The Food and Drug Administration is back in the headlines, with a political appointee overruling agency scientists to reject an application from the drugmaker Moderna for a new flu vaccine, and FDA Commissioner Marty Makary continuing to take criticism from anti-abortion Republicans in the Senate for alleged delays reviewing the safety of the abortion pill mifepristone.

Meanwhile, in a very unlikely pairing, Sen. Elizabeth Warren, the Massachusetts Democrat, and Sen. Josh Hawley, the conservative Republican from Missouri, are co-sponsoring legislation aimed at breaking up the “vertical integration” of health care — when a single company owns health insurers, drug middlemen, and clinician practices.

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

Panelists

Among the takeaways from this week’s episode:

• A top FDA official overruled agency staff in refusing to consider Moderna’s application for a new flu vaccine. The rejection, which Moderna is challenging, comes after the company consulted with the agency under President Joe Biden on how to develop the clinical trial for the vaccine and then spent considerable time and money. Clear, consistent federal guidance is important to maintaining the drug development ecosystem, and the decision stands as a warning to other companies developing new treatments.
• With measles cases rising and trust in federal vaccine recommendations falling, the Vaccine Integrity Project, based at the University of Minnesota’s Center for Infectious Disease Research & Policy, and the American Medical Association are launching their own vaccine review process — a parallel vaccine recommendation project offering an alternative to what are seen as ideologically driven federal recommendations.
• President Donald Trump unveiled the new TrumpRx website, billed as helping people save money on prescription drugs. But the site’s offerings are limited and offer limited benefits: It serves only those trying to buy drugs without insurance coverage, and some of the biggest savings are on popular obesity drugs rather than other commonly needed treatments. Nonetheless, it offers Trump a chance to stamp his name on an effort to lower drug prices.
• And more reporting is illuminating the health-related side effects of Trump’s immigration crackdown, including infectious disease outbreaks at detention centers. While at least some of the problems are not new to immigration enforcement, the large numbers of people being detained are intensifying the problems.

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

Julie Rovner: ProPublica’s “The Children of Dilley,” by Mica Rosenberg.  

Alice Miranda Ollstein: Politico’s “Why Washington’s All-In on Smart Rings,” by Amanda Chu.  

Lizzy Lawrence: KFF Health News’ “US Cancer Institute Studying Ivermectin’s ‘Ability To Kill Cancer Cells,’” by Rachana Pradhan.  

Jackie Fortiér: Stat’s “The New Childhood Vaccine Guidelines Have a Paid Leave Problem,” by Ariana Hendrix.  

Also mentioned in this week’s episode:

• Stat’s “Prasad Overruled FDA Staff To Reject Moderna’s Flu Vaccine Application,” by Lizzy Lawrence.
• KFF Health News’ “Public Health Workers Are Quitting Over Assignments to Guantánamo,” by Amy Maxmen.
• KFF Health News’ “‘I Can’t Tell You’: Attorneys, Relatives Struggle To Find Hospitalized ICE Detainees,” by Claudia Boyd-Barrett.

[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 covering Washington. We’re taping this week on Thursday, Feb. 12, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go. 

Today, we are joined via videoconference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hi.  

Rovner: And up early to join us from California, my KFF Health News colleague Jackie Fortiér. Welcome, Jackie.  

Jackie Fortiér: Hey, everyone. 

Rovner: No interview this week, but plenty of news. So let’s jump right in. We will start this week at the Food and Drug Administration, where things are — why don’t we call it — newsmaking. The biggest FDA story that broke this week was controversial vaccine chief Vinay Prasad outright rejecting an application for a new flu vaccine from Moderna, maker of the mRNA covid vaccine that so many anti-vaxxers have criticized. Lizzy, you broke this story. Congratulations. What happened exactly? And why is this such a big deal beyond the flu vaccine? 

Lawrence: This is a big deal because to refuse to file is a pretty rare occurrence in general, because in general the FDA and industry like to have agreed-upon standards for clinical trials before companies embark on them and pour millions of dollars into them. So that was surprising. And then— 

Rovner: And refuse to file means that they said that they’ve got the application and said: Yeah, we’re not accepting that. We’re not going to review this. Right? 

Lawrence: Yes, yes. And Prasad wrote that the grounds for this was that it wasn’t an adequate, controlled trial. Well, Moderna is saying that actually the FDA greenlit this trial back under the Biden administration in 2024. They acknowledged that there was basically a control vaccine that the FDA say they would prefer that Moderna use for the older population. But they said, however, it’s acceptable if you don’t do that. 

Rovner: And I want to make sure I understand this. The complication here is that this is supposed to be a better vaccine for older people, but right now there’s vaccines for older people that start at age 65 and this is a vaccine that’s supposed to start at age 50, right? So it was unclear who they were going to test it against, whether it was going to be the 50-to-64s or the 65s and older. Because there isn’t a vaccine right now that’s approved for 50 and up, right? 

Lawrence: Exactly, exactly. So it was there’s the high-dose vaccine, which is recommended for the above-65s, but that is not recommended for the 50-to-64, which is part of why Moderna didn’t use that high-dose vaccine, because the population that they were studying was broader than this over-65s. So anyway, so yeah, so refusing to file is already rare, and then for there to be an overriding refuse to file, where the, I was told, basically, while there may have been individuals who agreed with Dr. Prasad’s assessment, the review team, every discipline, thought that it was reviewable. And the head of vaccines wrote a memo explaining why he thought it was viable, so that the career staff kind of documented their thoughts here. It’s not clear whether this will be made public ever, but one would hope, with radical transparency, but we’ll see. Despite that, Dr. Prasad still refused to review Moderna’s application. 

Rovner: So obviously it’s a big deal for the flu vaccine, but it’s a big deal beyond this. Moderna’s CEO was on cable news this morning, said that, as you said, after consulting with the FDA officials about the trial, they spent a billion dollars on this trial. How do we expect companies to invest in new medicines like this if the FDA is basically acting on vibes? 

Lawrence: I don’t know. Yeah. And it’s interesting. It doesn’t seem like there’s a ton of sympathy from this administration. Even back last year, [FDA] Commissioner [Marty] Makary tweeted something — this was when they were limiting, wanted to require more data for covid vaccines for the under-65 crowd. And I think he said something like: Our goal is not to save companies money. That’s not something we — which of course that isn’t. The FDA’s goal is to promote public health. But it’s definitely a change in tune. I think that in the past, the FDA has understood that you’re really only going to get innovation if you have clear, consistent guidance and that it’s a really worst-case scenario for a company to spend a billion dollars on a clinical trial and then there’s nothing to show for it and nothing for it to benefit patients, either. So. 

Rovner: Is this over? What happens now? 

Lawrence: So now Moderna has requested a meeting to challenge this decision, and now there begins a kind of negotiation. It might be possible that the FDA would, in fact, would review at least the 50-to-64 cohort, because they don’t have any objections there, seemingly. But we’ll have to see. On a call yesterday, a senior FDA official talked about Moderna kind of coming to the agency with humility and acknowledging that the FDA had recommended this high-dose vaccine. And so I don’t know. I think companies are definitely — it’s a lesson that they’re, especially if you’re in the vaccine space, you have to tread very carefully. 

Rovner: Yeah. And I would think others in the drug space, too. It’s not just — that’s the point of this — it’s not just vaccines. Alice, you wanted to say something. 

Ollstein: Oh, yeah. Not only the monetary investment, which we’ve touched on a bunch, but companies spend years. So it’s the time investment as well. And why would you dedicate years of effort to something that you’re not sure if a political appointee is going to swoop in and override career scientific officials’ assessment, if you can’t trust the regulatory system to work as it’s always worked. There really is just a lot of risk there, and you might see people not making these submissions on all kinds of fronts. Of course, this is coming as we’ve had a really bad flu season. I’ve had people in my life get really sick and say it’s been really, really bad. So the prospect of having something that works better to prevent, or even just make it milder, not coming to fruition is rough. 

Rovner: Yeah. And this year, as we know, this year’s flu vaccine was not very well matched to the strains that ended up circulating. And that’s kind of the point of this Moderna vaccine, this mRNA vaccine, is that they say it would be much faster for them to match strains to what’s going around. If it works as the clinical trials suggest it would actually be a better flu vaccine than we have now. 

Well, meanwhile, cases of measles are also continuing to multiply, as they do when people aren’t vaccinated, and not just in the places we’ve talked about, like Texas and South Carolina, but also all around us here in the nation’s capital, apparently, as a result of people traveling here for the anti-abortion March for Life in January. There have been more than 730 confirmed cases of measles in the U.S. already this year. That’s four times more than have been typical for a full year, and it’s not yet the middle of February. Yet that doesn’t seem to be deterring the administration from its anti-vaccine activities. So now, the American Medical Association and the University of Minnesota Vaccine Integrity Project have announced they’ll convene a parallel group of experts to make vaccine recommendations, basically saying they are done following the Centers for Disease Control and Prevention. This has been brewing for a while. Right, Lizzy? 

