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

Julie Rovner: Hello, from 吃瓜不打烊 and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 吃瓜不打烊. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, July 23, 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. 

Margot Sanger-Katz: Hello. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, Julie. 

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

Joanne Kenen: Hi, everybody. 

Rovner: Later in this episode, we’ll have our “How Would You Fix It?” interview with Louisiana Republican Sen. Bill Cassidy, chairman of the Senate Health, Education, Labor, and Pensions Committee. But first, this week’s news. I want to start this week with what I’m calling the “Shrinking Safety Net.” The Center on Budget and Policy Priorities is reporting that overall participation in SNAP [Supplemental Nutrition Assistance Program], the nation’s food stamp program, is down by more than 4陆 million people. That’s about 11% between last year’s enactment of the Republican budget bill and this past April. In Arizona, nearly half the recipients have left the rolls, and in Louisiana, Florida, and Oklahoma, it’s closer to 20%. Nearly half of those losing benefits are children, according to the analysis, and this is before some of the biggest cuts to the program even take effect. What does this mean, and what does it portend for Medicaid cuts that the SNAP declines are so much larger than were anticipated when this bill was passed in 2025? 

Sanger-Katz: The Republican bill put a lot of new burdens on states that to administer SNAP, and it created these penalties that if they had a lot of errors, then they were going to end up having to pay a much larger percentage of that total bill. And I think what’s happened is that that sort of spooked a bunch of states, and I think Arizona in particular, is facing some complicated politics around the program. And so I think in their effort to reduce the error rate, they’ve created a lot more paperwork for beneficiaries to prove that they’re eligible, because the state doesn’t want to take a chance that if they go back and check later, that there will be some mismatch and they will get dinged for making an error. So I think there are real lessons for what’s going to happen in Medicaid. The SNAP changes are happening a little faster than the changes to Medicaid. But I think there are a lot of the same incentives. There also are going to be increased penalties for states that have a high error rate in Medicaid, and there are going to be additional paperwork requirements added to Medicaid for people to prove that they’re complying with the work requirement and certain other things that didn’t exist before. 

Rovner: And as we’ve said a bunch of times before, states who are anticipating these cuts are already making cuts because they have to do budgets before some of these cuts take effect. Joanne, you wanted to say something? 

Kenen: No, I think that Medicaid changed suddenly on June 1, right? I mean, the coverage losses were expected under the legislation. That’s how the money was saved. CBO says people will lose coverage, and that’s where the savings were, by and large. The interim final rule that dropped 鈥� but we didn’t know how bad it would be. We didn’t know how many people, partly because states had a fair, they had certain things they had to do, but they had a lot of flexibility in how to do them. So that the coverage losses were an unknown, right? They might have been as bad as the liberal critics said, and they might not have been as bad as some of the defenders of the law said. It was a wait-and-see. On June 1, as we’ve talked about before on the podcast, CMS [Centers for Medicare & Medicaid Services] dropped an interim final rule, and it changed things a lot. And it basically took away a lot of the state flexibility. And instead of letting states say, “OK, you have such-and-such a disease. We know you have such a disease. We have your medical records. We have the coding from the bills from Medicaid. This is, clearly, you can’t work.” That’s no longer good enough. You can’t use their medical history. Every single person who’s sick on Medicaid, who can’t work, who contends they can’t work, has to go for a workup by a physician. Right now we’re not sure if it’s other health providers, who really isn’t trained in disability medicine. Manatt just came out with a study just a day or two ago saying that the coverage losses are going to be much higher than anticipated. And there’s a lot of hurdles for individuals, and there’s a lot of costs for the states. So, like, the SNAP is now, like, OK, that was SNAP, and this is Medicaid. Now it’s just much more alarming to watch what happened in SNAP. 

Sanger-Katz: I think another lesson from SNAP is that we’re going to see a lot of state variability in the outcomes. You know, these are both programs, they’re federally funded, but they’re administered by states, and states have different capacities. They have different bureaucracies. They have different tolerances for spending money on these programs. And we’re seeing, even in SNAP, there’s kind of like people are losing coverage everywhere. But like in Arizona, it’s like half of the people. And I think that what we’re likely to see something similar play out in Medicaid, where some states either are just not willing to spend the money, or they’re very scared of penalties, and so they’re like really have very strict criteria. And other ones just, like, won’t be good at it, and they’ll make a lot of mistakes, and that will cause people to lose coverage too. I think every state is different. Every state is building this from the ground up, and there are going to be different levels of policy planning, risk tolerances, and just like general glitchiness as they roll it out. And I think we’re seeing that in SNAP. It’s a lesson of what we’re seeing now that will carry over almost certainly. 

Ollstein: And to that point, I think, in some places, like Joanne said, you are going to have to, you know, basically get a doctor’s note in order to keep your Medicaid coverage. But other states are trying right now to come up with some kind of formula to make that not have to happen. So saying, you know, if you have X many inpatient visits per year and Y many outpatient visits per year, or you have this many drugs that you’re on, then that is enough proof that you are too medically frail to work part-time. And so they’re trying to come up with ways to just pull it from data and not have to rely on patients and providers and give them this extra burden. But we’ll see if that’s approved by CMS. We’ll see if that’s successful. I mean, CMS’ guidance left states a little bit in the dark about how to operationalize this. 

Rovner: Well, that is the perfect setup, I would say, for my next question, which is we have a couple of stories from my colleagues here at 吃瓜不打烊 about complications to come from the Medicaid cuts, particularly the work requirements that states need to have in place by next Jan. 1. One of the stories, by Sam Whitehead, is about doctors who are worried about being swamped by patients who need medical documentation that they’re too frail to be subject to the work rules. Said one doctor in the story. “We’re trained to learn about someone’s symptoms, make diagnoses, treat them. We are not trained to make these kinds of work determinations.” The other story, by Rachana Pradhan, Samantha Liss, and Kate Wells, is about how an automated eligibility system from IT giant Deloitte is rejecting eligible people with disabilities in several states, including Michigan, Tennessee, and Texas. Deloitte works on Medicaid eligibility systems in more than half the states. It’s heavily involved in creating these IT systems for their work rules. Fair to say, both of these things, as you guys were all leading up to, do not bode well for what’s about to happen to Medicaid. 

Kenen: No, and an additional factor, it’s not just Deloitte. I mean, states had contracted with the vendors. They didn’t have a lot of time. This bill was signed into law just about a year, almost exactly a year, ago, and they had 18 months to get ready. It’s Jan. 1, 2027. This June change to the rules means they have to really rework a lot of the tech they were doing, and they were given seven months. So is this as big as healthcare.gov? No, but it’s complicated, and the sort of blueprint and tech plans they were doing now have to be modified. And they’re still waiting on more guidance. There are still unknowns. 

Rovner: For those who don’t remember healthcare.gov 鈥�  

Kenen: How can anybody not remember healthcare.gov? 

Rovner: There were people who were not around in 2013, Joanne, when healthcare.gov rather dramatically failed to launch. Sorry, Alice, I interrupted you. 

Ollstein: Yeah, no, we did some reporting about this weeks ago, and basically experts told us, Look, it’s problematic if these determinations are left up to individual physicians. There can be biases. Physicians aren’t trained to make these kind of determinations, like you said. People might not even be able to reach a doctor and make an appointment to get that outcome. But they’re saying if it’s not up to physicians, that could be even worse. If it’s up to some sort of algorithm or some sort of state bureaucratic office that never even meets the person and just makes a determination, and they may not know how to appeal it. And so states are worried about it being a lose-lose situation. 

Rovner: Yeah, well, in the Deloitte story, that’s exactly what it was. It was, you know, it was basically an automated system that was bouncing eligible people, either bouncing them out or putting them in inappropriate programs for which they weren’t eligible. They were having trouble finding a real person to fix what was obviously a mistake. 

Sanger-Katz: And I think one thing that both of these stories really emphasized to me is that whatever you think about the merits of this policy change, you know, like I think there are lots of Americans who think that it is reasonable to have a work requirement for Medicaid. And I also think there are lots of people who think that you shouldn’t just get out of that because you have a medical diagnosis. That there should be some reason why you can’t work. If we’re requiring people to work, maybe we want to require people to demonstrate that they can’t work, to get an exception. But whatever you think about the merits of those arguments, this is a monumentally difficult task for states to implement. This is not an easy policy. There is no all-knowing eye that can sort of look over the Medicaid population and decide who is eligible or not eligible according to these criteria. States have to create rules. They have to create what kinds of proof they’ll allow. They have to build computer systems that can sort people and that can make these determinations. And all of that is new and is very difficult. And is very slow. States, in most cases, don’t even build their own computer systems. They work with these contractors that do it for them, and the contractors have a mixed track record in really executing in a really clean way. So, I just think, you know, when you talk to people about this, I feel like we always talk about this in healthcare. There’s like the legislation. There’s like the idea, and Congress is trying to get the idea. These are the people that we want to get Medicaid, and these are the people that we want to encourage to work in order to maintain Medicaid. I think on the theoretical level, there’s that. But then there’s like the nitty-gritty implementation, and that’s like the regulatory process, that’s the state government, that’s the procurement, that’s the contracting. And I just think there’s a lot of sand in the gears of that. This is actually not easy for states to do, and even the states that are devoting a lot of resources to it and want to get it right, and even the states that really believe in the goals of the policy are probably like just bumping into a lot of the difficulties now. 

Kenen: And many of the people affected have chronic diseases; they’re up and down. You can have good periods when you’re working. You can have bad periods when you can’t, and that’s the nature of chronic diseases for many, many, many individuals. It’s inconsistent. So if you go to the doctor on Jan. 1, that doctor really doesn’t know. I mean, this is true of mental health as well. You know, how long can you work? How consistently you work? There’s just going to be all sorts of problems, and I promise to stop there. 

Rovner: OK. Well, also this week there are two immigration-related safety net stories. First, the Trump administration has officially rescinded the Biden administration’s rewrite of the so-called public charge rules, which are designed to ensure that legal immigrants are financially self-sufficient. The new rules, or the lack thereof, give immigration agents far more leeway to decide on their own who might or might not become dependent on government benefits. Alice, you covered this back in Trump I. It ended up with lots of people who were actually eligible for benefits not using them because they feared becoming or being deemed a public charge when applying for a green card or more permanent immigration status. Any reason to think the same thing isn’t about to happen again? 

Ollstein: No, there is no reason to think that history will not repeat itself. Although I will say that the policy now is not exactly the same as it was during the first Trump administration. The new policy just gives a lot of discretion to individual immigration officers to make a determination, looking at, like, the totality of someone’s circumstances. And so, you know, Medicaid and some of these other safety net programs that people are legally eligible for didn’t used to count against someone when they were applying for a green card, and now they could. Again, it’s not mandatory that, Oh, if you’re enrolled in Medicaid, automatically you’re barred. But it is something that an immigration officer would be allowed to consider. And so, yeah, a lot of concern not only from the immigrant ICE [Immigration and Customs Enforcement] community, but from states. I mean, this could affect state budget if people are going to need to turn for uncompensated care to other providers. There’s concern from the public health community about if people don’t have coverage to get vaccinated and to get checkups. It’s not like there are islands of immigrants. This is folks [who] are incorporated into our society. We live in a society, as we discovered during covid, and what impacts some people impacts everybody. 

Rovner: Yeah, and, I think as Margot said, it’s one of these things where the concept sounds great, and the carrying it out is a lot harder. Well, also a couple of weeks ago, we talked about how nursing homes and assisted living facilities are freaking out about the repeal of temporary protected status for immigrants from Haiti and Syria because so many of them work in the long-term care space. This week,  about how this immigration crackdown is reaching even further, to seniors who don’t yet need medical services but still require help with routine activities, who live in these, you know, senior buildings. There’s already a labor shortage for home health aides and others in eldercare, which is generally very hard work for very low pay. This could spiral into a real crisis. We’re going to end up with Gen X and millennials having to take care of their own baby boomer parents. 

Sanger-Katz: There was a really interesting study that was published a few months ago from Jonathan Gruber, the economist at MIT, and some of his colleagues that basically found that increases in the population of immigrants in a given place actually reduced mortality among Medicare beneficiaries. It seems really clear that immigrants are a really important part of the caregiving workforce in America right now. And, as you said, Julie, it’s home health workers, it’s nursing home employees, it’s people who work in hospitals, and it’s also people who are doing some of this kind of, like, informal elder care, helping out in assisted livings, helping people at home. You know, they may not be providing healthcare services, but they are helping elderly people who have healthcare needs. 

Rovner: It’s the people who work in the dining rooms. It’s the custodians in these senior buildings. I mean, it’s the people who, you know, who help people get around and drive them to doctor’s appointments. 

Sanger-Katz: I felt like that study 鈥� I was really struck by, because you get the sense that it’s not just that we see these people in these jobs, but that having more of them around actually seems to have a health protective effect for the people that live there. Because I think it does make it easier to staff all of these jobs and to staff them with people who are competent and who want to do that kind of work. 

Kenen: And who have language skills. There’s actually been studies showing that it helps to have more Spanish-speaking staff in nursing homes and rehab facilities. 

Rovner: All right. Well, meanwhile, Margot, since you are here, let us talk about surprise medical bills. A few weeks ago, we talked about the blockbuster story you wrote with Sarah Kliff about how some doctors were getting gigantic multiples of what Medicare or private insurance would have paid through the negotiation system that was set up to settle claims between insurers and providers. Now the administration says they may need to fix it? Catch us up. 

Sanger-Katz: Yeah, I mean this was a bit of a surprise to me, I will say.  that sort of gave us a sense of the scope of the system. Wasn’t hugely surprising, but the top-line numbers are. It looks like the amount of money that this system has awarded to doctors and other healthcare providers increased from around $4 billion in 2024 to $14 billion in 2025. So you can just like really see there’s been a huge growth in the number of cases, but it also seems like doctors are winning higher awards per case. And so, what’s happening is that the overall cost of the system has really ballooned. The Trump administration has said very little about this. They did finalize one regulation that had been proposed in the Biden administration that was kind of technical fixes. And yesterday they said that people are gaming the system and that they need to, quote, “clean it up.” So I do think this is the first indication we’ve seen that there is concern by Trump officials that there may be a problem with this arbitration system that doctors are using to resolve these disputes. But they provided no specifics at all about what they will do, what policy avenues they will pursue, and, you know, in a lot of my conversations with the players in this system, people have not identified, like, really obvious, easy places where the regulators can make big changes. I think there are some small changes that the regulators can make, but almost everyone that I talk to about this problem seems to think that Congress probably has to make changes to address some of the excessive spending that we’re seeing. And there seems to be very little appetite for that. So I’m really looking forward to seeing what it is the Trump administration has in mind, what kinds of policies they will pursue here. But, based on what they’ve said so far, I don’t know what they’re going for. And I would say, based on what I know about this topic, it is not obvious to me what the easy levers are for them to pull. 

Rovner: And I will add that I 鈥� in my interview with Sen. Cassidy, I asked him about this, and he kind of demurred, suggesting that, as you will hear, that, Well, if we can fix problems with price transparency in general, that could fix this problem. Because then people won’t end up going to the doctors who are going to go to arbitration and win, you know, multi-$100,000 awards from these arbitrators. But I think you’re right, Margot. I think we’ll see. 

Sanger-Katz: I will just say, to push back on what Sen. Cassidy apparently told you, is one thing that really has worked about this law is patients are completely protected. In these situations where these large arbitration awards are being generated, patients are never asked to pay more than they’re in network cost sharing. And so I don’t know how realistic it is to ask patients to change their shopping behavior in order to resolve these high payouts. I think that the incentives probably really have to be focused much more on the insurance companies and the healthcare providers themselves. 

Rovner: Yeah, well, we will see how that goes. All right, next: testosterone testing at the Department of Defense/War. Really. Secretary Pete Hegseth has ordered that male service members over age 30 will be required to be screened for, quote, “testosterone deficiency” annually, although testosterone replacement therapy, if a deficiency is found, will be voluntary. Hegseth said this is necessary for troops to operate, quote, “at their absolute best.” But doctors warn that rather than maintain military readiness, inappropriate hormone therapy can cause infertility or increase the chance of heart rhythm changes and bone fractures, and that screening at age 30 is inappropriate anyway. And in addition to everything else, isn’t this basically gender-affirming care? I thought this administration was against that. 

Ollstein: So basically, everything that is getting restricted for trans people is much more widely used by cisgendered people. So most young people who are put on puberty blockers are not trans. Most people who get top surgery are not trans. And most people who, you know, use these hormone treatments are not trans. And so, yes, this is an example of that double standard that, you know, is seen in other areas of medicine coming into play for sure. Not to mention the medical risks that you point out. It’s just sort of a cartoonish idea of what masculinity entails and what contributes to it that doesn’t really align with science. 

Rovner: Yeah, I’ve seen just an enormous amount of head-scratching about this whole thing, I mean, I’m just wondering, is he trying to deflect attention from other things going on at his department? 

Kenen: No, there’s a whole subculture that’s all about more testosterone. We should be clear that there’s some people who do, medically, have low testosterone, just like there’s some people who medically have low thyroid or other endocrine problems. I mean, you 鈥� and there’s medication for that, and it’s appropriate if you are clinically, you know, in that category. 

Rovner: Right. And having low testosterone can cause medical problems that can be addressed. 

Kenen: Right. So if you are really low 鈥� like not, sort of, what the “Bro World” says is low 鈥� but if you’re what, you know, a medical lab says is low, yes, that’s an appropriate, it’s an appropriate treatment. But there’s this whole sort of cultural thing that more testosterone is better. And it’s just one of these things 鈥� like with many other supplements, but this is a little bit more complex 鈥� it has taken off and sort of taken a cultural thing of its own. I mean, I saw a quote and I wrote it down, and I forgot to write down where I saw it, so I apologize for that. It might have been The Times, but I don’t know. And it’s a great quote from a physician who said, “If you just dole out the testosterone, the testes will shrink, and you can’t reliably count on them coming back.” That’s just sort of, like, that’s not penetrating the cultural idea to start T-maxing. 

Rovner: Right, more testosterone is better. 

Sanger-Katz: Although I think our Health and Human Services secretary has also said that he himself takes testosterone, so I think it’s not just the defense secretary. I think there are a number of high-level Trump officials who seem to be enthusiasts for this particular kind of treatment. 

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

So the public health panic of the week concerns cyclospora, a parasite that’s hard to detect, hard to get rid of, and causes a very nasty gastrointestinal illness. Cyclosporiasis, which is the ailment the parasite causes, is more common in the summer because it tends to infect fresh produce, mostly lettuce and herbs, and thin-skinned fruit like berries. But this summer, we’ve seen an explosion of cases (pun intended): more than 11,000 in 41 states. It’s maybe up by the time I’m even saying this. Normally, the FDA and the CDC [Centers for Disease Control and Prevention] would be all over this, trying to trace back where the infected food came from. But we know that both agencies have lost a lot of scientific staff in the past year. Over the weekend, the FDA announced that it had detected the parasite in lettuce from Mexico that wasn’t part of an initial lettuce recall that was linked to Taco Bell and many large grocery chains. Then the FDA backtracked, saying, “Yeah, it was a false positive.” But apparently, that doesn’t mean that the Mexican lettuce from produce giant Taylor Farms is not implicated. Now everybody is confused about what’s safe to eat. Joanne, you wrote an entire book about public health communication. How are we still so bad at communicating this kind of thing?  

Kenen: This is a really difficult thing, right? It’s very hard to track because it takes about two weeks for you to get symptoms. And then now, if people are sick, they’re going to sort of think that might be what they have. But you know, a few weeks ago, before there was publicity, you know, we all get tummy aches, right? And you don’t necessarily seek medical care. In this case 鈥� it can really go on and be very severe and can last, and people will seek medical care. But for some people, it’s not as 鈥� we don’t really know how many people are affected, and we also don’t know how many people are currently infected and 鈥� not yet showing symptoms. It’s big; it’s thousands. But the confusion here, I mean, first of all, you know, as you noted, CDC and FDA have both had cutbacks. There’s fewer staff. There’s fewer resources. This is really confusing, and it’s been made more confusing by absolutely everybody. There have been people who 鈥� there’s been political contacts. Taylor Farms has contacted the White House. 鈥� When the FDA found that false sample, they really did not communicate it that well. They didn’t say, This is one sample that might have led us to find yet another source, but what we’ve told you is already true. And follow our advice. They just 鈥� made it sound like it really wasn’t Taylor Farms. Then there was another thing where Taylor Farms said the FDA apologized. The FDA said they didn’t apologize, and then the Taylor Farms got a lot of attention because it deleted its social media posts. But I went onto their website last night, and it’s still there. They’re still saying that the FDA apologized. It’s confusing, too, because it’s primarily iceberg lettuce, but every summer there’s some of this, and it’s from cilantro, it’s from basil, it’s from raspberries is a biggie. So the CDC isn’t saying, OK, a lot of this is coming from Taylor Farms, but really be careful about these other things because we’re still investigating. I actually saw, I won’t identify the reporter or the publication, but in a major national report, major national paper, once the lettuce was identified at Taco Bell, this person said, “Oh, I’ve had these raspberries in my refrigerator. I’m glad I can eat them now.” Well, we don’t know that they can eat them now, you know. And then there’s the usual rumors that 鈥� everywhere there’s rumors, right? I mean, you can’t stop them. They just proliferate. So I think everybody has made a communication mistake every single step of the way. And then you have you know conspiracy theories about absolutely everything that, you know, it’s not really the lettuce. And then people think 鈥� Oh, we’re hearing it was Taco Bell in five states. Well, if I didn’t eat Taco Bell, I’m OK. No, because you could have bought the lettuce, and not all the lettuce is called Taylor Farms. And then people think, Well, if I go to a fancy organic store, it’s OK. No, you know, just don’t eat raw lettuce. The other thing I learned is it’s, like, the contamination. It’s really, really difficult. 鈥� If farmworkers are not able to, like, wash their hands well, and they were using hand sanitizer. That’s not good enough to get rid of this stuff. Chlorine isn’t good enough to get 鈥� this is really a hard parasite to deal with. 

Rovner: Yeah, basically, I think I’ve heard them say, If you want to eat lettuce, buy a head of lettuce and throw away the outside three layers, and then eat the rest. 

Kenen: Right, and then wash the rest of it. You’re also seeing all these recipes now online for how to stir-fry your lettuce. 

Rovner: That’s true, yes. Cooking does kill the parasite. 

Kenen: I’m growing my own. That’s my solution. 

Rovner: I’ve been picking my own. 

Kenen: Right, right. But I ran out, so I just had to plant more, but 鈥�  

Rovner: All right. Finally, this week at the Department of Health and Human Services, Secretary Robert F. Kennedy announced the latest in the department’s fraud crackdown: the withholding of more than a billion dollars in Medicaid funds from Minnesota and California. HHS is accusing those Democratic-governed states of failing to properly document shared Medicaid spending, mostly for home care services. Minnesota officials told Stateline that the feds have yet to explain exactly what deferrals are for or how they calculated the amount. Similarly, California officials said HHS is targeting the state for political reasons, and that home care actually saves the federal government money by keeping people out of more expensive nursing homes. Now, states and the federal government have been fighting over fraud since the beginning of the Medicaid program, but this is really the first time HHS has withheld this level of funds. I feel like this story is kind of flying under the radar. It’s a big deal. We spent the whole first part of this podcast talking about how states are having to spend time and effort and money to get these work requirements ready. I mean, this could really cripple some states’ Medicaid programs, couldn’t it? 

Sanger-Katz: Yeah, this is real money, and this is a kind of rescinding of money that Centers for Medicare & Medicaid Services really have almost never done before. I think it’s somewhat unpredictable to state. At least with, like, the work requirement, there’s some policy planning. There’s some awareness of what the rules of the road are and things that they can do. I think there’s a couple things going on here at once. One is that there is a lot of fraud in Medicaid. The administration is pointing to a problem that is real. I feel like the comments of the California officials that home-based care for elder people saves money by keeping people out of nursing homes 鈥� that is true, but only if those services are actually being provided to people. If there are fraudulent services in that sector, which we know that there are, that’s not really benefiting anyone’s health. That’s just wasting money and giving it to criminals. So, I think the administration feels like this fraud message is really powerful for them. There’s obviously a lot of political discussion about healthcare affordability, how healthcare has gotten so expensive, and I think neither party has a really great policy answer for that. I think the Trump administration is focusing on this one. They’re saying, “Well, this is just pure waste. If we can get this pure waste out of the system, that will lower the cost of healthcare.” And so I think they’re kind of banging this drum over and over again. But I don’t know that this particular mechanism is helping states actually reduce fraud. I think it’s more punishing states that are seen as political enemies, and I do think that the loss of those dollars is really going to affect the functioning of those programs. 

Rovner: Well, meanwhile, a new poll from my colleagues here at KFF suggests that the administration’s focus on health fraud rather than healthcare cost writ large might be politically misplaced. According to the poll, nearly two-thirds of voters think the administration’s anti-fraud efforts towards Medicaid are motivated mostly by politics, and fewer than half think the effort is likely to save taxpayers money. The poll also found that more than two-thirds of respondents, including half of Republicans, say that ensuring Medicaid beneficiaries can get the care they need is a higher priority than preventing fraud. That doesn’t feel like a really winning political issue, does it? 

Kenen: No. And another thing that was interesting in that poll, I mean, the way Dr. [Mehmet] Oz speaks about it is that there’s a lot of people cheating, and it’s sort of the welfare-ization of Medicaid. You know, these are all lazy bums. I mean, it’s not that there’s nobody dishonest on the rolls in any federal program. None of us would say that, but most of the fraud is from providers, and that’s clear. These, you know, huge rings of nursing home fraud in Brooklyn, and 鈥� every few years there’s this enormous one. And I thought it was interesting on the KFF poll that the majority across both parties actually think it is the providers. It wasn’t a huge majority, I think it was 55%, thought it was the providers, not the individuals. And but also, as you mentioned, Julie, they’re retaliating against blue states. 

Rovner: Yeah, yeah. I mean, this is their, sort of, This is how we’re going to address healthcare affordability, says this administration, and the poll suggests that maybe that’s not a really good way to go about it. All right, that is this week’s news. Now we’ll play my interview with Sen. Bill Cassidy, and then we will come back with our extra credits. 

I am so pleased to welcome Louisiana Republican Sen. Bill Cassidy to “How Would You Fix It?” Sen. Cassidy is a physician and the chairman of the Senate Health, Education, Labor, and Pensions Committee, which has been churning out health legislation of late. Sen. Cassidy, thanks for taking the time to join us. 

Bill Cassidy: Julie, thank you for having me. 

Rovner: I mostly want to talk about your “MVP” health agenda, but first, just a little bit of current events. President Trump has announced a 100% tariff on imported generic drugs starting in two years, and a 200% tariff after that, all in an effort to move that drugmaking back to the U.S. Do you think that’s a good idea, and will it work? 

Cassidy: Is it a good idea? It depends on whether or not it increases our national security and whether or not it actually ultimately ends up giving patients the price of generic drugs at an equal price, and thirdly, whether or not we avoid any contamination or other products like that. The national security might be something worth paying for. We know, God forbid, [if] we ever get in a hot war with China, the question is, can we bring generic drugs, which are principally made across the Pacific, across the Pacific to help us. So there is that national security aspect of it. That’s No. 1. No. 2, though, I’ve gone to a Dr. Reddy’s, which is owned out of India, used to have a generic site in Shreveport, and the cost basis of producing drugs in the United States was just significantly more than in India. And so it may be that consumers pay a little bit more. I’m hoping there’s an economic analysis showing if the cost-benefit ratio is adequate. I will finally say that I do think it’s important that we have some of our drugs produced here. I’m told that drugs like penicillin and cephalosporins are now almost all made in China. Again, going back to: Do we want China to have that sort of leverage for these drugs to be produced principally, maybe 99%, over there, and we don’t have access to them if tension rises between the two countries? I do think that is something worth investing in. 

Rovner: So also this week, U.S. measles cases have now topped last year’s total and are at the highest level in 35 years. You made it clear, even during HHS Secretary RFK Jr.’s confirmation hearing, that you see the risks of weakening federal policy and public confidence in vaccines. Do you think that Kennedy ever intended to keep the promises that he made to you around ACIP [the Advisory Committee on Immunization Practices] and the vaccine schedule? And what would you say to doctors who now place some blame on you for creating an environment where anti-vaccine sentiment is echoed by the nation’s health department? 

Cassidy: Well, first, I can’t get inside somebody’s mind. If they agree to guardrails and disregard those guardrails, you can judge me. But you may decide my judgment wasn’t very good, but I don’t think you can say I acted in bad faith. Why? Because I’m pretty sure that RFK was going to have the president’s ear whether he was in office or not. In office, we had guardrails that I had the expectation would be kept. Out of office, but with influence, there’d be no guardrails. So sometimes in politics and in life, it’s not a black-or-white choice. It’s not like, oh my gosh, this is the pure driven way, and this is, you know, darkness and whatever. No, it is something trying to decide what is the best with countervailing influences. I think doctors particularly know that, because it’s often the cases we care for patients that you have to come to something that you don’t quite yet know what the next step is, and you’re working towards it. Perhaps they’ll have more sympathy if they put it in light of their own medical practice. 

Rovner: So, are you going to try to have him back and keep pushing him to keep the promises that he made? 

Cassidy: I have made a request that he come back before the committee. 

Rovner: But we haven’t heard back yet? 

Cassidy: Not had a confirmation that he will yet. 

Rovner: Well, onto our bigger topic. You’ve proposed something you’re calling the Money and Value for Patients Agenda, or MVP, as a replacement, I guess, for the Affordable Care Act. How would that work? 

Cassidy: It’s not a replacement for the Affordable Care Act. It is only restricted to that which is in the employer-sponsored insurance market. And if we can look at where people are getting subsidies for their health insurance 鈥� you have a sophisticated audience, so I’ll speak this way鈥� we can see that if you’re on Medicaid, you basically get 100% of your healthcare costs paid for. If you’re on the exchanges and less than 250% of federal poverty, it’s like 85%-plus. And then after that, it’s your marginal tax rate. If you’re at the 15% marginal tax rate, you pay your premium on a pretax basis, which means you get a 15% break. If you’re at the 37% marginal tax rate, much wealthier, you get a 37% pretax break on the money you paid for your premium. So the people who are middle-income on employer-sponsored insurance are the ones who are getting the least assistance from the tax code or the federal government to purchase their health insurance. What?! The people who are trying to do it the best 鈥� they’re working; they’re not on Medicaid. Some people on Medicaid work, but many don’t. The people who are working are the ones who get the least assistance. So, what can you do about that? What I would do in my MVP plan is give an advanceable tax credit to those on employer-sponsored insurance below a certain marginal tax rate, and if you’re below some percent, you would get it. 

Rovner: So very rich people wouldn’t get this. 

Cassidy: No, it’d be like less than 22% marginal tax rate. And so those are the people who need the help. Let’s focus where people need help. And that’s negotiable, but that’s just an example. Under my calculations, a family of four could get up to $2,000. Now, why is that important? Many families, maybe most, will not have more than $2,000 of out-of-pocket expense in a given year. Now, one year they may 鈥� the wife’s pregnant, or the son, you know, gets in a car wreck 鈥� but most years they’ll have less than $2,000. So that would potentially cover all of their out-of-pocket, particularly if you couple it with the price transparency legislation we’ll discuss in a second. And because the family now has $2,000 to cover their out-of-pocket, they can choose a policy with a higher deductible, which means a lower premium. OK, so if currently the average deductible for a small-business plan is about $3,000, you give them $2,000, they’re going to choose a $5,000 deductible, and that will lower their premium substantially. I like to speak, Julie, of the cost of being insured, which is not just your premiums, but your copays and your deductible. We’re given $2,000 for that copay and that deductible, which allows you to take a lower-cost premium, and you put it all together. And my favorite economist, ChatGPT, says that you could potentially save $5,000-$6,000 per year, per family, and that makes a significant, meaningful difference in their ability to afford life. 

Rovner: So, is this in addition to employer coverage, or would this be instead of employer coverage? 

Cassidy: No, this would be in addition to employer coverage. Right now, we see that small businesses are dropping coverage, and so this would, obviously, if the employee is choosing a cheaper plan because the plan they choose is a higher deductible, then it becomes less expensive for the employer. And so they can better afford to continue to offer. So this is a way to help that small business as well. I’ve talked to a small-business owner back home, several small-business owners. It’s becoming very difficult for them to give salary increases and/or hire more people if they continue to provide health insurance. So, if we’re able to take a little bit of that burden off of the employer to give an adequate insurance policy, then hopefully they can increase wages and/or hire more people and expand their business. So it’s a benefit not just for the family, but also for their employer. And frankly, the federal government ends up earning more tax dollars because, not getting too complicated, but the less money you’re spending on a pretax basis, the more money going into your post-tax paycheck, the more taxes you pay for payroll tax, etc. 

Rovner: I’m thinking of private equity and some of the gaming of one of the laws that you were instrumental in getting passed to prevent surprise medical bills. How do you try to protect consumers from people in healthcare who are literally just in it for the profits? 

