Bostic learned of a federal program designed to help people who suffer rare vaccine reactions.

The Vaccine Injury Compensation Program was created in 1986 after a flood of vaccine injury lawsuits drove drugmakers from the market. Congress aimed to offer a faster and more generous path to compensation for people injured by vaccines, while shielding manufacturers from liability. The VICP, commonly known as vaccine court, is taxpayer-funded. The government pays any award to claimants as well as attorneys fees.

Bostic filed a claim in 2022 for compensation to cover her son’s spiraling medical bills. She then contacted the Carlson Law Firm, which referred her to Arizona-based attorney Andrew Downing — who now serves as a senior adviser to Health and Human Services Secretary Robert F. Kennedy Jr.

Downing declined to comment and HHS did not respond to requests for comment for this article.

Downing, who has represented hundreds of plaintiffs in vaccine court in Washington, D.C., signed on to take their case, according to a contract reviewed by KFF Health News. They agreed Downing would pursue the claim before the VICP.

Bostic shared documents and medical records as he requested them. Months passed as she waited for news on her son’s case.

After several months of making court filings, Downing told her it was time to opt out of the vaccine program and sue the drugmaker. When she refused to opt out, he withdrew from the case.

The government paid Downing $445 an hour for representing Bostic, which is typical for program attorneys with his experience, according to court records.

Three years later, Bostic said, she hasn’t received a dime for her son’s injury. Thomas, now 18, endures debilitating pain that doctors say may never go away.

Rather than help them work through the program, Bostic feels that Downing steered them away from it and toward a lawsuit against the manufacturer. The VICP ultimately dismissed her case.

Bostic was furious that the court paid Downing anything.

“Y’all could’ve gave that to me for my son,” she said. “How dare y’all.”

In Business With Washington

In June, Kennedy’s HHS also awarded Downing’s law firm, Brueckner Spitler Shelts, a sole-source federal contract to consult on an overhaul of the VICP. The contract has grown to $410,000. Downing is the only attorney listed on the firm’s website who has practiced in vaccine court.

Kennedy has routinely questioned vaccine safety and called the VICP “broken,” saying it shields drug companies from some liability “no matter how negligent they are.” As a personal injury lawyer, Kennedy previously spearheaded civil litigation against vaccine maker Merck.

Downing and about a dozen other lawyers have transferred hundreds of clients from the vaccine program to civil suits, where the financial rewards — for patients and their lawyers — could run far higher, according to a KFF Health News analysis of court records and program data. They’ve collected millions of taxpayer dollars in attorneys fees from vaccine court while launching precisely what it was designed to avoid: lawsuits against vaccine manufacturers.

This shift in legal strategy has fueled Kennedy’s crusade against Merck, and it could end up hurting some vaccine-injured clients, several experts said.

University of California Law-San Francisco professor Dorit Reiss has studied vaccine court for over a decade and has tracked the rise of anti-vaccine forces in American politics. She said VICP attorneys who are also suing vaccine makers have “incentives to direct more people” to lawsuits, “when it might not be in their best interest.”

A Delicate Balance

Kennedy has criticized the VICP as a barrier to accountability. But for Bostic, vaccine court offered an opportunity to hold the government to its promise of caring for casualties of widespread immunization.

Like any medication, vaccines can have side effects. Serious reactions to routine shots are rare, but for the unlucky few who bear this burden, the government promises recourse through its administrative program.

Vaccine court aims to strike a balance between protecting public health and helping individuals who may pay its price. The no-fault program allows claimants with vaccine-related injuries to get help without showing that the vaccine maker did anything wrong, even when the evidence doesn’t meet courtroom standards.

The program has made more than 12,500 awards, totaling roughly $5 billion in compensation. Historically, nearly half of claims have been resolved with some kind of award.

If patients aren’t satisfied with the outcome or don’t get a ruling within 240 days, they may leave the administrative program and sue the vaccine maker in civil court. Plaintiffs could potentially win larger awards. Lawyers could obtain higher fees, which they can’t in vaccine court.

But winning a civil suit is far more difficult, in part because plaintiffs have a greater burden of showing the vaccine caused their injury and that the maker was at fault. Since the VICP was created, no vaccine injury lawsuit has won a judgment in regular court, records show.

That hasn’t stopped some lawyers from trying. After the requisite 240 days, they have transferred hundreds of VICP claims into civil litigation against HPV vaccine manufacturer Merck, the KFF Health News analysis found.

The lawyers who represented those claims include Downing and other VICP attorneys with ties to Kennedy, court records show. Those include Kennedy advisers and people who work in the law office of his longtime personal lawyer Aaron Siri or with Children’s Health Defense, the anti-vaccine outfit Kennedy founded, as well as a former Kennedy co-counsel in suits against Merck over its HPV vaccine, Gardasil.

Downing, whose law firm biography describes him as “one of the preeminent litigation attorneys in the Court of Federal Claims,” has not won an HPV vaccine injury claim in the past five years, records show. Vaccine court did compensate dozens of HPV vaccine claims in that time, but most — including nearly all of Downing’s — were withdrawn upon reaching the opt-out period.

VICP data and court records show that over the past five years, Downing and other lawyers withdrew roughly 400 Gardasil claims from vaccine court before a ruling was issued. The plaintiffs received nothing from the program. Hundreds of these cases joined the litigation against Merck, according to court records.

Once the opt-out period arrived in Bostic’s case, Downing informed her that he was preparing to withdraw her son’s claim and move the case back to the original law firm for a lawsuit against Merck.

“That,” he wrote in an email, “was the plan all along.”

Fighting for Compensation

Thomas, who hopes to enroll in community college and become a computer programmer, has intermittent numbness in his fingers and stabbing sensations in his arm nearly every day. The pain often radiates across his back or up his neck, and he’s developed migraines. Once an active kid who dreamed of playing basketball professionally, he now spends his time playing video games and trying to sleep during lulls in his pain.

Bostic’s claim on behalf of her son made him one of about 1,000 people who have filed with vaccine court for HPV vaccine injuries. More than 200 have received compensation — just over one for every million shots given. Court records show program awards were typically $50,000 to $100,000, with some also covering past medical bills or future health care expenses.

Richard Hughes IV, a health care attorney and former pharmaceutical executive who teaches vaccine law at George Washington University Law School, reviewed Thomas’ records and said cases like his were exactly what the vaccine program was designed to address.

“That just seems straightforward,” Hughes said of Thomas’ claim. “That should have gotten compensated.”

Bostic wanted the federal agencies that had approved and recommended Gardasil to answer for her son’s injuries. The single mother hoped compensation from the program would allow Thomas to see specialists including neurologists, afford natural treatments, and enroll in physical therapy.

“He would have had the best of the best health care,” she said.

When Downing took their case, Bostic said, he told her during a phone call that vaccine court’s $250,000 limit on pain and suffering was too low for her son’s injury. Bostic said Downing advised she could get more money by suing Merck, though that could take longer.

“I said, ‘No, that will take years. My son needs help now,’” Bostic recalled.

Bostic said she told Downing she wanted a fund set up for Thomas’ health care as soon as possible.

In the following weeks, Bostic sent paperwork to Downing’s office but had difficulty getting in touch with him, email and text messages show. Downing’s billing records show a gap in his work on the case from late September until mid-November.

In November 2022, Downing emailed Bostic, “The opt out date for K.T.’s case is set for April 23, 2023. At that point, we will be in a position to opt K.T.’s case out of the Vaccine Program and move the case back over to the Carlson Law Firm for handling in the Merck litigation.”

Bostic said she was confused at the time by that language. But she remembers being emphatic in a follow-up phone call with Downing, repeatedly telling him she would not opt out.

After that, Bostic said, she didn’t hear from Downing for months despite calling his office and leaving messages with secretaries.

Downing’s billing records show that he and his paralegals spent fewer than nine hours on Bostic’s case in that stretch. This included time spent requesting, reviewing, and filing medical records, as well as drafting and filing extension requests. The billing records did not include any communication with Bostic during that time.

The court granted each of Downing’s extension requests, pushing back the deadline a month at a time.

In April 2023, Downing sent Bostic an email noting that 240 days had passed, so he could drop their government claim and they could sue Merck.

“Gardasil cases do not receive very fair treatment in the Vaccine Program,” Downing wrote, adding that he would withdraw as her attorney if Bostic stayed in the program.

Bostic chose to stick with vaccine court, later telling the vaccine court judge by email that she’d advised her attorney “I was not trying to become a millionaire.”

That exchange of emails in April is when Bostic said she learned Downing was already representing plaintiffs in lawsuits over Gardasil. The litigation encompassed hundreds of other patients who — most of them under Downing’s counsel — had filed VICP claims in recent years.

Running out the 240-day clock, critics say, is allowed but subverts the program’s intent.

Some legal experts criticize the way Downing handled Bostic’s case.

“They trusted him to file the VICP case,” Reiss said. “It’s his job to zealously advocate for his clients. In this case, his clients want to go through VICP. It’s his job to fight for them in VICP, not to wait for 240 days.”

When Downing joined HHS as a senior adviser to Kennedy, court records show, he handed off his remaining vaccine court cases to other attorneys in firms involved in the litigation against Merck.

A New Approach

The vaccine program has long faced criticism for giving claimants too little, too late. Even VICP advocates see the need for reform, with eight officials deciding a growing backlog of claims, driving up wait times. The cap on pain and suffering payments has not changed since 1986. But the court can award further compensation like a fund for lifetime medical care that can reach millions.

Most vaccine-injured individuals are better off in the administrative program than in civil litigation, legal experts said.

Renée Gentry, director of GWU’s Vaccine Injury Litigation Clinic and a founding member of the Vaccine Injured Petitioners Bar Association, has represented hundreds of families alleging vaccine injuries. Most of them, she said, aren’t focused on big payouts; rather, they “want their kid taken care of or they want to be taken care of.”

For claims that often fail in vaccine court, however, Gentry said a lawsuit may be the best option. According to Gentry, HPV vaccine claims like Thomas’ are particularly challenging to win in the VICP.

“If you’re not going to win, then you want those clients to have at least an opportunity at something,” she said.

For Mark Sadaka, a prominent vaccine court lawyer representing some claims in Merck litigation, sending clients to regular court is a last resort.

Sadaka said certain Gardasil injury claimants, such as those alleging mental rather than physical harm, might be better off in litigation. But by sticking it out in the VICP, Sadaka has won HPV vaccine injury claims that were the first of their kind, including for narcolepsy, alopecia, and even a deadly arrhythmia.

“He’s going to get taken care of for the rest of his life,” Sadaka said of his client who won compensation for narcolepsy in 2023. “And he doesn’t have to pay me anything.”

Sadaka, like all program lawyers, gets an hourly rate from the VICP. He said that he could make much more money representing the same claims in traditional litigation, since he could get a cut of any awards.

“It’s a better thing for me to file in regular court and get a higher fee, but for the client, sometimes it makes sense, sometimes it doesn’t,” Sadaka said. “My role is to explain both sides in gross detail for them and give them as much information as possible so they can make an informed decision.”

According to Sadaka, some lawyers in the VICP automatically advise their clients to leave vaccine court and file a lawsuit.

“If they can extract settlements, they’re going to be very happy to put that money in their pockets,” Hughes noted.

Winning a lawsuit or reaching a major settlement could also spell trouble for nationwide vaccine access, replaying the events that gave rise to vaccine court in the 1980s.

Some vaccine lawyers and policymakers believe Kennedy and his colleagues might welcome a return to those days.

“If they can bring down the system, that’s a feather in their cap,” Hughes said.

Lawyers cannot win contingency fees in vaccine court. They get paid for time spent on reasonable claims whether they win or lose. Downing made more than $1 million representing clients before the VICP in recent years, according to court records.

A January VICP report shows that since fiscal year 2020, the program has paid scores of attorneys about $280 million — including over $43 million for cases they did not win.

In each of the last two fiscal years, lawyers got roughly $9 million for VICP claims in which their clients got nothing. That was more than the program had ever previously paid to attorneys for unsuccessful claims, according to vaccine court data.

‘Learning How To Cope’

After discovering her attorney would not pursue VICP compensation for her son, Bostic decided to advocate for Thomas herself.

“Please help me,” she wrote in a letter to the court.

VICP staff gave Bostic extra time to find a new lawyer and gather records.

The following months proved difficult for the family. Bostic was hospitalized with a life-threatening condition. Her mother’s health declined. She was laid off and lost her family’s health insurance.

By the time Bostic could take Thomas to a pediatric neurologist to get medical records for his VICP case, she said, the doctor had moved hours away to Orlando.

Bostic repeatedly missed deadlines and failed to communicate with program staff as required, court records show. Emails, docket entries, and letters suggest she may have misunderstood some court orders and not received others.

When Thomas’ medical records remained incomplete for another year, the presiding official dismissed Bostic’s claim, writing that while he had sympathy for what she and her son had endured, “the case cannot be allowed to remain pending indefinitely.”

Thomas said he can no longer play basketball with friends. He can’t even help his mother carry groceries into the house.

“I got to live with this, and there’s pain,” he said.

Bostic now works from home as a bank fraud analyst. With an income just above the cutoff for government assistance, she puts in overtime in hopes of affording health insurance for Thomas and her six other children.

“People are asking, ‘How’s your son doing?’” Bostic said. “I normally say, ‘Still the same. We just learning how to cope with it.’”

Methodology

The KFF Health News analysis began with court records for cases in the U.S. Court of Federal Claims, which includes vaccine court. We first identified all cases since 2006 (when the HPV vaccine was introduced) in which the “nature of suit” field explicitly mentioned human papillomavirus, or in which “nature of suit” was categorized as “other” vaccine injury/death and the case text included the word “papillomavirus.” The latter made up about 10% of identified cases, mostly claims filed before the HPV vaccine was added to the program or claims involving multiple vaccines. We cross-referenced the number of cases with data from VICP reports to verify completeness.

After identifying the relevant vaccine court cases, we pulled these claims’ filing and closing dates and took the difference to find the number of days that each case spent in vaccine court. To estimate total attorneys fees awarded for these claims, we added the fee amounts recorded in dozens of the VICP rulings and derived a minimum estimate based on the number of such cases.

We then searched federal court records for litigation over Merck’s HPV vaccine, Gardasil, and pulled the names of the plaintiffs and attorneys involved. To gauge the scale of claims diverted from the VICP to litigation, we searched for each attorney in the Gardasil-related vaccine court cases and searched for the last name of each plaintiff in the titles of those cases.

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“It’s just the cost of doing business with our borders being somewhat porous for global and international travel,” Abraham said. “We have these communities that choose to be unvaccinated. That’s their personal freedom.”

Infections from other countries, however, accounted for only about 10% of measles cases detected since Jan. 20, 2025, the official start of the deadly measles outbreak in West Texas, which spread to other states and Mexico. The rest were acquired domestically. This marks a change since the U.S. eliminated measles in 2000. Measles occasionally popped up in the U.S. from people infected abroad, but the cases rarely sparked outbreaks, because of extremely high rates of vaccination. Two doses of the measles, mumps, and rubella vaccine strongly prevent infection and halt the virus’s spread.

To maintain its measles elimination status, the U.S. must prove that the virus has not circulated continuously in the nation for a year, between Jan. 20, 2025, and Jan. 20, 2026. To answer the question, scientists are examining whether the major outbreaks in South Carolina, Utah, Arizona, and Texas were linked.

Health officials confirmed that the main measles virus strain in each of these outbreaks is D8-9171. But because this strain also occurs in Canada and Mexico, CDC scientists are now analyzing the entire genomes of measles viruses — about 16,000 genetic letters long — to see whether those in the United States are more closely related to one another than to those in other countries.

The CDC expects to complete its studies within a couple of months and make the data public. Then the Pan American Health Organization, which oversees the Americas in partnership with the World Health Organization, will decide whether the U.S. will lose its measles elimination status. And that would mean that costly, potentially deadly, and preventable measles outbreaks could become common again.

“When you hear somebody like Abraham say ‘the cost of doing business,’ how can you be more callous,” said pediatrician and vaccine specialist Paul Offit, in an online discussion hosted by the health blog Inside Medicine on Jan. 20. “Three people died of measles last year in this country,” Offit added. “We eliminated this virus in the year 2000 — eliminated it. Eliminated circulation of the most contagious human infection. That was something to be proud of.”

Abraham said vaccination remains the most effective way to prevent measles but that parents must have the freedom to decide whether to vaccinate their children. Several states have loosened school vaccine requirements since 2020, and vaccine rates have dropped. A record rate of kindergartners, representing about 138,000 children, obtained vaccine exemptions for the 2024-25 school year.

