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

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

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

Anna Edney: Hi, everybody. 

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

Joanne Kenen: Hi, everybody. 

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

Emmarie Huetteman: Hey there. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Carey: Emmarie, you wanted to jump in. 

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

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

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

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

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

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

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

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

Carey: Emmarie. 

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

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

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

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

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

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

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

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

Carey: Oh yeah. 

Kenen: 鈥攕ince the Garden of Eden, right? 

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

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

Michelle Canero: Thank you for having me. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Michelle Canero, thanks again. 

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

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

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

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

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

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

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

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

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

Kenen: and , @joannekenen. 

Carey: OK. Anna? 

Edney: and and , @annaedney. 

Carey: And Emmarie. 

Huetteman: You can find me on . 

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

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

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

Lauren Weber: Hello, hello. 

Carey: Tami Luhby of CNN. 

Tami Luhby: Glad to be here. 

Carey: And Shefali Luthra of The 19^th. 

Shefali Luthra: Hello. 

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

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

Carey: Of course. 

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

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

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

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

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

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

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

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

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

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

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

Weber: And will he stay on message? 

Carey: Exactly. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Carey: Yes, great story. 

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

Carey: Sure. 

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

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

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

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

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

Luhby: Many comments. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Carey: All right. Shefali. 

Luthra: On Bluesky:  

Carey: And Tami. 

Luhby: You can find me at . 

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

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

Julie Rovner: Hello from 麻豆女优 Health News and WAMU 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, Feb. 5, 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 Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Good morning. 

Rovner: Anna Edney at Bloomberg News. 

Anna Edney: Hi, everybody. 

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

Kenen: Hi, everybody. 

Rovner: Later in this episode, we’ll have my interview with Renuka Rayasam about our new 麻豆女优 Health News project “Priced Out.” If you have a story you’d like to share with us about your inability to afford your health insurance or your health care, I will post a link in our show notes. But first, this week’s news. 

So after a two-week detour, during which funding for the Department of Homeland Security was separated out for a separate resolution, which is still TBD, President [Donald] Trump on Tuesday signed into law the rest of an omnibus spending bill that includes funding for the remainder of the fiscal year for the Department of Health and Human Services, as well as a separate health package that includes, among other things, new rules for pharmacy benefit managers and an extension of temporary Medicare programs, expanding payment for telehealth and so-called hospital at-home care. Sandhya, you succinctly summarized all of this the last time you were on, when we thought this was about to become law. But I think it bears repeating that the spending part of this bill includes very few of the cuts to health programs President Trump asked for in his budget proposal last year. How confident are we that this money is actually going to get spent the way Congress is ordering? 

Raman: I think that’s kind of difficult to say. I think one clue we can look at is in the lead-up to this. We did have some of the different grants rescinded and then reinstated in a short amount of time 鈥� related to mental health and in public health and a few other areas like that 鈥� in order to get this across the finish line. I don’t know what guarantees we have that if it’s not this, it’s something else. But I think they do seem a little bit more confident that they got a little bit more language in there this time to prevent that. But I think we’ll also see, as we get into fiscal 2027 spending and what the White House ends up proposing there. 

Rovner: Yeah, I heard an interview with Sen. Tammy Baldwin, who’s the ranking Democrat on the subcommittee that handles HHS, saying that, you know, unlike last year, when it was just a continuing resolution, this year they actually put in language that says, You will spend this this way. But of course, they’ve had language that’s supposed to spend certain things a certain way, which they have thus far ignored, right? 

Raman: Yeah, and I think it’s something that comes up in all of the hearings they have on this that, you know, appropriators love to say Congress has the power of the purse. You know, this is what they are there to do, is to dole out who gets what. And so it’s an affront to them to say, you know, you’ve spent all this time deciding how much should go to various things, and then it doesn’t actually end up that way. So we’ll see how that plays out. 

Rovner: As you mentioned, it’s worth noting that the president’s budget for fiscal 2027, which starts in just eight months, is already technically late. It was due this past Monday. Any idea when we’ll see a budget from the administration? What might be in it? I know it usually comes after the president’s State of the Union, but that speech is usually at the end of January, and this year the State of the Union isn’t until the end of February. 

Raman: So, I will say that almost always the White House budget comes after the date that it’s supposed to, in statute. But we are, I think, expecting at this point either very late this month or pushing into next month, in terms of when we get it. I think in terms of what would be in there, a lot of what we can look to is similar to what we saw in last year’s request; since the White House budget request is a wish list 鈥� it’s the things the White House wants, not necessarily the things they will get. So I think we can look for a lot of the same proposed cuts as before, because some of those were even proposed in the first Trump administration. I think we can also probably look for a lot of, you know, MAHA-oriented things proposed in there that didn’t get across the finish line 鈥� the new agency, Administration for a Healthy America, and just kind of flushing that out. And I think those are the big things I’d look for as we get closer to that. 

Rovner: Well, turning to the Affordable Care Act 鈥� remember the Affordable Care Act and those expired subsidies that are driving up costs for millions of Americans? Remember the frantic negotiations in the Senate to come up with a compromise after the House passed a Democratic-led effort to extend those enhanced subsidies for three more years? Well, apparently, negotiations on a deal have collapsed, and it’s, apparently 鈥� as we’ve said many times 鈥� over the often insurmountable issue of abortion. Is this really it for the ACA negotiations, or could this issue come back later this winter, even spring, as more and more people end up dropping their coverage because they can’t afford the new premiums? 

Edney: I think that’s the key point, is we don’t have those numbers. We don’t have a great sense of what that’s going to look like. So I think that when lawmakers start getting those phone calls, that could revive things. I think certainly with the ACA, as it relates to the Hyde Amendment 鈥� which it is kind of a “never say never,” like, it often kills these deals, but then suddenly something can kind of appear so 鈥� so, yeah, I think you’re right. 

Rovner: Yeah, the Hyde Amendment, just for those who don’t remember, is what basically bans federal funding for abortion through the Labor-HHS spending bill. But anti-abortion forces want to put it in permanent law, rather than having it renewed every year through the spending bill process. And that’s a hang-up that almost blocked the ACA from becoming law in the first place, because even Democrats disagreed over it. 

Edney: Exactly, yeah, and it comes up every single time. You know, there’s 鈥� just no solution, no good solution. 

Raman: I feel like this is maybe the last straw at this point, based on the conversations from the Hill this week. I mean, there was a little hope earlier in the week when we talked to Sen. Tim Kaine [D-Va.], and he said, you know, we’ll see in the next couple days or so, we’re still talking. They met this week. They’re planning to meet more this week and talk about it, and then I think in the last day or so, it just 鈥� I think both sides were kind of admitting that it was done 鈥� because of this issue, [and] there are a couple of other things that are sticking points, and even things that they hadn’t gotten to really ironing out. But they’d said it was kind of moot at this point, if they couldn’t get over Hyde and some of the stuff related to health savings accounts, so. … There are some people that are still hopeful that said that maybe, but I really don’t see how they continue without the people that are most focused on this in the Senate, like really dialing into it. 

