But officials warned that all optional Medicaid services are still under review as the state health department looks for cuts to offset a shortfall driven by higher-than-expected Medicaid costs.
Jon Ebelt, a spokesperson with the Montana Department of Public Health and Human Services, said the agency is preparing a request to the federal government to add doula care to the state’s Medicaid program. It would cost the state about $118,000 in its first year to provide doula Medicaid reimbursements, according to .
His April 15 comments came three weeks after department officials told 麻豆女优 Health News that the state budget deficit had put those plans on hold. Ebelt denied that a final decision had been made in March to scrap the doula Medicaid payments, which state lawmakers approved in a bill last year. The coverage is “now proceeding as planned,” he said.
“At the time of your initial inquiry, we were still in the process of analyzing the appropriation,” Ebelt said.
Federal health officials must approve any amendments to the state’s Medicaid program before payments can begin. reimburse doulas through Medicaid.
Doulas are trained, nonmedical workers who support people through pregnancy and after they give birth. The care they provide is in health complications, which has prompted more states to cover doula services in recent years.
Montana lawmakers who supported expanding Medicaid to cover doula care in 2025 cited scarce maternity services, especially in rural and Indigenous communities. But this year, the state has a Medicaid budget deficit of more than and is expecting a similar shortfall next year. Plus, federal policy changes slated to take effect later this year are expected to increase costs.
“鈥奣here’s a need and a desire for doula services, but a lot of people can’t afford it,” said Sheri Walker, a Helena-based doula and president of the . “So that means many of us have other jobs that we have to juggle.”
Walker is a part-time labor and delivery nurse outside of her doula work.
On March 25, health department spokesperson Holly Matkin said in an email to 麻豆女优 Health News that the agency “will not be moving forward with the implementation of doula services in the Montana Medicaid benefit package at this time.” She had added that it was unclear whether state law gives the department the authority to authorize coverage during the budget shortfall.
State Sen. , a Democrat who sponsored last year’s bipartisan doula reimbursement bill, said she didn’t know about the department’s plans until she saw 麻豆女优 Health News’ reporting. Neumann said she and groups that had backed the legislation began calling health officials, making the case for doula services as a low-cost way to provide critical care.
After about a week, Neumann said, state officials told her the agency was moving ahead with doula services after all.
“They were on the chopping block,” Neumann said. “This is a story of how important it is for all Montanans to pay attention and stay connected to what’s happening.”
Ebelt did not clarify what led the department to change its position. However, he warned that optional Medicaid services, such as doula services, may still be cut.
“All optional services, including this service, are being reviewed,” Ebelt said, referring to doula care. He did not respond to a follow-up query as to whether the department might still decide to postpone the program following federal approval.
are types of care that states choose to cover through their Medicaid programs but aren’t required by federal law. That can include covering eyeglasses, prescription drugs, and prosthetics, and more specialized care such as physical therapy, or inpatient psychiatric services for people under 21.
Those services may not sound optional, said , who studies Medicaid financing at 麻豆女优, a health information nonprofit that includes 麻豆女优 Health News. But she said they’re one of the few avenues states have to make adjustments when budgets get tight.
Congressional Republicans’ One Big Beautiful Bill Act, the spending measure President Donald Trump signed into law last July, is expected to put more states in a budget crunch as its provisions start to take effect by the end of the year. The federal government has estimated that the law will reduce federal Medicaid spending by nearly $1 trillion over 10 years. The law also left states with a higher share of the costs to provide food assistance.
Williams said many states expanded services in recent years by boosting optional Medicaid benefits and provider pay.
“We could see them walk those back,” Williams said.
Montana’s financial problems preceded federal changes. Last year, state lawmakers cut some of the health department’s funding and underestimated Medicaid use. The state also overestimated what the federal government would pay toward Montana’s Medicaid costs.
Health officials must outline a plan to cut costs before the state’s 2027 budget year begins on July 1. Simultaneously, the agency is trying to hire more staffers to begin vetting whether Medicaid enrollees meet or are exempt from new work requirements that also go in place July 1. The new rules, mandated through long-delayed state legislation and the federal spending law, will have a three-month grace period.
Stephanie Morton, executive director of , said she’s grateful the state is back on track to pay for doula services through Medicaid. But she said she’s worried about potential health care cuts to come.
“We know that doulas are a critical piece of that infrastructure, but standing alone and losing other sources of care really isn’t optimal,” Morton said. “These are not robust systems as it stands.”
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/medicaid/doula-care-pregnancy-medicaid-montana-budget-cuts/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
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麻豆女优 Health News Michigan correspondent Kate Wells discussed urgent care clinics offering abortions on Apple News Today on April 15.
麻豆女优 Health News Montana correspondent Katheryn Houghton discussed doula Medicaid reimbursements on Montana Public Radio on April 9.
- Read Houghton’s “This Northern Cheyenne Doula Was About To Start Getting Paid 鈥 Then Medicaid Cuts Hit.”
麻豆女优 Health News contributor Michelle Andrews discussed farm bureau health plans on The Yonder Report on April 8.
- Read Andrews’ “Farm Bureau Health Plans Beat the ACA on Prices With an Age-Old Tactic: Rejecting Sick People.”
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .
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According to new data from the Centers for Disease Control and Prevention, there were 3.6 million births in 2025, a from 2024. The fertility rate dropped to 53.1 births per 1,000 women ages 15 to 44, down 23% since 2007.
The Trump administration has said it wants to reverse this trend. President Donald Trump has called for “a new baby boom,” and aides have solicited proposals from outside advocates and policy groups ranging from baby bonuses to expanded fertility planning. The administration is also the federal government’s only dedicated family planning program: Title X.
For more than five decades, Title X has been geared 鈥 with bipartisan support 鈥 toward giving low-income women access to contraception, screening for sexually transmitted infections, and reproductive health care regardless of ability to pay. At its peak, the served more than 5 million patients a year. Title X clients have reported the program as their sole source of health care in a given year.
In early April, the Department of Health and Human Services for Title X grants for fiscal year 2027, which begins in October. The 67-page Notice of Funding Opportunity included only one mention of contraception 鈥 describing it as overprescribed, associated with negative side effects, and part of a broader “overreliance on pharmaceutical and surgical treatments.”
The grant notification reshapes the program from its traditional public health intervention efforts to focus on fertility, family formation, and reproductive health conditions such as polycystic ovary syndrome, endometriosis, low testosterone, and erectile dysfunction.
While Title X will continue to help women “achieve healthy pregnancies,” the grant document does not explicitly reference preventing unintended pregnancies 鈥 a long-standing goal of the program.
Jessica Marcella, who oversaw the Title X program as a senior official in the Biden administration, said the new funding notice amounts to a wholesale redefinition of family planning.
“What we’re seeing is trying to use our nation’s family planning as a Trojan horse for an entirely different agenda,” Marcella said, noting that Trump eliminating Title X altogether.
Birth Rates and Fertility Trends
The administration is overhauling Title X in the context of declining birth rates. But researchers who study fertility trends say the decline is driven by forces that have little to do with contraception access and that restricting it is unlikely to produce more births.
The most important factors, according to demographer Alison Gemmill of UCLA, are timing-related. “Childbearing is increasingly delayed as part of a broader shift toward later adult milestones, including stable employment, leaving the parental home, and marriage,” she said.
Most American women, she said, still complete their childbearing years with an average of two children, suggesting a shift toward smaller families rather than an increase in childlessness.
“Having children has become more contingent and more planned,” she said.
Much of the decline since 2007 reflects women postponing births rather than forgoing them.
“The average number of babies women are having in their whole lives has not fallen. It’s still more than 2.0 for women aged 45,” said Philip Cohen, a professor of sociology at the University of Maryland.
Phillip Levine, an economist at Wellesley College, said the birth rate has declined due to shifts in how women approach work, leisure, and parenting. “Efforts to reverse those patterns would be more successful if they can make childbearing more desirable, not make it harder to prevent a pregnancy,” he said.
Asked about the role of contraception in reducing maternal mortality and how the new funding notice advances that goal, HHS press secretary Emily Hilliard said in a statement: “Applicants for the 2027 Title X funding cycle will be expected to align with the administration’s stated priorities in the released Notice of Funding Opportunity. HHS, under the leadership of Secretary Kennedy and President Trump, will continue to support policies that support life, family well-being, maternal health, and address the chronic disease epidemic. HHS remains focused on improving maternal outcomes and ensuring programs are administered consistent with applicable law.”
Marcella said the new funding notice is the product of two converging forces: the Make America Healthy Again movement, with its skepticism of conventional medicine and emphasis on lifestyle and behavioral interventions, and a pronatalist agenda that seeks to boost birth rates by steering policy toward family formation.
The document’s language reflects both: It repeatedly invokes “optimal health” and “chronic disease” while sidelining the contraceptive services that have defined Title X for .
Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, which represents health professionals focused on family planning, said tying Title X to birth-rate goals replaces individual decision-making with a government objective. The program “is designed to facilitate access to family planning services, including services to achieve and prevent pregnancy,” she said.
Title X’s New Focus
The administration’s changes have been welcomed on the right.
Emma Waters, a senior policy analyst at the conservative Heritage Foundation, who has advocated for what she calls “restorative reproductive medicine,” said the new funding notice reflects overdue attention to neglected aspects of women’s health.
“I was particularly encouraged to see language that spoke to the delays in diagnosis for conditions like endometriosis, the need for women to practically understand how their cycle and fertility works, and to ensure that real root-cause was promoted through Title X,” Waters said.
She described the notice as an expansion, not a narrowing, of the program’s mission: “I see this iteration of Title X as the fulfillment of its purpose. The goal was never just 鈥榤ore contraception’ but a wholesale empowerment of women to govern their own fertility.”
Waters also argued that untreated reproductive health problems may contribute to lower birth rates.
“One of the interesting aspects of this debate, and one that is often overlooked, is the degree to which painful and unaddressed reproductive health problems may suppress or create ambivalence around a woman’s desire to have kids,” she said, pointing to endometriosis.
An estimated of reproductive age have endometriosis, and of those, . Scientifically speaking, the relationship is an association, not a proven cause. Women aren’t screened for endometriosis if they don’t have symptoms, and the condition may be more prevalent than is recognized. Researchers still do not fully understand why some women with endometriosis struggle to conceive while others do not, and treating the disease does not reliably restore fertility.
Infertility rates in the U.S., meanwhile, have not risen. An found them essentially flat between 1995 and 2019, even as the national birth rate fell sharply 鈥 a divergence that points away from untreated reproductive disease as an explanation.
Meanwhile, in February, the American College of Obstetricians and Gynecologists enabling earlier diagnosis of endometriosis without surgery, a step toward addressing the delays Waters described. But the first-line treatment ACOG recommends is hormonal therapy, part of the same category of care the funding notice dismisses as part of an “overreliance on pharmaceutical and surgical treatments.” The effect, reproductive health experts say, is a contradiction: Title X is now prioritizing diagnosis of endometriosis while deemphasizing the drugs clinicians use to treat it.
Treatments that have been shown to improve fertility in women with endometriosis, such as laparoscopic surgery and in vitro fertilization, are . When President Richard Nixon signed Title X into law in 1970, as a way to expand access to family planning services 鈥 helping women determine the number and spacing of their children by making contraception and related preventive care more widely available, particularly for those who could not afford it. , not Title X, is the primary government health insurance program covering health care for low-income women, but, like many commercial insurance plans, it .
Many of the conditions prioritized in the funding notice deserve attention, said Liz Romer, a former chief clinical adviser for the HHS Office of Population Affairs who helped write updated guidelines for the family planning program. But they fall outside the scope of what Title X can realistically provide.
“There’s not even enough funding to support the core premise of contraception,” Romer said. “And so, if you want to expand Title X funding, you can expand the scope, but you can’t move away from the foundation.”
The emergence of an anticontraception ideology within federal health policy is striking, she said, given how broadly the public supports access to birth control. Eight in 10 women of childbearing age surveyed by 麻豆女优 in 2024 reported having in the previous 12 months.
Laura Lindberg, director of the Concentration in Sexual and Reproductive Health, Rights and Justice at Rutgers School of Public Health, said, “If contraception is sidelined in Title X, it won’t just change language on paper but will show up as fewer options and more barriers for patients.” Funding could move away from providers who offer a full range of contraceptive care, she added, “toward organizations that are ideologically opposed to contraception and don’t deliver the same standard of health care services.”
The Stakes Are High
The United States already has one of the highest maternal mortality rates among wealthy nations 鈥 as of 2024. According to the CDC, in the U.S. may be preventable. Medical research shows that pregnancy carries substantially higher risks of blood clots, stroke, and cardiovascular complications than hormonal contraception.
And since the Supreme Court’s Dobbs decision in 2022, which overturned the constitutional right to abortion established by Roe v. Wade, access to abortion has been significantly curtailed across much of the country. While national abortion numbers have risen, driven largely by telehealth and interstate access, research shows births have increased in states with bans, with an estimated , disproportionately among young women and women of color.
Dr. Christine Dehlendorf, who directs the Person-Centered Reproductive Health Program at the University of California-San Francisco, said “there is absolutely no evidence for any positive outcome of restricting access to contraception.” Restrictions would instead increase demand for abortion care and make it harder for women to prevent high-risk pregnancies.
Since Trump returned to office, more than a dozen Title X grantees have had their grants frozen, forcing some health centers to stop delivering services, lay off staff, or close. During the first Trump administration, regulatory changes led to a decline in Title X participation from more than . The program grew slowly under the Biden administration, reaching about 3 million clients, before the current round of disruptions began.
The second Trump administration’s overhaul of the program, Marcella said, “directly undermines the public health intent of our nation’s family planning program and will potentially exclude millions of individuals from getting the care they have relied on for decades. It’s bad policy.”