Lawrence: Yes. As soon as the secretary fired all of the experts who served on the advisory panel to the CDC on vaccines, I think there’s been unease. And now, as you said, there’s an active parallel public health establishment that’s trying to spread credible information and provide an alternative resource, because it’s clear that HHS [the Department of Health and Human Services] has become compromised when it comes to vaccine recommendations. And yet, you’re seeing the spread of infectious diseases right now. 

Fortiér: Having kind of this rival court is not surprising, because they’ve refused to participate in any of the Advisory Committee on Immunization Practices meetings for months and months. I do wonder if this will maybe change some of the tone. We do have an upcoming ACIP meeting in February. Normally we would have a agenda out by now. Before Secretary [Robert F.] Kennedy [Jr.] we would have them weeks in advance, and we haven’t seen one yet, so we’re really not totally sure what they’re going to be talking about. But Dr. [Mehmet] Oz did say this week that he finally advised people — he’s the CMS [Centers for Medicare & Medicaid Services] director— to take the vaccine. And there’s been over 933 cases in just South Carolina during this outbreak that started last October. And so when I talk to people on the ground who are treating folks in South Carolina and have been treating them for months, and they’ve been doing vaccine clinics and things like that, they were just so fed up with Dr. Oz and the administration, because they partially blame them for these various outbreaks. And I had one of them tell me, like, well, it’s like a band-aid on a bullet hole. Like, now they’re finally encouraging people to get vaccinated when we could have had this months ago. 

Rovner: And, of course, the CDC doesn’t have a director at the moment, because the Senate-approved director was summarily fired and/or quit, not clear which, after refusing to basically rubber-stamp the immunization panel’s recommendations that had not been made at the time. So the American Academy of Pediatrics is suing to stop this February ACIP meeting. I did not hear what the last decision was on that, but I know that there’s still a lot of movement around here. I guess the big worry is: Who should the public trust now? Is it going to be this sort of grouping of medical societies led by the AMA, or the CDC, which people and doctors are used to following the advice of? 

Ollstein: And there’s all these state alliances forming to do the same thing. And so I think, yeah, the more competing recommendations the average person hears, the more they just sort of throw their hands up and say: I don’t even know who to trust anymore. I’m not listening to any of these people. And the trust that’s eroded in the federal government, that’s going to be really hard to recuperate in the future. You can’t just flip a switch and say: OK, it’s a different government. We trust them again. Once those seeds of doubt are planted in people’s minds, it’s really hard to unearth. And so, if not permanent damage, all of this is doing at least very long-term damage to the idea of expertise and authoritative information. 

Rovner: And science, which this administration insists it wants to follow. Well, turning to FDA-related “MAHA” [“Make America Healthy Again”] news, the agency said last week it would relax enforcement of its food additive regulations to make it easier for manufacturers to say they’re not using artificial dyes. Now this was a huge deal when the agency announced the phaseout of artificial coloring. Looking at you, fancy-colored Froot Loops. Now the administration says it’s going to allow foodmakers to say they’re not using artificial colors as long as they’re not using petroleum-based dyes. Apparently, natural dyes are OK. But even that is controversial, and it appears that this whole effort really relies on manufacturers’ willingness to comply rather than, you know, actual regulation, which is kind of what the FDA does for a living. It’s a regulatory agency. 

Ollstein: Well, every time the word “natural” comes up, I always laugh because there is no definition of that. And there are plenty of things that are natural that could kill you or hurt you very badly. And there are plenty of things that are synthetically manufactured that are helpful and fine for you. And so it has this veneer of safety, veneer of health with no actual substance. So my red flags go up whenever I hear that word, and I think everyone should be skeptical. 

Rovner: But it goes with RFK Jr.’s quest now that you should, quote, “eat real food.” 

Lawrence: Right. Yeah. I was going to say same with “chemical.” I feel like, “chemical” abortion drug, “chemical.” And it’s like, a lot of things are chemicals. That’s not— 

Ollstein: Yeah, like in your own body, naturally. 

Lawrence: Yeah. 

Ollstein: You have chemicals. 

Lawrence: We are chemicals. 

Ollstein: We are chemicals. 

Rovner: You guys are all too young to remember the Dow Chemical advertising line “Better Living Through Chemistry,” which at the time, in the ’60s and ’70s, was true. There was, there — we’ve had a lot of better living through chemistry. And some of it has turned out to be maybe not so good for us, but a lot of it has turned out to be pretty darn good for us. 

Well, finally, in FDA land, Commissioner Marty Makary this week met with anti-abortion senators about that ongoing review of the abortion pill mifepristone, which senators want the FDA to remove from the market. Alice, how’d that meeting go? 

Ollstein: Not great for the FDA, from what I was told. I got on the phone with Sen. Josh Hawley after it, and he was extremely frustrated. He said he didn’t get answers to any of the questions he’s been sending in public letters to the FDA for months and now asking in this briefing behind closed doors that they held on Capitol Hill this week. He said he didn’t get answers about what the timeline is for this review of the abortion pill mifepristone, what the review consists of, whether it’s even begun, really, whether it’s even underway. And so he is sort of concluding that this is not going anywhere, and he wants Congress to step in and take action. Now, Congress has tried to step in and take action before. They’ve tried to put restrictions on mifepristone in the FDA funding bill. That didn’t pass. So I don’t know if this is even plausible in this environment where Congress can’t really pass much of anything anymore. 

But Hawley is not just another Republican senator. He is very intertwined with the anti-abortion movement. His wife is an extremely prominent anti-abortion lawyer who’s led a lot of the major cases trying to restrict or ban mifepristone. They founded their own anti-abortion advocacy group. And so it really shows that the tensions, clashes, whatever we want to call them, between the anti-abortion movement and the Trump administration, so after backing the Trump administration for years and years, they’re really getting fed up. And they’re fed up that even after they achieved their grand goal of overturning Roe v. Wade, there are actually more abortions happening now than before, and that’s largely through these pills and people’s ability to get them. And so they’re getting increasingly impatient with the Trump administration, who has been sort of stringing them along and saying: Yeah, we’re working on it. We’re working on it. But they want to see results. Now, of course, if there were some sort of restrictions imposed, that could have a big political effect. And so a lot of Republicans are very torn about that. But not Sen. Hawley. Sen. Hawley wants to see it.  

Rovner: That’s right. Well, moving to what I call FDA-adjacent news, one of the many thorny issues that FDA has been dealing with is the compounding of those very popular and very pricey obesity drugs. When the drugs were in shortage, it was legal for compounders to make their own copies. But now the shortage for both of the leading medications — semaglutide, made by Novo Nordisk, and tirzepatide, made by Eli Lilly — is over, and those cheaper copycats were supposed to be pulled from the market. So it was a bit of a surprise when the company Hims, one of those direct-to-consumer drug sites, announced the unveiling of a semaglutide tablet just weeks after the first such drug was approved by the FDA, by Novo Nordisk. The FDA promptly referred the company to the Justice Department for possible violation of federal drug laws, after which Hims said, Oh, maybe we won’t start selling the drug after all. Oh, and Novo is suing for patent infringement. But I would think that the war over the “fat” drugs, as President [Donald] Trump likes to call them, is likely to lower prices just as effectively as government regulation might. Or am I misreading that? Lizzy, this has been quite the sideshow, if you will. 

Lawrence: Yeah. It might. I think that the compounding, the FDA’s crackdown on Hims was very interesting to me because I think before the commissioner had come into his role, there was some speculation. He had worked for a telehealth company that prescribed compounded drugs. And there’s also, I think compounders have tried to tap into a little bit of the MAHA medical freedom aspect. But clearly that’s not been the case, at least at the FDA. They are clearly very upset about this and mean business, and I think it’s tying into their crackdown on direct-to-consumer drug advertising as well. But as far as price, yeah. I think the deals that Trump has managed to strike with the companies could actually be reducing price for patients. I think we’ll have to see. I know there’s obviously drug pricing programs as well that they could pursue. So, yeah, we’ll have to see.  

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

OK. We’re back. And speaking of President Trump, there’s also drug news this week that’s not directly related to the FDA. That’s the official unveiling of TrumpRx, the website the president says will lower drug prices like no one’s “ever seen before.” That’s a direct quote, by the way. Except it turns out that’s not quite the case. First, these discounts are only for people who are paying out-of-pocket, not those with insurance, which makes them valuable mostly for people who have no coverage or people who take drugs that insurance often doesn’t cover, like those for obesity or infertility. Yet of the 43 drugs so far that are promoted on the TrumpRx website, about half already have cheaper generic copies available through sites like GoodRx and Mark Cuban’s Cost Plus Drugs. And really, the website just points people to already existing manufacturer websites that were already offering those lower prices. So what is the point of TrumpRx? 