Information on vaccines has been muddied by Health and Human Services Secretary Robert F. Kennedy Jr., who previously founded an anti-vaccine organization. He has undermined vaccines throughout his tenure. On national television, he has repeated scientifically debunked rumors that vaccines may cause autism, brain swelling, and death.

Jennifer Nuzzo, director of the Pandemic Center at Brown University, disparaged the Trump administration’s focus on finding genetic technicalities that may spare the country’s measles-free status. “This is the wrong thing to pay attention to. Our attention has to be on stopping the outbreaks,” she said.

“If we keep our status, it should be because we have stopped the spread of measles,” she said. “It’s like they’re trying to be graded on a curve.”

The Trump administration impeded the CDC’s ability to assist West Texas during the first critical weeks of its outbreak and slowed the release of federal emergency funds, according to KFF Health News investigations. However, the agency stepped up its activity last year, providing local health departments with measles vaccines, communication materials, and testing. Abraham said HHS would give South Carolina $1.5 million to respond to its outbreak, which began nearly four months ago and had reached 646 cases as of Jan. 20.

If the CDC’s genomic analyses show that last year’s outbreaks resulted from separate introductions from abroad, political appointees will probably credit Kennedy for saving the country’s status, said Demetre Daskalakis, a former director of the CDC’s national immunization center, who resigned in protest of Kennedy’s actions in August.

And if studies suggest the outbreaks are linked, Daskalakis predicted, the administration will cast doubt on the findings and downplay the reversal of the country’s status: “They’ll say, who cares.”

Indeed, at the briefing, Abraham told a reporter from Stat that a reversal in the nation’s status would not be significant: “Losing elimination status does not mean that the measles would be widespread.”

Data shows otherwise. Case counts last year were the highest since 1991, before the government enacted vaccine policies to ensure that all children could be protected with measles immunization.

Lauren Sausser contributed reporting.

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They wrote that the claims and policy changes in the memo from Vinay Prasad, the head of the FDA’s Center for Biologics Evaluation and Research, pose “a threat to evidence-based vaccine policy and public health security” and break sharply from long-standing scientific norms.

What is unfolding inside the FDA is not a narrow dispute over covid vaccines. It is an attempt, according to critics and vaccine scientists, to rewrite the rules governing the entire U.S. vaccine system — how risks are weighed, how benefits are proved, and how quickly lifesaving shots reach the public. Former agency leaders warn that if these changes take hold, the consequences could be lasting: fewer vaccines, slower updates, weakened public trust, and more preventable outbreaks.

Prasad made clear he sees the moment as corrective. “Never again will the US FDA commissioner have to himself find deaths in children for staff to identify it,” he wrote, telling employees the agency’s mission, and its “worldview,” would change.

Prasad’s email reopened old arguments about covid vaccines, using what is generally considered weak and misleading science in the peer-reviewed research community. He claimed that FDA staff had found “at least 10” deaths in children that happened “after and because of” covid vaccination, using reports from the Vaccine Adverse Event Reporting System.

The VAERS system is notoriously crowdsourced, meaning anyone can contribute, and scientists say it serves only as a clearinghouse for reports. For example, a person could file a report saying that after getting a flu shot, their hair turned purple. Though that report would remain in the database until it was reviewed, it cannot prove the cause of medical events. But Prasad argued that the true number of deaths was likely higher because many cases go unreported.

On Substack, Inside Medicine reported Dec. 11 that Prasad used incomplete information and that a Dec. 5 internal FDA memo set the pediatric death toll from covid shots somewhere between zero and seven. Department of Health and Human Services spokesperson Emily Hilliard wrote, “The FDA’s investigation into deaths caused by Covid vaccines is still ongoing and there’s no final count yet of those deaths.”

Prasad also accused the FDA and the Centers for Disease Control and Prevention of downplaying the risk of heart inflammation, called myocarditis, in young men; criticized the agency for approving shots for teenagers; and suggested that school and workplace vaccine mandates may have “harmed more children than we saved,” adding that “we do not know if we saved lives on balance.”

By comparison, more than 2,100 American children died of covid itself since the pandemic began, the CDC reported.

Based on his erroneous and misleading claims about covid vaccines, Prasad proposed a major overhaul of how vaccines are approved. He said the FDA should stop relying on immune markers to establish the efficacy of shots, such as antibody levels, and instead require large placebo-controlled randomized trials that track hospitalizations and deaths before approving most new vaccines.

Many immunologists and vaccine experts say it’s unethical to test vaccines known to be effective against disease with a control group that would receive a placebo, exposing them to infection.

“There is a rock-solid principle in bioethics that it is unethical to test any drug or vaccine against a placebo if it is known to be safe and effective. The reason is that such placebo-controlled trials would effectively deny patients access to a vaccine that could prevent a dangerous infectious disease,” said Lawrence Gostin, a professor of global health law at Georgetown University.

Prasad called the current flu vaccine system an “evidence-based catastrophe,” questioned the approval of vaccines for pregnant women based on immune response alone, and raised concerns about giving multiple vaccines at once. He told staff to rewrite FDA guidelines to match his new “worldview” and said anyone who disagreed with his “core principles” should resign.

The former FDA leaders expressed alarm in the NEJM article. They said Prasad is exploiting public frustration over the federal response to covid to spark doubt about the entire childhood vaccine system, which could undo decades of success in protecting children from deadly diseases.

“This is really different. And it’s really dangerous. And people will be hurt, particularly by the vaccine decisions,” former FDA commissioner Robert Califf said in an interview. He also warned that Prasad’s proposed policies — which he noted echo positions on vaccines held by Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist — could shake the entire vaccine market.

“The goal of RFK seems to be to make it impossible for vaccines to be available in the U.S.,” he said. If the proposals advance, he added, “it won’t be a viable business.”

Hilliard pushed back sharply on those concerns, writing: “The American people deserve evidence-based science. Prasad’s email lays out a philosophical framework that points us toward that higher standard. We will soon release documents laying out that framework and data confirming how the COVID vaccine resulted in children’s deaths that previous leadership failed to properly investigate.”

For generations, the childhood vaccine program has depended on clear rules, strong safety systems, and public trust. Experts say Prasad’s ideas, based on claims they argue are not supported by real evidence, could make it much harder to test, approve, and deliver vaccines to families.

Fueling Parental Doubt

Prasad’s memo indicates he considers VAERS reports as proof that vaccines caused children’s deaths. The system, though, is designed to be only an “early warning system” for potential safety issues with vaccines that can be investigated further.

“VAERS signals should never be taken as proof of true vaccine risks without careful, confirmatory studies,” said Katherine Yih, an epidemiologist and longtime investigator with the Vaccine Safety Datalink, a CDC program.

Doing so, scientists say, directly feeds public fear at a time when many parents are already unsure whom to trust.

“Causation requires converging evidence, not just one report or coincidence,” said Robert Hopkins, medical director of the National Foundation for Infectious Diseases.

Prasad’s framework, however, treats uncertainty as a reason to halt development entirely.

Experts fear this doubt won’t stay limited to covid vaccines. Once parents start to question the FDA’s honesty, they may begin doubting long-standing vaccines for measles, polio, or whooping cough — shots that have protected children for decades.

“Science must be transparent,” Gostin said. If families believe the FDA is misusing data or silencing experts, confidence in the entire vaccine system can collapse, he said. “There’s a public narrative that people have lost trust in science, but that’s not true. The vast majority want the FDA to make decisions based on the best scientific evidence. Once they believe that the agency is marginalizing scientists and cherry-picking evidence, their trust will plummet.”

Delicate Vaccine Pipeline

Prasad’s new framework will likely make it far harder for companies to produce or update vaccines. The 12 former FDA commissioners warned that requiring clinical trials for all new or updated shots would slow vaccine improvements and leave people unprotected. His plan, they wrote, “would impede the ability to update vaccines in a timely fashion, especially for respiratory viruses.”

For fast-changing viruses like flu and covid, this could be disastrous. There’s simply not enough time to run full clinical trials every time a virus mutates.

There are also major business effects. Vaccine development is costly, and companies may decide the U.S. is no longer worth the risk. If companies slow down or leave the market, families could face shortages, fewer innovations, and fewer protections for their kids.

‘Checks and Balances’

Science depends on open and public debate. Prasad’s memo warned his employees against it. In addition to demanding that FDA staff members who disagree with him resign, he said their disputes should stay private and called leaks “unethical” and “illegal.”

Susan Ellenberg, a former director of the FDA’s Office of Biostatistics and Epidemiology, warned that Prasad risks destroying the process that makes science credible. “If disagreement is treated as disloyalty, you lose the only mechanism that keeps science honest,” she said.

Without strong internal debate, safety reviews become weaker. “You lose the checks and balances that make vaccine safety science credible,” said Kathryn Edwards, a pediatric infectious disease specialist at Vanderbilt University Medical Center who served on the Clinical Immunization Safety Assessment Network during the covid pandemic.

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The enhanced premium tax credits that since 2021 have helped millions of Americans pay for insurance on the Affordable Care Act marketplaces will expire Dec. 31, despite a last-ditch effort by Democrats and some moderate Republicans in the House of Representatives to force a vote to continue them. That vote will happen, but not until Congress returns in January.

Meanwhile, the Department of Health and Human Services canceled a series of grants worth several million dollars to the American Academy of Pediatrics after the group again protested HHS Secretary Robert F. Kennedy Jr.’s changes to federal vaccine policy.

This week’s panelists are Julie Rovner of KFF Health News, Lizzy Lawrence of Stat, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• The House on Wednesday passed legislation containing several GOP health priorities, including policies that expand access to association health plans and lower the federal share of some Affordable Care Act exchange marketplace premiums. It did not include an extension of the expiring enhanced ACA premium tax credits — although, also on Wednesday, four Republicans signed onto a Democratic-led discharge petition forcing Congress to revisit the tax credit issue in January.
• In vaccine news, the American Academy of Pediatrics spoke out against the federal government’s recommendation of “individual decision-making” when it comes to administering the hepatitis B vaccine to newborns — and HHS then terminated multiple research grants to the AAP. Meanwhile, the Centers for Disease Control and Prevention is funding a Danish study of the hepatitis B vaccine in West Africa through which some infants will not receive a birth dose, a strategy that critics are panning as unethical.
• Also, a second round of personnel cuts at the Department of Veterans Affairs is expected to exacerbate an existing staffing shortage and further undermine care for retired service members.
• The FDA is considering rolling back labeling requirements on supplements — a “Make America Health Again”-favored industry that is already lightly regulated.
• And abortion opponents are pushing for the Environmental Protection Agency to add mifepristone to the list of dangerous chemicals the agency tracks in the nation’s water supply.

Also this week, Rovner interviews Tony Leys, who wrote the latest “Bill of the Month” feature, about an uninsured toddler’s expensive ambulance ride between hospitals.

Plus, for a special year-end “extra-credit” segment, the panelists suggest what they consider 2025’s biggest health policy themes: 

Julie Rovner: The future of the workforce in biomedical research and health care. 

Lizzy Lawrence: The politicization of science. 

Tami Luhby: The systemic impacts of cuts to the Medicaid program. 

Alice Miranda Ollstein: The resurgence of infectious diseases. 

Also mentioned in this week’s podcast:

• The Washington Post’s “American Academy of Pediatrics Loses HHS Funding After Criticizing RFK Jr.,” by Lena H. Sun and Paige Winfield Cunningham.
• MedPage Today’s “FDA Vax Chief Jumped the Gun on Claims of Kid Deaths From COVID Shots,” by Jeremy Faust.
• The Washington Post’s “VA Plans To Abruptly Eliminate Tens of Thousands of Health Care Jobs,” by Meryl Kornfield, Hannah Natanson, and Lisa Rein.
• NBC News’ “FDA Says It May Relax Warning Label Rule for Dietary Supplements,” by Berkeley Lovelace Jr.
• Politico’s “New Anti-Abortion Campaign Takes Aim at EPA Drinking Water Rules,” by Alice Miranda Ollstein and Ariel Wittenberg.
• The Washington Post’s “What Happened When Dr. Oz Took Charge of a Wonky Health Agency,” by Paige Winfield Cunningham.
• Politico’s “Dr. Oz Makes His Mark,” by Joanne Kenen.

[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 KFF Health News and WAMU Public Radio in Washington, D.C., and welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Dec. 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 video conference by Tami Luhby of CNN. 

Tami Luhby: Hello. 

Rovner: Alice Ollstein of Politico. 

Alice Miranda Ollstein: Hi, there. 

Rovner: And I am pleased to welcome to the podcast panel Lizzy Lawrence of Stat News. Lizzy, so glad you’ll be joining us. 

Lizzy Lawrence: Thanks so much for having me. I’m excited. 

Rovner: Later in this episode, we’ll have my interview with Tony Leys, who reported and wrote the latest KFF Health News “Bill of the Month” about yet another very expensive ambulance ride. But first, this week’s news. 

Well, remember when House Speaker Mike Johnson complained during the government shutdown that the issue of the additional ACA [Affordable Care Act] subsidies expiring was a December problem? Well, he sure was right about that. On Wednesday, the House, along party lines, passed a bill that Republicans are calling the “Lower Healthcare Premiums for All [Americans] Act,” which actually doesn’t, but we’ll get to that in a moment. Notably, not part of that bill was any extension of the enhanced tax credits that now are going to expire at the end of this year, thus doubling or, in some cases, tripling what many consumers who get their coverage from the ACA marketplaces will have to pay monthly starting in January. Speaker Johnson said he was going to let Republican moderates offer an amendment to the bill to continue the additional subsidies with some changes, but in the end, he didn’t. 

So, four of those Republicans, from more purple swing districts worried about their constituents seeing their costs spike, yesterday signed on to a Democratic-led discharge petition, thus forcing a vote on the subsidies, although not until Congress returns in January. Before we get to the potential future of the subsidies though, Tami, tell us what’s in that bill that just passed the House. 

Luhby: Well, there are four main measures in it, but none of them, as you say … they will lower potentially some premiums for certain people, but they’re really a bit of a laundry list of Republican favorite provisions. 

So, one of the main ones is association health plans. They would allow more small businesses — and, importantly, the self-employed — to band together across industries. This could lower health insurance premiums for some people, but these plans also don’t have to adhere to all of the ACA protections and benefits that are offered. So, it may attract more healthier people or be more beneficial for healthier people, but not for everyone, for sure. 

There are some PBM, pharmacy benefit manager, reforms. They would have to provide a little more information to employers about drug prices and about the rebates they get, but it may not really have … the experts I spoke to said it’s really just tinkering around at the edges and may not be that consequential. 

Rovner: And it’s not even as robust a PBM bill as Republicans and Democrats had agreed to last year … 

Luhby: Exactly. 

Rovner: … that Elon Musk got struck at the last minute because the bill was too long. 

Luhby: Exactly, it’s a narrower transparency. There are narrower transparency provisions. It would also, importantly, refund the cost-sharing provisions. And remember, there are two types of subsidies in the Affordable Care Act. There are the premium subsidies, which is what everyone is talking about, the enhanced premium subsidies. But these are cost-sharing reductions that lower-income people on the exchanges receive to actually reduce their deductibles and their copayments and coinsurance, their out-of-pocket expenses. 

President [Donald] Trump, during his first term, in an effort to weaken the Affordable Care Act, ended the federal funding for these cost-sharing subsidies, but the law requires that insurers continue to provide them. So what the insurers did was they increased the premiums of the “silver” plans in order to make up some of the difference, but those silver plans, remember, are tied to … the cost of those silver plans are what determines the premium subsidies that people get. So, basically, by refunding or by once again funding these cost-sharing subsidies, insurers will lower the premiums for those silver plans, which will, in turn, lower the premium subsidies that the government has to pay and save the government money. 

The people in silver plans probably won’t be affected as much, but what happened after Trump ended the cost-sharing subsidy funding is that with these increased premium subsidies that are tied to the silver plans, a lot of people were able to buy “gold” plans. They were able to buy better plans for less because they got bigger premium subsidies, or they were able to buy “bronze” plans for really cheap. So basically, this provision will end, will reduce the premium assistance that people get, and it’ll effectively raise premium payments for people in a lot of plans, which will make it more difficult for them. 

Rovner: Which was a wonderful explanation, by the way, of something that’s super complicated. 

Luhby: Thank you. 

Rovner: But I’ve been trying to say it basically moves money around. It takes money that had been … it lowers how much the federal government will have to pay, while at the same time loading that back onto consumers. 

Luhby: Right. 

Rovner: So, hence my original statement that the “Lower Premiums for All” Act doesn’t lower premiums for all. So, this is … 

Luhby: No, there’ll be a lot of people in gold and bronze and “platinum” plans who will be paying a lot more, or they’ll have to, if they’re in gold, they may have to shift to silver, which means they’ll just be paying more out-of-pocket when they actually seek care. 