Rovner: Yeah, they seem to be sort of consumed right now with figuring out what to do about the Department of Homeland Security in general, and ICE [Immigration and Customs Enforcement] in particular. And I’m glad you mentioned health savings accounts, because obviously that’s been a big Republican push, to give more money directly to people, rather than to insurance companies. Well, it turns out  in the Journal of the American Medical Association [Network] this week that found that cancer patients who have those high-deductible health plans, which get combined with the health savings accounts, those patients had lower rates of survival compared to those with more comprehensive insurance coverage. Quoting from the study, “These data suggest that insurance coverage that financially discourages medical care may financially discourage necessary care and ultimately worsen cancer outcomes.” That’s not going to help Republicans in their efforts to make patients more financially responsible for their care, I wouldn’t think. 

Edney: Yeah, I think a lot of these things that a cancer patient can’t afford 鈥� I mean, this isn’t a $40 copay; often it’s hundreds of thousands of dollars, they’re considering selling property, selling a house, whatever. So it’s not 鈥� something that people are shopping around for, becoming more fiscally responsible, trying to find, like, a cheaper option to do this. This is something that, clearly, if they could do it, they would. And you know, instead, as this study showed, they’re more at risk of dying because they can’t get these treatments. 

Kenen: I think that just in general, you know, that these high-deductible plans people treat them as for an emergency, for a catastrophic expense, which means people are delaying 鈥� uninsured people and poorly insured people 鈥� often delay preventive care and screening. And therefore, if you catch a cancer, and I don’t know the stage of diagnosis 鈥� I read part of the study; I didn’t read the entire thing. I don’t know the stage of diagnosis. But if your cancer is caught later because you didn’t do preventive screening, some of which are free now, and some of which are not, or some of which are just caught by, you know, when you’re going in for something else, whatever. Later-stage cancer diagnosis is a worse cancer diagnosis. So the disincentives for preventive care, the disincentives for going in earlier, because you don’t want a big bill for something that you are hoping is nothing, is part of the overall picture. 

Rovner: Yeah, and I mean, it also bears saying that, you know, when we were first arguing about health savings accounts and high-deductible health plans, high-deductible health plans had deductibles of, like, $500 or $1,000. Now, high deductibles are five figures. They’re $10,000 and up. And that’s way more than just inflation over the last 20 years. We know that generally people don’t even have $400 set aside for an emergency. So the idea that they can meet a $10,000 deductible so their insurance can kick in is kind of fanciful, I think, for most people. 

All right. Well, meanwhile, there is lots more news on the vaccine front. In an  this week, the new chair of the CDC’s [Centers for Disease Control and Prevention] Advisory Committee on Immunization Practices, Kirk Milhoan, said that the panel should be viewed, quote, “more as a safety committee.” “Efficacy,” he said, “will be secondary.” Basically, he’s saying the panel, whose actual charge is to weigh benefits versus risks of various immunizations, is going to put its finger on the scale to emphasize the risks. Am I reading that right, Anna? 

Edney: Yeah, that’s what, that’s how I read his conversation with Politico. 鈥� They’re really charged now to look at the risks of these, which is interesting, because, to put it mildly, because I think it’s kind of a warped way of thinking about vaccines, generally. 鈥� There are some risks 鈥� but we are potentially stopping how many hundreds, thousands of deaths from polio or something like that. So seems like it could get worked into focusing on those risks versus the lives that are saved by it. It seems to be the direction that this administration certainly wants to go. 

Rovner: And that’s, I mean, the point of having 鈥� an expert outside committee is for them to actually do that weighing of benefit versus risk, at least that was my assumption. It’s what I’ve always been told in the almost 40 years I’ve been doing this. 

Edney: Right, and whether it should be a required vaccine versus something you 鈥� deciding to get or something like that. Conversation can help with those kinds of decisions. But this is something 鈥� a vaccine doesn’t come to market if the FDA is looking at these risks when they consider it in the clinical trials, and that side of it is vetted by the people who are able to have access to a lot of that information. I don’t know that the panel is going to see [it] in the same way, because if you’re looking at the adverse-event database that is kept on vaccines, anyone can send in a side effect to that, or, you know, say that something happened after they had a vaccine. And it can be tough to read that and actually get helpful information from that if we’re looking at the post-market vaccine side effects coming in. 

Rovner: We will continue to watch this space. And it turns out that the changes to vaccine policy extend beyond the United States, too. Reuters broke the story this week that the U.S. is threatening to stop giving money to the global vaccine group Gavi, unless it promises to phase out the use of vaccines that still contain the preservative thimerosal, which has long since been cleared of accusations about causing autism. Gavi provides vaccines to children in the poorest parts of the world, and to stretch its funding, it often relies on less expensive, multidose vaccine vials, which use preservatives to prevent contamination. Apparently, this threat applies to the $300 million the U.S. is already withholding from Gavi that was approved by Congress and to any future funding. So now the U.S. is exporting its effort to scale back childhood immunizations around the world, too? 

Edney: Yeah. It was surprising to see something like that, kind of a demand like that put on Gavi. I guess, in a way, it’s surprising that the administration is still funding Gavi, maybe at all. So you know, I guess, maybe not as shocking that they asked for certain stipulations to be met. But as you mentioned, it is a way to stretch the vaccines to get them to people and countries who otherwise might not have any access to them. So there’s been concern, as you said, that has been debunked about thimerosal, and so we’re not using them that much in vaccines in the U.S., but it’s kind of pushing a first-world problem on other countries. 

Kenen: One really helpful way of thinking about the risk of this preservative is it’s been, as Anna just said, it’s been phased out, not entirely, but mostly in the United States. But in the years 鈥� like, most children are not getting it in their shots. And it has to do with storage of large quantities versus individual vials. We don’t have to go into details there. It’s just not, there’s not much of it anymore, and the autism rate has continued to go up while the thimerosal use went down. So that’s 鈥� even if you’re not a biostatistician, a statistician, it should tell you something, you know. 鈥� If that was the cause, we wouldn’t be seeing more cases. The rise of autism is a complicated thing. We don’t have time to discuss all the theories and measurements and how we do it right here, but it’s easy to understand: One went up, and one went down. It didn’t cause it. 

Rovner: Well, finally, on the vaccine front, this week, here’s what happens when fewer people get immunized. Two detainees at one of the Department of Homeland Security’s family detention centers in Texas have now tested positive for measles, which, as we have discussed at some length, is among the most contagious diseases in the known world. Measles has also been found at another detention facility in Arizona. Now, in the first Trump administration, I remember complaints about children who were being held in detention, having been separated from their parents, being vaccinated without their parents’ permission. But which is worse? Getting vaccinated without parents’ permission, or getting a potentially deadly vaccine-preventable disease? 

Edney: Yeah, that’s certainly, certainly, I think, an easy answer. But you know 鈥� these detention centers, it’s so scary because everyone is just packed in there. Everything we’ve heard is how crowded they are, and the people not even being able to lay down. So you do have to wonder whether they’re starting to think differently about just letting it rage through there, or what’s going to happen. I mean, we don’t know yet if quarantine has worked, or anything along those lines. 

Raman: And I think that goes hand in hand a little bit with what we’ve talked about in the past, about, you know, it already being harder to get care for the folks in these facilities, and providers not being able to do that. And if you’re not able to stop something that is so contagious and spreading, it’s just going to exacerbate the whole situation. 

Rovner: Yeah, we have talked at some length about health care for people who are in these detention camps, and how it appears to be significantly lacking. All right, we’re going to take a quick break. We will be right back. 