Lawrence: Great question. Yeah. This administration has been very focused on, obviously, media and wins and attaching President Trump’s name to things. So it accomplishes that goal. Maybe it does raise awareness for these other sites that already exist. But that’s a theme of a lot of the movement on health care so far, has been — there’s been a lot of chaos, and then there’s also sometimes things that they announce as like a grand, brand-new, no-one’s-ever-thought-of-it-before policy, but then there are already, of course, existing programs or avenues for that. 

Rovner: And to be fair, Trump has jawboned down some prices, including some prices for the obesity drugs, by basically dragging in the CEOs of these companies and saying, You will lower prices. 

Lawrence: Yeah, yeah. The dealmaking has been effective. And I think the question is: Will this last beyond his administration? Will there be a legacy there? 

Ollstein: I think there’s also some danger in overpromising, because he’s out there saying things that don’t comport with how math works. He’s basically suggesting prices will come down so many percents that we’ll be getting paid to take drugs, because that’s what more than 100% is. And people who are hearing that, voters who are hearing that, if they aren’t seeing that show up in their bills, if they’re not actually seeing those drastic, drastic drops that they’re being promised by the president, are they going to get upset? And is that going to impact how they vote? So yes, there has been some, on the margins, improvements, but when you’re out there promising 600% reductions and not delivering, there’s a risk to that. 

Rovner: Jackie, you wanted to add something. 

Fortiér: Well, I was going to say, I think it’s also confusing for a lot of people, from a consumer perspective, because you log on and I think people, they hear these huge promises, like Alice is talking about, and then they think that they can, necessarily, buy the drugs through there and immediately get them shipped, what these third parties like Hims and Weight Watchers are doing a lot of with the GLP-1s. And that’s not how this works. You still have another step of getting a prescription and then going to the pharmacy and using these to potentially get discounts and lower prices, in the same way that these have been available from pharmaceutical manufacturers and other things like GoodRx for years. But it’s that disconnect between, even if you can get a discount, actually getting the discount and crediting the Trump administration for that that I think is going to be really difficult for a lot of voters to make that connection in the way that the administration wants them to. 

Rovner: And this was ever the case with rebates — for other consumer products, not just talking about drugs. We’ll give you a $15 rebate, but you have to fill out 87 forms and send it to this place and get it exactly right, do it before the end date, and we’ll send you back $15. Because they count on most people not being able or willing to follow all of the various steps. So instead of giving everybody the discounted price, they make you really basically work for your discount, which is a consumer thing, but it’s pretty popular in the drug space as well. Rather than just lowering prices, they’re going to say, We will give you a discount, but you’re going to have to do this, that, and the other thing in order to get it. 

Fortiér: Right. But when you’re president and you want credit for it, it’s going to be a little more — it’s harder in order to make that connection. Sorry. 

Rovner: Yes, that’s true. That is a good point. All right, moving on. We have talked a lot about consolidation in the health care industry, particularly companies like UnitedHealthcare, which used to be just an insurer, now owns its own PBM [pharmacy benefit manager], its own claims processing company, and thousands of medical practices around the country. Well, now an extremely unlikely pair in the Senate, Massachusetts Democrat Elizabeth Warren and Missouri Republican Josh Hawley, have joined to introduce something called the Break Up Big Medicine Act, which would basically outlaw so-called vertical integration, like that of United and, to a somewhat lesser extent, Cigna and CVS Health, which owns Aetna, the insurer. Some are referring to this as the health version of the 1932 Glass-Steagall Act, which separated commercial from investment banking — and, side note, whose repeal in 1999 is considered a major factor setting off the financial crisis of 2008. But that was a risk thing. It was done to prevent another stock market crash like the one in 1929. This is a cost thing. This is to go after high health care costs. Could it work? Could it pass? And is this the beginning of the next big thing in health reform? 

Lawrence: Perhaps. Yeah. Last year, I worked with my colleagues on a series kind of examining UnitedHealth Group and the effects of consolidation on doctors and patients. And at the time, I think, there were some vocal lawmakers on either side of the aisle who were criticizing this, especially in the wake of the murder of the UnitedHealth CEO, and which had a surprising — the public sort of had this reaction and to— 

Rovner: Not in United’s favor. 

Lawrence: Not in United’s favor. And so I think that there is, this is a political issue that affects everyone, Republican and Democrat, the, well, cost in general, but I think there’s a lot of resentment and anger, and it seems like that is bringing together these unlikely and pretty powerful senators. I’m not an expert on the Hill. I don’t know if this has a chance. Especially, it’s targeting massive, powerful companies with hands in every part of the health care system. So it’s something that you would imagine the entire health care industry would fight against. But, yeah, I don’t know. 

Rovner: And I will point out that Sen. Josh Hawley, in addition to all his anti-abortion activities, last year, when Congress was debating the Medicaid cuts, kept vowing not to vote for those Medicaid cuts. So he’s — which, of course, in the end, he did — but he’s been sort of on the consumer side of health care for a while now. It’s just this is not brand new to him. 

Lawrence: Right. And I’m not sure how many other Republican senators would follow him down this path. But it’s definitely a noteworthy development, and curious to see where it goes. 

Rovner: Yeah, I’m curious to see sort of if the populist part of health care costs sort of rises to the fore. We’ll have to, we will have to watch that space. Well, finally this week, more on the impact of the Trump administration’s immigration crackdowns and health. My KFF Health News colleague Amy Maxmen has a story about health professionals in the U.S. Public Health Service Commissioned Corps actually resigning rather than accepting postings to Guantánamo Bay, Cuba, where some immigrants are being detained in prisons that used to hold al-Qaida suspects. Another KFF Health News story by Claudia Boyd-Barrett describes how when people detained by ICE [Immigration and Customs Enforcement] end up in the hospital, often their immediate families and their lawyers aren’t even allowed to know where. And remember, last week we talked about cases of measles in some immigration detention facilities. Well, now there are two confirmed cases of tuberculosis at the ICE facility at Fort Bliss in El Paso, Texas. I’m thinking maybe the health part of this is starting to kind of get to people as much as the whole depriving-civil-liberties part. 

Fortiér: Yeah, and there’s also been cases of covid-19, which makes sense. You’re going to have respiratory viruses as you get hundreds of people grouped together. That makes sense. A judge in California a couple days ago ordered that there had to be adequate health provided to detainees in one specific California — it was a prison and now it’s an ICE detainee facility. That’s specific to there, but it’s — more and more senators, I think, are also looking at this and pointing out that they’re just not providing the health facilities that people need. And especially ongoing care — a lot of folks need diabetes treatment, and that treatment just isn’t really happening in many cases. 

Rovner: Yeah, we’ve talked about this at some length, over many weeks, that people in detention are not getting health care, even though it is required, that we keep hearing stories about people not getting needed health care. I didn’t know until I read this story that people who actually end up being hospitalized, that their family members are not allowed to know. That’s allegedly, well, it is because of security, because the idea is that if somebody who’s in detention is in a hospital, you don’t necessarily want bad people knowing that and being able to come to the hospital. But these are people often who are, as we have documented at length, do not have criminal records, and it’s hard to find out where they are. Alice, you wanted to add something. 

Ollstein: Yeah. So there was a recent GAO [Government Accountability Office] report about this, and it found that people were not getting evaluated when they entered a facility to see if they were medically vulnerable and at risk of having a really bad episode or emergency, and that even children, pregnant women, vulnerable populations weren’t getting that initial evaluation, which then led to problems down the road. And it also said that people upon their release — either deportation or release within the United States if that’s what a court ordered — they weren’t being given their medical records, their prescriptions. And so the continuity of care was disrupted. And it’s important to note that that GAO report was about a few years ago under the Biden administration. So this isn’t new. These problems aren’t new, but they’re getting much worse, because the number of people detained is at record levels and so everything’s just getting multiplied. 

Rovner: Yeah, it is. Well, we will keep watching that space. OK, that’s this week’s news. Before we get to our extra credits, I am pleased to present the winner of our annual KFF Health News Health Policy Valentine contest. It’s from [Andrew Carleen] of Massachusetts, based on a story about Medicare Advantage overpayments. And it goes like this: “I thought it was love. My heart felt spring-loaded. Turns out our relationship was significantly upcoded.” Congratulations, and happy Valentine’s Day to all. 

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

Ollstein: Sure. So I have a kind of fun story [“Why Washington’s All-In on Smart Rings”] from my co-worker Amanda Chu about how the Oura ring has taken over D.C. They have been heavily lobbying the Trump administration and Congress to prevent tough regulations. Basically, there’s a debate about whether it should be regulated as a medical device or not. 

Rovner: Tell us again what it does. 