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At the Trump administration’s request, a federal judge in Louisiana this week agreed to delay a ruling affecting the continued availability of the abortion drug mifepristone. That angered anti-abortion groups that want the drug, if not banned, at least more strictly controlled. But the administration clearly wants to avoid big abortion fights in the run-up to November’s midterm elections.
Meanwhile, the administration’s proposed budget for fiscal year 2027 calls for more than $15 billion in cuts to programs at the Department of Health and Human Services. It’s a significant number, but less drastic than cuts it proposed for fiscal 2026.
This week’s panelists are Julie Rovner of 麻豆女优 Health News, Lauren Weber of The Washington Post, Alice Miranda Ollstein of Politico, and Maya Goldman of Axios.
Panelists
Among the takeaways from this week’s episode:
- The Trump administration says it is conducting a thorough scientific review of the abortion pill mifepristone at the Food and Drug Administration. Yet advocates on both sides of the abortion debate think the administration is just trying to buy time to avoid a controversial decision about medication abortion before November’s midterm elections.
- It’s budget time on Capitol Hill. With the unveiling of the president’s spending plan for fiscal 2027, Cabinet secretaries will make their annual tour of congressional committee hearings. HHS Secretary Robert F. Kennedy Jr., whose Hill appearances have been few during his tenure, is scheduled to testify before six separate House and Senate committees before the end of the month.
- Back at HHS, Kennedy appears to be trying to reconstitute the Advisory Committee on Immunization Practices in a way that will enable him to restock it with vaccine skeptics without running afoul of a March court ruling that he violated federal procedures with his replacements last year.
- Continuing his efforts to promote his Make America Healthy Again agenda, Kennedy announced this week that he will launch his own biweekly podcast. He also announced efforts to combat microplastics in the water supply and to get hospitals to stop serving ultraprocessed food to patients.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: The Atlantic’s “,” by Katherine J. Wu.
Maya Goldman: 麻豆女优 Health News’ “,” by Amanda Seitz and Maia Rosenfeld.
Lauren Weber: CNN’s “,” by Holly Yan.
Alice Miranda Ollstein: Politico’s “,” by Simon J. Levien.
Also mentioned in this week’s podcast:
- JAMA Internal Medicine’s “,” by Lauren J. Ralph, C. Finley Baba, Katherine Ehrenreich, et al.
- 麻豆女优 Health News’ “,” by Vanessa G. Sánchez, El Tímpano.
- The New York Times’ “,” by Ellen Barry.
- Stateline’s “,” by Nada Hassanein.
- The Washington Post’s “,” by Lena H. Sun.
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: Hello, from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, April 9, at 9:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go.
Today, we are joined via video conference by Lauren Weber of The Washington Post.
Lauren Weber: Hello, hello.
Rovner: Alice Miranda Ollstein of Politico.
Alice Miranda Ollstein: Hi, everybody.
Rovner: And my fellow Michigan Wolverine this national championship week, Maya Goldman of Axios. Go, Blue!
Maya Goldman: Go, Blue.
Rovner: No interview this week, but plenty of news. So let’s get right to it. We’re going to start with reproductive health. On Tuesday, a federal judge in Louisiana ruled for the Trump administration and against anti-abortion forces in a lawsuit over the availability of the abortion pill mifepristone. Wait, what? Please explain, Alice, how the administration and anti-abortion groups ended up on opposite sides of an abortion pill lawsuit.
Ollstein: Yeah. So this has been building for a while, and it is not the only lawsuit of its kind out there. There are several. A bunch of different state attorneys general, who are very conservative and anti-abortion, have been suing the FDA in an attempt to either completely get rid of the availability of the abortion pill mifepristone or reimpose previous restrictions on it. So right now, at least according to federal rules, not according to every state’s rules, you can get it via telehealth. You can get it delivered by mail. You can pick it up at a retail pharmacy. You don’t have to get it in person handed to you from a doctor like you used to. So these lawsuits are attempting to bring back those restrictions or get the kind of national ban that a lot of groups want. And so you have other ones pending: Florida, Texas, Missouri, you have a bunch of ones. So this is the Louisiana version. And the Trump administration, it’s important to note, they are not defending the FDA or the abortion pill on the merits. They are saying, we don’t want this lawsuit and this court to force us to do something. We want to go through our own careful process and do our own internal review of the safety of mifepristone, and then we may decide to impose restrictions. But they’re asking courts to give them the time and space to complete that process and saying, you know, This is our power we should have in the executive branch. And so, in this case, the judge, in ruling for the Trump administration, basically just hit pause. This doesn’t get rid of the case. It just puts a stay on it for now, and that’s important. In some of these other cases, the Trump administration has asked the courts to throw out the case, but that was not the situation here. So this doesn’t mean that abortion pills are going to be available forever. This doesn’t mean nothing’s going to happen, and they’re going to be banned. This just means, you know, we’re kicking the can down the road.
Rovner: I was saying, just to be clear. I mean, we know that this FDA quote-unquote “study” 鈥 whether it is or isn’t going on 鈥 is part of, kind of, a delaying tactic by the administration, because they don’t want to really make abortion a big front-and-center issue in the midterms. So they’re trying to sort of run the clock out here. Is that not sort of the interpretation that’s going on right now?
Ollstein: That’s what people on both sides assume is going on. It’s really been fascinating how everyone is being kept in the dark about what’s happening inside the FDA 鈥 and if this review is even happening, if it’s real, if it’s in good faith, what is it based on? And so it’s become this sort of Rorschach test, where people on the left are saying, you know, They’re laying the groundwork to do a national ban. This is just political cover. They just want to wait until after the midterms, and then they’re going to go for it. And people on the right are saying, you know, The administration is cowardly, and they aren’t really doing anything, and they’re just trying to get us to shut up and be patient. We don’t know if either of those interpretations or neither of them are true.
Rovner: Lauren, you want to add something?
Weber: I just think it’s pretty clear this is also just on a [Health and Human Services Secretary Robert F.] Kennedy [Jr.] priority. I mean, let’s go back. The man 鈥 comes from one of the top Democratic political families originally. You know, there’s obviously been a lot of chatter around his anti-abortion beliefs. Now, obviously, he’s on a Republican ticket. I think some of that plays into this as well. And he already has his hand on the stove on so many other hot issues that, [if] I had to guess, I don’t think that they’re trying to rock the boat on this one. 鈥 I think, some background context too, to some of what’s going on.
Rovner: We’ll get to some of those hotter issues. But, meanwhile, the Journal of the American Medical Association [Internal Medicine] has a suggesting that medication abortion is so safe that it could be provided over the counter 鈥 that’s without any consultation with a medical professional, either in person or online. This doesn’t feel like it’s going to happen anytime soon, though, right? While we’re still debating the existence of medication abortion in general.
Ollstein: That’s right. I mean, there are a lot of people who can’t get this medication prescribed by a valid doctor right now, let alone over the counter. I will say it is common in a lot of parts of the world to get it over the counter, whereas in the United States, the most common way to have a medication abortion is with a two-pill combination, mifepristone and misoprostol. In a lot of parts of the world, people just use misoprostol alone, and it is effective and it is largely safe. It’s slightly less safe than using both pills together. And so I think there’s a lot of international data out there, and people point to that and advocate for this. And I will say there are activist groups in the United States who are setting up networks, underground networks, to get these pills to people with no doctor’s involvement. And so that is already going on. I think that a lot of people would prefer to get it from a doctor if they could. But because of bans and restrictions, they can’t. And so people are turning to these activist groups.
Rovner: I will point out, as a person who covered the entirety of the fight to have emergency contraception 鈥 which is not the abortion pill 鈥 made over the counter, it took like, 15 years. It shortened my life covering that story. Lauren, did you want to add something?
Weber: Yeah, I just wanted to say I find it really interesting. Obviously, reproductive issues end up taking 15 years, as you pointed out, to make it over the counter. But there are a lot of things that are considered potentially more dangerous that you can order up in a pretty basic telehealth visit or even just buy in not-so-sketchy ways that the administration is also even looking to deregulate. So I think the differences of access of this compared to other less studied, potentially more unsafe medication is quite striking.
Goldman: Part of [President Donald] Trump’s “Great Healthcare Plan” is making more medications available over the counter. So this is certainly something that they have said they want to do, in general. This is a political nightmare, though, to do that for abortion.
Ollstein: Yeah, and people have been pointing to this and a lot of other policies for a while to argue about something they call abortion exceptionalism, in which people apply a different standard to anything related to abortion, a different safety standard, a different standard of scrutiny than they do to medications for lots of other purposes. And you’ve seen that, and that comes up in lawsuits and political arguments about this. And I think, you know, people can point to this as another example.
Rovner: So last week, we talked about the federal family planning program Title X, which finally got funded after months of delays. But Alice, you warned us that the administration was planning to make some big changes to the program, and now those have finally been announced. Tell us what the plan is for a program that’s provided birth control and other types of primary and preventive care since the early 1970s.
Ollstein: Well, the changes have sort of been announced. They’ve more been teased. What we are still waiting for is an actual rule, like we saw in the first Trump administration, that would impose conditions on the program. And so what we saw recently, it was part of a wonky document called a “Notice of Funding Opportunity,” or NOFO, for those in the D.C. lingo. And basically it was signaling that when groups reapply 鈥 they just got this year’s money, but when they reapply for next year’s money 鈥 it sets up sort of new priorities and a new focus for the entire program. And what was really striking to me is, you know, this is a family planning program. It was created in the 1970s and it is primarily about delivering contraception to people who can’t afford it around the country, providing it to millions of people who depend on this program, and the word “contraception” did not appear in the entire 70-page document other than an assertion that it is overprescribed and has bad side effects. And instead, they signaled that they want to shift the program to focus on, quote, “family formation.” So this is really striking to me. I think we saw some signs that something like this was coming. You know, about a year ago, there was some Title X money approved to focus on helping people struggling with infertility. But that was sort of just a subset of the program, and now it looks like they want to make that, you know, an overriding focus of the program. So I think when the actual rule to this effect drops, and we don’t know when that will be 鈥 will they wait till after the midterms to, you know, avoid blowback? Who knows? I think there will certainly be lawsuits then. But I think right now, this is just sort of a sign of where they want to go in the future. And it’s important to note that it came very quickly on the heels of a big backlash from the anti-abortion movement over the approval of this year’s funding going out to all of the clinics that got it before, including Planned Parenthood clinics. The anti-abortion groups were agitating for Planned Parenthood to be cut off at once, you know, not in the future, right now.
Rovner: Just to remind people that the ban on Planned Parenthood funding from last year was for Medicaid, not for the Title X program.
Ollstein: Right.
Rovner: And that’s why Planned Parenthood got money.
Ollstein: Yes, and Planned Parenthood is not allowed to use any Medicaid or Title X money for abortions, but the anti-abortion groups say it functions like a backdoor subsidy, and so they wanted it to be cut off. So they were very pissed that this money went out to Planned Parenthood. And so very quickly after, the administration put out this document, saying, Look, we are taking things in another direction, and it is not the direction of Planned Parenthood.
Rovner: Lauren, you want to add something?
Weber: Oh, I just wanted to say Alice has really been owning the beat on all the Title X coverage, so 鈥
Rovner: Absolutely.
Weber: 鈥 glad we are able to have her explain it to us. But just wanted to throw out a kudos for breaking all the news on that front.
Goldman: Yeah, great coverage.
Rovner: Yes. Very happy to have you for this. Turning to the budget, which is normally the major activity for Congress in the spring, we finally got President Trump’s spending blueprint last week. It does propose cuts to discretionary spending at the Department of Health and Human Services to the tune of about $15 billion, but those cuts are far less deep than those proposed last year. And, as we have noted, Congress didn’t actually cut the HHS budget last year by much at all. And many programs, like the National Institutes of Health, actually got small increases. Is this budget a reflection of the fact that the administration is recognizing that cuts to Health and Human Services programs aren’t actually popular with the public or with Congress, for that matter, going into a midterm election?
Weber: I think it’s that last little piece you mentioned there, Julie. I think it’s the “going into the midterm election.” I think you hit the nail on the head there. Cuts are also not good economically for many Republicans. You know, we saw Katie Britt be one of the 鈥 the Alabama Republican senator 鈥 be one of the most outspoken senators in general about some of the cuts that were floated for the budget for HHS last year. So I think what you’re hinting at, and what we’re getting at, is that it’s not politically popular, it can be economically problematic, on top of the scientific advances that are not found. So I suspect you are right on that.
Ollstein: The administration knows that this is “hopes and dreams” and will not become reality. It did not become reality last year. It almost never becomes reality. And I think you can see the sort of acknowledgement that this is about sending a message more than actually making policy in things like Title X, because at the same time they put out this guidance from HHS about the future of Title X, moving away from contraception, in the president’s budget he proposed completely getting rid of Title X, completely defunding it, which he has in the past as well. And so why would they put out guidance for a program that doesn’t exist?
Goldman: I think, also, this is the second budget that they’re putting out in this administration, right? So now they are just a little more used to what’s going on, and they have more of their feet under them.
Weber: As a preview for listeners, too, I’m sure we will have Kennedy asked about this budget when he appears in a series of so many hearings next week and the week after. And there were a lot of fireworks last year with him and various members of Congress about the budget. So I am sure that we will hear a lot more on this front in the weeks to come.
Rovner: Yeah, I would say that’s one thing that the budget process does, is when the president finally puts out a budget, the Cabinet secretaries travel to all of the various committees on Capitol Hill to, quote, “defend the president’s budget,” which is sometimes or, I guess in the case of Kennedy, one of the few chances that they get to actually have him in person to ask him questions. But in the meantime, you know, we have the budget, then we have the president himself, who at an Easter lunch last week 鈥 that was supposed to be private, but ended up being live-streamed 鈥 said, and I quote, “It’s not possible for us to take care of day care, Medicare, Medicaid, all these individual things.” The president went on to say that states should take over all that social spending, and the only thing the federal government should fund is, quote, “military protection.” Did I just hear a thousand Democratic campaign ads bloom?