And then there’s a fourth provision that’s not as consequential: It’s called choice plans. It’s to help employers give … it’s to make it easier for employers to give money to people to buy coverage on the exchanges. 

Rovner: Yeah, which I think nobody disagrees with. But Alice, there’s another even catch to the cost-sharing reductions, which is that it’s only for states that ban abortion or that don’t ban abortion. Now I forget, which is it? 

Ollstein: So, it’s, yeah. So the great compromise of the Affordable Care Act was that it’s up to states whether to allow, require, or prohibit plans on the Obamacare exchanges from covering abortion. And as states do, they went in different directions, so about half ban it and about the other half, it’s 50-50 on requiring abortion coverage and just allowing it, leaving it up to individual plans. And so yes, this provision sought to penalize states that allowed abortion. And so, it’s expanding the definition of the Hyde Amendment from where it was before, basically saying if any federal funding is going to a plan that uses other money to pay for abortion, then that counts as funding abortion, even though the money is coming out of different buckets. 

And so, this has been a big fight on Capitol Hill this year. And as I wrote yesterday, it’s nowhere near being resolved. I mean, even if lawmakers were going to come together on everything else related to the subsidies, which they are not, the abortion debate was still in the way as an impediment, including in the Senate as well. 

Rovner: Yeah. So, what are the prospects for these additional subsidies? And I should go back and reiterate that what Tami and I were talking about were the original tax credits that were passed with the Affordable Care Act, not the enhanced ones, the bigger tax credits that are expiring at the end of the year. So, Republicans have now forced this vote, so we know that the House is going to vote on extending these subsidies — in January, after they’ve expired, which is a whole issue of complication itself. But I mean, is there any prospect for a compromise here? Might they go home and get enough pushback from constituents who are seeing their costs go up so much they’re going to have to drop their insurance that they might change their minds? 

Ollstein: Well, Democrats and advocacy groups are trying to ramp up that pressure. We’ve been covering some ad campaigns and efforts. Democrats are holding town halls in Republican districts where the representatives are not holding town halls to shine a light on this. They’re highlighting the stories of individual, sympathetic-character folks who are having their premiums go way up. 

So, there were press conferences just this week I saw with retirees and people who are on Social Security Disability and small-business owners and single parents, and it’s not hard to find these stories; this is happening to tens of millions of people. And so, I think this is going to be a major, major political message going into next year. Whether it’s enough to make Republicans who are still so ideologically opposed to the Affordable Care Act agree on some kind of an extension, that remains to be seen. And we really haven’t, despite the defection of a small handful this week in joining the Democrats on an extension — which was really notable and a sign that Speaker Johnson is not keeping his caucus in array. But the vote hasn’t happened yet, and we’ll see if spending time back in the districts over the holidays makes people more or less willing to compromise. It can go either way. 

Rovner: I saw a lot of people yesterday saying that, Well, even if the House were to pass the clean three-year extension of the enhanced subsidies — which is what’s in the Democrats’ bill — the Senate just voted on it last week and voted it down, so it wouldn’t have any chance. To which my response was, “Hey, Epstein files.” When the jailbreak happened in the House on that, the Senate voted, I believe, unanimously for it. So, things can change in the Senate. Sorry, Tami, I interrupted you; you wanted to say something. 

Luhby: No, I was just going to say that yes, things can certainly change and there have been surprises before, but this is obviously also not a new issue. I mean, the Democrats have been running ads, people have been speaking out. We have all been writing stories about the cancer survivors or cancer patients who may have to drop their coverage in the middle of their treatment because they can’t afford the new premiums, or all of these stories. So, none of this is new, but we’ll see. There’s obviously … what is somewhat new is the administration’s message on increasing affordability, and this is a huge affordability issue. So, maybe that will spur some change in votes or change in mindset. 

Rovner: Well, definitely a January story too. 

Well, moving on to this week in vaccine news, the Centers for Disease Control and Prevention has made it official — after being blessed by the acting director of the agency, who is neither a doctor nor a public health professional — the U.S. government is no longer recommending a birth dose of the hepatitis B vaccine, which by the way, has been shown to reduce chronic hepatitis B in children and teenagers by 99% since the recommendation was first issued in 1991. 

And merging two stories from this week, there’s also news about the American Academy of Pediatrics, which has been among the most vocal medical groups protesting the vaccine schedule changes. The AAP said the hepatitis B change will “harm children, their families, and the medical professionals who care for them.” And in a move that seems not at all coincidental, the Department of Health and Human Services on Wednesday terminated seven federal grants to the AAP worth millions of dollars, for work on efforts including reducing sudden infant deaths, preventing fetal alcohol syndrome, and identifying autism early. According to The Washington Post, which broke the story, an HHS spokesman said the grants were canceled because they “no longer align with the Department’s mission or priorities.” 

First, this is not normal. Second, however, it’s HHS in 2025 in a microcosm, isn’t it? Either get with the program or get out. Lizzy, you’re nodding. 

Lawrence: Absolutely. Yeah, I think this has become very commonplace in this administration. And also interestingly, yesterday, the HHS posted in the federal register that the CDC offered a $1.6 million grant to a group of Danish researchers who study in Guinea, West Africa, to run a placebo-controlled trial of hepatitis B vaccine for newborns. And so, we’re seeing an active removal of funds from the American Academy of Pediatricians [Pediatrics], and then giving funds now to research. And this is a research group actually that RFK Jr. has cited their studies before, they study overall health effects of vaccines. And so, it will be really interesting to see if this is a trend that continues, if they’re kind of … we already know that HHS, the CDC’s vaccine panel, there’s been discussions about making our vaccine schedule closer to Denmark’s. Now there’s this money being given to Danish researchers who align with the way that they think about vaccines is similar to Kennedy and to another official at FDA, called Tracy Beth Høeg, who is also on the CDC’s panel as the FDA representative. So, yeah. 

Rovner: And who is Danish, I believe. 

Lawrence: Yes, her husband is Danish, and so she lived in Denmark for many years. 

Rovner: I saw some scientists complain about that study in Guinea-Bissau, because they say it’s actually unethical to use a placebo to study the hepatitis B vaccine because we know that it works. So if you’re giving a placebo to children, you’re basically exposing them to hepatitis B.  

Lawrence: Right. 

Ollstein: Yeah. I saw that too. And a lot of folks were saying this would never be approved to be done in the U.S. And so, doing it in another country is reminding people of colonial experiments in medicine that were really unethical and subjected people to more risks than would be allowed here. And like you said, basically knowingly withholding something that is safe and effective and giving someone a placebo instead. 

Another issue I saw raised was that it is not a double-blind study; it is a single-blind study. And so, that allows for potential biases there as well. 

Lawrence: Right. And I was also seeing that the Guinea Ministry of Health is planning to mandate a universal hep B dose in 2027. 

Rovner: Oops. 

Lawrence: So, that’s a crazy … yeah, you have babies born before that year who are not given this dose, and then after … so yeah, it raises all kinds of ethical concerns, and it’s just remarkable that the government would just pull away and offer this money to them. 

Rovner: HHS in 2025. Specifically on the covid vaccine, there were two stories this week. One is a study in the Journal of the American Medical Association that found that pregnant women vaccinated against covid-19 are less likely to be hospitalized, less likely to need intensive care, and less likely to deliver early, if they can track the virus, than those who are unvaccinated. And over at MedPage Today, editor Jeremy Faust, who’s both a doctor and a health researcher, says that FDA vaccine chief Vinay Prasad overstated his case when he said the agency has found at least 10 children who’ve died as a result of receiving the covid vaccine. Turns out the actual memo from the scientists assigned to research the topic concludes the number is somewhere between zero and seven, and five of those cases have only a 50-50 chance of being related to the vaccine. This isn’t great evidence for those who want to stop giving the vaccine to children and pregnant women, I would humbly suggest. 

Lawrence: Right, right. Yeah, the memo that Vinay Prasad sent, which was immediately leaked, was remarkable in that it included no data backing up his claims. And this is a really tricky area, when I’ve talked to scientists at the agency who focus on these issues. I think sometimes it’s hard to say that there are cases that are very subjective, and so this is a discussion that needs to be handled delicately, and it’s a really severe claim to say that this has killed 10 children. And so, that discussion needs to be shared transparently and allow for experts to really weigh in. 

Rovner: Yeah. Well, another issue that’s going to bleed over into January. All right, we’re going to take a quick break. We will be right back. 

So in other administration health news, it appears, at least according to The Washington Post, that the on-again, off-again cuts to medical personnel at the Department of Veterans Affairs are on again. The Post is reporting that the VA is planning to eliminate up to 35,000 doctors, nurses, and support personnel. That’s on top of a cut of 30,000 people earlier in 2025. Altogether, it’s about a 10% cut in total. Apparently, most of the positions are currently unfilled, but that doesn’t mean that they’re unneeded, particularly after Congress dramatically expanded the number of veterans eligible for health benefits by passing the PACT Act during the Biden administration. That’s the bill that allowed people to claim benefits if they were exposed to toxic burn pits. What is this second round of cuts going to mean for veterans’ ability to get timely care from the VA? Nothing good, I imagine. 

Luhby: Well, I’ve been speaking over the past year or two to a VA medical staffer, who wishes to remain anonymous for obvious reasons. And one thing they told me is that their boss, who was also a medical practitioner, took one of the retirements, and that they have to now cover their boss’ shift. And they’ve asked if the boss is going to be replaced because they obviously can’t do two people’s jobs well, and they’ve been told that the boss will not be replaced. 

There’s also, on top of all of this, there’s a hiring freeze and there’s restrictions in hiring. So, it’s been very difficult for agencies, including the VA, including the medical personnel, to get new people. And again, the person I’ve spoken to said that the veterans are not getting the care, as good care as they were last year because this person just can’t do two people’s jobs. And it’s on the medical side, but the source also said that it’s throughout the hospital with the support staff and even the custodial staff. I mean, just … there’s a lot of unfilled positions that are affecting overall care.  

Rovner: I feel like a big irony here is that during the first Trump administration, improving care at the VA and lowering the wait times was a huge priority for President Trump, not just for the administration. He talked about it all the time. And yet, here he’s basically undoing everything that he did for veterans during the first administration. 

All right. Well, meanwhile, NBC is reporting that the FDA is considering rolling back the rule that requires dietary supplement makers to note on their labels that their products have not been reviewed by FDA for safety and efficacy. This was a compromise reached by Congress after a gigantic fight over supplements in 1994 — I still have scars from that fight — following a series of illnesses and deaths due to tainted supplements a couple of years before that. The idea was to let supplements continue to be sold without direct FDA approval, as long as customers were informed that they were not intended to “diagnose, treat, cure, or prevent any disease,” a phrase that I’m sure you’ve heard many times in commercials. Of course, diet supplements are practically an article of faith for followers of the “Make America Healthy Again” movement. I would assume that this is part of RFK Jr.’s vow to loosen what he has called the “aggressive suppression” of vitamins and dietary supplements. Lizzy, you’re nodding. 

Lawrence: Yeah, this is super interesting because this was one of the first things a year ago, when RFK was announced as the HHS secretary, when people were speculating on what some of his priorities would be, deregulating supplements was a big one. And so, I think this will be a really interesting space to watch and see. And it’s emblematic, too, of the uneven view of products regulated by the FDA, where there are some products where there’s … that RFK and other leaders at the FDA are super “pro” and well, we don’t actually need as much evidence here. And then others, like vaccines or SSRIs [selective serotonin reuptake inhibitors], where it seems that they want to really raise evidence standards, which is not how the FDA is supposed to work. It’s supposed to be dispassionately, with no bias, reviewing medical products. 

Rovner: And I would point out, in case I wasn’t clear before, that supplements are barely regulated now. Supplements are regulated so much less than most everything else that the FDA regulates. Sorry, Alice, you wanted to say something. 

Ollstein: Yeah. It also, I think, reveals an interesting public perception issue, where the message that a lot of people are getting is that the pharmaceutical industry is this big, bad, evil corporate thing that is out to harm you, and it has all these documented harms, whereas supplements are natural and wellness and seen as the underdog and the upstart. And I think people should remember that supplements are a huge corporate industry as well, and, like Julie and Lizzy have been saying, regulated a lot less than pharmaceuticals. So, if you’re taking a prescription drug, it’s been tested a lot more than if you’re taking a supplement. 

Rovner: Yeah, absolutely. So while most of the coverage of HHS in 2025 has been pretty critical, this week, two of our fellow podcast panelists, Joanne Kenen and Paige Winfield Cunningham, have stories on how the breakout star at HHS in this first year of Trump 2.0 turns out to be Dr. Oz. Apparently being an Ivy League-trained heart surgeon with an MBA actually does give you some qualifications to run the agency that oversees Medicare, Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act. I think I noted way back during his confirmation hearings that he clearly already had the knack of how to deal with Congress: flatter them and take their parochial concerns seriously. That’s something that his boss, RFK Jr., has most certainly not mastered as of yet. And it turns out that Dr. Oz has both leadership and policy chops. Who could have predicted this going into this year? 

Luhby: Well, one thing that’s interesting is that we were all, I think, watching what Dr. Oz would do with Medicare and Medicare Advantage, because it’s obviously something that he had promoted on his shows. It’s something that the Biden administration was trying to crack down on. And it has been interesting that he has not been giving carte blanche to the insurers. He has been cracking down on them as well. I listened to a speech that he gave before the Better Medicare Alliance, which is the group that works with Medicare Advantage insurers. And he said basically, “You guys have to step up,” and so, it’ll be interesting to see going forward what additional measures they take. But yeah, he’s certainly not bending over to the insurers. 

Rovner: Yeah. I will say, like I said, I noticed from the beginning, from when he came to his confirmation hearing, that somebody had briefed him well. Apparently, according, I think it was in Joanne’s story, he’s been talking regularly to his predecessors from both parties about how to run the agency, which surprised me a little bit. I will be interested to see how this all progresses, but if you had asked me to bet at the beginning of the year of the important people at HHS who were running these agencies who would do the consensus best job, I’m not sure I would’ve had Dr. Oz at the top of my list. 

Luhby: Well, and one thing to also point out that was really interesting in Paige’s story, particularly, is that what we’ve been hearing at other agencies — the CDC, and across the Trump administration — that a lot of the political appointees are really at odds with the staff. They’re not communicating with the staff; there were concerns about that after the CDC shooting over the summer. And one thing that, obviously, Dr. Oz is very personable, he knows how to reach out to an audience. And in this case, his audience is also his staff. And it was notable that Paige detailed about how he really is interacting a lot with the staff. And I’m sure that’s obviously helping morale and helping the mission at CMS. Also, of course, it’s an agency that RFK has not focused on. 

Rovner: I say, what a shock, treating career staff with some respect, like they know what they’re doing. 

All right. Well, finally, we end this year on reproductive health, pretty much the same way we began it, with anti-abortion groups attacking the abortion pill, mifepristone. We know that despite the fact that abortion is now illegal in roughly half the states, the number of abortions overall has not fallen, and that is because of the easy availability, even across state lines, of medication abortion. Alice, you’ve got quite the story this week about an unusual way to go after the pill. Tell us about it. 

Ollstein: Yeah. So this is a trend I’ve been covering for the last few years, and it’s anti-abortion groups trying to use various environmental laws to achieve the ban on the pills that they want to achieve. And so, there’s been some various iterations of this over the years. The latest one is that groups are jumping on a EPA [Environmental Protection Agency] public comment process that’s going to kick off any day now. So, this is what the EPA does. Every few years, they update the list of chemicals that need to be tracked in water around the country. So this is a big deal. It costs a lot to track these chemicals. There can only be so many chemicals on the list. And these groups are trying to rally people around the country to demand that the EPA add mifepristone and its components to this list. 

Rovner: This is wastewater, right? Not drinking water? 

Ollstein: No, this is drinking water. 

Rovner: Oh, it is drinking water. 

Ollstein: There are other efforts to use wastewater laws to restrict abortion pills, yes. So we talked to scientists that say there is no evidence that mifepristone in the water supply is causing any harm whatsoever. On the other hand, there is tons of evidence of other chemicals, and so we have scientists in our story talking about how if they put mifepristone on this list, it would push out another more dangerous chemical from being on that list. 

So, just to zoom out a little bit, while this particular campaign tactic, whatever you want to call it, may not succeed, I think it’s part of a bigger project to sow doubt in the public’s mind about the safety of mifepristone in various ways. We’ve been seeing this all year, and for several years. But I think that this kind of gross-out factor of there’s abortions in the water! Even without scientific evidence of that, I think it contributes to the public perception. And KFF had some polling recently showing that doubt about the safety of the pills has increased over the past few years. And so, these kinds of campaigns are working in the court of public opinion, if not quite yet at federal agencies. 

