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

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

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

Anna Edney: Hi, everybody. 

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

Joanne Kenen: Hi, everybody. 

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

Emmarie Huetteman: Hey there. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Carey: Emmarie, you wanted to jump in. 

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

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

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

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

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

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

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

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

Carey: Emmarie. 

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

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

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

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

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

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

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

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

Carey: Oh yeah. 

Kenen: 鈥攕ince the Garden of Eden, right? 

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

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

Michelle Canero: Thank you for having me. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Michelle Canero, thanks again. 

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

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

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

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

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

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

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

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

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

Kenen: and , @joannekenen. 

Carey: OK. Anna? 

Edney: and and , @annaedney. 

Carey: And Emmarie. 

Huetteman: You can find me on . 

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

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

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. 

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

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

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

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

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

Rovner: Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: And Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, there. 

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

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

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

Rovner: Lauren. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: But a lot of people are thanking you. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Lauren? 

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

Rovner: Margot. 

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

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

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

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

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

Shefali Luthra: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

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

Joanne Kenen: Hi, everybody. 

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

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

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

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

Rovner: That’s a fair assessment. Anna. 

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Yes. 

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

Rovner: Right. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Oh, it is. 

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

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

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Rovner: And then maybe cut it back later. 

Kenen: No, but it’s exceeded expectations. 

Rovner: Absolutely. 

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

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

Kenen: Right. Right. 

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

Kenen: Right.  

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

Rovner: They made it fail. 

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

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

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

Rovner: The ones that passed by voters. 

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

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

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

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

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

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

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

Andy Schneider: Thanks for having me, Julie. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Schneider: Julie Rovner, thank you very much. 

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

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

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

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

Rovner: That’s what it was for. 

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

Rovner: It is not. Shefali. 

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

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

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

Luthra: I am at Bluesky, . 

Rovner: Anna. 

Edney:  and , @annaedney. 

Rovner: Joanne. 

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

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

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

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

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

Anna Edney: Hi, everybody. 

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

Joanne Kenen: Hi, everybody. 

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

Emmarie Huetteman: Hey there. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Carey: Emmarie, you wanted to jump in. 

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

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

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

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

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

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

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

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

Carey: Emmarie. 

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

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

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

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

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

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

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

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

Carey: Oh yeah. 

Kenen: 鈥攕ince the Garden of Eden, right? 

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

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

Michelle Canero: Thank you for having me. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Michelle Canero, thanks again. 

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

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

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

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

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

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

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

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

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

Kenen: and , @joannekenen. 

Carey: OK. Anna? 

Edney: and and , @annaedney. 

Carey: And Emmarie. 

Huetteman: You can find me on . 

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

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

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. 

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

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

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

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

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

Rovner: Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: And Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, there. 

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

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

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

Rovner: Lauren. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: But a lot of people are thanking you. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Lauren? 

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

Rovner: Margot. 

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

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

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

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

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

Shefali Luthra: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

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

Joanne Kenen: Hi, everybody. 

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

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

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

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

Rovner: That’s a fair assessment. Anna. 

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Yes. 

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

Rovner: Right. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Oh, it is. 

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

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

Kenen:&苍产蝉辫;础苍诲&苍产蝉辫;迟丑别苍鈥�&苍产蝉辫;

Rovner: And then maybe cut it back later. 

Kenen: No, but it’s exceeded expectations. 

Rovner: Absolutely. 

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

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

Kenen: Right. Right. 

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

Kenen: Right.  

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

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

Rovner: They made it fail. 

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

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

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

Rovner: The ones that passed by voters. 

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

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

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

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

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

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

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

Andy Schneider: Thanks for having me, Julie. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Schneider: Julie Rovner, thank you very much. 

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

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

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

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

Rovner: That’s what it was for. 

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

Rovner: It is not. Shefali. 

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

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

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

Luthra: I am at Bluesky, . 

Rovner: Anna. 

Edney:  and , @annaedney. 

Rovner: Joanne. 

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

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