[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 we at 麻豆女优 Health News have a story this week 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 “Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records.” 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, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me on X , or on Bluesky . Where do you guys hang these days? Maya. 

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

Rovner: Alice. 

Ollstein: I’m on Bluesky  and on X . 

Rovner: Lauren. 

Weber: Still @LaurenWeberHP on both  and . 

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

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

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

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

Rachel Cohrs Zhang: Hi, everybody. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: And Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hello. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Lawrence: Yeah, is there another deadline to miss? 

Cohrs Zhang: I don’t think so. 

Lawrence: I think this was the only one. 

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

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

Cohrs Zhang: Yeah. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Luthra: That’s true. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Keith: Thanks, Julie. 

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

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

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

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

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

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

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

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

Luthra: I am on Bluesky . 

Rovner: Rachel. 

Cohrs Zhang: On X , or . 

Rovner: Lizzy. 

Lawrence: I’m on X  and  and . 

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