Cassidy: Why not price transparency? If you don’t know the price of something, you can’t get a better deal. And that’s whether you’re the patient or whether you’re the business. And so the initial step to make sure that people are getting their best deal is price transparency. And, by the way, the wonderful thing in the last year or so, I’ve been exposed to people doing wonderful work, and people are developing apps on the phone, and you could say, “Hey Siri, where’s the urgent care center near me? What is their price schedule for a routine earache?” OK, I’m going to go to this one near me because it’s $50, not $150. So I go there, and then I come out with a prescription. “Hey Siri, where’s the cheapest place to get this prescription for amoxicillin, 500 milligrams BID?” Siri tells you, or the app tells you, not Siri, but the app. And these are, like, being developed now. I mean, this is not 鈥� no, this is now. And so if you couple money in the pocket with price transparency, giving the individual the ability to determine where to go to get the best price 鈥� and we have some other provisions in there that protect the patient, a lot of provisions 鈥� then you are going to bring value to the patient. That’s part of the solution in the employer-sponsored insurance market. 

Rovner: Sen. Bill Cassidy, thank you very much. 

Cassidy: Thank you, 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. Alice, why don’t you go first this week? 

Ollstein: Yeah, I have a story from our friends over at Roll Call. This is “,” by Ariel Cohen. And this is about a recent decision that, like so many things these days, flies under the radar because there’s so much going on at once. And just in the category of grant cuts, there’s so much going on. So this is about the sudden slashing of a bunch of HIV prevention grants to community organizations. They’re now saying they’re going to redirect the same funding to state and local health departments, and those state and local health departments can, if they want, then pass it on to the community organizations. But 1) that’s, you know, more bureaucracy, more headaches. But also, what this article smartly points out is that that then makes the community organizations no longer eligible for 340B, which was helping them buy all of this medication much more cheaply. And so losing that designation, losing those grants, is a really big deal for these groups that are trying to afford doses of expensive medication like PrEP to distribute to communities. 

Rovner: Yeah, again, some of these things that sort of look small end up with far-reaching consequences. Joanne. 

Kenen: This was the first extra credit that actually made me invent a word, which was “yikes-maxing”! You know, like, it was so wild. It’s from Stat by Adam Feuerstein. I probably have that wrong. 

Rovner: Feuerstein. 

Kenen: OK, and the headline is “.” So, for 20 years, this guy 鈥� he was a doctor. He was convicted of one assault. He was pending trial on another sexual assault allegation, and he disappeared right before his trial. He left notes that he was going overseas, transferred property to his kids, etc. Well, he did not go overseas to live as a fugitive. He was right here posing as a cancer expert, and he worked for two biotech companies. And he purported to have expertise in all this very advanced, cutting-edge drug development for cancer, which was not his actual background. So, like, how did he get these jobs? Why wasn’t he vetted better? He was finally tracked down on a yacht called the Silver Lining, and, in fact, the alleged assault, because one of them wasn’t ever went to trial, was on yacht. Yachts were his, apparently, his favorite locale for his alleged assaults. So he has been arrested, but it’s not just like this guy needs to go to trial, but, like, how did these companies 鈥� did they even look at his LinkedIn? I mean, he was using a fake name. How did this happen? It’s a huge scandal, and it’s also a great yarn. 

Rovner: I can’t wait to see the movie that somebody’s going to make out of this. Margot. 

Sanger-Katz: I wanted to recommend an article from Andrea Hsu on All Things Considered and NPR. “.” And this is a story about a growing number of men who are entering the nursing profession, and, in particular, a look at the University of Alabama in Birmingham that is really trying to recruit men into the profession. And you know, I feel like caregiving professions have traditionally been kind of a female domain, but I think there’s a new openness by men to enter these careers, which I think can be very fulfilling. They’re very secure. They’re relatively high-paying. My colleague Claire Cain Miller did a story in the Pacific Northwest almost 10 years ago, I think, where she interviewed a number of male nurses about their work and had these beautiful portraits shot of them, and it just is a piece that has stayed with me for a long time. Just thinking about these men in these caregiving roles and why some of our, like, more conventional ideas of masculinity prevent men from entering these professions that I think can be really great careers and really fulfilling for them. So I just thought this new story was really good. I was interested in what this university is doing to recruit men, and I think the idea of male nurses and a nursing profession that is more gender-diverse is really interesting. 

Rovner: And in 2026, unlikely to be taken over by AI. It’s one of those rare career paths. It’s probably still going to be around for a while. All right, my extra credit this week is from The New York Times. It’s called “.” It’s by Arijeta Lajka, Isabelle Niu, Mark Boyer, James Surdam, and Dan T. Peters. It’s a video, and it shows how AI-generated doctors, Eastern medicine health practitioners, and wellness influencers are all over social media, making often dangerous health claims to sell all manner of questionable supplements. The money line from the piece, quote: “Ads like this would be illegal on U.S. television, but on the internet they face little enforcement.” Apparently, some of the big social media companies are trying to find and extinguish ads that make misleading claims or are not noted to be AI. But for now, it is still very much buyer and watcher beware.  

All right, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. We also had production help this week from Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts 鈥� as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X , and on Bluesky . Where do you guys hang these days? Margot. 

Sanger-Katz: I’m on social media , and you can reach me on Signal at sangerkatz.01. 

Rovner: Joanne. 

Kenen: I’m mostly on  and  @JoanneKenen. 

Rovner: Alice. 

Ollstein:  on X, and  on Bluesky. 

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

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

Julie Rovner: Hello, from 吃瓜不打烊 and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 吃瓜不打烊. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, July 16, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everyone. 

Rovner: And Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

Rovner: Later in this episode, we’ll have the latest in our “How Would You Fix It?” series, this week with Elizabeth Mitchell of the Purchaser Business Group on Health, which represents employers and institutional buyers of health insurance and health services. But first, this week’s news. 

So, Congress is back from its July Fourth break with lots of changes, but still not a ton of forward progress on its legislative agenda. Sen. Mitch McConnell, who was hospitalized in June for what his office now says was a fall followed by a case of pneumonia, is still out. And close [President Donald] Trump ally South Carolina Republican Sen. Lindsey Graham died suddenly over the weekend. He’s already been replaced temporarily by his sister, Darline Graham Nordone, who presumably will be a reliable vote for Trump priorities, but probably not the dealmaker and mover-and-shaker her brother had been. In the House, members approved a surprisingly divisive bill to make daylight saving time permanent. But there doesn’t look to be a very clear legislative path for things like, oh, the annual spending bills that need to be done by Sept. 30? And yet another party-line Republican budget bill that might or might not be partly paid for by another push on healthcare fraud. What are you folks hearing about the major things that Congress has to do before the end of the fiscal year?  

Ollstein: Well, the thing that amused me the most that I saw was that leadership in the House, who are facing the same struggles over and over, herding the cats and getting enough Republicans to stay in line to pass even these party-line, you know, slim-majority bills, they’re trying the same tactic they tried with the last reconciliation bill, which is Hey, I know you’re disappointed that all of the things you wanted in this bill are not included, but don’t worry; there’ll be another one after it, so just vote for this one. And so they said that when they were working on “Reconciliation 2.0,” they said, Don’t worry; all the things you want, including Planned Parenthood’s Medicaid funding, that’ll be in 3.0. And now that we have 3.0, and it’s not included, and a bunch of other things they want are not included, they’re saying, Don’t worry; we’ll put it in 4.0. Now, there’s a lot of skepticism that even 3.0 can get done, so 4.0 seems like a wild fantasy at this point. 

Rovner: Yeah, I saw the reference to “Reconciliation 4.0,” and it’s important to remember that there’s only a limited number of budget reconciliation bills you can do. Each budget resolution gives you two or three, I guess, if you include 鈥� you can do a separate one to increase the debt ceiling. But generally, each budget resolution gives you a chance to do a tax reconciliation bill and a spending reconciliation bill. And when they neglect to do the budget resolutions, sometimes they can have a year where they’ll do two budget resolutions for two different fiscal years. But really, that just leaves them four. And I think, I’m not sure there’s a budget resolution that can come for a Reconciliation 4.0. But I guess we’re gonna see. I mean, basically, this really is all about: There’s a segment of the Republicans, particularly in the House, but I think also in the Senate, that want to permanently defund Planned Parenthood from Medicaid, which the Senate parliamentarian has said they can’t do on a permanent basis, and that just sort of continues to string this out, right? 

Ollstein: Right, and there are Republicans in the House that don’t want to take a vote on that in an election year. They worry it could hurt them politically, and then you have the more conservative wing of the party that is very upset that Planned Parenthood recently got its Medicaid funding back, because that law from last year was allowed to expire. So you just have a lot of angst and finger-pointing and upset Republican-on-Republican arguments going on this week, you know. Not to mention, there’s only, I think, seven weeks that they’re in session before the midterms. After the midterms, you could start to have attendance problems, and so people are very, very skeptical that 3.0, but especially some sort of 4.0, could happen. 

Rovner: Yeah, well, so the legislative agenda is kind of stalled. But there were confirmation hearings this week for the administration’s nominees for a couple of top Health and Human Services posts: head of the Centers for Disease Control and Prevention and assistant secretary for preparedness and response. Anything newsworthy from the nominees, Erica Schwartz or Sean Kaufman? Sandhya, you were at this hearing, yes? 

Raman: Yeah. I think this was really interesting to me because, up until yesterday, we had a lot of people kind of pleased with the nomination of Erica Schwartz as, you know, a more kind of mainstream, like, career type health official to be the head of the CDC, and you know even Democrats were pretty pleased with this. And, you know, we even had people that were more MAHA [Make America Healthy Again]-aligned, you know, being more skeptical that she would speak to some of their concerns that they’ve had. And what we had at the hearing was her kind of shifting gears, you know, deflecting on a lot of questions, being asked about various things, being asked about cuts to mRNA research, and saying, Oh, you know, I’m not familiar with that. Saying that she wasn’t familiar with some of the changes related to food safety, while we’re in the cyclosporiasis situation that we are right now. And even issues like the CDC Office [on] Smoking and Health, which she said, you know, smoking prevention was like one of her top priorities when she was working pre-government, and, you know, saying she wasn’t familiar with that office being eliminated. So that was interesting. And even you had the [Health, Education, Labor and Pensions Committee] chairman, Sen. Bill Cassidy, saying, you know, it seems like you’re a little overprepared for this and not answering. But I think the main takeaway was just vaccines. We had so many questions about vaccines from Cassidy, but just throughout the members of the [HELP] committee, trying to kind of garner where they were on it. And again, it was kind of, you know, walking that line to kind of appeal to the widest selection of people as possible. And I don’t think that that was what necessarily everyone was expecting there. For the ASPR [assistant secretary for preparedness and response] nominee, Sean Kaufman, there had been reporting earlier in the week about some of his old LinkedIn posts suggesting some of his comments about, you know, pediatric vaccination and things, and him being a little bit more skeptical. But he came out pretty strongly in favor, saying, I think, vaccines are safe and effective. But I think that there’s still some questions there when you talk to both of the nominees about, you know, whether or not they’d be willing to buck the secretary or the president if push comes to shove on some of these issues. And I think that was what really raised some eyebrows by some of the members on the committee. 

Rovner: I would say Cassidy got pretty exercised about some of the vaccine stuff. Do we know whether that’s going to make him not want to vote for some of these nominees? I mean, that’s pretty much up to him whether these things move forward. And you know, he has since said, after voting for Kennedy, that he was he was 鈥� I don’t think he said that it was a mistake, but he said that Kennedy has not kept the commitments that he made to Cassidy and the committee. So, you know, Cassidy 鈥� who’s a lame duck, has at least another chance to exercise some power here. Is he gonna? 

Raman: He did do some fiery exchanges with both of them on some of the vaccine-related issues, but at no point, I mean, did he come down as strong as that. I mean, at some point, he was saying to Schwartz, the CDC nominee, that, you know, I came in here ready to support you. Like, I want assurances on some of these things. But he didn’t, you know, indicate that he was gonna draw the line there. I mean, I guess we’ll see. I think one thing that did stand out was that he said that his conversations with her, you know, one-on-one, physician-to-physician, before the hearing were a bit different from what he was hearing in the hearing. So it depends, you know, are there more conversations? Does something sway? But it seems like it’s still, you know, heading towards, you know, getting across the finish line. 

Rovner: And to be clear, Erica Schwartz is, you know, she’s a doctor and an epidemiologist, and, you know, ran healthcare, I think, for the Coast Guard. I mean, she’s got a lot of government experience as well. 

Raman: She’s a former deputy surgeon general. She’s, yes, absolutely. 

Rovner: Yeah. Yeah. I mean, she clearly, clearly, on paper, she is more than qualified for this job. It’s just whether Cassidy is angry enough to actually, you know, put his power where his mouth has been. 

Well, there was some health-related news out of the hearing for Todd Blanche, the acting attorney general nominated to take the job permanently. Under questioning from several anti-abortion Republican senators, Blanche rather specifically promised to examine something called the Comstock Act, an anti-vice law from the late 1800s, to potentially outlaw the mailing of abortion pills, regardless of what the FDA says. Alice, what would that mean? 

Ollstein: So, I think it’s important to emphasize that Blanche only promised to review this. He didn’t promise to make any specific changes. I saw a lot of anti-abortion activists getting, I think, a little overly excited about what he said. You know, they could review it and take no action. I think it’s also important to remember that Trump specifically promised on the campaign trail not to use the Comstock Act to go after abortion pill providers. You already have activists on the other side, pro-abortion rights activists, characterizing that as the kind of national ban, federal ban that Trump also promised not to enact. You know he specifically has this, you know, “leave it to the states” stance, and you could argue he’s already broken that in some ways. But this would be a much bigger way. So, a lot of different ways the government could cut off access to abortion pills by mail came up in the hearing. The Comstock Act is one of them. I think what abortion rights activists find troubling about the Comstock Act, in particular, is that it could be used to cut off access to both mifepristone and misoprostol, whereas the strategies that the anti-abortion movement is using that are focused on the FDA are pretty much only focused on just one of those two drugs that have to be used together for abortions. So, if the FDA were to act to restrict mifepristone, people could still have abortions just using misoprostol. But if they tried to use the Comstock Act, they could cut off access to both, which could also impede people’s access to those drugs for nonabortion purposes, which they are used for. 

Rovner: Misoprostol has a lot of other uses. I mean, mifepristone is primarily an abortion drug that’s also used for miscarriage. But misoprostol is an anti-ulcer drug that’s used for a whole lot of different indications that have nothing to do with reproductive health. 

Ollstein: And that’s a big part of why the Biden administration put out this memo from the DOJ [Department of Justice] saying that they don’t think the Comstock Act should be used to prosecute doctors who prescribe abortion pills and mail them because you can’t know if the person is ordering them for a legal or illegal purpose. And, you know, obviously people quibble with that in various ways, but that is the sort of underlying rationale, and that precedent is still in place, and that’s what these senators were trying to push Blanche to change, if confirmed. 

Rovner: And yeah, I say, and clearly all of this depends on whether or not Blanche gets confirmed as attorney general, which is still up in the air, mostly for other reasons. But 鈥� 

Ollstein: Yeah, absolutely, people are upset with him for the handling of the [Jeffrey] Epstein files and all kinds of stuff. And just one GOP senator on the committee could block him from going forward. So it’s not all about this, but this is definitely in the mix. 

Rovner: Yes, I think so. Well, moving on, as we’ve noted, the big cuts to Medicaid from the 2025 Republican budget bill mostly don’t start until next January. But states whose fiscal years started this July 1 are already making changes in order to be ready. Several states are already trimming back Medicaid benefits that are optional for states, including many community-based long-term care services. This is despite Republican assurances last year that traditional populations of moms and kids, seniors, and those with disabilities wouldn’t be impacted by the cuts. Stat has a  out of Maryland about cuts to a family caregiver program that may leave a family with the choice of either going bankrupt or putting their disabled child into an institution. It’s hard to see how this isn’t going to be a big campaign issue, right? I mean, this, you know, there were all of these claims that, you know, we’re really only going after the able-bodied Medicaid recipients. That’s not what states are doing.  

Raman: I mean, we’ve already seen it becoming a campaign issue. I mean, even before this was passed into law, we saw Democrats really, like, going in on this far before the midterms, you know, emphasizing this over and over and over again. And I see, you know, they’re going to continue doing that, especially when costs are such a big issue for voters this year. And if you lose Medicaid, then that is another added cost for you if you have a health issue of any kind. But I think what’s even more interesting is how this has been really played back on the Republican side. They’re not talking about this as much as they did a few months ago. Even, you know, we passed the anniversary of the law earlier this month, and there wasn’t a big push on this like there has been on other issues. They’ve really shifted into talking more about 鈥� as for in the healthcare bubble, we’re talking about fraud, fraud, fraud, not any of the things that were in the “Big Beautiful Bill.” 

Rovner: Yeah, things that they hoped people would see as an advantage are not so much right now. Well, another tack that states seem to be taking is not to cut Medicaid for recipients, but rather to get someone else to help pay the bill. And they’re targeting large employers of low-wage workers who have Medicaid. New Jersey is planning to charge those larger employers a fee. Other states are looking at ways to do something similar. But there’s not just pushback from business groups, who obviously don’t want to pay a fee for their workers who are eligible for and get Medicaid. Some advocates for low-income people say that it will make it harder for workers who get Medicaid to stay employed if their employers will be penalized. I know this was, you know, this came up many years ago 鈥� I think just after the beginning of the Affordable Care Act, when there was concern that a lot of big employers were actually going to dump their workers onto Medicaid. Many of them in the end did not. But it’s hard to see how this is really going to catch on. I grant states creativity for, like, OK, we’re not allowed to ask healthcare providers to help pay our Medicaid bills anymore. So now we’re going to ask big employers to help pay our Medicaid bills. 

Edney: Well, I think it’s an interesting 鈥� it’s probably a tough calculation for the people, you know, that are actually making this decision. The person who’s deciding, you know, do I take this employer insurance or Medicaid? And then you do want to push employers to offer plans that are affordable and that are comprehensive. That’s what they’re supposed to do, especially these big employers. But there can be kind of a lot of calculation that goes into this: maybe the size of the household, who else in the household might be working. So you know, I can see why it might feel like it’s not just on the company, but maybe some of the employees who are making these decisions could end up suffering. 

Rovner: Yeah, as I say, kind of points for creativity, but not clear that this is actually going to catch on because there are clearly going to be problems with it. States are going to have to keep looking to figure out how to continue to pay their 鈥� share of the Medicaid bills. As Sandhya already mentioned, some of you may have noticed the U.S. is having an outbreak of something called cyclosporiosis, which is an infection caused by a parasite that causes, let’s just say, major gastrointestinal upset. Screening for the parasite, which, by the way cannot easily be washed off of infected produce or other food products, used to be part of a list of parasites whose reporting was mandatory to the CDC’s Foodborne Diseases Active Surveillance Network, known as FoodNet. But it was made optional last year, and, as of now, we still don’t know what foodstuff is spreading this parasite 鈥� although suspicion’s being cast on lettuce or some other leafy green vegetable. Is this yet another “I told you so” about cuts to public health? And is anybody really gonna care, other than the thousands of people who are really sick right now? 

Edney: Yeah, I think that, absolutely, this is another “I told you so” in the sense that, like, you can’t just decide what bacteria you’re going to track if, you know, it pops up and you can’t really control that. And I think that a lot of people already care, you know 鈥� I think you’ve seen a lot of decisions being made, at least that’s what social media has indicated. I have not seen, like, shopping numbers, but people seem to be concerned. 鈥� They don’t want to buy lettuce, raspberries, cilantro, things that have been implicated in these outbreaks before. And so, with states not reporting to FoodNet, it’s harder to track in real time. So it’s taking longer to narrow down what food is responsible for this, what, who the producer is. So people are left wondering and left just cutting, you know, entire fresh fruits and vegetables out of their diet at this point. They’re really worried. 

Rovner: It kind of cuts against the whole “eat healthier.” 

Edney: Exactly. 

Rovner: Like when the healthiest things might cause all kinds of problems. 

Edney: Yeah, I mean, you know, if all you feel comfortable eating is packaged goods and microwaving all your food to make sure it’s safe, I think it is a problem. And there are people I think who do feel that way, especially in states, you know, in the Midwest that have a lot higher numbers of these cases. 

Rovner: I would say the federal government keeps saying, “Oh, we get cyclospora outbreaks every year,” and we do. But this is much, much higher than it has been in many years. Sorry, Alice, you wanted to say something. 

Ollstein: Well, I mean, it’s the classic situation of, you know, when public health is working well, it’s completely invisible, and so it’s easy to take it for granted. And you can say, well, there hasn’t been a serious outbreak in this many years. What’s the point of this expensive monitoring and prevention program? And turns out, this is why. It’s a very thankless sector because when it’s working well, you don’t get any kudos. You don’t get any awards for not having an outbreak of diarrhea parasite. But everybody gets upset when there is an outbreak of diarrhea parasite. 

Rovner: And screwworm, which we also have after we canceled some of the watchouts for it. All right, we’re going to take a quick break. We will be right back.  

OK, we are back. So in news from what I’m calling the “Department of Updates,” a couple of weeks ago we talked about Health and Human Services Secretary Robert F. Kennedy Jr. calling up libertarian candidates in Iowa in an effort to get them to drop out of House races in order to prevent them from siphoning votes from Republicans. Well, now Oregon Democratic Sen. Ron Wyden is officially asking the U.S. Office of Special Counsel for an investigation into whether that violated the Hatch Act, which generally prohibits federal employees from participating in political activities. Of all the, quote, “scandals” attributed to RFK Jr. since he’s been in office, where does this one rank? 

Edney: That’s a really good question. I’m not sure a lot of people might understand the gravity of it, but a person in appointed position is not really supposed to be weighing in and putting their thumb on elections and influencing those outcomes. I mean, that’s the law. And so it is a Democrat asking for this investigation, which the consequences might be less heavy, I guess, you never really know. I mean, I think it does, kind of the whole situation. Secretary Kennedy’s trying to influence these does kind of show you how worried they are, how worried he is, that he might have to go up before Congress should Democrats win the House and answer a lot of questions under subpoena. 

Rovner: Yeah, and of course that’s exactly what he said to the libertarian candidates when he was trying to get them drop out is, like, if the Democrats take over the House, I’m going to spend all of my time, you know, on Capitol Hill rather than working to, you know, make America healthy again. That was his argument.  

All right. Well, another topic we have spoken about before is the proposed rule from the Office of Management and Budget to give political appointees far more power over which scientific and medical grants get funded. The comment period for the rule closed this week with nearly half a million comments filed. That’s a whole lot, by the way. And our friends at Stat, with help from researchers at the University of North Carolina,  that have been posted so far, and found them overwhelmingly in opposition to the rules, with concern about politicization of science dominating the reasons. I still feel like this is an under-covered story. We’re talking about the fate of more than a trillion dollars in federal funding each year, and a huge change in the way this money is allocated and spent. I mean, you know, already we’ve seen the administration trying to hold back some of this money and getting pushback from Congress, but this would basically codify, if you will, the ability of political appointees to say, We’re not going to give you money unless we agree with it. Essentially. 

Raman: I mean, I think even from the get-go of this comment period, there has been that groundswell of people submitting comments. You know, even a few days in, we were hitting numbers that we would usually maybe not see even throughout the whole comment period for other proposed rules. And so much of that in, like you said, the scientific community has been this. But grants extend to so many departments in the federal government and cover so many different things, and I think it’s kind of hard to quantify just how sweeping something like this would be. Even, you know, looking at a few different pieces, just because the types of grants are so different. 鈥� So many grants are multiyear, and might go from one administration to another, and then be implemented. And if politicization of approving or rubber-stamping continuing grants is there, that would create a lot of up and down in terms of Will these things continue? So I will not be surprised if as we get a little further along there is more litigation filed with people trying to stop this. It’s just we’re at this stage now where proposed rule time is not really where you would you would get that. There needs to be a little further in the process. But yeah, I think this is something that a lot of people are really keeping an eye on. But it is something that’s harder, I think, to communicate out to folks that maybe don’t realize that they are using grant money for something that is available in their community.  

Rovner: We need a Schoolhouse Rock! for peer review and grant-making. Maybe I’ll have to do a video with the dog. Yes, my next video with the dog. 

Ollstein: Just quickly, I will say that the abortion rights community is very anxious about this. They worry that it will lead to any sort of research remotely tied to reproductive health will be cut unless it’s, you know, explicitly pro-abstinence, pro-fertility. But again, like we talk about with so many things, when you implement these changes, it cuts both ways, and a Democratic administration in the future could wield this in ways that conservatives don’t like. And so 鈥� 

Rovner: I think what freaks out the science and medical community is just the lack of continuity. It’s that if it’s going to change back and forth, I mean, one of the things that research really depends on is that research takes as long as it takes, and that often stretches way across Democratic and Republican administrations. That’s kind of the idea of not having this be in charge of political appointees. So I think that’s a lot of 鈥� I mean, I have obviously have not read half a million comments, but many of the comments I’ve seen have suggested that there’s concern about the going back and forth that would be as damaging as anything else. 

All right. Well, speaking of updates,  that the Department of Health and Human Services is backing away from a new regulation proposed with much fanfare last December that threatened to withhold Medicare and Medicaid funding from hospitals that offered transgender care to minors. Some 30,000 comments on that rule were filed, including those from major medical groups urging that the rule be rejected as an unwarranted interference in medical care. The administration actually pushed back against the NPR story, saying the rule hasn’t been officially pulled, which does appear to be the case. But it seems that officials are kind of trying to have it both ways by leaving the possibility that it could be revived hanging over hospitals’ heads. Is this kind of a clever way to put pressure on hospitals to do what the administration wants without actually having it litigated about whether the administration has the legal authority to do this in the first place? 

Edney: Yeah, I think that’s a good point, that are they sort of leaving it in place without ever fully implementing it? Because states are supposed to be able to regulate this, not have the federal government tell them what to do. And certainly, you know, the hospitals could have their say in it. So they could have been facing a lot of litigation, and I think not pulling it doesn’t mean that it’s not gone. It’s just, you know, according to the story, they clearly decided not to go forward with it. But leaving it in place does kind of, for the hospitals that already moved on this, and we did see some that got nervous. Then, you know, they might be the ones who kind of keep everything in place, just because they’re not sure. 

Rovner: Yeah, I mean they’re making the point that they’re not moving forward on it now. But that doesn’t mean that they’re never moving forward on it, which seems to be a theme from this administration on a whole lot of things. It’s like: We’re not going to do this now, but we still could do it later.  

Well, finally this week, there’s always plenty of news on reproductive health. Alice, I feel like I’m being transported back to, like, 2014 or even 2018, but it looks like the Trump administration is going to try again to  as required by the Affordable Care Act. Why are we debating this again now? 

Ollstein: So this is the case that won’t die ever. Apparently. This is about a workaround in the Affordable Care Act that was created so that religious employers who really object to contraception for, you know, deeply held faith reasons, there’s a workaround so they don’t have to pay for the insurance that covers contraception for their employees. But their employees can still access that contraception coverage if they want it. But certain groups have kept suing over this again and again over the years. It went all the way up to the Supreme Court, and then it came back, and now it’s bouncing around in the lower courts because they say that even participating in that workaround is a violation of their beliefs. Now, on a sort of parallel track 鈥� 

Rovner: They are facilitating 鈥� right, obviously, they are facilitating. They’re “complicit.” That’s the word they’re using; they are complicit in allowing people to get contraception, which they don’t believe in. 

Ollstein: Correct, and 鈥�  

Rovner: “They” not the people who are getting it, “they” the people who are complicit in getting it. 

Ollstein: The bosses, yes. 

Rovner: Right. The bosses. 

Ollstein: So, sort of on a parallel track, the Trump administration tried to vastly expand the number of companies, the kind of companies that could say we don’t want to provide contraception for our employees, so that now it doesn’t have to be because of a religious belief. It could just be because of an ideological belief. And also now this could be, you know, a big for-profit, publicly traded company, not just a small religious group. Folks have been fighting this, and so here we are back in court again. This is, you know, an ongoing struggle. Of course, you know it’s important to remember that the question of whether or not working folks can access contraception has much higher stakes now that abortion is illegal in much of the country. 

Rovner: We will see. Well, and while abortion doesn’t seem to be as big a political issue in 2026 as it was in 2022, we are seeing ballot measures in several key states, as well as abortion being centered in places like the Maine Senate race, where ostensibly pro-choice Republican Sen. Susan Collins’ vote to confirm Supreme Court Justice Brett Kavanaugh is being hung around her neck, even though she doesn’t have an actual Democratic opponent yet, after Graham Platner dropped out. How is abortion shaping up as a political issue this year? Alice, you’re, I assume, following this. Sandhya, so are you, right? 

Ollstein: It’s interesting. I have a story coming on this in the next day or so. The Democrats who are jockeying for the chance to take on Collins and all of the outside groups supporting them and rushing through this process, they’re very anxious about the ability to make the case that Susan Collins has, as they say, betrayed, you know, her promises to protect abortion rights by confirming not only the Supreme Court justices who helped overturn Roe v. Wade, but a lot of lower court judges who have voted for abortion restrictions in a lot of states. And so they want to be able to put that front and center in their campaign against him. And so they’re really anxious about the records of the Democrats running, because they don’t want to muddy that message at all, and to have Susan Collins have the opportunity to say, Actually, these people have a worse record than me on this issue. And so there’s a lot of hand-wringing on that front. And it’s just tough because some of the Democrats running have a mixed record on this. They used to oppose abortion, and then in more recent years have, you know, passed very strong legislation supporting it. And then you have a lot of candidates who have no record at all on this. They have no voting record. Some of them have never held office before, or this issue just has not been something they’ve had a chance to work on. And so, it is tough for voters to compare someone who has a mixed record but made real accomplishments for abortion rights versus people with no record at all. 

Rovner: So, abortion is going to be an issue, but maybe not sort of 鈥� like with the attorney general, “in the mix” 鈥� is that a fair way to put it? 

Ollstein: Oh, absolutely! And no matter what, it’s going to be a huge part of the campaign against Susan Collins. You’re already seeing groups start to air ads about it. 

Rovner: All right. Well, that is this week’s news. Now we’ll play excerpts from my “How Would You Fix It?” interview with Elizabeth Mitchell. You can . And then we will come back and do our extra credits. 

I am pleased to welcome Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health, to “How Would You Fix It?” PBGH represents large employers and other institutional buyers of healthcare from both the public and private sectors. Elizabeth Mitchell, thanks for joining us. 

Elizabeth Mitchell: So glad to be here. A lot to fix. 

Rovner: Yeah, a lot to fix. So I want to start by having you talk a little bit about employers’ role in the U.S. healthcare system 鈥� how it started, and why it persists. 

Mitchell: Yeah, well, I think we know it was an accident of history, right? They weren’t looking to get into the healthcare business, but when, you know, they were looking for alternatives to wages, when there were limits on what they could offer, and they started with what was a pretty inexpensive offering, helping pay for hospital care. And that has now grown to be the second-largest line item in their budgets after payroll. So it has taken on a life of its own. Employers cover over 160 million Americans, so they are a major player in healthcare in the U.S., for better or worse. But they are committed to achieving just a better system because they’re paying for it and because their employees need it. 

Rovner: What’s unique about large employers, particularly the large employers that you represent 鈥� the ones that not only pay for their workers’ health benefits but also design and manage them in most cases? 

Mitchell: Yeah, it’s a great question. I work with large and jumbo self-insured employers and public purchasers like CalPERS. 

Rovner: CalPERS, for those who don’t know, is the California pension system. 

Mitchell: Yeah, they are the second-largest purchaser after Medicare, I believe. So not small. And honestly, the major difference for large employers is the leverage, right? They have the ability to negotiate arrangements that small employers just don’t have. You know, there is somewhat of a myth that the health plans are responsive to large employers. That is sadly not often the case. As large employers have sought to exercise that leverage, the system has consolidated in response, so the health insurers have consolidated, the health systems have consolidated. So there’s been this arms race of consolidation, meaning that even the largest employers in the world are smaller and don’t have the leverage many times. So they’re looking at how can they align or aggregate even across large employers to really drive the changes they’re looking for? 

Rovner: Well, the premise of this entire project is that we’re heading towards another major national debate over health because just about every stakeholder is unhappy with the status quo. I assume that’s at least as true for large employers now as it was in the early 2000s, when the ground was being laid for the Affordable Care Act. Do you agree with that? And just how dissatisfied are your members with the current functioning of the healthcare system? 

Mitchell: I do not know any employers that are happy with the current system. I will say that that dissatisfaction is growing exponentially every year of double-digit price increases and lack of access and just administrative complexity. We are seeing readiness for wholesale changes that I’ve never seen before. So there is very high frustration, but I also see that as a big opportunity. 

Rovner: So how would your members fix the system? What are some of those policy changes that they would like to see? 

Mitchell: So there is no simple answer. I know that goes without saying, but there’s a collection of changes that we are prioritizing based on evidence. So one of them is primary care, really robust primary care 鈥� and not the kind that is just set up as a feeder into the health system 鈥� is a top priority for our members. Another really is more on the purchasing side, right? There is so much administrative waste in the system. And some of our members now are turning to AI just to look at their contracts and realize that they are paying these absurd fees they never agreed to. And then finally, transparency. It is absolutely essential. There are immediate savings opportunities just by looking at the data and realizing you can get the exact same quality or better-quality service across the street for a fraction of the price. And that has immediate savings for out-of-pocket costs as well. So, using transparent information to find the best partners, banning anticompetitive practices, and investing in primary care and high-quality specialty care. Those are my top few. 