Rovner: Another one we will be watching. All right, that is this week’s news. Now we’ll play my “Bill of the Month” interview with Tony Leys, and then we’ll come back and do our very special year-end extra credits. 

I am pleased to welcome back to the podcast KFF Health News’ Tony Leys, who reported and wrote the latest KFF Health News “Bill of the Month.” Tony, welcome back. 

Tony Leys: Thanks for having me, Julie. 

Rovner: So, this month’s patient had a very expensive ambulance ride, alas, a story we’ve heard as part of this series several times. Tell us who he is and what prompted the need for an ambulance. 

Leys: He is Darragh Yoder, a toddler from rural Ohio. He had a bacterial skin infection called [staphylococcal] scalded skin syndrome, which causes blisters and swelling. His mom, Elisabeth, took him to their local ER, where doctors said he needed to be taken by ambulance to a children’s hospital in Dayton, about 40 miles away. They put in an IV and then put him in the ambulance. His mom went with and said the driver didn’t go particularly fast or use the siren, but did get them there in about 40 minutes. 

Rovner: But it still was an ambulance ride. So, how big was the bill? 

Leys: $9,250. 

Rovner: Whoa. Now, this family doesn’t have insurance, which we’ll talk about in a minute. So, it wasn’t an in- or out-of-network thing. Was this unreasonably high compared to other ground ambulance rides of this type? 

Leys: It’s really hard to say because the charges can be all over the place, is what national experts told me. But if Darragh had been on Medicaid, the ambulance company would’ve been paid about $610, instead of $9,200. 

Rovner: Whoa. So, what eventually happened with the bill? 

Leys: The company agreed to reduce it about 40% to $5,600 if the family would pay it in one lump sum. They did, they wound up putting it on a credit card, a no-interest credit card, so they could pay it off overtime. 

Rovner: Now, as we mentioned, this family doesn’t have insurance, but they belong to something called a health sharing ministry. What is that? 

Leys: Members pool their money together and basically agree to help each other pay bills. And they were thinking that that would cover maybe about three-quarters of what they owed, so … 

Rovner: Have they heard about that yet? 

Leys: I have not heard. 

Rovner: OK. So, what’s the takeaway here? I imagine if a doctor says your kid who has an IV attached needs to travel to another facility in an ambulance, you shouldn’t just bundle them into your car instead, right? 

Leys: I sure wouldn’t. Yeah, no. I mean, at that point, she felt like she had no choice. I mean, she did say if she would’ve just driven straight to the children’s hospital instead of stopping at the local hospital, they would’ve gotten there sooner than if once she stopped at the local hospital and they ordered an ambulance. So, that’s in retrospect what she wishes she would’ve done. But if they’d had insurance, the insurer would’ve presumably negotiated a lower rate, and they wouldn’t have had to do the negotiation themselves. 

Rovner: So, they are paying this off, basically? 

Leys: Yeah, they paid it in one lump sum, which is a stretch for them, but they felt like they had no choice. 

Rovner: All right. Tony Leys, thank you very much. 

Leys: Thanks for having me, Julie. 

Rovner: OK, we’re back. It’s time for our extra-credit segment. That’s usually where we each recognize a story we read this week we think you should read too. But since this is our last podcast of the year, I wanted to do something a little bit different. I’ve asked each of our panelists to take a minute or two to talk about what they see, not necessarily as the biggest single health story of the year, but the most important theme that we’ll remember 2025 for. Tami, why don’t you start us off? 

Luhby: OK. Well, I think that Medicaid has been a big issue in 2025 and will continue to be going forward. Among the most consequential health policies enacted this year were the sweeping Medicaid changes contained in the One Big Beautiful Bill [Act], which Congress passed over the summer. The legislation enacts historic cuts to [the] nation’s safety net, with the biggest chunk coming from Medicaid, which serves low-income Americans. It would slash more than $900 billion from Medicaid, according to the Congressional Budget Office. About 7.5 million more people would be uninsured in 2034 due to these Medicaid provisions. And most of that spike would come from Congress adding work requirements to Medicaid for the first time. We know that that happened in 2018, states were trying to do … well, the Trump administration allowed certain states to do that. It really only took effect in Arkansas, and about 18,000 people lost coverage within months from the work requirements, many of whom, the advocates say, many people are working, they’re going to get caught up in red tape. They’re either working or they’re eligible for exemptions, but they’ll get caught up in red tape. 

So, what the Big Beautiful Bill requires is in states that have expanded Medicaid, working-age adults without disabilities or [dependent] children under age 14 would have to work, volunteer, or attend school or job training programs at least 80 hours a month to remain eligible, unless they qualify for another exemption, such as being medically frail or having substance abuse disorder. The package also limits immigrants’ eligibility for Medicaid, requires enrollees to pay some costs, and caps state and local government provider taxes, which is a key funding source for states and which will have ripple effects across hospitals and across states in general. 

Now, what’s important to note is, most of these provisions haven’t taken effect yet. Most of them actually take effect after the midterm elections next year. So, they’ll be rolling out in coming years and the full impact is yet to come. 

Rovner: Alice. 

Ollstein: So, I have chosen the resurgence of infectious diseases that we are seeing right now. I think measles is really the canary in the coal mine. Because it’s so infectious, that’s what’s showing up first, but it’s not going to be the last infectious disease that the country had almost squashed out of existence that is now, as I said, resurging. And so, I think that a lot of different policies and trends are feeding into this. And I think we have the rollback of vaccine requirements at the state level, at the federal level. We have policies that deter people from seeking out testing and treatment, especially some of these anti-immigrant policies that we’re seeing. And then just cuts to public health and public health staff, cuts to surveillance, so it’s just harder to know where the outbreaks are happening and how bad they are. It’s hard to get reliable data on that. And so I think, yes, we’re seeing measles first, but now we are starting to see whooping cough, we’re starting to see some other things, and it’s really troubling, and it could have a political impact too. 

I have talked to a bunch of candidates who are running in next year’s midterms who say that they’re able to point to outbreaks right there in their state to say, “This is the consequence of Republican health policies, and this is why you should vote for me.” So, I would be keeping an eye on that in the coming year. 

Rovner: Lizzy. 

Lawrence: So, my chosen theme is the politicization of science. And my focus has been on the FDA as an FDA beat reporter, but there’s been the politicization of science in every agency. And this is something that used to be pretty taboo, right? I keep thinking these days about the [Barack] Obama HHS secretary, Kathleen Sebelius, and the legal and political repercussions she faced when she vetoed an FDA decision to make Plan B over-the-counter. And those days seem very far away, because now we’re seeing at the FDA speedier drug reviews being used as a bargaining chip in deals between the White House and companies in exchange for companies lowering their prices. 

At the FDA and CDC, you’re seeing skeptics or more political officials completely taking over operations, reopening debates on things like vaccines, antidepressants during pregnancy, RSV, monoclonal antibodies, based on thin or even really no or debunked evidence. 

You’re seeing the White House just today use CMS to pull funding from hospitals that perform gender-affirming surgeries. You’re seeing NIH [the National Institutes of Health] pull funding from research studies that go against Trump administration ideology. So, there’s really so many examples, too many to count, of political leaders wielding in power and trying to shape science to fit their agendas in the way that they see the world. 

And then I’d say that has a trickle-down effect to the way that everyday people think about science, and it calls everything into question and makes … People look to politicians and to the heads of public health agencies to tell them the truth. I mean, maybe not politicians, but it seems that doctors and medical experts’ voices are increasingly being drowned out by the political re-litigating of science that has been settled for a long time. So, I think this is a very important topic and one that I’ll keep watching closely in the next year. 

Rovner: Yep. So my topic builds on Lizzy’s. It’s how this administration is using a combination of personnel and funding cuts and new regulations to jeopardize the future of the scientific and health care workforce well into the future. The administration has frozen or terminated literally billions of dollars in grants from the National Institutes of Health and the National Science Foundation, not just causing the shutdown of many labs, but making students who are pursuing research careers rethink their plans, including those who are well into their graduate studies. Some are even going to other countries, which are happily poaching some of our best and brightest. 

And as we’ve talked about so many times before in this year’s podcast, the administration also seems intent on basically choking off the future health care workforce. The big budget bill includes caps on how much medical students can borrow in federal loans. That’s an effort to get medical schools to lower their tuition, but most observers think that’s unlikely to happen. The Education Department has decreed that those studying to be nurses, physician assistants, public health workers, and physical therapists are not pursuing a “profession,” thus also limiting how much they can borrow. And a new $100,000 visa fee is going to make it even more difficult for hospitals and clinics, particularly those in rural areas, to hire doctors and nurses from outside the U.S., at a time when international medical workers are literally the only ones working in many shortage areas. These are all changes that are going to have ramifications, not just for years, but potentially for generations. So, these are all themes that we will continue to watch in 2026. 

OK, that is this week’s show and our last episode for 2025. Thank you to all of you listeners for coming with us on this wild news ride. As always, thanks to our editor, Emmarie Huetteman, and this week’s producer-engineer, Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me on X @jrovner, or on Bluesky @julierovner. Where are you guys hanging these days, Alice? 

Ollstein: Mostly on Bluesky @alicemiranda, and still on X @AliceOllstein. 

Rovner: Tami. 

Luhby: You could find me at cnn.com. 

Rovner: Lizzy. 

Lawrence: You can find me at Stat News, on LinkedIn at Lizzy Lawrence, on X @LizzyLaw_, and on Bluesky — and I forget my username, but I’m somewhere there. 

Rovner: Don’t worry about it. OK, we will be back in your feed in January. Until then, be healthy. 

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Congress is running out of time to avert a huge increase in health care premium payments for millions of Americans who buy insurance through the Affordable Care Act marketplaces. Dec. 15 is the deadline to sign up for coverage that begins Jan. 1, and some consumers are waiting to see whether the credits will be extended, enabling them to afford coverage next year.

Meanwhile, a federal vaccine advisory panel handpicked by Health and Human Services Secretary Robert F. Kennedy Jr. voted last week to end the universal recommendation for a hepatitis B vaccine dose at birth. It’s just the start of what are expected to be major changes in childhood vaccine recommendations overall.

This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Maya Goldman of Axios, and Sheryl Gay Stolberg of The New York Times.

Panelists

Among the takeaways from this week’s episode:

• As of Thursday morning, the Senate was preparing to vote on competing health proposals, neither of which was expected to pass: one, from Democrats, that would extend the enhanced ACA premium tax credits and a second, from Republicans, that would instead add money to health savings accounts for some ACA enrollees. With the credits set to expire and time running out to sign up for plans, it is likely that coverage will be unaffordable for some Americans, leaving them uninsured.
• The Advisory Committee on Immunization Practices’ decision to end its recommendation that newborns be immunized against hepatitis B is a major development in the federal government’s shift away from promoting vaccines. While the panel coalesced around the claim that babies are most likely to contract hepatitis B from their mothers, the reality is that the virus can live on household items, posing a threat of chronic disease and death to unvaccinated children.
• In reproductive health news, House Speaker Mike Johnson removed insurance coverage of fertility treatment for service members from the National Defense Authorization Act before the legislation’s passage, and anti-abortion groups are calling for the firing of Food and Drug Administration head Marty Makary over reports he is slow-walking policy changes on medication abortion.

Also this week, Rovner interviews Georgetown University professor Linda Blumberg about what the GOP’s health plans have in common.

Plus, for “extra credit” the panelists suggest health policy stories they read (or wrote) this week that they think you should read, too: 

Julie Rovner: The Washington Post’s “Rural America Relies on Foreign Doctors. Trump’s Visa Fee Shuts Them Out,” by David Ovalle.  

Anna Edney: Bloomberg News’ “Abbott Fired a Warning Shot on Baby Formula — Then Launched a Lobbying Blitz,” by Anna Edney.  

Sheryl Gay Stolberg: The New York Times’ “The Married Scientists Torn Apart by a Covid Bioweapon Theory,” by Katie J.M. Baker.

Maya Goldman: ProPublica’s “These Health Centers Are Supposed to Make Care Affordable. One Has Sued Patients for as Little as $59 in Unpaid Bills,” by Aliyya Swaby.

Also mentioned in this week’s podcast:

• Politico’s “’Sort of Blackmail’: Billions in Rural Health Funding Hinge on States Passing Trump-Backed Policies,” by Alice Miranda Ollstein, Ruth Reader, and Liz Crampton.
• The New York Times’ “Kennedy’s Methodical 2-Decade Quest To Dismantle Vaccine Policy,” by Sheryl Gay Stolberg and Christina Jewett.
• Bloomberg News’ “FDA Slow Walking a Long-Awaited Abortion Pill Safety Study,” by Charles Gorrivan, Riley Griffin, and Rachel Cohrs Zhang.
• The Associated Press’ “Affordable Care Act Enrollment Is Slightly Ahead of Last Year So Far, Despite Expiring Subsidies,” by Ali Swenson and Nicky Forster.

[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 KFF Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Dec. 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 Anna Edney of Bloomberg News. 

Anna Edney: Hi, Julie. 

Rovner: Maya Goldman of Axios News. 

Goldman: Great to be here. 

Rovner: And I’m pleased to welcome to the podcast panel my friend and longtime health reporting colleague, Sheryl Gay Stolberg of The New York Times. Sheryl, so glad to have you join us. 

Stolberg: I’m so glad to be here, Julie. 

Rovner: So, later in this episode, we’ll have my interview with Linda Blumberg of Georgetown University. Linda has spent years analyzing Republican proposals to fix health care and has some interesting observations to share. But first, this week’s news. 

We will start again with the continuing saga of the expiring enhanced tax credits for the Affordable Care Act. Starting Jan. 1, millions of people who get their insurance from the Obamacare marketplaces will face huge increases in what they have to pay in premiums. Some will find those increases so big they’ll have no choice but to drop their insurance altogether. And next Monday, Dec. 15, is the deadline for people to sign up for coverage that starts in January. So, the Senate is set to vote today on two different options. The first, backed by all the chamber’s Democrats, calls for a straight, three-year extension of the enhanced payments that were first implemented in 2021. Those extra payments made insurance so much more affordable that enrollment basically doubled from about 12 million people in the marketplaces to about 24 million. That bill, though, is unlikely to achieve the 60-vote majority it would need to advance. The Senate is also scheduled to consider a Republican alternative, sponsored by Finance Committee Chairman Mike Crapo of Idaho and Health Committee Chair Bill Cassidy of Louisiana. It wouldn’t extend the enhanced tax credits at all. Instead, it would provide either $1,000 or $1,500 for a tax-preferred health savings account that individuals could use for routine health expenses to be coupled with a high-deductible insurance policy. “High-deductible” meaning many thousands of dollars. It’s not expected to achieve 60 votes either. So, assuming both of these plans fail to muster the needed 60 votes, where does that leave us? 

Edney: I think that leaves us looking for what the next turn of the key will be. I mean, will they be able to come to some agreement on extending the tax credits — likely — or the subsidies — likely after. Like you said, enrollment has been underway, and people are enrolling even though they don’t really know what the fate of these will be. So, it’ll be interesting to see how the marketplace reacts given what happens. But I don’t think there’s a really clear idea yet, except that everyone thinks that something might start moving once these votes are dispensed with. 

Stolberg: I think what happens is that a lot of Americans are going to lose their health insurance. We know that the number of Americans insured on the Obamacare exchange is more than double after the enactment of these extended tax credits in 2021. I think there were 11 million; now there are 24 million. And people, as you said in the outset, have to decide now. And maybe they’ll sign up now. But if they lose these credits, I think that a lot of folks are going to suddenly find themselves without insurance coverage. And I think politically for Republicans, that is going to be a big problem going into next year’s midterms. They know this, and that’s why they’re scrambling to come up with some kind of alternative that does not have Obamacare in its name. But we also know that the alternatives that they’re proposing won’t go very far in terms of offsetting out-of-pocket costs for people who are struggling to pay for health care. 

Rovner: Things are starting to bubble up in the House, too. I mean, we’ve seen this. … We knew we were going to have this Senate vote, which is everybody protected by everyone to be a show vote, but now Republicans in the House are getting skittish as well. 

Goldman: Yeah, absolutely. And we’ve seen a couple different proposals in the House. So, there are some moderates that are Republican moderates that are proposing a straight, two-year extension. I think, like Anna said, we’ll see what happens after the Senate votes today, if that brings people to the table or not. I think one thing that struck me this week is The Associated Press reported that ACA sign-ups are actually slightly ahead of where they were at this time last year. But of course, that doesn’t mean that that’s going to result in more overall enrollment. There is still a lot that needs to be ironed out there. One thing that I’m wondering is: Is health coverage just something that people are biting the bullet on at this point? And they’re like, Well, I know it’s really expensive, but I still need to have health insurance. And is that going to … even if people do drop off, we’re so far away, politically speaking, from the November elections, that, is that actually going to resonate still? I don’t know. 

