. Has there ever been a time when the balance between personal liberty and public health has been tilted so heavily towards personal liberty as it is right now?  

Stolberg: I don’t think so. We’ve had anti-vaccine activism in the United States for as long as we’ve had vaccines. And especially at the turn of the 20th century, around the time when smallpox was kind of racing through Boston and other cities, there was a big anti-vaccine push. You might remember, in 1905, the Supreme Court ruled that states could mandate vaccination to protect the public health, and that was in a case brought by a pastor in Cambridge, Massachusetts, who didn’t want to get vaccinated for smallpox. And then we had the ’60s, when, you know, vaccines were new, and public health people were touting them, and there was a big embrace of vaccination. So it’s very interesting to see what Hegseth has done. And what came up yesterday in the HELP Committee hearing, where [Sen.] Patty Murray reminded Kennedy that during the Great Influenza of 1918, the flu was very indiscriminate, and a lot of soldiers were killed. It did not strike only young people and old people. It struck down people in the prime of their life, many, many in the military. And she said that, you know, this was an issue for readiness. And Kennedy was like, You think the flu is going to kill people? Like, the flu is not going to kill people. And it seemed obvious to me that he did not really understand that influenza is not the same all the time, that the virus mutates, and it very well could mutate into a pandemic strain. And he himself is pushing for a universal influenza vaccine, which has been kind of like the dream of public health people, so we could guard against, you know, all types of flu strains. 

Rovner: And not have to redo the vaccine every year. 

Stolberg: Right. So, in short answer to your question, I think certainly not in the last 50 or even 100 years have we seen the ascendancy of the medical freedom movement and the argument that individual liberty takes precedence over the health of the community. 

Rovner: Yeah. Alice, you wanted to add something. 

Ollstein: Yeah. I’ve also seen a lot of people pointing out that it’s not like this is an across-the-board embrace of individual liberty. I mean, if you’re in the military, you still can’t grow a beard if you’re a man, even if you have a skin condition where shaving really hurts and is bad for your skin. You don’t have the personal medical freedom to transition from male to female, or female to male. You don’t even have the personal freedom to wear what you want, to have the hairstyle you want, and so this is really just about vaccines. And, like Sheryl said, you know, really could threaten military readiness. There have been several wars in the past where more soldiers died of disease than died of violent combat impacts. So this is a very interesting carve-out that has a lot of people worried. 

Rovner: Also on the vaccine front at HHS, NIH [National Institutes of Health] Director Jay Bhattacharya, who was actually acting in his role as acting director of the Centers for Disease Control and Prevention, has reportedly canceled publication of a study that found the covid vaccine dramatically reduced hospitalizations and emergency department visits. Bhattacharya,  and The New York Times, complained that the study’s methodology was flawed. But CDC officials say not only is it the same methodology used in the past, but it’s also basically unheard of for a study approved by CDC’s own scientists not to be published in the agency’s “Morbidity and Mortality Weekly Report” once it reached the stage that this study had reached. Is there any conclusion to be drawn here? Other than that the study’s results contradict the administration’s position that the covid vaccine is not helpful.  

Stolberg: Raises a question about radical transparency, that’s for sure. Secretary Kennedy came into office promising radical transparency. This doesn’t seem radically transparent.  

Rovner: No. Kennedy keeps saying 鈥� and he said how many times during these hearings? 鈥� that he’s trying to restore trust in the science agencies. And this does not strike a lot of people as a way to restore trust when something is canceled because you don’t like the results. Victoria, did you want to add something?  

Knight: Yeah, I mean, I think that’s a great point. He just said multiple times throughout all these hearings, especially when Democrats were questioning him on vaccines, that I’m willing to look at studies, I’m willing to look at data, I’m willing to review everything, if you’re bringing up maybe things he allegedly said he had not seen before, data or whatever. So yeah, exactly this goes exactly against that. You would think if there’s a study showing something, he’d be willing to view it. If that was his philosophy. 

Rovner: We would see. All right. Well, meanwhile, President Trump continues to make his health policy out of the White House. Last Saturday, he summoned his top health officials, plus popular podcaster Joe Rogan, to the Oval Office to sign an executive order to facilitate research into and to fast-track FDA review of some previously banned psychedelic substances, including ibogaine and LSD, which are legally considered to have no medicinal uses. This is actually not all that controversial. It’s part of an ongoing push from researchers who say that some of these substances might well be useful for treating things like severe depression, PTSD, and even opioid dependence. But what made this so unusual is that it was apparently pushed to fruition in just a matter of days by a text from Joe Rogan to President Trump. So what message does this send about the so-called gold-standard science being the only thing that counts in this administration, when a podcaster with a big following that the president wants can spring loose a major policy shift in less than a week? 