Rovner: There are voices both on the left and now on the right who would like to get rid of the basically employer-based system that we have 鈥� you know, “Medicare for All” 鈥� and would anticipate, would take that away, you know, basically would have the government, if not providing them, at least paying for all healthcare services. Now we’re seeing Republicans talking about, you know, big bad insurance companies, and we should just give people money, and they should buy their own care. Where are large employers on that, sort of? I assume they would like to keep some semblance of the system that we have now in a reformed system, or am I wrong? Are they ready to give it up and let everybody fight it out for who provides healthcare? 

Mitchell: Well, I represent a subset of jumbo employers who are very progressive, very innovative, and very invested in fixing the system. That said, I don’t think anybody would say it’s working right now. We have a very real affordability crisis. And I would say jumbo self-insured employers are some of the best-positioned actors to do something about that. They have the opposite incentives. They want lower cost and better quality. So if they are empowered and enabled, in some cases through policy change, to be more effective purchasers, I do think that that is a viable strategy still. Because even if you just gave everyone cash, you still have a price problem. It just becomes the problem of the patient instead of the purchaser, because prices are the issue here, and consolidated, unresponsive providers and plans. There is a tendency, and it’s not totally unjustified, of blaming the customer. But there are some aspects of our system that need to change. Whether the government’s paying for it, individuals are paying for it, or employers are paying for it. So it’s a matter of how do we get at that? If it was Medicare for All, they set prices. Maybe that will work. I think the opponents of that historically have been hospitals and health insurers, not employers. But employers are committed to playing a very active role in achieving affordable, high-value care. 

Rovner: Well, that was sort of my question: Are employers ready to say: We just, we would like to wash our hands of this and let somebody else do it? Or would they prefer to stay involved? Or I guess I’m sure it depends on the details.  

Mitchell: It depends. I mean, again, we don’t work very much with small and midsized employers, but 鈥� 

Rovner: I’ll talk to them separately. 

Mitchell: Yeah, it wouldn’t surprise me if they wanted to wash their hands of it, because they have so little leverage. I think that there are large employers who remain committed to this. But depending on the policy environment that we are in in the next three to five years, who knows? I do think that if employer-sponsored insurance doesn’t demonstrate real affordability in the next few years, you know, I think it’s an open question. 

Rovner: So we seem as a society to be growing further apart rather than closer together on a lot of policy issues 鈥� not just healthcare, but education, climate, immigration. How do we get back to a place where people who disagree can work together to address something that everybody agrees is a problem, like the state of our healthcare system? I realize that’s sort of beyond your pay grade, but unless people think about it, we’re not going to get there. 

Mitchell: No, I think it’s a really, really important question. I don’t necessarily have the answer. But, I mean, I think it’s also finding where we have agreement, right? Everyone, well, all the people I work with, think we are paying too much for healthcare, so we’ve got to have a clear goal of affordability. And employers alone can’t fix that, right? So how do they partner with clinicians and providers and communities and governments to actually achieve that? I think if you focus on those sort of pragmatic shared goals, I mean, it may lower the temperature a bit. Healthcare is also so complex. Everybody sees different sides of the elephant, and they, so they have very strong views. They’re not wrong. It’s just not the whole system. So really, taking a systems approach, understanding the existing practices and incentives and behaviors. I think level-setting on why we are where we are is also really important. And I do not believe it is well understood. I talk to Congress a lot, and staff, and agencies, and administration, and, you know, there is a pretty deep understanding of Medicaid and Medicare, but not the commercial market. So really understanding the actual barriers, I think, would go a long way to sort of, you know, at least some initial consensus. 

Rovner: So more education, basically. 

Mitchell: Education and alignment on large goals, even if we have some differences on, you know, how we get there, and respecting that there are going to be different strategies, you know. I’m in Maine right now, and rural Maine may need a whole different approach to paying for rural behavioral health than you would have needed in San Francisco. So let’s be open to multiple approaches to the same problems. 

Rovner: Looking forward to the debate. Elizabeth Mitchell, thank you so much. 

Mitchell: Thank you. 

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

Edney: Sure. This is a story that I wrote. It’s “.” During covid, obviously, a lot of personal protective equipment we had issues getting it. There were shortages, and so the government decided to spend almost a billion dollars on these handful of companies that they were going to try to boost medical glove-making here. And those are like the nitrile exam gloves you see in every hospital, every doctor’s office. And we were not fully making them here. The main ingredient, particularly the most important piece, we weren’t making here. Well, fast-forward six years, we are still not making it here. So none of those companies that the government funded are making medical gloves. And so, essentially, we’re at the point where there are full entire factories built with huge reactors and things to try to make this main ingredient because it’s a petroleum product. But they aren’t able to finish the project; they aren’t plugged in and ready to go. And the U.S. government has decided they’re not going to fund that anymore. These went from Trump 1 to Biden to Trump 2, and Trump 2 has said we’re letting this go. We’re not going to do it, and this factory will probably end up being sold for parts. Others have shut down, and we’re getting our medical gloves still mostly from Malaysia. Kind of the reason I wanted to write this now is because it’s just when the government decided to abandon this project, but also because of the war with Iran has raised the cost of petroleum products, which is the main, you know, nitrile butadiene rubber. And so the cost of that has gone way up, and so we’re kind of in this cycle where we still can’t get it, but it’s still being affected by outside forces. 

Rovner: Well, thank you for doing the accountability journalism on this. It was. I really, really liked this story.  

Ollstein: Thank you. 

Rovner: Sandhya. 

Raman: So my extra credit this week is from my colleagues Nyah [Phengsitthy] and Skye [Witley] at Bloomberg Law, and it’s called “.” So they spent a few months looking at the, you know, hundreds of different supplements and different packaged foods that have been, like, trying to gain momentum in this space because of the popularity of GLP-1 medications and just, you know, there has been really limited federal oversight of claims of these, you know, the supplements and the foods. It’s causing 鈥� 

Rovner: I would say, and to be clear, these aren’t people trying to make GLP-1s. These are people making supplements that are to appeal to people who are on GLP-1s, saying, you know, if you want it because you’re not eating as much, here’s a way you could get the nutrition that you need. 

Raman: Yes, absolutely. So you know, it might say like GLP-1-friendly, or, you know, it might be on, you know, a snack food you buy, or, you know, just a supplement that’s unregulated at a drugstore. And just a lot of the confusion there. There’s not a lot of research on some of these things. There’s, you know, a lot of litigation brewing in different places related to this, and there’s not, you know, a standard federal definition of what something like “GLP-1-friendly” even means. So they have a great deep dive into this. So you should take a read.  

Rovner: Yeah, at some point, Congress is going to have to take another look at the whole supplement regulation thing. But I thought this was really fascinating because it’s just a whole new sort of category of supplements that has popped up in the wake of the GLP-1 popularity. Alice. 

Ollstein: I have a story from my co-workers Amanda Chu and Robert King [“”], and it’s about how the federal government’s attempt to crack down on what they claim as widespread Medicaid fraud in Minnesota, in particular, is having all of these damaging spillover effects and has cut off Medicaid payments to a bunch of providers: mental health, eldercare, all kinds of things 鈥� folks that are not suspected of committing fraud at all. The state is pausing payments to a wide range of providers while they try to implement these new anti-fraud measures, and so it just is a good look at the danger of using kind of a sledgehammer to go after a more narrow problem. 

Rovner: Yep 鈥� I think we’re going to see that more and more as sort of these Medicaid sort of crackdowns and the fraud crackdowns continue. My extra credit this week is from Mississippi Today. It’s called “.” It’s by Sophia Paffenroth and our own podcast pal Joanne Kenen. And it’s about something I’ve been talking about a lot this entire very hot summer, which is the impact that heat and the lack of air conditioning has on health. We know excessive heat takes a special toll on the elderly and those with respiratory issues, but it’s also super dangerous for pregnant people and the very youngest among us. And while Mississippi has been taking some novel steps to address that, a lack of attention by medical professionals and a lack of research, along with budget cuts, have been making that task much harder. It’s a topic I’m sure we will all continue to watch. 

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

Raman: On  and on  @SandhyaWrites. 

Rovner: Anna. 

Edney:  and  @annaedney. 

Rovner: Alice. 

Ollstein: On Bluesky  and on X . 

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 吃瓜不打烊 and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 吃瓜不打烊. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, July 9, 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 Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: Rachel Roubein of The Washington Post. 

Rachel Roubein: Hi, everybody. 

Rovner: And Victoria Knight of Bloomberg News. 

Victoria Knight: Hi, everyone. 

Rovner: Later in this episode, we’ll have my 吃瓜不打烊 “Bill of the Month” interview with Samantha Liss, about a woman who fought back against a series of insurance company prior authorization denials and won, but it wasn’t easy. But first, this week’s news. 

So we’re just a little more than halfway through the year; I thought this would be a good time to take measure of where we are in terms of healthcare politics. First, Affordable Care Act premiums. As we’ve been reporting, as data has come in, enrollment in ACA plans has dropped pretty precipitously in the wake of Congress letting the expanded covid-era subsidies lapse, with millions of people finding themselves unable to pay unsubsidized or less subsidized premiums. Now we’re starting to get a look at proposed premiums for next year, and we’re looking at more eye-popping increases. Insurers are saying they have no choice. Among other reasons for the increases, the healthiest people are the ones who are most likely to decide they don’t need or can afford to live without insurance, while the sicker people will hang on to it as long as they can, even if they have to go without other necessities. Is this the beginning of the insurance death spiral that everyone’s always been so worried about? 

Knight: Enhanced subsidies expired at the end of December 2025, and we knew we wouldn’t really start seeing the data till the summer. So we’re just now starting to see the effects, and we’re seeing, yeah 鈥� the data varies state by state, but we’re seeing a lot of people drop off, and we’re seeing premiums rise. And then that’s in addition to all of the Medicaid overhaul changes that Republicans also included in their big tax-and-spending bill last year. And so we’re starting to see those.The work requirements will go into effect in January, but some states are starting now, and they have to be in effect by next January. And so Medicaid is also a huge one, where people are starting to lose coverage as well. So I think Medicaid and then Affordable Care Act combined, we are going to see a lot more uninsured people, and I think that conversation is going to start entering the election conversation, potentially more than we’ve seen it as of now 鈥� which is really surprising, given that Democrats shut down the government last year over the ACA tax credits, and then really haven’t been talking about it as much. But I think we’re starting to see it trickle back in. 

Rovner: Yeah, and you know, Republicans say 鈥� and I don’t want to let this sort of go unsaid 鈥� that well, you know, one of the big reasons for the drop in enrollment is because there were all these phantom enrollees, people that insurance companies had enrolled, who didn’t even know they were covered, and the insurance companies were just collecting the premiums from the federal government. I’ve read too many stories about real people who said, Yeah, my insurance used to be $300 a month, and now it’s $1,100 a month, and I can’t afford it anymore. I mean, not to say there weren’t some phantom enrollees; there obviously were. We knew 鈥� that fraud is an issue, but this does feel bigger than just, Oh, we’ve gone after fraud, and so this should be the right size for the Affordable Care Act marketplace. 

Luthra: It’s very obvious that people have, in fact, lost insurance, like, people have said, “I have lost insurance, I have stopped paying for it because it is too expensive.” Voters have said this is a very big concern for them, because they are going without health insurance, and I mean, to your point, Julie. Yes, there is some level of fraud, of course, but also one of the data points for these phantom enrollees was people who enrolled and then didn’t use health insurance, and that’s actually very normal to not use your health insurance. I have gone many years, you know, you don’t use it some years, then you use it others, and that is what keeps the market healthy, that is why we have risk pools that work. So it seems like this is just an argument that doesn’t really stand scrutiny, and also just doesn’t really make much sense. 

Rovner: Yeah, I mean, the whole point of health insurance is, or insurance in general, is that you only use it when you need it, and that if you’re young and healthy, the people that we want to be insured, and a lot of the people who got insured when it got really cheap to get insurance with those enhanced subsidies, it’s like, Oh, I can afford, you know, $25 a month in case something happens. And then nothing happens, and so they don’t use it. Which is, again, not to say that there weren’t some phantom enrollees, we know this, but there were also, I suspect, a lot of people who had insurance and just didn’t need it during the course of the year. And that was, as you say, it was those premiums that helped pay for the sick people who actually did need to use their insurance over the course of the year. 

Roubein: Then, in talking about, as you mentioned, is insurance sort of in a spiral, , I believe it was this week, about the employer-based health insurance system. And they talked to some small-business owners who said just how expensive it is, and one of them was sort of making the decision between do I lay off employees or do I get rid of health insurance? So, like, these are just very, very real decisions that people are making, as business owners, are making: Can I cover these kind of rising prices or not? 

Rovner: And you literally anticipated my next question, which was to bring up the Stat story, which is a whole series looking at the impact of rising health insurance costs on small businesses. But it raises the broader question of: Is the era of employer-provided insurance nearing its breaking point? And what happens if employers really do start dropping insurance en masse? I mean, this, you know, obviously the first tension point comes with small business, for whom this is a bigger outlay of money compared to, you know, how much they bring in and how much they pay their workers than it is for larger companies. But this has always been the concern that at some point businesses are just going to say we can’t do this anymore. This can’t be what Republicans want, because one presumes the next step after that is, oh, you know, things like “Medicare for All” that presumably they hate a lot more. 

Luthra: Well, that’s what’s so interesting, right, is there’s so much chatter right now about this insurgent DSA [Democratic Socialists of America], yet again seems like something we have, in fact, seen happen in the past. And part of that message is Medicare for All, and what that means is maybe a little bit squishy. We don’t fully know, we never quite fully know, but it does seem like there’s a lot of interest in broadly making health insurance and healthcare more affordable. And there’s a lot of energy on the left and on this growing more progressive movement to use government as a vehicle for health insurance, and I mean, if you have fewer employers providing health insurance, then that does strengthen the case that someone should step in. 

I think I’m still not fully sure if we can say when or what a breaking point looks like, because employers have been talking about this for so long. I mean, as long as a lot of us have been covering healthcare, there’s been talk about employer healthcare expenditures getting unsustainable, and yet here we are still in this system. The inertia continues. And the other thing that I keep thinking about is what about public sector workers, right, unions who have negotiated for these benefits that they are not going to give up, and those are often very good health insurance plans. It’s just so complicated because our system is so fragmented to get us toward having health insurance for people. 

Rovner: Yeah, this is like my fourth time going around with: Are employers going to stop providing health insurance? Well, meanwhile, to continue the theme of this week, which is everything old is new again, we have the return of death panels and Medicare catastrophic health insurance. First, death panels. Back in 2009, during the debate over the Affordable Care Act, there was a bipartisan provision that would have paid doctors to have end-of-life conversations with Medicare patients 鈥� things like: Do you want to be kept alive on a ventilator? Republicans called them “death panels,” and the ensuing controversy nearly sank the entire bill. In the end, the provision was jettisoned as more trouble than it was worth. Fast-forward to last month, and lo and behold, the Trump administration is proposing to regularize end-of-life conversations, including by possibly penalizing hospitals that don’t record a patient’s end-of-life wishes in their electronic medical records. Now, dare I say, this was considered by most bioethicists and other experts to be a good idea back in 2009 and a good idea now in terms of good patient care. But what happened to make Republicans do such an about-face, other than it’s no longer part of a bigger bill that they hate. As my fellow health reporter friend Jonathan Cohn put it: Some of us would like our summer of 2009 back, please. 

Luthra: I mean, part of it is like political convenience, right? This is something that most people know is, in fact, a good thing. I mean, I think when you explain it to a consumer, also in the correct and not misleading terms, yes, people would like the doctors to know what they would want if they had a medical emergency or catastrophe. That is good policy. But the death panel discourse was somewhat cynical 鈥� I think that’s noncontroversial to say 鈥� that this was a targeted political attack to try and bring down the Affordable Care Act. And so, of course, when you are divorced from those politics, this is just something that is practical when you think about the actual implementation of health insurance and provision of care. 

Rovner: I just didn’t want to let it go unnoticed that this was something that the Republicans used for great political gain back in 2009 reappearing 16 years later as “noncontroversial.” We’ll see if it stays that way. And going back even further in time, a group of Senate Democrats, led by Finance Committee Ranking Member Ron Wyden, have introduced a bill to cap annual out-of-pocket costs to patients on Medicare at $5,000 per year. What, you say? How can Medicare be basically the only insurance policy in America with no cap on what patients can be required to pay for long hospital stays or expensive outpatient care? Well, let me tell you a story of the first big bill I covered back in the late 1980s. It was called the Medicare Catastrophic Coverage Act. It did create an out-of-pocket cap for Medicare, but it was financed by a surtax on wealthier Medicare beneficiaries themselves, and after a not-always-truthful campaign, not unlike the one over death panels, Congress actually repealed the law about 18 months after it passed, in 1989. So, after almost 40 years, will Congress finally put Medicare in line with just about every other health insurance policy on the planet? Or will they stumble, as usual, about how to pay for it? Because it would be expensive to put a cap on what patients could be asked to pay for Medicare. 

Knight: We’re starting to see Democrats really trying to release a lot of proposals now, particularly around healthcare, trying to contrast themselves with Republicans, and being like, look what they did, they let enhanced ACA subsidies expire, they did this Medicaid overhaul, everyone is dropping coverage. Here’s our solution: Republicans took your coverage away, we want to give you coverage, we want to help you reduce costs for your healthcare. And so I think we’re seeing that Sen. Ron Wyden, ranking member of the Finance Committee 鈥� if the Senate somehow becomes a Democratic majority, then he would be Finance chair, most likely. He has been putting out a lot of proposals around healthcare, trying to show what he would do if he does gain a gavel in the next Congress. I think the Senate is less likely that it’s going to turn Democratic. I think we’ll probably have a split Congress, if I have to guess, and perhaps the House goes Democratic. So, I think the long and short of it is, I think this proposal is unlikely to go much of anywhere for a while, but it is something that I think we could see have some more traction potentially in a few years if there is another Democratic trifecta or something like that. I think Democrats want to build more on a lot of proposals they put together in the Inflation Reduction Act, capping cost in Medicare, capping cost of drugs, things like that. This would build on that. 

Rovner: Yeah, and keeping with our themes, this is sort of a Let’s make a case for this year’s midterms that we’re the party of health. Rachel, you wanted to add something. 

Roubein: I agree with what Victoria was saying. It’s messaging [indecipherable] ahead of the midterms. It’s, I mean, it’s definitely an interesting, long-standing, as you noted, issue, Julie, but I mean, generally both parties view seniors, older adults as really important voting blocs, and we tend to see various proposals around Medicare around these times, or even accusations from both parties. I think it was in 2023 Republicans and Democrats were accusing each other of cutting Medicare. It’s kind of a tradition of, like, “Mediscare,” as you will. 

Rovner: Yes, actually, and after the Affordable Care Act passed, the Republicans regained control of Congress, talking about not so much the rest of the Affordable Care Act, but the Medicare cuts in the Affordable Care Act, which, of course, were made to pay for a lot of the other things in the Affordable Care Act. 

Well, next up, hospitals in the crosshairs. Now, this is one of those occasional moments in health policy when policymakers in Washington in both parties dare to criticize hospitals, which are powerful political voices, because not only is there one in every congressional district, they are also usually major employers, as well as taking care of sick people. But for decades now, Democrats and Republicans have asked whether nonprofit hospitals, in particular, are providing enough community benefit to earn their right not to pay taxes. Before leaving for the July 4 recess, the House Ways and Means Committee approved a bill that requires a lot more transparency from hospitals about how they justify their tax-exempt status. A related issue has to do with a program that’s nerdily referred to as 340B. It requires drugmakers to sell to nonprofit hospitals and community health clinics at deep discounts. Then those hospitals can turn around and bill insurers, and sometimes patients, full prices for those drugs and keep the difference to help pay for otherwise uncompensated care. Drugmakers hate it, of course, saying it’s being abused. Hospitals say it’s critical to their ability to provide care, and now the administration and Congress are both trying to reform it. So, this House Ways and Means bill addresses both issues. Victoria, you covered it. What would the bill do? 

Knight: Yeah, it’s really interesting. I think Congress is kind of a hamster wheel always, with which healthcare entity they want to go after. And so, last Congress, it was pharmacy benefit managers, which is the third-party group that moves between drugmakers and pharmacies and helps with dispensing drugs. They went after them. They hit PBMs really hard in the government appropriations bill that was passed earlier this year, and so now PBMs are kind of off the target, and I think hospitals may be next. But hospitals are really, really hard to go after. But we’re starting to see a lot more movement in this Congress on hospitals, and so this bill, it’s basically a new reporting requirement. It would require nonprofit hospitals to, yeah, justify their tax-exempt status by giving a lot of data to the government, and so that would be how much charity care they’re providing compared to their financial assistance policy. So, how much did they say they’re going to help people? How much are they actually helping people? Also, their community benefit, and a lot, just a lot more financial data as well. And there’s kind of like a tiered system within the bill, so bigger hospitals that make more money, they would have additional reporting requirements, and that includes on the 340B drug discount program. And so, what are they paying for the drugs? What are they giving them to patients for? That kind of information. Hospitals were very not happy with this. It was advanced out of Ways and Means, but on a partisan basis. So we’ll see if it has any more movement. I’m doubtful I would make it to a further place on the House floor or something, but you never know. We’ll see. 

Rovner: I know there’s efforts in Senate and the Finance Committee, and in the HELP [Health, Education, Labor, and Pensions] Committee to looking at 340B. Sen. [Bill] Cassidy’s been looking at it too, although you know it’s the fight between two behemoths, the drug industry and the hospital industry, and as long as Congress has been grappling with this, they have not been able to come up with a useful compromise that works for everybody, which is why I think they keep grappling with it. 

Knight: Yeah, Energy and Commerce members just released a new bill this week on it. It’s really seeing a lot more action, and the program really has, the 340B drug discount program has really increased the usage over time if you look at the stats. So it makes sense that maybe Congress will step in, but it’s really difficult to find a solution. Drugmakers and hospitals are both OK with it, and so yeah, it will continue. 

Rovner: As we like to say, the status quo likes to status quo. All right, we’re going to take a quick break. We will be right back.  

So, July 4 marked the one-year anniversary of the signing of that big Republican budget bill, and with that, the one-year ban on Medicaid funding for Planned Parenthood expired. You may or may not recall that in order to get the provision into the budget bill in the first place, past the Senate parliamentarian, the ban had to be only for a single year. That means Planned Parenthood clinics around most of the country can once again bill Medicaid for non-abortion services like birth control and cancer screenings and STI testing. And anti-abortion activists are big mad. Shefali, did Congress not extend the ban because it didn’t want to, or because it couldn’t? And what might this mean for the impending midterms? We haven’t seen a lot of reproductive health in this sort of go-round either. 

Luthra: I mean, I think when we look back to a year ago, there’s a reason that originally abortion opponents wanted this to be a 10-year defunding. That was not possible due to the parliamentarian’s interpretation of what could be kept in the reconciliation bill. So we had this one-year program instead. And even at the time, I talked to abortion opponents, whom I reconnected with again just now, and there was never really a very strong belief that this would be politically viable to renew months before a midterm election, because Republicans have a very slim majority, as we’ve discussed many times on this podcast, and defunding Planned Parenthood is unpopular. KFF has done great polling that shows that this is very unpopular, and so it’s just a very, very big ask to get Republicans, especially those in vulnerable seats, those that went blue in the presidential election, to vote to defund Planned Parenthood once more. I think what is really interesting is you are continuing to see Republicans get a lot of pressure from abortion opponents to take this up again, and so far there hasn’t really been much movement. I think it highlights how difficult it has been for the anti-abortion movement to get really concrete victories in the first two years of a Republican trifecta. This was their biggest win, and it’s over. And they have something to show for it, right? Maybe around two dozen Planned Parenthood clinics shut down between last July and this July. But if that’s the biggest thing you get in the first Republican administration and congressional majorities since the overturn of Roe v. Wade, that’s probably not what they had hoped for, or what they would have expected coming into this. 

Rovner: Yeah, and as we have discussed, anti-abortion activists are also big mad that the Trump administration has not reversed the FDA’s loosening of regulations on the abortion pill mifepristone that allows it to be sold via telehealth over state lines. A new law taking effect in Iowa this week bars Iowa residents from getting medication abortion from Iowa providers via telehealth. But, like other states with even stricter abortion bans, that law doesn’t really touch telehealth providers in other states with shield laws from prescribing and sending those same medications to Iowa residents. That’s what the anti-abortion forces really, really, really want, right? 

Luthra: Yeah, and it’s just, it’s legally very difficult for them to come up with a framework that will prevent that interstate telehealth, unless the federal government intervenes, and since they aren’t getting much movement from the administration, that is why they are putting so much emphasis on federal courts. And we have so many legal challenges to mifepristone in the works. We had one that very briefly interrupted telehealth earlier this year. That case is still ongoing. It’s possible that it yields some sort of policy implications before the midterm elections, though we’ll see. But this is just a very difficult situation to stop interstate telehealth, unless you have someone with authority beyond state governments 鈥� and really that is federal courts, and that’s the federal government. 

Roubein: You can imagine this is going to come up when there’s a new Food and Drug Administration commissioner named. This is something that Sen. Josh Hawley, Sen. Bill Cassidy, they will be asking about this and pushing on this because they were very upset with how former FDA Commissioner Marty Makary handled this. 

Rovner: By basically continuing to put it off, although to some extent we don’t know whether that was Makary’s doing or it came from higher up at HHS [Department of Health and Human Services]. I’m interested, apparently there’s going to be a confirmation hearing for attorney general nominee Todd Blanche next week, and I think some are going to ask him, because one outlet that the anti-abortion movement sees is getting the Justice Department to settle the lawsuit filed in Louisiana, challenging the FDA’s sort of down-regulating, if you will, of mifepristone. So they’re saying that the Justice Department should simply settle that lawsuit. Would that actually overrule FDA? I’m still a little bit vague on how that might work. 

Luthra: That feels legally tricky, because there are other parties in the suit as well. The manufacturers have stepped in, and so there’s a real possibility that even if the Justice Department moved to settle, I mean, I don’t think we can say that this doesn’t necessarily end the case or end mifepristone’s availability through telehealth. And realistically it just seems that you need something stronger and perhaps through a different avenue. And, again, I think it’s really important for us to underscore that this is all pretty unpopular policy, and the Trump administration knows it is unpopular, and they probably would not want abortion and abortion restrictions to be in the national spotlight heading into a midterm election where they are already looking vulnerable. 

Rovner: Yeah, well, I’ll be interested to watch the attorney general confirmation hearings, which is not something I would normally say. While we’re on the subject of reproductive health, in general, in the fallout from last week’s narrower-than-expected Supreme Court decision upholding birthright citizenship, some Trump officials are now floating the idea of banning noncitizens from visiting the U.S. while pregnant to prevent them from giving birth to U.S. citizens. How would that work? 

Luthra: Just seems kind of difficult to implement, maybe more the kind of thing that you talk about on Fox News than the thing that you actually have a firm policy plan to put in place already. People are not given visas to come here solely for giving birth. Already people largely do not travel very late in pregnancy, because it is not a good idea. I think there’s something to be said for the fact that people will be looking in conservative spaces at ways to try and restrict immigrants from being here, find new pathways to prevent people from giving birth here, especially when they are immigrants. We had a hearing in Texas earlier this week where they were looking at surrogacy, and part of the argument there that conservatives are making is they believe that surrogates in the U.S. are being hired by people abroad to give birth to babies that will have U.S. citizenship. Again, this is all, like, very complicated, but I think what it shows is that the birthright citizenship issue is not going away, and that conservatives are looking for some kind of new strategy to weaken that protection that is very clearly spelled out in the Constitution. And we will see where that takes us. 

Rovner: Yeah, and to be clear, I mean, just like with fraud, there is birth tourism. There are, you know, particularly, I think there’s a lot of people from China going to the Northern Marianas, which is kind of halfway across the Pacific and a U.S. territory, to give birth. I think someone said there were more Chinese residents giving birth in Northern Marianas than there were residents of the Northern Marianas. So, I mean, there are problems, but that’s, as you point out, that’s already illegal. That’s not something that Congress would need to act to make illegal. Birth tourism is not a thing, but if you are born in the United States, then, said the Supreme Court, at least a small majority of the Supreme Court, you are a citizen, at least for now. 

All right. Finally, this week, two interesting stories about artificial intelligence in healthcare. First, Utah is in the midst of a pilot project allowing an AI chatbot to approve some prescription refills. Doctors, including the state’s medical board, are not thrilled with this. They’re worried about liability if something goes wrong, among other things. They’re also worried about a slippery slope. It’s just some relatively safe prescription drugs for now, but soon it will be all prescriptions, then lab tests, then who knows what? On the other hand, the makers of these tools say they’re exactly what’s needed to overcome the shortage of doctors and other health professionals. Let technology take over the routine stuff. Now, call me old-fashioned, but until customer service AI works a lot better than it does now, I’m not sure I’m ready for AI to be making my medical decisions, even my routine ones. 

Roubein: I mean, it’s definitely a controversial practice, as we’ve been seeing. I think doctors are sort of grappling with what is going to be the future here. 

Rovner: I mean, some of it can be helpful. We have sort of AI scribes now who can take notes, so that when you’re talking to your doctor, your doctor isn’t staring at a screen the entire time. I think everybody thinks that’s a good thing. But you know, then how accurate are the AI scribes? I know that just in voice transcription, it’s still not 100%. If you get a symptom or a drug wrong, that could be a bigger deal than when you’re doing a podcast transcript. 

Knight: There’s a great plot on The Pitt about this. 

Rovner: That’s right. I forgot. 

Knight: I know it’s super important, though. It was super important for the patient that the transcription was wrong. It was wrong. It said that they had a condition they did not have, so that could be really problematic. 

Luthra: I mean, one thing that I’ve sort of mulled over in other areas, as we see this push toward AI in certain areas, if it continues, is whether eventually we see some kind of divergence. I think there’s an open question, right? Do people actually want more things automated, or do they want more things done by a human? Do we see a world in which people pay a premium for things that are done by people, as opposed to AI, or vice versa? I mean, I think this is all just so early, but there’s a real possibility, at least it seems to me, that we see sort of different tiered offerings based on what’s perceived as better. And that raises questions also of who gets things that are maybe better versus who doesn’t, and what is better? I think there’s just so much that we don’t know, but there’s just a lot for us to sort of observe and interrogate as reporters. 

Rovner: I heard a story yesterday about robots climbing Mount Everest, and my only thought was: Why? It’s one thing if robots are doing things that are helpful, but it’s like, why would you need a robot to climb Mount Everest? Well, speaking of cautionary tales, a story from my 吃瓜不打烊 colleague Darius Tahir details how the launch of a pilot in six states to test an AI-powered prior authorization system for Medicare also hasn’t been smooth. Quoting from the story: “Patients, doctors, and other healthcare professionals who spoke with 吃瓜不打烊 say the effort has created confusion, errors, long wait times, and stress.” The opening anecdote of the story is about a patient who was asked to drive an extra 2陆 hours literally just to fill out a piece of paper. Again, the goal here is a valid one. Medicare wants to make sure that frequently abused medical services are really necessary. That protects both patients and the taxpayers who pay the bills for Medicare. But the concern is that maybe these systems aren’t quite ready for prime time. I mean, I feel like that’s sort of the bigger thing here is that we’re launching this stuff before it’s ready, not that we’re wanting to use it. 

Roubein: I thought this was a really interesting story, because this is a program out of the CMS innovation center [Center for Medicare and Medicaid Innovation], which was created by the Affordable Care Act, and the CMS innovation center is wonky; it’s there to test Medicare experiments. You don’t really always hear a lot, just it doesn’t always make like a huge splash about what’s happening. But this one has. You’ve heard talk about this in Congress, and concerns about this, particularly within Washington state. And I thought this was a really good story, saying this happened so quickly, these are actually what’s happening, sort of on the ground, because the theory with these models is, if they work well, they can be expanded, they can become a permanent part of the Medicare program. In theory, these are tests. 

Rovner: Yeah, whenever we talk about the innovation center, I point out it’s just as valid to have tests that don’t work, because then you can see what doesn’t work and try something else. Yeah, and it’s possible that this will straighten itself out at some point. It is off to 鈥� as many of these AI tests are 鈥� it’s off to a bit of a rocky start. All right, that is this week’s news. Now, we’ll play my “Bill of the Month” interview with Samantha Liss, and then we will come back and do our extra credits.  

I am pleased to welcome back to the podcast my colleague Samantha Liss, who reported and wrote the latest 吃瓜不打烊 “Bill of the Month.” Hi, Sam. 

Samantha Liss: Hi. 

Rovner: So, this month’s patient had the nerve to change Medicare Advantage plans. Those are the private plans that often cover more out-of-pocket costs than regular Medicare, but also limit choices, and as she found out the hard way, sometimes limit needed care. Tell us who she is, the ailment she’d had for two decades that needed treating. 

Liss: Yeah, thanks for having me. So I wrote this month about Margaret Hvatum. She lives outside St. Louis, and she is a part-time computer science professor. And she has a weakened immune system due to a rare condition known as primary immunodeficiency, and essentially it makes it difficult for her body to fight off infections. 

Rovner: So she’d been treating it successfully for a while, right? 

Liss: Yeah, she had. She relied on a drug known as Hizentra. 

Rovner: And Hizentra is what I would call a moderately expensive drug, not one of those that costs hundreds of thousands of dollars a month, which there are some that do, but this one was closer to $8,000 a month. And she had gotten prior authorization to take this drug from her previous Medicare Advantage plan, right? 

Liss: She did. That’s correct. 

Rovner: And it had been serving her well for some time? 