Goldman: I think this is a prime example of when you should take Trump seriously, but not literally. I don’t think that there’s any world, at least in the foreseeable future, where the federal government isn’t funding Medicare. But, you know, you certainly have to watch at the margins. It’s like, it’s not a secret that this is something that they’re interested in cutting back spending on. It’s super politically difficult to do that, and they know that, and that’s part of why, which I’m sure we’ll talk about in a little bit, they bumped up the payment rate for 2027 to Medicare Advantage plans.
Rovner: Which we will get to.
Goldman: Yeah, so I mean, it’s certainly an eye-opening statement, and you should remember it. But I don’t think that we’re in immediate jeopardy here.
Rovner: This is the president who ran in 2024, you know, saying that he was going to protect Medicare and Medicaid. I mean, it’s been, you know, against some of the recommendations of his own administration. I was just sort of shocked to see these words come out of his mouth. Lauren, you wanted to say something?
Weber: I mean, it’s not that surprising, though. I mean, look at what the One Big Beautiful Bill [Act] did to Medicaid. He’s already pushed through massive Medicaid cuts, which are essentially being offloaded to the states. So, I mean, I think this ideology has already borne out and will continue to bear out, and obviously it’s happening amid the backdrop of a war. So that plays into, obviously, the commentary as well.
Rovner: Well, meanwhile, Republicans are still talking about doing another budget reconciliation bill, the 2.0 version of last year’s Big Beautiful Bill, except this time it’s essentially just to fund the military and ICE [Immigration and Customs Enforcement] and border control, because Democrats won’t vote for those things, at least they won’t vote for additional military spending. What are the prospects for that to actually happen? And would Republicans really be able to do it if those programs are paid for with more cuts to Medicare and/or Medicaid, as some have suggested?
Goldman: You know, my co-worker Peter Sullivan wrote about this last week, and there was a lot of blowback from politicos, from advocates, from, you know, kind of across the spectrum of groups there. I think that it would be extremely politically unpopular, especially going into the midterms, to use health care as an offset. But I would say that Republicans are pretty good at rhetoric, right? That’s one of the things that they’re known for right now, and there’s always a way to spin it.
Rovner: Alice and I spoke to a group earlier this week, and I went out on a limb and predicted that I didn’t think Republicans could get the votes for another big budget reconciliation this year. I mean, look at how close it was last year. The idea of cutting any deeper seems to me unlikely, just given the margins that they have.
Goldman: And I think that is something that you do in between election years. That’s not something you do in an election year.
Rovner: That’s true, yes 鈥 you do tend to see these bigger bills in the odd-numbered years rather than the even-numbered years, but 鈥
Ollstein: And I think it’s important to remember that the reason Republicans are in this bind and that they feel like they have to keep reconciliation nearly focused on funding immigration enforcement is because Democrats refuse to fund immigration enforcement. And so they feel pressured to put all their effort and political capital towards that, and don’t want to mess that up by adding a bunch of other health care things that could cause fights and lose them votes.
Goldman: The money has got to come from somewhere.
Rovner: And health care is where all the money is. Speaking of Medicare and Medicaid, where most of the money is, there is news on those fronts, too. Maya, as you hinted on Medicare, the administration is out with its payment rule for private Medicare Advantage plans for next year. And remember, we talked about how HHS was going to really go after overbilling in Medicare Advantage and cut reimbursement dramatically? Well, you can forget all that. The final rule will provide plans with a 2.48% pay bump next year. That’s compared to the less than 1% increase in the proposed rule. That’s a difference of about $13 billion. The final rule also eliminated many of the safeguards that were intended to prevent overbilling. What happened to the crackdown on Medicare Advantage? Are their lobbyists really that good?
Goldman: Their lobbyists are pretty good. This was a year where there were 鈥 I think CMS [the Centers for Medicare & Medicaid Services] said there were a record number of public comments on their proposed rate, flat rate increase, flat rate update. But I think it’s also not that surprising. Historically, the final rate announcement for Medicare Advantage is almost always a little higher than the proposed because they incorporate additional data from the end of the previous year that wasn’t available when first rate is proposed, the initial rate is proposed. But certainly they backed away from a big change to risk adjustment, or, like, the way to adjust payment based on how sick a plan’s enrollees are. You get more pay 鈥
Rovner: Because that’s where the overbilling was happening, that we’d seen a lot of these wonderful stories that plans were basically, you know, inventing diagnoses for patients who didn’t necessarily have them or didn’t have a severe illness, and using that to get additional payments.
Goldman: Right. And they did move forward with a plan to prevent diagnoses that are not linked to information that’s in a patient’s medical chart from being used for risk adjustment. But a lot of plans had said, like, Yeah, this is, that’s the right thing to do, and it’s not going to be that impactful for us. You know, overall, this is a win for health insurance. I think one thing to note is that Chris Klomp, the director of Medicare, said, We’re still really focused on trying to right-size this program. That’s still a priority for us as an administration, but we also want to safeguard it. And so I think insurers are not off the hook entirely. There’s still going to be a lot of scrutiny, but their lobbyists are pretty good. And you know, no one wants to be seen as the candidate that cuts Medicare.
Rovner: And we have seen this before, that when Congress cuts “overfunding” for Medicare Advantage, the plans, seeing that they can’t make its big profits, drop out or they cut back on those extra benefits. And the beneficiaries complain because they’re losing their plans, or they’re losing their extra benefits, and they don’t really want to do that in an election year either, because there are a lot of people, many millions of people, who vote who are on these plans. So, in some ways, the plans have the administration over a political barrel, in addition to how good their lobbyists are.
Well, apparently, one group that HHS is still cracking down on are legal immigrants with Medicare. Most of the publicity around the health cuts in last year’s budget bill focused on the cuts to Medicaid. But about legal immigrants who’ve paid into the Medicare system with their payroll taxes for years and are now being cut off from their Medicare coverage. This is apparently the first time an entire category of beneficiaries are having their Medicare taken away. I’m surprised there hasn’t been more attention to this, or if it’s just too much all happening at once.
Ollstein: I mean, there’s a lot happening at once, and even just in the space of immigrants’ access to health care, there is so much happening at once. And so this is obviously having a huge impact on a lot of people, but so are 100 other things. And I think, you know, the zone has been flooded as promised. And really, state officials who are also dealing with a thousand other things, Medicaid cuts, you know, these federal changes, work requirements, are grappling with this as well.
Rovner: Lauren, you wanted to add something?
Weber: Yeah. I mean, I thought it was, there was a striking quote in the story from Michael Cannon, who basically said, The reason this isn’t resonating is because this won’t upset the Republican base. And I think that’s a striking quote to be considered.
Rovner: Michael Cannon, libertarian health policy expert, just kind of an observer to this one. But yeah, I think that’s true. I mean, or at least the perception is that these are not Republican voters, although, you know, as we’ve seen, you know, Congress has tried to take aim at people they think aren’t their voters, and it’s turned out that those are their voters. So we will see how this all plays out.
Well, at the same time that this is all going on, the folks over at the newsletter “Healthcare Dive” are reporting that the Centers for Medicare & Medicaid Services are trying to embark on all these new initiatives on fraud, and work requirements, and artificial intelligence with a diminished workforce. While CMS lost far fewer workers in the DOGE [Department of Government Efficiency] cuts last year than many other of the HHS agencies 鈥 it was in the hundreds rather than the thousands 鈥 CMS has long been understaffed, given the fact that it manages programs that provide health insurance to more than 160 million Americans through not just Medicare and Medicaid, but also the Children’s Health Insurance Program and the Affordable Care Act. I know last week, FDA Commissioner Marty Makary said he wants to hire more workers to replace the 3,000 who were RIF’ed or took early retirement there at the FDA. And CMS does have lots of job openings being advertised. But it’s hard to see how replacing trained and experienced workers with untrained, inexperienced ones are going to improve efficiency, right?
Goldman: Tangentially, I was talking to a health insurance executive yesterday who was saying that his team is so much bigger than CMS, and they cover a fraction of the market, and they’re often the ones coming to CMS and proposing ideas and working with CMS on it. I don’t, I think that is a dynamic that far predates this administration, but 鈥
Rovner: Oh, absolutely.
Goldman: But it’s certainly interesting. And 鈥 CMS has very ambitious plans, and not that many people to carry them out. But, you know, I think one thing that I also want to note is that when I talk to trade associations and stakeholders about this CMS, they are generally like, pretty support- 鈥 like, they say that they think they’re being heard, and they think that CMS and the career staff are doing, you know, the same kind of caliber of work that they’ve been doing, which I think is notable.
Rovner: And as we have mentioned many times, you know, Dr. [Mehmet] Oz, the head of CMS, is very serious about his job and doing a lot of really interesting things. It’s just, it’s hard, you know, in the federal government, if you don’t have the resources that you want to 鈥 if you don’t have the resources to match your ambitions. Let’s put it that way.
Well, meanwhile, on the Medicaid front, we’re already seeing states cutting back, and some of the results of those cutbacks. on how psychiatric units are at risk of being shut down due to the Medicaid cuts, since they often serve a disproportionate number of low-income people and also tend to lose money. And The New York Times has a of an Idaho Medicaid cutback of a program that had provided home visits to people living in the community with severe mental illness, until those people who lost the services began to die or to end up back in more expensive institutional care. Now the state has resumed funding the program, but obviously will end up having to cut someplace else instead. I know when Republicans in Congress passed the cuts last year, they said that people on Medicaid who were not the able-bodied working-age populations wouldn’t see their services cut. But that’s not how this is playing out, right?
Weber: I just think the story by Ellen Barry, who you should always read on mental health issues in The New York Times, “,” is such an illustrative example of unintended consequences from these cuts. And the reason that they’re being reversed 鈥 by Republican legislators, no less 鈥 in Idaho, is because it’s more expensive to have cut the money from it than it is efficient. I mean, what they found was, is that after they cut the money to the schizophrenia program, they saw this massive uptick in law enforcement cases and hospitalizations, uninsured hospitalizations, that this avoided. And I think it’s a real canary in the coal mine situation, because we’re only starting to see these states cut these things off. And this was a pretty immediate multiple-death consequence. And I think we’re going to see a lot of stories like this, of a variety of programs that we all don’t even have any idea that exist in the safety net across the country that are being chipped away at.
Rovner: Well, turning to other news from the Department of Health and Human Services, we’re getting some more competition here at What the Health? Health secretary Kennedy has announced he’ll be unveiling his own podcast, called The Secretary Kennedy Podcast, next week. He promises to, according to the trailer posted online on Wednesday, quote, “name the names of the forces that obstruct the paths to public health.” OK then, we look forward to listening.
Meanwhile, in actual secretarial work, the secretary this week also unveiled changes to the charter of the Advisory Committee on [Immunization] Practices after a federal judge last month invalidated both the replacement members that he’d appointed last year and the changes made to the federally recommended vaccine schedule. So what’s going to happen here now? Will this get around the judge’s ruling by watering down the expertise that members of this advisory committee are supposed to have in vaccines? And why hasn’t the administration appealed the judge’s ruling yet?
Goldman: You know, I don’t have actual answers to this, but I do wonder and speculate that this is going to end up being some kind of legal whack-a-mole situation where the secretary and HHS says, OK, you don’t like it that way? We’ll do it this way, and then they’ll do it another way, and advocates will sue, and we’ll see how this plays out going forward in the courts. I think this is not the end of the story. Even though the judge’s decision was a big win for vaccine advocates, it’s just we’re in the midpoint, if that.
Rovner: And Lauren, speaking of vaccines, your colleague Lena H. Sun has on HHS and vaccine policy.
Weber: Yeah, Lena Sun is always delivering. She found out that the acting director of the CDC [Centers for Disease Control and Prevention] at the time delayed publication of a report showing that the covid-19 vaccine[s] cut the likelihood of emergency department visits and hospitalizations for healthy adults last winter by about half. So even though Kennedy is not talking more about vaccines, it appears that, based on this reporting, that some of his underlings are not necessarily touting the benefits of vaccine, so to speak. And I’m very curious, going back to Kennedy’s podcast, I found the rollout of that so interesting because the teaser was very leaning into the Kennedy that got elected, you know, someone who speaks about, you know, dark truths that are hidden from the public, and so on. And then the press team had these statements of, like, Kennedy will investigate the affordability of health costs and food and nutrition. And I think this dichotomy of who Kennedy is and who the White House and the press secretary and HHS want Kennedy to be before the midterms really could come to a head in this podcast. So I think we will all be listening to hear how that goes.
Rovner: Yeah, we keep hearing about how the secretary is being, you know, sort of put on a leash, if you will. And, you know, told to downplay some of his anti-vaccine views and things like this. And that seems quite at odds with him having his own podcast. Alice, do you want to 鈥?
Weber: I guess, it depends on who’s editing the podcast and who they have on. I’m just very 鈥 you could even tell from the trailer to how his press secretary presented it, there was an interesting differential in framing, and I am curious how that plays out as we see guests on it.
Ollstein: I mean, it’s also worth noting that this is an administration of podcasters. I mean, you have Kash Patel, you have so many of these folks who have a history of podcasting, clearly have a passion for it, just can’t let it go while working a full-time, high-pressure government job.
Rovner: We shall see. Meanwhile, HHS, together with the Environmental Protection Agency, is waging war on microplastics, those nearly too impossible to detect bits of plastic that are getting into our lungs and stomachs and body tissues through air and water and food. The plan here seems to be to find ways to detect exactly how much microplastics we are all getting in our water and what the health impacts might be, since we don’t have enough information to regulate them yet. I would think this would be one of those things that pleases both MAHA [Make America Healthy Again] and the science community, right? Or is it just, as one MAHA supporter called it, theater?