Rovner: Yeah. I mean, one of the things that … I saw that AP story, too, that enrollment is actually higher than it was last year at this time. But you have to worry if there’s going to be what they call the death spiral, where only the people who need insurance the most sign up. You have to wonder whether these are the people who would sign up no matter what. And it’s the healthier people for whom it’s a bigger question mark — whether they actually need the health insurance at this much higher price — who are probably waiting right now. If you’re sick, you’re probably going to sign up no matter what. So, in some ways, I wondered if that was more of a warning signal than anything else. 

Goldman: That’s a great point. 

Stolberg: I think the death spiral is a real concern, especially with the plan that Cassidy and Crapo are putting forward. It would drive people into either catastrophic plans or “bronze” plans, which are lower costs, but high-deductible. And the people who are going to get into those plans are healthy people. That is going to deprive the risk pools for sick people of the healthy. And we know what happens when the risk pools become imbalanced like that. Then insurance costs really skyrocket for the people who need it most. 

Rovner: Yeah. Now, even if Republicans do decide they want to sue for peace, if you will, there are a lot of other obstacles to a bipartisan deal. We’ve talked about abortion. But it looks like there are other things that Republicans want to do that Democrats are not going to want to accept. 

Stolberg: Such as ending support for IVF [in vitro fertilization] coverage like they did in the defense bill this week? 

Rovner: Yeah, which we’ll get to in a little while. 

Stolberg: OK. 

Rovner: Yeah. I mean, I could see a bipartisan deal. I’m just dubious partly — and we’ve said this, I think, every week for the last five or six weeks — that Republicans won’t vote for an extension without permanent abortion restrictions, and Democrats won’t vote for an extension with permanent abortion restrictions. But I know that some of these Republican bills also would deprive legal immigrants. There are anti-fraud provisions, some of which might be supported by Democrats, some of which might be seen as so onerous that they would prevent legitimate people from legitimately signing up. Does anybody actually see a bipartisan deal happening? I guess how scared do Republicans have to get before they’re willing to do something that the Democrats would agree to? 

Stolberg: I don’t see a bipartisan bill happening in time. I mean, Cassidy said at this hearing last week, literally pleading with his colleagues saying, We can talk about grand plans, Bernie [Sanders, I-Vermont] can talk about “Medicare for All,” and we can talk about this, but we got to do something in three weeks. Well, now it’s two weeks, and they’re not going to come to some compromise, especially not one involving abortion or undocumented immigrants by Christmas. It’s not going to happen. 

Rovner: Yeah. Congress loves to give itself deadlines and then not meet them. 

Goldman: Absolutely. And I think we have Republicans with their grand plans, and you can’t implement a full HSA [health savings account] expansion in the time that they’ve allotted. That’s just not practicable. 

Rovner: Yeah. I think this is a war of talking points at this point. All right. Well, the ACA may be this week’s news, but I don’t want to miss out on the vaccine news from late last week after we taped. As predicted, HHS Secretary RFK Jr.’s [Health and Human Services Secretary Robert F. Kennedy Jr.] handpicked CDC [Centers for Disease Control and Prevention] advisory committee on vaccine practices voted to roll back the universal recommendation for a first dose of the hepatitis B vaccine for infants, right after birth. Instead, the panel recommended making the vaccine the subject of “individual-based decision-making.” What’s the difference between that and actually recommending the vaccine? Is this a really big change? Anna, Sheryl, you guys have been watching this closely. 

Edney: Yeah, I think that it’s a big change in the sense that it can be pretty confusing for parents. And it injects this idea of the vaccine possibly being harmful — although that’s not something that’s seen in the data — and also that maybe it’s just not that big of a deal, which is the problem of the success of the vaccine is the vaccine works. Hepatitis B cases in newborns go down, and people think, Oh, well, we don’t really have to worry about this anymore. But that’s just not the case. Obviously, as we’ve seen with other diseases of late, these things can come back. 

And so I think it’s not going to change at the moment, at least, necessarily insurance coverage for having the vaccine, but it does leave open this door that, Well, maybe you should talk to your doctor, see if it’s really the best thing. And there’s just a lot coming at you as a new parent or a parent with a new child on the way, and a lot of medical advice to wade through, and things like that. So, this adds an extra piece to that for which a lot of the medical societies and doctors, Sen. Cassidy included, have said, This isn’t something that we’ve had a big question mark on. It’s been actually really, really helpful in the health of children. 

Rovner: Yeah. Hepatitis B cases in children and teens have gone down 99%. 

Stolberg: That’s right, since 1991. I was going to say, I think this is a really big deal. And it’s a really big deal for a couple of reasons. One, it’s not science-based. There’s no evidence that delaying the vaccine makes it any safer for children. Two, it’s a really big deal because of the debate that Kennedy and his allies have created around what was once not given any thought. And it’s also a big deal because, as doctors will tell you, in theory, one could argue, as Kennedy and his group do, that this is a disease that’s transmitted sexually, or it’s transmitted through intravenous drug use. And for infants, the real risk is mother-to-child transmission. Well, first of all, that’s not entirely true. The virus can last and live on household items like scissors, or tables, or whatever. We know that newborns are the ones that are most at risk. 

And we also know that the best time to capture or vaccinate a newborn is when they’re there in the hospital, and they have access to medical professionals who can administer the vaccine. And unlike countries like Denmark, which follow up their babies, our babies don’t get that kind of follow-up. And so the likelihood is that kids will not get vaccinated when they’re older. Parents will forget about it, and they will have missed that critical opportunity to be protected against an infection that can cause chronic liver disease and death. 

Goldman: Yeah. And there was a lot of discussion during the meeting on, Oh, well, we need to do a better job of screening the mothers for hepatitis B, and you should still get the newborn vaccine if you test positive, et cetera, et cetera. But that’s not ACIP’s [Advisory Committee on Immunization Practices] job to say that we should be screening mothers, so they don’t have any authority there to enforce that. And a CDC staff member said, We’re working on that. But, like Sheryl said, we don’t have the same kind of system that they have in other countries, where you can get those follow-up appointments, and get women in for prenatal care that they need. And so I agree, it’s going to be a huge, huge issue. 

Rovner: Yeah. Well, speaking of those other countries, later on Friday after the meeting, in news that some might have missed, President [Donald] Trump issued an executive order basically telling RFK Jr. that he can do anything he wants with the childhood vaccine schedule because he should compare it to our “peer nations.” Sheryl, you had a big story last week about RFK’s plans for vaccine policy. What are they? 

Stolberg: Well, what I reported with my colleague Christina Jewett is that Kennedy has been on this two-decade crusade to really upend American vaccine policy. Ultimately, he would like to end all mandates for childhood vaccination. That’s not within his purview. That’s in the purview of the states. But he wants to revisit the entire childhood vaccine schedule. And you can see in what he has done by installing his allies, some of whom presented at this ACIP meeting last week, he’s put them in key places. People like Mark Blaxill, who is a parent of a child with autism, who was a founder of a group called Safe Minds, which was an advocacy group. Mark Blaxill now works for the CDC. He’s a smart, Harvard-educated businessman, not a doctor, but he presented on hepatitis B. We saw Aaron Siri, Kennedy’s lawyer, presenting on the childhood vaccine schedule. 

This is a committee that is supposed to be comprised of medical experts — people who are physicians who’ve administered care. And what we are seeing is Kennedy installing these people and others, sprinkling them throughout the department, or bringing them in, to carry out his vision. And he was very clear about that vision in an interview with me. I mean, he firmly believes, as he said — he was careful — he said that autism has gone up over these past decades, and it’s the same time as the childhood vaccines have become … we’ve had more widespread use of vaccines. We’ve also had more widespread drinking of pumpkin spice lattes, as Kennedy’s critics note, but Kennedy has said vaccines must be a potential culprit. I thought that was very interesting that he put that word in — potential. It was a wiggle word. But frankly, what he thinks is that vaccines are responsible, and he has said as much in other interviews. 

Rovner: And yet, while this is going on at this very high level, we’re now having a huge and growing measles outbreak in South Carolina, in addition to the one that we’ve already had in Texas. This is really having an impact on parents’ willingness to have their children vaccinated. I mean, that, I think at this point, cannot be denied just by the evidence. 

Edney: Yeah. Fewer parents are getting their kids vaccinated for school. They’re getting more waivers and things like that, too. So, we do see that this is definitely giving parents who maybe had concerns, or have felt some kinship with the MAHA [Make America Healthy Again] movement as it’s grown, the ability to do what they feel is right, less so following the science. 

Stolberg: Peter Hotez, who is at Baylor University, told me that he was not surprised when there was a measles outbreak in Texas, and in particular in that part of West Texas, because vaccination rates in that corner of the state had been dropping precipitously in the years prior to the outbreak. And he said he could see it coming. 

Goldman: I think it’s also, it’s not just people that are very in line with the MAHA movement at this point. I think if you’re not paying as close of attention as we are, the messages that you’re seeing are, Vaccines are bad. We need to look into vaccines. I don’t know, should I get a vaccine? Should I give my children vaccines? And I think that’s really taking hold. 

Rovner: Another story that we’re going to follow into 2026. All right, we’re going to take a quick break. We will be right back.  

Turning to reproductive health, the last big bill Congress is trying to finish before leaving for the year is the National Defense Authorization [Act]. And for the second year in a row, House Speaker Mike Johnson has ordered the removal of a provision passed by both the House and the Senate that would provide military personnel the same fertility coverage that other federal employees and members of Congress get. Right now, fertility treatments like IVF are only covered for those in the military who have service-related injuries or illnesses. I thought this was a priority for President Trump. At least he keeps saying that it is. 

Stolberg: I think this is daylight between Trump and Mike Johnson, clearly. 

Rovner: I have to say, I was surprised. Since when can the speaker just take something out of a bill that was passed by both the House and the Senate? 

Stolberg: Also, not to mention that members of Congress have this coverage. 

Rovner: That’s right, which they only got fairly recently. I’m surprised that there’s, I would say, less pushback. There obviously is pushback. There are people who are really furious about this, but in the manner of how things work in Congress, this is literally the second time he’s done it. And his spokespeople admit that he did it. And he says, Well, I only want this if it’s done ethically. And a reminder, he’s from Louisiana, which is the state that has current restrictions on the destruction of excess embryos from IVF that’s made IVF difficult to obtain in that state. It’s one person exerting his will over the rest of the Congress. 

Stolberg: Yeah. I think that’s the most interesting thing about it is the daylight between Johnson and Trump and also Kennedy on this issue. Because while Trump and Kennedy profess to be anti-abortion, it’s not really a top-of-mind issue for either one of them. But it is for Johnson. And I guess I can’t imagine Trump vetoing the defense bill, so I guess this is going to go through. 

Rovner: Yeah, without it. Again. Well, speaking of who it’s a priority for, much [to] the frustration and anger of the anti-abortion movement, a new report finds that the percentage of medication abortions using telehealth continues to grow, including those from states with shield laws that protect prescribers to states that have abortion bans, to patients in those states that have abortion bans, which underlines a story from your colleagues at Bloomberg, Anna, suggesting that FDA commissioner Marty Makary is “slow-walking” the safety study of the abortion pill that was promised to anti-abortion lawmakers, that he’s apparently slow walking that until perhaps after the midterms. 

I hasten to add that HHS spokesman Andrew Nixon denies the studies being deliberately delayed. But just the story has angered anti-abortion forces so much [that] they’re now calling for Makary’s firing. And Missouri Republican Sen. Josh Hawley, who’s been at the forefront of the fight against the abortion pill, and I believe the person who got the promise for this study, has called the allegations unacceptable and is demanding answers by this Monday. Combined with what’s going on with the carousel of center directors at the FDA, how much longer can Makary last under this continuing onslaught? 

Edney: Yeah, what I was thinking of when you were talking about this story is this is just one in a tiny slice of all the things that seem to be coming at Makary and going wrong, and calling into question his ability to manage the FDA. I think specifically — you were just mentioning this with abortion, Sheryl — that it’s not top of mind for Trump or RFK. So, I’m not sure that this is the thing that does him in unless Sen. Hawley or something breaks on that end. Maybe there are some senators who will be upset enough as more, or if, more details come out. 

I think that definitely Makary appears to be fighting for his job. I think there have been some great stories in The Washington Post and The Wall Street Journal talking about these discussions at the White House every few weeks, where should we keep doing this? Do we need to think of maybe putting someone different in leadership? He’s still there. And so, it seems that RFK is backing him pretty publicly. Obviously, that can change at a moment’s notice. So, something to keep a really close eye on. 

Goldman: Something that we’ve been talking about on my team related to that is that it’s going to be really hard to get anyone else approved through the Senate for any of these positions. And they can install an acting director, but there are limits to how long that can last. And so I think that that is maybe partially helping with some job security for a lot of these people at these high levels. 

Stolberg: I think it would be very hard to get someone else installed given the broken promises that Kennedy has made to Cassidy. They’re going to be very wary. And also, Makary is in the arc, or the spectrum, of people who could fill that job. He’s actually kind of moderate, if you will. And I talked to someone close to Kennedy who said that Kennedy still has confidence in him. So, his ouster, I think, would require the White House bigfooting Kennedy. And I’m not sure that that would happen. 

Rovner: And they have, as we’ve noticed, other things to deal with right now. Finally this week, remember that $50 billion Congress included for rural health in last summer’s big budget bill to offset the nearly $1 trillion in cuts to Medicaid? Well, now the Trump administration is effectively telling states that if they want to claim a share of that money, they need to make changes that align with other Trump administration policies — things like barring people from using food stamps for junk food, or legalizing short-term insurance plans that many states worry could destabilize the individual insurance market. Now, I wouldn’t call this outright coercion, but I remember that the Supreme Court basically did just that when they ruled that the ACA’s Medicaid expansion had to be voluntary. Is this really going to fly, that the Trump administration could say, You can’t have this money unless you do other things that we want you to do? 

Goldman: If I’m remembering correctly, all states that have all right to applications will get a baseline of money, and states can get more money for certain things that they apply for. And so I think that maybe that makes this a little different. But I think states will be very upset if they don’t get the money that they want, that they are asking for. And it’ll be interesting to see if there is legal action on the back end, too. 

Rovner: Yeah. I mean, clearly this $50 billion for rural health is not enough to even begin to make up for the cuts that are coming to Medicaid. So, we’re talking about small amounts of money. It’s just, I don’t remember seeing conditions that were quite this blatant. And you’re right, Maya, it’s not all of the money, but it is some segment of the money. But for them to just literally come out and say, We’re going to give you money if you do what we want. I would think at some point Congress gets to say, Hey, not what we had in mind. 

Stolberg: But Congress won’t say it. Not this Congress. 

Rovner: Yeah, not this Congress. So maybe a future Congress. All right. Well, that is this week’s news. Now, we will play my interview with Linda Blumberg of Georgetown University, and then we will come back and do our extra credits.  

I am pleased to welcome to the podcast Linda Blumberg. Linda is a research professor at Georgetown University and an institute fellow in the Health Policy Division of the Urban Institute, and one of my go-to people whenever I have a really complicated question about health policy. Linda, welcome to What the Health? 

Linda Blumberg: Thanks so much for having me here. 

Rovner: So, to the unpracticed eye, it looks like Republicans in the House and Senate are just now coming up with all these new and different health plans. But, in fact, most of them are variations on what Republicans have been pushing, not just for years, but for decades in some cases. Is there anything really new, or is this just a long list of golden oldies? 

Blumberg: I think this is basically a list of things that have been brought out before. Now, they have to present them and talk about them in the context of the Affordable Care Act, which they didn’t have to do many years ago. They’re working around in terms of what they’re impacting on the Affordable Care Act, and how these other pieces would fit in with what they want to do there. But they’re essentially the same things they’ve been talking about for a long time. 

Rovner: So, you’ve been analyzing these plans for years now. And while they may look different on the surface, you say they all have one thing in common: that they work to segment rather than pool risk. Can you explain that in layman’s terms? 

Blumberg: Sure. When I talk about segmenting health care risk, what I’m talking about is policies, or strategies that place more of the financial responsibility of paying for medical care on the people who need that care when they need it, or on those who are most likely to need medical care. That is the opposite of pooling risk more broadly, which actually takes health care costs and spreads them to a greater extent across people, both healthy and sick. 

Rovner: So basically, protecting sick people, which is the idea of health insurance in general, right? 