Liss: Yeah, she really liked it. It worked well for her. 

Rovner: And she was running marathons, as I noted. 

Liss: Yes, she … I think running, it’s safe to say running is an obsession for her. She 鈥� there’s not many races she hasn’t participated in. In fact, when she was vacationing over the summer, she sent me pictures from a marathon she completed in Norway. So it’s definitely what she loves to do in her spare time. 

Rovner: So a patient with a serious condition being successfully treated, she changes Medicare Advantage plans, and lo and behold, her new plan says, yeah, nope, we’re not going to approve your taking this drug anymore. Now, I thought Medicare Advantage plans had promised last year to stop using so much prior authorization and making patients and their doctors jump through bureaucratic hoops to get needed care. Why did she need to get prior authorization for this drug again? 

Liss: Yeah, that’s a really good question. I thought the same thing. Humana and many other Medicare Advantage plan insurers had made commitments that they were going to ease this burden of requiring prior authorization. And when I asked about Margaret’s case, they said 鈥� Humana told me that these commitments are for medical services only and do not apply to prescription medications, which surprised me, actually. 

Rovner: Yeah, it surprised me too. So, Humana, her new plan, denies her the drug, she misses her medication, promptly ends up in the hospital with an infection, which her new insurer declined to pay for, too, right? 

Liss: Right. 

Rovner: So, what ultimately happened with the bills, both for the drug and the resulting hospital stay? 

Liss: Yeah, so Humana reversed their initial denials, and I think, you know, one takeaway for us, for the readers and listeners here, is that patients should appeal prior authorizations because they often get their denials reversed. And, in fact, according to our colleagues at KFF, 81% of Medicare Advantage appeals were partially or fully overturned in 2024. 

Rovner: So is there a takeaway here, besides just making a fuss? I mean, according to your story, Margaret and her husband are considering moving to Norway because he’s a citizen and they can qualify for that country’s national health insurance. That feels a little bit extreme and not possible for many people. 

Liss: It does, doesn’t it? Yeah, you know, it can be an exhausting process, is what experts told me, because prior authorization too often puts the onus on patients and doctors, who also get frustrated, too. But you know, I think the real takeaway is: Appeal. 

Rovner: Don’t take no for a final answer. 

Liss: That’s right. 

Rovner: Samantha Liss, thank you very much. 

Liss: Thank you. 

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. Shefali, you chose first this week. Why don’t you go first? 

Luthra: Sure. My story is from Stat. It is by Katie Palmer. The headline is “.” And Katie wrote about a secret-shopper study that was published in JAMA, looking at how easy it is to now get GLP-1 drugs and how little oversight there is from doctors. I think this kind of research is so interesting, because anyone who talks to anyone who has gotten GLP-1, or anyone who opens their social media, or sees ads on the internet, has probably figured out that it is very, very easy now to get a GLP-1 drug, even if you don’t medically qualify for them, typically. And that is really complicated, because these drugs have a lot of benefits, including many we don’t know about. However, they are also relatively new. There are a lot of things we don’t know about them still. They probably are not a good fit for everyone, but 鈥� 

Rovner: They have a lot of side effects. 

Luthra: Yes, and there’s a lot of societal pressure on people potentially to be a lot thinner in a world where GLP-1s are more ubiquitous. And I think all of that just really deserves interrogation, deserves scrutiny. It is completely changing our culture and our health as a society, and I really appreciate that this story just put some numbers and put some heft toward what people have probably observed. But now we can say, yeah, this is actually a thing and it deserves scrutiny. 

Rovner: Yeah, it definitely does. It was really good study. Victoria. 

Knight: I also have a Stat story for my extra credit. It is called “.” And I’m always interested in lobbying and just the dynamics of power in Washington, and I thought this is a really good look at the alcohol industry, and how they wield power in Washington, kind of a peek behind the curtain. And it shows, it kind of begins the story with an anecdote about how a former staffer of the American Cancer Society felt bad for telling a reporter or kind of downplaying the risk of alcohol to cancer to a reporter back in the day, and then had to apologize to the reporter. And so it’s showing how lobbyists in the alcohol industry have influenced things like the American Cancer Society or other entities to not fully talk about the risk of alcohol related to cancer, or just generally the health risk of alcohol. So, this did a really good job of connecting the dots of who is connected to who in D.C. in the alcohol industry, and what lobbyist is married to this person, and just really interesting to show how the alcohol lobby is still trying to wield influence at a time when really a lot of Americans are not drinking as much as well. And so they’re trying to hold on to their power. Will that still be successful? I guess we’ll see. But yeah, it was great. 

Rovner: Yeah, it’s part of a series on the dangers of alcohol. It’s really, really interesting. Really well done. Rachel. 

Roubein: My extra credit this week is “” by Christina Jewett of The New York Times. I thought it was an interesting broad, sweeping look at tobacco policy under Trump, particularly looking at some of the cuts last year. And so Christina starts out the story by describing ads that we’ve all seen, I think, are all kind of part of the cultural moment of trying to stamp out tobacco use, such as one with, like, a man with a hole in his throat using a voice box to speak, that were powerful. Christina reports that the CDC’s 14-year ad campaign went dark last year, and that was several moves by the Trump administration. That change unraveled parts of the government’s anti-smoking initiative. She also writes about how the CDC’s Office on Smoking and Health, which managed that campaign and worked with states on smoking cessation measures, has been shut down for more than a year. She said in recent weeks CDC has given states small funding to air ads from the campaign’s archive, but there has been an impact where, in interviews with people who ran quit lines in several states, calls have plummeted, along with enrollment in programs that offered counseling, nicotine, gum, and patches. And some of this comes 鈥� as you know, Secretary Robert F. Kennedy Jr. talks about chronic disease a lot, but public health experts that I’ve spoken to in the past have pointed to kind of a contradiction here, where there is not much talk about trying to reduce the rates of smoking, which is a major cause of chronic disease. From the HHS’ response to Christina, they said that the CDC “remains committed to tobacco prevention control and continues to support this priority through outreach, education, and surveillance.” 

Rovner: Yeah, it was a really, really good piece. Well, my extra credit this week is from Tina Reed at Axios, and it’s called “.” It seems that the combination of peptide popularity and cryptocurrency payments are helping Chinese fentanyl manufacturers make more money at less risk from selling those loosely regulated peptides instead. Said one expert quoted in Tina’s story: “They departed from a trade in which they could be sanctioned or indicted by the U.S., and reappeared in a very lucrative scene that has widespread buy-in.” Um, yay, capitalism. Really, really interesting story. 

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

Knight: I’m on X. 

Rovner: Shefali. 

Luthra: I’m @shefali on . 

Rovner: Rachel. 

Roubein: on X; at Bluesky. 

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

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

Julie Rovner: Hello from 吃瓜不打烊 and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 吃瓜不打烊, and as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping early this week in advance of the holiday on Wednesday, July 1, 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 Alice Miranda Olstein of Politico. 

Alice Miranda Ollstein: Hello there. 

Rovner: Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hi. 

Rovner: And making her What the Health? debut, my 吃瓜不打烊 colleague Amanda Seitz. Welcome. 

Amanda Seitz: Hello, Julie. Thanks for having me. 

Rovner: Tons of health news again this week. So, we will jump right in. We’re going to start at the Supreme Court, where the justices wrapped up the 2025-26 session by deciding that, yes, the 14th Amendment does mean what it says regarding birthright citizenship, which would have been a very big health story if it had gone the other way. Still, in this last crush of cases, there were some that will have more of an impact on health policy than might appear at first blush, and even some impact on health politics. So, policy first: In a decision handed down Monday, the justices said that presidents may fire members of nearly all independent agencies for any reason, not just malfeasance in office. Previously, Congress had written into laws establishing many of these bodies, like the Federal Trade Commission and the Equal Employment Opportunity Commission, that presidents could not dismiss members just because they disagreed with their policy positions. In overturning a case that has stood since 1935, the majority of justices said, nope, the president can fire just about anybody considered part of the executive branch, except maybe not members of the Federal Reserve Board. That one is still TBD. Still, this is likely to have a major impact on agencies that do a lot of health policy, like the Federal Trade Commission, yes? 

Lawrence: Yeah, already we’ve seen a lot of the politicization of agencies across government, so this is just even further embolden the administration to enforce political loyalty, fealty, among civil servants. 

Rovner: This decision is making my head spin, because I’m so used to seeing a lot of these commissions that have a certain number of members who are appointed by a president of one party and a certain number appointed by a president another party to create, at least in theory, balance, and this basically says: Balance schmalance. It’s what the president wants. 

Ollstein: I think it’s especially impactful given how little lawmaking Congress has been able to do recently and how much policy is decided at the agency rulemaking and enforcement level, which is what a lot of these previously independent agencies took on, And so I think delegating even more power to the executive branch in a moment where Congress has already sort of let a lot of that go could be huge down the road. Of course, while this is being cast accurately as a big win for the Trump administration, we should, of course, remind listeners that this cuts both ways and a future Democratic president could do a lot more that conservatives may really hate. 

Rovner: Yeah. I 鈥� what goes around comes around. I’m just thinking: Wow, what happens when a Democrat gets back in office? Are they going to just completely remake all of these agencies? And maybe Congress will, at some point, say maybe that wasn’t such a great idea. We will see how this one plays out. I imagine it will be over a much longer term. 

Well, in a decision that was more about immediate politics than policy, the court last week said that people who claim they got cancer from the pesticide glyphosate cannot sue under state laws, because the federal Environmental Protection Agency, not states, decides whether to label the chemicals, sold under the trade name Roundup, as a carcinogen. Needless to say, members of the Make America Healthy Again movement, for whom pesticides are top concern, are not happy. This is the second loss for MAHA adherence on glyphosate this year. HHS [Health and Human Services] Secretary Robert F. Kennedy Jr. back in February endorsed an executive order from President [Donald] Trump to declare glyphosate important to national security in order to protect the nation’s food supply. How mad are the MAHA folks at this point? Amanda, I know you’ve written about this. Alice, you have, too. 

Seitz: Yeah, I think the tension has really been building between this movement and the White House for months, and now it’s, now they’re really mad. And meanwhile, we’re not seeing a lot of action from HHS to appease the MAHA moms. They started the year with this new food pyramid and the Eat Real Food campaign and some rallies that were really promising, but since then things have been a lot quieter. And I think they’re kind of at the point now where a lot of these women who support this movement, they lean conservative, they’re white women, but they’re probably not going to flip their vote, necessarily, but they might sit these midterms out at this point. 

Rovner: And that’s really the biggest concern. It’s not so much the people who are part of your base are going to vote for the opponents. It’s that they’re not going to vote, right? 

Ollstein: Yeah, and they were already feeling demoralized about some of the other, what they view as setbacks under this administration. They came in with such high hopes that this administration, especially with RFK at HHS, would really be aggressive on both pharmaceuticals and the food industry and, like I said, are very disappointed in what we’ve ended up with. And this administration’s decision to back this corporate shield on the pesticides is really what some people are viewing as a final straw. And we know the White House is worried about the political fallout of this, because they invited a bunch of these activists to the White House to sort of reassure them, make nice. That was several months ago, but the decision, I think, really undermines those charm-offensive efforts. 

Seitz: I wanted to add that, to Alice’s point, this is a group that was told that they would see a wholesale shake-up of the food industry from the ground up, literally, starting with pesticides. So they’re just really disappointed at this point. They have not seen a lot of bold action, really, since the food dyes, since the food pyramid, and those policies are months old at this point. 

Ollstein: And a lot of those are voluntary. They’re not even binding. They’re just agreements with companies that can be reversed in the future. 

Rovner: Well we will get back to RFK Jr. in a few minutes, but first, one more Supreme Court decision, an immigration case that does have huge health implications. As part of the theme of giving the president still more power, a majority of justices said that President Trump could end so-called Temporary Protected Status for certain classes of immigrants who come from countries that are deemed unsafe to return to because of natural disaster or civil unrest. In this current case, the countries in question are Haiti and Syria. This will have an almost immediate impact on healthcare, because there are more than a quarter of a million Haitian immigrants living in the U.S. under TPS, and many of them work in healthcare, often as caregivers and workers in nursing homes and other long-term care facilities. The industry group LeadingAge estimates that long-term care facilities could lose up to 8% of their workforce as a result of this ruling. What happens if 8% of the long-term care workforce gets deported in the next few months? 

Seitz: Well, the governor of my home state of Ohio, who’s a Republican through and through, said it would be a job killer for his state, so that tells you how concerned he is. 

Ollstein: And the long-term care and elder care sector is so heavily dependent on these workers. Staffing is already a huge concern. The pay is not good. The work is extremely hard. It’s very hard to find people willing to do this work, and in some places foreign workers make up a majority of the workforce. They don’t all come from these specific countries, but a lot of them do. This is already a big blow to all of these assisted living and other kinds of facilities that have already struggled to recruit and retain staff. And as the baby boomer generation gets older, there’s only going to be way more demand, and so it’s increasing demand and decreasing supply at a kind of dangerous time. And we’ve seen all these reports about what happens with understaffing. Injuries go up in these facilities, health problems go unaddressed, and these are people’s grandmas and grandpas. This is real. 

Rovner: And people are going to end up taking care of their own grandmas and grandpas, because these facilities aren’t going to have the beds available, because they don’t have the staff there to take care of them. I’ll be interested to follow this, because I think of all the things that we talk about that are going to have sort of long tails, this one’s going to have pretty immediate impact if they really start deporting a lot or even detaining a lot of these people. And even some of them who may not be immediately deported simply can no longer go to work, because if they take away their immigration status, they’ll no longer be here, they’ll no longer be working legally. So this will have probably some impact that we will see fairly quickly. 

Well, also impacted by a federal court injunction are students pursuing healthcare careers. Late last week, a federal district court judge here in Washington, D.C., blocked part of a new regulation from the Department of Education that was supposed to take effect today. The regulation limits how much certain graduate students can borrow from the federal student loan program. Under the new rules, those pursuing certain professional degree programs, including doctors, dentists, and veterinarians, can borrow up to $50,000 a year, up to a total of $200,000, while those in what’s deemed nonprofessional programs will be limited to $20,500 a year and $100,000 in total. In both cases, those limits are often lower than what those degrees actually cost. The administration says that’s an effort to get schools to lower tuition. But groups representing nurse practitioners and physician assistants, whose professions didn’t make the, quote, “professional” degree list, sued, and now at least that part of the regulation is on hold. But the overall caps do take effect today. What’s the potential impact here? This is one that, as I said, has probably a longer tail, right? That we won’t see the impact right away? 

Seitz: I think on its face this sounds like a very well-intentioned regulation, right? You don’t want people taking out more money than they realistically can make, but $20,000 barely covers preschool tuition in major cities these days, so that’s going to be extremely limiting. And again, we’re talking about professions that are already facing huge shortages. The nursing shortages have gone on for years. They’ve festered. There’s been no real meaningful policy to fix that issue. So these industries need workers, and this is not going to improve this outlook. It’s going to make it much worse. 

Rovner: Yeah, I talked to the head of one of the nursing groups, and one of the big concerns here, when you’re talking about shortages, it’s not so much not being able to train nurses but not being able to train the people who are going to train the nurses. It’s nurse educators. The limit is, you can make more as a nurse than you can make teaching people to be nurses, and so it’s really hard to get those nurse educators. And so they have to limit 鈥� there’s a lot of people who would like to become nurses. It’s a pretty good career. Pays pretty well. It’s pretty solid. But because they literally don’t have enough teachers, and limiting who can go pursue these careers is not really going to help this. I think that’s part of what got this, at least this part of the regulation, stayed. But it seems implausible that schools are going to say, Well, we’ll just lower our tuition so you guys can afford to come. It’s going to be more that people aren’t going to be able to afford to pursue these careers unless they can afford private loans, or they come from families that are wealthy enough to underwrite their education. 

Seitz: Yeah, and high-qualified applicants are already turned away every year from nursing school. So now you’re making your pool even smaller, with an industry that is already struggling to fill roles, paying lots and lots of money to get people into these roles. 

Rovner: Yeah, I think this is part of a broader effort that we will see the impact from, but not immediately. All right, we’re going to take a quick break. We will be right back. 

Turning to activity at HHS, Secretary Kennedy has been busy the past few weeks. As predicted, the department reissued the charter for the Advisory Committee on Immunization Practices so that it no longer requires members to have vaccine research expertise. The idea here is to get around a court decision that said the anti-vax members that he had installed earlier weren’t qualified. At least that’s the assumption. Right, Lizzy? 

Lawrence: Right, I think this is the 鈥� ACIP has been on hold for so long now, and they’re trying to find a way to convene this committee without recruiting the traditional types of people that are typically advising on immunization. So, yeah. 

Rovner: People with expertise in immunization policy? 

Lawrence: Right, so yeah, we’ll see who they come up with. I think this has just been such a mess from the beginning, and I’m curious how they will interpret the courts saying you need to have people with expertise here. 

Rovner: I’d say, along those same lines, Lizzy,  on a different advisory committee, this one at FDA on compounding pharmacies. Tell us about that one. 

Lawrence: Yeah, so it seems that the peptides committee is the new ACIP. So, in July, FDA will discuss whether to allow, I think, five to seven peptides, allow compounders to manufacture them. And HHS has been very involved. This, Secretary Kennedy went on Joe Rogan and said he would really like to see these peptides added back to the list. The FDA does not agree with this. I’ve been told that HHS was very involved in the planning of this committee, the selection of the members. Most of these members who they added are longevity wellness physicians whose financial interests in making peptides more available to the public, and so they are not impartial. And I know that career staff have raised concerns, but those concerns were ignored. However, interestingly, the FDA has kind of gotten ahead of what could happen at this meeting, because in the meeting materials, the career staff said the agency does not want to add these peptides to the list. We do not think that compounders should be allowed to make them. And so they’re entering the discussion, saying the agency actually doesn’t want to do this. So now we’re going to have to see what HHS does, what some of these advisers do, who clearly would like the FDA to ease restrictions. I think it’ll be very tense. It’s a very bizarre situation. 

Rovner: And just to backtrack, peptides are supplements, basically, right? They’re amino acids, and there’s not a lot of good research that suggests whether they are good for you or not. But they’re super popular, right? 

Lawrence: Right, right. They are super popular, very much hawked by influencers who make claims that they do anything from reverse aging to boosting energy to helping with chronic pain. And there’s very little clinical data, in humans, at least, about the actual safety and efficacy of a lot of these products. 

Rovner: Yet another advisory committee for us to watch. Meanwhile, in one of his first full-length national interviews since losing his primary, Senate Health, Education, Labor, and Pensions Committee Chairman Bill Cassidy went on CBS’ Face the Nation last week and let RFK Jr. have it 鈥� rhetorically, at least 鈥� saying the secretary violated the agreements that he made with Cassidy in order to win his vote for confirmation. Now, Kennedy, in a separate interview with News Nation, said that’s not true, that he has kept all the promises he made to Cassidy. Amanda, just looking at the vaccine issue alone would suggest that Cassidy kind of has a stronger case here, right? 

Seitz: Yes, I’ve had this conversation myself multiple times with HHS. Kennedy has clearly flouted the promises that Cassidy says he extracted from him around ACIP, around vaccinations. They’ve overhauled the nation’s childhood vaccine schedule. They’ve raised repeated doubts about vaccine safety. Period. End of story. You can’t just throw an asterisk right on a webpage that raises doubts about vaccine safety and say that you’ve met the promise. They have not met the promises that Cassidy says that he extracted from him. But at the end of the day, Kennedy gave numerous signs throughout his confirmation hearings that he was never really serious about keeping those promises. He and Cassidy even got in disagreements. Everyone saw these disagreements during the hearings over the safety and efficacy of vaccines, of the research that Kennedy was citing, so I think the only person at the end of the day who thought that Kennedy was going to keep his promises was maybe Cassidy himself. 

Rovner: And Cassidy himself said in the interview, I thought this was kind of interesting, that his choice was to vote for Kennedy and have at least some, he would call them, guardrails, or if Kennedy didn’t get confirmed that Trump was going to appoint him as a White House health czar, and then he, Cassidy, would have no impact over what Kennedy would be able to do. So it was better to have some power than no power 鈥� that was his justification. Although in neither case does it seem that Cassidy has had any power over what Kennedy has done. 

Seitz: Yes, and then even if Kennedy were a White House czar, sure, he would have the ear of Trump, presumably, but he wouldn’t have a microphone over public health as the health secretary, where he gets to broadcast all of his doubts about vaccine safety. So I think that’s a little bit of a disingenuous argument. 

Rovner: And not to mention the chance to remake all of these committees that we’ve just been talking about. Well, apparently Kennedy is freelancing in politics, even while he’s trying to run HHS. The Washington Post had a  last week about RFK Jr. trying to convince a Libertarian candidate in Iowa to drop out of a contested U.S. House race to prevent him from siphoning off votes from the Republican candidate, because, argued Kennedy, if Democrats take over the majority in the House after this next election 鈥� and this was on tape 鈥� quote, “I don’t want to be fighting subpoenas for the next two years instead of improving America’s health.” Apparently, Kennedy was careful not to spell out that he could make it worth the candidate’s while to drop out, because that would be illegal. But some ethics experts suggest that what he did might have been illegal anyway and was certainly unethical. Are we at the point where nobody even cares about stuff like this? I remember when this would have been a gigantic story. Here’s a Cabinet member basically getting involved in an election and kind of sort of promising a candidate that if he drops out, they could do something to help him. 

Ollstein: There was another recent allegation of something like this happening in the race that ousted Cassidy. John Fleming, who was another candidate in the race that was not successful, said that he was getting pressure from the Trump administration to drop out and was being promised various jobs and things, and so I think that we are seeing at least an uptick in allegations of meddling, if not an uptick in meddling itself. And yeah, just a lot of attempts to exert control over the outcome of these races that some conservatives are worried may backfire because it’s resulting in some maybe less palatable people winning primaries and facing tougher races in the general election, not in the ones we just mentioned but in some other places. 

Rovner: Yeah, and that’s happening on the left, too, although we will leave that for another day. Well, moving on, and still kind of on the RFK beat, we’re still waiting for the administration to name a new director for the Food and Drug Administration, but we did get a nominee for deputy [HHS] secretary, Chris Klomp. Now, this shouldn’t be much of a surprise. Even though he’s officially at the Centers for Medicare & Medicaid Services, Klomp has been kind of running a lot of day-to-day stuff at HHS already, right Amanda? 

Seitz: Yes, he is really well liked, both at HHS and then within the White House, too. He’s seen kind of as this bridge between the two agencies. And I think, too, he’s a really smooth operator in an administration that is not particularly well known for its diplomacy. So if the Trump administration has any chance of getting someone through right now, especially with the clock ticking on how much longer Republicans might be in power, Klomp is going to be you guy. So, he kind of makes friends and allies wherever he goes, and I would imagine that he is going to be maybe making an argument, even to Democrats, saying that he can be the adult in the room right now that HHS really needs, that he’s proven to be that. 

Rovner: Yeah, I was at a breakfast with him, and he was very impressive. I will say that. And yes, unlike a lot of the other members of this administration, just in the way he deals with people. He’s very conciliatory and searching for common ground and knows his stuff, clearly. So there’s 鈥� I’ll be interested to see what goes on with that. Lizzy, before we leave this, where are we with naming a new FDA commissioner? I’ve seen like a dozen names floated. 

Lawrence: I know. They’re all over the place. And some of the names I had actually heard back in 2024. I remember hearing about Heidi Overton and Jeff Vacirca, a cancer doctor, before. Yeah, like Amanda said, time is ticking. There are still, the surgeon general has not, there’s not been a hearing scheduled. Or maybe there has been hearings scheduled, but鈥� 

Rovner: I think Cassidy said he wants to go ahead in July with hearings for the surgeon general and the new head of the CDC. We at least have nominees. 

Lawrence: Yes, there are at least nominees, but, yeah, no hearings on the calendar. And then, and obviously, a finite number of days that Congress is in session. And I’ve heard that they want to name someone soon, and there are certain other, there’s kind of career FDA officials in the mix. Rick Pazdur’s name has been floated around. I don’t know how real that is, but鈥� 

Rovner: Longtime FDA official. 

Lawrence: Longtime FDA official. Yeah, so we’ll see. I know that they want to get this done soon, but time is not on their side. 

Rovner: We will see. All right, next topic. In his interview with Face the Nation, Sen. Cassidy said one of the things he’s most proud of is passing the No Surprises Act, which spares patients in most cases from those nasty surprise bills when they inadvertently get care outside of their health plan’s network. And while that part of the law does seem to be working pretty well, the part where insurers and healthcare providers battle out how much should be paid is not, and we have two great blockbuster stories this week detailing that in pretty vivid detail. First from our podcast pals Margo Sanger-Katz and Sarah Kliff at The New York Times, a  how surgical assistants are using the No Surprises Act to win fees from insurance companies that are multiples higher than the surgeons they are assisting, 25 times higher in some cases. Second, from Lizzy’s colleague at Stat, Tara Bannow, the  who are getting around the surprise-bill law by declining to take Medicare, which is the federal trigger to get them covered under the rules. Instead, the hospitals are using the same arbitration process that the surgical assistants are using, and, to quote from Tara’s story, “It’s been a gold mine, quadrupling its revenue.” So clearly, the arbitration part of this law is not working as intended. Why aren’t we seeing efforts in Congress to fix this? This would normally be something that Congress would say: OK, this didn’t work. Let’s go back and see what might. 

Seitz: Because Congress isn’t doing anything right now? I think it’s really fascinating. These stories are coming out at a really bad time for the hospitals and health systems especially, because they’re always trying to point fingers at insurance companies and pharmaceutical companies for high healthcare prices. But Congress has really been pushing back on the hospitals and scrutinizing them much closer, their role in driving up healthcare costs, and this is just such damning evidence of how these physician groups are outright gaming the system. So while you don’t see Congress maybe taking action, it’s really coming at a bad time for these healthcare systems who are arguing that they’re going to be facing these deep cuts and potential closures because of the actions that Congress has taken with the One Big Beautiful Bill Act. It kind of starts to feel a little like the boy who cried wolf, because at the beginning when the surprise-billing act passed, you did see a lot of hospitals come out and say: This is really horrible for us. We’re not getting the fair deal out of these arbitrations. There were some hospitals that were even suggesting that they could close over this. So you’re kind of, to see how much they’re making off of all of these arbitrations is really just bad timing for these healthcare systems that are saying: We’re not driving up costs. We’re losing money hand over fist because of all these cuts that Congress has made. 

Rovner: Yeah, basically it looks like the providers are winning the arbitration way more often than not and getting much higher payments than they would have gotten otherwise, certainly much higher payments than they would have gotten from trying to bill patients who didn’t have the money. Put it this way: It is not saving money, as I believe the CBO [Congressional Budget Office] estimated when the bill was first passed. 

Lawrence: It’s a really bad look, and just to shout out Tara’s story, which was fantastic, I think she gets at, too, how this can also affect patient care. She zeroed in on a hospital that is making so much money in this arbitration process and is also still trying to deny people who are entering an emergency, what they think is an emergency room, where under EMTALA [the Emergency Medical Treatment and Labor Act] they’re not supposed to make you pay before treating you, and that’s not happening. And so there’s some very damning details in that. 

Rovner: Yeah, because if you don’t take Medicare you don’t have to obey EMTALA either. Kind of handy for them. Well, finally this week, drug prices. And speaking of things that aren’t working as expected, Medicare this week begins temporary coverage of those expensive weight loss drugs, GLP-1s. Originally this coverage was going to be offered through Medicare Part D prescription plans, but insurers balked. They were worried that it would drive up premiums for everybody else, which it probably would have. So CMS officials cut a deal directly with the makers of the main drugs, Novo Nordisk and Eli Lilly, to sell their blockbusters Wegovy and Zepbound at $50 a month each, along with another Lilly drug, Foundayo, but only until the end of 2027. Then what happens? This feels like either the biggest bait and switch of all time or a change to dig Medicare’s financing hole even deeper. Or am I missing something? 

Seitz: Or let the next administration pick up the issue, right? That’s kind of what the Biden administration did on this issue鈥� 

Rovner: Sure. 

Seitz: 鈥攂efore it walked out the door. I think maybe it gives them a chance to sort of see how much, because we are entering into the unknown, how much it will cost. And I’ve talked to people inside of the administration about their approach to coverage, and although Kennedy has historically opposed GLP-1s, I think there’s also this recognition that Medicare is so expensive at this point that the GLP-1s do offer potential to trim down some of those expenses if people, older people, do become healthier from using them. So I would imagine that this is a little bit of a test of that. 

Rovner: Yeah, and there’s all this tantalizing evidence that GLP-1s don’t just let people lose weight but they actually do make them healthier. They make it less likely to have heart attacks and strokes and things, or get, Type 2 diabetes, things that do cost Medicare a lot more money. But there is still in law, speaking of Congress, a ban on Medicare paying for drugs simply for weight loss, because, as we’ve said before, back in 2003 when Congress passed this law, there weren’t effective weight loss drugs, and the weight loss drugs that were out there were, in some cases, dangerous. So at the time, it made sense to have this ban. It doesn’t necessarily make sense anymore now that we have the GLP-1s. But another place where Congress could change it and hasn’t yet. So we will have to see how this one plays out. 

Well, finally, the Trump administration is still hoping to bring down drug prices in the U.S. by getting other countries to raise theirs. Germany is under a U.S. trade investigation for threatening to pay less for U.S.-made drugs in order to address a budget shortfall of its own, although it appears to be pushing ahead with those plans, despite U.S. threats to impose more tariffs. Can the U.S. really force countries to pay more for their drugs? This seems like a bit of a tilting-at-windmills thing. 

Ollstein: They’ve been scrambling for years to do anything other than directly regulate the companies that are here and are charging a lot, because that is more politically challenging. And so they’re twisting themselves into pretzels to do this bank shot via other countries, which have completely different healthcare systems that are much more centralized, much more heavily regulated by the government. And instead of thinking, Well, what can we imitate from some of these countries that have successfully kept prices low?, instead, Let’s try to make them raise them, so ours are less in comparison. So it’s just very interesting to see where the effort is going in this space. 

Rovner: Yeah, because we do, it’s the one affordability issue that the president has been all over since his first term. He wants to bring down drug prices. He finds it, as most people do, unfair that the U.S. is basically footing the bill for most pharmaceutical research, because other countries have price controls. But yeah, there does seem to be a lot of trying workarounds, every workaround they possibly can except imposing price controls of our own. 

Ollstein: Right, because there are things they could do. They could expand the number of drugs that Medicare negotiates, for instance, now that we have a sort of a toehold in that space established under the Biden administration. But like you said, instead we’re seeing some of these more elaborate workarounds, including importation attempts and all kinds of things. 

Rovner: Yeah, well, gives us plenty more to talk about. All right, that is this week’s news. Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Alice, why don’t you go first this week? 

Ollstein: Yeah, so I have a piece on an important issue that has flown kind of under the radar. This is from Stateline by Kelcie Moseley-Morris, and it is called “.” And she documents that the agency is canceling 53 out of 67 grants worth a total of about $68 million to different organizations around the country 鈥� universities, community groups, city and state health departments, freestanding clinics that have been using this funding for programs to help increase access to contraception for teens, sex education. And these have been very, very successful over the past several decades. The teen pregnancy rates have gone way, way down, in large part thanks to improved sex education and contraception access. And now there is worry about backsliding from experts who spoke for this piece. And it’s worth knowing that the Trump administration tried to do something pretty similar, during the first Trump administration, and there was a lawsuit, and it got successfully blocked, a successful lawsuit that blocked this attempt to defund these programs. So that very well could happen again. At least the lawsuit is very likely. The outcome is unknown. 

Rovner: Yeah, again, so much going on, it’s easier to miss some of these things. Lizzy. 

Lawrence: Yeah, so my extra credit is from The Wall Street Journal: “,” by Dave Michaels, Sadie Gurman, and Liz Essley Whyte. This piece really caught my eye because, similar to what we were talking about with pesticides, it’s another area where MAHA HHS is saying one thing and then the other areas of government are doing the complete opposite, where there has been this media blitz initiative, Operation Stork Speed, to improve the baby formula supply, make it safer, look at contaminants. Meanwhile, you have the DOJ [Department of Justice], and the Journal reported that prosecutors really thought they had a good case. They were investigating Abbott, an Abbott facility where potentially deadly bacteria was discovered and caused infant deaths, and so they wanted to criminally charge Abbott. But then, but there is this effort under the Trump administration to not pursue criminal cases against corporations. And so I just thought this was a really telling piece about the differing, conflicting policies and narratives coming out of the administration. 

Rovner: Yeah, it raised a lot of questions. Good story. Amanda. 

Seitz: My extra credit is “,” by Sharon Lerner and Anna Maria Barry-Jester in ProPublica. And this article looked at how the State Department would not release billions of dollars in monetary aid to African countries for lifesaving treatment to address HIV, malaria, tuberculosis, until the countries agreed to share the personal health data of their citizens with the U.S. So, in Uganda, for example, they got a contract, the reporters got a contract that says the U.S. will get, quote, “direct, real-time access to nine of the nation’s health data systems for seven years.” And the privacy and health experts consulted in the story raised concerns about how exposed this could leave a lot of the citizens that are inadvertently sharing their data with the U.S. I thought this was a really interesting article because the Trump administration, we’ve been reporting on how the Trump administration has been very interested in obtaining wide swaths of personal health data of U.S. citizens. But this shows that their interest apparently goes very global, and it raises a lot of questions about why the U.S. is so interested in this data and what exactly they’re doing with it. 