Back on Capitol Hill, National Institutes of Health Director Jay Bhattacharya appeared before the Senate HELP [Health, Education, Labor & Pensions] Committee on Tuesday and tried to make the case that the agency’s work hasn’t been disrupted by the on-again, off-again funding and grant cuts made during the course of 2025. He pointed out that eventually NIH did spend all of the money that was appropriated to it, but boy, a lot of it came in the last couple of weeks of the fiscal year. Also, as we’ve discussed at some length, there are plenty of stories out there that show that, in fact, funding disruptions have hurt science, including two new ones this week. Stat News has a  who are having trouble finding positions in labs 鈥� even those students who have their own funding via scholarships or fellowships 鈥� because the labs don’t know how to plan for what they’re going to have in terms of money. And here at 麻豆女优 Health News, we have a story about a Harvard breast cancer lab that’s lost seven of its 18 lab employees after getting its grant frozen and eventually unfrozen, but too late to apply for it to be renewed. Bhattacharya made a big deal of, you know, the NIH, it’s like, OK, we spent all your money. But turning this spigot off and then on again, and then off and then on again, doesn’t feel like a particularly efficient way to spend it. 

Kenen: No, it hurt. It’s really well documented. There are labs all across the country that were hurt, and that meant science that didn’t happen, or didn’t happen as fast and as well as it could have and should have happened. So 鈥� to say on-again, off-again biomedical science funding is fine and dandy. It’s not fine or dandy. 

Rovner: And there were patients whose care was disrupted. 

Kenen: And people in clinical trials who were taking a risk, and inconvenience as well as risk, to be part of a clinical trial. I mean, this was more true of some of the stuff in Africa, when the USAID [United States Agency for International Development] money went away, but some really extreme examples there. But people whose care was interrupted, and people who had volunteered in clinical trials whose care has been interrupted. 

Rovner: Yeah, and people, I mean, for whom these clinical trials were their last chance for, you know, for life or death. I mean, we did see stories from all across the country about clinical trials that got, just stopped in their tracks, and you can’t really restart those, because now you’ve interrupted the care. So the science from them is not going to be as valuable. I mean, you basically have to start over. 

Kenen: You could restart but not where you left off. You have to start again. 

Rovner: Right, exactly. You have to start again, which is also not a great use of money. 

Well, meanwhile, over at the FDA, there are still apparently some pretty loud complaints over the agency’s new, quote, “priority voucher” program, which promises expedited approvals for drugs that, quote, “align with national priorities,” which can apparently be political as well as medical. Our podcast panelist Lizzy Lawrence, over at Stat,  from an employee town hall at FDA, as well as members of Congress who are continuing to express concerns about the potential, if not actual, politicization of the drug review process with this program. Anna, what are you hearing? 

Edney: Yeah, I think that that is still the concern. That town hall did not fix anything in the sense that there’s 鈥� it’s a completely new paradigm for how they are choosing drugs and pushing them to the front of the line. The FDA has never before really been supposed to or has considered price or anything beyond Is this drug going to be beneficial? They would give things priority review, if it was something that was for lifesaving treatments, or something that just, you know, had, was a huge advance, never existed before. But now they’re saying, If you align with the national views, and nobody really knows exactly what that means. It seems to be that, you know, maybe if you made a deal with Trump to bring down drug prices, you might get some of these. Or if it’s, you know, if you’ve promised to build more manufacturing in the U.S., you might get this. Or if it’s a drug that they just like, then you might get it. I think there’s still just a lot of concern about the legality of this. So even among some drugmakers, there are ones obviously who want this. There are about, I think, 15 right now who have this voucher to get to the front of the line to be, have a superfast review. But there is concern from some that, if another administration comes in, is this even valid? You know, if we get approval, do we even, does it even count if they want to, like, take it, if somebody wants to take it off the market, just given the process? So there’s 鈥� you know, people have quit at the FDA over it, very high-profile people, and it’s interesting that it’s still going, that Marty Makary, the commissioner, is still trying to sell it. And [he] even told staff, you know, according to the reporting from Lizzy, that he was doing it because it was really their idea. So. 

Rovner: Meaning the staff’s idea. 

Edney: Yeah, that’s one way to sell it. 

Rovner: I saw that part. I feel like this is a theme throughout the department, which is that, you know, we’ve had for decades in Republican administrations, and Democratic administrations, science sort of shielded from the political leadership of these agencies, of the FDA and the NIH and the CDC, that the science 鈥� that you can lay over the politics. It’s like, here are our priorities, but the science is the science. And I feel like we’ve had now politics entering every single one of these what are supposed to be scientific agencies, right? 

Edney: Yeah, that’s absolutely true. There’s more political appointees. I think this was brought up when Bhattacharya was before Congress, as well. At NIH, there’s more political appointees, just people with an idea in mind of what might be more important than something else, rather than following where the science is going at the moment. And in the case of FDA, before it was not about trying to go as fast as possible. And it’s not just that there’s politics injected, but it’s that we’re cutting out the regular reviewers with the scientific knowledge because they would like to go faster. That’s part of the appeal, I guess, of the voucher. 

Rovner: Yeah, well, we’ll see how that plays out. All right, that’s the news for this week. Now we will play my interview with 麻豆女优 Health News’ Renuka Rayasam, and then we will come back and do our extra credits. 

I am pleased to welcome back to the podcast my 麻豆女优 Health News colleague Renuka Rayasam, who is spearheading our newest series, called “Priced Out.” I will, of course, post links to the first stories in our show notes. Renuka, welcome back to What the Health? 

Renuka Rayasam: Thanks for having me, Julie. 

Rovner: Tell us about this project and what the goal is in pursuing it. 

Rayasam: So actually, we started thinking about this a year ago, my colleague Sam Whitehead and I. And we looked at what was happening both with health care costs generally, but also with what Congress was likely to do or not do. And we realized we’re going to start to see uninsurance rates climb back up after years and years of falling. And so that’s what was the impetus for this project. And then, of course, by the end of the year, Congress didn’t extend enhanced subsidies for ACA premiums. People started to feel and see their ACA premiums jump because of that and because of other things that have led to an increase in health care costs. And overall, obviously, people are feeling the pinch in their budgets, and health care is no exception. And this was born out of watching all those trends come together. And then people started writing to us and saying things like: I have insurance, but my deductible is a quarter of my take-home income. You know: I’m a lawyer. I have my own business, but I can’t afford for my family to be on insurance this year. I can’t afford my medication. I can’t afford going to the doctor. And so I think that was really how this series came together, was hearing those stories about people who, whether they’re insured or not, and often not, were just really facing these high costs of health care. 

Rovner: Yeah, as you say, this is not just the binary: Do you have insurance or do you not have insurance? A lot of this is about people who have health insurance and still can’t afford to access care. That’s a big part of this, isn’t it? 

