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

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

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

Lauren Weber: Hello, hello. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, everybody. 

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

Maya Goldman: Go, Blue. 

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

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

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

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

Rovner: Lauren, you want to add something? 

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

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

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

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

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

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

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

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

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

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

Ollstein: Right.  

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

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

Rovner: Lauren, you want to add something? 

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

Rovner: Absolutely.  

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

Goldman: Yeah, great coverage. 

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

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

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

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

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

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

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

Rovner: Which we will get to. 

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

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

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

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

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

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

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

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

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

Goldman: The money has got to come from somewhere. 

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

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

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

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

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

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

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

Rovner: Lauren, you wanted to add something? 

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

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

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

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

Rovner: Oh, absolutely. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: As it were. 

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

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

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

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

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

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

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

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

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

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

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

Rovner: Alice. 

Ollstein: I’m on Bluesky  and on X . 

Rovner: Lauren. 

Weber: Still @LaurenWeberHP on both  and . 

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

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

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

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

Rachel Cohrs Zhang: Hi, everybody. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: And Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hello. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Lawrence: Yeah, is there another deadline to miss? 

Cohrs Zhang: I don’t think so. 

Lawrence: I think this was the only one. 

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

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

Cohrs Zhang: Yeah. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Luthra: That’s true. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Keith: Thanks, Julie. 

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

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

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

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

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

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

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

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

Luthra: I am on Bluesky . 

Rovner: Rachel. 

Cohrs Zhang: On X , or . 

Rovner: Lizzy. 

Lawrence: I’m on X  and  and . 

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

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

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

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

Shefali Luthra: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

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

Joanne Kenen: Hi, everybody. 

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

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

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

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

Rovner: That’s a fair assessment. Anna. 

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Yes. 

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

Rovner: Right. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Oh, it is. 

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

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

Kenen:&苍产蝉辫;础苍诲&苍产蝉辫;迟丑别苍鈥�&苍产蝉辫;

Rovner: And then maybe cut it back later. 

Kenen: No, but it’s exceeded expectations. 

Rovner: Absolutely. 

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

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

Kenen: Right. Right. 

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

Kenen: Right.  

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

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

Rovner: They made it fail. 

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

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

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

Rovner: The ones that passed by voters. 

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

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

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

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

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

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

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

Andy Schneider: Thanks for having me, Julie. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Schneider: Julie Rovner, thank you very much. 

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

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

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

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

Rovner: That’s what it was for. 

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

Rovner: It is not. Shefali. 

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

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

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

Luthra: I am at Bluesky, . 

Rovner: Anna. 

Edney:  and , @annaedney. 

Rovner: Joanne. 

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

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

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

Julie Rovner: Hello from 麻豆女优 Health News and WAMU public radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Jan. 29, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

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

Alice Miranda Ollstein: Hello. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Hi. 

Rovner: And Rachel Roubein of The Washington Post. 

Rachel Roubein: Hi, everyone. 

Rovner: No interview this iced-in week here in Washington, but still lots of news. So last week at this time, Congress was busy patting itself on the back for being poised to pass all 12 annual appropriation bills before their Jan. 30 deadline, including the two biggest ones, those funding the Departments of Defense and Health and Human Services. Still, as I believe I said at the time, it’s not done until it’s done, and, well, it’s not done. What happened, of course, is that after the House passed the remaining six spending bills and left for a week’s recess, on Saturday, federal [Border Patrol] officers shot and killed a VA [Department of Veterans Affairs] ICU nurse, Alex Pretti, on the streets of Minneapolis, where he was participating in an ICE [Immigration and Customs Enforcement] protest. That second killing of a civilian in three weeks turned Senate Democrats, who were supposed to approve the spending package this week, unanimously against the spending bill for the Department of Homeland Security, which includes ICE and which is included within the appropriations package passed by the House last week. But it’s not as easy as splitting off the Homeland Security bill and passing the other five. If the Senate changes anything about the package, it has to go back to the House, which, as I mentioned, isn’t even in town this week. So where are we? And how likely is it that we’re going to look at a partial government shutdown come Saturday? 

Ollstein: So it’s really a mess right now. You have some in both parties who are calling for passing the rest of the bills and pulling out the Homeland Security funding to keep negotiating. Some people are saying they should do a very short-term CR [continuing resolution] 鈥� a week, a couple weeks 鈥� in order to give Congress more time to negotiate these reforms and restrictions that Democrats are demanding. But then you have House Republicans who are saying, Oh, if we’re opening this all back up again, we have some demands, too, and we want more of this and more of that and XYZ. And so they’re saying, We’re gonna defund all sanctuary cities. So, like you said, once you open this back up, it opens up a whole can of worms. That said, the Democrats’ base is really saying don’t give one penny more to this agency that they see as completely running amok and violating life and civil liberties. And so we’re really at kind of an impasse right now. 

Rovner: This is a classic never-count-your-chickens in Congress. Maya, you want to add something. 

Goldman: Yeah, I was going to say, it seems like the health care package is collateral damage here, right? There’s a lot of agreement, bipartisan agreement, that these changes that they’re trying to make, PBM [pharmacy benefit manager] changes, things like that, should be passed. But then, like you said, Julie, it’s never over till it’s over, and more time between getting a bill negotiated and actually passing it just gives interest groups more time to get things changed. So that will be interesting to see. 

Rovner: And just a reminder for those who aren’t following this as closely as we are, there is this health package that’s riding along in this spending-bill package that includes the PBM reform and extensions for things like home health care and telehealth and other things that are not technically spending-bill issues but that need to be renewed periodically by Congress. So that’s also sitting out there waiting to see what the Senate decides to do and then what the House decides to do, depending on what the Senate decides to do. 

Roubein: And the last government shutdown, in the fall, was based on health care. But as you mentioned, the fight was over Affordable Care Act subsidies, which is not part of this package that Julie mentioned. 

Rovner: That’s right. So that will continue. But I want to talk about ICE. We have tiptoed into the immigration debate as it impacts health care in recent months, but now it’s really front and center, and I’m talking about more than just the fight over ICE tactics in Minnesota and blocking the spending bill for the entire Department of Health and Human Services. Maya,  about how ICE presence in hospitals and other health care facilities is having an impact on patient care. Tell us what you found. 

Goldman: Yeah, a lot of physicians and nurses in Minneapolis, Twin Cities, and also across the country are saying that this is approaching, or has already become, a public health crisis. And the problem is twofold. It’s, Part 1, patients aren’t coming to get the care that they need, because they’re worried about leaving their homes. And one doctor during a press conference said she even has patients who don’t want to take telehealth appointments, because they’re afraid of getting on the phone or getting on the computer, because they’re worried they’re being surveilled. So that’s a huge problem. And then some doctors are also saying that ICE presence in and around hospitals is making it harder for them to do their jobs of providing care, because there are reports of agents being aggressive and sort of being in places where they are not supposed to be, or are physically impeding care. So two sides of the coin. 

Rovner: Yeah, a reminder that ICE was largely forbidden from operating in, quote, “sensitive” areas like schools and churches and health facilities, in both Republican and Democratic administrations, until [President Donald Trump] changed it last January. We’ve heard a lot since then about ICE being in all of these sensitive locations, right? 

Goldman: Yeah, yeah. And I think it’s important to note the Department of Homeland Security, when I reached out to them, said that they are not conducting enforcement operations in hospitals, even though they are now allowed to. If they take a patient who’s in custody to the hospital, they are in the hospital. They can get a warrant to come into the hospital. They can be in public spaces like parking lots and waiting rooms, waiting for people. 