Goldman: I think this is a great example of the, you know, part of the reason why MAHA is so interesting to such a wide swath of people. Like, there’s a lot of legitimate concern, not that other concerns aren’t necessarily legitimate, but there’s a lot of concern over, from the scientific community, over microplastics. I’m honestly surprised that we’re this far into the administration with this announcement. I would have thought that this is something they would have done sooner, but they obviously had other priorities as well.
Rovner: Well. Finally, this week, speaking of other priorities, HHS Secretary Kennedy and CMS Administrator Dr. Oz are declaring war on junk food in hospitals. Again, this seems like a popular and fairly harmless crusade; hospitals shouldn’t be serving their patients ultraprocessed food. Except, almost as soon as the announcement came out, I saw tons of pushback online from doctors and nurses who worried about patients for whom sugary food or drinks are actually medically indicated, or who, because of medications they’re taking, or illnesses they have, can only eat, or will only eat, highly palatable, often processed food. Nothing in health care is as simple as it seems, right?
Weber: I think what’s also interesting is one of my favorite examples in the memo they put out was they hope that every hospital, as an example, could serve quinoa and salmon. And I just am curious to see how fast that gets implemented. And it’s a very valid 鈥 a lot of people complain about hospital food. It’s a very valid thing to push for better food. But I also question, as I understand it, this seems more like a carrot than a stick when it comes to the regulation they put out.
Rovner: As it were.
Weber: As it were. And so I’m curious to see how it gets implemented. That said, there are hospitals that have taken it upon themselves 鈥 the Northwell [Health] example in New York is a good example 鈥 to really improve their hospital food. And frankly, it’s a money maker. If your food’s better, people come to your hospital, especially in an urban area where there is hospital competition. So you know, like most MAHA topics, there’s a lot of interesting points in there, and then there’s a lot of what’s the reality and what’ actually going to happen. And so I’ very curious to see how this continues to play.
Rovner: I did a big story, like, 10 years ago on a hospital chain that had its own gardens, that literally grew its own healthy food. So this is not completely new but, again, interesting.
All right, that is this week’s news. Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Alice, why don’t you start us off this week?
Ollstein: I have a piece from my co-worker Simon [J.] Levien, and it is called “.” This is about thousands of doctors around the country who are from other countries that are placed on, you know, a list by the Trump administration of places where they want to scrutinize and limit the number of immigrants coming from there. And so these are people who are already here, already practicing, have poured years into their training, have been living here, and, in some cases, are the only folks willing to work in certain areas that have a lot of medical shortages, and they just can’t practice because their paperwork isn’t getting processed in time. And so they’re sort of in this scary limbo, and that’s putting these hospitals and clinics that they work in in a really tough bind. And so they’re hammering the Trump administration to give them answers about what their fate is. You know, they’re not trying to deport them yet, but they’re not allowing them to continue working either.
Rovner: For an administration that’s been pushing really hard to improve rural health care, this does not seem to be a way to improve rural health care. Maya.
Goldman: My extra credit this week is called “.” It’s a great 麻豆女优 Health News scoop from Amanda Seitz and Maia Rosenfeld. It’s a really great example of the administration, you know, sort of moving in silence, doing these small regulatory announcements that could have big impact. Basically, the Office of Personnel Management is asking for personally identifiable medical information from health insurers, and its reasoning is to analyze costs and improve the health system, but they could get very detailed medical information from federal employees, including things like, did they get an abortion? Are they undergoing gender-affirming care? And, obviously, there is a strong concern that that could be used against them.
Rovner: Yeah 鈥 this was quite a scoop. Really, really interesting story. Lauren.
Weber: Mine was a pretty alarming story by Holly Yan at CNN: “.” And basically there’s this type of drug test that the scientists have found is not that effective, and it’s led to things like bird poop being scraped off a man’s car appearing on a drug test as cocaine, a great-grandmother’s medication testing positive for cocaine, and a toddler’s ashes registering as meth or ecstasy, and horrible legal and other consequences of this kind of misdiagnosis in the field. And the reason these drug tests are often done is because they’re cheaper. There’s a more expensive, more accurate version, but these are cheaper. They’re done in the field. But the potential side effects and horrible, wrongly accused effects are quite large, and so Colorado has passed this law to try and move away from this. And it’s curious to see if other states will follow suit.
Rovner: Yeah, this was something I knew nothing about until I read this story. My extra credit this week is from The Atlantic by Katherine [J.] Wu, and it’s called “.” And it’s about how some of the very top career officials from the NIH [National Institutes of Health], the CDC, and other agencies have, after having been put on leave more than a year ago, finally been reassigned to far-flung outposts of the Indian Health Service in the western United States. They got news of their proposed reassignments with little description of their new roles and only a couple of weeks to decide whether to move across the country or face termination. Now, if these officials’ skills matched those needed by the Indian Health Service, this all might make some sense. But what the IHS most needs are active clinicians: doctors and nurses and social workers and lab technicians. And those who are now being reassigned are largely managers, including 鈥 and here I’m reading from the story, quote 鈥 “the directors of several NIH institutes, leaders of several CDC centers, a top-ranking official from the FDA tobacco-products center, a bioethicist, a human-resources manager, a communications director, and a technology-information officer.” The Native populations who are ostensibly being helped here aren’t very happy about this, either. Former Biden administration Interior Secretary Deb Haaland, a Native American who’s now running for governor in New Mexico, called the reassignment proposals, quote, “shameful” and “disrespectful.” Also, and this is my addition, not a very efficient use of human capital.
OK, that’s this week’s show. Thanks this week to our fill-in editor, Mary-Ellen Deily, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts 鈥 as well as, of course, . Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me on X , or on Bluesky . Where do you guys hang these days? Maya.
Goldman: I am on LinkedIn under my first and last name, , and on X at .
Rovner: Alice.
Ollstein: I’m on Bluesky and on X .
Rovner: Lauren.
Weber: Still @LaurenWeberHP on both and .
搁辞惫苍别谤:听We will be back in your feed next week.聽Until then, be healthy.
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<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2181013&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>MARQUETTE, Mich. 鈥 Providing abortions was the last thing Shawn Brown thought she’d be doing when she opened an urgent care clinic in this remote town in Michigan’s Upper Peninsula.
But she also wasn’t expecting the Planned Parenthood in Marquette to shut down last spring. Roughly 1,100 patients relied on that clinic each year for cancer screenings, IUD insertions, and medication abortions. Now the area has no other in-person resource for abortions. “It’s a 500-mile stretch of no access,” Brown said.
So the doctor, who describes herself as “individually pro-life,” added medication abortions to Marquette Medical Urgent Care’s already busy practice, which treats a steady flow of kids with the flu, college students with migraines, and tourists with skiing injuries.
At least 38 abortion clinics shut down last year in states where they’re still legal, according to data collected by , a project supported by a number of nonprofits that helps people find abortion options. Even states that recently protecting abortion rights, such as Michigan, have had clinics close since the U.S. Supreme Court overturned Roe v. Wade in 2022. And as shutter , patients are losing access to pregnancy care. “You cannot have a high-risk pregnancy up here,” Brown said. “It’s a scary place.”
Now communities are coming up with alternatives, such as Brown’s urgent care.
The idea that urgent cares “could be an untapped solution to closures for abortion clinics across the country is really exciting,” said Kimi Chernoby, the chief operating and legal officer at , a national nonprofit that works to improve professional training and patient outcomes for women in emergency medicine.
One patient at the Marquette urgent care on a recent day was a woman whom 麻豆女优 Health News agreed to identify by only her first initial, “A,” to protect her medical privacy. She drove more than an hour on snowy backroads while her kids were in day care to get to her appointment.
Her youngest is still a baby, A said, and she got pregnant again while taking the progestin-only birth control pill, which is less likely to interfere with breast milk production but slightly less effective than the regular pill.
“Financials, housing, vehicles 鈥 it’s a lot,” she said. And another baby is “just not something that we could really do even at this time.”
She said she was making the long round trip because receiving abortion care in an office felt more secure than being treated by “someone that I’ve never met, or receiving meds that were just shipped to me.”
Face-to-Face Care
In one of the urgent care’s exam rooms, A sat in a chair against the wall, waiting quietly for the doctor. Viktoria Koskenoja, an emergency medicine physician, knocked on the door and then greeted her warmly, pulling up a stool across from her.
“Are you confident in your decision that you want to go ahead? Or do you want to talk about options?” she said.
“No, I’m pretty set on it,” A said.
Koskenoja previously worked at Planned Parenthood. When she learned its Marquette clinic was closing, she started crying and making calls. She recalled asking everyone she knew in health care in Marquette: “What are we going to do?”
One of her first calls was to Brown, a friend and fellow emergency medicine doctor. Their families harvest maple syrup together each spring.
In the wake of the Planned Parenthood closure, Koskenoja convened a community meeting downtown at the Women’s Federated Clubhouse, an 1880s-era building where guests sip from gold-rimmed china teacups on lace tablecloths. The goal: brainstorm new ways to provide abortion access in the Upper Peninsula.
officials said that growing financial challenges and the Trump administration’s cuts to funding, including for the public insurance program Medicaid, had prompted the closures of some brick-and-mortar clinics in the state.
Plus, the availability of pills by mail exploded after the 2022 Dobbs v. Jackson Women’s Health Organization decision overturned Roe. As abortion became illegal in many states, telehealth abortions went from 5% of all abortions provided to 25% by the end of 2024, , a national reporting project that tracks shifts in abortion volume.
Planned Parenthood of Michigan’s telehealth appointments increased 13% for patients in the Upper Peninsula after the Marquette location closed, said Paula Thornton Greear, president and CEO of Planned Parenthood in the state.
All the abortion patients Koskenoja sees at the urgent care have one thing in common: They want to talk to someone in person.
“I had a patient order the pills online and then get scared to use them because they felt like they were going to screw it up, or they weren’t sure they could rely on the pills,” she said. “So they literally came in here with the pills in their hand.”
Others have medical complications or need an ultrasound to determine how far along they are with the pregnancy.
“It annoys me that telehealth is considered an acceptable thing in rural areas,” Koskenoja said. “As though we’re not the human beings that like talking to human beings and looking someone in the eye, especially when something serious is going on.”
The Urgent Care Option
The options presented at that community clubhouse meeting were limited. The few family medicine doctors and OB-GYNs in the area were either already putting patients on months-long waitlists or were too “rightward leaning,” Brown said.
But urgent cares are designed to fill gaps in the system, she said, ready to take walk-ins who aren’t already patients.
Brown knew from her years in the emergency room that medication abortions aren’t that complicated. The for first-trimester and are essentially the same: one dose of mifepristone, followed by misoprostol after 24 to 48 hours.
“Clinically, I was never worried about it,” she said.
The biggest hurdle was getting medical malpractice insurance, Brown said. At first, insurers balked, demanding “onerous and unrealistic” documentation and additional training, she said. Then they quoted a $60,000 annual premium for medication abortions 鈥 about three times the cost of insuring the entire urgent care. Ultimately, Brown said, the urgent care’s broker pushed back, providing data that medication abortions didn’t add “significant liability.”
The company agreed to a premium of about $6,000 per year, she said.
The community pitched in, too. A local donor covered an ultrasound machine. And supporters started a nonprofit to help pay for the costs of the medication and additional staffing, bringing the price for patients down from about $450 to an average of about $225, based on a sliding scale.
Word spread quickly once Marquette Medical began offering medication abortions, Brown said. Now the office provides as many as four per week, with patients traveling from as far away as Louisiana. The clinic is on track to match the volume of abortion patients treated at the local Planned Parenthood office before its closure, Brown said.
As pills by mail become the next major target for abortion opponents, Chernoby said, it will be critical to offer more care in more brick-and-mortar places. Brown said the Marquette clinic has already fielded questions from a large academic medical center that plans to start providing medication abortion at its own urgent cares later this year.
“It’s a wonderful idea, but it’s potentially got major pitfalls,” said David Cohen, a professor at the Drexel University Kline School of Law who studies abortion access.
Urgent cares that provide medication abortion would have to abide by state-specific laws 鈥 some mandate 24-hour waiting periods or facility structural requirements 鈥 and federal regulations, such as the FDA’s requirement that mifepristone prescribers be certified by the drug’s distributors and obtain signed patient agreements.
If abortion access isn’t a core part of a health organization’s mission, “do you want to be on that list? I don’t know if you do,” Cohen said. “There’s just a very particular regulatory environment” around abortion.
Making a Choice
In the exam room, Koskenoja listened as A talked about why she decided to seek an abortion. She has four kids at home, including the baby.
“You OK if we do an ultrasound, just confirm how far along you are, make sure it’s not an ectopic pregnancy?” Koskenoja asked.
“Yeah,” A said.
Koskenoja noted A’s reaction to the question. “OK. You’re making a face?”
“Yeah, I just don’t 鈥 yeah, it’s fine. I just don’t want to see it.”
“Oh, you don’t have to see it,” Koskenoja said.
“I just don’t want to hear a heartbeat or anything like that,” A said.
“Definitely not,” Koskenoja said.
After the ultrasound, Koskenoja stepped out into the hall to give A time to call her partner.
When A said she was ready, Koskenoja stepped in and asked her how she was feeling. A had made up her mind. She said that her partner would be supportive of whatever she decided and that she didn’t want to have another baby right now.
“As much as I know this baby would be loved no matter what, it’s just not a good time,” A said quietly, her hands in her lap.
“Most people who get abortions love babies,” Koskenoja said. And you can still have more in the future, she assured A.
This kicked off a long conversation about the mental load of parenting and the pros and cons of various birth control options. A said she wanted to get her tubes tied, but Koskenoja suggested her partner consider a vasectomy instead. It’s a much less invasive procedure, she said. “You’ve had a lot of kids. I feel like it could be his turn to take some responsibility.”