Ollstein: It’s a ring you wear on your finger that monitors different health metrics. And so the Trump administration MAHA movement has gone all in on this. They love it. The Pentagon has a huge contract with them. Other government agencies are looking at it, too. I think it’s interesting because it is this very sort of conservative mindset of individual responsibility in health care and, oh, if you could just track your own metrics and do the right things. That’s an approach that is sort of counter to the idea of public health and government protecting your health through policy. 

Rovner: And we know HHS Secretary Kennedy is a big fan of wearables. 

Ollstein: Exactly, and this is one of the most popular ones right now. And so this story does a good job digging into all the lobbying and also into concerns about data privacy and pointing out that these technologies are moving much faster than government can regulate them. And that is leaving some lawmakers really concerned about who could have access to this data. 

Rovner: Jackie. 

Fortiér: Mine is by Ariana Hendrix. She’s a writer based in Norway. It’s entitled “The New Childhood Vaccine Guidelines Have a Paid Leave Problem.” It was published in Stat. And she writes eloquently about being a parent in Norway and knowing that her children wouldn’t go to day care until they were about 16 months old, because Norway has paid parental leave. And she points out, beyond the vaccine debate there’s a bigger issue, that the U.S. lacks universal health care and federal paid parental leave. So changes in infant vaccines in the U.S. have a large effect, because babies in the U.S. often go to day care, when they’re around a lot of other kids when they’re just a few weeks old. So she points to the, in January, the infant RSV [respiratory syncytial virus] vaccine was moved to the high-risk category of shots, so now it isn’t routinely recommended for all babies in the U.S. And RSV, of course, is the most common cause of hospitalizations for infants, and that’s due to the fact that they’re exposed to the virus in day care a lot earlier than other children in other countries like Norway and Denmark whose vaccine schedules U.S. officials are now kind of trying to emulate. So she does a really great job of laying out how families face greater health and financial risks in the U.S. without the same safety net that other countries have. 

Rovner: Or just the same social policies that other countries have. 

Fortiér: Yeah, it reminded me— 

Rovner: It’s hard to, right, it’s hard to import another country’s — part of another country’s — policies without importing all of them. It is really good story. Lizzy. 

Lawrence: Yeah. So my piece is by Rachana Pradhan and KFF Health News, and it’s about the “US Cancer Institute Studying Ivermectin’s ‘Ability To Kill Cancer Cells.’” And I thought this piece was very interesting, just because in general I’ve been fascinated by — politicization of medicine isn’t new — but just like right-wing-coded products and left-wing-coded products. And in this piece, Rachana talks about NIH [National Institutes of Health] Director Jay Bhattacharya kind of talking about how, It’s the people’s NIH and if a lot of people are using it, well, we want to investigate it. So she just, she does a really good job of kind of unpacking why this is problematic, that they’re kind of just choosing a random medication and there’s not really any scientific reason to be investing in it as much as they are. And she got a response from NIH after the fact as well, kind of where they were trying to defend this decision to pour this much investment. And so, yeah, I think it’s just a really interesting development in NIH land. 

Rovner: It is. My extra credit this week is from ProPublica, by Mica Rosenberg, and it’s called “The Children of Dilley.” It’s about what immigration detention looks like from the point of view of children being held at a family facility in Dilley, Texas. That’s the one where the two cases of measles were diagnosed earlier this winter. The story includes some pretty wrenching letters and video calls from kids who were living elsewhere in the U.S., while their parents were mostly working within the immigration system. And these kids had been ripped from their daily lives, their other parents and siblings in some cases, their schools and their classmates, and in many cases, from hope itself. Wrote one 14-year-old from Hicksville, New York, quote: “Since I got to this Center all you will feel is sadness and mostly depression.” It really is a must-read story. 

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

Fortiér: Bluesky mainly, @jackie-fortier. 

Rovner: Alice. 

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

Rovner: Lizzy. 

Lawrence: On X, @LizzyLaw_. On Bluesky, @lizzylawrence. 

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

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USE OUR CONTENT

This story can be republished for free (details).

The Department of Health and Human Services is funded for the rest of the fiscal year. But lawmakers remain concerned about whether the Trump administration will spend the money as directed.

Meanwhile, negotiations over extending expanded subsidies for Affordable Care Act plans have broken down in the Senate, mostly over a perennial issue — abortion. The subsidies’ expiration at the end of 2025 has left millions of Americans unable to afford their health insurance premiums.

This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Sandhya Raman of CQ Roll Call.

Panelists

Among the takeaways from this week’s episode:

• President Donald Trump signed government spending legislation that provides for HHS, as well as a separate measure that addresses pharmacy benefit managers and some Medicare programs. Meanwhile, Trump has yet to put out his own budget — traditionally a president’s wish list of priorities. On the health side, that is likely to include familiar “Make America Healthy Again” ideas, such as funding for a new agency, proposed last year, that would be known as the Administration for a Healthy America.
• In Congress, negotiations over renewing more-generous ACA premium tax credits have collapsed. While lawmakers are likely to continue hearing from constituents about the high cost of health care, now Senate negotiators are signaling that the chances of renewing the expired tax credits are low.
• A new study in JAMA finds that cancer patients covered by high-deductible health plans had lower rates of survival. The research suggests that high out-of-pocket costs discourage preventive and necessary care — and it comes as little surprise in an environment where many Americans cannot afford unexpected bills for a few hundred dollars, let alone four- or five-figure deductibles.
• And a new interview reveals a very different mandate for Health and Human Services Secretary Robert F. Kennedy Jr.’s remade vaccine advisory panel: to scrutinize the risks of immunizations, rather than balance their risks and benefits. The interview with the panel’s chair, published by Politico, quoted him saying Americans should view them “more as a safety committee,” adding, “Efficacy will be secondary.” The notion that the panel will no longer balance a vaccine’s potentially health- and lifesaving effects against its possible side effects flies against decades of government best practices.

Also this week, Rovner interviews KFF Health News’ Renuka Rayasam about a new reporting project, “Priced Out,” which explores the increasing unaffordability of insurance and health care. If you have a story you’d like to share with us, you can do that here.

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

Julie Rovner: Politico’s “DeSantis’ Canadian Drug Import Plan in Florida Goes From Campaign Trail to Tough Realities,” by Arek Sarkissian.

Sandhya Raman: The Washington Post’s “Free HIV Drugs Save Lives. Why One State Is Restricting Access for Thousands,” by David Ovalle.

Anna Edney: The Atlanta Journal-Constitution and Associated Press’ “Forever Stained: Inside America’s Carpet Capital: An Empire and its Toxic Legacy,” by Dylan Jackson, Jason Dearan, and Justin Price.

Joanne Kenen: Inside Climate News’ “‘Toxic Colonialism’ on the Bay of Bengal,” by Johnny Sturgeon.

Also mentioned in this week’s episode:

• Politico’s “‘Efficacy Will Be Secondary’: RFK Jr.’s Vaccine Advisers Have a New Mission,” by Sophie Gardner.
• KFF Health News and WBUR’s “NIH Grant Disruptions Slow Down Breast Cancer Research,” by Martha Bebinger.
• Stat’s “FDA Commissioner Marty Makary Tries To Soothe Staff Concerns Over Voucher Program” by Lizzy Lawrence.
• Stat’s “Tenuous Biomedical Funding Has Put First-Year Ph.D. Students in a Bind,” by Jonathan Wosen.
• JAMA Network Open’s “High-Deductible Health Plans and Mortality Among Cancer Survivors,” by Justin M. Barnes, Arjun Gupta, Meera Ragavan, Patricia Mae Santos, September Wallingford, and Fumiko Chino.

[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 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, Feb. 5, 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 Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Good morning. 

Rovner: Anna Edney at Bloomberg News. 

Anna Edney: Hi, everybody. 

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

Kenen: Hi, everybody. 

Rovner: Later in this episode, we’ll have my interview with Renuka Rayasam about our new KFF Health News project “Priced Out.” If you have a story you’d like to share with us about your inability to afford your health insurance or your health care, I will post a link in our show notes. But first, this week’s news. 

So after a two-week detour, during which funding for the Department of Homeland Security was separated out for a separate resolution, which is still TBD, President [Donald] Trump on Tuesday signed into law the rest of an omnibus spending bill that includes funding for the remainder of the fiscal year for the Department of Health and Human Services, as well as a separate health package that includes, among other things, new rules for pharmacy benefit managers and an extension of temporary Medicare programs, expanding payment for telehealth and so-called hospital at-home care. Sandhya, you succinctly summarized all of this the last time you were on, when we thought this was about to become law. But I think it bears repeating that the spending part of this bill includes very few of the cuts to health programs President Trump asked for in his budget proposal last year. How confident are we that this money is actually going to get spent the way Congress is ordering? 