Rovner: And as we’re hearing, that’s exactly what they’ve been doing. 

Goldman: Exactly. 

Rovner: Even though they’re not, quote-unquote, “conducting enforcement operations” there. Doesn’t mean they’re not there. So even the American Medical Association, not exactly a left-wing group, issued a statement expressing concern about ICE activity in and around hospital emergency rooms, which it called a, quote, “tactic fueling fear among patients and hospital staff alike.” Are we starting to turn a corner here? I feel like this is, maybe it was a combination of what happened last week, coincided with the big snowstorm in half the country and people were stuck inside watching TV. I do feel like there’s way more awareness than there was even two or three weeks ago of this stuff. 

Ollstein: I think it remains to be seen whether there is a meaningful policy and practice change or just a sort of symbolic or rhetorical change. There’s a different tone being struck. There’s sort of backpedaling on the immediate reaction from government officials we heard, which was to blame the people who were killed for their own killings. There are calls for investigations coming from both sides of the aisle. There are calls for some top officials’ resignations. But again, we’re hearing from people on the ground that things have not actually shifted in the enforcement behavior of these agents. And so I think it really remains to be seen what happens in Congress in terms of passing policies. There’s discussion of putting limitations in the spending bill on what ICE can do. But again, there is a lot of concern that I’ve heard from the advocacy community that they’re going to set up some government official 鈥� whether it’s [Homeland Security Secretary] Kristi Noem or [Trump deputy chief of staff] Stephen Miller or, already we’ve seen [Border Patrol official Gregory] Bovino 鈥� to be a fall guy and then nothing will actually change substantially beyond that. And so there’s continued anxiety around that. 

Rovner: Yeah, and just a reminder that even if the spending bill doesn’t, for the Department of Homeland Security, didn’t pass and they didn’t even do a continuing resolution, ICE has I believe it’s $75 billion from the budget bill that passed last year. So they have a big chunk of money to keep operating regardless. Talk about collateral damage 鈥� it would be all of these other agencies that would have to sort of stop operating if there is some kind of a shutdown. 

Well, meanwhile, it’s not just ICE that’s going after the state of Minnesota. The Centers for Medicare & Medicaid Services earlier this month cut off a chunk of the state’s Medicaid funding going forward. They’re charging that the state is, quote, “operating its program in substantial noncompliance” with rules to detect waste, fraud, and abuse. This is not how this is supposed to work. CMS can sanction states for their anti-fraud efforts being lacking, but there’s supposed to be a lot of due process first, with lots of hearings and appeals and fact-finding and all kinds of mumbo jumbo that we do go through before people actually get sanctioned. That’s apparently not what’s happening here. Although the ICE headlines are overshadowing the other punitive measures the federal government is taking toward Minnesota, I’m kind of surprised this aspect of the story isn’t getting more attention. Might it when other governors realize that this could happen to them, too, even if they didn’t happen to be on the ballot against Trump in the last election, like Minnesota Gov. [Tim] Walz was? 

Goldman: Yeah, I was talking to somebody in the Medicaid space from a different blue state who was saying this feels like a turning point, something that they are scared of happening in their state as well. And, yeah, I think there are a lot of things that we need to see how they’ll play out, but this is definitely raising eyebrows. 

Rovner: Yeah, and I will post in the show notes  by Andy Schneider 鈥� who’s at Georgetown University and who wrote, when he worked on the Hill, wrote a lot of the Medicaid statute 鈥� explaining how this is all supposed to work and quite how different this is. But I would expect to be hearing more about this in the coming days and weeks, particularly if the administration doesn’t back off, because it’s a lot of money and, as we know, Medicaid is a huge, huge piece of every single state’s budget. 

Well, meanwhile, on the abortion front, last week was the annual March for Life, marking the anniversary of the now overturned Supreme Court decision Roe v. Wade, and it’s fair to say that the anti-abortion movement is not happy with the Trump administration’s actions so far on the issue. Let’s start with what the administration did do to prove its devotion to the anti-abortion cause, To mark the movement’s big day in D.C., the Department of Health and Human Services reinstated its first-Trump-term ban on the use of fetal tissue in biomedical research, which President [Joe] Biden had reversed, and it expanded pretty dramatically the so-called Mexico City Policy that bans U.S. funding for international groups that, quote, “perform” or “promote” abortion. Now things like DEI [diversity, equality, and inclusion] and gender-affirming care are included, too. Alice and Rachel, you guys cover this. What should we know about these two new policies? It doesn’t seem like much, because they had both been in effect before, but it’s pretty big. 

Ollstein: So the fetal tissue ban is also, research, is also an expansion of the first-term version, just like the Mexico City Policy. It goes further than before. And so the new version bans not only in-house government research but also government funding of research at outside institutions that use fetal tissue that was donated from abortions, and that has been used in all kinds of really important medical research, development of vaccines, etc. And so there is a lot of concern about that. They also imposed new restrictions on accepting new stem cell lines. There are lots of existing stem cell lines that they just keep propagating over and over from a long time ago, but they’re pausing accepting new ones while, they say, they’re exploring alternatives that they find more ethical. All of this has really rattled the research community. 

And as for the Mexico City Policy, the expansion there is far beyond the issue of abortion. It’s banning funding going to groups that promote what they consider DEI and what they consider gender ideology. And so this is groups that serve the trans community in other countries and have programs for specific marginalized groups. So again, a lot of concern in the public health world because in order to tackle big public health problems, you often need to direct resources to the communities most at risk, and often that is the trans community, that is racial minorities. And so there’s a fear of this really impeding the delivery of services in a way that will impact the broader population. 

Rovner: All right, so now to what the administration didn’t do that makes the anti-abortion movement so unhappy 鈥� anything further to restrict the abortion pill mifepristone. In fact, as expected, the Justice Department filed its brief in a closely watched lawsuit out of Louisiana this week, urging the court to pause the suit while the FDA [Food and Drug Administration] finishes its study of mifepristone, a study that abortion opponents say is the FDA purposely using to drag its feet on any action. So what the heck is going on here? Rachel, you start. 

Roubein: Yeah, basically the Department of Justice  in this lawsuit in Louisiana, and basically their justification was that: The Food and Drug Administration is reviewing mifepristone. We need time to do that. So that was basically what their ask was, was, like: Put this on pause. We will do this review that, as you said, anti-abortion advocates have been upset and said that it has been moving too slowly. 

Ollstein: So I really saw the legal brief was kind of a Rorschach test that people could see different things and signs in it, because you had the pro-abortion-rights community looking at them saying: Look, they’re saying that the FDA didn’t properly review this in the past, and that’s why they’re doing this rigorous review now. That’s a sign that they’re going to impose restrictions. Also, the anti-abortion side looked at it and they were upset, one, that the Justice Department is arguing that the FDA allowing telemedicine doesn’t harm the states, and the states believe that it does, and so they’re saying: You can’t prove harm. You don’t have standing to bring this case. I think really the common theme in this filing and in some other ones last year related to these state abortion lawsuits is that the Trump administration is defending federal power and federal decision-making, and that can cut both ways. And so they’re saying, Leave it to us. And the anti-abortion groups are saying: We don’t trust you. We don’t want to leave it to you. We want to let these state lawsuits move forward. 