Stolberg: So I have a theory about this, actually. Well, first, it is highly unusual that Trump would step in on this, right? Like it’s not the ordinary course of science that the president issues these executive orders. But Casey Means, who is President Trump’s nominee for surgeon general, has advocated the use of psilocybin, and so has Secretary Kennedy, for that matter. But this is one of the things that is kind of stalling her nomination. [Sen.] Susan Collins has raised concerns about this. I guess I just kind of wonder if Trump is trying to put his imprimatur on this research, maybe as a backhanded way to give her a boost? Or maybe I’m just too Machiavellian, and maybe it’s just that Joe Rogan texted him, and he was like, Yeah, that’s a good idea. 

Rovner: And it was, in fairness, it was already in the works. 

Stolberg: Yeah. And, I mean, there is a lot of legitimate scientific reasons to do this kind of research. 

Rovner: And, I will say, I mean, I’ve studied this, and I believe breaking just today, they’re, you know, rescheduling marijuana. Again, all of these technical changes are to make it easier to do the research. Part of the problem has been that because these substances were scheduled as having no medicinal uses, you couldn’t get them to do the research. So one of the things that this does is make it easier. To have Joe Rogan in the Oval Office on a Saturday morning struck me as, like, OK, this is a little strange. 

Knight: But isn’t that how this administration works? Right? I mean, I think that, just in general, there’s a lot of influencer types that 鈥� I would say, Joe Rogan, podcaster, influencer type 鈥� that just have influence in this White House because they have forged a connection with Trump. And so, if they say something to him, he will take that into account and change policy sometimes. 

Rovner: And he wants the young male demographic, which Joe Rogan very much represents. All right, we’re going to take a quick break. We will be right back.  

OK, we are back. And turning to the Affordable Care Act, despite reassurances from Trump administration officials that the lapse of the Biden-era additional premium tax credits didn’t result in a big drop in coverage, we’re getting more data suggesting that is not the case. A new report this week from the group representing the 21 states that run their own marketplaces show[s] about 900,000 enrollees dropped coverage in the first three months of this year. Compared to last year, disenrollments are up 24%. Hardest hit, not surprisingly, are older enrollees between the age 55 and 64. Their premiums are higher to begin with, so the loss of additional subsidies hits them harder. Meanwhile, even people who have managed to keep coverage are paying more, as many dropped the more generous “gold” and “silver” plans, for those with higher deductibles but lower premiums. And those deductibles are often eye-popping indeed 鈥� not just $1,000 or $1,500 a year, but often more than five figures. I know I say this roughly every other week, but I’m surprised this isn’t making more of an impact in the national conversation. I mean, you know, I keep seeing people who say I’m having to drop my insurance or, you know, I have insurance and I can’t afford to use it because my deductible is $10,000. I know it sort of swept into this whole “affordability” thing, but I thought this might have come up more during seven hearings with the secretary of HHS.  

Knight: I mean, I think it’s partly because there is just so much happening in the world right now that everything else is getting pushed aside in a way, if it’s not related to the Iran war or gas prices or things like that. But I do think, I mean, we’ll see, but Democrats, once we were starting to get 鈥� you know, we just started to get some of this data about ACA enrollment and how it’s changing now that the premium tax credit, enhanced premium tax credits, were not extended by Congress, we’re just now starting to get some of the data. So I think as we see more data, and then we’ll see even more of that going into the summer, I think Democrats, at least, will be hitting this really hard on the campaign trail, and maybe that will permeate and become part of more of the national conversation. We’ll see, but they’re at least gonna message on it, certainly.  

Rovner: Yeah, I think, you know, one of the things that’s important to remember is that the administration, it’s telling the truth when it says, you know, most people were still enrolled in January, because a lot of those people got auto-enrolled. And it takes several months of not paying your premiums before you can actually get kicked off your insurance. So in fact, we’re only just starting to see how many people. 