Blumberg: Well, from my perspective, yes. The situation is because there is — what we in economics call — a very skewed distribution of health care spending, that means that in any particular year, at any particular moment in time, most people are pretty healthy and don’t use much medical care, and the great bulk of health care spending falls on a small percentage of the population. And so, when you’re only looking in the short term, when you’re not looking broadly across time, or across somebody’s life, then people who, when you segment health care risk, you can create savings for people when they’re super healthy. The problem is that it increases the cost even more when they are not healthy, and none of us are healthy forever. 

Rovner: And just to be clear, the percentage of people who use the majority of health care is really, really tiny, isn’t it? 

Blumberg: Yeah. So, for example, there is a rule of thumb that around the top 5% of health care spenders account for basically half of all health care spending, and the bottom half of spenders account for less than 3% of health care spending. But that is at a particular moment in time, again. And I think the problem is when we think about health care spending as Who’s going to win? Who’s going to lose? in terms of money, right now, at a particular moment in time. Instead of thinking about what happens to us over the course of our lifetime, which is, then, when we spread the costs much more broadly, we’re more protected. We have access to adequate affordable health care under broad-based pooling of health care risk. When we segment it, we’re really making people much more vulnerable to not being able to get the care they need when they need it. 

Rovner: And how do things like health savings accounts, and giving consumers more power to go out and negotiate on their own, how do those actually segment risk? 

Blumberg: So, the more you take the dollars that are being spent on health care and remove it from the health insurance pool — the amount of money that is going to pay for claims through health insurance,  whether it’s public or private insurance — the more you take it out of the insurance pool and you put it on the individuals, the more we’re separating the risks and putting heavier costs on people when they need care. So, a health savings account gives us some cash, or allows us to put some cash into an account to use when we’re needing care. But it also comes with health insurance plans that are much higher deductibles and much larger out-of-pocket costs. 

And so what we see in practice is that the people who have these accounts, they tend to not … First of all, they tend to be much wealthier people because they’re tax advantages for wealthy people, not for people who are [of] much more modest means. And when they go to get care, there’s usually not that much money in the account to help them pay for these much larger deductibles and out-of-pocket costs. And so they’re paying for a lot more when they need the care. The insurance kicks in at a much higher level of spend. And so the financial burden, even though they’ve paid lower premiums when they need the care, the financial hit is on the individual. 

Rovner: So why shouldn’t we put higher-risk people in a different pool? Since, as you point out, most people are healthy most of the time. That would reduce costs for more people than it would raise costs for. Right? 

Blumberg: Well, it would, at a particular moment in time, but the problem is we don’t stay healthy all of the time. And so, I’m not born with a stamp on my head that says, You’re going to be a low spender, and so you’re going to be better off over here. All I need is a broken leg. All I need is somebody in my family to develop diabetes. God forbid, a kid gets hit by a car, or develops a brain tumor. Stuff happens from out of the blue. And then, if that’s the case, if I’m in a situation that could really make it so that I can’t access, or my loved ones can’t access, the care that they need when they need it. And by the way, as we age, everybody tends to use more and more care. 

So, you can save money at a moment of time by segmenting risk in these ways, but if you do it, you’re putting so many people at risk for not being able to get adequate care when they need it. And because of that skewed distribution of health care spending, it’s a situation where what you save when you’re healthy from segmenting risk is really pretty small compared to the extra amount you have to spend for pooling risk. Because if you take these dollars, and you spread them over everybody, then the increment that you have to spend in order to make sure you’re protected, and everybody else is protected when they need medical care, is not that big. 

Rovner: Is there some ideological reason why Republicans seem to be coalescing around these risk-segmentation ideas? 

Blumberg: I’m not a psychologist, so the motivation escapes me. Because I do think people are better off over the course of their lifetimes when we spread risk broadly. I think part of the issue is the other philosophical difference between conservatives and more progressive policymakers is the idea of income distribution. And the truth of the matter is that really wealthy people, if they get sick and have a high-deductible plan, or they have a much more narrow set of benefits that are being offered to them, they have wealth that can take them a long way to get to buy medical care. They can pay for the broken limb. They can pay for various different medications. 

If they have a very serious illness, or injury that’s longer lasting, they may not — even wealthy people — may not be able to cover the costs, or it may really have a big impact on them. But by and large, wealthy people are able to insulate themselves to some degree, even with very pared-down coverage. Whereas somebody who’s middle-income, who’s lower-income, who’s not super wealthy, is not going to be able to access that care. So, if your focus is on protecting the assets of those with a lot of wealth, this is a positive in that regard. 

Rovner: So how does this ongoing debate about these enhanced premium subsidies play into this whole thing? 

Blumberg: When we’re talking about the enhanced premium tax credits, which seem to be, by the end of this week, will be going by the wayside, those are actually pooling mechanisms, too. And I think it’s important for people to understand that financial assistance for lower- and middle-income people, one of the great things that it does — as a secondary effect of just giving those people insurance coverage — is it brings a lot more healthier people into the pool. People who are healthy, young, who wouldn’t have been able to afford health insurance coverage before, and so would have remained uninsured and did before these credits were in place. It brings them into the pool. It lowers the average medical expenses of people insured. And by pooling risk in that way, it actually lowers the premium. Because as the average cost of the individuals enrolled goes down, the premiums go down, too. 

And so one of the things besides these other strategies, which would tend to segment risk further, as we talked about, the strategy that they are denying — which is continuing these enhanced subsidies — is also going to further segment risk because it’s going to push healthier people out of the pool that can’t afford it anymore. Same with, by the way, the people who are immigrants but are residing here legally, who are no longer going to be able to access assistance to buy coverage in the marketplaces as they have been for the last number of years, they also tend to be people who use less medical care on average. And so those immigrants being in our insurance pools are actually helping to subsidize American citizens who are less healthy. And so by saying, Listen, we’re not going to let you in. We’re not going to give you subsidies to make it affordable for you to come in. We’re actually pushing the average cost of the health insurance coverage upward for no good reason, honestly. 

Rovner: Linda Blumberg, thanks very much. 

Blumberg: My pleasure. Good to see you. 

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

Edney: Yeah, thank you. I had a story just published today. It’s in Bloomberg: “Abbott Fired a Warning Shot on Baby Formula — Then Launched a Lobbying Blitz.” And I took a deep look at this issue of preterm infant formula. So, for preemies that are born really early, there’s this big debate right now on whether formula is harming them, or whether it’s something else that’s causing one a day, essentially, to die from this awful disease, necrotizing enterocolitis. And so Abbott is struggling because they don’t make a lot of money off of this formula, but they’re being sued for billions and billions of dollars. So they really want Congress, any agency, the White House, whoever, to intervene in some way. 

They’re throwing everything at the wall to see what can stick. And I’ll just say one tidbit that I found that was really interesting. There’s a lot of debate. There was an NIH [National Institutes of Health] report on this disease recently that moved in Abbott’s favor a little bit. I did learn through my reporting that the report was ghostwritten by a company that does a lot of work with Abbott, and lists them as a client. So that’s an interesting conflict of interest there, maybe a hook to get you guys to go read it. Thanks. 

Rovner: Oops. I’m definitely going to go read it. Maya, why don’t you go next? 

Goldman: Yeah, I’m excited to read that, Anna. 

Edney: Thank you. 

Goldman: My extra credit this week is from ProPublica. It’s by Aliyya Swaby and it’s called “These Health Centers Are Supposed To Make Care Affordable. One Has Sued Patients for as Little as $59 in Unpaid Bills.” There are a lot of details in the story, but I think the headline tells you the gist of it. But what stuck out to me about this is I think in health journalism and health policy, we often talk about the safety net as if it’s magic and going to catch everyone, or at least I find myself slipping into that mindset sometimes. And I think it’s really important to look into how people on the ground are actually experiencing these services. And it’s also a reminder, unfortunately, that there are bad actors everywhere. 

Rovner: Alas. Sheryl. 

Stolberg: So, my extra credit this week is actually more of a science policy story than a health policy story, but it is a fascinating yarn. It’s titled “The Married Scientists Torn Apart by a COVID Bioweapon Theory.” It’s in The New York Times by my colleague Katie J.M. Baker. And this is the story of two Chinese virologists who were married, and the woman came to believe that covid was a bioweapon created in a lab, and that the Chinese government had purposefully grown this virus and released it to set off the pandemic. And this doctor fell under the sway of people like Steve Bannon, Trump’s ally, and an exiled Chinese billionaire who had reason to want to blame the Chinese government, and who brought her to the United States, placed her in a series of safe houses once she arrived, and arranged for her to meet some of Trump’s top advisers. 

And she has now gone underground, and her husband actually moved to the United States to try to find her. And she’s basically in hiding. She’s cut off contact with her family. And it’s heartbreaking, and poignant, and also, from my perspective, revelatory about just the politics that have come to define our debates around science and health in the wake of the pandemic. 

Rovner: Yeah, it is quite the story. All right. My extra credit this week is from The Washington Post. It’s called “Rural America Relies on Foreign Doctors. Trump’s Visa Fee Shuts Them Out,” by David Ovalle. And we’ve talked about this issue before. These fees were mainly aimed at tech companies, who are the biggest users of the H1B visa program, but this new $100,000 fee is already preventing particularly rural practitioners from bringing medical professionals to places in the United States that Americans just don’t want to practice. This story centers on an overworked kidney disease practice in North Carolina that’s still waiting on a U.S.-trained doctor that it hired months ago, who is stuck in India. We’ve already talked about how the Medicaid cuts are going to hit rural areas particularly hard. This fee to bring in international medical professionals sounds like it’s making that even worse.  

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

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

Rovner: Anna? 

Edney: X or Bluesky @AnnaEdney,and LinkedIn as well. 

Rovner: Sheryl. 

Stolberg: And I’m on X and Bluesky @sherylnyt, and LinkedIn under my own name. 

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

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More children would be hospitalized because of this preventable disease. Some would lose their hearing. Some would die. Measles is also expensive. A new study — not yet published in a scientific journal — estimates that the public health response to outbreaks with only a couple of cases costs about $244,000. When a patient requires hospital care, costs average $58,600 per case. The study’s estimates suggest that an outbreak the size of the one in West Texas earlier this year, with 762 cases and 99 hospitalizations, costs about $12.6 million.

America’s status hinges on whether the country’s main outbreaks this year stemmed from the big one in West Texas that officially began Jan. 20. If these outbreaks are linked, and go on through Jan. 20 of next year, the U.S. will no longer be among nations that have banished the disease.

“A lot of people worked very hard for a very long time to achieve elimination — years of figuring out how to make vaccines available, get good vaccine coverage, and have a rapid response to outbreaks to limit their spread,” said Paul Rota, a microbiologist who recently retired from a nearly 40-year career at the Centers for Disease Control and Prevention.

Instead of acting fast to prevent a measles comeback, Robert F. Kennedy Jr., a lawyer who founded an anti-vaccine organization before taking the helm at the Department of Health and Human Services, has undermined the ability of public health officials to prevent and contain outbreaks by eroding trust in vaccines. The measles vaccine is safe and effective: Only 4% of more than 1,800 confirmed U.S. cases of measles this year have been in people who had received two doses.

Kennedy has fired experts on the vaccine advisory committee to the CDC and has said, without evidence, that vaccines may cause autism, brain swelling, and death. On Nov. 19, scientific information on a CDC webpage about vaccines and autism was replaced with false claims. Kennedy told The New York Times that he ordered the change.

“Do we want to go back into a prevaccine era where 500 kids die of measles each year?” asked Demetre Daskalakis, a former director of the CDC’s national immunization center, who resigned in protest of Kennedy’s actions in August. He and other scientists said the Trump administration appears to be occupied more with downplaying the resurgence of measles than with curbing the disease.

HHS spokesperson Andrew Nixon said in a statement that vaccination remains the most effective tool for preventing measles and that the “CDC and state and local health agencies continue to work together to assess transmission patterns and ensure an effective public health response.”

Looking for Links

CDC scientists are indeed tracking measles, alongside researchers at health departments and universities. To learn whether outbreaks are linked, they’re looking at the genomes of measles viruses, which contain all their genetic information. Genomic analyses could help reveal the origin of outbreaks and their true size, and alert officials to undetected spread.

Scientists have conducted genomic analyses of HIV, the flu, and covid for years, but it’s new for measles because the virus hasn’t been much of a problem in the U.S. for decades, said Samuel Scarpino, a public health specialist at Northeastern University in Boston. “It’s important to get a surveillance network into place so that we could scale up rapidly if and when we need it,” he said.

“We are working with the CDC and other states to determine whether what we’re seeing is one large outbreak with continued spread from state to state,” said Kelly Oakeson, a genomics researcher at the Utah Department of Health and Human Services.

At first glance, the ongoing outbreak in Utah and Arizona, with 258 cases as of Dec. 1, seems linked to the one in Texas because they’re caused by the same strain of measles, D8-9171. But this strain is also spreading throughout Canada and Mexico, which means the outbreaks could have been sparked separately from people infected abroad. If that happened, this technicality could spare the U.S. from losing its status, Rota said. Being measles-free means the virus isn’t circulating in a country continuously year-round.

Canada lost its measles-elimination status in November because authorities couldn’t prove that various outbreaks from the D8-9171 strain were unrelated, said Daniel Salas, executive manager of the comprehensive immunization program at the Pan American Health Organization. The group, which works with the World Health Organization, includes health officials from countries in North, South, and Central America, and the Caribbean. It makes a call on measles elimination based on reports from scientists in the countries it represents.

Early next year, PAHO will hear from U.S. scientists. If their analyses suggest that measles has spread continuously for a year within the U.S., the organization’s director may revoke the country’s status as measles-free.

“We expect countries to be transparent about the information they have,” Salas said. “We will ask questions, like, ‘How did you determine your findings, and did you consider other angles?’”

In anticipation of PAHO’s assessment, Oakeson and other researchers are studying how closely the D8-9171 strains in Utah match others. Instead of looking at only a short snippet of genes that mark the strain, they’re analyzing the entire genome of the measles virus, about 16,000 genetic letters long. Genetic mutations occur naturally over time, and the accumulation of small changes can act like a clock, revealing how much time has ticked by between outbreaks. “This tells us the evolutionary history of samples,” Oakeson said.

For example, if one child directly infects another, the kids will have matching measles viruses. But measles viruses infecting people at the start of a large outbreak would be slightly different than those infecting people months later.

Although the Texas and Utah outbreaks are caused by the same strain, Oakeson said, “more fine-grained details are leading us to believe they aren’t super closely related.” To learn just how different they are from each other, scientists are comparing them with measles virus genomes from other states and countries.

Ideally scientists could pair genetic studies with shoe-leather investigations into how each outbreak started. However, many investigations have come up dry because the first people infected haven’t sought care or contacted health departments. As in West Texas, the outbreak in Utah and Arizona is concentrated in close-knit, undervaccinated communities that are leery of government authorities and mainstream medicine.

Researchers are also trying to learn how many measles cases have gone undetected. “Confirmed cases require testing, and in some communities, there’s a cost to going to the hospital to get tested: a tank of gas, finding a babysitter, missing work,” Andrew Pavia, an infectious disease doctor at the University of Utah, said. “If your kid has a measles rash but isn’t very sick, why would you bother?”

Subtle Surveillance

Pavia is part of a nationwide outbreak surveillance network led by the CDC. A straightforward way to figure out how large an outbreak is would be through surveys, but that’s complicated when communities don’t trust public health workers.

“In a collaborative setting, we could administer questionnaires asking if anyone in a household had a rash and other measles symptoms,” Pavia said, “but the same issues that make it difficult to get people to quarantine and vaccinate make this hard.”

Instead, Pavia and other researchers are analyzing genomes. A lot of variation suggests an outbreak spread for weeks or months before it was detected, infecting many more people than known.

A less intrusive mode of surveillance is through wastewater. This year, the CDC and state health departments have launched efforts to test sewage from households and buildings for measles viruses that infected people shed. A study in Texas found that this could function as an early warning system, alerting public health authorities to an outbreak before people show up in hospitals.

The quiet research of CDC scientists stands in stark contrast to its dearth of public-facing actions. The CDC hasn’t held a single press briefing on measles since President Donald Trump took office, and its last publication on measles in the agency’s Morbidity and Mortality Weekly Report was in April.

Rather than act fast to limit the size of the Texas outbreak, the Trump administration impeded the CDC’s ability to communicate quickly with Texas officials and slowed the release of federal emergency funds, according to investigations by KFF Health News. Meanwhile Kennedy broadcast mixed messages on vaccines and touted unproven treatments.

Daskalakis said that as the outbreak in Texas worsened, his CDC team was met by silence when they asked to brief Kennedy and other HHS officials.

“Objectively they weren’t helping with the Texas outbreak, so if we lose elimination, maybe they’ll say, ‘Who cares,’” Daskalakis said.