Just to very quickly go back, the Trump administration did one other thing around the March for Life as a bone to the anti-abortion community, throwing them a bone, and that is they are attempting to claw back tens of millions of dollars in covid loans that went to Planned Parenthood affiliates. A lot of these loans were already forgiven by the Biden administration, but they are trying anyways to claim there was fraud going on and to get their money back. This boils down to sort of wonky arguments of whether the specific state Planned Parenthood chapters are considered enough part of national Planned Parenthood that they can’t claim to be a small business. This is going to be a legal fight. Planned Parenthood maintains they did absolutely nothing wrong. The state affiliates are separate from the national group, but鈥� 

Rovner: Which they are, by the way. 

Ollstein: They are. They are. And courts have found that they are in the past. However, the anti-abortion movement was very excited about this. They see it as the first step towards declaring all Planned Parenthoods ineligible for any government funding, something they’re calling debarment, which they’ve been pushing for for a while. So that’s one other thing to keep an eye on. 

Rovner: And a reminder, many, many Planned Parenthoods don’t and never have offered abortion. Well we won’t get as far into the weeds as we could here, but if you press me, I will. All right, we’re going to take a quick break. We will be right back. 

So over at the Department of Health and Human Services, we have yet another mysterious case of stopping funding and then almost immediately restarting it. Earlier this month, the Substance Abuse and Mental Health Services Administration cut off nearly $2 billion worth of grants to drug abuse and mental health providers, only to reverse that decision a day later. Now, nearly the same thing has basically happened with about $5 billion worth of grants from the Centers for Disease Control and Prevention to all 50 state health departments for things like community outreach, emergency preparedness, and disease outbreaks. According to The Washington Post, which broke , notices to states were sent out Friday and barely 12 hours later, an HHS official told the Post the funding pause, quote, “had been lifted.” Still, it apparently took several more days for states to be able to access their funding portals. You can’t help but think that at least some of this is an actual effort to destabilize the nation’s public health infrastructure, right? They can’t be that sort of disorganized that they’re going to cut off funding and put it back. There has to be a reason here. Rachel, you’re smiling. 

Roubein: My colleague Lena Sun and I were hearing about this on Saturday, ahead of the big storm. State officials were trying to kind of figure out what’s going on. With the mental health grants, you saw a very kind of concerted push from the advocacy community, from Republicans and Democrats on the Hill, to push for, that was a termination of those grants, to be rescinded, and they were within about a day. This happened sort of over the weekend, and it happened very quickly. So, I can’t say what the result of sort of the change was, because the notices were dated Friday, but state officials didn’t really start getting them till on Saturday. And then we’d heard sort of midday Saturday that the temporary pause was lifted. But it definitely threw, sort of, state and local health departments that we were talking about into sort of a state of confusion trying to figure out sort of what they needed to do and by when. 

Rovner: Yeah, and we have seen this repeatedly from this administration. These are sort of two dramatic cases just this month, but the stopping and starting of grant funding is making it impossible to do any planning and figure out what you can do when. It’s just, it feels like just a matter of, Let’s make it as hard as possible for these people to do their jobs. 

Goldman: Yeah, and鈥� 

Rovner: By “these,” yeah, I’d say by “these people” I mean the grant recipients, not the people who are overseeing the money. 

Goldman: I can’t claim to know exactly what’s going on behind the scenes, but I think, what do you expect to happen when you gut all of the administrative functions of these agencies, which is what HHS did earlier this year? And of course, some of those people have come back, but there’s a lot of instability in HHS’ rank-and-file workforce itself, and so that naturally will trickle down to their grantees. 

Rovner: Right, and particularly at the CDC. Well, adding to that, elsewhere at the CDC, some key databases, mostly concerning vaccines, are not being updated. That’s according to  in this week’s Annals of Internal Medicine medical journal. The study found what the authors called “unexplained pauses” in nearly half of the 82 databases they studied that are normally updated monthly. Eighty-seven percent of those databases were on vaccination-related topics. Now, this could be political. It could also be due, as Maya was just saying, to the budget and personnel cuts at CDC that we’ve talked about so much over the past year. But it does seem that we’re continuing to fly ever more blind on things like disease surveillance, right? 

Goldman: Yeah, and then when you couple that with the state and local public health divisions are the ones who would be the backstop there, but if their funding is in question now, that is even more concerning for public health surveillance. 

Rovner: Yeah, and of course, we are in the middle of big measles outbreaks in South Carolina and Texas and trying to watch that closely, but it’s hard to do if you only have sort of state-by-state backups to look at. 

All right. Well, before we go, we need to talk about the Affordable Care Act. Remember the Affordable Care Act? Before it was subsumed by all the other headlines? Apparently, the Senate is still working on a bipartisan compromise that could restart lapsed subsidies that have spiked health insurance premiums for millions of Americans. And apparently things aren’t going all that well. And to add to it, here’s the headline on the press release for , hot off the presses just this morning 鈥� quote, “.” On the other hand, the poll did find that Republicans still trust Republicans more. And while the ACA remains pretty popular overall, it is less popular with Republicans than it was before last fall’s campaign by Republicans to blame all of the health care system’s ills on the 2010 health law. So where does that leave us? We’re with 鈥� this is the end of January. People who have been sort of reenrolled in the ACA are starting to get these huge premium notices that they may or may not be able to pay. Has Congress just kind of moved onto the next crisis? 

Ollstein: So some people in Congress are still trying to resolve this crisis, even as new crises pile up. The bipartisan talks are still going on, but there is just not a lot of optimism here. There is not really agreement on lots of aspects of extending the subsidies, and all of this is really discussing, at most, sort of a one-year extension. And so they would just have to have this whole fight all over again. But yes, I would say things are looking more bleak on that front than even a few weeks ago. I don’t know what my fellow panelists think. 

Rovner: And any anybody have optimism for getting these subsidies extended? I’m not seeing anybody raising their hand. Well, we will continue, obviously, to watch this space. 

All right. Lastly, health insurers are starting to get the same heartburn as the pharmaceutical industry. Last week, in back-to-back hearings at the House Energy and Commerce and Ways and Means committees, the heads of five of the biggest health insurers got pretty much filleted by members of both parties. Then this week, the Trump administration kind of shocked the markets by offering a much-smaller-than-expected increase for private Medicare Advantage plans. Those have been the darlings of Republicans for a couple of decades now. Maybe Republicans do really mean it when they say they want to stop giving so much taxpayer money to health insurers? 

Goldman: I was a little bit struck by how surprised everybody was at this, because I think [CMS Administrator] Dr. Mehmet Oz has been hinting that he’s much more amenable to cracking down on reported improper behavior among Medicare Advantage plans than people anticipated the next Trump administration would be. And there’s really this groundswell in the House of Representatives as well among Republicans to sort of rein in improper spending in Medicare Advantage. 

Rovner: Sen. Bill Cassidy has been pretty鈥� 

Goldman: Yes. 

Rovner: 鈥攐utspoken on it, which surprised a lot of people. Now his, the committee that he’s the chairman of doesn’t have jurisdiction over this, but he is also a member of the Finance Committee, which does have jurisdiction over this. 

Goldman: Exactly. Exactly. And so to me it wasn’t that surprising, I have to say. But it sent shock waves through the markets? Obviously, insurers are saying that if this is finalized as proposed, they’re going to have to cut benefits for seniors even more, they’re going to have to raise premiums and things like that. And of course this could be a bad political move, potentially, for Republicans. But I think鈥� 

Rovner: Because there are lots of Republican voters who are in Medicare Advantage plans鈥� 

Goldman: Absolutely. 

