The Politics of Grant Cuts
The Host
The Trump administration has conceded in court documents that it used purely political considerations to cancel grant funding previously approved by Congress. But that has provoked a surprisingly muted response from lawmakers, who under the Constitution control the power of the purse.
Meanwhile, Republicans in the Senate summoned former National Institutes of Health and White House official Anthony Fauci to testify ā again ā about his handling of the covid pandemic. Fauci, however, refused to answer questions, citing the advice of his attorneys.
This weekās panelists are Julie Rovner of ³Ō¹Ļ²»“ņģČ, Rachel Cohrs Zhang of Bloomberg News, Shefali Luthra of The 19th, and Liz Essley Whyte of The Wall Street Journal.
Panelists
Among the takeaways from this weekās episode:
- Recent court filings shed light on how the Trump administration has used politics to justify its decisions to cancel federal grants. While similar revelations may have been explosive under other presidents, the filings have triggered muted, if any, responses from lawmakers.
- The Trump administration announced this week that it would end the temporary Medicare Part D subsidies, introduced under the Biden administration, that help lower the monthly premiums older Americans pay for drug coverage. While next yearās premiums probably would have increased anyway, the change ā which many will notice when they shop for plans later this year, shortly before the midterm elections ā may not help Republicans in the voting booth.
- Meanwhile, Sen. Rand Paul (R-Ky.) brought Fauci before the committee he chairs to address accusations related to his role in the nationās covid response as a key adviser to Presidents Donald Trump and Joe Biden. But little of substance was said, with the hearing quickly devolving into political grandstanding as Fauci asserted his constitutional right not to self-incriminate.
- An FDA advisory panel voted to recommend the agency make it easier for Americans to obtain several previously banned compounds known as peptides ā even as FDA staff caution that thereās no evidence they are safe. The panel included members who stand to profit from expanded access to peptides.
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Plus, for āextra creditā the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: The Arkansas Timesā ā,ā by Byron Tate.
Rachel Cohrs Zhang: ³Ō¹Ļ²»“ņģČā āTrump Administration Demands Hospitals Share Emergency Room Records,ā by Amanda Seitz, Maia Rosenfeld, and Darius Tahir.
Liz Essley Whyte: Statās ā,ā by J. Todd R. Lawrence and Madison A. Kesler.
Shefali Luthra: The Washington Postās ā,ā by Aaron E. Carroll.
Also mentioned in this weekās podcast:
- The New York Timesā ā,ā by Tony Romm and Brad Plumer.
- CalMattersā ā,ā by Mikhail Zinshteyn.
- The Wall Street Journalās ā,ā by Liz Essley Whyte.
- Bloomberg Newsā ā,ā by Rachel Cohrs Zhang.
- ³Ō¹Ļ²»“ņģČā āTrump Has Quietly Throttled an Agency Devoted to the Safety of American Healthcare,ā by Arthur Allen.
- The Washington Postās ā,ā by Lauren Weber.
- Politicoās ā,ā by Alice Miranda Ollstein and Ariel Wittenberg.
Click to expand the transcript Transcript: The Politics of Grant Cuts
[Editorās note: This transcript was generated using transcription software. It has been edited for style and clarity.]
Julie Rovner: Hello, from ³Ō¹Ļ²»“ņģČ and WAMU Public Radio in Washington, D.C. Welcome to What the Health? Iām Julie Rovner, chief Washington correspondent for ³Ō¹Ļ²»“ņģČ. And, as always, Iām joined by some of the best and smartest health reporters covering Washington. Weāre taping this week on Thursday, July 30, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today, we are joined via video conference by Rachel Cohrs Zhang of Bloomberg News.
Rachel Cohrs Zhang: Hi, everyone.
Rovner: Liz Essley Whyte of The Wall Street Journal.
Liz Essley Whyte: Hello.
Rovner: And Shefali Luthra of The 19th.
Shefali Luthra: Hello.
Rovner: No interview this week, but more than enough news, so weāll get right to it. I want to start with a story that I feel like is getting a little bit buried because it broke last Friday. on a federal court filing in which the Trump administration admitted that it canceled $7.5 billion in clean-energy grants solely because they were located in states represented by Democrats that voted for Kamala Harris in 2024. In other words, the actions were purely political. Now, this is before the administration finalizes proposed rules that would give political appointees still more power over how grant funding is distributed. I heard one pundit say on cable news that in any other administration, this sort of information would lead to an immediate impeachment inquiry. But these days, itās just another day that ends in āy.ā Is the lack of public outcry about this because everyone already assumes that everything this administration does is political? Or is this considered just too inside baseball for most voters?