Rayasam: Yeah, absolutely. I mean, so interesting talking to this guy, Noah Hulsman. He’s in Louisville, Kentucky. He owns a skateboard shop there. Youngish guy, 37 and he was saying, you know, he had a “gold” plan last year that he bought through the exchange, and now he has a “bronze” plan, and he’s paying the same amount per month for his premium, but he’s, like, you know, if something were to actually go wrong, I can’t afford my deductible, like, I can’t pay the bills I need for my shop and meet my deductible. And his shoulders hurt, and he’s, like, I can’t afford to get it looked at because of the copays and all the out-of-pocket costs that come along with that. And I think, you know, in this administration and in this Congress, this GOP-led Congress, a lot of talk of things like short-term health plans and lowering premium costs, but these are a lot of plans that come with high costs if you actually try to go and use the health care. And that’s the sticker shock that people are going to face when they start to actually try to go and get health care when they have an issue that they need to get taken care of. 

Rovner: So one of the first stories in this series includes some actionable information, as we call it, for folks who are looking for alternate ways to afford the care that they need if they’ve had to drop or scale back their insurance. What are some of those ways? 

Rayasam: Sure. So I’ll put this caveat out there: Every single person I spoke with in putting these tips together said, even if you have a high deductible, even if the out-of-pocket costs are really high, you should have health insurance because that is the best protection against big bills. If something really catastrophic were to happen, it’s better than nothing. It’ll keep you from going bankrupt. So that’s a caveat out there. But if, after all of that, you still cannot find a plan, you can still, can’t find a plan that you can afford 鈥� which is a lot of people, that’s, you know, it’s not a negligible number of people in this country. A few things you can do: Talk to your doctor. I think a lot of people are really nervous about talking to their doctor about money and costs, but, you know, I think if a doctor knows this patient is paying out-of-pocket, they might have a cheaper cash-pay option. They might be able to adjust care to try things that are maybe less expensive, you know, maybe get the same quality of care, but try different things that might be a little cheaper. If your doctor is not budging, then go to a place that does specialize in treating patients without insurance. So federally qualified health clinics, community health clinics, a lot of doctors will advertise cash pay. I’m seeing that more and more, actually, a lot of doctors saying, Hey, we do cash-pay options. When you get a prescription from your doctor, don’t just head to the local pharmacy. Comparison-shop. It’s a lot easier to shop for drugs than doctors. A lot of drugmakers have coupons and drug discounts and other ways you can get those products for cheaper. And a lot of big-box retailers 鈥� like Walmart, Costco 鈥� will offer generic options for your prescription for really affordable prices, and so 鈥� be sure that you’re shopping around and that you’re being a smart consumer and looking at different avenues and ways to get care. You know, one last thing I’ll mention is something people don’t think about a lot, which is their local county health center. They have a lot of services, disease testing and screenings, and, in a lot of cases, even mental health or substance abuse care. So contact your local county, see what’s out there, and look around. There are ways to get care if you don’t have insurance. It’s harder. It’s going to take more time, but there are options out there. 

Rovner: Can you give us a preview of some of the upcoming stories in the series? 

Rayasam: That’s a good question. So we’re starting to get people who are writing to us and talking about their concerns and, like I said, these are people who could no longer afford their insurance premiums, people who’ve had to scale back on the coverage they’ve gotten and are dealing with that. And so we’re going to sift through those responses and start to write more stories about the things that people are facing and the consequences of that. You know, one of the women I talked to for this first story was talking about how she started rationing her rheumatoid arthritis medication when she found out that she wasn’t going to be able to afford her ACA plan. So we’re, you know, going to dive deeper into issues like that. And, you know, what are the health risks if you have to ration your medication? What are the problems there? What are ways that people can get into troubles? Things like medical credit cards. I think people might be tempted to turn to a medical credit card, but I think there’s a lot of ways that can make the problem of cost of care worse, you know, if that interest starts compounding. And so I think we’re going to look into all the ways that the cost of care [is] affecting people 鈥� their physical health, their financial health, and just their overall well-being. It’s incredibly stressful, and it can really affect so many parts of your life to not have access to affordable care. 

Rovner: Well, it’s a really important series. Renuka Rayasam, I’m looking forward to reading the rest of it. 

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. Sandhya, why don’t you go first this week? 

Raman: All right. So I picked a story from The Washington Post by David Ovalle, and it’s called “[].” And his story looks at some of the impacts after the Florida AIDS Drug Assistance Program, which is funded through federal money; it’s helped a lot of people with HIV who weren’t able to afford antiretroviral drugs, be able to afford that. And what’s happened in Florida is that the state officials have lowered the income thresholds to get those benefits, saying that there are financial difficulties. And just kind of looking at, you know, some of the cases, and how that’s affecting people over there. 

Rovner: Yeah, good story. Joanne. 

Kenen: This is from Inside Climate News by Johnny Sturgeon, and it’s called “.” And I had never heard of this before. There’s something called shipbreaking. And shipbreaking is exactly what it sounds like. You take a great big ship, like a big transport, you know, freighter transport ship 鈥� we’re not talking about, like, little rubber things in a bathtub. And they are full of heavy metals, radioactive materials, and all sorts of toxic waste. And the way you get them out when you’re done with them is you ram them into the beach as hard and fast as you can. It’s shipbreaking! So this is in poor areas, in areas that already have, you know, pollution: India, Pakistan, and Bangladesh are not known for having the cleanest air and water in the world, and poor people live near there. And it’s huge, it’s a really interesting story about something that you would have thought, like, somebody was making up on a comedy show. But it’s happening, and it’s harming people, and it’s harming the planet. 

Rovner: Yeah, I never thought about what happens to a ship when you’re done with it. 

Kenen: I thought there would be some way of, like, I think in our country, we have some way of taking them apart safely. But no. I mean, and this is a global thing. I mean 鈥� it’s not just ships from the region. 鈥� This is happening to hundreds of ships a year. 

Rovner: Anna. 

Edney: Following in the theme of Joanne’s article, mine is “.” This was a really interesting collaboration with al.com, The Atlanta Journal-Constitution, The Associated Press, and a few others. I won’t name all of them, but it’s a look at 鈥� there’s a town in Georgia that is the carpet capital of the U.S., and is how they use Scotchgard on all the carpets, and how that has forever chemicals in it, and has, over the years, just polluted the water there, and people are getting sick. You know, someone’s goats all died. It’s a really inside look at how the local government, the industries, have all collaborated to get to this point. And you know, just as something was potentially being done about PFAS under the Biden administration, the Trump administration has rolled a lot of that back, so I think it makes that particularly relevant now. 

Rovner: Yeah, it does. All right, well, I also have a story from Florida. My extra credit’s from Politico. It’s called “.” It’s by Arek Sarkissian, and it’s from the “Who could possibly have seen this coming, except everyone?” file. It turns out that although FDA specifically gave Florida permission to begin importing cheaper drugs from Canada 鈥� more than two years ago, Florida was the first state to actually get permission to do this. And although the state has spent an estimated $82 million in state taxpayer funds to contract with a logistics company and open a warehouse for the drugs, it seems that none have been imported yet. Why? Well, because Canada apparently wasn’t kidding when it said its government had no interest in selling drugs to Balkan states so that they could basically import Canada’s price controls. But fear not. The DeSantis administration says it’s still trying to get the program up and running, and it has until May of this year to do that, under the permission that was granted by the FDA. I will be watching that space but not holding my breath. 

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

Raman: I’m on  and on  @SandhyaWrites. 

Rovner: Joanne. 

Kenen: I’m on  and  . 

Rovner: Anna. 

Edney:  and X . 