Rovner: 鈥攁nd don’t want to see their benefits cut. 

Goldman: Absolutely, and Medicare Advantage insurers have been saying this over and over again. The Biden administration was also pretty conservative on Medicare Advantage. I guess maybe “conservative” is a funny word choice, but鈥� 

Rovner: Light-handed. 

Goldman: Yes. 

Rovner: Were light-handed. 

Goldman: Yes, I think, and insurers were largely able to weather that. Of course, there are some changes that they’re making this year. We’re seeing some market realignment. So it, another year of that, who knows what would happen. But I think it still remains to be seen how impactful this will actually be for beneficiaries. 

Rovner: Yeah, well, another constituency to get riled up in the run-up to the midterms. All right, that is this week’s news. Now it’s time for our extra-credit segment. That’s where we each recognize the story we read this week we think that you should read, too. Don’t worry if you miss it. We’ll 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. So I have this fascinating investigation from The New York Times. The headline is “.” So this is a story about these nursing home industry groups making massive donations to Trump’s super PAC and, after that, gaining a lot of access to him and using that access to lobby for the scrapping of a rule that required minimum staffing in nursing homes. And that rule was already not really being enforced, but now they are getting rid of it formally. And so I think the story does a good job of saying, Look, we can’t prove exactly that they got rid of this rule because of the donations, but it is part of a pattern where people who have given a lot of money to the president’s various groups have gotten just an incredible amount of access to him and other top officials. And the story also stresses why we should care about all of this. There’s just been a lot of horrific data coming out of nursing homes of problems caused by understaffing, patients experiencing preventable injuries, infections and other health problems that go unnoticed until it’s too late or it gets way more serious, and even facilities using, basically drugging patients to keep them easy to control and complacent, because there just isn’t enough staff to attend to them. People who have dementia and other things need a lot of care and can get upset and disoriented. And instead of taking care of them, they’re putting them on heavy psychotropic drugs. And so it’s a really sad and serious situation, and this article shows some potential pay to play. 

Rovner: Yeah, I tend to be, in general, skeptical of administrations doing things that we thought they were going to do anyway and someone else happened to give them money. But this draws a pretty clear line. They did do what they were going to do anyway, which was going to sort of not really enforce these regulations. Anyway it’s really good story. Should read it. Maya. 

Goldman: My extra credit this week is “,”on NBC News by Berkeley Lovelace Jr. And it’s one of those stories that, wow, I wish I had written this. It’s a really great explanation of one of the sort of lesser-talked-about side effects of losing enhanced ACA subsidies, which is that people are going into plans that are 鈥� they’re still opting to be in insurance, but they’re taking plans that are lower premiums but much higher deductibles, which means that their coverage is less valuable. And they might still have to pay a lot of money out-of-pocket for most services, and then they might not seek those services, which sort of negates the purpose of having health insurance and its effect on public health. And this story shows that Kentucky, Idaho, Massachusetts, New York, Virginia, Rhode Island, California are all seeing decreases in “silver” plan enrollment, which is sort of that lower-deductible, higher-premium tier, and increases in “bronze” enrollment, which is super-high-deductible. So huge thing to watch. 

Rovner: Really, really good explanation. Rachel. 

Roubein: My extra credit is by Stat News. The headline is “,” by O. Rose Broderick. And the story lays out how the Department of Health and Human Services yesterday, on Wednesday, announced the appointment of new members to a federal committee that will advise Secretary [Robert F.] Kennedy [Jr.] on autism. Broderick reports that many of the new members of the committee, which is called the Interagency Autism Coordinating Committee, have publicly expressed or belonged to groups that have publicly expressed a belief in the debunked claim that vaccines can cause autism. Stat had  earlier this week that the members of the committee had met in secret and that some members of the kind of broader autism community were worried about the panel. And just kind of for sort of the big-picture point of view, Kennedy, last year, pledged to find the causes of autism. And during his tenure as HHS secretary, he’s challenged years of public health messaging on vaccines, such as instructing the CDC to contradict the long-settled scientific conclusion that vaccines do not cause autism. Kennedy, in a press release yesterday, called the researchers “the most qualified experts 鈥� leaders with decades of experience studying, researching, and treating autism.” 

Rovner: Yet another piece of this. There’s a lot of advisory committees at HHS, and there are many of them worth keeping a close eye on. All right, my extra credit this week is from Science magazine, by Monica Hersher and Jeffrey Mervis. It’s called “,” and it puts some actual numbers to the science brain drain that we’ve been talking about. The authors looked at 14 agencies across the federal government, including the NIH [National Institutes of Health], FDA, and CDC at HHS. They noted that those 10,000-plus experts represented only 3% of the more than 300,000 federal workers who’ve left employment since Trump took office, but they represent 14% of the total number of Ph.D.s in science, technology, engineering, math, and health fields. Most quit or retired after taking buyouts rather than being fired, according to the data. But as the authors noted, quote, “these departing Ph.D.s took with them a wealth of subject matter expertise and knowledge about how these agencies operate.” Certainly a win for the Trump administration, which wants to remake the federal government’s approach to science. For the rest of us, we will have to wait and see. 

OK, that’s this week’s show. Before we go, a reminder that our annual 麻豆女优 Health Policy Valentine contest is open. We want to see your clever, heartfelt, or hilarious tributes to the policies that shape health care. Submit your poem, whether conventional, free-form, or haiku, by noon Eastern on Wednesday, Feb. 4. The winning poem will receive a custom comic illustration in the  on Feb. 13. I will post a link to  in our show notes. 

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

Goldman: You can find me on  under my name or on X, . 

Rovner: Alice. 

Ollstein: Still on X, , and on Bluesky, . 

Rovner: Rachel. 

Roubein:  under my name. Bluesky, . X, . 

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

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

Anna Edney: Hi, everyone. 

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 麻豆女优 Health News’ Elisabeth Rosenthal, who reported and wrote the latest “Bill of the Month,” about an ER trip, a scorpion pepper, and a ghost bill. But first, this week’s news. Let’s start this week on Capitol Hill, where both houses of Congress are here and legislating. This week alone, the Senate rejected a Democratic effort to accept the House-passed bill that would renew for three years the Affordable Care Act’s expanded subsidies 鈥� the ones that expired Jan. 1.  

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

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

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

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

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

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

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

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

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

Rovner: Yeah, we will, but we’ll believe it when 鈥� we get to the signing ceremony. 

Ollstein: Exactly. 

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

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

Rovner: Yeah. 

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

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

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

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

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

Rovner: It’s $5.3 trillion. 

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

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

Kenen: No, it’s sustainable, if we’re sustaining it at a high 鈥� in economically 鈥� zany price.  

Rovner: Right. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Puberty blockers! 

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

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

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

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

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

Edney: Yeah. 

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

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

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

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

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

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

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

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

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

Elisabeth Rosenthal: Thanks for having me back. 

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

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

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

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

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

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

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

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

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

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

Rovner: I know the feeling. 

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

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

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

Rovner: Libby Rosenthal, thank you so much. 

Rosenthal: Oh, sure. Thanks for having me. 

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

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

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

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

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

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

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

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

Ollstein: Mostly on Bluesky  and still on X . 

Rovner: Joanne. 

Kenen: I’m mostly on  or on  . 

Rovner: Anna. 

Edney:  or X . 