Whyte: Well, I was gonna say I think this has long been peopleās suspicions about why certain grants are cut in the way that they are, or some of these Medicare/Medicaid investigations are the way that they are. And so I think maybe the lack of outcry was just people shrugging their shoulders and saying, I mean, yeah, we guessed that, you know. I donāt know.
Cohrs Zhang: It was really chaotic too, and hard to keep track of all these different things for people whose job it is to do so. So I feel like the fact that this is protracted for so long, weāre like, which DOGE [Department of Government Efficiency] cuts were those? And I think it is important, certainly, and Iām glad thereās been coverage of it, just for the record, and just kind of for history purposes and just understanding the limits of that kind of change to government at that speed. But yeah, I think it is just hard to break through in this news cycle, and it was very chaotic and confusing for everyone.
Luthra: One thing I have been thinking about, though, is when you think about these states where grants were canceled, there are a lot of people who live there who did, in fact, vote for Donald Trump. And depending on the size of the state, you probably have members of Congress who are actually in Republican districts. And that, I think, is really interesting. And I just wonder if eventually there is some sort of conversation. Those are probably in some cases members who might be a little bit more on the defensive in other ways, just given the political environment we are in. And is this an issue that Democrats can talk about and highlight and sort of bring to voters and say, you know, your representative is not here defending your interests because of these broader sort of punitive measures being taken by the White House. I think thatās an interesting thing that we donāt know the answer to yet.
Rovner: I know I keep saying this, but I canāt believe that Republicans on the [Senate] Appropriations Committee arenāt being louder about this. This is the one power that they have. Itās why you get on the Appropriations Committee, is you get to steer money to your state or your district. That is the great perquisite of being in Congress, and the administration is basically taking it away. And theyāre just letting them. I mean, Susan Collins told Politico, quote, āI obviously think thatās wrong.ā But she doesnāt seem willing to do anything about this. I mean, sheās the chairman of the Senate Appropriations Committee!
Cohrs Zhang: I think weāre, like, testing the checks-and-balances system to its fullest extent. This administration. They can only pick so many fights, you know.
Whyte: Yeah, Susan Collins, especially, this whole administration has had to choose about when to say something and when to push behind closed doors, push publicly. I mean, thereās been lots of stuff that she hasnāt liked.
Rovner: Yeah, for sure. Well, this is not the only case where the government has admitted to canceling grants for political reasons. In a case brought by researchers from the University of California, the administration confirmed it canceled some grants because like ādiversity,ā āgender,ā and āvaccine hesitancyā to cut off funding. The plaintiffs in that case argue that itās a First Amendment violation. Again, weāve known for some time that this has been happening. Are the courts just too slow to be able to deal with it, Rachel? Thatās kind of what you were intimating. This has been dragging out, sort of bit by bit by bit.
Cohrs Zhang: Yeah, I think itās hard. And I ā just like with these grants dragging out too, it has impact for the people who are supposed to be receiving this funding and how their cycles work and hiring and just all the ⦠that grant process. But I think itās hard to make that connection, back to the individual voter. And I think thatās just a tough hill to climb in terms of public communications. So I think, yeah, weāre seeing these similar themes play out.
Luthra: And one thing that I think is really relevant that I keep coming back to is we did see a test run of this with the USAID [United States Agency for International Development] cuts at the beginning of the administration. Those happened very quickly. The courts took a very, very long time, and by the time there was any kind of real momentum in any direction, it was too late. People did not have money, firms had downsized, people had left their jobs, left the industry altogether. And, at the time, that seemed to me like a really striking test. If this is able to happen here, and it shows that things just continue, why not happen in other areas as well, where you have these grants being put out there that have maybe ideological tension with where the administration wants to be going?
Rovner: So I wanted to talk about some specific impacts on health policy, notably AHRQ, the Agency for Healthcare Quality and Research, which, like USAID, the administration has all but eliminated, despite the fact that it was appropriated nearly $350 million for this year in a bill signed by President Trump. AHRQ, which is down to a fraction of its original staff and hasnāt funded any grants in more than a year, is actually a completely bipartisan creation from the 1990s. It was established to study healthcare quality and access issues, many of which go neatly hand in hand with the āMake America Healthy Againā agenda. Earlier this month, the administration stopped funding more than 100 grants, and an HHS [Department of Health and Human Services] spokeswoman told my ³Ō¹Ļ²»“ņģČ colleague Arthur Allen only that the agency plans to establish a new, quote, āframework,ā which I thought was the job of Congress. Again, too small to attract much notice?