Raman: I think that’s kind of difficult to say. I think one clue we can look at is in the lead-up to this. We did have some of the different grants rescinded and then reinstated in a short amount of time — related to mental health and in public health and a few other areas like that — in order to get this across the finish line. I don’t know what guarantees we have that if it’s not this, it’s something else. But I think they do seem a little bit more confident that they got a little bit more language in there this time to prevent that. But I think we’ll also see, as we get into fiscal 2027 spending and what the White House ends up proposing there. 

Rovner: Yeah, I heard an interview with Sen. Tammy Baldwin, who’s the ranking Democrat on the subcommittee that handles HHS, saying that, you know, unlike last year, when it was just a continuing resolution, this year they actually put in language that says, You will spend this this way. But of course, they’ve had language that’s supposed to spend certain things a certain way, which they have thus far ignored, right? 

Raman: Yeah, and I think it’s something that comes up in all of the hearings they have on this that, you know, appropriators love to say Congress has the power of the purse. You know, this is what they are there to do, is to dole out who gets what. And so it’s an affront to them to say, you know, you’ve spent all this time deciding how much should go to various things, and then it doesn’t actually end up that way. So we’ll see how that plays out. 

Rovner: As you mentioned, it’s worth noting that the president’s budget for fiscal 2027, which starts in just eight months, is already technically late. It was due this past Monday. Any idea when we’ll see a budget from the administration? What might be in it? I know it usually comes after the president’s State of the Union, but that speech is usually at the end of January, and this year the State of the Union isn’t until the end of February. 

Raman: So, I will say that almost always the White House budget comes after the date that it’s supposed to, in statute. But we are, I think, expecting at this point either very late this month or pushing into next month, in terms of when we get it. I think in terms of what would be in there, a lot of what we can look to is similar to what we saw in last year’s request; since the White House budget request is a wish list — it’s the things the White House wants, not necessarily the things they will get. So I think we can look for a lot of the same proposed cuts as before, because some of those were even proposed in the first Trump administration. I think we can also probably look for a lot of, you know, MAHA-oriented things proposed in there that didn’t get across the finish line — the new agency, Administration for a Healthy America, and just kind of flushing that out. And I think those are the big things I’d look for as we get closer to that. 

Rovner: Well, turning to the Affordable Care Act — remember the Affordable Care Act and those expired subsidies that are driving up costs for millions of Americans? Remember the frantic negotiations in the Senate to come up with a compromise after the House passed a Democratic-led effort to extend those enhanced subsidies for three more years? Well, apparently, negotiations on a deal have collapsed, and it’s, apparently — as we’ve said many times — over the often insurmountable issue of abortion. Is this really it for the ACA negotiations, or could this issue come back later this winter, even spring, as more and more people end up dropping their coverage because they can’t afford the new premiums? 

Edney: I think that’s the key point, is we don’t have those numbers. We don’t have a great sense of what that’s going to look like. So I think that when lawmakers start getting those phone calls, that could revive things. I think certainly with the ACA, as it relates to the Hyde Amendment — which it is kind of a “never say never,” like, it often kills these deals, but then suddenly something can kind of appear so … so, yeah, I think you’re right. 

Rovner: Yeah, the Hyde Amendment, just for those who don’t remember, is what basically bans federal funding for abortion through the Labor-HHS spending bill. But anti-abortion forces want to put it in permanent law, rather than having it renewed every year through the spending bill process. And that’s a hang-up that almost blocked the ACA from becoming law in the first place, because even Democrats disagreed over it. 

Edney: Exactly, yeah, and it comes up every single time. You know, there’s … just no solution, no good solution. 

Raman: I feel like this is maybe the last straw at this point, based on the conversations from the Hill this week. I mean, there was a little hope earlier in the week when we talked to Sen. Tim Kaine [D-Va.], and he said, you know, we’ll see in the next couple days or so, we’re still talking. They met this week. They’re planning to meet more this week and talk about it, and then I think in the last day or so, it just … I think both sides were kind of admitting that it was done … because of this issue, [and] there are a couple of other things that are sticking points, and even things that they hadn’t gotten to really ironing out. But they’d said it was kind of moot at this point, if they couldn’t get over Hyde and some of the stuff related to health savings accounts, so. … There are some people that are still hopeful that said that maybe, but I really don’t see how they continue without the people that are most focused on this in the Senate, like really dialing into it. 

Rovner: Yeah, they seem to be sort of consumed right now with figuring out what to do about the Department of Homeland Security in general, and ICE [Immigration and Customs Enforcement] in particular. And I’m glad you mentioned health savings accounts, because obviously that’s been a big Republican push, to give more money directly to people, rather than to insurance companies. Well, it turns out there’s a study in the Journal of the American Medical Association [Network] this week that found that cancer patients who have those high-deductible health plans, which get combined with the health savings accounts, those patients had lower rates of survival compared to those with more comprehensive insurance coverage. Quoting from the study, “These data suggest that insurance coverage that financially discourages medical care may financially discourage necessary care and ultimately worsen cancer outcomes.” That’s not going to help Republicans in their efforts to make patients more financially responsible for their care, I wouldn’t think. 

Edney: Yeah, I think a lot of these things that a cancer patient can’t afford — I mean, this isn’t a $40 copay; often it’s hundreds of thousands of dollars, they’re considering selling property, selling a house, whatever. So it’s not … something that people are shopping around for, becoming more fiscally responsible, trying to find, like, a cheaper option to do this. This is something that, clearly, if they could do it, they would. And you know, instead, as this study showed, they’re more at risk of dying because they can’t get these treatments. 

Kenen: I think that just in general, you know, that these high-deductible plans people treat them as for an emergency, for a catastrophic expense, which means people are delaying — uninsured people and poorly insured people — often delay preventive care and screening. And therefore, if you catch a cancer, and I don’t know the stage of diagnosis — I read part of the study; I didn’t read the entire thing. I don’t know the stage of diagnosis. But if your cancer is caught later because you didn’t do preventive screening, some of which are free now, and some of which are not, or some of which are just caught by, you know, when you’re going in for something else, whatever. Later-stage cancer diagnosis is a worse cancer diagnosis. So the disincentives for preventive care, the disincentives for going in earlier, because you don’t want a big bill for something that you are hoping is nothing, is part of the overall picture. 

Rovner: Yeah, and I mean, it also bears saying that, you know, when we were first arguing about health savings accounts and high-deductible health plans, high-deductible health plans had deductibles of, like, $500 or $1,000. Now, high deductibles are five figures. They’re $10,000 and up. And that’s way more than just inflation over the last 20 years. We know that generally people don’t even have $400 set aside for an emergency. So the idea that they can meet a $10,000 deductible so their insurance can kick in is kind of fanciful, I think, for most people. 

All right. Well, meanwhile, there is lots more news on the vaccine front. In an interview with Politico this week, the new chair of the CDC’s [Centers for Disease Control and Prevention] Advisory Committee on Immunization Practices, Kirk Milhoan, said that the panel should be viewed, quote, “more as a safety committee.” “Efficacy,” he said, “will be secondary.” Basically, he’s saying the panel, whose actual charge is to weigh benefits versus risks of various immunizations, is going to put its finger on the scale to emphasize the risks. Am I reading that right, Anna? 

Edney: Yeah, that’s what, that’s how I read his conversation with Politico. … They’re really charged now to look at the risks of these, which is interesting, because, to put it mildly, because I think it’s kind of a warped way of thinking about vaccines, generally. … There are some risks … but we are potentially stopping how many hundreds, thousands of deaths from polio or something like that. So seems like it could get worked into focusing on those risks versus the lives that are saved by it. It seems to be the direction that this administration certainly wants to go. 

Rovner: And that’s, I mean, the point of having … an expert outside committee is for them to actually do that weighing of benefit versus risk, at least that was my assumption. It’s what I’ve always been told in the almost 40 years I’ve been doing this. 

Edney: Right, and whether it should be a required vaccine versus something you … deciding to get or something like that. Conversation can help with those kinds of decisions. But this is something — a vaccine doesn’t come to market if the FDA is looking at these risks when they consider it in the clinical trials, and that side of it is vetted by the people who are able to have access to a lot of that information. I don’t know that the panel is going to see [it] in the same way, because if you’re looking at the adverse-event database that is kept on vaccines, anyone can send in a side effect to that, or, you know, say that something happened after they had a vaccine. And it can be tough to read that and actually get helpful information from that if we’re looking at the post-market vaccine side effects coming in. 

Rovner: We will continue to watch this space. And it turns out that the changes to vaccine policy extend beyond the United States, too. Reuters broke the story this week that the U.S. is threatening to stop giving money to the global vaccine group Gavi, unless it promises to phase out the use of vaccines that still contain the preservative thimerosal, which has long since been cleared of accusations about causing autism. Gavi provides vaccines to children in the poorest parts of the world, and to stretch its funding, it often relies on less expensive, multidose vaccine vials, which use preservatives to prevent contamination. Apparently, this threat applies to the $300 million the U.S. is already withholding from Gavi that was approved by Congress and to any future funding. So now the U.S. is exporting its effort to scale back childhood immunizations around the world, too? 