Ollstein: This is just the beginning. And the fact that we’re already seeing such coverage losses means that there’s going to be more. And I think it’s going to have a political impact in certain contexts. I mean, there was a report just about the big drop in enrollment in Georgia, and Georgia is a major swing state with some major races coming up, and so I expect it to have a big impact there. And so I think, rather than being like a dominant national message, I think in certain places where you’re really seeing the strain. I’ll also point out that it’s not just about people becoming completely uninsured. There’s also a big shift from people being in more comprehensive health care plans to people moving into skimpy, high-deductible health care plans. And that’s going to have a lot of ripple effects going forward as well, and going to lead to a lot of struggle. And so I think it contributes to the overall sense that people are really in financial dire straits and can’t afford basic daily life.  

Stolberg: We’re going to see that, coupled with a lot of Democrats talking, as they did during the hearings, about cuts to Medicaid. Kennedy insists that we’re not cutting Medicaid, but if you talk to any rural hospital executive around the country, they will tell you that they are crumbling under the loss of Medicaid reimbursements. And I think that those, the Medicaid and also the ACA enrollments, will emerge as powerful issues for Democrats.  

Rovner: Kennedy was repeating the age-old argument that’s always made that if the amount of money to Medicaid goes up, it can’t be a cut, even though that doesn’t keep up with inflation or enrollment or the number of people. Yeah, so, I mean, it’s like&苍产蝉辫;鈥�&苍产蝉辫;if you’re paying more, if your mortgage goes up and you’re paying more for it and it goes up more than you’re paying, than you’re able to pay, then that’s really a cut in your income. So it’s a perennial argument that we do see.  

Stolberg: It’s Washington accounting.  

Rovner: Yeah. Finally, this week, there is news on the reproductive health front. In Pennsylvania, a state appellate court ruled that a 1982 ban on the use of public funds to pay for abortion violates that state’s Equal Rights Amendment. Now this case could still be appealed to the state Supreme Court, but this is a pretty significant ruling for a very purple swing state, right, Alice? And it could lead to state-funded Medicaid coverage for abortion, if it’s upheld. 

Ollstein: That’s right. And I will say there was a major state Supreme Court race last year, and it was all about abortion rights 鈥� that was, like, the dominating issue in it. And the progressives prevailed on that message. I think you’re really seeing, like you said, a very mixed state, a very purple state, really being swayed in the direction of supporting abortion rights. And we’ve seen that in a lot of states, you know, since Dobbs 鈥� states you might not expect to go in that direction. And I think it’s going to continue to dominate state Supreme Court races as an issue. You’re seeing that right now with Georgia. I would advise folks to keep an eye on that. There’s a very pro-abortion rights message for those candidates in that race.&苍产蝉辫;鈥�&苍产蝉辫;But this is specifically the issue of Medicaid coverage of abortion, I think, is going to keep coming up over and over as well, because it’s really getting at the question of, yes, you can have legal access to abortion on paper, but if you can’t afford it, is it really accessible? So this could open up access to a lot of low-income people that would not maybe be able to afford it otherwise.  

Rovner: And for the people who are wondering, Wait a minute, I thought Medicaid coverage of abortion is banned 鈥� it’s federal Medicaid coverage of abortion is banned. States may use their own money if they wish to pay for abortion, and many bluer states do. That’s the question at hand here.  

Meanwhile, in South Carolina, lawmakers are advancing a ban on abortion that’s so strict it would subject women who have abortions to punishment, although not as severe as the punishment for those who perform abortions. I thought this was a basic tenet of the anti-abortion movement, that the women who have abortions are also victims and shouldn’t be punished. Is that changing?  

Ollstein: It’s been a very loud debate recently. You have different wings of the anti-abortion movement who are clashing on this, and many are watching the total number of abortions in the U.S. go up since Dobbs, and say this incremental strategy where we shield women who have abortions from prosecution and only go after the doctors. Some of the hard-liners feel that that’s not working, and so they have to try something else in order to actually have the chilling effect that they want to have and deter people from even attempting to get abortions. And then you have a lot of the more mainstream groups who really are against that strategy, and say that, you know, this will just drive voters into the arms of Democrats if we look like we’re the quote-unquote “war on women” that we’ve been accused of waging all these years. And so it’s a very active debate right now.  

Stolberg: I was going to say, do you remember when Trump was running in 2015 and he said that he thought women should be punished for having abortions? And there was a big firestorm over it from the anti-abortion movement. And he basically shut up on that. 

Rovner: Yes, I do remember that.  