Luthra: Probably. I mean, voters donāt know what AHRQ is. Like, we know about it because of our jobs, but this is not something people wake up and think about or talk to their neighbors about. It just feels very divorced from a lot of peopleās realities. Even though, to your point, the consequences are far-reaching. They are long-term, and, also, the significance in terms of, as Rachel pointed out, separation of powers, checks and balances are also very striking.
Rovner: I mean, AHRQ studies things like patient safety. Iām old enough to remember when the, you know, the big Institute of Medicine [now National Academy of Science] report came out that said how many people were injured by medical errors. It was a huge, huge issue. I mean, for years. And thatās basically what AHRQ does, and thatās what this administration says that they care about. They care about gold-standard science. They care about fraud. They care about making the health system safer. And yet, you know, AHRQ is just, well, we donāt know what it is, so weāre going to make it go away, basically.
Whyte: Obviously, the HHS has not been as clear on this as you might hope and expect for the āmost transparent administration in history.ā But it is clear that, like, Kennedy is looking for pots of money to do the things that he wants to do. And it seems like this is one of the pots theyāve landed on as something that can be shifted around.
Rovner: Yeah, so it does. Well, one cut that is likely to be noticed is the administrationās decision to end the temporary subsidy for Medicare Part D that prevented the addition of an out-of-pocket cap on how much enrollees have to spend each year on prescription drugs from spiking those monthly premiums. This will almost certainly raise premiums for many, if not most, of the 25 million seniors who have stand-alone Part D drug plans. And they will see those increases right before Election Day, because Medicare open enrollment starts Oct. 15. And, by the way, seniors vote in disproportionate numbers in midterm elections. If I was a political adviser for this administration, I donāt think I would have advised doing this. Am I missing something here?
Cohrs Zhang: I think you are seeing thereās an interesting shift happening in terms of the power of the fiscal conservative wing of the administration. And I think weāll continue to see that play out. I will say itās unclear, like, how much premiums would have increased anyway without this subsidy program ending, given that the premium increases are capped by statute, in the Inflation Reduction Act through 2029. So, I mean, there is a chance that they might have gone up 6% anyway. Weāre maxing out that increase. But the messaging certainly was not stellar for them. And I think we saw some cleanup efforts on that, for them trying to say that, you know, most seniors will see, you know, no increase or an increase of less than $10 a month.
Rovner: Or theyāll have, I think Dr. [Mehmet] Oz said, theyāll still have an option for a cheaper plan. Of course, that cheaper plan might not cover all their drugs, but ā¦
Cohrs Zhang: Yes. So I think thatās just like a ⦠this is one, I think, data point in this larger theme Iām thinking about. And how do we see ā as we move past the midterm elections and affordability may not be top of mind if thereās no electoral accountability for it ā how does that change what weāre seeing out of these agencies?
Rovner: Iām just old enough to remember when, you know, you donāt raise costs for Medicare beneficiaries right before a midterm election, which is what this will do. Well, it isnāt all cuts. The administration this week finally released the $600 million that Congress had appropriated for the global Vaccine Initiative, Gavi. That was money for last year and this year. The funding had been blocked by HHS Secretary Robert F. Kennedy Jr. even though it goes through the State Department, not the Department of Health and Human Services. Kennedy had been concerned that Gavi was paying for vaccines containing the preservative thimerosal, which has been accused, and cleared, of causing autism. Do we know what finally sprung this money loose?
Cohrs Zhang: I think there was a deadline of Sept. 30, and the funding would have expired. And we did see kind of an exchange with Secretary of State Marco Rubio and Susan Collins, where he said, āYou know, Iām going to take ownership of this, and weāre going to get it done.ā And so I think there was a push by administration officials to get this funding pried loose. And I think there are questions about whether Gavi was kind of heading this way already with some of these vaccines. I think they were starting the transition, but I think there ⦠weāll see how the implementation works on it. But I think there might be an argument that maybe this transition might have happened maybe faster ⦠or to a broader degree.
Rovner: The transition away from using thimerosal.
Cohrs Zhang: Yes, the states ⦠thereās one hexavalent vaccine where countries could already apply to transition to a different formulation without thimerosal starting in 2023. So, but maybe an option would be broader. Just thereās kind of a lot up in the air as to actually how this gets operationalized in the timeline.
Rovner: Yeah, I was thinking, though, this might have been one of the cases where Congress complaining, both publicly and privately, did actually have some impact. But also, I know a lot of it was Marco Rubio stepping in and saying, āHey, this is a State Department thing.ā And finally, you know, I say a year and eight months later, the money gets distributed. All right, weāre going to take a quick break. We will be right back.