Edney: Yeah. It was surprising to see something like that, kind of a demand like that put on Gavi. I guess, in a way, it’s surprising that the administration is still funding Gavi, maybe at all. So you know, I guess, maybe not as shocking that they asked for certain stipulations to be met. But as you mentioned, it is a way to stretch the vaccines to get them to people and countries who otherwise might not have any access to them. So there’s been concern, as you said, that has been debunked about thimerosal, and so we’re not using them that much in vaccines in the U.S., but it’s kind of pushing a first-world problem on other countries. 

Kenen: One really helpful way of thinking about the risk of this preservative is it’s been, as Anna just said, it’s been phased out, not entirely, but mostly in the United States. But in the years … like, most children are not getting it in their shots. And it has to do with storage of large quantities versus individual vials. We don’t have to go into details there. It’s just not, there’s not much of it anymore, and the autism rate has continued to go up while the thimerosal use went down. So that’s … even if you’re not a biostatistician, a statistician, it should tell you something, you know. … If that was the cause, we wouldn’t be seeing more cases. The rise of autism is a complicated thing. We don’t have time to discuss all the theories and measurements and how we do it right here, but it’s easy to understand: One went up, and one went down. It didn’t cause it. 

Rovner: Well, finally, on the vaccine front, this week, here’s what happens when fewer people get immunized. Two detainees at one of the Department of Homeland Security’s family detention centers in Texas have now tested positive for measles, which, as we have discussed at some length, is among the most contagious diseases in the known world. Measles has also been found at another detention facility in Arizona. Now, in the first Trump administration, I remember complaints about children who were being held in detention, having been separated from their parents, being vaccinated without their parents’ permission. But which is worse? Getting vaccinated without parents’ permission, or getting a potentially deadly vaccine-preventable disease? 

Edney: Yeah, that’s certainly, certainly, I think, an easy answer. But you know … these detention centers, it’s so scary because everyone is just packed in there. Everything we’ve heard is how crowded they are, and the people not even being able to lay down. So you do have to wonder whether they’re starting to think differently about just letting it rage through there, or what’s going to happen. I mean, we don’t know yet if quarantine has worked, or anything along those lines. 

Raman: And I think that goes hand in hand a little bit with what we’ve talked about in the past, about, you know, it already being harder to get care for the folks in these facilities, and providers not being able to do that. And if you’re not able to stop something that is so contagious and spreading, it’s just going to exacerbate the whole situation. 

Rovner: Yeah, we have talked at some length about health care for people who are in these detention camps, and how it appears to be significantly lacking. All right, we’re going to take a quick break. We will be right back. 

Back on Capitol Hill, National Institutes of Health Director Jay Bhattacharya appeared before the Senate HELP [Health, Education, Labor & Pensions] Committee on Tuesday and tried to make the case that the agency’s work hasn’t been disrupted by the on-again, off-again funding and grant cuts made during the course of 2025. He pointed out that eventually NIH did spend all of the money that was appropriated to it, but boy, a lot of it came in the last couple of weeks of the fiscal year. Also, as we’ve discussed at some length, there are plenty of stories out there that show that, in fact, funding disruptions have hurt science, including two new ones this week. Stat News has a story about first-year PhD students who are having trouble finding positions in labs — even those students who have their own funding via scholarships or fellowships — because the labs don’t know how to plan for what they’re going to have in terms of money. And here at KFF Health News, we have a story about a Harvard breast cancer lab that’s lost seven of its 18 lab employees after getting its grant frozen and eventually unfrozen, but too late to apply for it to be renewed. Bhattacharya made a big deal of, you know, the NIH, it’s like, OK, we spent all your money. But turning this spigot off and then on again, and then off and then on again, doesn’t feel like a particularly efficient way to spend it. 

Kenen: No, it hurt. It’s really well documented. There are labs all across the country that were hurt, and that meant science that didn’t happen, or didn’t happen as fast and as well as it could have and should have happened. So … to say on-again, off-again biomedical science funding is fine and dandy. It’s not fine or dandy. 

Rovner: And there were patients whose care was disrupted. 

Kenen: And people in clinical trials who were taking a risk, and inconvenience as well as risk, to be part of a clinical trial. I mean, this was more true of some of the stuff in Africa, when the USAID [United States Agency for International Development] money went away, but some really extreme examples there. But people whose care was interrupted, and people who had volunteered in clinical trials whose care has been interrupted. 

Rovner: Yeah, and people, I mean, for whom these clinical trials were their last chance for, you know, for life or death. I mean, we did see stories from all across the country about clinical trials that got, just stopped in their tracks, and you can’t really restart those, because now you’ve interrupted the care. So the science from them is not going to be as valuable. I mean, you basically have to start over. 

Kenen: You could restart but not where you left off. You have to start again. 

Rovner: Right, exactly. You have to start again, which is also not a great use of money. 

Well, meanwhile, over at the FDA, there are still apparently some pretty loud complaints over the agency’s new, quote, “priority voucher” program, which promises expedited approvals for drugs that, quote, “align with national priorities,” which can apparently be political as well as medical. Our podcast panelist Lizzy Lawrence, over at Stat, got a readout from an employee town hall at FDA, as well as members of Congress who are continuing to express concerns about the potential, if not actual, politicization of the drug review process with this program. Anna, what are you hearing? 

Edney: Yeah, I think that that is still the concern. That town hall did not fix anything in the sense that there’s — it’s a completely new paradigm for how they are choosing drugs and pushing them to the front of the line. The FDA has never before really been supposed to or has considered price or anything beyond Is this drug going to be beneficial? They would give things priority review, if it was something that was for lifesaving treatments, or something that just, you know, had, was a huge advance, never existed before. But now they’re saying, If you align with the national views, and nobody really knows exactly what that means. It seems to be that, you know, maybe if you made a deal with Trump to bring down drug prices, you might get some of these. Or if it’s, you know, if you’ve promised to build more manufacturing in the U.S., you might get this. Or if it’s a drug that they just like, then you might get it. I think there’s still just a lot of concern about the legality of this. So even among some drugmakers, there are ones obviously who want this. There are about, I think, 15 right now who have this voucher to get to the front of the line to be, have a superfast review. But there is concern from some that, if another administration comes in, is this even valid? You know, if we get approval, do we even, does it even count if they want to, like, take it, if somebody wants to take it off the market, just given the process? So there’s … you know, people have quit at the FDA over it, very high-profile people, and it’s interesting that it’s still going, that Marty Makary, the commissioner, is still trying to sell it. And [he] even told staff, you know, according to the reporting from Lizzy, that he was doing it because it was really their idea. So. 

Rovner: Meaning the staff’s idea. 

Edney: Yeah, that’s one way to sell it. 

Rovner: I saw that part. I feel like this is a theme throughout the department, which is that, you know, we’ve had for decades in Republican administrations, and Democratic administrations, science sort of shielded from the political leadership of these agencies, of the FDA and the NIH and the CDC, that the science … that you can lay over the politics. It’s like, here are our priorities, but the science is the science. And I feel like we’ve had now politics entering every single one of these what are supposed to be scientific agencies, right? 

Edney: Yeah, that’s absolutely true. There’s more political appointees. I think this was brought up when Bhattacharya was before Congress, as well. At NIH, there’s more political appointees, just people with an idea in mind of what might be more important than something else, rather than following where the science is going at the moment. And in the case of FDA, before it was not about trying to go as fast as possible. And it’s not just that there’s politics injected, but it’s that we’re cutting out the regular reviewers with the scientific knowledge because they would like to go faster. That’s part of the appeal, I guess, of the voucher. 

Rovner: Yeah, well, we’ll see how that plays out. All right, that’s the news for this week. Now we will play my interview with KFF Health News’ Renuka Rayasam, and then we will come back and do our extra credits. 

I am pleased to welcome back to the podcast my KFF Health News colleague Renuka Rayasam, who is spearheading our newest series, called “Priced Out.” I will, of course, post links to the first stories in our show notes. Renuka, welcome back to What the Health? 

Renuka Rayasam: Thanks for having me, Julie. 

Rovner: Tell us about this project and what the goal is in pursuing it. 

Rayasam: So actually, we started thinking about this a year ago, my colleague Sam Whitehead and I. And we looked at what was happening both with health care costs generally, but also with what Congress was likely to do or not do. And we realized we’re going to start to see uninsurance rates climb back up after years and years of falling. And so that’s what was the impetus for this project. And then, of course, by the end of the year, Congress didn’t extend enhanced subsidies for ACA premiums. People started to feel and see their ACA premiums jump because of that and because of other things that have led to an increase in health care costs. And overall, obviously, people are feeling the pinch in their budgets, and health care is no exception. And this was born out of watching all those trends come together. And then people started writing to us and saying things like: I have insurance, but my deductible is a quarter of my take-home income. You know: I’m a lawyer. I have my own business, but I can’t afford for my family to be on insurance this year. I can’t afford my medication. I can’t afford going to the doctor. And so I think that was really how this series came together, was hearing those stories about people who, whether they’re insured or not, and often not, were just really facing these high costs of health care. 