Rovner: Yeah, it does. Wow. All right. Well, before I do my extra credit, an update on my  about Tennessee effectively cutting off a program that provides medical aid to undocumented families with children with disabilities. Last Friday, a federal judge ordered the state Department of Health not to share with federal immigration authorities the names and addresses of the families of the 400 children in the program, at least for now. We’ll keep following this story, though. 

OK, my extra credit this week is a wonky but really important story from Modern Healthcare called “.” It’s by Michael McAuliff, and it answers a question I’ve been asking for years about the acquisition of doctors’ practices by private equity and other firms, which is: What happened to all those state “corporate practice of medicine” laws? Just about every state bans what’s known as the corporate practice of medicine, which basically says that medical decisions must be made by licensed medical professionals, not by laypeople with profit as their main motive. Well, it appears that states are beefing up some of those old laws, and California has now penalized the first company under its new statute. So, we’ll see if other states follow suit. We will also watch that space. 

OK, that’s this week’s show. 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, , and on Bluesky, . Where are you guys hanging about these days? Alice. 

Ollstein: On Bluesky, , and on X, . 

Rovner: Lizzy. 

Lawrence: On Bluesky, , and on X, . 

Rovner: Amanda. 

Seitz: And I’m on X, . 

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

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

Julie Rovner: Hello from 吃瓜不打烊 and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 吃瓜不打烊, and as always I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, June 25, 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 Maya Goldman of Axios News. 

Maya Goldman: Hello. 

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

Joanne Kenen: Hey, everybody. 

Rovner: And my KFF Health news colleague Rachana Pradhan. 

Rachana Pradhan: Hey, Julie. 

Rovner: No interview this week, but way too much news, so let’s see how much we can squeeze in. We’re going to start this week at the Department of Health and Human Services, where we have a pair of stories about grant funding passed by Congress and signed into law by President [Donald] Trump still not getting where it’s supposed to go. , our podcast pal Paige Winfield Cunningham reports that states and health organizations are waiting for nearly half a billion dollars for a variety of programs, including suicide hotlines and opioid addiction treatment centers, because of a convoluted clearance process that involves artificial intelligence and political appointee sign-offs to, quote, “ensure alignment with Agency priorities.” Quoting from Paige’s story: “One former career staffer at the CDC who served under four administrations said fewer than five or six grant notices in a year would typically get reviewed at the HHS level. Now it’s all of them.” , except this one is about delays in grant funding from the National Institutes of Health, where with just three months left in the fiscal year, 90% of the $37 million in grant funding from the National Institute on Disability, Independent Living, and Rehabilitation [Research] has yet to be released. I know I sound like a broken record, but that’s not how any of this is supposed to work, right? 

Goldman: Right. 

Pradhan: No, I think this is, more or less, some version of this has been going on since January, February of 2025, but I think now it’s being more institutionalized in federal policy. That’s what they’re attempting to do. Whereas in the first few months of the current Trump administration, it was instituted at 鈥� “haphazard” probably doesn’t really do it justice 鈥� but it was sort of this very chaotic process of instituting these new layers of political appointee review on what federal money was funding, ultimately, right? And whether political appointees decided that it was something that they thought the federal government should be doing. 

Rovner: At the beginning, they just froze everything. 

Pradhan: Right. 

Kenen: They cut everything. 

Pradhan: And then they鈥� 

Rovner: Then they cut everything 

Pradhan: 鈥攕tarted cutting things. Right. Things like which we’ve all talked about and done plenty of reporting on, right? Things that aren’t supported by political appointees, regardless of their scientific merit, right? And so now this has sort of taken on an even broader evolution, so that it is formal federal government policy regulation that political appointees can review every dollar that goes out for anything, almost, right? All grantmaking, which is just an extraordinary sum of money. 

Goldman: Yeah. 

Rovner: And Congress, remember Congress, which owns this spending power, said in last year’s appropriations, You will spend this money the way we are telling you to. And the president signed those bills, promising to do that, and now is not. Maya, you wanted to say something. 

Goldman: I was just going to say, I think there was so much focus 鈥� like Rachana said, when in the DOGE [Department of Government Efficiency] era 鈥� on federal funding in healthcare and getting trapped in this purgatory space, and I think there’s maybe a misconception that that has kind of stopped. But it’s still, like you said, it’s becoming institutionalized. It’s the opposite of stopped. And like you said, Congress, this was not Congress’ intention. So it’ll be very interesting to see what happens, especially as these OMB [Office of Management and Budget], this OMB guidance for鈥� 

Rovner: Which we’ll get to in a second. But before we get there, this is not just happening at HHS. It’s happening in other parts of the Trump administration. Former KFF Health Newser Anna Maria Barry-Jester  that over at the State Department, the administration is defying congressional orders to continue to spend money on food, medicine, and other humanitarian foreign aid that used to go out under the auspices of USAID [the U.S. Agency for International Development], which the administration dissolved last year without congressional permission. As at HHS, State Department officials are not only not spending the money as Congress directed, but when members of Congress have asked, officials have simply not responded to their request. Not surprisingly, for those who have been paying attention, a lot of this circles back to Russell Vought at the Office of Management and Budget, who has said many times he believes that the president, rather than Congress, should exercise the majority of federal spending power, regardless of what the Constitution said. Is there a point where Congress, which is increasingly unhappy with the president over a lot of things right now, including a lot of Republicans, does take its spending power back? 

Kenen: But they can’t cut the check. Congress has made its displeasure on the spending, they voiced it before. Congress is getting a little friskier right now, but they yielded a lot of their power to the executive branch, and there’s a lot more tension going on right now on other things. They can yell and scream and pass bills, but if the executive branch of OMB, which has explicitly basically said: Congress, you give advice. You don’t decide. Even though that’s pretty much what they’ve said since 2025. So Congress can’t run over to the OMB and get into the federal treasury and take out a bunch of cash and go give it to some rural hospital somewhere, or NIH, or some scientists. They can pass the law, but they can’t 鈥� it’ll probably, this too, will end up with the Supreme Court at some point. But they’ve been reluctant to, certain battles they have, everybody’s sort of constitutional crises, they’ve tried to avoid to date, although not entirely. 

Pradhan: Well, like Joanne said: What can they really do? I’m not a lawyer. I don’t know. What beyond sort of kicking and screaming can they do? 

Kenen: Well, they can, I think they could probably take it to court on a separation of powers or constitutional powers, but I think that that’s the ultimate constitutional crisis that people have been afraid to hit that button. 

Rovner: There was a Supreme Court decision in the Nixon administration that said the administration can’t impound money appropriated by Congress, and that’s what Russell Vought would like to have go back to the Supreme Court, because he thinks this Supreme Court might overturn it, but they haven’t yet. I guess everybody’s afraid to kind of call the bluff. 

Kenen: Because it gets us into an even messier territory than we are already in, and we are in a very messy territory. 

Rovner: We are definitely in a very messy territory. Algae filled. 

Kenen: Algae-filled, yes. 

Rovner: We’ll get to that. Moving on, as Maya already hinted, there are these proposed new rules from the aforementioned Office of Management and Budget that would give political appointees even more power over how federal grant funding is distributed. It turns out that buried in that proposal is language that would effectively disqualify from funding most research into diversity, equity, and inclusion, what this administration defines as, quote, “woke.” I would add, this comes as the journal Science reports that  of scientists who are women or from underrepresented racial and ethnic groups found that those who participated in a special undergraduate program sponsored by the National Institutes of Health were twice as likely to earn their PhD than peers who didn’t participate in those programs. In other words, at least in this case, DEI works if your goal is to achieve more representation in science. But I guess that’s no longer the goal, right? 

Goldman: I think there’s also so many research questions that have real impact on people’s health that just must by nature incorporate words that would be flagged as DEI, and so we could miss out on real scientific breakthroughs if this goes through. 

Rovner: Yeah, they’ve apparently got these AI programs that are just grabbing off words like “gender” or things that might in scientific contexts have nothing to do with DEI. 

Pradhan: And I think one of the things about DEI, too, that probably gets lost in the current era is that it definitely has, of course, a racial and ethnic component, but also it has a big gender component. In science and across fields, DEI programs have benefited women, wholesale. So I think, and if that’s the goal, to undo these things, it won’t necessarily just have consequences for racial and ethnic minorities but women scientists in other fields also. 

Rovner: One of the big stories I covered in the early ’90s was the fact that women weren’t allowed to participate in most clinical trials, because scientists were afraid that they would, the fact that: Oh my God. They have hormones. They would mess up the results. And as a result, so many medical breakthroughs, we had no idea if they worked on women or not, because women were never tested. That only changed when women members of Congress insisted that the NIH start including women in their clinical trials. And again, a lot of these programs to bring more women into science have helped. There have been blind spots about gender, so it really has been, if not for quote-unquote “affirmative action” for women, there would be an awful lot of stuff that we simply would not know about women’s health. I only add that up as: These things in the 1990s were really bipartisan.  

So Wednesday was the fourth anniversary of the Supreme Court’s Dobbs decision that overturned the five-decade-old right to abortion under Roe v. Wade. And in a twist I don’t think any of us could have predicted, even though nearly half the states have banned or severely restricted abortion during that time, there were nearly twice as many abortions in 2025 as in 2021, the last full year before Roe was overturned. Rachana, how did this happen and how much does it have to do with mail order abortion drugs? 

Pradhan: Quite a lot. Yes, I don’t think this is something that anti-abortion groups at all expected or wanted to see. Certainly not what they wanted to see. After Roe v. Wade was overturned, pills being sent via telemedicine or telehealth is a big part of this. Even women in states that have enacted almost total bans on abortion are still able to get pills in the mail, and that is responsible for this, in large part. 

Rovner: And of course, anti-abortion groups are furious that the Trump administration’s FDA [Food and Drug Administration] has not rolled back the policy yet that the Biden administration put in during covid allowing the mailing of these pills. Now they’re agitating for acting attorney general Todd Blanche to drop the government’s defense of a case that was filed by Louisiana challenging that mail delivery of mifepristone. But even if that were to happen, medication abortions can continue just by using the second pill in the two-pill combination that’s used for abortion, which is misoprostol. And states can’t really ban misoprostol, because it’s used for so many other things, right? 

Pradhan: Right, they would be 鈥� I don’t know. Never say “never,” I guess. But it would be, it’s hard to see a path for that. Yeah, so our colleague Kate Wells, who’s based in Michigan, wrote this great story this week stating this exact thing, right? Because even though the research shows that the combination of two drugs for medication abortion, so mifepristone and misoprostol, taken together is the most effective, but that doesn’t mean the misoprostol alone does not work. And so it does work 鈥� it’s just not as effective. And there might be some greater potential for side effects 鈥� right? 鈥� if you only take the latter medication. So yeah, it’s not, so it’s not so easy 鈥� right? 鈥� to cut off access. 

Rovner: Meanwhile, let’s talk about the politics of this. Democrats who had been hoping to ride support for abortion rights to electoral ascendance may either be over- or underconfident. That’s according to  by our podcast panelist Alice Ollstein of Politico. Since Dobbs was overturned, voters, even in some pretty red states 鈥� I’m looking at you, Missouri 鈥� have approved ballot initiatives to ensure abortion rights in those states. But that hasn’t translated into votes for Democrats in many of those states. Voters approved the abortion rights referendums and voted back in Republicans who are anti-abortion. What’s up with this? 

Goldman: I think one interesting point that Alice made in that article is that a lot of voters think, OK, I voted for abortion rights, so now I can vote for other candidates based on other issues. Which is a super interesting trend to watch, especially to see if that trickles into other policy areas, too. 

Rovner: Yeah, I had not thought about that until I read Alice’s piece, and it’s like, yeah, that makes good sense. In the past, I think anti-abortion voters have very much been single-issue voters, but abortion rights voters have not. They want abortion rights, but they also want other things, and I think a lot of them in some of these states think, Well, we’re protecting abortion rights here in our state, so it’s OK to vote for this anti-abortion politician, even though they didn’t think all the way through that that anti-abortion politician in a federal office might vote for a federal ban that would override what you just voted for in your state. Joanne, you wanted to say something. 

Kenen: I think a lot of people don’t connect dots or don’t think things through. We know that in these very, very, very red, some of the most conservative states in the country, have voted big for Medicaid expansion when it became a ballot initiative, and then they went ahead and voted the same people who had fought it for years back into the governor’s mansion and back into the legislature. So I think, whether people don’t connect dots or that all of us can hold contradictory, more than 鈥� all human beings have some contradictory thoughts and impulses. I can’t explain exactly why this is happening . But it’s not only abortion. It’s particularly acute. Americans are for more gun control than our lawmakers, or gun regulation, than our lawmakers enact, and yet they keep voting in people who limit gun ownership or gun rights more stringently than the public in polls says they want. So this is one of several hot-button political issues 鈥� abortion and gun control, arguably the most domestically hot-button there are 鈥� that there is this inconsistency, and I don’t know that anyone’s really successfully explained it. It’s not just low information. It’s more than that. It’s, Yes, I want this, but I also want that. 

Rovner: Right. It’s holding two thoughts at the same time. You’re right. It’s a human thing. 

Pradhan: Well, and Julie, you mentioned this, right? Which is that a single-issue voting on abortion on the left is not 鈥� yeah. And Alice says this in the lead of her story 鈥� right? 鈥� which is the main issues of the day right now are affordability concerns across gas, food, housing. That does seem to still be the driving concern, and understandably so, right? Everything is more expensive, much more expensive than it was two years ago. So people are hurting, and so I don’t know that abortion rights would surpass, or people who are more likely to support an abortion rights ballot initiative are ones that are also not going to be inclined to vote for Republicans on the ballot during the midterm elections, because they’re not happy with some of those other, broader affordability issues. 

Rovner: Yeah, I think affordability is clearly going to be the issue of the moment, probably still when we get to the midterms. But who knows. We’ve got a whole summer to get through. All right, we’re going to take a quick break. We’ll be right back. 

Moving on to vaccine policy, you might remember back in April when we talked about a study by researchers at the Centers for Disease Control and Prevention that found last year’s covid vaccine reduced hospital visits and hospitalizations by more than half. It was supposed to appear in the CDC’s journal, the Morbidity and Mortality Weekly Report, but it was spiked by NIH director and acting CDC director Jay Bhattacharya, who said the study had methodological issues. Well, apparently that wasn’t a problem for the peer reviewers at the Journal of the American Medical Association, because the study is in this week’s . But even though it’s out there now, how is the public to have any idea who to trust when it comes to science policy? We’re now here, we have peer-reviewed journals that are publishing one thing and the government saying, No, this is not good enough. Did the doubters win simply by sowing doubt? 

Goldman: It’s a great question, and I think that’s a very interesting dynamic with this administration, is that the health officials in this administration have rose to prominence on a platform of bringing trust back into federal health policy. And I think for many people you could argue that there is less trust than there was at the beginning of the administration. And certainly not for everybody, but it’s just there are a lot of wires being crossed in different directions, and it’s hard to know where to go. 

Pradhan: I think one of the things I think about when it comes to trust in the government, like Maya said, right? We have, OK, so there are definitely certain voters that now do not trust the CDC and the government nearly as much, if it all, because of who is in charge. So distrust has arisen among those people. But when I talk to people who are supporters of the “medical freedom” movement and who are very skeptical of vaccines for themselves, for their children, I’ve asked them sometimes, Look, you’re seeing these changes, even going back to last year. This year, the CDC Advisory Committee on Immunization Practices, they made a bunch of changes to the U.S.’ vaccine schedule. And I asked, I remember one time I did an interview and I said, “Well, do you trust the CDC now?” And it’s not a slam dunk. People who are so distrustful of institutions and government agencies and even the medical system or our healthcare system, it’s not like they’re like, “Oh, yes, please, like everything the government says now, you know, I’m just going to take it at face value and just believe it.” It’s almost like it’s like a misunderstanding. I kind of wonder this for the people who are in charge, like leaving government now. It’s like: Do you understand this? Because they’re not just automatically going to take what you say. It’s sort of antithetical to years of thinking, potentially, that they’ve had, right? So鈥� 

Goldman: That’s such a good point. 

Pradhan: I don’t know that now, all of a sudden, are they going to become just a mouthpiece for what RFK Jr. [HHS Secretary Robert F. Kennedy Jr.] and his political appointees are saying. I don’t think so. 

Rovner: I think they’re just making everybody mistrust everything. Joanne, you wanted to add something. 

Kenen: I think, I do a lot of work on trust in healthcare, and I’ve been all over the country the last couple of months since our book came out, talking about it and being on panels. And it’s really, I mean, it’s a cliche to say distrust in healthcare or the health system or public health is an existential crisis. It’s a cliche we’ve heard all the time. But just because it’s a cliche doesn’t mean it’s not a crisis. The divisions in our country spill over from the politics into things that determine whether or not we and our families and our friends and our kids are healthy or not healthy, and I think this sort of whiplash of deep distrust of the other side is probably going to continue for some years as political officeholders and appointees change. But this, the CDC, I’m not 鈥� the last poll I saw, I’m not sure if it’s a record low of trust, but it’s definitely plummeted. But it’s the Democrats who used to trust the CDC, now don’t. Now, maybe that’ll rise again when the new CDC director, she’s confirmed, which is likely. Maybe she’ll be able to rebuild, and maybe things will get a little bit better. But right now, there’s so 鈥� a combination of deep distrust and a whole lot of mixed messaging. It can be very confusing to understand medical advice, and it can be very hard to access our medical system. So it’s just this really toxic brew of risk factors mixed in with the distrust. 

Rovner: Meanwhile, we had a real-world example of distrust and re-trust in public health this week. Secretary of Defense Pete Hegseth has quietly reinstated requirements for new military recruits to be vaccinated against the flu after a flu outbreak at Lackland Air Force Base sickened more than 200 recruits, with four people hospitalized. Hegseth had removed the mandate, which had been in effect since the end of World War II, with much fanfare back in April. Didn’t take long to kind of see why that mandate made sense, right? 

Kenen: Yes, because this is actually a force readiness issue. It’s not just, Oh, people got sick. Most young, healthy people, and most people in military service 鈥� most, not all 鈥� are young and healthy. These were recruits. These were young. Most of them are going to be OK. But first of all, not all of them are going to necessarily be OK. There’s one possible death. The last I heard that somebody had died, but it wasn’t necessarily from flu, and that was under investigation. And one of you may have more recent information than what I read a few days ago. So, we have four people hospitalized. We do not have a confirmed death. But it was 160 people, which is a whole lot of people. And if it happened here, it’s a big red flag, because your soldiers are supposed to be ready to fight, not in the bed with the flu. So, it happened in one particular location, but it really should have showed this national security interest. You really don’t want your fighting force with a 104 fever and feeling crappy. 

Rovner: I would say it’s also completely predictable that when you bring鈥� 

Kenen: Yes. 

Rovner: 鈥攁 whole bunch of people in and have them sleep together in close quarters and stress them physically and mentally, which is what basic training does, and then somebody gets sick, it’s going to spread. 

Kenen: It’s also one, that’s really one of the big causes of the spread of the 2018-2019 鈥� I mean, excuse me, the 1918-1919 so-called Spanish flu, which it wasn’t. It was actually, a lot of it was spread 鈥� it was just as we were getting into World War I. There was a lot of young recruits. A lot of it’s 鈥� there’s argument about exactly what happened where, but certainly a base in Kansas was one of the big spreaders of that, of what became a global pandemic. 

Rovner: In other words, we’ve seen this TV program before. 

Kenen: We didn’t have 鈥攔ight. We didn’t have vaccines yet. It wasn’t鈥� 

Rovner: We didn’t have TV either, but, yeah. 

Kenen: We had imagination, right? 

Rovner: Point taken. 

Kenen: We had carrier pigeons. 

Rovner: All right. 

Pradhan: I feel like anyone with school-age children or kids who are in college could’ve. It’s like, Oh, who could have predicted?&苍产蝉辫;驰辞耻&苍产蝉辫;丑补惫别&苍产蝉辫;鈥�&苍产蝉辫;

Rovner: Yeah, yeah. 

Pradhan: 鈥攎assive numbers鈥� 

Rovner: Any parent. 

Pradhan: 鈥攐f people in a small place, and Oh, look, a flu outbreak. It’s as inevitable as things can be these days, right? I think that this probably is pretty high up there, right? 

Rovner: Yeah. All right. Well, so, moving on. In things I definitely did not have on my bingo card for 2026, Indiana is imposing price controls on hospitals. Under the new law, as reported by my 吃瓜不打烊 colleagues Phil Galewitz and Samantha Liss, hospitals in the state will have to charge employer health insurance plans no more than a multiple of what they pay Medicare, or else run the risk of losing their tax-exempt status. Now, Vermont also does this, but Indiana is politically very much not like Vermont. Is this the leading edge of a Republican backlash to high healthcare prices? 

Kenen: Maybe. We just don’t know. You know 鈥� Indiana’s Indiana. But we have, and we’ve talked about it鈥� 

Rovner: Indiana’s really red, though, and they have a really red governor who used to be a really red senator. 

Kenen: Yes, but we don’t know what’s going to spread, right? But what we’ve talked in the podcast frequently over the last couple of months, hospitals are in the spotlight about pricing in a way that they haven’t. We’ve been really focused on drug prices. And we’ve sort of, we have a different relationship with hospitals. And we also all don’t get hit by hospitals every year, where most of us do buy drugs, so 鈥� but hospitals are really getting a lot of attention, bipartisan, I mean, in red and blue states, in Congress. There have been hearings. It’s not like the tobacco executive hearings, but it is sort of a lot more skeptical of why do hospitals, are they 鈥� to use the buzzword of the day 鈥� why are they so unaffordable? Why are your bills so inexplicable? Why can’t you understand? So, the whole system is based on cost shift, and one reason hospitals have been pressed to charge a lot more than Medicare is they say that Medicare payments don’t cover their costs, and they 鈥� it’s the great big, the shell game of American healthcare. But I don’t know that we know what the next step is state-wise. But you know what? It may be a domino. We don’t know yet. 

Rovner: I know I’m interested watching the backlash of Republicans against high healthcare spending. They’re coming out against managed care. They’re coming out against hospital prices. I will point out that for my entire career, the person who’s been loudest about nonprofit hospitals overcharging has been [Sen.] Chuck Grassley. 

Kenen: Right. 

Rovner: Very Republican senator from Iowa. 

Kenen: It’s not just that they 鈥� right. He’s been consistent on this for decades, and he’s said that it’s not just that they charge a lot. It’s that: What are they really doing to deserve that? They’re supposed to get a tax break in exchange for community benefits. But show me the benefit. How are you defining and measuring? And is it truly a benefit to the community, as a layperson would think of, Oh, benefiting the community? Or is it some little niche thing that they say is their public service. 

Pradhan: And one thing about Indiana in particular, I think Samantha Liss, who’s one of the reporters on the story you mentioned. Right, Julie? Actually two years ago, what’s really interesting is she had written also about, I think, and this is sort of a case study, I think, somewhat 鈥� right? 鈥� in how consolidated your healthcare markets are. Right? I think that that’s a big driver as to whether a state or a governor or anyone wants to take action on these things. I remember she wrote about these two rival hospitals that were in Terre Haute, Indiana. They were seeking to merge, and then they pulled back their merger application because there were so much opposition, because it would have left 鈥� Terre Haute is like a city of maybe close to 60,000 people, and for that city and the surrounding area, they would have had only one hospital operator. So, and that was a big deal at the time. So I think Terre Haute, Indiana, is far from the only place where that is sort of a living reality, right? And that’ll be a big motivator, I think, sometimes, too. 

Rovner: But, yes, I will say that both Indiana and Vermont have a lot of these small, sort of midsize consolidated areas where hospitals can basically charge at will. Maya, did you want to say something? 

Goldman: Yeah, I was going to add, I think Indiana has been on the cutting edge of a lot of health policy, especially among red states. They’ve done a lot with price transparency and employer advocacy, and so it’s not surprising to see Indiana do this as much as it would be a different red state. I think it does really indicate to me that people in the state, state governments, and citizens are really frustrated that Congress isn’t acting fast enough for them. They’re, like Joanne said, there’s a lot of discussion happening in Congress around hospitals and needing to lower prices, but there’s not a lot of action happening. And people have power to do that at the state level, and they’re exercising it. So I think we will see more happen there. 

Rovner: Here’s another issue where states sort of have power. While we were talking about strange bedfellows, Colorado has become the second state, after Florida, to get FDA approval for a plan to import cheaper prescription drugs from Canada. Except Florida hasn’t been able to get its program up and running, because it can’t find a Canadian wholesaler that’s willing to sell the drugs to them. What makes Colorado think that they’re going to have any better luck? And mightn’t both of these states just take a page from Indiana and think about their own price controls, if that’s what they want, rather than importing Canada’s price controls? 

Kenen: I can’t imagine if Colorado decided to do price controls that it wouldn’t be stuck in court. We’ve joked over the years that if you want your child to have full employment for life, become a healthcare lawyer? I think that if Colorado were to do that, which it really just suggested, it would not be immediately reality for consumers. There’s so much cost shifting in healthcare, because our system is just insane, that everybody can say, honestly, I’m not the only culprit. The whole system is too expensive with all this indirect shifts of costs and confusing charges, and it’s hard for experts to understand. 

Rovner: I feel like a lot of federal members of Congress have also sort of looked at these. Let’s import cheaper drugs from somewhere else.  

Kenen: Because it sounds good. 

Rovner: This has been going on since the ’90s. 

Kenen: Yeah. 

Rovner: And nobody’s been able to make it work. And Canada has said very clearly, it’s like: We can’t sell you all of our drugs or we won’t have enough drugs for the people here, which is who we buy drugs for. 

Kenen: But it sounds good. 

Rovner: It does sound good. 

Kenen: And that’s why it’s gone on for 30 years now, closer to 40. 

Rovner: Yeah it is 30 years now. 

Kenen: Yeah, and if you live in New England, you can go to Canada and get them, but there’s been sort of on-paper authorizations to do it for quite a 鈥� I don’t remember when the first one was, Julie. It was a long time ago. 

Rovner: Yeah. Well, they’re 鈥� yes, they allowed the FDA to allow states. The first one that actually sort of in theory became legal was the Florida one. And again, that was a couple of years ago, and it’s not off the ground. All right. Well, finally this week, in a drug price adjacent story, props to our podcast pal Lizzy Lawrence at Stat for the  of the week. Lizzy revealed that drugmaker Eli Lilly granted compassionate use to an unnamed 79-year-old individual to use its still-investigational obesity drug retatrutide, which trials have so far shown to be even more potent than Lilly’s other blockbuster obesity drug, tirzepatide. Now, compassionate use is supposed to allow people with terminal conditions to get early access to promising drugs that are not yet approved. Apparently, this patient is not only obese but has obstructive sleep apnea and pulmonary hypertension. Yet both of those conditions, while very serious, are not considered terminal. So the obvious question here is: Who is this 79-year-old patient, and is he named Donald Trump? So far, nobody’s been able to find out, though the White House has been very adamant, at least after Lizzy’s story came out, that it is not the president. So, why is everybody so excited about this story? 

Kenen: Because it’s weird. 

Rovner: Fair. 

Kenen: Lizzie’s story is great, but it’s just a strange saga, right? And in her first story, she said someone who was 79 at the time, which was a couple of months ago, because President Trump just turned鈥� 

Rovner: Turned 80. 

Kenen: Right. The idea that one person and only one person would get this drug. And we all remember he did get 鈥� and that was life-threatening. I’m not saying he shouldn’t have gotten it, but he did get it, a monoclonal antibody, when he was hospitalized with covid in his first term. And it may have saved his life. But that was a life-threatening situation. 

Rovner: Yes, that’s what compassionate use is supposed to be used for. 

Goldman: Right. And I think it obviously does matter who, if this person is President Trump. But I think Lizzy does a really good job in the story of explaining that, regardless of who this person is, this is not typically how this program is used, and so it should raise eyebrows that the administration and Eli Lilly are allowing this to happen, regardless of who the person that’s getting this is. 

Kenen: And it could be somebody who has a connection to Lilly. It could be anything, right? It’s a tantalizing question, but we don’t know. 

Pradhan: Yeah, and I do think it sort of begs the question. The White House, after the story published, only firmly said it was not the president. Probably would have been very helpful for them to have said that prior to the story publishing. Why they鈥� 

Rovner: And they were asked. 

Pradhan: Of course, they were asked, right? They were asked, and they did not directly answer. I don’t pretend to know why that decision was made, but I think it probably would have been a good public service to definitively say whether it was the president or not before the story first ran, before it sort of caused this big hullabaloo on social media and elsewhere, right? 

Rovner: And perhaps predictably, Democratic Sen. Maggie Hassan of New Hampshire has now written a stern letter to the administration, demanding 鈥� and I believe also to Lily 鈥� demanding to know if not who this is, at least how this happened, because it is an unusual use of the compassionate use exception. 

Pradhan: Can I ask a question also? This is one thing that I was wondering when reading Lizzy’s story is, so clearly certain people in the NIH and the FDA are HIPAA-protected individuals. So if they were to release or leak identifying information about this patient, that’s not allowed. But not everyone is, surely. Do we really think 鈥� someone must have seen the details of who this person is. And they would not be subject to HIPAA [the Health Insurance Portability and Accountability Act] if they were to cough up the name, right? 

Rovner: Well, I’m sure that people will continue to see, including those of us here at 吃瓜不打烊. All right, that is this week’s news. Now it’s time for our extra-credit segment. That’s where we each recognized 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. Joanne, your extra credit involves the second-buzziest story of the week, the saga of the green Reflecting Pool. Please tell us about it. 

Kenen: OK, one story that’s my extra credit, and one story I’m also going to, related story, that I’m going to just give a shout out to. Sarah Kaplan at The [Washington] Post wrote “.” And basically she talks about climate change and health, and that the reason that there’s this algae 鈥� and actually there’s many kinds of algae. I’m not an expert on all the kinds of algae. But there is one called cyanobacteria, which is highly toxic. It is present 鈥� my understanding is it’s among several kinds of algae in the Reflecting Pool. But it is becoming more dominant because of climate change. And that’s toxic. That’s not a good thing to have. What I didn’t know 鈥� I don’t want to go on too long 鈥� but it’s sort of fascinating that they fill the Reflecting Pool with water from the Tidal Basin, which is the surrounding, the water that, for the people who aren’t in Washington, is the water around the Jefferson Monument and the cherry trees and all that, which in turn comes from the Potomac River, which is polluted. And painting a reflecting pool and then pouring in polluted water might not have been the smartest thing to do. And also apparently the American flag blue is darker than the old gray and it retains more heat and makes the problem worse. So sort of the big public health message is that 鈥� here the big joke is Making Algae Great Again 鈥� but that there is saying something about the state of our planet and the state of our water, and that even things that we think of as harmless are not necessarily harmless. And then, just relatedly, for anyone who’s really interested in good reporting on this and great writing on this is the cultural critic of The Washington Post, Philip Kennicott, has been writing a lot about the changes to Washington, and  the Reflecting Pool and called, he said it looked like a kale smoothie. 

Pradhan: Oh. 

Rovner: Vivid. OK, Maya. 

Goldman: My extra credit this week is from Stat. It is an article by O. Rose Broderick called “.” And I think this is a potentially very consequential move from the Trump administration that isn’t getting enough coverage. The SparkNotes version is that the Supreme Court held in 1999 a decision known as Olmstead that said you can’t have unjustified institutional isolation of people with disabilities 鈥� that’s a form of discrimination. The Trump administration put out a memo sort of reinterpreting what unjustified institutional isolation means. This notably doesn’t change existing laws around integration requirements for people with disabilities, but it signals where the Trump administration’s head is at with regards to disability rights. And the article also notes that the motivation for this change isn’t really clear, especially since community care is usually cheaper than institutional care. But it does mention that one possible factor could be to give the government more flexibility to tackle homelessness, perhaps by forced institutionalization. So, certainly one to watch. 

Rovner: Yeah, definitely. Rachana. 

Pradhan: So my extra credit is a story [“Arrests of Immigrant Parents Create Mental Health Crisis for Children”] written by our [吃瓜不打烊] colleague Claudia Boyd-Barrett. It is just devastating. If I, so 鈥� grab a tissue box if you’re going to read it. She wrote about how, the consequences for children who have parents that are either detained by ICE [Immigration and Customs Enforcement] or deported out of the United States, and she has these incredible, really just heartbreaking stories of these children who have been separated from their parents and sort of the emotional toll that it is taking on them. So it’s, the way I think about it is it’s, during the first Trump administration there was a big thing about families being separated at the border, and it was the family separation crisis. But now it’s happening again, just not at the border necessarily. 

Rovner: Yeah. It is quite a story. Well, my story affects both immigration and disability. It’s from The Washington Post. It’s by Sylvia Foster-Frau, and it’s called “.” Now, this is a state program that’s separate from Medicaid, called Children’s Special Services, that helps low-income families with children with disabilities pay for critical things like wheelchairs and feeding tubes and ventilators. Until now, it has served families with no other way to get care, including those who are undocumented and therefore ineligible for Medicaid. But now, the 400 families on the program have been notified by the state that if they want to keep their benefits, their immigration status will be reported to federal authorities. The story profiles one family, asylum seekers from Honduras who have a 10-year-old with spina bifida and autism and whose care, including wheelchairs and catheters, has so far been paid for by the program. Now the mom says she’s going to have to drop out of the program rather than risk being deported, but she has no idea how she will pay for the care that her son needs. It is also pretty wrenching. 