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

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

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

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

Lauren Weber: Hello, hello. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, everybody. 

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

Maya Goldman: Go, Blue. 

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

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

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

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

Rovner: Lauren, you want to add something? 

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

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

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

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

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

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

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

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

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

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

Ollstein: Right.  

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

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

Rovner: Lauren, you want to add something? 

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

Rovner: Absolutely.  

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

Goldman: Yeah, great coverage. 

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

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

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

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

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

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

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

Rovner: Which we will get to. 

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

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

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

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

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

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

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

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

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

Goldman: The money has got to come from somewhere. 

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

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

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

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

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

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

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

Rovner: Lauren, you wanted to add something? 

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

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

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

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

Rovner: Oh, absolutely. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: As it were. 

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

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

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

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

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

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

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

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

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

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

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

Rovner: Alice. 

Ollstein: I’m on Bluesky  and on X . 

Rovner: Lauren. 

Weber: Still @LaurenWeberHP on both  and . 

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

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

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

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

Rachel Cohrs Zhang: Hi, everybody. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: And Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hello. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Lawrence: Yeah, is there another deadline to miss? 

Cohrs Zhang: I don’t think so. 

Lawrence: I think this was the only one. 

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

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

Cohrs Zhang: Yeah. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Luthra: That’s true. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Keith: Thanks, Julie. 

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

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

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

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

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

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

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

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

Luthra: I am on Bluesky . 

Rovner: Rachel. 

Cohrs Zhang: On X , or . 

Rovner: Lizzy. 

Lawrence: I’m on X  and  and . 

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

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

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

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

Shefali Luthra: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

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

Joanne Kenen: Hi, everybody. 

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

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

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

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

Rovner: That’s a fair assessment. Anna. 

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Yes. 

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

Rovner: Right. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Oh, it is. 

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

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

Kenen:&苍产蝉辫;础苍诲&苍产蝉辫;迟丑别苍鈥�&苍产蝉辫;

Rovner: And then maybe cut it back later. 

Kenen: No, but it’s exceeded expectations. 

Rovner: Absolutely. 

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

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

Kenen: Right. Right. 

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

Kenen: Right.  

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

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

Rovner: They made it fail. 

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

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

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

Rovner: The ones that passed by voters. 

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

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

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

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

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

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

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

Andy Schneider: Thanks for having me, Julie. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Schneider: Julie Rovner, thank you very much. 

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

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

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

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

Rovner: That’s what it was for. 

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

Rovner: It is not. Shefali. 

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

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

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

Luthra: I am at Bluesky, . 

Rovner: Anna. 

Edney:  and , @annaedney. 

Rovner: Joanne. 

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

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

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

Julie Rovner: Hello from 麻豆女优 Health News and WAMU public radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Jan. 29, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

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

Alice Miranda Ollstein: Hello. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Hi. 

Rovner: And Rachel Roubein of The Washington Post. 

Rachel Roubein: Hi, everyone. 

Rovner: No interview this iced-in week here in Washington, but still lots of news. So last week at this time, Congress was busy patting itself on the back for being poised to pass all 12 annual appropriation bills before their Jan. 30 deadline, including the two biggest ones, those funding the Departments of Defense and Health and Human Services. Still, as I believe I said at the time, it’s not done until it’s done, and, well, it’s not done. What happened, of course, is that after the House passed the remaining six spending bills and left for a week’s recess, on Saturday, federal [Border Patrol] officers shot and killed a VA [Department of Veterans Affairs] ICU nurse, Alex Pretti, on the streets of Minneapolis, where he was participating in an ICE [Immigration and Customs Enforcement] protest. That second killing of a civilian in three weeks turned Senate Democrats, who were supposed to approve the spending package this week, unanimously against the spending bill for the Department of Homeland Security, which includes ICE and which is included within the appropriations package passed by the House last week. But it’s not as easy as splitting off the Homeland Security bill and passing the other five. If the Senate changes anything about the package, it has to go back to the House, which, as I mentioned, isn’t even in town this week. So where are we? And how likely is it that we’re going to look at a partial government shutdown come Saturday? 

Ollstein: So it’s really a mess right now. You have some in both parties who are calling for passing the rest of the bills and pulling out the Homeland Security funding to keep negotiating. Some people are saying they should do a very short-term CR [continuing resolution] 鈥� a week, a couple weeks 鈥� in order to give Congress more time to negotiate these reforms and restrictions that Democrats are demanding. But then you have House Republicans who are saying, Oh, if we’re opening this all back up again, we have some demands, too, and we want more of this and more of that and XYZ. And so they’re saying, We’re gonna defund all sanctuary cities. So, like you said, once you open this back up, it opens up a whole can of worms. That said, the Democrats’ base is really saying don’t give one penny more to this agency that they see as completely running amok and violating life and civil liberties. And so we’re really at kind of an impasse right now. 

Rovner: This is a classic never-count-your-chickens in Congress. Maya, you want to add something. 

Goldman: Yeah, I was going to say, it seems like the health care package is collateral damage here, right? There’s a lot of agreement, bipartisan agreement, that these changes that they’re trying to make, PBM [pharmacy benefit manager] changes, things like that, should be passed. But then, like you said, Julie, it’s never over till it’s over, and more time between getting a bill negotiated and actually passing it just gives interest groups more time to get things changed. So that will be interesting to see. 

Rovner: And just a reminder for those who aren’t following this as closely as we are, there is this health package that’s riding along in this spending-bill package that includes the PBM reform and extensions for things like home health care and telehealth and other things that are not technically spending-bill issues but that need to be renewed periodically by Congress. So that’s also sitting out there waiting to see what the Senate decides to do and then what the House decides to do, depending on what the Senate decides to do. 

Roubein: And the last government shutdown, in the fall, was based on health care. But as you mentioned, the fight was over Affordable Care Act subsidies, which is not part of this package that Julie mentioned. 

Rovner: That’s right. So that will continue. But I want to talk about ICE. We have tiptoed into the immigration debate as it impacts health care in recent months, but now it’s really front and center, and I’m talking about more than just the fight over ICE tactics in Minnesota and blocking the spending bill for the entire Department of Health and Human Services. Maya,  about how ICE presence in hospitals and other health care facilities is having an impact on patient care. Tell us what you found. 

Goldman: Yeah, a lot of physicians and nurses in Minneapolis, Twin Cities, and also across the country are saying that this is approaching, or has already become, a public health crisis. And the problem is twofold. It’s, Part 1, patients aren’t coming to get the care that they need, because they’re worried about leaving their homes. And one doctor during a press conference said she even has patients who don’t want to take telehealth appointments, because they’re afraid of getting on the phone or getting on the computer, because they’re worried they’re being surveilled. So that’s a huge problem. And then some doctors are also saying that ICE presence in and around hospitals is making it harder for them to do their jobs of providing care, because there are reports of agents being aggressive and sort of being in places where they are not supposed to be, or are physically impeding care. So two sides of the coin. 

Rovner: Yeah, a reminder that ICE was largely forbidden from operating in, quote, “sensitive” areas like schools and churches and health facilities, in both Republican and Democratic administrations, until [President Donald Trump] changed it last January. We’ve heard a lot since then about ICE being in all of these sensitive locations, right? 

Goldman: Yeah, yeah. And I think it’s important to note the Department of Homeland Security, when I reached out to them, said that they are not conducting enforcement operations in hospitals, even though they are now allowed to. If they take a patient who’s in custody to the hospital, they are in the hospital. They can get a warrant to come into the hospital. They can be in public spaces like parking lots and waiting rooms, waiting for people. 