Rovner: Yeah, as you say, this is not just the binary: Do you have insurance or do you not have insurance? A lot of this is about people who have health insurance and still can’t afford to access care. That’s a big part of this, isn’t it? 

Rayasam: Yeah, absolutely. I mean, so interesting talking to this guy, Noah Hulsman. He’s in Louisville, Kentucky. He owns a skateboard shop there. Youngish guy, 37 and he was saying, you know, he had a “gold” plan last year that he bought through the exchange, and now he has a “bronze” plan, and he’s paying the same amount per month for his premium, but he’s, like, you know, if something were to actually go wrong, I can’t afford my deductible, like, I can’t pay the bills I need for my shop and meet my deductible. And his shoulders hurt, and he’s, like, I can’t afford to get it looked at because of the copays and all the out-of-pocket costs that come along with that. And I think, you know, in this administration and in this Congress, this GOP-led Congress, a lot of talk of things like short-term health plans and lowering premium costs, but these are a lot of plans that come with high costs if you actually try to go and use the health care. And that’s the sticker shock that people are going to face when they start to actually try to go and get health care when they have an issue that they need to get taken care of. 

Rovner: So one of the first stories in this series includes some actionable information, as we call it, for folks who are looking for alternate ways to afford the care that they need if they’ve had to drop or scale back their insurance. What are some of those ways? 

Rayasam: Sure. So I’ll put this caveat out there: Every single person I spoke with in putting these tips together said, even if you have a high deductible, even if the out-of-pocket costs are really high, you should have health insurance because that is the best protection against big bills. If something really catastrophic were to happen, it’s better than nothing. It’ll keep you from going bankrupt. So that’s a caveat out there. But if, after all of that, you still cannot find a plan, you can still, can’t find a plan that you can afford — which is a lot of people, that’s, you know, it’s not a negligible number of people in this country. A few things you can do: Talk to your doctor. I think a lot of people are really nervous about talking to their doctor about money and costs, but, you know, I think if a doctor knows this patient is paying out-of-pocket, they might have a cheaper cash-pay option. They might be able to adjust care to try things that are maybe less expensive, you know, maybe get the same quality of care, but try different things that might be a little cheaper. If your doctor is not budging, then go to a place that does specialize in treating patients without insurance. So federally qualified health clinics, community health clinics, a lot of doctors will advertise cash pay. I’m seeing that more and more, actually, a lot of doctors saying, Hey, we do cash-pay options. When you get a prescription from your doctor, don’t just head to the local pharmacy. Comparison-shop. It’s a lot easier to shop for drugs than doctors. A lot of drugmakers have coupons and drug discounts and other ways you can get those products for cheaper. And a lot of big-box retailers — like Walmart, Costco — will offer generic options for your prescription for really affordable prices, and so … be sure that you’re shopping around and that you’re being a smart consumer and looking at different avenues and ways to get care. You know, one last thing I’ll mention is something people don’t think about a lot, which is their local county health center. They have a lot of services, disease testing and screenings, and, in a lot of cases, even mental health or substance abuse care. So contact your local county, see what’s out there, and look around. There are ways to get care if you don’t have insurance. It’s harder. It’s going to take more time, but there are options out there. 

Rovner: Can you give us a preview of some of the upcoming stories in the series? 

Rayasam: That’s a good question. So we’re starting to get people who are writing to us and talking about their concerns and, like I said, these are people who could no longer afford their insurance premiums, people who’ve had to scale back on the coverage they’ve gotten and are dealing with that. And so we’re going to sift through those responses and start to write more stories about the things that people are facing and the consequences of that. You know, one of the women I talked to for this first story was talking about how she started rationing her rheumatoid arthritis medication when she found out that she wasn’t going to be able to afford her ACA plan. So we’re, you know, going to dive deeper into issues like that. And, you know, what are the health risks if you have to ration your medication? What are the problems there? What are ways that people can get into troubles? Things like medical credit cards. I think people might be tempted to turn to a medical credit card, but I think there’s a lot of ways that can make the problem of cost of care worse, you know, if that interest starts compounding. And so I think we’re going to look into all the ways that the cost of care [is] affecting people — their physical health, their financial health, and just their overall well-being. It’s incredibly stressful, and it can really affect so many parts of your life to not have access to affordable care. 

Rovner: Well, it’s a really important series. Renuka Rayasam, I’m looking forward to reading the rest of it. 

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

Raman: All right. So I picked a story from The Washington Post by David Ovalle, and it’s called “[Free HIV Drugs Save Lives. Why One State Is Restricting Access for Thousands].” And his story looks at some of the impacts after the Florida AIDS Drug Assistance Program, which is funded through federal money; it’s helped a lot of people with HIV who weren’t able to afford antiretroviral drugs, be able to afford that. And what’s happened in Florida is that the state officials have lowered the income thresholds to get those benefits, saying that there are financial difficulties. And just kind of looking at, you know, some of the cases, and how that’s affecting people over there. 

Rovner: Yeah, good story. Joanne. 

Kenen: This is from Inside Climate News by Johnny Sturgeon, and it’s called “‘Toxic Colonialism’ on the Bay of Bengal.” And I had never heard of this before. There’s something called shipbreaking. And shipbreaking is exactly what it sounds like. You take a great big ship, like a big transport, you know, freighter transport ship — we’re not talking about, like, little rubber things in a bathtub. And they are full of heavy metals, radioactive materials, and all sorts of toxic waste. And the way you get them out when you’re done with them is you ram them into the beach as hard and fast as you can. It’s shipbreaking! So this is in poor areas, in areas that already have, you know, pollution: India, Pakistan, and Bangladesh are not known for having the cleanest air and water in the world, and poor people live near there. And it’s huge, it’s a really interesting story about something that you would have thought, like, somebody was making up on a comedy show. But it’s happening, and it’s harming people, and it’s harming the planet. 

Rovner: Yeah, I never thought about what happens to a ship when you’re done with it. 

Kenen: I thought there would be some way of, like, I think in our country, we have some way of taking them apart safely. But no. I mean, and this is a global thing. I mean … it’s not just ships from the region. … This is happening to hundreds of ships a year. 

Rovner: Anna. 

Edney: Following in the theme of Joanne’s article, mine is “Forever Stained: Inside America’s Carpet Capital: An Empire and its Toxic Legacy.” This was a really interesting collaboration with al.com, The Atlanta Journal-Constitution, The Associated Press, and a few others. I won’t name all of them, but it’s a look at … there’s a town in Georgia that is the carpet capital of the U.S., and is how they use Scotchgard on all the carpets, and how that has forever chemicals in it, and has, over the years, just polluted the water there, and people are getting sick. You know, someone’s goats all died. It’s a really inside look at how the local government, the industries, have all collaborated to get to this point. And you know, just as something was potentially being done about PFAS under the Biden administration, the Trump administration has rolled a lot of that back, so I think it makes that particularly relevant now. 

Rovner: Yeah, it does. All right, well, I also have a story from Florida. My extra credit’s from Politico. It’s called “DeSantis’ Canadian Drug Import Plan in Florida Goes From Campaign Trail to Tough Realities.” It’s by Arek Sarkissian, and it’s from the “Who could possibly have seen this coming, except everyone?” file. It turns out that although FDA specifically gave Florida permission to begin importing cheaper drugs from Canada — more than two years ago, Florida was the first state to actually get permission to do this. And although the state has spent an estimated $82 million in state taxpayer funds to contract with a logistics company and open a warehouse for the drugs, it seems that none have been imported yet. Why? Well, because Canada apparently wasn’t kidding when it said its government had no interest in selling drugs to Balkan states so that they could basically import Canada’s price controls. But fear not. The DeSantis administration says it’s still trying to get the program up and running, and it has until May of this year to do that, under the permission that was granted by the FDA. I will be watching that space but not holding my breath. 

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

Raman: I’m on X and on Bluesky @SandhyaWrites. 

Rovner: Joanne. 

Kenen: I’m on Bluesky and LinkedIn @JoanneKenen. 

Rovner: Anna. 

Edney: Bluesky and X @annaedney. 

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

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The actions of federal Immigration and Customs Enforcement agents are having ramifications far beyond immigration. Medical groups say that ICE agents in health facilities in Minneapolis and other cities are imperiling patient care, while in Washington, the backlash from a second fatal shooting by agents in Minnesota has stalled action on an eleventh-hour suite of spending bills.