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

Kenen: I am mostly on  and Bluesky, . 

Rovner: Maya. 

Goldman: I am also on  and still on X, . 

Rovner: Rachana. 

Pradhan: You can find me , , and , @rachanadpradhan. 

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

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

Julie Rovner: Julie, hello from 吃瓜不打烊 and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 吃瓜不打烊. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, June 18, 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 Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Sheryl Gay Stolberg of The New York Times. 

Sheryl Gay Stolberg: Hi, Julie. 

Rovner: And Anna Edney of Bloomberg News. 

Anna Edney: Hello. 

Rovner: Later in this episode, we’ll have my interview with Michael Cannon of the libertarian Cato Institute and Liz Fowler of the Johns Hopkins Bloomberg School of Public Health. Michael and Liz, who are on opposite sides of most things in the health debate, are jointly promoting the idea of eliminating, or at least scaling back, the employer health insurance tax exclusion that underpins much of the U.S. healthcare system but also drives up health spending. But first, this week’s news. 

Let’s start this week on Capitol Hill, where Democrats in the Senate say they plan to use the Congressional Review Act to force a vote to disapprove the Trump administration’s Affordable Care Act payment rule that was finalized in May. For those who haven’t been paying close attention, this is the rule for next year’s plans. It includes things like allowing non-network plans that could open policyholders to unlimited out-of-pocket spending, or else possibly no available providers of care in their area, as well as new catastrophic policies with lower premiums but deductibles well into the five figures. 

The CRA is a handy tool for Congress. It allows the minority to force a vote on the floor and only requires a simple majority of both houses to pass. Few rules are actually canceled using this procedure, but it does allow members of Congress to highlight an issue, in this case playing into Democrats’ desire to keep one of their best midterm electoral issues, healthcare, front and center. So, will this succeed at getting attention, even if it ultimately doesn’t cancel the rule? Or is there just too much else going on right now? I have to say, I haven’t seen a lot of coverage of this other than from my colleague Julie Appleby. Bless her heart for bringing this story to everybody’s attention. 

Stolberg: I think that by November this will resonate. We’re in a situation now where costs are rising, gas costs are going up, and they may go down if this Iran deal goes through, but healthcare and the cost of care is always an issue for Americans. It’s long been an issue that Democrats have led on. I actually find it interesting. What [President Donald] Trump is trying to do really kind of undercuts the very premise of Obamacare, which was to offer kind of a baseline level of care, to require that plans gave people a baseline level of care. You know, come November, it’s going to be just after the enrollment period of October, and I think Democrats are going to be talking about this. And then, it might not resonate or break through now, but they will point back to this vote in this moment. 

Edney: Yeah. I was going to say that I do think it’s possible by then. I think you were right to say that right now it’s hard for things to break through, but by the midterms we may see, as a direct result of this, people losing coverage. And I think that coverage losses 鈥� or deciding not to have coverage any longer, because it’s too expensive. So, I do think that coverage losses, whether it’s in the ACA marketplace or Medicaid, are going to be a big campaign issue. And if Democrats can point to this vote as a direct line to We support you having your coverage and Republicans don’t, that could be something that breaks through to those potentially millions of people who no longer have care. 

Rovner: Yeah, last week I described this as the drip, drip, drip of declining coverage, which is that we sort of keep seeing these things bit by bit. Rather than sort of one dramatic, Oh my goodness, I can’t afford my coverage and I’m going to drop it, we’re seeing people scrambling to try and keep coverage, or to buy down to have less expensive plans with bigger deductibles. And then, once they start to seek care, they’ll realize they can’t handle those deductibles. So it’s happening in pieces rather than all at once. 

Well, speaking of that Affordable Care Act rule, props to the eagle-eyed Reed Abelson, your colleague at The New York Times, Sheryl, for spotting a little-noticed piece of the rule that allows insurers to offer loans to patients who can’t immediately come up with those multi-thousand-dollar deductibles should they need medical care. Now, this is not a new idea. Overall, veterinarians have long offered payment plans to pet owners, as have health practitioners, whose services are often not covered by insurance, like cosmetic surgeons. But for necessary medical care, it seems like loading patients with still more medical debt seems like a less-than-popular solution to high healthcare costs. Or is that just me? Lauren. 

Weber: I mean,  was a blockbuster, and also just horrifying. And what kind of dystopian future are we all in? Instead of paying your premiums, you’re also paying your payment plan to the same people. It’s already been said enough that there’s some concern that health insurance plans are gobbling up so many parts of the healthcare market. You wonder what happens when they also become essentially your mortgage broker. And so I think the story deserves a lot more attention, because I think a lot of Americans would be quite terrified if they realized that is potentially the future. 

Edney: And it seems like the point should be to make coverage more affordable, not to find new ways for you to pay the same really high amounts. 

Stolberg: I just was going to say I thought it was interesting that Reed pointed out that roughly a third of Americans have some kind of medical debt, and she linked to an analysis, a  in HealthAffairs, about medical debt and collections being very common and large. 

Rovner: Yeah, I’m just noting the irony of Republicans deciding to come out against Big Insurance, and yet this 鈥� talk about own goals, going against exactly what you’re saying. Let’s make Big Insurance less popular by having people owe money on a payment plan, have a credit card to pay their insurance company back for things that their insurance company basically isn’t covering anymore. Yes, presumably with interest, so Big Insurance will make even more money. 

Well, moving on, it’s been a busy week on the reproductive health front. In Texas, the state’s Republican platform includes a plank calling for women who have abortions to be held criminally liable for murder after another Texas anti-abortion group fought unsuccessfully to have it removed. , the attorney general’s office is sending cease-and-desist letters to out-of-state organizations that offer abortion pills via telehealth. The letters say the companies, including some well-known ones like Plan C and Cambridge Reproductive Health Consultants, must stop all advertising, sale, and delivery of pills to Alabama residents or face potential legal action, including fines of $2,000 per violation. On the other hand, one former abortion provider in the state pointed out that the letters themselves act as an advertisement for the various services that otherwise people might not know anybody about, or where they are. Is this just performative? Or do we think there are going to be real efforts to reach distributors outside states with abortion bans, despite shield laws in the states where those distributors are actually located. 

Weber: It’s probably a mix of both, right? I think that some of it is for press coverage. I did find the former abortion provider saying this is a giant billboard for all these products to be somewhat quite the comment to be made. But it’s true. If you live in Alabama and you went to this woman who is an abortion advocate, she could not tell you where to look these things up online, and now there’s a plethora of media coverage and attorney general’s letters that lead you right to the source. 

Rovner: With their addresses. 

Weber: With their addresses. With their web addresses. And so鈥� 

Rovner: That’s right. 

Weber: It’s an interesting move on all counts. I think it’s just a one and another. I think I don’t think we’re going to just see this from Alabama. 

Stolberg: Yeah, I was going to say this is part of a broader assault by the anti-abortion movement on abortion medication, and in particular mifepristone. And my colleague Pam Belluck and I  about this lawsuit that was brought by the state of Louisiana, which instead of targeting the manufacturers of the pill, they want courts to bar a policy allowing abortion providers to provide or prescribe mifepristone and send it through the mail. This was the policy of the Biden administration’s FDA [Food and Drug Administration]. The Trump administration has said, We’re studying this issue. That study seems to be going on a very long time. Some people suggest it will go on past the midterms, so鈥� 

Rovner: That seems to be the strategy. 

Stolberg: Right. But nonetheless, now that Roe [v. Wade] is gone and states regulate abortion, we are seeing this kind of clash between states about what can happen from one state to another, and I think this is part of that. 

Rovner: Yeah, and as we’ve pointed out multiple times in multiple ways, anti-abortion groups are furious that the administration has not rolled back this ability to send these pills through the mail, because that is why I think we’re seeing less backlash to some of these bans than we would have otherwise, because a lot of these bans are fairly easily evadable by going, having a telehealth appointment with a doctor in another state and getting the pills in the mail. And there’s very little that the ban states, as we’ve discovered, can do to stop it. So they’re sort of trying everything, including these cease-and-desist letters. But this is clearly a fight that’s going to go on unless and until the administration steps in or the courts step in. And we’re, I guess, at this point waiting on both. 

Meanwhile, the Huffington Post has a truly  about women who get positive home pregnancy tests, arrange to travel or take time off from their jobs to get an abortion, only to discover once they get to the clinic that they weren’t actually pregnant at all. It seems most of the false positives are coming from the same brand, Clearblue. And it’s not that the tests are wrong as much as they appear to be too sensitive, likely picking up pregnancies that either end themselves before they’re fully established or picking up the hormone that the tests detect from sources other than an active pregnancy. The most chilling part of the story is at the very end, with one doctor wondering how many women are doing telehealth abortions with pills who were never actually pregnant to begin with. It seems that do-it-yourself healthcare maybe isn’t as foolproof as we’ve made it out to be? 

Weber: I think the story, just 鈥� first off, everyone should read it, because it’s an incredible deep dive. She managed to uncover multiple complaints that physicians who provide abortion had made to the FDA, which appear to have been undealt with, and it speaks to the tragedy of some of these people that take time out of their day, raise money, travel across state borders to potentially try to end their pregnancy, and realize they don’t have a pregnancy at all, and the emotional trauma of that. But more than anything it speaks to the fact that as abortion rules have become more restrictive, you need to know if you are pregnant earlier than ever, so that’s why a lot of these people are taking these pregnancy tests. And the fact that this is so sensitive, the article does posit that it could be picking up pregnancies that are called chemical pregnancies, which don’t end up becoming actual pregnancies. But the point is that usually if you wanted to go check that, you would go to a doctor and they would check your blood levels and see if they were rising. But a lot of women are afraid to do that in this current environment. And so I feel like it’s a big story of unintended consequences and horror that has unfolded as some of these pregnancy tests are not accurate. 

Rovner: Yeah, and in some cases there are multiple cases. Go ahead, Sheryl. 

Stolberg: Lauren’s words, “unintended consequences,” were just what I was about to say. This is part of a whole panoply of things that were not foreseen by anyone, really, when Roe was overturned. A couple years ago I went to Idaho  how OB-GYNs, especially those who dealt with complicated pregnancies, were fleeing the state because of the restrictive abortion rules. And that was leading family practice doctors, like one I featured, without help in caring for patients with complicated pregnancies. And that, too, is sort of an unintended consequence. And when we were talking before about the abortion pill being sent across state lines, yes, you can evade the bans that way, but it still leaves women without medical care, without follow-up care should something go awry. So a lot of things happened, have flowed from the Dobbs [v. Jackson Women’s Health Organization] case that we didn’t think about at the beginning. 

Rovner: Yeah, one of the things that I’ve written about is it’s not just OB-GYNs who are leaving states or not going to states in the first place, choosing not to do residencies there. 

Stolberg: Right. 

Rovner: But it’s other doctors who are not going to some of the states with bans, because doctors who finish their medical school and residencies tend to be of reproductive age. And they are women, or if they are men and have spouses and want to start families, they’re worried about being in states that don’t have enough doctors if there’s a difficult pregnancy. We’re talking about people who want to get pregnant being a little bit concerned about going to states with abortion bans, because so many of the doctors who would deal with difficult pregnancies have left. So it’s just, it spins out and out and out and out. 

Well, finally, in something from the Trump administration that will please anti-abortion forces, a new grant announcement for a George W. Bush-era program promoting the adoption of frozen embryos left over from IVF [in vitro fertilization] refers to them as, quote, “children who already exist and are in need of a family.” Is this formal announcement the quiet beginning of this administration’s effort to establish fetal personhood in federal law? Or is it just another way to pacify pro-lifers who are still angry over the other administration policies we were just talking about that they don’t like so much? 

Stolberg: Huh. That’s interesting. 

Rovner: Sheryl, you probably remember the “snowflake babies” from the Bush administration. 

Stolberg: OK, I’m actually the person who  on the front page of The New York Times, and then suddenly snowflake babies and their parents were appearing at the White House and on Capitol Hill, it was a group called鈥� 

Rovner: Remind younger people who these snowflake babies are. 

Stolberg: So, there was a group called 鈥� this was at a time when we were talking about excess embryos left over from in vitro fertilization and what should happen with them, and鈥� 

Rovner: And whether they should be allowed to be used for stem cell research. 

Stolberg: Right. That’s exactly right. And whether they should be allowed to be used for stem cell research. And there was a group called Nightlight Christian Adoptions. They’re a Christian adoption agency, and they had come up with another way, they said, in which infertile couples were literally adopting embryos that were left over from other people’s pregnancy effort attempts. And this was a solution for deeply religious people who did believe that life begins with the embryo and did not want to destroy their embryos and also did not want to have to pay in perpetuity for them to be housed in a lab somewhere. And they called them snowflake babies. And so this is something that George Bush talked about and became enshrined in, I guess, his administration. And, I don’t know. I guess Trump is looking back 20-some-odd years or so, reviving the past. 

Rovner: Well, there has been, there 鈥� it’s a program that has continued. 

Stolberg: Right. 

Rovner: And there were some adopted embryos even during the Biden administration. But I guess the question that sort of comes up now is, by describing them as already children鈥� 

Stolberg: Yeah. Are they laying the groundwork for this? 

Rovner: 鈥攁re they setting 鈥� yes, are they laying the legal groundwork? Lauren, you wanted to add something. 

Stolberg: Maybe. 

Weber: I was just curious. Does this lay the legal groundwork that any leftover embryo would then qualify for this program? What if you didn’t want your leftover embryo to go through this? I’m curious. The regulation seems a little unclear. 

Stolberg: I think parents retain the right. Parents retain the right to, they are in essence the property 鈥� I don’t like to use that word, but 鈥� 

Rovner: I think legally, though, that’s what they are. 

Stolberg: And legally, embryos created by an infertile couple belong to that couple. And in fact we’ve seen, and my colleague Caroline Kitchener  a lawsuit between a husband and wife who divorced and the woman wanted to implant the embryo and the man did not. And the question was, who quote-unquote “owned” the embryo. But I think that personhood question is really interesting, Julie, and maybe it does establish, in a way, a government recognition of embryos as people that is unprecedented. 

Rovner: Yeah, that’s certainly the concern, that it’s sort of taking it one step further. All right, we’re going to take a quick break. We will be right back. 

We are back. And speaking of issues the administration is trying to tiptoe around, let’s turn to vaccine policy. Last month, the Journal of Toxicology and Environmental Health announced it was retracting a 2010 study that linked the hepatitis B vaccine to an increased risk of autism, because, and I’m quoting here, “due to fundamental methodological flaws the study’s conclusions are unsound.” That was one of the studies cited by Secretary Robert F. Kennedy Jr.’s handpicked advisory committee to change the recommendations for the birth dose of the hep B vaccine. Separately, the journal Toxicology Reports retracted a 2021 study that claimed a link between vaccines and sudden infant death syndrome, also citing methodological errors 鈥� which is typical, by the way, for why studies are retracted. Yet that retraction led Secretary Kennedy to write a letter to the journal demanding to know why and giving the journal’s editor a deadline of June 26 to respond. What is Secretary Kennedy trying to accomplish here? And will it work or is it just coming off as bullying? 

Edney: I think certainly it’s coming off a little bit as bullying in the sense that this was a decision that the journal made about something that 鈥� clearly this happens, because it happened with this other study. I think that in Secretary Kennedy 鈥� and Sheryl, you’ve written about this, and others 鈥� he does still have a vaccine agenda, whether he’s allowed, or an anti-vaccine agenda, whether he’s allowed to talk鈥� 

Rovner: We’ll get to that in a moment. 

Edney: 鈥攐r not. So I think when he makes these requests, he’s kind of trying to sow doubt into what these other doubts the journal is bringing out. 

Rovner: Lauren, you want to say something. 

Weber: Yeah, I just, I think in general, this is a pattern of actions by Kennedy that several experts have described to me as somewhat hypocritical. He’s attempting to bully a medical journal. He had a big thing about all information should be free during covid, no one should be silenced. And here he is using his platform to potentially change things on that front. And then he also recently issued a quarantine order for someone with hantavirus to stay in Nebraska, which flies in the face of a lot of his “medical freedom” rhetoric during covid. And so I think some of these moves are really interesting because they seem to strike at a contradiction in a lot of the rhetoric he espoused before coming into office. And even on top of the vaccine of it all, I just, I think that’s important context to consider. 

Rovner: And Sheryl, we spent some time last week talking about  about the secretary. But anything you would like to add, please do. 

Stolberg: Yes. I think this is not at all out of character for the secretary. The secretary has long believed that the established medical journals are censoring what he views as legitimate research, i.e. research into the alleged harms of vaccines. And even before he became secretary, when he was running for president, he laid out a very clear agenda in which he said he was going to use government science to lay the groundwork for research that could be used in court against pharmaceutical makers, vaccine makers, and he was also going to take on the medical journals. And in the aftermath of covid, what we saw was also this sort of alternative ecosystem of medical journals growing up, published by these covid contrarian doctors, the Independent Medical Alliance, and other groups. So it wasn’t surprising to me at all that Kennedy went on the offensive against a journal that retracted a study, because he and his allies have long complained that these journals are censoring them. When journals find fault with research that Kennedy likes or supports his views, he doesn’t want to hear about that. 

Rovner: Well, separately, or perhaps not so separately, the Justice Department, on Kennedy’s behalf, is asking for an expedited appeal of a lower-court ruling that found his changes to the childhood vaccine schedule to be, quote, “arbitrary and capricious” and his handpicked vaccine advisory committee members unqualified for their posts. The administration is arguing that because the ACIP [Advisory Committee on Immunization Practices] is currently frozen, the administration can’t act on new vaccines for this fall, including for things like flu, RSV [respiratory syncytial virus], and covid. The , meanwhile, which brought the lawsuit that got the changes stayed, argues that Kennedy can reconstitute ACIP anytime he wants, as long as he follows the federal advisory committee rules and appoints members with vaccine expertise. How might this standoff get resolved? Or does this standoff need to be resolved? There are arguments the FDA has already approved a vaccine for this fall. Insurers have already said they’re going to cover it. So is this, speaking of things that are performative, also performative? 

Stolberg: That’s 鈥� I think we’re in uncharted territory, Julie. In the past, the CDC’s [Centers for Disease Control and Prevention’s] vaccine advisory committee has met well in advance of every upcoming fall, the flu season, to discuss vaccines to protect the American public and kind of issue their recommendations, which guide what insurers cover. And as a result of this lawsuit, we’re in a place where kind of everything is going on without that central pillar that backs up these decisions. So insurance companies are saying, Yeah, we’ll cover, and the FDA is saying, Yeah, we’ll approve, but there are no experts, outside experts, really thinking through what the right policy is. So, I suppose鈥� 

Rovner: Technically there’s not even an acting director of the CDC, right? Because it went on too long? 

Stolberg: That’s right. 

Rovner: Or is that 鈥� so Jay Bhattacharya鈥� 

Stolberg: Well, Jay Bhattacharya is functioning as the acting director but technically he is not the acting director. He is acting in the capacity of director or something like that? 

Rovner: I believe that is the phrase. 

Weber: Who needs senior leadership? 

Rovner: Yeah. It’s all very weird, so鈥� 

Weber: They’re all gone. 

Stolberg: I think it’s a question of, can the government function without this? Yes. Is the government doing the best work for the American people without this system in place? You know, probably not. 

Rovner: Well, meanwhile, more quietly, since the White House ordered Kennedy to back off his more public anti-vaccine efforts, it appears that things are still happening, just a bit more out of public view. Both  and now  are reporting new efforts to study possible ill effects of vaccines at the CDC, the NIH [National institutes of Health], and elsewhere in the department. Quoting from the Washington Post story, by Lena Sun and our podcast panelist Rachel Roubein: “Kennedy’s allies are embedding his agenda in institutions that decide what gets studied, who does vaccine research and how these findings are translated into policy. This could keep the Trump administration’s questioning of vaccines’ safety alive for years to come,” close quote. Could these changes have an even longer-term impact than some of RFK Jr.’s sort of splashier actions that we were just talking about, that could be more easily overturned by an incoming administration? 

Weber: I think absolutely, Julie. I think at the end of the day, too, some of what my colleagues Rachel and Lena found was that they are exploring adding new members to ACIP, that they’re also exploring adding a new Office of Science in the CDC. What does that mean? If is that an Office of Science that Kennedy agrees with? Or is that an Office of Science? These are the questions one has to ask. And then, what kind of long-term ramifications are there for that? Many public health experts say that this continued back-and-forth on vaccines just leaves a lot of people confused and will likely contribute to lower vaccination rates, which could contribute to the continuous rise of preventable, vaccine-preventable, disease. And so there’s a lot of concern that some of this groundwork that’s being laid to underpin some of Kennedy’s long-held beliefs could have a very, very long tail. 

Rovner: Yeah, and of course we’re already seeing cases, not just measles spreading but whooping cough and the kinds of diseases that are preventable with vaccines that people are now not getting for their kids. 

Well, finally this week, two amazing stories related to HHS but not of HHS. One is from The New York Times’ Christina Jewett and Kenneth Vogel, and it’s a  into how lobbying has helped keep the potentially dangerous supplement kratom, if not on pharmacy shelves everywhere, then at least in gas stations and convenience stores around the country. This story has lots of twists and turns over several presidential administrations, but it does seem that Trump 2.0 has been welcoming, shall we say, to the kratom industry, which has in turn given lots of campaign contributions to the administration and its allies. Anna, I see you nodding. 

Edney: Yeah, I loved the story. I thought it was really well done. And, like you said, lots of twists and turns. And there was a really great quote, and I’m not looking at it, but it was along the lines of this being kind of a coin-operated policymaking administration. So, like, you’re 鈥� if you give enough money. That’s why we’re seeing it’s not your typical, like, Big Pharma putting a lot of lobbying in, right? It’s kratom, it’s flavored vapes, things that kind of you might have considered on the fringes bubbling up to hit. Even the president’s talking about them, and at press conferences that are completely unrelated. So I think that it was a great look at how this industry really kind of got into the administration, and in their view, in the industry view, it’s like, Listen, we’re just paying to be at the table, and we’ve never really been at the table before. But pretty much anyone who can bend the presidency, or someone in his administration, seems to be able to make these inroads that we haven’t seen before, when the product is not proven safe and has been shown to harm people and cause, lead to death. 

Rovner: Yeah. Sheryl, you wanted to add something. 

Stolberg: Yeah. So I was going to say, I lived through this story by my colleagues Ken Vogel and Christina Jewett, and props to them. We’ve been talking about this for a while. I noticed a while back, when  the MAHA [Make America Health Again] movement and Trump, that this company called Botanic Tonics had kind of donated like a million dollars to the MAHA PAC: And I thought: “What is this? Why are these people donating a million dollars to this PAC? Who are they? What is kratom?” And it turned out that my colleague Ken Vogel and also Christina Jewett were kind of already onto this. And the thing that they found to me that was so amazing is that not only this company and the promoters of kratom, which is kind of like an addictive gas station drug 鈥� it supposedly boosts energy 鈥� not only were they cultivating Kennedy, but also Markwayne Mullin, who now leads the Homeland Security Department but formerly was a senator, had an investment worth as much as a million dollars in this company, the company of Botanic Tonics. The company’s founder was an energy executive in Mullin’s home state. He’s this odd guy who I think had some sort of brush with the law and changed his name, and it was just this kind of crazy story of influence, like Anna said, kind of, or maybe you said, Julie, on the fringes but coming to the fore. 

Rovner: Yeah, and the original sin here, I think, and someday we’ll go into a deep dive on this, was the 1994 fight in Congress about dietary supplements and鈥� 

Stolberg: The DSHEA [the Dietary Supplement and Health Education Act]. Yes. 

Rover: Right. 

Stolberg: And I’ve thought a lot about this. That has created kind of the, what critics call, the wellness industrial complex, which allows these companies to sell things that are supplements as food, which means they are not regulated as stringently as drugs, can only be regulated after they come to market. And a lot of shady stuff is sold as a result. 

Rovner: Yeah, as I say, it goes back a lot of administrations. All right. Well, finally this week, my other story, and this is my extra credit this week. It’s the second blockbuster in the last three weeks for my 吃瓜不打烊 colleague Darius Tahir about President Trump’s stock trading. The previous one was about the prescription drug industry. This one is about tobacco. It seems that the teetotaling commander in chief is fine with other legal vices, that he holds more than $1.6 million in stock in tobacco giant Philip Morris, as well as positions in Altria and other tobacco companies. The tobacco industry has been good to him, too, giving millions to Trump-affiliated super PACs. And what has the administration given back? Quoting from the story: “It’s FDA piloted a fast-track program to approve nicotine pouches. It unveiled a program to allow vapes on the market more rapidly, despite resistance from career civil servants and leadership, culminating this year in guidance waving through flavored electronic cigarettes. It cut public health employees focusing on anti-tobacco policy. And it broadened enforcement against illicit e-cigarette, competitors to the big industry players with a financial relationship to Trump,” close quote. This is a big difference from the first Trump administration when it comes to tobacco, isn’t it? My recollection is that they were not quite this welcoming to tobacco from 2017 to 2020. Anna, I see you nodding. 

Edney: Yeah. 

Rovner: You did some work on this. 

Edney: Yeah, well, this was when, the first Trump administration was when Scott Gottlieb was the FDA commissioner, and he was quite anti-tobacco. And we went through this whole scare about kids getting some strange lung disease from vaping. And there were a lot more restrictions that 鈥� and less approvals, or clearances, whatever you want to call the tobacco side of FDA. So, I think it’s been a complete turnaround, where this time around the Trump White House would prefer to run roughshod over the FDA and get what they want for the tobacco industry, because they’re getting a lot of money from them. 

Rovner: Yeah, and props to Darius for connecting all of the dots. Lauren, you want to add something? 

Weber: Yeah. Let’s go back to  about Trump meeting over cheeseburgers with the tobacco guys at the White House. I think Darius’ piece lays out the money that maybe is hanging out there. But props to Darius for having two of these quite good stories looking at these conflicts of interest. 

Stolberg: Yes, during the Trump administration, the first Trump administration, Alex Azar, his health secretary, pressed Trump to take some sort of action restricting vaping, and Trump got really mad at Azar about it, and he complained privately and yelled at Azar, saying to him, You’re costing me votes, because the MAGA crowd likes vaping. This was recounted in a book. I’m pretty sure it was Phil Rucker and Carol Leonnig’s book, the two Washington Post reporters. So, Trump was, maybe he wasn’t this aggressive in supporting the tobacco industry, but then there’s this added component to it, which is that he thinks MAGA [the Make America Great Again movement] likes vaping. And he was yelling at Azar, saying: You’re costing me votes. You’re going to cost me this election. I’m sorry I ever did this. 

Rovner: Oh, we will see how this one plays out. All right, that’s this week’s news. Now, we’ll play my interview with Michael Cannon and Liz Fowler, and then we’ll come back and do our extra credits. 

I am pleased to welcome to the podcast two people who have taught me a lot over my years covering health policy. And full disclosure, I consider both of them friends. Liz Fowler is a distinguished scholar at the Johns Hopkins School of Public Health. During the Biden administration, she ran the Center for Medicare and Medicaid Innovation, an agency created by the Affordable Care Act, which she helped write as the chief health counsel on the Senate Finance Committee and implement as a senior official in the Obama administration. Michael Cannon is the director of health policy studies at the Cato Institute, a libertarian think tank here in Washington, D.C., and has spent most of the past 16 years trying to get the Affordable Care Act repealed after vehemently and almost successfully blocking its passage. Yet this unlikely pair is on a new mission, pointing out why the first step in the next round of health reform should be to get rid of something called the employer health insurance tax exclusion, which we will explain in a minute. Liz and Michael, welcome. Thanks for doing this. 

Liz Fowler: Thanks for having us. 

Michael Cannon: Thanks for having me. 

Rovner: So for most people this would be a hard question, but you guys have been on the circuit, so one of you give me the 30-second explanation of what the employer tax exclusion is and why it exists in the first place. 

Cannon: So when Congress passed the income tax in 1913, there was no such thing as health insurance, really. So they gave no thought to the question of if an employer provides health insurance to its employees, should that be subject to the tax. The Treasury bureaucrats, when someone presented that idea, said: This is really hard. We don’t know. We’ll just say we’ll exclude that from the tax base, so we won’t tax compensation in the form of employee health insurance. That was in the 1920s. In the 1940s 鈥� so that gave employer health insurance a boost. In the 1940s there were wage and price controls that gave it a further boost, because employer health insurance was exempt from those wage controls, so it gave employers a way to compete. But it’s really that tax exclusion that is responsible for the fact that more than half of U.S. residents have health insurance through an employer, because it works like this: If your employer gives you a dollar of cash, you have to pay federal income and payroll taxes on that, and you’re left with, on average, at the margin, 66 cents. The federal government takes a third of it. But if the employer gives you that same dollar as health insurance, then you get a dollar’s worth of health insurance. So you can see how this sort of distorts the prices, the after-tax prices that people face, when they’re choosing between more cash wages and spending that money on other things versus spending money on health insurance, employer-sponsored health insurance. And so people more often buy employer-sponsored health insurance, they demand more of it than they would otherwise, and this also lets employers end up controlling about, for the average family with employer coverage, $20,000 of the worker’s earnings. And all of these effects end up increasing spending on employer-sponsored insurance and increasing prices for health insurance, and the fact that it’s encouraging a form of insurance that disappears when you change jobs means it’s creating gaps in health insurance coverage. So, for decades, economists have said: Hey, this is a real problem. We need to solve this. And I would argue that it is really the reason that Congress wanted to enact the Affordable Care Act in the first place, to fill some of the gaps that this exclusion created. 

Rovner: So, Liz, originally this was considered a good idea. It’s like, Oh, we’re encouraging the creation of a new fringe benefit for workers: health insurance. When did it outlive its usefulness? 

Fowler: That’s a great question. I think our workforce is very different. Employment is very different than it was back in the 1940s and ’50s, when my parents or grandparents had the same job for decades and they all got health insurance through their workplace. That has eroded over time. I don’t know exactly, Michael probably knows exactly, what the trajectory has been. We’re now down to about 50% of employees receiving healthcare through their workplace. But people are employed in different ways than they used to. I’ve had several jobs throughout the course of my career. People don’t stay in the same job for decades anymore. And people piece together work in ways that they didn’t. Maybe they have more than one job. Maybe they have a part-time job over here and a part-time job over there. This tying health coverage to employment, I think, has become, is starting to become, anachronistic. And I think for me, in particular, watching the debate over HR1 [congressional Republicans’ One Big Beautiful Bill Act] and trying to tie Medicaid coverage to employment or community engagement brought up this whole question of: Why do we tie health benefits to work in 2026? 

And so that’s part of why I wanted to revisit this policy question, which we tried to tackle in the Affordable Care Act and didn’t get very far. And the sort of the distorted version that we included in the law, the “Cadillac tax,” was repealed with a bipartisan 鈥� what, almost unanimous 鈥� vote. So I think it’s time to sort of ask these questions again. It’s a very expensive part of the tax code. It’s one of the largest if not the largest tax expenditure in the U.S. tax code, to 鈥� what 鈥� close to upwards of $300 billion a year that this benefit provides to a group of workers who are more likely to get health coverage and more likely to get generous health coverage, and at the higher end of the income scale more likely to see a larger benefit. So all of these questions, I think, are ripe for revisiting. 

Rovner: So one of my most vivid memories from covering the Affordable Care Act was a roundtable hearing that the Senate Finance Committee had with all of these economists from across the spectrum talking about how to pay for the Affordable Care Act. And I remember 鈥� I actually went and looked this back up 鈥� one of the senators asked what would be the best way to pay for it And one by one by one, these witnesses, eminent health economists from literally every part of the political spectrum, says you need to do something about the employer tax exclusion, literally every one. And obviously, as you said, Liz, they tried. There was sort of the beginnings of this that we called the Cadillac tax, and it was ultimately repealed. Why is this so hard if it, as you guys point out, it doesn’t make very much sense anymore? 

Cannon: Well, it creates a lot of benefits for a lot of very powerful groups. It benefits the health industry because the government is effectively penalizing workers for every dollar of their earnings that they don’t spend on health insurance and medical care. It benefits large employers because they can spread the administrative costs of providing health insurance over a larger number of workers, which means they can take the savings and offer higher salaries than their smaller competitors do, which gives them an advantage in the labor market. So between those two groups right there, you have a very powerful coalition that has blocked, defanged, repealed every effort to try to limit or reform the exclusion, and there have been a lot. Presidents [Ronald] Reagan, [Bill] Clinton, Bush the younger, [Barack] Obama. Presidential candidate John McCain famously tried to reform the tax exclusion, and Barack Obama really, I would say, demagogued that that proposal. I didn’t favor that proposal either, but McCain’s policy director says he still has nightmares about the attack ads that Obama ran. And it’s because of the fear those 鈥� it’s not just that people have a financial interest in preserving this huge tax break for employer-sponsored insurance. It’s the fear that those special interest groups are able to demagogue, to play upon that people with employer-sponsored health insurance who have expensive medical conditions will lose their coverage and be left with nothing. 

Now I am not a fan of the Affordable Care Act, or what I now call Obamacare. We’ve discussed this. Liz and I do not see eye to eye on that one. I would repeal it tomorrow if I could. But if it is in place, then it actually helps with that problem. It helps with this fear that people would, if we reform the tax exclusion for employer-sponsored health insurance, that people will lose their coverage. There’s a lot of evidence to suggest that employer coverage will stick around for the vast majority of workers, but for those for whom it does not, the Obamacare exchanges are there as a sort of safety net, so that should make the politics a little bit easier. 