Well, speaking of things that may or may not be good politics, Republican Sen. Rand Paul of Kentucky called former NIH [National Institutes of Health] and White House science official Tony Fauci before his Homeland Security Committee Wednesday to rake him over the coals again over his handling of the covid pandemic. Fauci, who received a preemptive pardon from President Joe Biden as Biden was walking out of the Oval Office door in 2025, did not take the bait. He pleaded the Fifth, lest anything he said be used for a new prosecution for lying to Congress. Meanwhile, Paul says heāll try to find Fauci in contempt of Congress, which, by the way, would take 60 votes, which feels a little unlikely. Separately, several red-state attorneys general say they now want to investigate Fauci since his pardon doesnāt cover state prosecutions. First, prosecute him for what? And is relitigating covid origins and lockdowns really good politics for Republicans? Iām sure it riles up the base, but itās hard to see them running on this as their health agenda.
Whyte: So Rand Paul actually said on TV last night that he just thinks his committee needs to do the contempt of Congress vote, and then they can refer it to the DOJ [Department of Justice]. So they may not need 60 votes. So that will be interesting. Meanwhile, [Sen.] Ron Johnson [R-Wis.] has also threatened to subpoena Fauci. And the Florida attorney general is opening an investigation. And Alabama Sen. Tommy Tuberville says if he becomes governor, heās going to try to figure out a way to prosecute Fauci in Alabama. So thereās definitely a lot of focus on Dr. Fauci.
Rovner: I repeat, though, prosecute him for what?
Whyte: Well, you know, before the hearing, Rand Paul was saying, Yeah, his preemptive pardon covers stuff in the past, but if he lies again at this hearing, then we will, you know, go after him or whatever.
Rovner: Right, and thatās why he didnāt, thatās why he pleaded the Fifth.
Whyte: Right, which is why it was viewed as an ⦠entrapment situation that he should probably steer clear of, and why he would not even answer, like, what is the color of the carpet.
Rovner: And what color his tie was, or was it Sen. [Josh] Hawleyās tie?
Whyte: Yeah, and what day of the week it was, yeah. Whether itās good politics for Republicans, I think weāll have to see. Thereās an Ohio candidate that theyāve tried to get for being, you know, covid czar or whatever, and that really hasnāt gone anywhere in Ohio. Sheās polling OK. So I think thatās a good question on whether voters still care about this or not. I think obviously a lot of them do, but, like, the suburban women who are, you know, the famous swing voters, what do they think about Dr. Fauci? Will be interesting to see.
Rovner: Yeah, I mean, I guess just for watching the questioning, it seemed that theyāre trying to, you know, that we know that Democrats have more enthusiasm going into this midterm than Republicans. And it looked like the Republicans were trying to, you know, reactivate the angry covid base, if you will, to get them to come out and vote. Itās just hard to know how many people are angry enough to come out, you know, six years later.
All right. Well, speaking of buzzy stories, Liz, you about how Trump might be pushing RFK Jr. on childhood vaccine policy rather than what we all assumed was the other way around. So tell us about it.
Whyte: Yeah, this is a bit of a counterintuitive news development for two reasons. One, because everybody thinks RFK Jr. is the big vaccine skeptic in the administration. And two, because the White House had, you know, is widely reported that they were telling HHS to āix-nay on the accines-vayā ahead of the midterms ā like, just dial it down a little bit because of polling they had from the winter that showed while food and ag [agricultural] stuff was really popular, the other MAHA stuff, vaccine skepticism, was not, and they kind of wanted to tone it down. But the president does what he wants. He does not always listen to the polling. And he has been telling Kennedy since at least May, why arenāt you doing more to probe the connection, in his mind, between vaccines and autism? And this took Kennedy aback, actually, at a golf course lunch in May. He was surprised because he was still under the impression they were supposed to be dialing back. And President Trump told him, āYou have the yips,ā which I just think is such a funny word.
Rovner: Itās a golf term.
Whyte: Yes, itās a golf term. And that has continued to be, actually, a point of tension between the two men, with the president venting his frustration to Kennedy at a mid-June Oval Office meeting. And part of the reason weāre seeing some of this increased action, even if itās not, you know, really talked about much, but appeals to the federal appeals court to speed up the decision for the key vaccine advisory panel of the CDC [Centers for Disease Control and Prevention], and then also there was that EO [executive order] in May that Trump put out on the childhood vaccine schedule, and just kind of general scrambling behind the scenes to figure out, like, what they can deliver for the president, who is, Iām told, a results guy and wants to see results and thinks, you know, itās been a year and a half, and why arenāt there results? So, weāll see where that leads.