Koskenoja handed her a small, handsewn “comfort bag” that all medication abortion patients receive. It was filled with the pills, reminders about when to take them, a handwritten note of support from local community members, pain meds, comfortable socks, and a heating pad.
“Call us if you need anything,” she told A. “Any questions?”
“No,” A said.
“OK. Good luck,” Koskenoja said before A walked out past the waiting room, filled with sick babies and other patients, to drive back to her kids.
This <a target="_blank" href="/health-care-costs/abortion-providers-clinics-closing-urgent-care-michigan-upper-peninsula/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2174428&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>A mom of seven, Pipe is a doula on the reservation who supports new and expectant parents. She does that work free, around her day job. That’s because in this town of about 2,000 people, the closest hospital that delivers babies is 100 miles away.
“Women need this help,” Pipe said.
Doulas ready parents for childbirth, support their deliveries, and can be a steady presence in a baby’s first months. their work with lower rates of costly birth and postpartum complications 鈥 especially in hard-to-reach places like Lame Deer.
But that help can be scarce. As Pipe put it: “Doula doesn’t pay the bills around here.”
Things were supposed to change this year. Montana was set to join that reimburse doulas through their Medicaid programs to ease gaps in care. Montana lawmakers approved the payments last year, authorizing up to $1,600 per pregnancy. Pipe hoped that money would give her the chance to leave her post office job one day to help more parents.
But the state Department of Public Health and Human Services postponed adding doula services to its Medicaid program in late March, citing a budget shortfall driven in part by higher-than-expected Medicaid costs.
“DPHHS will not be moving forward with the implementation of doula services in the Montana Medicaid benefit package at this time,” department spokesperson Holly Matkin told 麻豆女优 Health News.
The news caught Pipe by surprise 鈥 she hadn’t heard any updates in a while, but the state had finalized its licensing rules for doulas in January. Last year, she supported three people through their deliveries. She doesn’t have time for much more. That weighs on her. the people on the Northern Cheyenne Indian Reservation , and the people she helps usually can’t afford to pay a doula.
“I was looking forward to serving more people,” Pipe said. “Now that’s not going to happen anytime soon.”
Charlie Brereton, who heads the health department, told state lawmakers in March that the agency projected a $146.3 million shortfall in federal Medicaid funds for this year. Health officials predict another deficit next year as states feel the effects of Republicans’ massive tax-and-spending law, the One Big Beautiful Bill Act. Signed last year, that law is projected to reduce federal Medicaid spending by nearly $1 trillion over 10 years.
Matkin said it’s “unclear” whether the agency can authorize doula coverage this year. The deficit will lead the department to seek supplemental funding from state lawmakers. When an agency makes that kind of request for the first year of the state’s two-year budget cycle, requires it to create a plan to reduce its spending.
Around the country, optional Medicaid services 鈥 such as doula support, home health care, and dental work 鈥 are at risk of losing funding as states brace for federal Medicaid cuts to hit their bottom lines. Already, lawmakers in Idaho are considering their own reductions to Medicaid to balance the state’s budget. cutting tens of millions of dollars in services for people with disabilities.
In Montana, doula services are unlikely to be the only Medicaid cutbacks announced. “All options are on the table,” Brereton told lawmakers in March.
Stephanie Morton, executive director of Healthy Mothers, Healthy Babies-The Montana Coalition, said more than half of Montana’s counties are designated as maternity care deserts.
“Budget cuts will continue to diminish the limited services families rely upon in these counties,” said Morton, whose nonprofit had advocated for doula Medicaid reimbursement. “This decision feels like the first of many rollbacks and cuts Montanans will face.”
Laboring Alone
At the check-in just outside town, Pipe handed a waking newborn to his mother and unwrapped a new swaddle for the child. This would have to be a quick visit 鈥 she was already late for work.
The mother, Britney WolfVoice, held her newborn son as her three young daughters stood close by. Pipe has been with WolfVoice and her husband for the birth of their newborn son and youngest daughter.
She helped them create delivery plans. For the birth of WolfVoice’s youngest daughter a few years ago, Pipe brought cedar oil, a sacred plant used for prayer, and calmed WolfVoice through her contractions. For the recent birth of her son, when hospital backlogs delayed WolfVoice’s induction, Pipe encouraged her to advocate for an earlier appointment by routinely calling the hospital. Doctors had recommended the procedure to avoid complications.
“Misty is one person who I can count on to be my voice,” WolfVoice said.
If someone needs a ride to a doctor’s appointment, Pipe takes time off work to drive them. If a client goes into labor when Pipe’s at the post office, she texts two other free doulas she knows of on the reservation to see if they have time to help until her shift ends. But they also have day jobs.
Pipe herself has ridden that 100-mile stretch between home and the hospital in labor and in the back of an ambulance. Twice, she gave birth in emergency rooms along the way. In one of her pregnancies, she miscarried at home and couldn’t get a doctor appointment for days.
The long distance to receive care often meant her husband had to stay behind to tend to their other children at home.
“I labored alone so many times,” Pipe said. “I just want to make sure no one’s alone.”
Rural maternity care deserts are a , especially as labor and delivery units continue to shutter. In many tribal communities, a lack of care coincides with long-standing inequities caused by centuries of .
Predominantly Indigenous communities face the longest distances to obstetric facilities compared with all other racial and ethnic groups, according to a 2024 report from the March of Dimes. That’s part of the reason Indigenous women are far more likely to get sick from pregnancy and as white women.
Indigenous patients are supposed to be guaranteed access to health care through the federal Indian Health Service. But the chronically underfunded agency has severe gaps. A small fraction of its hospitals and clinics offer labor and delivery. As of 2024, only seven states had either an IHS or tribal birth facility, . To help fill in those shortfalls, Medicaid is the for many Native Americans, according to 麻豆女优.
Even where care exists, Native women can experience a distrust of health systems, according to Pipe and other health workers. The U.S. government has a long history of removing children from tribal homes and forcing Native American women to undergo sterilization.
of the Pacific Institute for Research and Evaluation’s Southwest center has studied premature deaths among Native Americans. A member of the Fort Sill-Chiricahua-Warm Springs-Apache Tribe, Haozous said data on maternal health disparities in pregnancy and postpartum often misses a key point.
“It’s not that women are just not taking care of themselves,” Haozous said. “The system is set up for them to not have access to care.”
On top of funding cuts, the One Big Beautiful Bill Act will add more frequent eligibility checks and work requirements to access Medicaid. Those changes, when they take effect later this year and next, will lead an estimated 5.3 million people to lose their coverage by 2034.
Native Americans are exempt from some of the law’s new rules, such as the work requirements. Even so, tribal patients can get tangled in administrative hurdles. That includes struggling to enroll in the first place or to prove their tribal status. A full-time college student, WolfVoice said that when she got pregnant, it took about six months to enroll in the state’s Medicaid program.
Despite Montana’s long struggle with a backlogged Medicaid system, state officials aim to implement work requirements this summer, well before the federal deadline.
鈥Moccasins on the Ground’
As Pipe pulled into her driveway one day after a full shift at the post office, her kids ran to her. She was also greeted by Felicia Blindman, a 63-year-old public health nurse who used to work for the tribe. The two sat in lawn chairs into the night and brainstormed ways to connect more women to services 鈥 such as free prenatal classes.
Pipe’s four youngest children played around them. Her 14-year-old daughter is already certified as an Indigenous doula. Her 8-year-old daughter has begun helping Pipe pick up prescriptions for moms without a car who live out of town. Pipe hopes one day they could do that work full-time, if they want to.
Because of the lost Medicaid payment, Pipe said, she will continue to balance her job with her birth work, even if it means persuading more people to become doulas, such as family and respected community members, to cover more ground.
“It’s not going to stop me from training more birth workers, more young people, more aunties,” Pipe said. “For now, I guess it’s more about grassroots, moccasins on the ground, helping each other.”
She said that means telling pregnant people who walk into the post office she’s there to help if they need support. At least, as long as she’s not at her day job.
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The Trump administration this week missed a deadline to nominate a new director for the Centers for Disease Control and Prevention. Without a nominee, current acting Director Jay Bhattacharya 鈥 who is also the director of the National Institutes of Health 鈥 has to give up that title, leaving no one at the helm of the nation’s primary public health agency.
Meanwhile, a week after one federal judge blocked changes to the childhood vaccine schedule made by the Department of Health and Human Services, another blocked a proposed ban on gender-affirming care for minors.
This week’s panelists are Julie Rovner of 麻豆女优 Health News, Rachel Cohrs Zhang of Bloomberg News, Lizzy Lawrence of Stat, and Shefali Luthra of The 19th.
Panelists
Among the takeaways from this week’s episode:
- A federal judge ruled against the Trump administration’s declaration intended to limit trans care for minors, though the ruling’s practical effects will depend on whether hospitals resume such care. And a key member of the remade federal vaccine advisory panel resigned as the panel’s activities 鈥 and even membership 鈥 remain in legal limbo.
- Two senior administration health posts remain unfilled, after President Donald Trump missed a deadline to fill the top job at the Centers for Disease Control and Prevention 鈥 and the Senate made little progress on confirming his nominee for surgeon general.
- The percentage of international graduates from foreign medical schools who match into U.S. residency positions has dropped to a five-year low. That’s notable given immigrants represent a quarter of physicians, many of them in critical but lower-paid specialties such as primary care 鈥 particularly in rural areas. Meanwhile, new surveys show that more than a quarter of labs funded by the National Institutes of Health have laid off workers and that federal research funding cuts have had a disproportionate effect on women and early-career scientists.
- And new data shows the number of abortions in the United States stayed relatively stable last year, for the second straight year 鈥 largely due to telehealth access to abortion care. And a vocal opponent of abortion in the Senate, with his eyes on a presidential run, introduced legislation to effectively rescind federal approval for the abortion pill mifepristone.
Also this week, Rovner interviews Georgetown Law Center’s Katie Keith about the state of the Affordable Care Act on its 16th anniversary.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: Stat’s “,” by John Wilkerson.
Shefali Luthra: NPR’s “,” by Tara Haelle.
Lizzy Lawrence: The Atlantic’s “,” by Nicholas Florko.
Rachel Cohrs Zhang: The Boston Globe’s “,” by Tal Kopan.
Also mentioned in this week’s podcast:
- Stat’s “,’” by Jonathan Wosen.
- 麻豆女优 Health News’ “Rising Health Costs Push Some Middle-Aged Adults To Skip the Doc Until Medicare,” by Sam Whitehead.
- Guttmacher’s “,” by Isaac Maddow-Zimet and Kimya Forouzan.
- United for Medical Research’s “.”
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: Hello, from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest reporters covering Washington. We’re taping this week on Thursday, March 26, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go.
Today, we are joined via video conference by Rachel Cohrs Zhang of Bloomberg News.
Rachel Cohrs Zhang: Hi, everybody.
Rovner: Shefali Luthra of The 19th.
Shefali Luthra: Hello.
Rovner: And Lizzy Lawrence of Stat News.
Lizzy Lawrence: Hello.
Rovner: Later in this episode we’ll have my interview with Katie Keith of Georgetown University about the state of the Affordable Care Act as it turns 16 鈥 old enough to drive in most states. But first, this week’s news.
So, it has been another busy week at the Department of Health and Human Services. Last week, a federal judge in Massachusetts blocked the department’s vaccine policy, ruling it had violated federal administrative procedures regarding advisory committees. This week, a federal judge in Portland, Oregon, ruled the department also didn’t follow the required process to block federal reimbursement for transgender-related medical treatment. The case was brought by 21 Democratic-led states. Where does this leave the hot-button issue of care for transgender teens? Shefali, you’ve been following this.
Luthra: I mean, I think it’s still really up in the air. A lot of this depends on how hospitals now respond 鈥 whether they feel confident in the court’s decision, having staying power enough to actually resume offering services. Because a lot of them stopped. And so that’s something we’re still waiting to actually see how this plays out in practice. Obviously, it’s very symbolic, very legally meaningful, but whether this will translate into changes in practical health care access, I think, is an open question still.
Rovner: Yeah, we will definitely have to see how this one plays out 鈥 and, obviously, if and when the administration appeals it. Well, speaking of that vaccine ruling from last week 鈥 which, apparently, the administration has not yet appealed, but is going to 鈥 one of the most contentious members of that very contentious Advisory Committee on Immunization Practices has resigned. Dr. Robert Malone, a physician and biochemist, said he didn’t want to be part of the “drama,” air quotes. But he caused a lot of the drama, didn’t he?
Cohrs Zhang: He has been pretty outspoken, and I think he isn’t like a Washington person necessarily 鈥 isn’t somebody who’s used to, like, being on a public stage and having your social media posts appear in large publications. So I think it’s questionable, like, whether he had a position to resign from. I think his nomination was stayed, too. But I think it is 鈥 the back-and-forth, I think, there is a good point that this limbo can be frustrating for people when meetings are canceled at the last minute, and people have travel plans, and it does 鈥 just changes the calculus for kind of making it worth it to serve on one of these advisory committees.
Rovner: And I’m not sure whether we mentioned it last week, but the judge’s ruling not only said that the people were incorrectly appointed to ACIP, but it also stayed any meetings of the advisory committee until there is further court action, until basically, the case is done or it’s overruled by a higher court. So 鈥 vaccine policy definitely is in limbo.
Well, meanwhile, yesterday was the deadline for the administration to nominate someone to head the Centers for Disease Control and Prevention since Susan Monarez was abruptly dismissed, let go, resigned, whatever, late last summer. Now that that deadline has passed, it means that acting Director Jay Bhattacharya, who had added that title to his day job as head of the National Institutes of Health, can no longer remain acting director of CDC. Apparently, though he’s going to sort of remain in charge, according to HHS spokespeople, with some authorities reverting to [Health and Human Services] Secretary [Robert F.] Kennedy [Jr.]. What’s taking so long to find a CDC director?