Stolberg: So&苍产蝉辫;鈥�&苍产蝉辫;you can see how things have evolved. Of course, that was, you know, when Roe was still into effect. Then we got Dobbs, and, as Alice said, things are changing.  

Rovner: Yes, things are changing. All right. Well, that is this week’s news, or at least as much as we have time for. Now we will play my “How Would You Fix It?” interview with David Blumenthal, and then we’ll come back and do our extra credits. 

I am pleased to welcome to “How Would You Fix It?” David Blumenthal, a true Renaissance man of health policy. When I first met David in the 1980s, he was teaching at Harvard Medical School, doctoring in Boston, and writing about health policy. Since then, he has served as president of the health policy research organization The Commonwealth Fund, and, before that, as national coordinator for health information technology in the Obama administration. In his “spare time,” air quotes, David has written countless journal and other articles and several books, most notably, with political scientist James Morone, The Heart of Power: Health and Politics in the Oval Office, which chronicles presidential health policies from Teddy Roosevelt through George W Bush. Now he and Morone are out with a follow-up book called Whiplash: From the Battle for Obamacare to the War on Science, which covers the rather eventful last three administrations in health care. David Blumenthal, thank you so much for joining us. 

David Blumenthal: Oh, it’s my pleasure. What a great introduction. Thank you so much for that. 

Rovner: So, if it’s Congress that makes the laws, why is it that the president is so pivotal when it comes to health policy? 

Blumenthal: Well, people forget that there is only one official in the United States who is elected by all the people, and that is the president. That gives him 鈥� or someday her, we hope 鈥� a legitimacy, a symbolic authority, and an ability to rise above the din of Washington conversation to reach the American people and to build support or mobilize opposition to whatever an enterprising congressman or senator has in mind. Those same congressmen and senators really crave direction, most of them, from the president to know what that official’s priorities are, so they can line up behind it. They also want to know what the president might veto before they put a lot of effort into things. So all those things are reasons why presidents have a level of authority which is often underappreciated, especially in health care, where the day-to-day conversation often focuses on what a senator or a congressman or a committee chairman is saying. But in the end, unless the president is behind something important, it’s not going to happen in the Congress. 

Rovner: And pretty much everything major in health care has had a president spearheading it, hasn’t it? 

Blumenthal: Exactly. Some that have succeeded, like Medicare and Medicaid, Lyndon Johnson’s proposals, and some that have not, like the Clinton health plan. And then, of course, the Affordable Care Act, which was uniquely the product of President Barack Obama’s sponsorship, passion, enduring commitment, with a lot of help from Nancy Pelosi. 

Rovner: Can you talk a little bit about tinkering versus major reforms, and what you’ve learned from studying the last dozen or so major health reform debates? I know just in the 40 years I’ve been doing this, you know federal government has gone back and forth between We should try to do something big; no, we can’t do something big, so we should try to do something small; no, it doesn’t work if we do something small, we should try to do something big. It’s just been this constant swaying. 

Blumenthal: Well, one of the stories that we tell in both of our books is the story of the dance that has gone on over the ages between proponents of major health care reform and opponents. And this has typically been Democratic proponents and Republican opponents. And the story is this: Somebody in the Democratic Party proposes a massive health care reform proposal, and the Republicans scream socialism, government control, death panels, whatever, and propose an alternative that is smaller, more about free markets, more about the private sector, more about competition. The Democratic proposal goes down in flames, and then 20 years later, the Democrats come back and propose what the Republicans proposed the first time. Then the Republicans say socialism, government control, more limited government, more free market, more private sector. Same thing happens. It goes and goes and goes. What we saw with the Affordable Care Act was that the effort to get anything meaningful in the way of coverage, with a less governmentally oriented program, had run out its rope. There was just nowhere else for conservatives to go, which is why we got the Heritage Foundation proposing what Gov. Mitt Romney and Ted Kennedy accepted in Massachusetts as the basis for health care reform. So I think what happened was that 鈥� and this, I think, you saw mostly in the repeal-and-replace failure 鈥� the Republicans could not come up with anything that was more incremental, less comprehensive, and still made a difference for people’s insurance, especially on the issue of preexisting conditions. 

Rovner: They were OK with the repeal, just not with the replace. 