Rovner: Well, meanwhile, if this puts Kennedy in hot water with the president, what the newest, who the newest likely candidate is should RFK Jr. leave his post, either voluntarily or not so voluntarily. Tell us about your story.
Cohrs Zhang: So I have been working on this story for a very long time. But I think weāve seen kind of this surprise in Washington that Dr. Oz, whoās leading Medicare and Medicaid, has actually like navigated the Trump administration with great skill, and I think we were finally able to capture the scope of that, him translating that skill into personal relationships with the president, with the secretary, and getting himself a seat at the table on far more policy issues than a CMS [Centers for Medicare & Medicaid Services] administrator would normally get. And I think we saw, those of us who remember the first Trump administration, how ugly things got between HHS and CMS ā was like very adversarial, like a really bad time in there, very toxic. But I think weāve seen him take a more, like, cooperative approach. He wields his influence, is more explaining things. He is a medical doctor, his training, unlike the secretary. And I think there is just, like, a general trust and, like, personal friendship between the two of them that has translated into this interesting dynamic, where Dr. Oz kind of serves as a go-between on some of these issues between the White House and the secretary and gets everybody kind of to the place where they need to go. And heās just a good communicator and has built a lot of trust and parlayed that into getting himself a seat at the table.
Rovner: Yeah, and Liz ⦠your story about Kennedy and Trump also suggested that Ozās favor is rising, shall we say?
Whyte: Yeah, the White House staff love Oz because they know they can send him to the Hill. They can put him on TV. Like, heās going to do a great job. Rachel had this too. You know, the president calling and texting Oz and saying, you know, what about this issue? and it has nothing to do with CMS. Heās, you know, being called upon to do other stuff that is not in his portfolio. So yeah, every lobbyist is just, like, watching their clock and seeing when Oz takes over. I donāt know that itās that straightforward. I think the president and secretary have a very warm friendship, and it took a lot for Kristi Noem to get let go, and I donāt think weāre anywhere near that. So weāll have to see if the mood changes after the midterms. But it doesnāt seem to me that anything would be imminent.
Rovner: I would add that I know Oz is the one person practically in the entire administration, not just at HHS, who actually does well when he goes to the Hill. Who, you know, is respectful and sort of understands how administration officials are supposed to conduct themselves when they are in front of the people who theoretically are responsible for them having their jobs.
Whyte: Yeah, youāll find the Democrat staffers are like, Oh, we actually like Oz, which is funny, I think.
Rovner: Heās a good politician! What can I say? Rachel, do you want to add something?
Cohrs Zhang: I will say, though, he did play a role in selling all these Medicaid cuts that are going to be coming down the pike.
Rovner: He did.
Cohrs Zhang: And so I think he is going to be the face of this when they actually go to implement it.
Rovner: He will.
Cohrs Zhang: So yeah, weāll see how that goes.
Rovner: Weāll see how that goes.
Cohrs Zhang: What time frame theyāll be doing that in. But yeah, certainly. Yeah, itās interesting.
Whyte: Theyāve kind of given up selling that, too. You know, itās not something theyāre being like, Oh, look at all the great stuff we did with Medicaid in the One Big Beautiful Bill. Itās very much pivoted to fraud.
Rovner: Yeah, but when it starts, when it takes effect next year, I think thereās going to be, there will be lots of questions to answer. Shefali, do you want to add something before we move on?
Luthra: The only thing that really just I keep thinking about is the long history of this relationship between Dr. Oz and the president, and, in particular, when during the 2016 campaign he was the one to talk about the presidentās testosterone levels on TV and how they were excellent. And I just think itās really special that weāve come full circle in this way.
Rovner: Yes, yes, it is, and we have. All right, moving on. One thing that Secretary RFK Jr. said this week thatās pretty clearly not true is that the department has the cyclospora parasite outbreak, quote, āunder control.ā A former deputy commissioner of food at the FDA under both the first Trump administration and President Biden told Politico this week that, quote, āit is starting to approach a catastrophic level in terms of how mismanaged itās been on multiple fronts.ā Rachel, youāre keeping an eye on this. What is the latest? What do we know about cyclospora and where itās coming from? And are the recalls that are in existence enough to stop it?