To quote D.C. cardiologist and frequent cable TV health policy commentator , “The problem here is that there’s no candidate who’s qualified, MAHA acceptable, and Senate confirmable. Those job requirements are mutually exclusive.” That feels kind of accurate to me. Is that actually the problem? Rachel, I see you smiling.
Cohrs Zhang: Yeah. I think it is tough to find somebody who checks all of those boxes. And though it has been 210 days since the clock has started, I would just point out that there has been a significant leadership shake-up at HHS, like among the people who are kind of running this search, and they came in, you know, not that long ago. It’s only been, you know, a month and a half or so. So I think there certainly have been some new faces in the room who might have different opinions. But I think it isn’t a good look for them to miss this deadline when they have this much notice. But I think there’s also, like, legal experts that I’ve spoken with don’t think that there’s going to be a huge day-to-day impact on the operations of the CDC. It kind of reminds me of that office where there’s, like, an “assistant to the regional manager vibe” going on, where, like, Dr. Bhattacharya is now acting in the capacity of CDC director, even though he isn’t acting CDC director anymore. So, I think I don’t know that it’ll have a huge day-to-day impact, but it is kind of hanging over HHS at this point, as they are already struggling with the surgeon general nomination, to get that through the Senate. So it just creates this backlog of nominations.
Rovner: I’ve assumed they’ve floated some names, let us say, one of which is Ernie Fletcher, the former governor of Kentucky, also a former member of the House Energy and Commerce health subcommittee, with some certainly medical chops, if not public health chops. I think the head of the health department in Mississippi. There was one other who I’ve forgotten, who it is among the names that have been floated 鈥
Cohrs Zhang: Joseph Marine. He’s a cardiologist at Johns Hopkins, who has 鈥 is kind of like in the kind of Vinay Prasad world of critics of the FDA and, like, CDC’s covid booster strategy.
Rovner: And yet, apparently, none of them could pass, I guess, all three tests. Do we think it might still be one of them? Or do we think there are other names that are yet to come?
Cohrs Zhang: Our understanding is that there are other candidates whose names have not become public, and I think there’s also a possibility they don’t choose any of these candidates and just drag it on for a while because, at this point, like, I don’t know what the rush is, now that the deadline is passed.
Lawrence: Yeah, is there another deadline to miss?
Cohrs Zhang: I don’t think so.
Lawrence: I think this was the only one.
Cohrs Zhang: This was the big one that they now have. It’s vacant, but it was vacant before as well. Like, I think, earlier in the administration, when Susan Monarez was nominated.
Rovner: But she, well 鈥 that’s right, she was the “acting,” and then once she was nominated, she couldn’t be the acting anymore.
Cohrs Zhang: Yeah.
Rovner: So I guess it was vacant while she was being considered.
Cohrs Zhang: It was. So it’s not an unprecedented situation, even in this administration. It’s just not a good look, I guess. And I think there is value in having a leader that can interface with the White House and with different leaders, and just having a direction for the agency, especially because it’s in Atlanta, it’s a little bit more removed from the everyday goings-on at HHS in general. So I think there’s definitely a desire for some stability over there.
Rovner: And we have measles spreading in lots more states. I mean, every time I 鈥 open up my news feeds, it’s like, oh, now we have measles, you know, in Utah, I think, in Montana. Washtenaw County, Michigan, had its first measles case recently. So this is something that the CDC should be on top of, and yet there is no one on top of the CDC. Well, Rachel, you already alluded to this, but it is also apparently hard to find a surgeon general who’s both acceptable to MAHA and Senate confirmable, which is my way of saying that the Casey Means nomination still appears to lack the votes to move out of the Senate, Health, Education, Labor & Pensions Committee. Do we have any latest update on that?
Cohrs Zhang: I think the latest update, I mean, my colleagues at Bloomberg Government just kind of had an update this week that they’re still not to “yes” 鈥 like, there are some key senators that still haven’t announced their positions publicly. So I think a lot of the same things that we’ve been hearing 鈥 like Sens. Susan Collins and Lisa Murkowski and Bill Cassidy obviously have not stated their positions publicly on the nomination. Sen. Thom Tillis, who you know is kind of in a lame-duck scenario and doesn’t really have anything to lose, has, you know, said he’s not really made a decision. So I think they’re kind of in this weird limbo where they, like, don’t have the votes to advance her, but they also have not made a decision to pull the nomination at this time. So either, I think, they have to push harder on some of these senators, and I think senators see this as a leverage point that I don’t know that a lot of 鈥 that all of the complaints are about Dr. Means specifically, but anytime that there is frustration with the wider department, then this is an opportunity for senators to have their voice heard, to 鈥 potentially extract some concessions. And so there’s a question right now, are they going to change course again for this position, or are they going to, you know, sit down at the bargaining table and really cut some deals to advance her nomination? I just don’t think we know the answer to that yet.
Rovner: Yeah, it’s worth reminding that, frequently, nominations get held up for reasons that are totally disconnected from the person involved. We went 鈥 I should go back and look this up 鈥 we went, like, four years in two different administrations without a confirmed head of the Centers for Medicare & Medicaid Services because members of Congress were angry about other things, not because of any of the people who had actually been nominated to fill that position. But in this case, it does seem to be, I think, both Casey Means and, you know, her connection to MAHA, and the fact that among those who haven’t declared their positions yet, it’s the chairman of the committee, Bill Cassidy, who’s in this very tight primary to keep his seat. So we will keep on that one.
Also, meanwhile, HHS continues to push its Make America Healthy Again priority. Secretary Kennedy hinted on the Joe Rogan podcast last month that the FDA will soon take unspecified action to make customized peptides easier to obtain from compounding pharmacies. These mini-proteins are part of a biohacking trend that many MAHA adherents say can benefit health, despite their not having been shown to be safe and effective in the normal FDA approval process. The FDA has also formally pulled a proposed rule that would have banned teens from using tanning beds. We know that the secretary is a fan of tanning salons, even though that has been shown to cause potential health problems, like skin cancer. Lizzy, is Kennedy just going to push as much MAHA as he can until the courts or the White House stops him?
Lawrence: I guess so. I mean, we do have this new structure at HHS now that’s trying to 鈥 clearly 鈥 there are warring factions with the MAHA agenda and the White House really trying to focus more on affordability and less on 鈥 vaccine scrutiny and the medical freedom movement that is really popular among Kennedy’s supporters. 鈥 I’m very curious about what’s going to happen with peptides, because it’s a sign of Kennedy’s regulatory philosophy, where there’s some products that are good and some that are bad. It’s very atypical, of course, for 鈥
Rovner: And that he gets to decide rather than the scientists, because he doesn’t trust the scientists.
Lawrence: Right. Right. But there has been, I mean, the FDA has kind of been pretty severe on GLP-1 compounders Hims & Hers, so it’ll be interesting to see, you know, how much Kennedy is able to exert his will here, and how much FDA regulators will be able to push back and make their voices heard.
Rovner: My favorite piece of FDA trivia this week is that FDA is posting the jobs that are about to be vacant at the vaccine center, and one of the things that it actually says in the job description is that you don’t have to be immunized. I don’t know if that’s a signal or what.
Lawrence: Yeah, I think it said no telework, which Vinay Prasad famously was teleworking from San Francisco. So, yeah, I don’t know. But this was, I think it was for his deputy, although I’m sure, I mean, they do need a CBER [Center for Biologics Evaluation and Research] director as well.
Rovner: Yeah, there’s a lot of openings right now at HHS. All right, we’re gonna take a quick break. We will be right back.
So Monday was the 16th anniversary of the signing of the Affordable Care Act, which we will hear more about in my interview with Katie Keith. But I wanted to highlight a story by my 麻豆女优 Health News colleague Sam Whitehead about older Americans nearing Medicare eligibility putting off preventive and other care until they qualify for federal coverage that will let them afford it. For those who listened to my interview last week with Drew Altman, this hearkens back to one of the big problems with our health system. There are so many quote-unquote “savings” that are actually just cost-shifting, and often that cost-shifting raises costs overall. In this case, because those older people can no longer afford their insurance or their deductibles, they put off care until it becomes more expensive to treat. At that point, because they’re on Medicare, the federal taxpayer will foot a bill that’s even bigger than the bill that would have been paid by the insurance company. So the savings taxpayers gained by Congress cutting back the Affordable Care Act subsidies are lost on the Medicare end. Is this cost-shifting the inevitable outcome of addressing everything in our health care system except the actual prices of medical care?
Cohrs Zhang: I think it’s just another example of how people’s behavior responds to these weird incentives. And I think we’re seeing this problem, certainly among early retirees, exacerbated by the expiration of the Affordable Care Act subsidies that we’ve talked about very often on this podcast, because it affects these higher earners, and it can dramatically increase costs for coverage. And I think people just hope that they can hold on. But again, these statutory deadlines that lawmakers make up sometimes, not with a lot of forethought or rational reasoning, they have consequences. And obviously, the Medicare program continues to pay beyond age 65 as well. And I think it’s just another symptom of what the administration talks about when they talk about emphasizing, you know, preventative care and addressing chronic conditions 鈥 like, that is a real problem. And, yeah, I think we’re going to see these problems in this population continue to get worse as more people forgo care, as it becomes more expensive on the individual markets.
Luthra: I think you also make a good point, though, Julie, because the increase in costs and cost sharing is not limited to people with marketplace plans, right? Also, people with employer-sponsored health care are seeing their out-of-pocket costs go up. Employers are seeing what they pay for insurance go up as well. And there absolutely is something to be said about it’s been 16 years since the Affordable Care Act passed, we haven’t really had meaningful intervention on the key source of health care prices, right? Hospitals, providers, physicians. And it does seem, just thinking about where the public is and the politics are, that there is possibly appetite around this. You see a lot of talk about affordability, but a lot of this feels, at least as an observer, very focused on insurance, which makes sense. Insurance is a very easy villain to cast. But I think you’ve raised a really good point: that addressing these really potent burdens on individuals and eventually on the public just requires something more systemic and more serious if we actually want to yield better outcomes.
Rovner: Yeah, there’s just, there’s so much passing the hat that, you know, I don’t want to do this, so you have to do this. You know, inevitably, people need health care. Somebody has to pay for it. And I think that’s sort of the bottom line that nobody really seems to want to address.
Well, the other theme of 2026 that I feel like I keep repeating is what funding cutbacks and other changes are doing to the future of the nation’s biomedical and medical workforces. Last week was Match Day. That’s when graduating medical school seniors find out if and where they will do their residency training. One big headline from this year’s match is that the percentage of non-U.S. citizen graduates of foreign medical schools matching to a U.S. residency position fell to a five-year low of 56.4%. That compares to a 93.5% matching rate for U.S. citizen graduates of U.S. medical schools. Why does that matter? Well, a quarter of the U.S. physician workforce are immigrants, and they are disproportionately represented, both in lower-paid primary care specialties, particularly in rural areas, both of which U.S. doctors tend to find less desirable. This would seem to be the result of a combination of new fees for visas for foreign professionals that we’ve talked about, a general reduction in visa approvals, and some people likely not wanting to even come to the U.S. to practice. But that rural health fund that Republicans say will revitalize rural health care doesn’t seem like it’s really going to work without an adequate number of doctors and nurses, I would humbly suggest.
Lawrence: Yeah, absolutely. I mean, it’s patients that suffer, right? I mean, you need the people doing the work. And so I think that the impacts will start being felt sooner rather than later. That is something that hopefully people will start to feel the pain from.
Rovner: I feel like when people think about the immigrant workforce, they think about lower-skilled, lower-paid jobs that immigrants do, and they don’t think about the fact that some of the most highly skilled, highly paid jobs that we have, like being doctors, are actually filled by immigrants, and that if we cut that back, we’re just going to exacerbate shortages that we already know we have.
Luthra: And training doctors takes, famously, a very long time. And so if you are disincentivizing people from coming here to practice, cutting off this key source of supply, it’s not as if you can immediately go out and say, Here, let’s find some new people and make them doctors. It will take years to make that tenable, make that attractive, and make that a reality. And it just seems, to Lizzy’s point, that even in the scenario where that was possible 鈥 which I would be somewhat doubtful; medicine is a hard and difficult career; it’s not like you can make someone want to do that overnight 鈥 patients will absolutely see the consequences. I don’t know if it’s enough to change how people think about immigration policy and ways in which we recruit and engage with immigrant workers, but it’s absolutely something that should be part of our discussion.
Rovner: Yeah, and I think it’s been left out. Well, meanwhile, over at the National Institutes of Health, a , Lizzy, found that more than a quarter have laid off laboratory workers. More than 2 in 5 have canceled research, and two-thirds have counseled students to consider careers outside of academic research. A separate study published this week found that women and early-career scientists have been disproportionately affected by the NIH cuts, even though most of the money goes to men and to later-career scientists. As I keep saying, this isn’t just about the future of science. Biomedical research is a huge piece of the U.S. economy. Earlier this month, the group United for Medical Research , finding that every dollar invested produced $2.57 for the economy. Concerned members of Congress from both parties last week at an appropriations hearing got NIH Director Jay Bhattacharya to again promise to push all the money that they appropriated out the door. But it’s not clear whether it’s going to continue to compromise the future workforce. I feel like, you know, we talk about all these missing people and nomination stuff, but we’re not really talking a lot about what’s going on at the National Institutes of Health, which is a, you know, almost $50 billion-a-year enterprise.
Lawrence: Right. In some labs, the damage has already been done. You know, even if Dr. Bhattacharya [follows through], try spending all the money that has been appropriated. There are young researchers that have been shut out and people that have had to choose alternative career paths. And I think this is one of those things that’s difficult politically or, you know, in the public consciousness, because it is hard to see the immediate impacts it’s measured. And I think my colleague Jonathan wrote [that] breakthroughs are not discovered things, you know. So it’s hard to know what is being missed. But the immediate impact of the workforce and not missing this whole generation of scientists that has decided to go to another country or go to do something else, those impacts will be felt for years to come.