Rovner: And as we’re hearing, that’s exactly what they’ve been doing. 

Goldman: Exactly. 

Rovner: Even though they’re not, quote-unquote, “conducting enforcement operations” there. Doesn’t mean they’re not there. So even the American Medical Association, not exactly a left-wing group, issued a statement expressing concern about ICE activity in and around hospital emergency rooms, which it called a, quote, “tactic fueling fear among patients and hospital staff alike.” Are we starting to turn a corner here? I feel like this is, maybe it was a combination of what happened last week, coincided with the big snowstorm in half the country and people were stuck inside watching TV. I do feel like there’s way more awareness than there was even two or three weeks ago of this stuff. 

Ollstein: I think it remains to be seen whether there is a meaningful policy and practice change or just a sort of symbolic or rhetorical change. There’s a different tone being struck. There’s sort of backpedaling on the immediate reaction from government officials we heard, which was to blame the people who were killed for their own killings. There are calls for investigations coming from both sides of the aisle. There are calls for some top officials’ resignations. But again, we’re hearing from people on the ground that things have not actually shifted in the enforcement behavior of these agents. And so I think it really remains to be seen what happens in Congress in terms of passing policies. There’s discussion of putting limitations in the spending bill on what ICE can do. But again, there is a lot of concern that I’ve heard from the advocacy community that they’re going to set up some government official 鈥� whether it’s [Homeland Security Secretary] Kristi Noem or [Trump deputy chief of staff] Stephen Miller or, already we’ve seen [Border Patrol official Gregory] Bovino 鈥� to be a fall guy and then nothing will actually change substantially beyond that. And so there’s continued anxiety around that. 

Rovner: Yeah, and just a reminder that even if the spending bill doesn’t, for the Department of Homeland Security, didn’t pass and they didn’t even do a continuing resolution, ICE has I believe it’s $75 billion from the budget bill that passed last year. So they have a big chunk of money to keep operating regardless. Talk about collateral damage 鈥� it would be all of these other agencies that would have to sort of stop operating if there is some kind of a shutdown. 

Well, meanwhile, it’s not just ICE that’s going after the state of Minnesota. The Centers for Medicare & Medicaid Services earlier this month cut off a chunk of the state’s Medicaid funding going forward. They’re charging that the state is, quote, “operating its program in substantial noncompliance” with rules to detect waste, fraud, and abuse. This is not how this is supposed to work. CMS can sanction states for their anti-fraud efforts being lacking, but there’s supposed to be a lot of due process first, with lots of hearings and appeals and fact-finding and all kinds of mumbo jumbo that we do go through before people actually get sanctioned. That’s apparently not what’s happening here. Although the ICE headlines are overshadowing the other punitive measures the federal government is taking toward Minnesota, I’m kind of surprised this aspect of the story isn’t getting more attention. Might it when other governors realize that this could happen to them, too, even if they didn’t happen to be on the ballot against Trump in the last election, like Minnesota Gov. [Tim] Walz was? 

Goldman: Yeah, I was talking to somebody in the Medicaid space from a different blue state who was saying this feels like a turning point, something that they are scared of happening in their state as well. And, yeah, I think there are a lot of things that we need to see how they’ll play out, but this is definitely raising eyebrows. 

Rovner: Yeah, and I will post in the show notes  by Andy Schneider 鈥� who’s at Georgetown University and who wrote, when he worked on the Hill, wrote a lot of the Medicaid statute 鈥� explaining how this is all supposed to work and quite how different this is. But I would expect to be hearing more about this in the coming days and weeks, particularly if the administration doesn’t back off, because it’s a lot of money and, as we know, Medicaid is a huge, huge piece of every single state’s budget. 

Well, meanwhile, on the abortion front, last week was the annual March for Life, marking the anniversary of the now overturned Supreme Court decision Roe v. Wade, and it’s fair to say that the anti-abortion movement is not happy with the Trump administration’s actions so far on the issue. Let’s start with what the administration did do to prove its devotion to the anti-abortion cause, To mark the movement’s big day in D.C., the Department of Health and Human Services reinstated its first-Trump-term ban on the use of fetal tissue in biomedical research, which President [Joe] Biden had reversed, and it expanded pretty dramatically the so-called Mexico City Policy that bans U.S. funding for international groups that, quote, “perform” or “promote” abortion. Now things like DEI [diversity, equality, and inclusion] and gender-affirming care are included, too. Alice and Rachel, you guys cover this. What should we know about these two new policies? It doesn’t seem like much, because they had both been in effect before, but it’s pretty big. 

Ollstein: So the fetal tissue ban is also, research, is also an expansion of the first-term version, just like the Mexico City Policy. It goes further than before. And so the new version bans not only in-house government research but also government funding of research at outside institutions that use fetal tissue that was donated from abortions, and that has been used in all kinds of really important medical research, development of vaccines, etc. And so there is a lot of concern about that. They also imposed new restrictions on accepting new stem cell lines. There are lots of existing stem cell lines that they just keep propagating over and over from a long time ago, but they’re pausing accepting new ones while, they say, they’re exploring alternatives that they find more ethical. All of this has really rattled the research community. 

And as for the Mexico City Policy, the expansion there is far beyond the issue of abortion. It’s banning funding going to groups that promote what they consider DEI and what they consider gender ideology. And so this is groups that serve the trans community in other countries and have programs for specific marginalized groups. So again, a lot of concern in the public health world because in order to tackle big public health problems, you often need to direct resources to the communities most at risk, and often that is the trans community, that is racial minorities. And so there’s a fear of this really impeding the delivery of services in a way that will impact the broader population. 

Rovner: All right, so now to what the administration didn’t do that makes the anti-abortion movement so unhappy 鈥� anything further to restrict the abortion pill mifepristone. In fact, as expected, the Justice Department filed its brief in a closely watched lawsuit out of Louisiana this week, urging the court to pause the suit while the FDA [Food and Drug Administration] finishes its study of mifepristone, a study that abortion opponents say is the FDA purposely using to drag its feet on any action. So what the heck is going on here? Rachel, you start. 

Roubein: Yeah, basically the Department of Justice  in this lawsuit in Louisiana, and basically their justification was that: The Food and Drug Administration is reviewing mifepristone. We need time to do that. So that was basically what their ask was, was, like: Put this on pause. We will do this review that, as you said, anti-abortion advocates have been upset and said that it has been moving too slowly. 

Ollstein: So I really saw the legal brief was kind of a Rorschach test that people could see different things and signs in it, because you had the pro-abortion-rights community looking at them saying: Look, they’re saying that the FDA didn’t properly review this in the past, and that’s why they’re doing this rigorous review now. That’s a sign that they’re going to impose restrictions. Also, the anti-abortion side looked at it and they were upset, one, that the Justice Department is arguing that the FDA allowing telemedicine doesn’t harm the states, and the states believe that it does, and so they’re saying: You can’t prove harm. You don’t have standing to bring this case. I think really the common theme in this filing and in some other ones last year related to these state abortion lawsuits is that the Trump administration is defending federal power and federal decision-making, and that can cut both ways. And so they’re saying, Leave it to us. And the anti-abortion groups are saying: We don’t trust you. We don’t want to leave it to you. We want to let these state lawsuits move forward. 