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

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

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

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

Anna Edney: Hi, everybody. 

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

Joanne Kenen: Hi, everybody. 

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

Emmarie Huetteman: Hey there. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Carey: Emmarie, you wanted to jump in. 

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

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

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

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

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

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

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

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

Carey: Emmarie. 

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

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

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

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

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

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

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

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

Carey: Oh yeah. 

Kenen: 鈥攕ince the Garden of Eden, right? 

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

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

Michelle Canero: Thank you for having me. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Michelle Canero, thanks again. 

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

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

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

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

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

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

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

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

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

Kenen: and , @joannekenen. 

Carey: OK. Anna? 

Edney: and and , @annaedney. 

Carey: And Emmarie. 

Huetteman: You can find me on . 

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

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

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

Lauren Weber: Hello, hello. 

Carey: Tami Luhby of CNN. 

Tami Luhby: Glad to be here. 

Carey: And Shefali Luthra of The 19^th. 

Shefali Luthra: Hello. 

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

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

Carey: Of course. 

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

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

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

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

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

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

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

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

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

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

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

Weber: And will he stay on message? 

Carey: Exactly. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Carey: Yes, great story. 

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

Carey: Sure. 

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

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

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

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

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

Luhby: Many comments. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Carey: All right. Shefali. 

Luthra: On Bluesky:  

Carey: And Tami. 

Luhby: You can find me at . 

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

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

Julie Rovner: Hello from 麻豆女优 Health News and WAMU 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, Feb. 5, 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 Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Good morning. 

Rovner: Anna Edney at Bloomberg News. 

Anna Edney: Hi, everybody. 

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

Kenen: Hi, everybody. 

Rovner: Later in this episode, we’ll have my interview with Renuka Rayasam about our new 麻豆女优 Health News project “Priced Out.” If you have a story you’d like to share with us about your inability to afford your health insurance or your health care, I will post a link in our show notes. But first, this week’s news. 

So after a two-week detour, during which funding for the Department of Homeland Security was separated out for a separate resolution, which is still TBD, President [Donald] Trump on Tuesday signed into law the rest of an omnibus spending bill that includes funding for the remainder of the fiscal year for the Department of Health and Human Services, as well as a separate health package that includes, among other things, new rules for pharmacy benefit managers and an extension of temporary Medicare programs, expanding payment for telehealth and so-called hospital at-home care. Sandhya, you succinctly summarized all of this the last time you were on, when we thought this was about to become law. But I think it bears repeating that the spending part of this bill includes very few of the cuts to health programs President Trump asked for in his budget proposal last year. How confident are we that this money is actually going to get spent the way Congress is ordering? 

Raman: I think that’s kind of difficult to say. I think one clue we can look at is in the lead-up to this. We did have some of the different grants rescinded and then reinstated in a short amount of time 鈥� related to mental health and in public health and a few other areas like that 鈥� in order to get this across the finish line. I don’t know what guarantees we have that if it’s not this, it’s something else. But I think they do seem a little bit more confident that they got a little bit more language in there this time to prevent that. But I think we’ll also see, as we get into fiscal 2027 spending and what the White House ends up proposing there. 

Rovner: Yeah, I heard an interview with Sen. Tammy Baldwin, who’s the ranking Democrat on the subcommittee that handles HHS, saying that, you know, unlike last year, when it was just a continuing resolution, this year they actually put in language that says, You will spend this this way. But of course, they’ve had language that’s supposed to spend certain things a certain way, which they have thus far ignored, right? 

Raman: Yeah, and I think it’s something that comes up in all of the hearings they have on this that, you know, appropriators love to say Congress has the power of the purse. You know, this is what they are there to do, is to dole out who gets what. And so it’s an affront to them to say, you know, you’ve spent all this time deciding how much should go to various things, and then it doesn’t actually end up that way. So we’ll see how that plays out. 

Rovner: As you mentioned, it’s worth noting that the president’s budget for fiscal 2027, which starts in just eight months, is already technically late. It was due this past Monday. Any idea when we’ll see a budget from the administration? What might be in it? I know it usually comes after the president’s State of the Union, but that speech is usually at the end of January, and this year the State of the Union isn’t until the end of February. 

Raman: So, I will say that almost always the White House budget comes after the date that it’s supposed to, in statute. But we are, I think, expecting at this point either very late this month or pushing into next month, in terms of when we get it. I think in terms of what would be in there, a lot of what we can look to is similar to what we saw in last year’s request; since the White House budget request is a wish list 鈥� it’s the things the White House wants, not necessarily the things they will get. So I think we can look for a lot of the same proposed cuts as before, because some of those were even proposed in the first Trump administration. I think we can also probably look for a lot of, you know, MAHA-oriented things proposed in there that didn’t get across the finish line 鈥� the new agency, Administration for a Healthy America, and just kind of flushing that out. And I think those are the big things I’d look for as we get closer to that. 

Rovner: Well, turning to the Affordable Care Act 鈥� remember the Affordable Care Act and those expired subsidies that are driving up costs for millions of Americans? Remember the frantic negotiations in the Senate to come up with a compromise after the House passed a Democratic-led effort to extend those enhanced subsidies for three more years? Well, apparently, negotiations on a deal have collapsed, and it’s, apparently 鈥� as we’ve said many times 鈥� over the often insurmountable issue of abortion. Is this really it for the ACA negotiations, or could this issue come back later this winter, even spring, as more and more people end up dropping their coverage because they can’t afford the new premiums? 

Edney: I think that’s the key point, is we don’t have those numbers. We don’t have a great sense of what that’s going to look like. So I think that when lawmakers start getting those phone calls, that could revive things. I think certainly with the ACA, as it relates to the Hyde Amendment 鈥� which it is kind of a “never say never,” like, it often kills these deals, but then suddenly something can kind of appear so 鈥� so, yeah, I think you’re right. 

Rovner: Yeah, the Hyde Amendment, just for those who don’t remember, is what basically bans federal funding for abortion through the Labor-HHS spending bill. But anti-abortion forces want to put it in permanent law, rather than having it renewed every year through the spending bill process. And that’s a hang-up that almost blocked the ACA from becoming law in the first place, because even Democrats disagreed over it. 

Edney: Exactly, yeah, and it comes up every single time. You know, there’s 鈥� just no solution, no good solution. 

Raman: I feel like this is maybe the last straw at this point, based on the conversations from the Hill this week. I mean, there was a little hope earlier in the week when we talked to Sen. Tim Kaine [D-Va.], and he said, you know, we’ll see in the next couple days or so, we’re still talking. They met this week. They’re planning to meet more this week and talk about it, and then I think in the last day or so, it just 鈥� I think both sides were kind of admitting that it was done 鈥� because of this issue, [and] there are a couple of other things that are sticking points, and even things that they hadn’t gotten to really ironing out. But they’d said it was kind of moot at this point, if they couldn’t get over Hyde and some of the stuff related to health savings accounts, so. … There are some people that are still hopeful that said that maybe, but I really don’t see how they continue without the people that are most focused on this in the Senate, like really dialing into it. 