Rovner: So, obviously, the Cadillac tax didn’t work. What would be a step that would, that possibly could happen, that we could take to start to move away from this? 

Fowler: Well, one of the things that we initially tried to do in the Senate Finance Committee, in an early version of the Affordable Care Act, was to cap the exclusion. So you can say above the 80th percentile, or the 85th percentile, or something lower 鈥� below that will still exclude it from income. But if you get very generous coverage, very expensive coverage, we’ll start to鈥� 

Rovner: Like Cadillac-type coverage? 

Fowler: Well, but the difference is we’ll include that as income for the worker. I think that’s where we ran into problems and political challenges. I think there was some reluctance to tax individuals, and Oh, that looks like a new tax increase. So the Cadillac tax was, OK, let’s instead put that tax on employers and insurers instead of the workers, and that became very unpopular with, as you can imagine, the employers and the insurers. So it makes sense why it’s been a tortured history and it’s been hard to get done. I think one of the reasons, and Michael talked about this, why it was a little bit scary to go down this road in the past, because you didn’t know where people would get their health coverage if you tried to change the employer structure we have now. But now there is a place. There are marketplaces. And the bigger that risk pool, and the more people are part of it, I think the more affordable and the more stable it becomes over the long run. 

Additionally, I’m not sure employers want to stay in this business. I think it’s becoming very unsustainable to continue to provide very costly insurance that, where the cost is rising at quite a rapid pace, certainly higher than wages, and is eating more and more of a household’s income over time. And so I think if we really lift up the hood and start looking at the potential impacts, the opportunities, the options, the policy options on the table, and have an honest debate about what this could look like, I think there would be more openness perhaps now than there was back in 2010. 

Rovner: Well, thank you both for kicking this off. Michael Cannon. Liz Fowler. This was great. 

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. I’ve already done mine this week. Anna, why don’t you go next? 

Edney: Sure. Mine is in Politico Magazine. One of the co-authors is our podcast colleague Alice Miranda Olstein. It’s “.” And I thought it was a really smart look at something Trump had said, again talking about things he did in his first administration, that we could end the HIV epidemic in the U.S. by 2030 and put policies in place to try to get there. And Alice and her colleague talked to a lot of top former administration people to look at what happened, and it seems to be not one single lightning bolt but sort of that there were all these other policies around Trump 2.0 that 鈥擠OGE [the Department of Government Efficiency] and other things that cut a lot of this type of funding 鈥� that created this situation we’re in now, where no one, except maybe Trump himself, thinks we’re going to meet that 2030 goal. 

Rovner: Yeah, a lot of differences between Trump 1.0 and Trump 2.0, as we’ve been discussing. Sheryl. 

Stolberg: So my extra credit is “Tennessee Pharmacies Sell Potent Ivermectin, Led by Anti-Vaccine Doctor Who’s Taken 鈥楤ucketloads.’” And this appears in 吃瓜不打烊. It’s by Brett Kelman and Rachana Pradhan. And what I love about this story is it talks about how ivermectin, this drug that actually is a Nobel Prize-winning, generally safe drug approved for treating parasitic diseases in humans, has become kind of this ideological touchstone in our society. And it started during the covid pandemic. And now we’re seeing where people on the right and other influencers were pushing it as a treatment for covid without evidence that it worked, and in fact despite FDA warnings that taking too much of it could cause harm. And now it’s sold over the counter in Tennessee, and Marjorie Taylor Greene was promoting it as a treatment for hantavirus, and鈥� 

Rovner: Which it’s not. 

Stolberg: Which it’s not. Exactly. And it’s just sort of taken on this life in our culture, and I guess I just feel like this story sort of reflects something about this cultural moment and how we are addressing medicine and healthcare as a society, 

Rovner: Indeed. Lauren. 

Weber: So I chose a story titled “,” by Benjamin Mazer in The Atlantic. And it posits this basically interesting thesis, which is that a lot of these chatbots that people use, and even doctors use, are not really regulated by the FDA, and so you kind of are interacting with AI in any sort of healthcare setting, whether you know it or like it or not, and whether those tools are up to snuff or not. And the ending of the article is really the most alarming, because it basically is like: Is this like Uber and Lyft, where Uber and Lyft just disrupted the market so much that we all had to get on board without regulating it more, and that that’s what could happen to hospitals? And I think it’s a really interesting and fascinating question of: What is the role of government regulation when it comes to these AI tools being used in a hospital setting? And are they anywhere near equipped to catch up with what’s going on right now? 

Rovner: Yeah, it’s a really thoughtful piece. All right. That is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. We also had production help this week from Taylor Cook. A reminder: What the Health? is 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 questions or comments. We’re at whatthehealth@kff.org, or you can find me still on X, , and on Bluesky, . Sheryl, where are you on social media these days? 

Stolberg: I am @SherylNYT  and . 

Rovner: Anna. 

Edney: @annaedney  and . 

Rovner: Lauren. 

Weber: @LaurenWeberHP 鈥� the HP is for “health policy” 鈥�  and . 

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

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

Julie Rovner: Hello, from 吃瓜不打烊 and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 吃瓜不打烊. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, June 11, 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 Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hi there. 

Rovner: And Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

Rovner: Later in this episode, we’ll have my interview with my colleague Tricia Neuman, who’s stepping down from her post here as KFF senior vice president and executive director of the Program on Medicare Policy, after a long and distinguished career shaping and analyzing the nation’s most prominent health insurance program. But first, this week’s news. I want to start this week with kind of a slow-motion news story that I want to make sure doesn’t get overlooked. It’s the continuing signals of declining health insurance coverage in the U.S. The Commonwealth Fund reports this week that state Affordable Care Act marketplaces are seeing the predicted shedding of policies by consumers who can’t make their premium payments. In Maryland, for example, 13% of enrollees fell off their plans between open enrollment and April of this year. That’s compared to just 3% last year. At the same time, more people are becoming underinsured because they, quote, “bought down” coverage from gold- or silver-level policies to bronze, leaving them with lower premiums but often multi-thousand-dollar deductibles. Meanwhile, three Democrat-led cities and a Democrat-led county have sued the Department of Health and Human Services over the regulation governing sign-ups for next year’s Affordable Care Act plans, charging that changes like allowing non-network plans and still higher out-of-pocket caps violate the terms of the ACA itself. So what is the outlook for the ACA, now that it’s June and it seems pretty clear that Congress is not going to extend those additional subsidies that expired at the end of last year? 

Weber: I’d say it’s not looking good, Julie, the way you just laid it out. I mean, I think the bottom line is this is a train wreck we’ve been watching in slow motion for many, many months, in the sense that you’re going to see a lot of people lose coverage. This is not exactly happening during a booming economic time, so you’ve got people cutting back because of high grocery bills, high etc., and then they see their health care go up tremendously, and they can’t cut it. And then they end up in plans that could leave them with massive bills at the end of the day. I do think this will lead to more of a groundswell of outcry, because it’s hitting folks 鈥� most affected, as The Commonwealth Fund pointed out, are not those in the lowest category; it’s the folks 鈥� where the subsidies ran out kind of in the mid-tier. And so you’re getting some more middle-class or lower-middle-class folks that are seeing some very, very steep health care bills. 

Rovner: Yeah, and as you point out, at the same time they’re seeing their gas bills go up, and their grocery bill’s up and basically prices for everything else. But I mean, I think there was a lot of like real sticker shock with the insurance, because you know, well, you know, gas is up $1 a gallon, and it hurts to go from paying, you know, $25 or $30 to fill your tank to $45 or $50, it’s not like saying, Hey, you’re going to go from paying $300 a month to paying $1,300 a month, which is what we saw from a lot of people.  

Meanwhile, both doctor and patient groups are up in arms over the new Medicaid work rules issued by the Trump administration last week. Rather than allowing states to automatically exempt from the work requirement people with certain conditions that would qualify them as, quote, “medically frail,” the rules stipulate that beginning in 2028 Medicaid recipients will have to prove at least twice a year not just that they have a condition, but that that condition prevents them from working. Patient groups say that will result in people who most need health insurance losing it and possibly getting sicker. Doctors, including the American Medical Association, which was conveniently having one of its meetings this week, worry that the burden of making that determination is going to fall on them, and that doctors aren’t trained for these things. They also point out that many chronic conditions fluctuate, leaving people sometimes able to maintain daily activities, like working, and sometimes not. Might this get changed due to the outcry? I think the administration, so far, seems to be saying that not doing it this way lets too many people off the hook. 

Lawrence: Yeah, I mean, I think that this is one of those things 鈥� again, it’s starting in January 2028. There’s sort of a year tail. I’m curious 鈥� there’s enough time that this could keep getting pushed down the road and possibly reversed, and you know, there’s also legal challenges. I know that my colleagues wrote about the Legal Action Center saying that CMS [the Centers for Medicare & Medicaid Services] is exceeding its authority here, so definitely we should be watching to see what happens with that. 

Rovner: Like many people, I was surprised at the rules as they came out. But I’m also a little bit taken aback at how broad the backlash is, particularly to this part 鈥� to the really, you’re going to require people with cancer to prove that they can’t meet work requirements? And how are they going to do that? And are people on Medicaid really going to be able to get doctors to, like, write them notes to say this person should be exempted? I mean, it just, it seems like a huge bureaucratic morass. 

Lawrence: Absolutely. 

Raman: Oh, I was just gonna say, from all sides, you know, if you are on Medicaid, and maybe there’s the burden of just transportation to get to that appointment, and, you know, having the time and the energy if you have a chronic illness, but then also we’ve heard time and time again how workforce issues, doctors are already overworked and don’t have the time to do so many of the things they already have to do. This is another burden for them to be able to have to eventually do this with the limited time they do have. 

Rovner: Lauren. 

Weber: It also seems incredibly subjective. I mean, I know they said that they’re trying to get to it through the codes, but, as  [Miranda Ollstein], I mean, how does one even really evaluate that? And people can work in different stretches. Also, with the flexibility many people have now to work from home, there is an opportunity for some folks maybe to be able to work, depending on what their job is. It’s just a minefield of unintended consequences, probably. So we’ll see how that goes. 

Rovner: I’ll say, this has a long way to play out. Well, along similar lines, there are also concerns that the new crackdown on fraud that’s being spearheaded by the Trump administration is threatening people’s coverage as well. In Ohio, lawmakers rushing to address home healthcare fraud tried to speed through a bill that included a provision to ban family members from qualifying as care providers for people with disabilities. That was ultimately removed from the bill when it was pointed out that such a change could result in more people having to be institutionalized, costing the state far, far more than paying family members to help people. I’m sure we’re going to see similar efforts to crack down on fraud in more states, because the federal government is threatening to take away money. Although, as administration officials continue to claim widespread fraud throughout the home health and hospice care systems, I imagine that we’re going to see more give-and-take on this one too. 

Weber: It seems like another example of shoot first, look later. I mean, in general, that clearly would have been a very bad provision to keep in the bill. If you know anything about home healthcare, you know that most of the time it is a family member giving up much of their time and effort to keep a loved one in the home. And so wild that that was even in there to start with. I think in general this goes to this long-running conversation around fraud. Again, there is a lot of healthcare fraud. I think we should all be very clear. There’s a lot of fraud that needs to be addressed. But you can say a lot of things about fraud obliquely, but then when you get to the brass tacks, you got to be careful about what you’re doing. So this is just another example of that, and how we’ve seen the Trump administration move on this that may or may not end up in problematic outcomes. 

Rovner: Yeah, Dr. [Mehmet] Oz [the CMS administrator] keeps talking about, you know, family members who are helping carry in groceries or driving people to doctors’ appointments. That’s not what these paid caregivers are doing. These are people who are basically unable to work because they need to be with this person that they are caring for 24/7, 365. I mean, there’s a lot of work involved here that’s way more than I think a lot of people who are in Washington or, I guess in this case, in Baltimore writing these rules sometimes realize. And I think that was brought home rather vividly in Ohio when they tried to do this and then were suddenly given the facts on the ground and said, Oops, maybe we should try this another way. But Lauren, you’re right, it’s not to say that there isn’t plenty of fraud to be fought. 

Well, moving on, this week we also got the annual report from the trustees of Social Security and Medicare. Not much has changed from last year as far as when the trust funds that support the programs will technically become insolvent. For Medicare’s Hospital Insurance Trust Fund, it’s still 2033, but a quarter earlier 鈥� so three months’ difference. Still, that’s only seven years away. In earlier times, I’ve been doing this a long time, seven years to insolvency would set off alarm bells in Congress and the administration, and would prompt action, or at least attempted action. Are we yawning our way into a very large financial crisis impacting one of the most popular health programs in the country? 

Raman: I think it’s a combination of things. A) I feel like every year we are more loose with deadlines. We address them in Congress closer and closer to them. So something that several years ago would be a big conversation ahead of time, we push it closer. And I think also the appetite in Congress to get things done right now is low, to find bipartisan agreement. And so getting something done on this would be quite difficult right now with all the other competing priorities there. 

Rovner: I think they were floating the idea of another budget reconciliation bill 鈥� “Reconciliation 3.0,” I guess they were calling it. And my reading of the consensus is that it is not happening. Whether there’s not enough appetite or not enough votes, or combination of those two, it doesn’t look like Congress is ready to take on something as big as Let’s make sure that Social Security and Medicare are there for the retiring baby boomers and Gen Xers, who are going to shortly follow. 

Raman: Especially in a midterms year where they’re not in as much as they might be at other times. 

Rovner: Yes, that’s right. They are definitely in and out. All right. Well, we’re going to take a quick break. We’ll be right back. 

Meanwhile, over at the Department of Health and Human Services, our podcast colleague  of Secretary RFK Jr. over last weekend, saying he has, quote, “shown little interest in managing the details of work in his department,” and that he, quote, “is single-mindedly focused on his top priorities, including food recommendations and pesticide exposures, and hunting for evidence to support his long-held beliefs that vaccines are harmful.” And, indeed, the big press event Kennedy had this week was to tout his effort to get medical schools to teach their students more about nutrition, something most medical schools had already been doing, I hasten to add. And, of course, there are still no confirmed, and in some cases even nominated, heads for some major HHS agencies, including the FDA, the Centers for Disease Control and Prevention, and the Administration for Strategic Preparedness and Response, which oversees things like the Ebola outbreaks. I would note that Kennedy responded to Sheryl’s story just Wednesday 鈥� so, like, five days after it appeared, basically saying he’s doing much more than she realizes. What are we to make of this whole thing? 

Weber: I would encourage everyone to read Kennedy’s response, and then I would also be curious if Kennedy would like to show me where his public calendars are that he talks about in his tweet, because I would love to look at them, and I’m sure Sheryl would too. But I thought Sheryl’s framing of the story was very clear-headed and accurate. I mean, look, the bottom line is the secretary has not been publicly engaged on the Ebola response at all, which is somewhat surprising. He does not have any of these people in place. I mean, take your pick. I mean, it’s all these agencies are rudderless currently, and he has very clearly expressed serious interest in his pet projects, but has not been as engaged, according to Sheryl and all of our reporting, in some of these other issues. And I think it’s a fair look at what that means for his legacy going forward, and what that will mean in the months to come. 

Rovner: Right. And you know what’s going on actually in health right now. Over at FDA, they’ve apparently begun the safety study of mifepristone, the abortion pill, that the administration has been promising anti-abortion groups for more than a year now. But it appears that study won’t be ready before the midterms, which is actually what Republican strategists had advised, so it wouldn’t further inflame the campaign season. This is up your alley. Is this FDA acting Commissioner Kyle Diamantas’ effort to win the permanent job, or is this the White House still trying to kind of placate both sides to the debate for as long as it can possibly get away with? 

Lawrence: Yeah, so Kyle Diamantas has said to many different people that he doesn’t want the job, including to me via an HHS media spokesperson, so I tend to believe him. Although it seems likely that he will be in this role for a while, because of how many leadership positions the HHS needs to fill, and how few days there are of Congress. With the mifepristone study, it seems like, yeah, I mean, I think the timing is not lost on anyone. This seems to have worked out politically pretty well for the Trump administration, where it’s a six-month study, they can kind of see what happens in the midterms, and see, because you know, [Sen. Bill] Cassidy, this is a huge issue for him. Any FDA commissioner they’re going to put in front of him, he’s going to be hammering on mifepristone, pro-life issues. So, as long as they can pursue the strategy that they have been pursuing, of sort of just waiting and seeing and saying that they’re working and pushing it out. I think that’s what they’re going to keep doing. 

Rovner: I guess there’s this continuing promise that the administration will try to sort of rein back in on the mail-order abortion drugs, which is, I guess, what’s really 鈥� I don’t think anybody thinks that they’re going to try to revoke the approval of mifepristone. I think what the anti-abortion folks are hoping now is that they’re going to revoke the mail-order ability of people to get mifepristone, which, of course, we’ve seen people using in abortion-ban states to basically evade those abortion bans. It’s obviously a big deal for both sides that the administration would like to keep under wraps as long as it possibly can. Is that a fair assessment? 

Lawrence: Absolutely. Yeah, and I mean, there’s no safety reason to do that, so 鈥� there will be huge blowback from pro-choice advocates, but also within the agency, I would imagine, this would be a huge turning point. 

Rovner: Well, that’s the FDA. Then there is the National Institutes of Health, which actually does have a Senate-confirmed leader, Jay Bhattacharya, although he’s currently doing double duty, also overseeing CDC. But apparently things aren’t so great over at NIH. Last June, 300 NIH staffers published something they called the “Bethesda Declaration,” named for the location of NIH’s main campus, in which they said that the new administration’s policies were undermining the agency’s mission, wasting public resources, and harming the health of Americans and people across the globe. Now, one year later, about 70 NIH’ers have , including one we talked about last week that would give political appointees far more say about who gets research grants and how those grantees can behave. And another policy that would strip civil service protections from many senior employees, so they could more easily be fired for not going along with the administration’s political priorities. I guess this is this week’s trend. What seemed kind of shocking last year is now kind of status quo, right? I saw very little attention to any of these stories that are enormous changes from how the nation’s science agencies have operated over Republican and Democratic administrations in the 40 years I’ve been doing this. 

Raman: I think that one thing we’ve really seen is just how much some of these science-oriented groups have mobilized over some of these issues, just, you know, kind of stating that researchers that have been doing this kind of work for 20, 30, 40 years, that this is so out of the realm of anything they’ve seen before. This would, you know, jeopardize their research and their stability and just the way that they have been doing work for so many years. And I think even with both of the rules that we, that you mentioned, that has been something that has been really amplified by them. But I think it has been, given the number of other things happening, this space not really trickled down to the broader set of folks to really, you know, tap into. We have Ebola, we have so many other things that people, I think, are a little bit more top of mind, even though this is a huge change that under normal circumstances would have more attention paid to it. 

Rovner: Yeah, I think that’s fair. This is sort of the continuing shock and awe that we see of the administration trying to make all of the changes that it wants at once, so nobody gets a chance to focus on any of them. In sort of what we would consider normal times, any one of these would be the overwhelming story of the day. 

Well, all of this brings us to what I consider the wildest story of the week. There was plenty of drama at, of all places, the annual research meeting of the American Diabetes Association in New Orleans. And props, by the way, to the website MedPage Today for breaking this within hours of its happening last Friday. I will just read the original headline: “.” So the keynote address to open the conference was supposed to be given by NIH Director Bhattacharya, but he dropped out at the last minute. While the audience was inside listening to a talk instead from NIH senior adviser Richard Wojcik, five doctors and researchers, including the editor-in-chief of the association’s flagship medical journal, as well as a past president of the ADA, were outside handing out a thousand copies of an editorial from the journal criticizing the administration’s cuts to biomedical research. At the direction of the organization, those protesters 鈥� can you even really call them protesters? 鈥� were escorted out by security and told they could not return to the conference. And from there the backlash began. Sixty-five hundred people signed a letter of complaint to the association. Two top officials resigned, and, finally, five days later, the CEO apologized to the “editorial hander-outers” via a video. But I want to pose a larger question. This was a real-world playing out of the tensions that we were just talking about are boiling within science. Should they try to work with this administration, or should they try to fight it? It would appear that the answer to that is kind of still up for grabs. Isn’t that what this demonstrates? 

Lawrence: Yeah, I mean, I think that it’s a clear tension between what the members of these major medical organizations want, which, like you said, 6,500 people signed that letter. There is a real appetite to try to fight back and push back, but there’s a real fear among leadership to do anything. 鈥� This was just mind-boggling, and my colleague Liz wrote about the backlash, and their decision to escalate the situation in this way brought so much more attention than, you know, five people handing out a journal editorial would initially. So fear can lead people to do things that ultimately don’t serve their purposes. 

Rovner: Yeah, I left out the part about the ADA leaders sort of over the weekend trying to justify the expulsion of the “editorial hander-outers,” as I will call them, by saying, Oh, it could affect our 501(c)(3) status, or they were violating the code of conduct, for, you know, for the meeting. But not only did those things not fly, they did seem to make things worse. Lauren, you wanted to add something. 

Weber: I just want to say that’s probably the most press an ADA meeting has ever gotten in its entire life. So, I mean, if they 鈥� 

Rovner: Absolutely. 

Weber: At the end of the day, I mean, these, as you point out, Lizzy, I mean, this editorial guy read a lot more and got a lot more attention because of it, so we’ll see what happens from here. 

Rovner: Yeah, but I think it’s sort of a cautionary tale for leaders of these organizations who 鈥� do we want to fight or do we want to try to get along, and maybe you ought to ask your members first? We’ll see if this sort of comes out at other meetings. Now it’s the beginning of the summer, it’s when a lot of these scientific meetings happen. I’ll be watching more of them a little more closely. 

Well, finally, this week, it’s June, and that means it’s the season for working on the spending bills on Capitol Hill. This week we actually got a lengthy public markup of the bill that funds the majority of the Department of Health and Human Services. A reminder: FDA is funded in the Agriculture bill because food. Sandhya, how is the Labor-HHS bill shaping up? It looks like Congress isn’t going to go along with the big cuts proposed by the Trump administration, but that’s not saying there won’t be fights about funding, right? 

Raman: Yeah, so I would say you’re right. The big takeaway from this House markup is that it kind of bucked some of the White House’s suggestions on, you know, what to do with funding for this. They funded $111 billion for HHS, if this is made into law 鈥� so a much smaller cut 鈥� of what the White House was proposing. That included things like $100 million more for NIH, which has been something in the past worried about cuts; and funded some things that I think we’re interesting, you know, CDC’s office for smoking [Office on Smoking and Health], something that had been subject to the DOGE [Department of Government Efficiency] cuts last year; , something else that 鈥�  

Rovner: Yeah, I want to address that separate, I want to get to the amendments in a second. But I mean, just sort of in terms of funding, I mean, and we should point out that $100 million for NIH 鈥� NIH has a budget of like $40-some billion, so yeah, it’s not a big increase. It’s a rounding error increase, but it’s not a cut. 

Raman: Yes, not a cut. So the next step for this would be the House floor, but we might get kind of stalled there just because the issue on the Senate side is they’ve not agreed to top-line numbers for funding yet, and they need those in order to shape out the individual bills. So, without that, we’re kind of in a standstill, and it might be a little bit more like we’ve seen in some of the years past, where the House goes through, they make a bill, they vote on the bill, and then the Senate doesn’t publicly do theirs, but then we get to an agreement a little further down the line. But what Sen. Susan Collins, who heads the Senate Appropriations Committee, has been saying is that, you know, she wants more for NIH than what’s been presented here. But without those top lines, we don’t know. So, we’ll see, you know, in years past, we’ve really just, the funding year deadline has been pushed and pushed and pushed, so 鈥� 

Rovner: Into the next funding year. Often. 

Raman: Yes, and I think, especially like I said, when it’s a midterms year, they’re going to be in far less than normal. It’s not clear when there’s going to be the appetite to get all of that done. 

Rovner: So, often these spending bills, when they move 鈥� and of course they haven’t moved when they were supposed to for the last however many years 鈥� but it does sometimes give a chance for lawmakers to express frustration or doubt or simply disapproval with things that the administration is doing. And one of the things that they seem to be expressing disapproval is the administration’s plan to use prior authorization, which is very controversial, in Medicare, and AI 鈥� in fact, an AI prior authorization in Medicare, and on a bipartisan basis. They voted to tell the administration, No, please don’t do this. I’m wondering, you know, it may not become law on this bill, but this does suggest that there is bipartisan concern in Congress about these efforts on behalf of Medicare, right? 

Weber: Well, I think this goes back to our Medicare insolvency conversation earlier. Who votes? It’s the people that are on Medicare. So, and how unpopular would it be if they were to be limited in what they can access for their health care services? So, I think at the end of the day, the reason that’s bipartisan is these lawmakers know who’s keeping them in office, and prior authorization has a very bad name. I mean, it’s very interesting, because CMS has said that this will help cut down costs, but also has, out of the other side of its mouth, in hearings and so on, Oz has decried insurers using prior authorization. So there’s a lot of “for thee but not for me” vibes going on here. But at the end of the day, it doesn’t seem like this will advance because of the bipartisan opposition. 

Rovner: And of course, Lizzy, your colleagues at Stat have talked about, you know, private companies using enhanced prior authorization, which nobody seems to think is a great idea, and now we have Medicare proposing it. 

Lawrence: Yeah, I was going to say prior authorization, already unpopular, add AI to the mix. I mean, there’s not 鈥� yeah, Bob and Casey, my colleagues, , but just, in general, there is not a lot of goodwill for the AI industry with data centers and all kinds of unpopular initiatives. So, yeah, it makes sense we’re seeing strong bipartisan disapproval of this.  

Rovner: If it doesn’t show up in this bill, I wouldn’t be surprised to see it show up in some other bill that’s more likely to make it to the finish line. All right, that is this week’s news. Now we’ll play my interview with KFF’s Tricia Neuman, and then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast my colleague and friend Tricia Neuman, who is retiring as KFF senior vice president and executive director of the Program on Medicare Policy, after a long and distinguished career here and on Capitol Hill, shaping, analyzing, and explaining Medicare policy to people like me, as well as to the nation’s decision-makers. Tricia, thanks for taking some time as you wrap things up. 

Tricia Neuman: Julie, thank you for having me. 

Rovner: So, let’s go back to the beginning, if you can remember that. What got you interested in pursuing Medicare as your health policy specialty? 

Neuman: You know, I didn’t think about it as Medicare, but I thought about it in the context of my family. I was 鈥� I remember watching my grandfather and seeing him struggle. He had Alzheimer’s, and he was trying to tie his shoe, and he couldn’t remember, and I somehow got interested in aging. And I was interested in government, and so I came to Washington ready to do policy, and I ended up at the Senate Aging Committee, which was perfect. And I got into Medicare because I had an older colleague who said, Look, you got to choose a specialty; you can do Social Security, pensions, retirement income, or you can do health and long-term care. Figure it out and go there. And so I did. 

Rovner: Yeah, and like me, you can stay forever if you want to. 

Neuman: And I seem to have stayed forever. 

Rovner: So, what’s the biggest misperception about Medicare as it exists today? People look at Medicare, and it’s like a chameleon. They see all these different things. 

Neuman: Boy, I could give you a few answers to that. I mean, one answer is people think Medicare is going broke. Medicare cannot go broke, but Medicare faces financing challenges. Interesting, you know, we talk about that today. Today’s the day that the “Medicare Trustees Report” came out, and actually, there wasn’t much of a change, a notable change. It was a slight tweak, but it’s still 2033 for the year that Medicare will be insolvent. What that means is that there won’t be enough money to pay all benefits, but it doesn’t mean the program is going broke. To me what it means is it’s time to think about how to finance care for an aging population, and what are the policy options that can do that. It’s generally reducing spending or finding new revenues, but it’s easier to do it in advance than 鈥� to wait until we’re at the precipice of a crisis. So that’s really what it signals to me. But it cannot go broke. 

Rovner: Over the years, Congress has dealt with these periodic, you know, predictions about Medicare insolvency in various ways that they have, you know, sometimes they’ve actually acted when insolvency has seemed relatively near, and sometimes they have acted to make insolvency closer. This Congress doesn’t seem to be as plugged into Medicare as many previous ones. Is that a fair way to put it? 

Neuman: I think it’s fair. Julie, when you and I were working on the Hill, as your beat at the time at the Ways and Means Committee, Medicare was front and center. Medicare was part of budget conversations. Medicare was part of legislation that we dealt with every year. And that meant every year members of Congress worked hard to tweak the program, achieve some savings, also make some improvements. But Medicare was the big story. Really, of late, really, since the ACA, the ACA has been the story, Medicaid has been the story, but Medicare, oddly, has been sort of a stepchild off to the side. 

Rovner: I like to describe Medicare as one of the biggest paradoxes in health policy. Simultaneously, it’s incredibly popular 鈥� I mean, one of the most popular programs ever created by the federal government 鈥� and yet it’s actually pretty lacking as a really comprehensive health coverage. I think if people actually had, quote-unquote, “Medicare for All” the way we have Medicare today, they wouldn’t be very happy with it. 

Neuman: I think that’s right. I mean, people I know on Medicare, and soon that will be me, are very happy with the program. They like the fact that 鈥� it’s reliable, they can count on it. There are some issues between people in traditional Medicare and Medicare Advantage. But it’s, you know, people are pretty happy. At the same time, there’s relatively high cost sharing, premiums are going up, and Medicare doesn’t cover some of the most expensive things for people as they grow older, such as dental, which is a big one, hearing aids, vision, which is to a lesser extent not quite as expensive. And the big one that nobody really wants to address is long-term services and support, home care for people who need help at home, assisted living, nursing home coverage, all of that is super expensive, and Medicare really doesn’t cover it. And that is a big surprise to families when all of a sudden they have a family member who needs this help and Medicare won’t pay for it. 

Rovner: Yeah, I feel like about every five years, another generation of health reporters discovers, Hey, Medicare doesn’t cover long-term care. I never knew that. 

Neuman: And a lot of time they’re discovering it because a family member of theirs needs long-term care. 

Rovner: So, I know you’re retiring, but I also know that you’re going to continue to stay engaged, because I know you. What do you think is the biggest challenge that you hope that lawmakers will address in Medicare in the next five, 10 years? 

Neuman: Oh, I have a wish list. I do hope that they’ll continue to put affordability at the top of the list. That means looking at these expenses that are not covered by Medicare, keeping an eye on premiums. Right now, 7 million people on Medicare pay more than 10% of their income on Part B premiums. That’s a big deal. So, keeping an eye on affordability is really important. I also think there should be some attention to simplification. Medicare used to be this easy program, you turned 65, you got on Medicare. It’s not so easy anymore. The average Medicare beneficiary has a choice of dozens of plans, the Medicare Advantage, prescription drugs. It’s too complicated. And it’s not like it’s a one-and-done decision when you turn 65. You really need to think about this each year, and I think that’s a tall order. And simplifying the program would make it a lot easier for our aging population. 

Rovner: Well, you may be retiring, but I’m still going to call on you as my Medicare expert. 

Neuman: Always. 

Rovner: Tricia Neuman, thank you so much. 

Neuman: Thank you, Julie. 

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

Weber: Hats off to Annie Waldman’s “,” which published in ProPublica. I was green with envy upon reading this story. It’s not only beautifully crafted, but it’s just an incredibly incisive takedown, really, of this raw milk farm and all of the people it’s harmed, and how the government has really not stepped in. It hits at so many themes in this MAHA [Make America Healthy Again] moment 鈥� of free speech and, you know, free medical access, but also the questions of: Do consumers know the amount of risks that they’re taking on? And what is regulators’ role when you have this farm led by this evangelist for raw milk that has been at least linked to over 220 people’s illnesses, some of which are very severe, and continues to produce not only raw milk but milk that it puts into raw cheese that makes people sick. And very sick. This is not just, like, slightly sick, I mean it’s likely that this has potentially sickened way more than the numbers that are captured. It’s a very well-done piece. I could not recommend reading it more. 

Rovner: Lizzy. 

Lawrence: My piece that I chose for this week was from the Chicago Tribune: “,” by Christy Gutowski and Gregory Royal Pratt. Kind of similar to what Lauren was talking about, this is a story about regulatory failure, but in this case with a plastic surgeon operating in Chicago who has killed at least eight women during procedures like tummy tucks and liposuction 鈥� all women of color. He’s operating in a predominantly Latino neighborhood. And Chicago authorities started looking into him to try to revoke his license in 2020, but more than five years later nothing has happened. This was a truly horrifying story, and just major kudos to the reporters, for really, you know, they tracked down all of these women’s families. And in one case there was a complaint that the surgeon, you know, not only allegations that he killed people, but that he had carved his initials into someone. So it’s a really insane piece that I think, yeah, everyone should read. 

Rovner: Yeah. Sandhya. 

Raman: So I picked the story “, and it’s in CIDRAP from Liz Szabo. And this piece is part of a larger series for the 20th anniversary of the HPV [human papillomavirus] vaccine. But Liz just does a beautiful job juxtaposing, you know, one sister who battles and eventually, you know, lost a heartbreaking battle with cervical cancer, and how her sister was in the first batch of folks to get the HPV vaccine 20 years ago. And then, you know, the sister is talking about the importance of wanting her sons to get it that are pretty young. And it just really does a good job of showing the trajectory of how effective the vaccine has been in reducing cervical cancer since its rollout. 