Just to very quickly go back, the Trump administration did one other thing around the March for Life as a bone to the anti-abortion community, throwing them a bone, and that is they are attempting to claw back tens of millions of dollars in covid loans that went to Planned Parenthood affiliates. A lot of these loans were already forgiven by the Biden administration, but they are trying anyways to claim there was fraud going on and to get their money back. This boils down to sort of wonky arguments of whether the specific state Planned Parenthood chapters are considered enough part of national Planned Parenthood that they can’t claim to be a small business. This is going to be a legal fight. Planned Parenthood maintains they did absolutely nothing wrong. The state affiliates are separate from the national group, but鈥� 

Rovner: Which they are, by the way. 

Ollstein: They are. They are. And courts have found that they are in the past. However, the anti-abortion movement was very excited about this. They see it as the first step towards declaring all Planned Parenthoods ineligible for any government funding, something they’re calling debarment, which they’ve been pushing for for a while. So that’s one other thing to keep an eye on. 

Rovner: And a reminder, many, many Planned Parenthoods don’t and never have offered abortion. Well we won’t get as far into the weeds as we could here, but if you press me, I will. All right, we’re going to take a quick break. We will be right back. 

So over at the Department of Health and Human Services, we have yet another mysterious case of stopping funding and then almost immediately restarting it. Earlier this month, the Substance Abuse and Mental Health Services Administration cut off nearly $2 billion worth of grants to drug abuse and mental health providers, only to reverse that decision a day later. Now, nearly the same thing has basically happened with about $5 billion worth of grants from the Centers for Disease Control and Prevention to all 50 state health departments for things like community outreach, emergency preparedness, and disease outbreaks. According to The Washington Post, which broke , notices to states were sent out Friday and barely 12 hours later, an HHS official told the Post the funding pause, quote, “had been lifted.” Still, it apparently took several more days for states to be able to access their funding portals. You can’t help but think that at least some of this is an actual effort to destabilize the nation’s public health infrastructure, right? They can’t be that sort of disorganized that they’re going to cut off funding and put it back. There has to be a reason here. Rachel, you’re smiling. 

Roubein: My colleague Lena Sun and I were hearing about this on Saturday, ahead of the big storm. State officials were trying to kind of figure out what’s going on. With the mental health grants, you saw a very kind of concerted push from the advocacy community, from Republicans and Democrats on the Hill, to push for, that was a termination of those grants, to be rescinded, and they were within about a day. This happened sort of over the weekend, and it happened very quickly. So, I can’t say what the result of sort of the change was, because the notices were dated Friday, but state officials didn’t really start getting them till on Saturday. And then we’d heard sort of midday Saturday that the temporary pause was lifted. But it definitely threw, sort of, state and local health departments that we were talking about into sort of a state of confusion trying to figure out sort of what they needed to do and by when. 

Rovner: Yeah, and we have seen this repeatedly from this administration. These are sort of two dramatic cases just this month, but the stopping and starting of grant funding is making it impossible to do any planning and figure out what you can do when. It’s just, it feels like just a matter of, Let’s make it as hard as possible for these people to do their jobs. 

Goldman: Yeah, and鈥� 

Rovner: By “these,” yeah, I’d say by “these people” I mean the grant recipients, not the people who are overseeing the money. 

Goldman: I can’t claim to know exactly what’s going on behind the scenes, but I think, what do you expect to happen when you gut all of the administrative functions of these agencies, which is what HHS did earlier this year? And of course, some of those people have come back, but there’s a lot of instability in HHS’ rank-and-file workforce itself, and so that naturally will trickle down to their grantees. 

Rovner: Right, and particularly at the CDC. Well, adding to that, elsewhere at the CDC, some key databases, mostly concerning vaccines, are not being updated. That’s according to  in this week’s Annals of Internal Medicine medical journal. The study found what the authors called “unexplained pauses” in nearly half of the 82 databases they studied that are normally updated monthly. Eighty-seven percent of those databases were on vaccination-related topics. Now, this could be political. It could also be due, as Maya was just saying, to the budget and personnel cuts at CDC that we’ve talked about so much over the past year. But it does seem that we’re continuing to fly ever more blind on things like disease surveillance, right? 

Goldman: Yeah, and then when you couple that with the state and local public health divisions are the ones who would be the backstop there, but if their funding is in question now, that is even more concerning for public health surveillance. 

Rovner: Yeah, and of course, we are in the middle of big measles outbreaks in South Carolina and Texas and trying to watch that closely, but it’s hard to do if you only have sort of state-by-state backups to look at. 

All right. Well, before we go, we need to talk about the Affordable Care Act. Remember the Affordable Care Act? Before it was subsumed by all the other headlines? Apparently, the Senate is still working on a bipartisan compromise that could restart lapsed subsidies that have spiked health insurance premiums for millions of Americans. And apparently things aren’t going all that well. And to add to it, here’s the headline on the press release for , hot off the presses just this morning 鈥� quote, “.” On the other hand, the poll did find that Republicans still trust Republicans more. And while the ACA remains pretty popular overall, it is less popular with Republicans than it was before last fall’s campaign by Republicans to blame all of the health care system’s ills on the 2010 health law. So where does that leave us? We’re with 鈥� this is the end of January. People who have been sort of reenrolled in the ACA are starting to get these huge premium notices that they may or may not be able to pay. Has Congress just kind of moved onto the next crisis? 

Ollstein: So some people in Congress are still trying to resolve this crisis, even as new crises pile up. The bipartisan talks are still going on, but there is just not a lot of optimism here. There is not really agreement on lots of aspects of extending the subsidies, and all of this is really discussing, at most, sort of a one-year extension. And so they would just have to have this whole fight all over again. But yes, I would say things are looking more bleak on that front than even a few weeks ago. I don’t know what my fellow panelists think. 

Rovner: And any anybody have optimism for getting these subsidies extended? I’m not seeing anybody raising their hand. Well, we will continue, obviously, to watch this space. 

All right. Lastly, health insurers are starting to get the same heartburn as the pharmaceutical industry. Last week, in back-to-back hearings at the House Energy and Commerce and Ways and Means committees, the heads of five of the biggest health insurers got pretty much filleted by members of both parties. Then this week, the Trump administration kind of shocked the markets by offering a much-smaller-than-expected increase for private Medicare Advantage plans. Those have been the darlings of Republicans for a couple of decades now. Maybe Republicans do really mean it when they say they want to stop giving so much taxpayer money to health insurers? 

Goldman: I was a little bit struck by how surprised everybody was at this, because I think [CMS Administrator] Dr. Mehmet Oz has been hinting that he’s much more amenable to cracking down on reported improper behavior among Medicare Advantage plans than people anticipated the next Trump administration would be. And there’s really this groundswell in the House of Representatives as well among Republicans to sort of rein in improper spending in Medicare Advantage. 

Rovner: Sen. Bill Cassidy has been pretty鈥� 

Goldman: Yes. 

Rovner: 鈥攐utspoken on it, which surprised a lot of people. Now his, the committee that he’s the chairman of doesn’t have jurisdiction over this, but he is also a member of the Finance Committee, which does have jurisdiction over this. 

Goldman: Exactly. Exactly. And so to me it wasn’t that surprising, I have to say. But it sent shock waves through the markets? Obviously, insurers are saying that if this is finalized as proposed, they’re going to have to cut benefits for seniors even more, they’re going to have to raise premiums and things like that. And of course this could be a bad political move, potentially, for Republicans. But I think鈥� 

Rovner: Because there are lots of Republican voters who are in Medicare Advantage plans鈥� 

Goldman: Absolutely. 