Rovner: Yeah, they seem to be sort of consumed right now with figuring out what to do about the Department of Homeland Security in general, and ICE [Immigration and Customs Enforcement] in particular. And I’m glad you mentioned health savings accounts, because obviously that’s been a big Republican push, to give more money directly to people, rather than to insurance companies. Well, it turns out  in the Journal of the American Medical Association [Network] this week that found that cancer patients who have those high-deductible health plans, which get combined with the health savings accounts, those patients had lower rates of survival compared to those with more comprehensive insurance coverage. Quoting from the study, “These data suggest that insurance coverage that financially discourages medical care may financially discourage necessary care and ultimately worsen cancer outcomes.” That’s not going to help Republicans in their efforts to make patients more financially responsible for their care, I wouldn’t think. 

Edney: Yeah, I think a lot of these things that a cancer patient can’t afford 鈥� I mean, this isn’t a $40 copay; often it’s hundreds of thousands of dollars, they’re considering selling property, selling a house, whatever. So it’s not 鈥� something that people are shopping around for, becoming more fiscally responsible, trying to find, like, a cheaper option to do this. This is something that, clearly, if they could do it, they would. And you know, instead, as this study showed, they’re more at risk of dying because they can’t get these treatments. 

Kenen: I think that just in general, you know, that these high-deductible plans people treat them as for an emergency, for a catastrophic expense, which means people are delaying 鈥� uninsured people and poorly insured people 鈥� often delay preventive care and screening. And therefore, if you catch a cancer, and I don’t know the stage of diagnosis 鈥� I read part of the study; I didn’t read the entire thing. I don’t know the stage of diagnosis. But if your cancer is caught later because you didn’t do preventive screening, some of which are free now, and some of which are not, or some of which are just caught by, you know, when you’re going in for something else, whatever. Later-stage cancer diagnosis is a worse cancer diagnosis. So the disincentives for preventive care, the disincentives for going in earlier, because you don’t want a big bill for something that you are hoping is nothing, is part of the overall picture. 

Rovner: Yeah, and I mean, it also bears saying that, you know, when we were first arguing about health savings accounts and high-deductible health plans, high-deductible health plans had deductibles of, like, $500 or $1,000. Now, high deductibles are five figures. They’re $10,000 and up. And that’s way more than just inflation over the last 20 years. We know that generally people don’t even have $400 set aside for an emergency. So the idea that they can meet a $10,000 deductible so their insurance can kick in is kind of fanciful, I think, for most people. 

All right. Well, meanwhile, there is lots more news on the vaccine front. In an  this week, the new chair of the CDC’s [Centers for Disease Control and Prevention] Advisory Committee on Immunization Practices, Kirk Milhoan, said that the panel should be viewed, quote, “more as a safety committee.” “Efficacy,” he said, “will be secondary.” Basically, he’s saying the panel, whose actual charge is to weigh benefits versus risks of various immunizations, is going to put its finger on the scale to emphasize the risks. Am I reading that right, Anna? 

Edney: Yeah, that’s what, that’s how I read his conversation with Politico. 鈥� They’re really charged now to look at the risks of these, which is interesting, because, to put it mildly, because I think it’s kind of a warped way of thinking about vaccines, generally. 鈥� There are some risks 鈥� but we are potentially stopping how many hundreds, thousands of deaths from polio or something like that. So seems like it could get worked into focusing on those risks versus the lives that are saved by it. It seems to be the direction that this administration certainly wants to go. 

Rovner: And that’s, I mean, the point of having 鈥� an expert outside committee is for them to actually do that weighing of benefit versus risk, at least that was my assumption. It’s what I’ve always been told in the almost 40 years I’ve been doing this. 

Edney: Right, and whether it should be a required vaccine versus something you 鈥� deciding to get or something like that. Conversation can help with those kinds of decisions. But this is something 鈥� a vaccine doesn’t come to market if the FDA is looking at these risks when they consider it in the clinical trials, and that side of it is vetted by the people who are able to have access to a lot of that information. I don’t know that the panel is going to see [it] in the same way, because if you’re looking at the adverse-event database that is kept on vaccines, anyone can send in a side effect to that, or, you know, say that something happened after they had a vaccine. And it can be tough to read that and actually get helpful information from that if we’re looking at the post-market vaccine side effects coming in. 

Rovner: We will continue to watch this space. And it turns out that the changes to vaccine policy extend beyond the United States, too. Reuters broke the story this week that the U.S. is threatening to stop giving money to the global vaccine group Gavi, unless it promises to phase out the use of vaccines that still contain the preservative thimerosal, which has long since been cleared of accusations about causing autism. Gavi provides vaccines to children in the poorest parts of the world, and to stretch its funding, it often relies on less expensive, multidose vaccine vials, which use preservatives to prevent contamination. Apparently, this threat applies to the $300 million the U.S. is already withholding from Gavi that was approved by Congress and to any future funding. So now the U.S. is exporting its effort to scale back childhood immunizations around the world, too? 

Edney: Yeah. It was surprising to see something like that, kind of a demand like that put on Gavi. I guess, in a way, it’s surprising that the administration is still funding Gavi, maybe at all. So you know, I guess, maybe not as shocking that they asked for certain stipulations to be met. But as you mentioned, it is a way to stretch the vaccines to get them to people and countries who otherwise might not have any access to them. So there’s been concern, as you said, that has been debunked about thimerosal, and so we’re not using them that much in vaccines in the U.S., but it’s kind of pushing a first-world problem on other countries. 

Kenen: One really helpful way of thinking about the risk of this preservative is it’s been, as Anna just said, it’s been phased out, not entirely, but mostly in the United States. But in the years 鈥� like, most children are not getting it in their shots. And it has to do with storage of large quantities versus individual vials. We don’t have to go into details there. It’s just not, there’s not much of it anymore, and the autism rate has continued to go up while the thimerosal use went down. So that’s 鈥� even if you’re not a biostatistician, a statistician, it should tell you something, you know. 鈥� If that was the cause, we wouldn’t be seeing more cases. The rise of autism is a complicated thing. We don’t have time to discuss all the theories and measurements and how we do it right here, but it’s easy to understand: One went up, and one went down. It didn’t cause it. 

Rovner: Well, finally, on the vaccine front, this week, here’s what happens when fewer people get immunized. Two detainees at one of the Department of Homeland Security’s family detention centers in Texas have now tested positive for measles, which, as we have discussed at some length, is among the most contagious diseases in the known world. Measles has also been found at another detention facility in Arizona. Now, in the first Trump administration, I remember complaints about children who were being held in detention, having been separated from their parents, being vaccinated without their parents’ permission. But which is worse? Getting vaccinated without parents’ permission, or getting a potentially deadly vaccine-preventable disease? 

Edney: Yeah, that’s certainly, certainly, I think, an easy answer. But you know 鈥� these detention centers, it’s so scary because everyone is just packed in there. Everything we’ve heard is how crowded they are, and the people not even being able to lay down. So you do have to wonder whether they’re starting to think differently about just letting it rage through there, or what’s going to happen. I mean, we don’t know yet if quarantine has worked, or anything along those lines. 

Raman: And I think that goes hand in hand a little bit with what we’ve talked about in the past, about, you know, it already being harder to get care for the folks in these facilities, and providers not being able to do that. And if you’re not able to stop something that is so contagious and spreading, it’s just going to exacerbate the whole situation. 

Rovner: Yeah, we have talked at some length about health care for people who are in these detention camps, and how it appears to be significantly lacking. All right, we’re going to take a quick break. We will be right back. 