Cohrs Zhang: I donāt think theyāre stopping it, by any means, especially with an incubation period of two weeks. I think we are continuing to see more cases reported, and I think, like you mentioned, thereās, I think, fingers pointing in all directions. Our team and others have done reporting on just how Taylor Farms has handled themselves behind the scenes. The public spat between Taylor Farms and the FDA was not something you usually see in an outbreak of this kind. Itās just worth probably pointing out that the FDA did DOGE much of its communications staff that has experience with this sort of outbreak. We have, you know, officials shifting around, and thereās some key vacancies at the FDA as well in a lot of these leadership positions. So I think thereās been complaints, certainly, at, like, the report you mentioned about the federal response, but also about the company and their speed and their clarity and communication, and whether thatās truly serving the public interest or not. And I think there are, if Iām not mistaken, some ongoing investigations into other potential causes. But we are seeing a lot of these cases tied back to lettuce from a specific part of Mexico. So I think they have gotten the word out now, but just the confusion and the back-and-forth. And I think former FDA commissioner Scott Gottlieb got on CNBC and said he would have expected more communication from the FDA on this issue. But itās kind of a tough one when itās a voluntary recall, and thereās a company, and theyāve used some restrictions, you know, and what theyāre supposed to be talking about publicly. But I think there has just been so much consumer confusion, and thatās not in anyoneās interest.
Rovner: And as we said, this is not a simple thing to track. Itās not like E. coli; you canāt really find it. Liz, you and your colleagues reported, though, on, you know, Taylor Farms going straight to the White House to try and sort of go over the heads of the FDA on this.
Whyte: Yeah, Bloomberg and The Wall Street Journal had stories with different pieces of this, and it was, you know, in our story, you could see that they were trying to distance themselves from the outbreak before they got named publicly, which is kind of this new wild West of lobbying that weāre in, where it makes a lot of sense for companies to go straight to the White House and skip over dealing with career officials. And what was interesting was that the way all that played out with the communications is Taylor was able to say, FDA apologized to us, made this like really confusing statement. And the FDA, maybe because it didnāt have the comms folks with experience, like Rachel was talking about, at the FDA with, you know, various layers of people who have done this before, you know, it took them till the next day to say: By the way, our epidemiology on this is really good. Itās definitely still Taylor Farms. We just, like, had that one false positive. It was crazy to me how, like, twisted and turned that got.
Rovner: It was not well handled from a public communications standpoint, shall we say? All right. Well, one thing that we know that RFK Jr. thinks highly of are peptides; those are the amino acids that wellness influencers say can build muscle, heal injuries, and burn fat, among other things. Last week, an FDA advisory committee voted, over the objections of FDAās own scientists ā who say evidence on the benefits of peptides is either skimpy or nonexistent ā to nonetheless make it easier for compounding pharmacies to make and sell products containing several different specific peptides. Now, this is not just a scientific disagreement. Several members of this advisory panel are actual sellers of this product, right?
Whyte: Yeah, the panel was a bunch of members who either worked for companies that sell peptides or had a clinic that offers them. And the HHS said these people went through a conflict process. It doesnāt seem like it could have been as rigorous as the previous conflict processes that were in place. I havenāt seen a ton of reporting on that. But, you know, predictably they greenlighted most of the peptides that they looked at over and against the strong recommendations from FDA staff scientists who said we donāt have evidence that these are safe. Like, this is kind of unprecedented. The argument in favor was, well, you know, we do something similar with supplements. You know, Secretary Kennedy has said people should be free to try these out, and you know he wants to end the war on peptides. And meanwhile, scientists with a traditional background in looking at risk and benefits are saying the risks are there, the benefits are not proven, and this almost creates a different paradigm for how weāre looking at medical interventions now.
Rovner: Yeah, and I think weāve seen this across the FDA and across HHS. I mean, this is basically what theyāre, you know, calling gold-standard science. That thereās a lot of people ⦠go ahead, Rachel.
Cohrs Zhang: I was just gonna say, and Iām ⦠I think, looking forward, this creates a split decision, right, between the FDA scientists and the ag comm, and thatās gonna put the FDA in a tough position as to who what theyāre going to choose because former commissioner Marty Makary loved to say he was siding with the career scientists, and now we have this forum to hear what they actually think, like, presented to the public. So I think thatās going to be a tough decision ahead, and thatāll tell us how things are working inside.
Rovner: And of course, we only have an acting commissioner of FDA right now, so ā¦
Cohrs Zhang: Yes, with instructions to not make news.
Rovner: Finally, this week, news on reproductive health ā because there is always news on reproductive health. Shefali, we had a decision in one of the court cases challenging how the FDA regulates the abortion pill mifepristone, but itās not the case that weāve all been watching, right?