Rovner: 鈥攁nd don’t want to see their benefits cut. 

Goldman: Absolutely, and Medicare Advantage insurers have been saying this over and over again. The Biden administration was also pretty conservative on Medicare Advantage. I guess maybe “conservative” is a funny word choice, but鈥� 

Rovner: Light-handed. 

Goldman: Yes. 

Rovner: Were light-handed. 

Goldman: Yes, I think, and insurers were largely able to weather that. Of course, there are some changes that they’re making this year. We’re seeing some market realignment. So it, another year of that, who knows what would happen. But I think it still remains to be seen how impactful this will actually be for beneficiaries. 

Rovner: Yeah, well, another constituency to get riled up in the run-up to the midterms. All right, that is this week’s news. Now it’s time for our extra-credit segment. That’s where we each recognize the story we read this week we think that you should read, too. Don’t worry if you miss it. We’ll 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. So I have this fascinating investigation from The New York Times. The headline is “.” So this is a story about these nursing home industry groups making massive donations to Trump’s super PAC and, after that, gaining a lot of access to him and using that access to lobby for the scrapping of a rule that required minimum staffing in nursing homes. And that rule was already not really being enforced, but now they are getting rid of it formally. And so I think the story does a good job of saying, Look, we can’t prove exactly that they got rid of this rule because of the donations, but it is part of a pattern where people who have given a lot of money to the president’s various groups have gotten just an incredible amount of access to him and other top officials. And the story also stresses why we should care about all of this. There’s just been a lot of horrific data coming out of nursing homes of problems caused by understaffing, patients experiencing preventable injuries, infections and other health problems that go unnoticed until it’s too late or it gets way more serious, and even facilities using, basically drugging patients to keep them easy to control and complacent, because there just isn’t enough staff to attend to them. People who have dementia and other things need a lot of care and can get upset and disoriented. And instead of taking care of them, they’re putting them on heavy psychotropic drugs. And so it’s a really sad and serious situation, and this article shows some potential pay to play. 

Rovner: Yeah, I tend to be, in general, skeptical of administrations doing things that we thought they were going to do anyway and someone else happened to give them money. But this draws a pretty clear line. They did do what they were going to do anyway, which was going to sort of not really enforce these regulations. Anyway it’s really good story. Should read it. Maya. 

Goldman: My extra credit this week is “,”on NBC News by Berkeley Lovelace Jr. And it’s one of those stories that, wow, I wish I had written this. It’s a really great explanation of one of the sort of lesser-talked-about side effects of losing enhanced ACA subsidies, which is that people are going into plans that are 鈥� they’re still opting to be in insurance, but they’re taking plans that are lower premiums but much higher deductibles, which means that their coverage is less valuable. And they might still have to pay a lot of money out-of-pocket for most services, and then they might not seek those services, which sort of negates the purpose of having health insurance and its effect on public health. And this story shows that Kentucky, Idaho, Massachusetts, New York, Virginia, Rhode Island, California are all seeing decreases in “silver” plan enrollment, which is sort of that lower-deductible, higher-premium tier, and increases in “bronze” enrollment, which is super-high-deductible. So huge thing to watch. 

Rovner: Really, really good explanation. Rachel. 

Roubein: My extra credit is by Stat News. The headline is “,” by O. Rose Broderick. And the story lays out how the Department of Health and Human Services yesterday, on Wednesday, announced the appointment of new members to a federal committee that will advise Secretary [Robert F.] Kennedy [Jr.] on autism. Broderick reports that many of the new members of the committee, which is called the Interagency Autism Coordinating Committee, have publicly expressed or belonged to groups that have publicly expressed a belief in the debunked claim that vaccines can cause autism. Stat had  earlier this week that the members of the committee had met in secret and that some members of the kind of broader autism community were worried about the panel. And just kind of for sort of the big-picture point of view, Kennedy, last year, pledged to find the causes of autism. And during his tenure as HHS secretary, he’s challenged years of public health messaging on vaccines, such as instructing the CDC to contradict the long-settled scientific conclusion that vaccines do not cause autism. Kennedy, in a press release yesterday, called the researchers “the most qualified experts 鈥� leaders with decades of experience studying, researching, and treating autism.” 

Rovner: Yet another piece of this. There’s a lot of advisory committees at HHS, and there are many of them worth keeping a close eye on. All right, my extra credit this week is from Science magazine, by Monica Hersher and Jeffrey Mervis. It’s called “,” and it puts some actual numbers to the science brain drain that we’ve been talking about. The authors looked at 14 agencies across the federal government, including the NIH [National Institutes of Health], FDA, and CDC at HHS. They noted that those 10,000-plus experts represented only 3% of the more than 300,000 federal workers who’ve left employment since Trump took office, but they represent 14% of the total number of Ph.D.s in science, technology, engineering, math, and health fields. Most quit or retired after taking buyouts rather than being fired, according to the data. But as the authors noted, quote, “these departing Ph.D.s took with them a wealth of subject matter expertise and knowledge about how these agencies operate.” Certainly a win for the Trump administration, which wants to remake the federal government’s approach to science. For the rest of us, we will have to wait and see. 

OK, that’s this week’s show. Before we go, a reminder that our annual 麻豆女优 Health Policy Valentine contest is open. We want to see your clever, heartfelt, or hilarious tributes to the policies that shape health care. Submit your poem, whether conventional, free-form, or haiku, by noon Eastern on Wednesday, Feb. 4. The winning poem will receive a custom comic illustration in the  on Feb. 13. I will post a link to  in our show notes. 

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

Goldman: You can find me on  under my name or on X, . 

Rovner: Alice. 

Ollstein: Still on X, , and on Bluesky, . 

Rovner: Rachel. 

Roubein:  under my name. Bluesky, . X, . 

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

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

Anna Edney: Hi, everyone. 

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 麻豆女优 Health News’ Elisabeth Rosenthal, who reported and wrote the latest “Bill of the Month,” about an ER trip, a scorpion pepper, and a ghost bill. But first, this week’s news. Let’s start this week on Capitol Hill, where both houses of Congress are here and legislating. This week alone, the Senate rejected a Democratic effort to accept the House-passed bill that would renew for three years the Affordable Care Act’s expanded subsidies 鈥� the ones that expired Jan. 1.  

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

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

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

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

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

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

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

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

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

Rovner: Yeah, we will, but we’ll believe it when 鈥� we get to the signing ceremony. 

Ollstein: Exactly. 

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

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

Rovner: Yeah. 

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

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

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

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

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

Rovner: It’s $5.3 trillion. 

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

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

Kenen: No, it’s sustainable, if we’re sustaining it at a high 鈥� in economically 鈥� zany price.  

Rovner: Right. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Puberty blockers! 

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

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

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

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

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

Edney: Yeah. 

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

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

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

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

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

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

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

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

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

Elisabeth Rosenthal: Thanks for having me back. 

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

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

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

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

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

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

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

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

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

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

Rovner: I know the feeling. 

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

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

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

Rovner: Libby Rosenthal, thank you so much. 

Rosenthal: Oh, sure. Thanks for having me. 

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

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

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

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

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

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

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

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

Ollstein: Mostly on Bluesky  and still on X . 

Rovner: Joanne. 

Kenen: I’m mostly on  or on  . 

Rovner: Anna. 

Edney:  or X . 

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