Nixon, the HHS spokesperson, said Kennedy responded strongly to the Texas outbreak by directing the CDC to help provide measles vaccines and medications to communities, expediting measles testing, and advising doctors and health officials. The U.S. retains its elimination status because there’s no evidence of continuous transmission for 12 months, he added.

“Preliminary genomic analysis suggests the Utah and Arizona cases are not directly linked to Texas,” the CDC’s acting director, Deputy HHS Secretary Jim O’Neill, wrote on the social platform X.

Given Kennedy’s distortions of data on vitamin A, Tylenol, and autism, Daskalakis said the Trump administration may insist that outbreaks aren’t linked or that PAHO is wrong.

“It will be quite a stain on the Kennedy regime if he is the health secretary in the year we lose elimination status,” he said. “I think they will do everything they can to cast doubt on the scientific findings, even if it means throwing scientists under the bus.”

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“I don’t think people should be taking medical advice from me,” Kennedy told a Democratic congressman in May.

Kennedy once expressed different views — for example, about the need to proselytize about exercise. As he said on a podcast, he wants to use the “bully pulpit” to “obliterate the delicacy” with which Americans discuss fitness and explain that “suffering” is virtuous.

“We need to establish an ethic that you’re not a good parent unless your kids are doing some kind of physical activity,” Kennedy told the podcaster in September 2024.

The Department of Health and Human Services is tasked with communicating information to protect and improve the health and well-being of every American. It provides reminders about vaccinations and screenings; alerts about which food is unsafe; and useful, everyday tips about subjects such as sunscreen and, yes, exercise.

Under Kennedy’s watch, though, HHS has compromised once-fruitful campaigns promoting immunizations and other preventive health measures. On Instagram, the agency often emphasizes Kennedy’s personal causes, his pet projects, or even the secretary himself. Former agency employees say communications have a more political edge, with “Make America Healthy Again” frequently featured in press releases.

Interviews with over 20 former and current agency employees provide a look inside a health department where personality and politics steer what is said to the public. KFF Health News granted many of these people anonymity because they fear retribution.

One sign of change is what is no longer, or soon will not be, amplified — for instance, acclaimed anti-smoking campaigns making a dent in one of Kennedy’s priorities, chronic disease.

Another sign is what gets celebrated. On the official HHS Instagram account this year, out were posts saluting Juneteenth and Father’s Day. In, under Kennedy, were posts marking President Donald Trump’s birthday and Hulk Hogan’s death.

Commenting on such changes, HHS spokesperson Andrew Nixon said in an email that “DEI is gone, thanks to the Trump administration.”

Some elected officials are pointedly not promoting Kennedy as a source of health care information. Regarding the secretary’s announcement citing unproven links between Tylenol and autism, Senate Majority Leader John Thune told MSNBC that, “if I were a woman, I’d be talking to my doctor and not taking, you know, advice from RFK or any other government bureaucrat, for that matter.” (Thune’s office did not respond to a request for comment.)

At least four polls since January show trust in Kennedy as a medical adviser is low. In one poll, from The Economist and YouGov, barely over a quarter of respondents said they trusted Kennedy “a lot” or “somewhat.”

The department’s online messaging looks “a lot more like propaganda than it does public health,” said Kevin Griffis, who worked in communications at the CDC under President Joe Biden and left the agency in March.

Transition to a New Administration

The new administration inaugurated dramatic changes. Upon arrival, political appointees froze the health agency’s outside communications on a broader scale than in previous changeovers, halting everything from routine webpage updates to meetings with grant recipients. The pause created logistical snafus: For example, one CDC employee described being forced to cancel, and later rebook, advertising campaigns — at greater cost to taxpayers.

Even before the gag order was lifted in the spring, the tone and direction of HHS’ public communications had shifted.

According to data shared by iSpot.tv, a market research firm that tracks television advertising, at least four HHS ads about vaccines ended within two weeks of Trump’s inauguration.

“Flu campaigns were halted,” during a season in which a record number of children died from influenza, Deb Houry, who had resigned as the CDC’s chief medical officer, said in a Sept. 17 congressional hearing.

Instead of urging people to get vaccinated, HHS officials contemplated more-ambivalent messaging, said Griffis, then the CDC’s director of communications. According to Griffis, other former agency employees, and communications reviewed by KFF Health News, Nixon contemplated a campaign that would put more emphasis on vaccine risks. It would “be promoting, quote-unquote, ‘informed choice,’” Griffis said.

Nixon called the claim “categorically false.” Still, the department continues to push anti-vaccine messaging. In November, the CDC updated a webpage to assert the false claim that vaccines may cause autism.

Messaging related to tobacco control has been pulled back, according to Brian King, an executive at the Campaign for Tobacco-Free Kids, as well as multiple current and former CDC employees. Layoffs, administrative leaves, and funding turmoil have drained offices at the CDC and the FDA focused on educating people about the risks of smoking and vaping, King said.

Four current and former CDC employees told KFF Health News that “Tips From Former Smokers,” a campaign credited with helping approximately a million people quit smoking, is in danger. Ordinarily, a contract for the next year’s campaign would have been signed by now. But, as of Nov. 21, there was no contractor, the current and former employees said.

Nixon did not respond to a question from KFF Health News regarding plans for the program.

“We’re currently in an apocalypse for national tobacco education campaigns in this country,” King said.

Kennedy’s HHS has a different focus for its education campaigns, including the “Take Back Your Health” campaign, for which the department solicited contractors this year to produce “viral” and “edgy” content to urge Americans to exercise.

An earlier version of the campaign’s solicitation asked for partners to boost wearables, such as gadgets that track steps or glucose levels — reflecting a Kennedy push for every American to be wearing such a device within four years.

The source of funds for the exercise campaign? In the spring, leadership of multiple agencies discussed using funding for the CDC’s Tips From Former Smokers campaign, employees from those agencies said. By the fall, the smoking program hadn’t spent all its funds, the current and former CDC employees said.

Nixon did not respond to questions about the source of funding for the exercise campaign.

Food Fight

At the FDA, former employees said they noticed new types of political interference as Trump officials took the reins, sometimes making subtle tweaks to public communications, sometimes changing wholesale what messages went out. The interventions into messaging — what was said, but also what went unsaid — proved problematic, they said.

Early this year, multiple employees told KFF Health News, Nixon gave agency employees a quick deadline to gather a list of all policy initiatives underway on infant formula. That was then branded “Operation Stork Speed,” as if it were a new push by a new administration.

Marianna Naum, a former acting director of external communications and consumer education at the FDA, said she supports parts of the Trump administration’s agenda. But she said she disagreed with how it handled Operation Stork Speed. “It felt like they were trying to put out information so they can say: ‘Look at the great work. Look how fast we did it,’” she said.

Nixon called the account “false” without elaborating. KFF Health News spoke with three other employees with the same recollections of the origins of Operation Stork Speed.

“Things that didn’t fit within their agenda, they were downplayed,” Naum said.

For example, she said, Trump political appointees resisted a proposed press release noting agency approval of cell-cultured pork — that is, pork grown in a lab. Similar products have raised the ire of ranchers and farmers working in typically GOP-friendly industries. States such as Florida have banned lab-grown meat.

The agency ultimately issued the press release. But a review of the agency’s archives showed it hasn’t put out press releases about two later approvals of cell-cultured meat.

Wide-ranging layoffs have also hit the FDA’s food office hard, leaving fewer people to make sure news gets distributed properly and promptly. Former employees say notices about recalled foods aren’t circulated as widely as they used to be, meaning fewer eyeballs on alerts about contaminated ice cream, peaches, and the like.

Nixon did not respond to questions about changes in food recalls. Overall, Nixon answered nine of 53 questions posed by KFF Health News.

Pushing Politics

Televised HHS public service campaigns earned nearly 7.3 billion fewer impressions in the first half of 2025 versus the same period in 2022, according to iSpot data, with the drop being concentrated in pro-vaccine messaging. Other types of ads, such as those covering substance use and mental health, also fell. Data from the marketing intelligence firm Sensor Tower shows similar drops in HHS ad spending online.

With many of the longtime professionals laid off and new political appointees in place atop the hierarchy, a new communications strategy — bearing the hallmarks of Kennedy’s personality — is being built, said the current and former HHS employees, plus public health officials interviewed by KFF Health News.

Whereas in 2024, the agency would mostly post public health resources such as the 988 suicide hotline on its Instagram page, its feed in 2025 features more of the health secretary himself. Through the end of August, according to a KFF Health News review, 77 of its 101 posts featured Kennedy — often fishing, biking, or doing pullups, as well as pitching his policies.

By contrast, only 146 of the agency’s 754 posts last year, or about 20%, featured Xavier Becerra, Kennedy’s predecessor.

In 2024, on Instagram, the agency promoted Medicare and individual insurance open enrollment; in 2025, the agency has not.

In 2024, the agency’s Instagram feed included some politicking as Biden ran for reelection, but the posts were less frequent and often indirect — for instance, touting a policy enacted under Biden’s signature legislation, the Inflation Reduction Act, but without mentioning the name of the bill or its connection to the president.

In 2025, sloganeering is a frequent feature of the agency’s Kennedy-era Instagram. Through the end of August, “Make America Healthy Again” or variants of the catchphrase featured in at least 48% of posts.

Amid the layoffs, the agency made a notable addition to its team. It hired a state legislative spokesperson as a “rapid response” coordinator, a role that employees from previous administrations couldn’t recall previously existing at HHS.

“Like other Trump administration agencies, HHS is continuously rebutting fake news for the benefit of the public,” Nixon said when asked about the role.

On the day Houry and Susan Monarez, the CDC leader ousted in late August, testified before senators about Kennedy’s leadership, the agency’s X feed posted clips belittling the former officials. The department also derisively rebuts unfavorable news coverage.

“It’s very interesting to watch the memeification of the United States and critical global health infrastructure,” said McKenzie Wilson, an HHS spokesperson under Biden. “The entire purpose of this agency is to inform the public about safety, emergencies as they happen.”

‘Clear, Powerful Messages From Bobby’

Kennedy’s Make Our Children Healthy Again report, released in September, proposes public awareness campaigns on subjects such as illegal vaping and fluoride levels in water, while reassuring Americans that the regulatory system for pesticides is “robust.”

Those priorities reflect — and are amplified by — cadres of activists outside government. Since the summer, HHS officials have appeared on Zoom calls with aligned advocacy groups, trying to drum up support for Kennedy’s agenda.

On one call — on which, according to host Tony Lyons, activists “representing over 250 million followers on social media” were registered — famous names such as motivational speaker Tony Robbins gave pep talks about how to influence elected officials and the public.

“Each week, you’re gonna get clear, powerful messages from Bobby, from HHS, from their team,” Robbins said. “And your mission is to amplify it, to make it your own, to speak from your soul, to be bold, to be relentless, to be loving, to be loud, you know, because this is how we make the change.”

The communications strategy captivates the public, but it also confuses it.

Anne Zink, formerly the chief medical officer for Alaska, said she thought Kennedy’s messaging was some of the catchiest of any HHS director.

But, she said, in her work as an emergency physician, she’s seen the consequences of his health department’s policies on her puzzled patients. Patients question vaccines. Children show up with gastrointestinal symptoms Zink says she suspects are related to raw milk consumption.

“I increasingly see people say, ‘I just don’t know what to trust, because I just hear all sorts of things out there,’” she said.

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Working out of a tribal-owned hospital in Anchorage, Alaska, liver specialist Brian McMahon has spent decades treating the long shadow of hepatitis B. Before a vaccine became available in the 1980s, he saw the virus claim young lives in western Alaskan communities with stunning speed.

One of his patients was 17 years old when he first examined her for stomach pain. McMahon discovered she had developed liver cancer caused by hepatitis B, just weeks before she was set to graduate from high school as valedictorian. She died before the ceremony.

McMahon thinks often of an 8-year-old boy who showed no signs of illness until he complained of pain from what turned out to be a rapidly growing tumor on his liver.

McMahon can still hear his voice.

“He was moaning in pain, saying, ‘I know I am going to die soon,’” he recalled. “We were all crying.” The boy died at home a week later.

The hepatitis B virus is transmitted through blood and bodily fluids, even in microscopic amounts, and the virus can survive on surfaces for a week. Like many of his patients, McMahon said, both children contracted hepatitis B at birth or in early childhood.

That outcome is now preventable. A birth dose of the vaccine, recommended for newborns since 1991, is up to 90% effective in preventing infection from the mother if given in the first 24 hours of life. If babies receive all three doses, 98% of them have immunity from the incurable virus, with the protection lasting at least 30 years.

In the communities of western Alaska, years of targeted testing and widespread vaccination efforts led to the number of cases plummeting.

“Liver cancer has disappeared in children,” McMahon said. “We haven’t seen a case since 1995. Nor do we have any children under 30 that have gotten infected that we know of.”

He worries those hard-won gains could soon be rolled back.

Pushing Back the Dose?

A Centers for Disease Control and Prevention vaccine advisory panel appointed by Health and Human Services Secretary Robert F. Kennedy Jr. is scheduled to discuss and vote on the hepatitis B birth dose recommendation during its two-day meeting starting Dec. 4, potentially limiting children’s access.

On Tucker Carlson’s podcast in June, Kennedy falsely claimed that the hepatitis B birth dose is a “likely culprit” of autism.

He also said the hepatitis B virus is not “casually contagious.” But decades of research shows the virus can be transmitted through indirect contact, when traces of infected fluids like blood enter the body when people share personal items like razors or toothbrushes.

The committee’s recommendations carry weight. Most private insurers must cover the vaccines the Advisory Committee on Immunization Practices endorses, and many state vaccination policies are directly linked to its guidelines.

Neither ACIP nor the CDC is regulatory. They cannot mandate immunizations. It’s up to states to do that. But keeping the recommendation for a hepatitis B vaccine at birth preserves the widest range of options for families. They can choose to vaccinate at birth, wait until later in childhood, or not vaccinate at all, and insurance will continue to cover the cost of the shot as long as it remains approved by the Food and Drug Administration.

Two senior FDA officials — Commissioner Marty Makary and top vaccine regulator Vinay Prasad — suggested at the end of November that changes to the vaccine approval process may be coming. Vaccines must be approved by the FDA to be administered in the United States.

In internal agency emails obtained by PBS NewsHour and The Washington Post, Prasad questioned the routine practice of “giving multiple vaccines at the same time.” It’s not clear whether he was referring to combination vaccines that offer immunity against multiple diseases with a single shot. Three of the nine hepatitis B vaccines currently approved by the FDA are combination vaccines. The birth dose of the hepatitis B vaccine is given only as a stand-alone vaccine.

Contacted for comment, Health and Human Services spokesperson Emily Hilliard said in a statement that “ACIP will review the evidence at its meeting this week and issue recommendations based on gold standard, evidence-based science and common sense.”

‘Sowing Distrust’

If private insurers opt to still cover the shot, misinformation from the meeting still could lead families to falsely believe the vaccine could harm their babies, said Sean O’Leary, chair of the Committee on Infectious Diseases for the American Academy of Pediatrics and an assistant professor of pediatrics at the University of Colorado School of Medicine.

“Whatever comes out of this disaster of a meeting in December is going to be mainly designed around sowing distrust and spreading fear,” he said.

President Donald Trump, Kennedy, and some newly appointed ACIP members have mischaracterized how the liver disease spreads, ignoring or downplaying the risk of transmission through indirect contact. The hepatitis B virus is far more infectious than HIV. Unvaccinated people, including children, can get infected from microscopic amounts of blood on a tabletop or toy, even when the infected person is asymptomatic.

McMahon has cared for children who tested negative at birth and later became infected through indirect contact. In a study in the 1970s, nearly a third of such children went on to develop chronic hepatitis B without ever showing symptoms, he said.

“It’s a very infectious virus,” McMahon said. “That’s why giving everybody the birth dose is the best way to prevent it.”

The CDC recommends that all pregnant people be screened for hepatitis B, but it estimates that up to 16% are not tested and fall through the cracks. O’Leary and other experts say testing mothers for the virus shortly before or after delivery is unfeasible, because most hospitals lack the staff and resources.

The three-dose vaccine has a long track record of safety. Numerous studies show it is not associated with an increased risk of infant death, fever or sepsis, multiple sclerosis, or autoimmune conditions, and severe reactions are rare.

“We have an incredible safety profile,” O’Leary said. “No one expects to get in a car wreck, right? And yet we all put our seat belts on. This is similar.”

The CDC estimates that 2.4 million people in the U.S. have hepatitis B and that half do not know they are infected. The disease can range from an acute infection to a chronic one, often with few to no symptoms. If the disease is left untreated, it can lead to serious conditions such as cirrhosis, liver failure, and liver cancer. There is no cure.