Rovner: Yeah, this is another one where you can’t just turn the spigot back on and have it immediately refill.
Finally, this week, there is always reproductive health news. This week, we got the Alan Guttmacher Institute’s for the year 2025, which both sides of the debate consider the most accurate, and it found that for the second year in a row, the number of abortions in the U.S. remained relatively stable, despite the fact that it’s outlawed or seriously restricted in nearly half the states. Of course, that’s because of the use of telehealth, which abortion opponents are furiously trying to get stopped, either by the FDA itself or by Congress. Last week, anti-abortion Sen. Josh Hawley of Missouri introduced legislation that would basically rescind approval for the abortion pill mifepristone. But that legislation is apparently giving some Republicans in the Senate heartburn, as they really don’t want to engage this issue before the midterms. And, apparently, the Trump administration doesn’t either, given what we know about the FDA saying that they’re still studying this. On the other hand, Republicans can’t afford to lose the backing of the anti-abortion activists either. They put lots of time, effort, and money into turning out votes, particularly in times like midterms. How big a controversy is this becoming, Shefali?
Luthra: This is a huge controversy, and it’s so interesting to watch this play out. When I saw Sen. Hawley’s bill, I mean, that stood out to me as positioning for 2028. He clearly wants to be a favorite among the anti-abortion movement heading into a future presidential primary. But at the same time, this is teasing out really potent and powerful dynamics among the anti-abortion movement and Republican lawmakers, exactly what you said. Republican lawmakers know this is not popular. They do not want to talk about abortion, an issue at which they are at a huge disadvantage with the public. Susan B Anthony List and other such organizations are trying to make the argument that if they are taken for granted, as they feel as if they are, that will result in an enthusiasm gap. Right? People will not turn out. They will not go door-knocking, they won’t deploy their tremendous resources to get victories in a lot of these contested, particularly Senate and House, races. And obviously, the president cares a lot about the midterms. He’s very concerned about what happens when Democrats take control of Congress. But I think what Republicans are wagering, and it’s a fair thought, is that where would anti-abortion activists go? Are they going to go to Democrats, who largely support abortion rights? And a lot of them seem confident that they would rather risk some people staying home and, overall, not alienating a very large sector of the American public that does not support restrictions on abortion nationwide, especially those that many are concerned are not in keeping with the actual science.
Rovner: Yeah, I think the White House, as you said, would like to make this not front and center, let’s put it that way, for the midterms. But yeah, and just to be clear, I mean, Sen. Hawley introduced this bill. It can’t pass. There’s no way it gets 60 votes in the Senate. I’d be surprised if it could get 50 votes in the Senate. So he’s obviously doing this just to turn up the heat on his colleagues, many of whom are not very happy about that.
Luthra: And anti-abortion activists are already thinking about 2028. They are, in fact, talking to people like Sen. Hawley, like the vice president, like Marco Rubio, trying to figure out who will actually be their champion in a post-Trump landscape. And so far, what I’m hearing, is that they are very optimistic that anyone else could be better for them than the president is because they are just so dissatisfied with how little they’ve gotten.
Rovner: Although they did get the overturn of Roe v. Wade.
Luthra: That’s true.
Rovner: But you know, it goes back to sort of my original thought for this week, which is that the number of abortions isn’t going down because of the relatively easy availability of abortion pills by mail. Well, speaking of which, in a somewhat related story, a woman in Georgia has been charged with murder for taking abortion pills later in pregnancy than it’s been approved for, and delivering a live fetus who subsequently died. But the judge in the case has already suggested the prosecutors have a giant hill to climb to convict her and set her bail at $1. Are we going to see our first murder trial of a woman for inducing her own abortion? We’ve been sort of flirting with this possibility for a while.
Luthra: It seems possible. I think it’s a really good question, and this moment certainly feels like a possible Rubicon, because going after people who get abortions is just so toxic for the anti-abortion movement. They have promised they would not go after people who are pregnant, who get abortions. And this is exactly what they are doing. And I think what really stands out to me about this case is so much of it depends on individual prosecutors and individual judges. You have the law enforcement officials who decided to make this a case, and they’re actually using, not the abortion law, even though the language in the case, right, really resonates, reflects with the law in Georgia’s six-week ban. Excuse me, with the language in Georgia’s six-week ban. But then you have a judge who says this is very suspect. And what feels so significant is that your rights and your protection under abortion laws depend not only on what state you live in, but who happens to be the local prosecutor, the local cop, the local judge, and that’s just a level of micro-precision that I think a lot of Americans would be very surprised to realize they live under.
Rovner: Yeah, absolutely. We should point out that the woman has been charged but not yet indicted, because many, many people are watching this case very, very carefully. And we will too.
All right, that is this week’s news. Now I’ll play my interview with Katie Keith of Georgetown University Law Center, and then we’ll come back with our extra credits.
I am pleased to welcome back to the podcast Katie Keith. Katie is the founding director of the Center for Health Policy and the Law at the Georgetown University Law Center and a contributing editor at Health Affairs, where she keeps all of us up to date on the latest health policy, legal happenings. Katie, thanks for joining us again. It’s been a minute.
Katie Keith: Yeah. Thanks for having me, Julie, and happy ACA anniversary.
Rovner: So you are my go-to for all things Affordable Care Act, which is why I wanted you this week in particular, when the health law turned 16. How would you describe the state of the ACA today?
Keith: Yeah, it’s a great question. So, the ACA remains a hugely important source of coverage for millions of people who do not have access to job-based coverage. I am thinking of farmers, and self-employed people, and small-business owners. And you know, in 2025, more than 24 million people relied on the marketplaces all across the country for this coverage. So it remains a hugely important place where people get their health insurance. And we are already starting to see real erosion in the gains made under the Biden administration as a result of, I think, three primary changes that were made in 2025. So the first would be Congress’ failure to extend the enhanced premium tax credits, which you have covered a ton, Julie and the team, as having a huge impact there. The second is the changes from the One Big Beautiful Bill Act. And then the third is some of the administrative changes made by the Trump administration that we’re already seeing. So we don’t yet have full data to understand the impact of all three of those things yet. We’re still waiting. But the preliminary data shows that already enrollments down by more than a million people. I’m expecting that to drop further. There was some 麻豆女优 survey data out last week that about 1 in 10 people are going uninsured from the marketplace already, and that’s not even, doesn’t even account for all the people who are paying more but getting less, which their survey data shows is about, you know, 3 in 10 folks. So you know what makes all of this really, really tough, as you and I have discussed before, is, I think, 2025, was really a peak year. We saw peak enrollment at the ACA. We saw peak popularity of the law, which has been more popular than not ever since 2017, when Republicans in Congress tried to repeal it the first time. And 鈥 but now it feels like we’re sort of on this precipice for 2026, watching what’s going to happen with the data into this really important source of coverage for so many people.
Rovner: And 鈥 there’s been so much news that I think it’s been hard for people to absorb. You know, in 2017, when Republicans tried to repeal the Affordable Care Act, they said that, We’re trying to repeal the Affordable Care Act. Well, the 2025 you know, “Big, Beautiful Bill,” they didn’t call it a repeal, but it had pretty much the same impact, right?
Keith: It had a quite significant impact. And I think a lot, like, you know, there was so much coverage about how Democrats in Congress and the White House learned, in doing the Affordable Care Act, learned from the failed effort of the Clinton health reform in the ’90s. I think similarly here you saw Republicans in Congress, in the White House, learn from the failed effort in 2017 to be successful here. And so you’re exactly right. You did not hear any talk of “repeal and replace,” by any stretch of the imagination. I think in 2017 Republicans were judged harshly 鈥 and appropriately so, in my opinion 鈥 by the “replace” portion of what, you know, what they were going to do, and it just wasn’t there. And so you did not see that kind of framing this time around. Instead, it really is an attempt to do death by a thousand paper cuts and impose administrative burdens and a real focus on kind of who 鈥 you can’t see me, but air quotes, you know 鈥 who “deserves” coverage and a focus on immigrant populations. So 鈥 those changes, when you layer all of them on 鈥 changes to Medicaid coverage, Medicaid financing, paperwork burdens, all across all these different programs 鈥 you know, the One Big Beautiful Bill Act, it really does erect new barriers that fundamentally change how Medicaid and the Affordable Care Act will work for people. And so it’s not repealed. I think those programs will still be there, but they will look very different than how they have and, you know, the CBO [Congressional Budget Office] at the time, the coverage losses almost 鈥 they look quite close to, you know, the skinny repeal that we all remember in the middle of the morning 鈥 early, like, late night, Sen. John McCain with his thumbs down. The coverage losses were almost the same, and you’ve got the CBO now saying, estimating about 35 million uninsured people by 2028, which, you know, is not 鈥 it’s just erasing, I think, not all, but a lot of the gains we’ve made over the past 15, now 16, years under the Affordable Care Act.
Rovner: And now the Trump administration is proposing still more changes to the law, right?
Keith: Yep, that’s right. They’re continuing, I think, a lot of the same. There’s several changes that, you know, go back to the first Trump administration that they’re trying to reimpose. Others are sort of new ideas. I’m thinking some of the same ideas are some of the paperwork burdens. So really, in some cases, building off of what has been pushed in Congress. What’s maybe new this time around for 2027 that they’re pushing is a significant expansion of catastrophic plans. So huge, huge, high-deductible plans that, you know, really don’t cover much until you hit tens of thousands of dollars in out-of-pocket costs. You get your preventive services and three primary care visits, but that’s it. You’re on the hook for anything else you might need until you hit these really catastrophic costs. They’re punting to the states on core things like network adequacy. You know, again, some of it’s sort of new. Some of it’s a throwback to the first Trump administration, so not as surprising. And then on the legislative front, I don’t know what the prospects are, but you do continue to see President [Donald] Trump call for, you know, health savings account expansions. We think, I think, you know, the idea is to send people money to buy coverage, rather than send the money to the insurers, which I think folks have interpreted as health savings accounts. There’s a continued focus on funding cost-sharing reductions, but that issue continues to be snarled by abortion restrictions across the country. So that’s something that continues to be discussed, but I don’t know if it will ever happen. And you know anything else that’s kind of under the so-called Great Healthcare Plan that the White House has put out.
Rovner: You mentioned that 2025 was the peak not just of enrollment but of popularity. And we have seen in poll after poll that the changes that the Trump administration and Congress is making are not popular with the public, including the vast majority of independents and many, many Republicans as well. Is there any chance that Congress and President Trump might relent on some of these changes between now and the midterms? We did see a bunch of Republicans, you know, break with the rest of the party to try to extend the, you know, the enhanced premiums. Do you see any signs that they’re weakening or are we off onto other things entirely right now?
Keith: It’s a great question. I think you probably need a different analyst to ask that question to. I don’t think my crystal ball covers those types of predictions. But to your point, Julie, I thought that if there would have been time for a compromise and sort of a path forward, it would have been around the enhanced premium tax credits. And it was remarkable, you know, given what the history of this law has been and the politics surrounding it, to see 17 Republicans join all Democrats in the House to vote for a clean three-year extension of the premium tax credits. But no, I think especially thinking about where those enhanced tax credits have had the most benefit, it is states like Georgia, Florida, Texas, and I thought that maybe would, could have moved the needle if there was a needle to be moved. So I, it seems like there’s much more focus on prescription drugs and other issues, but anything can happen. So I guess we’ll all stay tuned.
Rovner: Well, we’ll do this again for the 17th anniversary. Katie Keith, thank you so much.
Keith: Thanks, Julie.
Rovner: OK, we’re back. It’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Lizzy, why don’t you start us off this week?
Lawrence: Sure. So my extra credit is by Nick [Nicholas] Florko, former Stat-ian, in The Atlantic, “” I immediately read this piece, because this is something that’s been driving me kind of crazy. Just seeing 鈥 if you’ve missed it 鈥 there have been 鈥 HHS has been posting AI-generated videos of Secretary Kennedy wrestling a Twinkie, wearing waterproof jeans, all of these things. And this has been, this is not unique to HHS 鈥 [the] White House in general has really embraced AI slop as a genre, and I can’t look away. And so I thought Nick did a good job just acknowledging how crazy this is, and then also what goes unsaid in these videos. I think I personally am just very curious if this resonates with people, or if it’s kind of disconcerting for the average American seeing these videos like, Oh, my government is making AI slop. Like I, you know, social media strategy is so important, so maybe for some people are really liking this. But yeah, I’m just kind of curious about public sentiment.
Rovner: I know I would say, you know, the National Park Service and the Consumer Product Safety Commission have been sort of famous for their very cutesy social media posts, but not quite to this extent. I mean, it’s one thing to be cheeky and funny. This is sort of beyond cheeky and funny. I agree with you. I have no idea how this is going over the public, but they keep doing it. It’s a really good story. Rachel.
Cohrs Zhang: Mine is a story in The Boston Globe, and the headline is “” by Tal Kopan. And this was a really good profile of Tony Lyons, who is Robert F. Kennedy Jr.’s book publisher, and he’s kind of had the role of institutionalizing all the political energy behind RFK Jr. and trying to make this into a more enduring political force. So I think he is, like, mostly a behind-the-scenes guy, not really like a D.C. fixture, more of like a New York book publishing figure. But I think his efforts and what they’re using, all the money they’re raising for, I think, is a really important thing to watch in the midterms, and like, whether they can actually leverage this beyond a Trump administration, or beyond however long Secretary Kennedy will be in his position. So I think it was just a good overview of all the tentacles of institutional MAHA that are trying to, you know, find their footing here, potentially for the long term.
Rovner: I had never heard of him, so I was glad to read this story. Shefali.