Back on Capitol Hill, National Institutes of Health Director Jay Bhattacharya appeared before the Senate HELP [Health, Education, Labor & Pensions] Committee on Tuesday and tried to make the case that the agency’s work hasn’t been disrupted by the on-again, off-again funding and grant cuts made during the course of 2025. He pointed out that eventually NIH did spend all of the money that was appropriated to it, but boy, a lot of it came in the last couple of weeks of the fiscal year. Also, as we’ve discussed at some length, there are plenty of stories out there that show that, in fact, funding disruptions have hurt science, including two new ones this week. Stat News has a  who are having trouble finding positions in labs 鈥� even those students who have their own funding via scholarships or fellowships 鈥� because the labs don’t know how to plan for what they’re going to have in terms of money. And here at 麻豆女优 Health News, we have a story about a Harvard breast cancer lab that’s lost seven of its 18 lab employees after getting its grant frozen and eventually unfrozen, but too late to apply for it to be renewed. Bhattacharya made a big deal of, you know, the NIH, it’s like, OK, we spent all your money. But turning this spigot off and then on again, and then off and then on again, doesn’t feel like a particularly efficient way to spend it. 

Kenen: No, it hurt. It’s really well documented. There are labs all across the country that were hurt, and that meant science that didn’t happen, or didn’t happen as fast and as well as it could have and should have happened. So 鈥� to say on-again, off-again biomedical science funding is fine and dandy. It’s not fine or dandy. 

Rovner: And there were patients whose care was disrupted. 

Kenen: And people in clinical trials who were taking a risk, and inconvenience as well as risk, to be part of a clinical trial. I mean, this was more true of some of the stuff in Africa, when the USAID [United States Agency for International Development] money went away, but some really extreme examples there. But people whose care was interrupted, and people who had volunteered in clinical trials whose care has been interrupted. 

Rovner: Yeah, and people, I mean, for whom these clinical trials were their last chance for, you know, for life or death. I mean, we did see stories from all across the country about clinical trials that got, just stopped in their tracks, and you can’t really restart those, because now you’ve interrupted the care. So the science from them is not going to be as valuable. I mean, you basically have to start over. 

Kenen: You could restart but not where you left off. You have to start again. 

Rovner: Right, exactly. You have to start again, which is also not a great use of money. 

Well, meanwhile, over at the FDA, there are still apparently some pretty loud complaints over the agency’s new, quote, “priority voucher” program, which promises expedited approvals for drugs that, quote, “align with national priorities,” which can apparently be political as well as medical. Our podcast panelist Lizzy Lawrence, over at Stat,  from an employee town hall at FDA, as well as members of Congress who are continuing to express concerns about the potential, if not actual, politicization of the drug review process with this program. Anna, what are you hearing? 

Edney: Yeah, I think that that is still the concern. That town hall did not fix anything in the sense that there’s 鈥� it’s a completely new paradigm for how they are choosing drugs and pushing them to the front of the line. The FDA has never before really been supposed to or has considered price or anything beyond Is this drug going to be beneficial? They would give things priority review, if it was something that was for lifesaving treatments, or something that just, you know, had, was a huge advance, never existed before. But now they’re saying, If you align with the national views, and nobody really knows exactly what that means. It seems to be that, you know, maybe if you made a deal with Trump to bring down drug prices, you might get some of these. Or if it’s, you know, if you’ve promised to build more manufacturing in the U.S., you might get this. Or if it’s a drug that they just like, then you might get it. I think there’s still just a lot of concern about the legality of this. So even among some drugmakers, there are ones obviously who want this. There are about, I think, 15 right now who have this voucher to get to the front of the line to be, have a superfast review. But there is concern from some that, if another administration comes in, is this even valid? You know, if we get approval, do we even, does it even count if they want to, like, take it, if somebody wants to take it off the market, just given the process? So there’s 鈥� you know, people have quit at the FDA over it, very high-profile people, and it’s interesting that it’s still going, that Marty Makary, the commissioner, is still trying to sell it. And [he] even told staff, you know, according to the reporting from Lizzy, that he was doing it because it was really their idea. So. 

Rovner: Meaning the staff’s idea. 

Edney: Yeah, that’s one way to sell it. 

Rovner: I saw that part. I feel like this is a theme throughout the department, which is that, you know, we’ve had for decades in Republican administrations, and Democratic administrations, science sort of shielded from the political leadership of these agencies, of the FDA and the NIH and the CDC, that the science 鈥� that you can lay over the politics. It’s like, here are our priorities, but the science is the science. And I feel like we’ve had now politics entering every single one of these what are supposed to be scientific agencies, right? 

Edney: Yeah, that’s absolutely true. There’s more political appointees. I think this was brought up when Bhattacharya was before Congress, as well. At NIH, there’s more political appointees, just people with an idea in mind of what might be more important than something else, rather than following where the science is going at the moment. And in the case of FDA, before it was not about trying to go as fast as possible. And it’s not just that there’s politics injected, but it’s that we’re cutting out the regular reviewers with the scientific knowledge because they would like to go faster. That’s part of the appeal, I guess, of the voucher. 

Rovner: Yeah, well, we’ll see how that plays out. All right, that’s the news for this week. Now we will play my interview with 麻豆女优 Health News’ Renuka Rayasam, and then we will come back and do our extra credits. 

I am pleased to welcome back to the podcast my 麻豆女优 Health News colleague Renuka Rayasam, who is spearheading our newest series, called “Priced Out.” I will, of course, post links to the first stories in our show notes. Renuka, welcome back to What the Health? 

Renuka Rayasam: Thanks for having me, Julie. 

Rovner: Tell us about this project and what the goal is in pursuing it. 

Rayasam: So actually, we started thinking about this a year ago, my colleague Sam Whitehead and I. And we looked at what was happening both with health care costs generally, but also with what Congress was likely to do or not do. And we realized we’re going to start to see uninsurance rates climb back up after years and years of falling. And so that’s what was the impetus for this project. And then, of course, by the end of the year, Congress didn’t extend enhanced subsidies for ACA premiums. People started to feel and see their ACA premiums jump because of that and because of other things that have led to an increase in health care costs. And overall, obviously, people are feeling the pinch in their budgets, and health care is no exception. And this was born out of watching all those trends come together. And then people started writing to us and saying things like: I have insurance, but my deductible is a quarter of my take-home income. You know: I’m a lawyer. I have my own business, but I can’t afford for my family to be on insurance this year. I can’t afford my medication. I can’t afford going to the doctor. And so I think that was really how this series came together, was hearing those stories about people who, whether they’re insured or not, and often not, were just really facing these high costs of health care. 

Rovner: Yeah, as you say, this is not just the binary: Do you have insurance or do you not have insurance? A lot of this is about people who have health insurance and still can’t afford to access care. That’s a big part of this, isn’t it? 