Expert’s Advice to Parents: Talk to a Doctor

William Schaffner, a professor of preventative medicine at the Vanderbilt University School of Medicine and a former voting member of ACIP, said some parents struggle to understand why a healthy newborn needs a vaccine so soon after birth, especially for a virus they feel certain they don’t have and often wrongly associate only with risky behaviors. Those perceptions, he said, mix with declining trust in public health and rising skepticism about vaccines.

His advice to expectant parents who are on the fence is to talk to their doctor about the shots. Even if the pregnant woman has tested negative, he said, it’s still important to give the baby the birth dose, because false negatives are possible and because the virus can spread so easily from surface contact. Babies who receive the full vaccine series starting from birth have their chance of liver cancer reduced by 84%.

“If you wait a month and if the mom happens to be positive, or the baby picks it up from a caregiver, by that time the infection is established in that baby’s liver,” Schaffner said. “It’s too late to prevent that infection.”

He said that if fewer people get vaccinated, hepatitis B will circulate at higher rates in American communities and the risk of contracting the virus will rise for everyone who doesn’t get the shots.

And more hepatitis B cases could mean higher costs for patients and the broader health care system. The CDC estimates treating someone with a less severe form of the disease costs $25,000 to $94,000 per year. For patients who require a liver transplant, annual medical expenses can climb above $320,000, depending on their treatment.

Over the past 30 years, the main adverse events parents have reported from their babies receiving the birth dose have been fussiness and crying, both of which pass quickly. Schaffner said that’s a very strong safety profile — for a newborn vaccine with a track record of protecting babies from an incurable disease.

“The data are so clear about this,” Schaffner said. “A whole array now of other countries have initiated this program. They’ve modeled it on us.”

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Many scientists and public health officials fear that the Centers for Disease Control and Prevention’s website, which now baselessly claims that health authorities previously ignored evidence of a vaccine-autism link, foreshadows a larger, dangerous attack on childhood vaccination.

“This isn’t over,” said Helen Tager-Flusberg, a professor emerita of psychology and brain science at Boston University. She noted that Kennedy hired several longtime anti-vaccine activists and researchers to review vaccine safety at the CDC. Their study is due soon, she said.

“They’re massaging the data, and the outcome is going to be, ‘We will show you that vaccines do cause autism,’” said Tager-Flusberg, who leads an advocacy group of more than 320 autism scientists concerned about Kennedy’s actions.

Kennedy’s handpicked vaccine advisory committee is set to meet next month to discuss whether to abandon recommendations that babies receive a dose of the hepatitis B vaccine within hours of birth and make other changes to the CDC-approved vaccination schedule. Kennedy has claimed — falsely, scientists say — that vaccine ingredients cause conditions like asthma and peanut allergies, in addition to autism.

The revised CDC webpage will be used to support efforts to ditch most childhood vaccines, said Angela Rasmussen, a virologist at the University of Saskatchewan and co-editor-in-chief of the journal Vaccine. “It will be cited as evidence, even though it’s completely invented,” she said.

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Kennedy personally ordered the website’s alteration, he told The New York Times. The CDC’s developmental disability group was not asked for input on the changes, said Abigail Tighe, executive director of the National Public Health Coalition, a group that includes current and former staffers at the CDC and HHS.

Scientists ridiculed the site’s declaration that studies “have not ruled out the possibility that infant vaccines cause autism.” While upward of 25 large studies have shown no link between vaccines and autism, it is scientifically impossible to prove a negative, said David Mandell, director of the Center for Autism Research at Children’s Hospital of Philadelphia.

The webpage’s new statement that “studies supporting a link have been ignored by health authorities” apparently refers to work by vaccine opponent David Geier and his father, Mark, who died in March, Mandell said. Their research has been widely repudiated and even ridiculed. David Geier is one of the outside experts Kennedy hired to review safety data at the CDC.

Asked for evidence that scientists had suppressed studies showing a link, HHS spokesperson Andrew Nixon pointed to older reports, some of which called for more study of a possible link. Asked for a specific study showing a link, Nixon did not respond.

Expert Reaction

Infectious disease experts, pediatricians, and public health officials condemned the alteration of the CDC website. Although Kennedy has made no secret of his disdain for established science, the change came as a gut punch because the CDC has always dealt in unbiased scientific information, they said.

Kennedy and his “nihilistic Dark Age compatriots have transformed the CDC into an organ of anti-vaccine propaganda,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

“On the one hand, it’s not surprising,” said Sean O’Leary, a professor of pediatrics and infectious disease at the University of Colorado. “On the other hand, it’s an inflection point, where they are clearly using the CDC as an apparatus to spread lies.”

“The CDC website has been lobotomized,” Atul Gawande, an author and a surgeon at Brigham and Women’s Hospital, told KFF Health News.

CDC “is now a zombie organization,” said Demetre Daskalakis, former director of the National Center for Immunization and Respiratory Diseases at the CDC. The agency has lost about a third of its staff this year. Entire divisions have been gutted and its leadership fired or forced to resign.

Kennedy has been “going from evidence-based decision-making to decision-based evidence making,” Daniel Jernigan, former director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, said at a news briefing Nov. 19. With Kennedy and his team, terminology including “radical transparency” and “gold-standard science” has been “turned on its head,” he said.

Cassidy Goes Quiet

The new webpage seemed to openly taunt Sen. Bill Cassidy (R-La.), a physician who chairs the Senate Health, Education, Labor, and Pensions Committee. Cassidy cast the tie-breaking vote in committee for Kennedy’s confirmation after saying he had secured an agreement that the longtime anti-vaccine activist wouldn’t make significant changes to the CDC’s vaccine policy once in office.

The agreement included a promise, he said, that the CDC would not remove statements on its website stating that vaccines do not cause autism.

The new autism page is still headed with the statement “Vaccines do not cause Autism,” but with an asterisk linked to a notice that the phrase was retained on the site only “due to an agreement” with Cassidy. The rest of the page contradicts the header.

“What Kennedy has done to the CDC’s website and to the American people makes Sen. Cassidy into a total and absolute fool,” said Mark Rosenberg, a former CDC official and assistant surgeon general.

On Nov. 19 at the Capitol, before the edits were made to the CDC website, Cassidy answered several unrelated questions from reporters but ended the conversation when he was asked about the possibility Kennedy’s Advisory Committee on Immunization Practices might recommend against a newborn dose of the hepatitis B vaccine.

“I got to go in,” he said, before walking into a hearing room without responding.

Cassidy has expressed dismay about the vaccine advisory committee’s actions but has avoided criticizing Kennedy directly or acknowledging that the secretary has breached commitments he made before his confirmation vote. Cassidy has said Kennedy also promised to maintain the childhood immunization schedule before being confirmed.

The senator criticized the CDC website edits in a Nov. 20 post on X, although he did not mention Kennedy.

“What parents need to hear right now is vaccines for measles, polio, hepatitis B and other childhood diseases are safe and effective and will not cause autism,” he said in the post. “Any statement to the contrary is wrong, irresponsible, and actively makes Americans sicker.”

Leading autism research and support groups, including the Autism Science Foundation, the Autism Society of America, and the Autism Self Advocacy Network, issued statements condemning the website.

“The CDC’s web page used to be about how vaccines do not cause autism. Yesterday, they changed it,” ASAN said in a statement. “It says that there is some proof that vaccines might cause autism. It says that people in charge of public health have been ignoring this proof. These are lies.”

What the Research Shows

Parents often notice symptoms of autism in a child’s second year, which happens to follow multiple vaccinations. “That is the natural history of autism symptoms,” said Tager-Flusberg. “But in their minds, they had the perfect child who suddenly has been taken from them, and they are looking for an external reason.”

When speculation about a link between autism and the measles, mumps, and rubella vaccine or vaccines containing the mercury-based preservative thimerosal surfaced around 2000, “scientists didn’t dismiss them out of hand,” said Tager-Flusberg, who has researched autism since the 1970s. “We were shocked, and we felt the important thing to do was to figure out how to quickly investigate.”

Since then, studies have clearly established that autism occurs as a result of genetics or fetal development. Although knowledge gaps persist, studies have shown that premature birth, older parents, viral infections, and the use of certain drugs during pregnancy — though not Tylenol, evidence so far indicates — are linked to increased autism risk.

But other than the reams of data showing the health risks of smoking, there are few examples of science more definitive than the many worldwide studies that “have failed to demonstrate that vaccines cause autism,” said Bruce Gellin, former director of the National Vaccine Program Office.

The edits to the CDC website and other actions by Kennedy’s HHS will shake confidence in vaccines and lead to more disease, said Jesse Goodman, a former FDA chief scientist and now a professor at Georgetown University.

This opinion was echoed by Alison Singer, the mother of an autistic adult and a co-founder of the Autism Science Foundation. “If you’re a new mom and not aware of the last 30 years of research, you might say, ‘The government says we need to study whether vaccines cause autism. Maybe I’ll wait and not vaccinate until we know,’” she said.

The CDC website misleads parents, puts children at risk, and draws resources away from promising leads, said Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. “Kennedy thinks he’s helping children with autism, but he’s doing the opposite.”

Many critics say their only hope is that cracks in President Donald Trump’s governing coalition could lead to a turn away from Kennedy, whose team has reportedly tangled with some White House officials as well as Republican senators. Polling has also shown that much of the American public distrusts Kennedy and does not consider him a health authority, and Trump’s own approval rating has sunk dramatically since he returned to the White House.

But anti-vaccine activists applauded the revised CDC webpage. “Finally, the CDC is beginning to acknowledge the truth about this condition that affects millions,” Mary Holland, CEO of Children’s Health Defense, the advocacy group Kennedy founded and led before entering politics, told Fox News Digital. “The truth is there is no evidence, no science behind the claim vaccines do not cause autism.”

Céline Gounder, Amanda Seitz, and Amy Maxmen contributed to this report.

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Scientists and advocates for trans rights say the change will make it much harder to understand cancer diagnoses and trends among the trans population. Certain studies have shown that transgender people are more likely to use tobacco products or less likely to receive routine cancer screenings — factors that could put them at higher risk of disease.

The change is a consequence of Trump administration policies recognizing only “male” and “female” sexes, according to cancer researchers.

Scientists said the change will affect all cancer registries, in every state and territory, because they receive federal funding. Starting in 2026, registries funded through the Centers for Disease Control and Prevention and the National Cancer Institute will categorize cancer patients as male, female, or not stated/unknown. And federal health agencies will receive data only on cancer patients classified that way.

Registries currently specify whether a cancer patient’s sex is “male,” “female,” “other,” various options for “transsexual,” or that the patient’s sex is not stated or unknown.

President Donald Trump in January issued an executive order stating that the government would recognize only male and female sexes. Cancer registry officials said the federal government directed them to revise how they collect data on cancer patients.

“In the U.S., if you’re receiving federal money, then we, essentially, we weren’t given any choice,” Eric Durbin, director of the Kentucky Cancer Registry and president of the North American Association of Central Cancer Registries, told KFF Health News. NAACCR, which receives federal funds, maintains cancer reporting standards across the U.S. and Canada.

Officials will need to classify patients’ sex as unknown when a “patient’s sex is documented as other than male or female (e.g., non-binary, transsexual), and there is no additional information about sex assigned at birth,” the new standard says.

Missing the Big Picture

Researchers said they do not have high-quality population-level data on cancer incidence in transgender people but had been making inroads at improving it — work now at risk of being undone.

“When it comes to cancer and inequities around cancer, you can use the cancer registries to see where the dirtiest air pollution is, because lung cancer rates are higher in those areas. You can see the impact of nuclear waste storage because of the types of cancers that are higher in those ZIP codes, in those areas of the country,” said Shannon Kozlovich, who is on the executive committee of the California Dialogue on Cancer.

“The more parts of our population that we are excluding from this dataset means that we are not going to know what’s happening,” she said. “And that doesn’t mean that it’s not happening.”

For decades, cancer registries have been the most comprehensive U.S. surveillance tool for understanding cancer incidence and survival rates and identifying troubling disease trends. Each year, cancer cases are reported by hospitals, pathology labs, and other health facilities into regional and statewide cancer registries. The compiled data documents cancer and mortality rates among regions, races, sexes, and age groups.

Two federal programs serve as the top authorities on cancer statistics, with information on tens of millions of cases. The CDC’s National Program of Cancer Registries provides funding to organizations in 46 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the U.S. Pacific Island territories. Its data represents 97% of the U.S. population. The National Cancer Institute’s Surveillance, Epidemiology, and End Results program, known as SEER, collects and publishes data from registries covering nearly half the U.S. population.

The information published by cancer registries has led to changes in treatment and  prevention, and the enactment of other policies designed to reduce diagnosis rates and mortality.

For example, data collected by cancer registries was essential in identifying rising rates of colorectal cancer among people younger than 50. As a result, U.S. guidelines now recommend that adults start screenings at age 45 rather than 50.

States have enacted their own measures. Lara Anton, spokesperson for the Texas Department of State Health Services, said epidemiologists with the Texas Cancer Registry in 2018 found that the state had the nation’s highest incidence rates of hepatocellular carcinoma, a liver cancer more common in men than women. The Cancer Prevention and Research Institute of Texas initiated a statewide effort aimed at reversing rising rates of liver cancer. The Texas Cancer Registry joined SEER in 2021.

“Once a cancer patient is entered into a cancer registry, we follow those patients for the rest of their lives. Because we really need to know, do patients survive for different types of cancer and different stages of cancer?” Durbin said. “That’s incredibly important for public policies.”

The North American Association of Central Cancer Registries maintains national standards outlining what kind of data registries collect for each diagnosis. It develops the list in partnership with the CDC, the National Cancer Institute, and other organizations.

For any given patient, under NAACCR’s standards, Durbin said, registries collect more than 700 pieces of information, including demographics, diagnosis, treatment, and length of survival. CDC and NCI-funded registries must specify the sex of each patient.

The NAACCR definitions and accompanying data standards are designed to ensure that registries collect case data uniformly. “Everyone essentially follows the standards” that NAACCR develops, Durbin said. Although registries can collect state-specific information, researchers said they need to follow those standards when sending cancer data to the federal government.

In an emailed statement, Department of Health and Human Services spokesperson Andrew Nixon said, “HHS is using biological science to guide policy, not ideological agendas that the Biden administration perpetrated.”

‘Backwards’ Progress

NAACCR routinely publishes updated guidelines. But the change to the “sex” category to remove transgender options in 2026 was an emergency move due to Trump administration policies, Kozlovich said. She was among a group that had pushed for changes in cancer data collection to account for sex and gender identity as separate data points.

According to an analysis of CDC data by the Williams Institute at the UCLA School of Law, 2.8 million people age 13 and older identify as transgender.

Scientists and trans rights advocates said in interviews that there are troubling signs that may make transgender people more likely to develop cancer or experience worse health outcomes than others.

“Without evidence of our health disparities, you take away any impetus to fix them,” said Scout, executive director of the LGBTQIA+ Cancer Network.

A study published in 2022 found that transgender and gender-diverse populations were two to three times as likely as cisgender people to report active use of cigarettes, e-cigarettes, or cigars. Tobacco use is a leading cause of cancer and death from cancer.

A Canadian study concluded in 2019 that transgender patients were less likely to receive recommended screenings for breast, cervical, and colorectal cancers. And a 2023 study from researchers at Stanford Medicine found that LGBTQ+ patients were nearly three times as likely to experience breast cancer recurrence as cisgender heterosexual people.

Scarlett Lin Gomez, an epidemiologist at the University of California-San Francisco and the director of the Greater Bay Area Cancer Registry, said that for at least 10 years the NCI had been interested in improving its ability to monitor cancer burden across patient populations with different sexual orientations and gender identities. Cancer registries are a logical place to start because that is what they’re set up to do, she said.

There’s been “slow but good progress,” Gomez said. “But now we’ve completely, personally, I think, regressed backwards.”

The decision not to capture transgender identity in cancer patients is just one change registries have confronted under the Trump administration, according to scientists leading surveillance efforts and state health agencies. An HHS mandate to reduce spending on contracts led to funding cuts for cancer registries in NCI’s SEER program. Scientists said CDC funds for registries haven’t been cut; however, the White House’s proposed fiscal 2026 budget aims to eliminate funding for the National Program of Cancer Registries.

Among the Trump administration’s other actions targeting trans people are canceling research grants for studies on LGBTQ+ health, dismantling the National Institutes of Health’s office for sexual and gender minority health, and stopping specialized services for LGBTQ+ youth on the 988 national suicide prevention hotline.

Without data, researchers can’t make a case to fund research that may help trans patients, Gomez said. “It’s erasure.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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