Luthra: My story is from NPR. It is by Tara Haelle. The headline is “.” Story says exactly what it promises, that if you have an infant, babies under 6 months, then getting a covid vaccine while you are pregnant will actually protect your baby, which is great because there is no vaccine for infants that young. I love this because it’s a good reminder of something that we were starting to see, and now it just really underscores that this is true, and in the midst of so much conversation around vaccines and safety and effectiveness, it’s a reminder that really, really good research can show us that it is a very good idea to take this vaccine, especially if you are pregnant.
Rovner: More fodder for the argument, I guess. All right, my extra credit this week is a clever story from Stat’s John Wilkerson called “.” And, spoiler, that loophole is that one way companies can avoid running afoul of their promise not to charge other countries less for their products than they charge U.S. patients is for them to simply delay launching those drugs in those other countries that have price controls. Already, most drugs are launched in the U.S. first, and apparently some of the companies that have done deals with the administration limited their promises to three years, anyway. That way they can charge U.S. consumers however much they think the market will bear before they take their smaller profits overseas. Like I said, clever. Maybe that’s why so many companies were ready to do those deals.
All right, that is this week’s show. As always, thanks to our editor, Emmarie Huetteman; our producer-engineer, Francis Ying; and our interview producer, Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X or on Bluesky . Where are you folks hanging these days? Shefali?
Luthra: I am on Bluesky .
Rovner: Rachel.
Cohrs Zhang: On X , or .
Rovner: Lizzy.
Lawrence: I’m on X and and .
Rovner: We will be back in your feed next week. Until then, be healthy.
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Health and Human Services Secretary Robert F. Kennedy Jr.’s effort to change how the federal government recommends vaccines against childhood diseases was dealt at least a temporary setback in federal court this week. A judge in Massachusetts sided with a coalition of public health groups arguing that changes to the vaccine schedule violated federal law. The Trump administration said it would appeal the judge’s ruling.
Meanwhile, some of the same public health groups continue to worry about the slow pace of grantmaking at the National Institutes of Health, which, for the second straight year, is having trouble getting money appropriated by Congress out the door to researchers.
This week’s panelists are Julie Rovner of 麻豆女优 Health News, Alice Miranda Ollstein of Politico, Margot Sanger-Katz of The New York Times, and Lauren Weber of The Washington Post.
Panelists
Among the takeaways from this week’s episode:
- The latest decision on potential changes to the federal childhood vaccine schedule, even if ultimately reversed by a higher court, may re-elevate the vaccine issue as midterm campaigns kick into gear 鈥 and just as the Trump administration is trying to downplay it.
- A new survey of Affordable Care Act marketplace enrollees from 麻豆女优, a health information nonprofit that includes 麻豆女优 Health News, illuminates how many people are struggling to afford health insurance after the expiration of the enhanced premium tax credits. A large majority of respondents say their costs are higher this year, with half saying their costs are “a lot higher.”
- A dip in the number of health care jobs last month could suggest medical facilities and other providers are bracing for the impact of federal funding cuts. A reduction in the number of people with health insurance 鈥 an expected outcome of the expiration of enhanced ACA tax credits and, soon, stricter eligibility limits for Medicaid 鈥 would probably mean more unpaid bills that hospitals and others must absorb.
- And clinics that rely on Title X funding to provide care are in a bind, with funding set to expire at the end of the month and the federal government only just recently releasing guidance about applying. Many clinics are bracing for a gap in funding.
Also this week, Rovner interviews 麻豆女优 President and CEO Drew Altman to kick off a new series on health care solutions, called “How Would You Fix It?”
Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: The New York Times’ “,” by Rebecca Robbins.
Lauren Weber: The Atlantic’s “,” by McKay Coppins.
Margot Sanger-Katz: Stat’s “,” by Tara Bannow.
Alice Miranda Ollstein: The New York Times’ “,” by Stephanie Nolen.
Also mentioned in this week’s podcast:
- 麻豆女优’s “,” by Lunna Lopes, Isabelle Valdes, Grace Sparks, Mardet Mulugeta, and Ashley Kirzinger.
- The Washington Post’s “,” by Lauren Weber, Caitlin Gilbert, Dylan Moriarty, and Joshua Lott.
- 麻豆女优 Health News’ “,” by Tony Leys.
- Politico’s “,” by Alice Miranda Ollstein.
- States Newsroom’s “,” by Kelcie Moseley-Morris.
- ProPublica’s “,” by Amy Yurkanin.
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.
Credits
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麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/podcast/what-the-health-438-rfk-vaccine-schedule-changes-blocked-obamacare-midterms-march-19-2026/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2171044&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>The legislation would prohibit state and local governments from requiring crisis pregnancy centers to perform abortions, provide referrals for abortion services, or inform patients about such services or contraception options. It also would allow crisis pregnancy centers to sue the violating government entity.
Wyoming lawmakers of the Center Autonomy and Rights of Expression Act, or , on March 4. Other versions have advanced in and this year. One was in 2025. The CARE Act is “model legislation” created by the , an anti-abortion, conservative Christian legal advocacy group.
A similar proposal, the , was introduced in Congress last year but hasn’t moved out of the House Energy and Commerce Committee.
The Wyoming bill says that pregnancy centers, many of which are affiliated with religious organizations, need legal protection after facing “unprecedented attacks” following the Supreme Court’s overturning of Roe v. Wade. It says that several state legislatures have introduced bills that . Opponents of these centers say they falsely present themselves to consumers as medical clinics, though they are not subject to state and federal laws that protect patients in medical facilities.
“Across the country, government officials are increasingly, increasingly targeting pregnancy care centers,” Valerie Berry, executive director of the in Cheyenne, said at a February legislative hearing on the Wyoming bill. “This legislation is not about creating division. It’s about protecting constitutional freedoms, freedom of speech, and freedom of conscience.”
Wyoming state , a Republican, expressed concern at the hearing about granting protections to pregnancy centers that other private businesses do not have.
“They have protections in place,” he said. “My issue with this is giving extra special protections.”
In 2022, Wellspring Health Access, the only clinic in Wyoming that provides abortions, in an arson attack.
“We are the ones providing the accurate information on reproductive health care, and we suffer the consequences for that,” Julie Burkhart, the president and founder of Wellspring Health Access, told 麻豆女优 Health News.
, a professor at the University of California-Davis School of Law, said the proposed legislation would insulate crisis pregnancy centers from having to meet the standards that medical organizations face. It would blur the line between advocacy and medical practice, she said. And such legislation provides Republicans with a potentially useful campaign message ahead of midterm elections.
“The GOP needs a messaging strategy as for how it cares about women even if it bans abortion and even if it doesn’t want to commit state resources to helping people before and after pregnancy,” Ziegler said. “The strategy is to outsource that to pregnancy counseling centers, which of course increases the incentive to protect them.”
Model Legislation
The Alliance Defending Freedom is the same group that , the 1973 court ruling that protected the right to abortion nationwide. The group drafted model legislation to establish a 15-week abortion ban that was the basis of a 2018 Mississippi law. That led to the Dobbs v. Jackson Women’s Health Organization Supreme Court case that overturned Roe.
The alliance said its attorneys were unavailable to comment on the organization’s strategy for the CARE Act. In for the bill, the group said federal, state, and local efforts are targeting pregnancy care centers in a “clear attempt to undermine and impede” their work and shut them down.
In recent years, have been targeted with vandalism and threats.
But the attacks the model legislation primarily aims to address are the legal and regulatory efforts by some states seeking more oversight of the crisis pregnancy centers, including a California law requiring centers to clearly inform patients about their services. That law was overturned when the Supreme Court ruled in favor of crisis pregnancy centers’ argument that it violated their First Amendment rights.
The Supreme Court is that will decide whether states can subpoena the organizations for donor and internal information.
It’s unlikely that crisis pregnancy centers would face such regulatory measures in the conservative states where the legislation is under consideration. One Wyoming lawmaker acknowledged that in the February committee hearing.
Differing Services
During that hearing, state , a Republican who heads the committee sponsoring the bill, presented the measure as “so important, especially with our maternity desert,” referring to a lack of access to maternity health care services.
Some crisis pregnancy centers may have a few licensed clinicians, but many do not. Many offer free resources, such as diapers, baby clothing, and other items, sometimes in exchange for participation in counseling or parenting classes.
Planned Parenthood clinics, by contrast, provide a range of health services, such as testing and treatment for sexually transmitted infections, primary care, and screenings for cervical cancer. They also are regulated as medically licensed organizations.
Since Roe was overturned, the abortion rights movement has faced significant challenges. Congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, to abortion providers. The move contributed to Planned Parenthood closing last year.
As of 2024, operated nationwide, according to a map created by researchers at the University of Georgia, compared with providing abortions at the end of 2025.
a research organization affiliated with the anti-abortion nonprofit SBA Pro-Life America, has suggested that pregnancy centers could help fill the gap left by the Planned Parenthood closures.
Ziegler said that would leave patients vulnerable to medical risks.
Centers’ Growing Power
Previous efforts in , Colorado, and Vermont to regulate crisis pregnancy centers arose from concerns over allegations of and questions about .
In 2024, in five states to investigate whether centers were misleading patients into believing that their personal information was protected under the Health Insurance Portability and Accountability Act, known as HIPAA, and to find out how the centers were using patients’ information.
Courts, including the Supreme Court, have regularly that argue the attempts at regulation are violations of their First Amendment rights to free speech and religious expression.
Crisis pregnancy centers also have seen a flood of funding since Roe was overturned.
At least , including crisis pregnancy centers, according to the Lozier Institute.
Six states distribute a portion of their federal Temporary Assistance for Needy Families funding 鈥 cash payments meant for low-income families with children 鈥 to crisis pregnancy centers. Texas, Florida, Tennessee, and Oklahoma have provided tens of millions of dollars for the organizations.
One analysis found that crisis pregnancy centers also received from 2017 to 2023, including from the 2020 relief package signed into law during Trump’s first term amid the covid pandemic.
Despite the challenges clinics that provide abortions face, Burkhart, the head of the Wellspring facility in Wyoming, said it’s important to continue offering access to people who need it. She’s helped open clinics in rural parts of other conservative states and said those clinics continue to see people walking through their doors.
“That proves to me, regardless of your religion, political party, there are times in people’s lives that people need access to qualified reproductive health care,” she said. “That includes abortion.”
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/courts/abortion-bans-clinics-crisis-pregnancy-centers-maternity-care-wyoming/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2166071&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>“I have these conversations with children starting at 8, 10, 12 years old: What do you want to be when you grow up?” Duane said. If you’re a child who wants to be a doctor, for instance, “there are things you need to put in place. If you hope to have children one day, there are things that you need to consider and have the conversation early.”
The proposal from Duane, a specialist in who is affiliated with the anti-abortion Charlotte Lozier Institute, got a warm reception from the audience gathered for the Trump administration’s inaugural .
The three-day event hosted by the Department of Health and Human Services last week was designed to “explore breakthroughs in research, prevention, diagnosis, and treatment of health conditions that affect women across the lifespan.” Government officials hosted an eclectic mix of wealthy philanthropists, alternative medicine influencers, health tech executives, and medical researchers to discuss a wide range of issues, from Lyme disease to gut health.
Seeking to reach women at a moment when President Donald Trump’s among a key voting bloc, the Make America Healthy Again movement, the administration-sponsored event elevated perspectives outside conventional standards of medical care and counter to many women’s health choices.
For example, during a 40-minute panel hosted by Alexis Joel, the wife of musician Billy Joel, several doctors raised concerns about how frequently hormonal birth control is used to treat women’s health symptoms. Two female physicians on the panel said they were uncomfortable with the idea of using birth control pills for their own treatment, noting that their “values” or “cultural perspective” did not align with use of the medication.
Nearly a third of U.S. women ages 18 to 49 report having used birth control pills in the previous 12 months, according to a . In addition to their use as a contraceptive, the pills are prescribed for , including preventing anemia from heavy periods and treating uterine fibroids.
Joel, who has about her experience with endometriosis, brought her own doctor, Tamer Seckin, to discuss the common, painful condition, in which thick tissue develops outside of the uterus. Seckin said women’s concerns about menstrual pain are often dismissed by doctors, leading to missed diagnoses.
Asima Ahmad, a doctor who specializes in fertility and co-founded Carrot, a company that offers job-based fertility benefits, offered another explanation for why the disease is overlooked.
“As providers, we should learn how to treat it, rather than covering it up with birth control pills or progesterone,” she said.
Hormonal birth control pills, which help slow the growth of new tissue, are for treating endometriosis, according to the American College of Obstetricians and Gynecologists.
Andrea Salcedo, a California OB-GYN on the panel who said she has endometriosis as well, said she declined birth control as a treatment. She noted her decision aligned with her “values,” in particular her desire to have more children.
“Is this all that we can do?” Salcedo said of being offered birth control.
Salcedo said she prescribes alternative treatments to her patients because she believes the root cause of infertility is directly related to gut health. Cod liver oil and vitamin A top her list, she said.
whether there is an association between vitamin deficiencies and endometriosis. Taking too much vitamin A can cause health problems, including if taken while pregnant.
Those supplements have been touted by HHS Secretary Robert F. Kennedy Jr. 鈥 including, falsely, as during an outbreak in Texas last year.
About a quarter of U.S. adults wrongly believe vitamin A can prevent measles infections, according to a .
The panel also coalesced around the idea that a lack of knowledge is the root problem: Girls do not receive enough education on how to become pregnant or identify the warning signs of infertility, the doctors suggested.
Education has become too hyperfocused on preventing pregnancy, Ahmad said.
“I was in junior high, and I was learning about trying not to get pregnant, and I was scared that if I sit in a room with a guy alone, I will,” she said. “They put all of this fear into it, but family planning isn’t just about preventing pregnancy. It’s about learning about how to build your family.”
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/public-health/hhs-women-health-conference-birth-control-teen-fertility-trump-rfk-maha/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
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