Rovner: Yeah, this is one of the great medical miracles that’s suddenly become controversial again. It’s really good. You should read the whole series. I will post links to it. My extra credit this week is from my 吃瓜不打烊 colleague Amy Maxman. It’s called “Anguished Parents. Doctors in Tears. Utah’s Long Measles Outbreak Takes a Toll.” Amy went to Utah and found that measles is taking a stronghold there for a whole variety of reasons, including the strength of the supplement industry that teaches residents to suspect mainstream medicine. It’s a really good read that shows the challenges public health still faces in things that we thought we had overcome years, if not decades, ago, like how to prevent childhood diseases like measles. 

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

Raman: I’m at  and on  @SandhyaWrites. 

Rovner: Lauren. 

Weber: I’m on  and on  as @LaurenWeberHP. The HP is for health policy. 

Rovner: Lizzy. 

Lawrence: I’m on  as @LizzyLaw_ and on  and  (Lizzy Lawrence). 

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

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

Julie Rovner: Hello, from 吃瓜不打烊 and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 吃瓜不打烊. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, May 28, 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 Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Great to be here. 

Rovner: And Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: Later in this episode, we’ll have my interview about the ongoing Ebola outbreak with Céline Gounder, 吃瓜不打烊’ public health editor-at-large and, conveniently for us, an infectious disease specialist. But first, this week’s news. I want to start this week with more of a trend than actual news, and that is the continued decline in health insurance coverage in the U.S.  on the number of children falling off the Medicaid rolls. It’s down about 1.75 million from the beginning of Trump 2.0 through this past January. Now, I thought we were told that none of the Medicaid cuts that Congress made last year would affect the core Medicaid constituencies: pregnant women, children, seniors, and people with disabilities. What’s happening here? 

Goldman: So, the law does exempt kids and parents of young kids from the eligibility and enrollment changes, work requirements, more frequent eligibility checks. That doesn’t mean that there aren’t going to be spillover effects, and we’re seeing that already, Absolutely, even though most of these provisions haven’t gone into effect. And there are a couple of reasons for that, including chilling effects from immigration enforcement and people who are in mixed-status households maybe not feeling comfortable enrolling their children in public benefits, even though their children would qualify, or also just confusion around who’s eligible for what. Often kids are eligible for Medicaid and Children’s Health Insurance Program 鈥� its sister program, CHIP 鈥� at a much higher income level than their parents, and that’s not communicated well to parents very often. And so one theory 鈥� is that this year, when a lot of parents maybe saw how much their ACA [Affordable Care Act] premiums were going up and decided that they couldn’t afford health coverage anymore, they were just pulling their whole family out of health insurance, even though their kids might still actually be eligible for Medicaid. And 鈥� there are a lot of other trends percolating in this, but I think it’s concerning to see this, these figures, even before this has really started. 

Rovner: Yeah, it’s funny, when you’re applying for health insurance, they’ve set it up so that you get funneled to the right place for which you’re eligible. But when you’re dropping your health insurance, there’s no funnel to say, hey, your kids might still be eligible for this, even though you’re no longer going to be getting Affordable Care Act insurance. 

Goldman: Exactly, and navigators for ACA coverage have also 鈥� funding for those programs have been cut, and so that’s harder, even harder for that process to actually work. 

Rovner: Yeah, I’ve also noticed in the states that are starting things like their work requirements early, there was kind of a shocking anecdote  鈥� one of the states that’s starting early 鈥� who’s blind, has multiple health problems, and a chemotherapy port, who was told that she might be required to work under these rules and was seeing about getting her port taken out when finally another person told her, No, you’re exempt. So, I mean 鈥� in some of the states that are speeding this up, there’s a lack of knowledge among the state workers, which I think was one of the big concerns about people who are going to be dropped off the rolls, not because they’re no longer eligible, but because of mistakes. 

Weber: We also know that, in general, Medicaid enrollment is a tricky process. Typically, there’s paper forms that may get lost in the mail. Parents may not get the forms for their kids. This was very eloquently actually described on The Pitt 鈥� which, shoutout for getting this part of health policy correct. Although I’m still irritated about their Medicare-Medicaid mix-up in one of the other episodes, but we’ll get over it. 

Rovner: Yeah, me too. There were two of those. 

Weber: Yes, but very eloquently show[ed] how a mom who had moved and missed some Medicaid paperwork was now really in a hole financially. And so, as Maya has reported out, you know, more of these children falling off the rolls really could lead to some dire consequences for the families to which they belong. 

Goldman: Yeah, and I think one important thing to mention is that a lot of these kids that are uninsured are still eligible, and when they go to the hospital, the hospital can help them enroll in retroactive Medicaid coverage, but they’re not getting their yearly checkup, or maybe, like in The Pitt, they miss their asthma medication, and so now they’re in the hospital, and costs are just going up for the whole health system. 

Rovner: Well, along those same lines, we have another story in our 吃瓜不打烊 series called “Priced Out” about how people who can no longer afford comprehensive coverage are patching together other forms of insurance, or in some cases not even actual insurance, that leaves them on the hook for thousands of dollars if they end up needing actual medical care, which kind of raises the perennial question with our health system: Is it better to have bad insurance and not know it, or to have no insurance, so at least you know that you’re not prepared if something happens. 

Weber: I thought what was so striking in that story was it led off with a retired teacher who said, I recognize I am gambling. I mean, that’s what she said, she’s very clear. But to her, I think her cost had risen something like $900-something a month, and the other plans that she cobbled together were $300 a month, and so to her the short-term risk was worth it. But as we all know, hospital stays can run you several thousand dollars and, you know, you can get hit by a car. You may be a very healthy person, but something bad can happen, and you are left with large, large medical debt. And I think it seemed like the folks interviewed in the story were at least clear that these plans were less favorable, but I do think there is also this submarket where a lot of folks think that the health ministry plan that they’re in is going to save them in case of an issue. And we have found over and over again, and KFF, in particular, has found over and over again in reporting, that’s just not the case. And so this whole question of Is a bad plan better than no plan? I don’t know, but it’s striking to see people say I’m willing to take the gamble, because this is just what these increases in premiums have meant for me. 

Luthra: I just think what’s so interesting about these, these health shares, in particular, is when I’ve talked to people who’ve used them or considered them, they know these are not insurance, but I don’t think they always fully understand just how restrictive they are, and how often medical needs will be dismissed as lifestyle choices. I mean, obviously, often contraception is not covered, but something related to drug or alcohol use might not be covered, because that’s immoral, right? Let’s say the ministry says, “Oh, well, this accident you got into, maybe that’s because of alcohol use.” That’s a huge expense that you just might not have realized wouldn’t be covered at all. And the other thing that I was just so struck by is very often childbirth isn’t covered. Or you have to be enrolled for a very long time before childbirth is covered, which health insurance is required to cover childbirth. It is very, very expensive. It’s fascinating, also, because a lot of these [sharing ministries] are so religiously aligned and ostensibly pro-family, etc. And yet this, in particular, is just something where people will opt for this instead because it looks more affordable than insurance. But very often you end up paying a not-zero amount of money, and ultimately getting basically nothing for very expensive, even bankrupting medical needs. 

Rovner: Or you’re gambling, you know, maybe, maybe you’ll get reimbursed, and maybe you won’t. Although these days people feel that way about their health insurance. Maya, you want to say something? 

Goldman: I think a lot of young people also take for granted that health insurance will cover preexisting conditions. If you’ve come up, you know, post-ACA, and certainly I do. I’m 28, and that’s, like, something that never even crossed my mind that I would need to consider, and that really struck me in this article. A lot of these alternative plans are not bound to those requirements. 

Rovner: Well, Shefali, I wanted to ask you in particular about  about how abortion rights supporters are trying to adapt reproductive health to fit under the bigger affordability umbrella that seems to be the theme of this year’s midterm campaigns 鈥� that things like whether or not to get pregnant or whether to get unpregnant, that those are all wrapped up in all sorts of financial issues, as you just mentioned. Is this a natural fit, or do you think they’re kind of forcing it here? 

Luthra: I think it really depends on how you talk about it, and the context of where you are. And after the mifepristone case was before the Supreme Court, I spent a lot of time looking at different Senate campaigns and examining how they’re talking about it. And one example is Jon Ossoff in Georgia actually has a really interesting example where he talks about access to abortion and healthcare as part of this larger argument around the state of reproductive healthcare, talking about hospital closures, talking about Medicaid cuts, and putting all of this together as this broader policy ecosystem that is making your healthcare harder to come by and ultimately threatening your life. I think that’s very interesting. It could work. It makes sense logically to me. The other one that does come to mind 鈥� and this is not abortion, but it’s related 鈥� is in Maine, Graham Platner talking about IVF [in vitro fertilization] in the lens of affordability, saying, Oh, I couldn’t afford it in America. I traveled to Norway to try and get fertility treatments. Those are fascinating approaches, and a lot of people who work in abortion rights advocacy will say this has long been an economic argument, and many of them will look at polling and put it out that says when you frame this as an economic story, voters really, really do appreciate it and resonate with it. I think sort of the question is whether we actually see these candidates 鈥� and it’s not lost on me the two who I mentioned are both men 鈥� actually talk about the word “abortion” specifically, rather than saying “reproductive healthcare” more broadly. And you know those are very different, and they just register with voters differently when you single out something as specific as abortion versus whether you don’t. 

Rovner: And Graham Platner, for those who don’t know, is going to be the Democratic candidate running against Susan Collins in Maine. Jon Ossoff is the incumbent Democrat in Georgia, which always feels weird to say. There haven’t been a lot of Democratic senators from Georgia, but right now there’s two. 

So, moving on, the Trump administration says the declines in health insurance coverage are fine because they’re more about fraud and kicking people off of public health insurance rolls who aren’t actually eligible or 鈥� in the case of Affordable Care Act broker fraud 鈥� who don’t even know they’re covered. But a lot of the tools in last year’s big budget bill are pretty blunt, and they’re going to impact both those who maybe shouldn’t be there and those the administration says it wants to keep serving. This week’s example is a newly proposed rule to implement that law’s cap on something called state-directed payments, which is, in fact, a key way many states help ensure adequate funding for hospitals, nursing homes, and other healthcare providers. Now, this isn’t fraud, but it is what analysts like to call creative funding, and Congress has every right to limit it. But that’s not to say that it won’t have an impact on healthcare at the delivery level, right? It’s not just going to impact people that the administration says don’t deserve to be covered. 

Goldman: Yeah, this came up when I was talking to children’s hospitals for the story on children’s coverage that I wrote this week. They’re saying, you know, this is going to affect all kids that we can care for. This is going to mean less money into our funds, and, you know, a lot of people argue that hospitals have enough money, but hospitals will say, “No, we don’t, not to take care of all the people that we need to take care of.” And this is going to be less money. And then it’s not just kids who are on Medicaid who are struggling, it’s all kids. And I think another interesting thing about this proposed rule is that it’s significantly more federal savings than was estimated originally. I think CBO, Congressional Budget Office, originally estimated that the state-directed payments provision would save about $150 billion, and this rule would save about $510 billion in federal funding. So hospitals are concerned. 

Rovner: Yes, this is always the issue. Are we overpaying hospitals? But when you take money out of it, what does that mean for the health system writ large? Which I imagine is going to continue to be a theme as we go forward. Well, the Trump administration is also going very high-profile in its health fraud-fighting effort. The president has put Vice President JD Vance in charge. Earlier this month, he announced that the administration will be withholding $1.3 billion in federal Medicaid funding from California, because, said the vice president, the state has not taken fraud very seriously. This is the second Democrat-led state the administration is taking the nearly unprecedented step of withholding funding from in advance, after Minnesota. California has responded that one reason the state’s home health bill has gone up is that it has raised wages for home healthcare workers, and it has expanded eligibility. It’s not because of fraud. Again, while there obviously is fraud 鈥� not just in Medicaid, but in all health programs, public and private, because there is so much money there 鈥� these blunt tools, I think, will probably punish more than just those who are defrauding the program. Right? 

Weber: I mean, absolutely. At the end of the day 鈥� look, it’s no coincidence that California is a blue state that seems to be getting targeted with that amount of cash. But let’s be very honest, there is a lot of fraud. I mean, all of us here have written stories about healthcare fraud. There is a lot of fraud to root out. So, to be very clear, I don’t think anyone should be upset about actual fraud being targeted. But there’s also a question of: What are the numbers? [Centers for Medicare & Medicaid Administrator Mehmet] Oz has gotten the numbers wrong before. The AP [Associated Press] had a great story on that a couple weeks ago. Show us the fraud, like, I want to see the actual fraud that we’re talking about. And, in addition, this reminds me of how the administration continuously says that they’re investing the most money in rural healthcare when they have this $50 billion rural healthcare fund. Well, the Medicaid cuts that [President Donald] Trump led is going to cut like triple that almost out of rural areas. So is this a talking point? Show us the money. I need to better understand what’s behind it. 

Rovner: Yeah, so far they’re doing well with a lot of very high-profile news events. We’ll see how much fraud they are actually able to ferret out. All right, we’re going to take a quick break, we will be right back. 

Let’s talk about Ebola. As you will hear later in this episode from our in-house expert, Dr. Céline Gounder, this is not likely to become the next covid or even a pandemic. But this administration, having hollowed out the Centers for Disease Control and Prevention and obliterated the U.S. Agency for International Development, is addressing this outbreak with many fewer arrows in its quiver. Lauren,  about someone close to this outbreak. Tell us about it. 

Weber: Yes, I was able to speak with an American missionary physician who was exposed to Ebola and actually evacuated to Prague and is sitting in basically like a bubble room waiting to see if he tests positive for Ebola. And what traumatizes him, as he was telling me, was that he’s sitting there, there’s all these people with endless gloves that are tending to him, he’s been evacuated, and stretchers with all this plastic and all these measures, and his colleagues that he worked alongside in the Congo are 鈥� you know, one died while we are in the middle of an interview, he learned of their death. And, in addition, they’re filling the hospitals themselves, that they say they don’t have enough gloves, they don’t have enough PPE [personal protective equipment]. There’s no vaccine to fight this current form of Ebola, and they’re in an environment in which people are very mistrustful. Ebola looks like malaria until it’s Ebola. And so you could send a family member into the hospital thinking it’s malaria, which is common in this part of the world, and then suddenly be told your relative has Ebola and died. A lot of people don’t believe it, and it’s leading to violence. And the usual public health measures and efforts by the international community to get in there are somewhat hampered. And Part Two, by the fact that this outbreak is happening in a really insecure region, where there’s roving militias and other violence. And there’s just a lot of concern that they caught this late, this could continue to explode, and case counts could really go up. But it was very humanizing to speak with this American missionary who obviously really put himself on the line to help these folks and is heartbroken to kind of be watching from afar as this continues to go poorly. 

Rovner: Well, meanwhile, the U.S. is banning foreign nationals who’ve been in any of these countries from entering the U.S. and also U.S. green-card holders who’ve been in countries where the virus is spreading. Not only that, but they’re not allowing exposed U.S. citizens to return, even though the U.S. has multiple facilities to care for exactly these types of patients. We have seen this before, just in the last 15 years. What happened to the medical freedom that this administration has been touting so much? 

Weber: It’s a real plot twist. I mean, these are the folks that said that they were the contrarians that oppose quarantine and mask mandates, and they are strictly having the hantavirus folks in Nebraska. They’re signing off on travel bans that go further than other administrations, and not allowing Americans back in and sending them to Kenya if they’re exposed. My colleague Lena Sun and I had a report a week ago about how the White House didn’t want exposed Americans back in the U.S., but the Kenya step is another step in that direction. Is really could have huge ramifications for the response as a whole, because it will likely limit the number of people that want to go. If you know that you’re not going to be able to be sent back, we saw, I think, yesterday the State Department union was like, look, our foreign service officers were sent here under the impression that they would be able to come back. I mean, this is somewhat completely uncharted territories in the vein of how they’re handling this. So we’ll see. 

Goldman: I’m very curious to see what the MAGA [Make America Great Again] base and the MAHA [Make America Healthy Again] base that were so anti-mask mandates and things like that during covid, like, what are they going to say? Are they going to say anything? Is it partially our responsibility as the media to point out this contradiction? 

Rovner: Yeah, and obviously there’s also so much else happening right now. It’s interesting that the hantavirus, which turned out to not be such a big deal, got so much play, and yet this, which could be a much bigger deal, is getting so much less attention. 

Weber: Do we think there’s maybe a reason for that? Let’s all be honest. The hantavirus cruise was a lot of wealthy, some Americans on a cruise sailing around Argentina and Antarctica. And then this outbreak is happening in Africa, and I think there’s less interest from the general public, as they feel like hantavirus is novel, whereas Ebola, they’ve heard about it before, so a depressing reality of some of that. 

Rovner: Yes, and also, you know, Americans and Europeans versus Africans. 

Weber: Yes, yes, exactly. 

Rovner: All right, moving on. I want to catch up on some drug price news, because there’s been a lot over the past few weeks. The Supreme Court earlier this month declined to hear a case challenging the Medicare drug price negotiation system that was implemented under the Biden administration, which ironically will probably redound to the credit of the Trump administration, even though it nominally opposed the Biden program. Also, earlier this month, the president announced a big expansion of his TrumpRx website, adding links to websites selling lower-cost generic drugs, including the site run by Mark Cuban, Cost Plus Drugs. But the most provocative drug price story I have seen this month came from my colleague Darius Tahir, noting that Trump himself was buying stock in drug companies just as he was negotiating with those companies to help bring drugs, particularly those GLP-1 medications that he likes to call “the fat drugs,” to more people. Now this isn’t technically illegal, although there are lots of efforts on Capitol Hill to outlaw individual stock trading by members. But I can’t help think if any other government official in any other administration ever did this, they would be out of a job instantly, if only for the appearance of the conflict of interest. This is just 鈥� Lauren, as you were saying 鈥� one in this whole long list of things that keeps happening, but every time I look at it, I’m like, he was doing what?! 

Weber: Julie, when I saw Darius’ story, I was blown away. First off, I feel like this should have been front-page news on every outlet. But secondly, it was a lot of money, it was like over $600,000. And now I understand they say that Trump himself, they don’t know whether he directed this or not. And in fairness, Trump’s not the only one. I mean, we’ve seen plenty of members of Congress that have done also questionable stock trades. But it is a very conflict-of-interest-looking-like thing, considering that CMS recently expanded massive access to these drugs. And so I do think conflicts of interest like this, especially in HHS [Department of Health and Human Services], which has constantly decried conflicts of interest, despite having many of them, are very important to highlight. And so, thank you to Darius for surfacing this. 

Rovner: Yes, we will never not have enough to do here as health reporters. Well, finally, this week I want to . President Trump this week had his third, quote, “annual” physical in the past 13 months 鈥� math does not math there 鈥� after which he said he checked out perfectly. But he is about to turn 80. He’s been caught on camera dozing off at public events in the Oval Office and has gone on hours-long social media rants in the wee hours of the night/morning. Now, much of this hasn’t been treated as news, because well, it’s pretty much par for the course for Trump, just more so. And therein lies the question: When does his increasingly aberrant behavior and obvious health issues, like visibly bruised hands and swollen ankles, become a public right-to-know issue? And is there a double standard for Trump compared to former President [Joe] Biden, when he began to show obvious signs of aging, and it was all over the news all of the time? I see raised eyebrows. 

Luthra: No, it’s such a good question. On the one hand, there was obviously a lot more scrutiny on Joe Biden’s age than there appears to be on Donald Trump’s. But part of it, I think, is that a lot of what you just highlighted, Julie, is out in the open. Everyone has seen the president dozing off on camera, whereas under the last administration, there were things that were not public that then became public, and that was obviously very important. That said, there’s certainly a level of focus on this issue that perhaps is lacking. Maybe it would be useful or newsworthy to put some more attention, even something that we already know, highlighting why it is important, putting together the fact that having this many physicals at this point in the presidency is actually more than normal. What could that mean, contextualizing it with everything we have seen publicly about the president’s sleep patterns, risk factors as you age, bruising, etc. But I think this kind of thing is complicated in terms of how you cover it appropriately and fairly, also just because you don’t want to assume things that you don’t have the evidence for. 

Rovner: And, in fair, I mean, Trump has not been transparent about his health, going back to when he was a candidate in 2016. He’s the only major presidential candidate, you know, he put out that, this famous letter from his personal doctor saying, you know, he’s the healthiest man I’ve ever seen. That’s pretty much what we get, having covered presidential health for a lot of administrations. We have much, much less information about Trump than we have had about previous presidents, which has been a continuing policy concern among doctors. I mean, this is not to single out Trump, who just happens to be president right now and turning 80. But this is, you know, an issue that goes back obviously to, you know, Dwight Eisenhower, to Woodrow Wilson, when he had a stroke, and they kept it a secret. Presidential health is a policy issue. 

Goldman: Yeah, I think that’s an important caveat, or note, I guess. Presidential health is not always as transparent as it claims to be, even going back, as you said. And so it’s not totally out of the ordinary that Trump wouldn’t be transparent about his health, even though, maybe ethically 鈥� presidents in general should be. 

Rovner: Obviously something else we will continue to watch. All right, that is this week’s news. Now we’ll play my interview with Céline Gounder. Then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast my colleague, Dr. Céline Gounder, KFF Health News’ editor-at-large for public health, a CBS News medical correspondent, and an internist, epidemiologist, and infectious disease doctor. I can’t think of anyone I trust more to explain what’s going on with Ebola than Céline. So, thank you very much for doing this. 

Céline Gounder: Oh, it’s my pleasure to be here, Julie. 

Rovner: So, when everybody was covering the hantavirus outbreak on that cruise ship a few weeks ago, experts like you were saying it was a cause for concern, but not likely to become a serious problem. All of those same experts seem much more concerned about this latest Ebola outbreak in Central Africa. How is this different from what we were just talking about with hantavirus, and how is it different from previous Ebola outbreaks? This is not the first one. 

Gounder: Yeah, so to give you a sense of perspective, when I first heard the reports of a viral respiratory illness out of Wuhan in very late 2019, early 2020, I was terrified by what I was hearing. When I heard the reports of the hantavirus outbreak on the cruise ship, I was concerned for the other people on the cruise ship. I was not worried about a larger outbreak, and I would be very surprised, especially at this point, if we see any further cases. With respect to this Ebola outbreak, I am very concerned about a very large, huge, regional epidemic, where we may have some sporadic spread to other countries outside of the region. I am not worried about a pandemic. So, this is one difference: An epidemic is usually within a certain region. Pandemic is when it goes worldwide. So, I think this is going to be an epidemic in Central, possibly also East, Africa, but not going beyond that. 

Rovner: So, how is this different from 鈥� you worked in one of the past Ebola outbreaks. This one people seem to think is more serious than the last couple that we’ve seen. 

Gounder: Yeah, so I worked in Guinea during the 2014-2016 Ebola epidemic. I was there for two months. You have some of the same risk factors for a large epidemic, so you have urban areas affected, you have cross-border spread. There you had the epidemic start in Guinea, then move to Liberia, then Sierra Leone, then back to Guinea, and then you also had migrant workers that would go back and forth. And so you have those same, exact risk factors with this current outbreak, and then, secondly, you have large refugee populations in South Sudan. And so both of those issues also further complicate movement, both in and out of the area. Healthcare workers trying to get in to address issues. Healthcare workers being safe doing this kind of work, and also getting supplies, in particular, PPE 鈥� personal protective equipment 鈥� as well as tests into the area to help respond. 

Rovner: What about the U.S. pullback in foreign aid? We’ve obviously, you know, seen sort of the demise of USAID and a hollowing out of the CDC here. I imagine that’s impacting how we’re responding to this. 

Gounder: Yeah, so starting with USAID. So, USAID funded the people on the ground that would do the contact tracing, who might help set up Ebola triage, as well as treatment units. And that funding is gone. In fact, over the last week, I’ve been talking to some of the Congolese doctors who used to have jobs funded by USAID. And, in addition, USAID really supported the supply chain infrastructure for the area. So now you’ve seen a collapse of their ability to get personal protective equipment. There are shortages of this, which is also contributing to healthcare workers getting infected right now. And then also pharmaceutical supply chain. So, you know, even the most basic of medications is a challenge to get into the area. With respect to CDC, there have been tremendous layoffs related to the DOGE [Department of Government Efficiency] cuts from last year. We had the CDC shooting last August, and morale at the agency is 鈥� it’s horrible, it’s horrible. And just in the last day or so, Dr. [Jay] Bhattacharya, who’s the NIH [National Institutes of Health] director, and also, I guess he’s calling himself something else, because he can’t technically be acting CDC director anymore. But 鈥� 

Rovner: He’s nominally in charge of CDC, without being the acting director. 

Gounder: Right, exactly, whatever that means. But he has asked for CDC staff to volunteer to go over to Kenya, and staff a quarantine and, sounds like, treatment unit for any American healthcare workers who might get sick or be exposed while responding to the Ebola outbreak. And based on what we’re hearing, it sounds like they do not want anyone with Ebola coming back into the U.S., including the very people they’re asking right now to volunteer to go to this unit in Kenya. So I think that is also going to further complicate the response. You know, like, if you volunteer for the Marines, you enlist, and you get sent overseas, and you have an injury, you expect to be repatriated as quickly as is possible for treatment here in the United States, right? That is not the case. These are people who are similarly putting their lives on the line, who are responding to that call for help, and we are not seeing similar respect for that sacrifice. 

Rovner: And yet, I mean, the U.S. is set up to take care of people with seriously contagious diseases, right? 

Gounder: Oh, yeah, we have over a dozen units that were specifically created for this very purpose. Several of them have hands-on expertise, experience with this. So, in particular, Emory [University School of Medicine] in Atlanta, [NYC Health + Hospitals/] Bellevue in New York City, where I am, as well as University of Nebraska Medical Center. All three of those have experience with Ebola, not just having done preparations. And it’s really confounding why you would not want to make use of that. When somebody gets Ebola, particularly if you’re talking about an American, you know, who has put themselves in harm’s way 鈥� there are some real questions about fairness and equity of access to certain levels of care 鈥� but American aid workers, the expectation is that they would get the full-court press. And that might include being on a ventilator, that might include needing dialysis, for example, and to do those things when somebody has Ebola, and you need to do that in biosafety Level 4 conditions, I have a hard time seeing how they’re going to be able to put that together in Kenya on such short notice. 

Rovner: So we learned a lot of lessons from covid, not all of them good, obviously. You have a , which I will post a link to, about the psychology of pushback. Can you talk about that briefly? Because I think that has a lot to do with how the U.S. is responding to this. 

Gounder: Yeah, and I think a lot of people may actually identify with their own experiences during covid. You had a lot of people who didn’t want to wear a mask. In fact, we saw masks being burned, right? People not wanting to get vaccinated. And what happens is, when you have somebody who, for whatever reason, people don’t trust telling them to do something, they feel like they’ve been backed into a corner and they lash out. And so you tell them to do something, very often they want to do the exact opposite. And I saw this exact same thing when I was in Guinea over 10 years ago now. It was related to the presidential elections at the time, and it was a way of expressing dissent towards the current, at that time current, president and ruling party. And so, you know, for Ebola, the measures are pretty basic, particularly at that time: It really came down to contact tracing, testing, safe burials. And people would refuse to do some of those really basic things, and it was their way, what we called in Guinea and French, La réticence c’est la résistance, so reticence and resistance. And you saw that whole spectrum manifest there, and I think we’re seeing the same thing all over again, predictably so, in the DRC [the Democratic Republic of Congo] right now. 

Rovner: So, what could this administration be doing better, or be doing that they’re not doing that could maybe help us tamp this down, I mean, before it gets out of hand? 

Gounder: Well, I am concerned it’s already out of hand. They’re only following up on one out of every five contacts, so that means four out of every five contacts could be seeding new chains of transmission. So I think this is going to get a lot worse before things start to turn around. In fact, I would predict this is going to be a year or two to control. I mean, based on prior experiences with the 2018-2019 outbreak in the same area, as well as the 2014-2016 outbreak in West Africa. This has the potential to be even worse. What could the U.S. be doing? Well, we are currently adopting a very isolationist stance with respect to our public health policy. The dismantling of USAID is a big part of that, but it’s not the only thing. And I think what is happening now, frankly, gives me flashbacks to the 2014 Ebola news and midterm elections, and the way in which Ebola was politicized at that time. At that time, President Trump was not president; he wasn’t even a candidate yet, but he spoke very loudly about having travel bans. He called for President [Barack] Obama to resign because he allowed, in fact, facilitated the transport of infected Americans back to the U.S. for treatment. And so he’s on the record as having said he never wanted anybody with Ebola in this country. And I think the current policy that you’re seeing is consistent with that. We’re headed into midterm elections again. We’re seeing travel bans being instituted for real this time, not just talked about. And one of the other concerns around travel bans at that time, and again now, was what would it mean for healthcare workers and other aid workers, their willingness to volunteer to respond? And I remember Craig Spencer, a very good friend of mine, he was hospitalized at Bellevue with Ebola, and it was right around that time as well, Kaci Hickox, a nurse who had responded, she came back to Newark Airport. Chris Christie, as I recall 鈥� 

Rovner: Then the governor of New Jersey. 

Gounder: Yeah, right, governor of New Jersey, Chris Christie, at that time mandated that she be quarantined. So she did not have symptoms, but that she be quarantined due to her work on, I think, it was the tarmac at Newark Airport with a Porta Potty and a tent, something along those lines. And I had a lot of friends at that time who pulled out of volunteering 鈥� between Craig getting sick and Kaci and the mandated quarantine really under inhuman[e] and humiliating conditions. And I think this time it’s going to be even worse because not only are you having to face potentially getting sick, but you may not get to come home. And it’s really unclear at what stage, if you get sick, would you be allowed home. Do you have to wait until you recover? And what if you die? What happens then? Does your body get repatriated? Does your family, right, get to receive the body? That’s a big deal for a lot of families to have that closure. So I know, even among my friends who, like me, are Ebola veterans, there’s a lot of hesitance about stepping up again. 

Rovner: Well, I hope we can call on you as this continues, alas. Thank you so much. 

Gounder: Oh, of course, 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. Maya, why don’t you start us off this week? 

Goldman: My extra credit this week is a story in The Texas Tribune by Terri Langford and Colleen DeGuzman titled “.” And you know, I think it’s obviously a very important political story in the fight over transgender rights, and specifically rights for transgender kids, and the medical practice around gender-affirming care. But one of the things that’s especially interesting to me about this settlement is that there’s not really demand for detransition services, at least at the level of having a dedicated clinic at a children’s hospital for them. And so this is basically a children’s hospital is going to put resources towards creating something that, or presumably put resources towards creating something that may not be used. And as hospitals are talking about how stressed they are for dollars, and just in general overextended, you know, I think this is a very interesting use of resources. 

Rovner: That’s one way to put it. Lauren. 

Weber: I have the New York Times investigation by Sarah Kliff and Margot Sanger-Katz 鈥� which, you know, as soon as you see those two names, you have to read it 鈥� titled “.” And it’s a great look and also builds upon, you know, some great reporting by The Wall Street Journal, I’ll have to shout them out as well in this area. But it details how, amid this focus on autism clinic fraud how 鈥� what that looks like on the ground. And it’s pretty terrible on the ground. A lot of these autism treatment clinics, the science is questionable on whether it really works. They’re encouraging people to send their kids there instead of to school. 鈥� There’s this horrific anecdote in the lede about how a child is woken up from a nap that can only last almost seven minutes, so they can bill more. I mean, it’s pretty gut-wrenching and gets at the clear issue in a lot of healthcare, which is that a lot of this is done to maximize profit and not necessarily for the patient. So it’s very well done. 

Rovner: Yeah, it is really scary. Shefali. 

Luthra: Mine is in the New York Times opinion section by Dr. Sejal Hathi. The headline is “.” She herself is a new mom, in addition to running the Oregon Health Authority, and she writes about how our postpartum care system is terrible. We do not care about new moms. We only care about infant checkups. We have very little medical care for people when they are postpartum, and that is not good, because pregnancy is really hard. You can have complications. Most pregnancy-related deaths happen after giving birth, not during. Most of them are preventable, and yet we don’t treat this as something that could be addressed, even though it very well could be, because in other countries they actually do make an effort to care about new moms. I love that she wrote about this from a personal and professional standpoint. I think it’s great, and I hope that it inspires some states to think about ways to improve postpartum health. 

Rovner: Yeah, that story made me so angry. Well, my extra credit this week is also about reproductive health. It’s from ProPublica by Pulitzer Prize-winning reporter Kavitha Surana. It’s called “.” And it’s about yet another case of a mom pregnant with her second child, a college-educated healthcare worker, whose membranes ruptured early, putting her at high risk of sepsis, but who couldn’t get the pregnancy terminated at the hospital where she worked, because the doomed fetus still had a heartbeat. This was a well-connected family. The patient’s father is a doctor. She was in the same sorority at the same college as Arkansas Gov. Sarah Huckabee Sanders, and she enlisted one of the top reproductive health lawyers in the country to plead her case with hospital officials. I won’t spoil the end for you, because you really should read the entire piece, but it underscores yet again that abortion bans can endanger people who don’t think they will ever want or need an abortion. 

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

Goldman: I am on LinkedIn under my name and on X . 

Rovner: Shefali. 

Luthra: On Bluesky . 

Rovner: Lauren. 

Weber: Still on  and  under @LaurenWeberHP. As I like to say, the HP is for health policy. 

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