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

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

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

Alice Miranda Ollstein: Hello. 

Rovner: Jessie Hellmann of CQ Roll Call. 

Jessie Hellmann: Thanks for having me. 

Rovner: And Sandhya Raman, now at Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

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

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

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

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

Hellmann: Yeah, exactly. 

Rovner: Let’s not get into the details. 

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

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

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

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

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

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

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

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

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

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

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

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

Ollstein: Power. 

Rovner: 鈥� power. For generations.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Elisabeth Rosenthal: Thanks for having me.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: And what happened with this case? 

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

Rovner: One cent. 

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

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

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

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

Rosenthal: Thanks, Julie, for having me. 

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

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

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

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

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

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

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

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

Raman: On  and on  . 

Rovner: Alice. 

Ollstein: On Bluesky  and on X . 

Rovner: Jessie. 

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

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

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

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

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

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

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

Rovner: Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: And Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, there. 

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

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

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

Rovner: Lauren. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: But a lot of people are thanking you. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Lauren? 

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

Rovner: Margot. 

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

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

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

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

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

Shefali Luthra: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

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

Joanne Kenen: Hi, everybody. 

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

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

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

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

Rovner: That’s a fair assessment. Anna. 

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Yes. 

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

Rovner: Right. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Oh, it is. 

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

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

Kenen:&苍产蝉辫;础苍诲&苍产蝉辫;迟丑别苍鈥�&苍产蝉辫;

Rovner: And then maybe cut it back later. 

Kenen: No, but it’s exceeded expectations. 

Rovner: Absolutely. 

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

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

Kenen: Right. Right. 

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

Kenen: Right.  

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

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

Rovner: They made it fail. 

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

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

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

Rovner: The ones that passed by voters. 

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

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

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

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

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

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

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

Andy Schneider: Thanks for having me, Julie. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Schneider: Julie Rovner, thank you very much. 

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

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

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

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

Rovner: That’s what it was for. 

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

Rovner: It is not. Shefali. 

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

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

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

Luthra: I am at Bluesky, . 

Rovner: Anna. 

Edney:  and , @annaedney. 

Rovner: Joanne. 

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

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

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

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

Lauren Weber: Hello, hello. 

Carey: Tami Luhby of CNN. 

Tami Luhby: Glad to be here. 

Carey: And Shefali Luthra of The 19^th. 

Shefali Luthra: Hello. 

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

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

Carey: Of course. 

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

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

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

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

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

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

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

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

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

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

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

Weber: And will he stay on message? 

Carey: Exactly. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Carey: Yes, great story. 

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

Carey: Sure. 

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

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

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

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

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

Luhby: Many comments. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Carey: All right. Shefali. 

Luthra: On Bluesky:  

Carey: And Tami. 

Luhby: You can find me at . 

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

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

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

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

Alice Miranda Ollstein: Hello. 

Rovner: Jessie Hellmann of CQ Roll Call. 

Jessie Hellmann: Thanks for having me. 

Rovner: And Sandhya Raman, now at Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

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

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

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

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

Hellmann: Yeah, exactly. 

Rovner: Let’s not get into the details. 

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

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

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

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

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

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

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

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

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

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

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

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

Ollstein: Power. 

Rovner: 鈥� power. For generations.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Elisabeth Rosenthal: Thanks for having me.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: And what happened with this case? 

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

Rovner: One cent. 

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

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

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

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

Rosenthal: Thanks, Julie, for having me. 

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

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

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

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

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

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

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

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

Raman: On  and on  . 

Rovner: Alice. 

Ollstein: On Bluesky  and on X . 

Rovner: Jessie. 

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

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

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

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

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

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

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

Rovner: Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: And Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, there. 

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

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

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

Rovner: Lauren. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: But a lot of people are thanking you. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Lauren? 

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

Rovner: Margot. 

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

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

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

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

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

Shefali Luthra: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

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

Joanne Kenen: Hi, everybody. 

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

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

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

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

Rovner: That’s a fair assessment. Anna. 

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Yes. 

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

Rovner: Right. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Oh, it is. 

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

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

Kenen:&苍产蝉辫;础苍诲&苍产蝉辫;迟丑别苍鈥�&苍产蝉辫;

Rovner: And then maybe cut it back later. 

Kenen: No, but it’s exceeded expectations. 

Rovner: Absolutely. 

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

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

Kenen: Right. Right. 

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

Kenen: Right.  

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

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

Rovner: They made it fail. 

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

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

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

Rovner: The ones that passed by voters. 

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

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

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

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

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

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

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

Andy Schneider: Thanks for having me, Julie. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Schneider: Julie Rovner, thank you very much. 

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

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

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

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

Rovner: That’s what it was for. 

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

Rovner: It is not. Shefali. 

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

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

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

Luthra: I am at Bluesky, . 

Rovner: Anna. 

Edney:  and , @annaedney. 

Rovner: Joanne. 

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

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

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

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.