Luthra: No, this was the Virginia case. And what it reminds us is that thereās actually a million different mifepristone cases because you have people looking for more restrictions on mifepristone, and you also have people looking for fewer restrictions on mifepristone. And a lot of the folks who provide the drug, the doctors and manufacturers, have argued that, in fact, there are more restrictions than are actually appropriate. That this is actually much safer, and it does not need to be so hard to get because, for all of the concerns from conservatives and abortion opponents, it actually is very difficult to prescribe and make mifepristone available without going through a lot of hoops of certification. And so we see, right, in some cases, like here, an effort to try and loosen those restrictions a bit and say this could be more available, especially, I mean, people when they have miscarriages, it is actually very hard to get mifepristone, even though it actually would be very beneficial for management. But I think what this does, practically, is again not much changes for now because we have so much going through so many courts in different ways. Realistically, I mean, access to the drug stays as what it is: available in some places, not available in others. And the big case that weāre all waiting for, the Louisiana one, that could possibly bring restrictions in, that very briefly did bring restrictions in mifepristone earlier this year ā weāll probably see more on that closer to the election. And that could be very interesting because, as weāve talked about so many times, this is not really an issue the White House or a lot of Republicans, frankly, would like to be in the news, because they know that restrictions on abortion just remain so unpopular and continue to be for a long time.
Rovner: And this is almost certainly heading for the Supreme Court, right? We now have a court, you know, a lower court saying that the Biden administrationās restrictions were too tight, and one assumes that coming out of Louisiana, we will have a decision that says that theyāre not tight enough.
Luthra: I would be stunned if the Supreme Court did not hear a mifepristone case in the coming few years. It just seems like weāve been building in this direction for a very long time. Youāre totally right. The split circuit looming makes that more likely. And I mean, realistically, if I supported abortion rights, if I wanted to make this pill more available, as the folks arguing against the Biden restrictions are, I donāt know that I would be thrilled about this being something before the Supreme Court because this is known to be a more conservative court. A lot of members who think abortion should be far less available than it is ā this is the same court that overturned Roe v. Wade. And so I think thereās a real possibility that as we see more and more abortion decisions make their way to the Supreme Court, the restrictions we have become even more so, and where we are now becomes a baseline for making this even more difficult for people to obtain.
Rovner: We will have to see. Meanwhile, our podcast pal Alice [Miranda] Ollstein has a co-bylined story at Politico this week about how anti-abortion groups are pulling out all the stops to try to show that the increased use of . Now they have a study, commissioned by the group Students for Life, claiming that mifepristone is showing up in, quote, āsignificant levelsā in waterways in Austin, Texas; Blacksburg, Virginia; and Carbondale, Illinois ā all major college towns, not coincidentally. And while the science behind this remains questionable, the politics donāt, right?
Luthra: Right. And this is a strategy theyāve been working on for quite some time, putting bills in state legislatures, talking to anyone who will listen about this, and saying, If we care about the environment, the left cares about the environment,why donāt we care about what they say is this mifepristone pollution in the water that they say is caused by medication abortions? And they want to use this argument as a different prong on the way to stop people from having mifepristone made available, of making medication abortions harder to obtain. We havenāt really seen this really yield fruit yet. However, this is part of, again, a longer-term strategy to lay groundwork. And studies like this, they create an intellectual groundwork as well. We saw that with the telehealth studies, the mifepristone safety and efficacy studies ā and I perhaps should do āstudiesā in air quotes because a lot of mainstream researchers call these not very good science. But if you create a large-enough body to point to, then ultimately you can have people in positions of power say, āWell, weāve looked at the evidence from all sides, and we see these real concerns, and weāre going to use them to inform policy.ā I donāt know that that will happen anytime soon, but itās certainly a goal that theyāre building toward.
Rovner: Theyāre talking points, basically.
Luthra: Absolutely.
Rovner: All right. Well, that is this weekās news. Now itās time for our extra-credit segment. Thatās where we each recognize a story we read this week we think you should read, too. Donāt worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Rachel, why donāt you go first this week?