Rayasam: Yeah, absolutely. I mean, so interesting talking to this guy, Noah Hulsman. He’s in Louisville, Kentucky. He owns a skateboard shop there. Youngish guy, 37 and he was saying, you know, he had a “gold” plan last year that he bought through the exchange, and now he has a “bronze” plan, and he’s paying the same amount per month for his premium, but he’s, like, you know, if something were to actually go wrong, I can’t afford my deductible, like, I can’t pay the bills I need for my shop and meet my deductible. And his shoulders hurt, and he’s, like, I can’t afford to get it looked at because of the copays and all the out-of-pocket costs that come along with that. And I think, you know, in this administration and in this Congress, this GOP-led Congress, a lot of talk of things like short-term health plans and lowering premium costs, but these are a lot of plans that come with high costs if you actually try to go and use the health care. And that’s the sticker shock that people are going to face when they start to actually try to go and get health care when they have an issue that they need to get taken care of. 

Rovner: So one of the first stories in this series includes some actionable information, as we call it, for folks who are looking for alternate ways to afford the care that they need if they’ve had to drop or scale back their insurance. What are some of those ways? 

Rayasam: Sure. So I’ll put this caveat out there: Every single person I spoke with in putting these tips together said, even if you have a high deductible, even if the out-of-pocket costs are really high, you should have health insurance because that is the best protection against big bills. If something really catastrophic were to happen, it’s better than nothing. It’ll keep you from going bankrupt. So that’s a caveat out there. But if, after all of that, you still cannot find a plan, you can still, can’t find a plan that you can afford 鈥� which is a lot of people, that’s, you know, it’s not a negligible number of people in this country. A few things you can do: Talk to your doctor. I think a lot of people are really nervous about talking to their doctor about money and costs, but, you know, I think if a doctor knows this patient is paying out-of-pocket, they might have a cheaper cash-pay option. They might be able to adjust care to try things that are maybe less expensive, you know, maybe get the same quality of care, but try different things that might be a little cheaper. If your doctor is not budging, then go to a place that does specialize in treating patients without insurance. So federally qualified health clinics, community health clinics, a lot of doctors will advertise cash pay. I’m seeing that more and more, actually, a lot of doctors saying, Hey, we do cash-pay options. When you get a prescription from your doctor, don’t just head to the local pharmacy. Comparison-shop. It’s a lot easier to shop for drugs than doctors. A lot of drugmakers have coupons and drug discounts and other ways you can get those products for cheaper. And a lot of big-box retailers 鈥� like Walmart, Costco 鈥� will offer generic options for your prescription for really affordable prices, and so 鈥� be sure that you’re shopping around and that you’re being a smart consumer and looking at different avenues and ways to get care. You know, one last thing I’ll mention is something people don’t think about a lot, which is their local county health center. They have a lot of services, disease testing and screenings, and, in a lot of cases, even mental health or substance abuse care. So contact your local county, see what’s out there, and look around. There are ways to get care if you don’t have insurance. It’s harder. It’s going to take more time, but there are options out there. 

Rovner: Can you give us a preview of some of the upcoming stories in the series? 

Rayasam: That’s a good question. So we’re starting to get people who are writing to us and talking about their concerns and, like I said, these are people who could no longer afford their insurance premiums, people who’ve had to scale back on the coverage they’ve gotten and are dealing with that. And so we’re going to sift through those responses and start to write more stories about the things that people are facing and the consequences of that. You know, one of the women I talked to for this first story was talking about how she started rationing her rheumatoid arthritis medication when she found out that she wasn’t going to be able to afford her ACA plan. So we’re, you know, going to dive deeper into issues like that. And, you know, what are the health risks if you have to ration your medication? What are the problems there? What are ways that people can get into troubles? Things like medical credit cards. I think people might be tempted to turn to a medical credit card, but I think there’s a lot of ways that can make the problem of cost of care worse, you know, if that interest starts compounding. And so I think we’re going to look into all the ways that the cost of care [is] affecting people 鈥� their physical health, their financial health, and just their overall well-being. It’s incredibly stressful, and it can really affect so many parts of your life to not have access to affordable care. 

Rovner: Well, it’s a really important series. Renuka Rayasam, I’m looking forward to reading the rest of it. 

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. Sandhya, why don’t you go first this week? 

Raman: All right. So I picked a story from The Washington Post by David Ovalle, and it’s called “[].” And his story looks at some of the impacts after the Florida AIDS Drug Assistance Program, which is funded through federal money; it’s helped a lot of people with HIV who weren’t able to afford antiretroviral drugs, be able to afford that. And what’s happened in Florida is that the state officials have lowered the income thresholds to get those benefits, saying that there are financial difficulties. And just kind of looking at, you know, some of the cases, and how that’s affecting people over there. 

Rovner: Yeah, good story. Joanne. 

Kenen: This is from Inside Climate News by Johnny Sturgeon, and it’s called “.” And I had never heard of this before. There’s something called shipbreaking. And shipbreaking is exactly what it sounds like. You take a great big ship, like a big transport, you know, freighter transport ship 鈥� we’re not talking about, like, little rubber things in a bathtub. And they are full of heavy metals, radioactive materials, and all sorts of toxic waste. And the way you get them out when you’re done with them is you ram them into the beach as hard and fast as you can. It’s shipbreaking! So this is in poor areas, in areas that already have, you know, pollution: India, Pakistan, and Bangladesh are not known for having the cleanest air and water in the world, and poor people live near there. And it’s huge, it’s a really interesting story about something that you would have thought, like, somebody was making up on a comedy show. But it’s happening, and it’s harming people, and it’s harming the planet. 

Rovner: Yeah, I never thought about what happens to a ship when you’re done with it. 

Kenen: I thought there would be some way of, like, I think in our country, we have some way of taking them apart safely. But no. I mean, and this is a global thing. I mean 鈥� it’s not just ships from the region. 鈥� This is happening to hundreds of ships a year. 

Rovner: Anna. 

Edney: Following in the theme of Joanne’s article, mine is “.” This was a really interesting collaboration with al.com, The Atlanta Journal-Constitution, The Associated Press, and a few others. I won’t name all of them, but it’s a look at 鈥� there’s a town in Georgia that is the carpet capital of the U.S., and is how they use Scotchgard on all the carpets, and how that has forever chemicals in it, and has, over the years, just polluted the water there, and people are getting sick. You know, someone’s goats all died. It’s a really inside look at how the local government, the industries, have all collaborated to get to this point. And you know, just as something was potentially being done about PFAS under the Biden administration, the Trump administration has rolled a lot of that back, so I think it makes that particularly relevant now. 

Rovner: Yeah, it does. All right, well, I also have a story from Florida. My extra credit’s from Politico. It’s called “.” It’s by Arek Sarkissian, and it’s from the “Who could possibly have seen this coming, except everyone?” file. It turns out that although FDA specifically gave Florida permission to begin importing cheaper drugs from Canada 鈥� more than two years ago, Florida was the first state to actually get permission to do this. And although the state has spent an estimated $82 million in state taxpayer funds to contract with a logistics company and open a warehouse for the drugs, it seems that none have been imported yet. Why? Well, because Canada apparently wasn’t kidding when it said its government had no interest in selling drugs to Balkan states so that they could basically import Canada’s price controls. But fear not. The DeSantis administration says it’s still trying to get the program up and running, and it has until May of this year to do that, under the permission that was granted by the FDA. I will be watching that space but not holding my breath. 

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

Raman: I’m on  and on  @SandhyaWrites. 

Rovner: Joanne. 

Kenen: I’m on  and  . 

Rovner: Anna. 

Edney:  and X . 

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