Blumenthal: Exactly, which is a story that we tell, in detail, in Whiplash. So incremental reform is the way Americans do business. We’ve now incremented our way to a four-legged stool that can achieve universal coverage. We have employer-sponsored insurance, which, of course, is subsidized by the government. We have Medicare, which is the third rail of health care politics. We have Medicaid, which can be expanded if states and the federal government choose, and we have the Affordable Care Act. And together, those got us, during the last years of the Biden administration, to 93% coverage of Americans. We have the tools to increment our way now to universal coverage, and that just seems 鈥� to be the way Americans want to do business, at least in health care. 

Rovner: How does that politicization of not just health insurance coverage but everything that surrounds health and health care becoming red or blue 鈥� how’s that going to impact the next big health debate? 

Blumenthal: Well, it’s red-blue. It’s also&苍产蝉辫;鈥�&苍产蝉辫;has racial overtones. It also has xenophobic overtones, with attitudes toward immigration. All these things now run straight through health care. I think there’s a difference between the psychology of opposition to vaccination and suspicion of the NIH and the people who come into play when it comes to the cost-control issue. Cost control is a bread-and-butter issue. Vaccination is about personal freedom, the sanctity of bodies, the freedom to say no. It has a different overtone and undertone to it. I think that the controversy over cost will be viewed much more as a traditional interest-group struggle, rather than as a red-blue struggle. And I think there’ll be some people from the Republican Party who will get to the point where their constituents are saying, We may have health insurance, but it’s not worth a damn because our deductibles are too high and our copayments are too high. We got to do something. And I think there’s a chance for a bipartisan solution on that score. 

Rovner: So we’re calling this series “How Would You Fix It?” How would you fix it if you could wave a wand and put aside all of the politics that I know you now know so well. But if you could do one or two things to make our health system function better, what would it be? 

Blumenthal: Well, you know, we, in writing the book, we spent some time with President Obama, who said, you know, I would have loved to have had “Medicare for All,” but I knew that was impossible. So we now have this Rube Goldberg apparatus providing us coverage, and I think we’re stuck with that. So what I would do first is make the Affordable Care Act as generous as it should have been and got to be after the Inflation Reduction Act. And I think if we did that and worked our way around the Supreme Court’s prohibition about requiring Medicaid expansion, which we almost did in the IRA 鈥� it’s little-known, but there was an alternative to expanding Medicaid that would have made it a federal program, added to the state program, and not be 鈥� go crosswise with the Supreme Court. That, plus&苍产蝉辫;鈥�&苍产蝉辫;so that would be just sort of make do everything we can to make coverage as universal as it could be. And then add to that a set of incremental changes that would reduce the cost of care. That would involve, I think, more regulation of private insurance to reduce the complexity of benefits and the complexity of billing. The Netherlands and Germany run their health systems through private insurance. They just standardize what the private companies offer. We could do that. In fact, the Affordable Care Act begins that process, especially in marketplaces like California, where private insurers are heavily regulated. 

The second is we need to break up the monopolies that have formed at the local level in the health care provider system, where you have virtually no competition based on price or anything else. We need to change the way we pay for care much more aggressively. Artificial intelligence has enormous potential to reduce administrative costs, but it also has an enormous potential to run them up. If the incentives in the system are not fixed, the incentives in the fee-for-service system will lead to using AI to maximize billing. 

Rovner: Which we’ve already seen. 

Blumenthal: Right, and not reduce administrative expenses. And so we need to give providers and other powerful interests an incentive to use AI to make the health care system work better, rather than to make it generate more revenue. So I think those are some of the things that we’ll need to do. So, build on what we have, the four-legged stool, the foundation for universal coverage we already have, and begin to take on the cost of care through changes that are, for which there are precedents elsewhere in the world, but which until now, we’ve been unwilling to take on. 

Rovner: David Blumenthal, we’ll see how this all plays out. Thank you so much. 

Blumenthal: Thank you, Julie. 

Rovner: OK, we’re back. 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. Victoria, why don’t you start us off this week? 