Cohrs Zhang: Mine is from ³Ō¹Ļ²»“ņģČ. The headline is āTrump Administration Demands Hospitals Share Emergency Room Records,ā by Amanda Seitz, Maia Rosenfeld, and Darius Tahir. I think this is one installment, and that this broader arc of coverage that they have really owned ā itās so diffuse. Thereās like states, and thereās providers, and thereās government officials involved, but I think it really illuminates kind of like where is the Trump administration looking for data? I think this is something that started during the DOGE era, where you had DOGE employees trying to get data from different government agencies. But youāre seeing it as, I think, weāve talked about previously, like, thereās a desire for studies and, you know, things to move faster. Like, where are we looking for data? I think this whole arc of coverage has been really valuable in illuminating: Where are they looking. Is this precedented? Kind of how could these datasets be used? What are the patient potential issues? Are there privacy issues? Can this data be protected? That I think are going to be really important as we kind of look into the rest of this administration, because weāre only a year and a half in. Like, we got a ways to go.
Rovner: And, oh I mean we say over many, many, many years itās always been Republicans who have been, you know, very much into the federal government shouldnāt have its hands in peopleās personal data, and yet here we have an administration thatās trying to get personal data from every single possible place.
Cohrs Zhang: Right, itās fascinating. And this just makes it so concrete. And I think itās great accountability work, and theyāve clearly developed great sourcing on this.
Rovner: Yeah. Liz.
Whyte: Mine is a by two doctors who are concerned about the burgeoning pediatric public health emergency, as they call it, about e-bikes and e-scooters. And Iāve been wondering about this for a long time because I see kids doing two, three kids on these scooters going so fast with no helmets. Itās always boggling my mind, but itās apparently gotten really bad. They looked at data from 2020 to 2021 and saw an increase in injuries, up 71% in just one year ā kid injuries with e-scooters and e-bikes. So that was 8,545 of those injuries in 2021. And the doctors discuss how, you know, these injury patterns that these kids get ā I mean, theyāre going up to like 28 mph ā look very similar to when a child gets hit by a car. And thatās, itās just real sad. So TBD on whether anybody does any kind of age-appropriate access standards or something like that that can help dial back these injuries. And then I guess Iām cheating Julie, but a shoutout to recently, about how peptide med spa clinics have less regulation at the state level than your local restaurant or hair salon. She contacted all 50 states, and I thought it was just a really good supplement to the peptide news that we saw recently.
Rovner: It was, and ⦠forgive me for not mentioning it, and we will link to that one too. But Iām so glad you did the e-bike thing because if you hadnāt done that, I was going to, because the number of kids just in my neighborhood, little kids on motorized vehicles, itās like: Shouldnāt they have to have driverās licenses to do this? Anyway. Shefali.
Luthra: My piece is by Aaron Carroll. It is an op-ed in The Washington Post. The headline is: ā.ā And what he talks about, I think, is just so smart. Itās about how it actually would be great if we had better and more research on SSRIs. However, the point he makes is that the government is actually not really approaching this from that kind of vantage. And instead the idea is to try and just cut back access to SSRIs, rather than learn more about them, learn how to make them work better, if they are as effective as they want them to be. And the point that he gets at the end as well is that while it is really good and worthwhile to investigate and study how well SSRIs work, one thing that we are actually getting into, which is really problematic, is stigmatizing use of them. And he talks about why thatās actually not good, and that is not actually helpful when it comes to thinking about how to make treatment for depression better and better and better. And I love this framing because we should try and make medications better for people. We should always be looking at treatments we have and saying, yes, they work. But what if we made them work better and better? What if we had fewer side effects? What if we made them more effective? That would be awesome. And I really love that he is putting those questions out there in a way that is smart and productive and forward-looking.
Rovner: And not partisan. This has never been partisan. This is just so ⦠itās all so unprecedented. All right. My extra credit this week is from The Arkansas Times. Itās called ā,ā by Byron Tate. And itās about exactly what the headline says. Since Congress gave states the option to extend Medicaid coverage to postpartum women for a full year after they give birth, 49 states have exercised that option ā all but Arkansas, where that coverage still ends after 60 days. And Arkansas has one of the nationās highest maternal mortality rates. So whoās against it? Apparently, the governor, Republican Sarah Huckabee Sanders, herself a mom. She says these women should be transitioning to other coverage, except apparently most of them are not. According to one study, 94% of those losing postpartum Medicaid are becoming uninsured instead.
OK, that is this weekās 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 ā as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. Weāre at whatthehealth@kff.org. Or you can still find me on X , and on Bluesky . Where are you folks hanging on socials these days? Rachel?
Cohrs Zhang: Iām on X and also on .
Rovner: Shefali.
Luthra: On Bluesky .
Rovner: Liz.
Whyte: I am on X ā with a āY,ā W-H-Y-T-E ā and . You can Google me.
Rovner: Iām sure people can find you. All right, weāll be back in your feed next week. Until then, be healthy.
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