Knight: Sure thing. My story for extra credit is in The New York Times, and the title is “,” by Sarah Kliff and Margot Sanger-Katz, Sheryl’s colleagues. So this is a really interesting look at the ramifications of the 2020 No Surprises Act that was passed by Congress. And the whole point of this act was to protect patients from surprise medical bills. Because, you know, it still happens nowadays, but this law helps it. Basically, sometimes patients go to an out-of-network doctor, they might get stuck with a really, really high bill, and it’s really difficult for them to pay. So Congress wanted to do something about it. They did, and now, basically, insurers and doctors have to go to an arbitrator if there is a conflict about the price of the bill, if it’s an out-of-network bill. This article really had a lot of great data points on how it seems arbitrators are really favoring doctors in these decision-making and awarding doctors with these really high amounts of money for these medical procedures. So basically, the doctors offer an amount of money that the medical procedure should cost, and the insurers offer one, and the arbitrator just picks one of the two prices. And so doctors are really getting awarded way more.&苍产蝉辫;鈥�&苍产蝉辫;Some doctors are profiting off of this by certain types of procedures, such as breast reduction that was mentioned in the title. And so it was really fascinating. And a few lawmakers were interviewed, and they were like, Well, we didn’t really think about that happening, but at least patients are protected. I don’t know if Congress will do anything about it, but it’s a new twist in our health care system.  

Rovner: Yeah, I love this story because there’s been complaints about the arbitration system pretty much since the law passed. And I think it takes, you know, a story like this for everybody to say, Oh, my goodness, is that what’s happening? Alice, why don’t you go next? 

Ollstein: Yes, I have a[n] analysis from The Washington Post. It’s called “,” and it’s looking at these science and research grants from the National Institutes of Health, and even though Congress has largely protected that funding and approved increases, even where the White House pushed for decreases, that money is not going out, and it’s really not going out to certain researchers researching certain topics, chief among them things that impact women’s health. And this is partially, as the article gets into, a result of this war on what’s viewed as DEI [diversity, equity, and inclusion]. And so research into conditions that primarily or solely impact women, like endometriosis, are seen as DEI and are therefore getting cut. And so it really gets into the toll that’s taking on these labs around the country that are, you know, potentially discovering breakthroughs, but are now in limbo and having to lay people off and has big consequences.  

Rovner: Another story that made me angry. Sheryl, you have one of Alice’s stories as your extra credit. 

Stolberg: I do. So this is from Politico by Alice and her colleague, Amanda Friedman: “.” And the reason I like this story is because it’s about Casey Means, and in how this 鈥� there’s a wave of attacks coming against her, kind of under the radar from the right, from abortion opponents, including the policy arm of the Southern Baptist Convention, and also people who, as we mentioned before, are perhaps raised questions about her embrace of psychedelics. And I think that what happens with Casey Means is really kind of a symbol, or it’s like a microcosm of what is going to happen with the MAHA movement. And yesterday, after the hearing, I asked Sen. Cassidy, who is kind of sitting on Casey Means’ confirmation, “When are we going to see a vote on Casey Means?” And he said, “No comment.” So I just think that this is something to watch, and I applaud Alice and her colleague for pointing out this kind of below-the-radar campaign to hold her up.  

Rovner: Yeah, really, really good story. All right. My extra credit, also from one of our podcast panelists, Rachel Roubein at The Washington Post. It’s called “.” And I love this story because it’s one of those “what seems simple is anything but” policy stories. What seems simple here is the idea that food stamps shouldn’t be used to pay for unhealthy food like candy and soda. But who determines what’s healthy and how is that decided? Thanks to a big pilot program from the Trump administration, two dozen states have received permission to make changes to the food and drink that’s eligible to be paid for using SNAP [Supplemental Nutrition Assistance Program] benefits, and 10 states have now implemented restrictions. But it’s a lot harder than just saying you can’t buy soda and candy. In some states, Gatorade and even Pedialyte are ineligible, even though those are often given to nurse sick kids. In Iowa, KitKat and Twix bars are eligible because they’re made with flour and so they’re not technically candy. Some SNAP rules are so arbitrary that 鈥� and this is not part of Rachel’s story because it just happened 鈥� a bipartisan group of U.S. senators on Wednesday introduced the “Hot Rotisserie Chicken Act” to make sure that Costco’s famous $4.99 roasted bird remains available to those getting federal food assistance. We will watch to see if that flies. Sorry. Not really sorry. 

Rovner: OK, that is this week’s show. Thanks to our editor this week, Stephanie Stapleton, and our producer-engineer, Francis Ying. We also had production help this week from Taylor Cook. 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 your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on Twitter , or on Bluesky . Where are you folks these days? Sheryl?  

Stolberg: I’m at @SherylNYTon , formerly Twitter, and . 

Rovner: Victoria. 

Knight: I’m  on X. 

Rovner: Alice. 

Ollstein:  on Bluesky and  on Twitter [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.] 

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.