Meanwhile, anti-abortion groups remain unhappy with the Trump administration over what they see as its reluctance to scale back the availability of the abortion pill mifepristone.

This week’s panelists are Julie Rovner of KFF Health News, Maya Goldman of Axios, Alice Miranda Ollstein of Politico, and Rachel Roubein of The Washington Post.

Panelists

Among the takeaways from this week’s episode:

• Concerns intensified this week over President Donald Trump’s immigration sweep after federal agents killed a second citizen in the midst of the crackdown in Minneapolis. Democrats in Congress are blocking approval of government spending as they call for renegotiating Department of Homeland Security funding, potentially forcing a partial government shutdown this weekend. In Minnesota and elsewhere, there are reports of patients postponing medical care and doctors pushing back on the presence of federal agents in hospitals.
• After the Department of Health and Human Services cut off some federal funding to Minnesota over allegations of Medicaid fraud, other Democratic-led states in particular are fearing HHS could do the same to them. Typically the federal government conducts investigations and imposes sanctions in response to concerns of fraud; it’s unusual that HHS has opted to halt some funding instead.
• Abortion opponents last week held their annual March for Life in Washington. The Trump administration marked the occasion by reinstating and expanding policies imposed during the president’s first term, including a ban on fetal tissue research and what’s known as the Mexico City Policy. Still, the administration has not made notable progress on a key goal of the anti-abortion movement: barring access to medication abortion.
• Meanwhile, senators are still trying to sort out a bipartisan compromise to restart the enhanced Affordable Care Act premium subsidies that expired last year. And insurance company executives appeared before House lawmakers last week to answer questions about affordability as the Trump administration announced a plan to keep reimbursement rates nearly flat next year for private Medicare Advantage plans.

And KFF Health News’ annual Health Policy Valentine contest is open. You can enter the contest here.

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

Julie Rovner: Science’s “U.S. Government Has Lost More Than 10,000 STEM Ph.D.s Since Trump Took Office,” by Monica Hersher and Jeffrey Mervis.

Maya Goldman: NBC News’ “Many Obamacare Enrollees Have Switched to Cheaper Bronze Plans. Here’s Why That Could Be Risky,” by Berkeley Lovelace Jr.

Alice Miranda Ollstein: The New York Times’ “After Donations, Trump Administration Revoked Rule Requiring More Nursing Home Staff,” by Kenneth P. Vogel and Christina Jewett.

Rachel Roubein: Stat’s “HHS Appoints 21 New Members to Federal Autism Advisory Committee,” by O. Rose Broderick.

Also mentioned in this week’s episode:

• Axios’ “Fear of ICE Is Driving Patients Away From Medical Care,” by Maya Goldman.
• Annals of Internal Medicine’s “Unexplained Pauses in Centers for Disease Control and Prevention Surveillance: Erosion of the Public Evidence Base for Health Policy,” by Jeremy W. Jacobs, Garrett S. Booth, Noel T. Brewer, and Janet Freilich.
• Politico’s “Trump Asks Federal Court To Hit Pause on Abortion Pill Case, Citing Ongoing Study,” by Alice Miranda Ollstein.
• The Washington Post’s “Freeze of Public Health Funds for States, Then Reversal, Sows Confusion,” by Lena H. Sun and Rachel Roubein.
• The Georgetown University Center for Children and Families’ “CMS Weaponizes Fraud Against Medicaid in Minnesota,” by Andy Schneider.
• KFF’s “KFF Health Tracking Poll: Health Care Costs, Expiring ACA Tax Credits, and the 2026 Midterms,” by Shannon Schumacher, Audrey Kearney, Mardet Mulugeta, Isabelle Valdes, Ashley Kirzinger, and Liz Hamel.

[Clarification: This article was revised at 12:30 p.m. ET on Jan. 30, 2026, to clarify that the agents involved in the Trump administration’s immigration crackdown represent not only the U.S. Immigration and Customs Enforcement agency but also the broader Department of Homeland Security.]

[Editor’s note: This transcript was generated using transcription software. 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, Jan. 29, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Hi. 

Rovner: And Rachel Roubein of The Washington Post. 

Rachel Roubein: Hi, everyone. 

Rovner: No interview this iced-in week here in Washington, but still lots of news. So last week at this time, Congress was busy patting itself on the back for being poised to pass all 12 annual appropriation bills before their Jan. 30 deadline, including the two biggest ones, those funding the Departments of Defense and Health and Human Services. Still, as I believe I said at the time, it’s not done until it’s done, and, well, it’s not done. What happened, of course, is that after the House passed the remaining six spending bills and left for a week’s recess, on Saturday, federal [Border Patrol] officers shot and killed a VA [Department of Veterans Affairs] ICU nurse, Alex Pretti, on the streets of Minneapolis, where he was participating in an ICE [Immigration and Customs Enforcement] protest. That second killing of a civilian in three weeks turned Senate Democrats, who were supposed to approve the spending package this week, unanimously against the spending bill for the Department of Homeland Security, which includes ICE and which is included within the appropriations package passed by the House last week. But it’s not as easy as splitting off the Homeland Security bill and passing the other five. If the Senate changes anything about the package, it has to go back to the House, which, as I mentioned, isn’t even in town this week. So where are we? And how likely is it that we’re going to look at a partial government shutdown come Saturday? 

Ollstein: So it’s really a mess right now. You have some in both parties who are calling for passing the rest of the bills and pulling out the Homeland Security funding to keep negotiating. Some people are saying they should do a very short-term CR [continuing resolution] — a week, a couple weeks — in order to give Congress more time to negotiate these reforms and restrictions that Democrats are demanding. But then you have House Republicans who are saying, Oh, if we’re opening this all back up again, we have some demands, too, and we want more of this and more of that and XYZ. And so they’re saying, We’re gonna defund all sanctuary cities. So, like you said, once you open this back up, it opens up a whole can of worms. That said, the Democrats’ base is really saying don’t give one penny more to this agency that they see as completely running amok and violating life and civil liberties. And so we’re really at kind of an impasse right now. 

Rovner: This is a classic never-count-your-chickens in Congress. Maya, you want to add something. 

Goldman: Yeah, I was going to say, it seems like the health care package is collateral damage here, right? There’s a lot of agreement, bipartisan agreement, that these changes that they’re trying to make, PBM [pharmacy benefit manager] changes, things like that, should be passed. But then, like you said, Julie, it’s never over till it’s over, and more time between getting a bill negotiated and actually passing it just gives interest groups more time to get things changed. So that will be interesting to see. 

Rovner: And just a reminder for those who aren’t following this as closely as we are, there is this health package that’s riding along in this spending-bill package that includes the PBM reform and extensions for things like home health care and telehealth and other things that are not technically spending-bill issues but that need to be renewed periodically by Congress. So that’s also sitting out there waiting to see what the Senate decides to do and then what the House decides to do, depending on what the Senate decides to do. 

Roubein: And the last government shutdown, in the fall, was based on health care. But as you mentioned, the fight was over Affordable Care Act subsidies, which is not part of this package that Julie mentioned. 

Rovner: That’s right. So that will continue. But I want to talk about ICE. We have tiptoed into the immigration debate as it impacts health care in recent months, but now it’s really front and center, and I’m talking about more than just the fight over ICE tactics in Minnesota and blocking the spending bill for the entire Department of Health and Human Services. Maya, you have a story about how ICE presence in hospitals and other health care facilities is having an impact on patient care. Tell us what you found. 

Goldman: Yeah, a lot of physicians and nurses in Minneapolis, Twin Cities, and also across the country are saying that this is approaching, or has already become, a public health crisis. And the problem is twofold. It’s, Part 1, patients aren’t coming to get the care that they need, because they’re worried about leaving their homes. And one doctor during a press conference said she even has patients who don’t want to take telehealth appointments, because they’re afraid of getting on the phone or getting on the computer, because they’re worried they’re being surveilled. So that’s a huge problem. And then some doctors are also saying that ICE presence in and around hospitals is making it harder for them to do their jobs of providing care, because there are reports of agents being aggressive and sort of being in places where they are not supposed to be, or are physically impeding care. So two sides of the coin. 

Rovner: Yeah, a reminder that ICE was largely forbidden from operating in, quote, “sensitive” areas like schools and churches and health facilities, in both Republican and Democratic administrations, until [President Donald Trump] changed it last January. We’ve heard a lot since then about ICE being in all of these sensitive locations, right? 

Goldman: Yeah, yeah. And I think it’s important to note the Department of Homeland Security, when I reached out to them, said that they are not conducting enforcement operations in hospitals, even though they are now allowed to. If they take a patient who’s in custody to the hospital, they are in the hospital. They can get a warrant to come into the hospital. They can be in public spaces like parking lots and waiting rooms, waiting for people. 

Rovner: And as we’re hearing, that’s exactly what they’ve been doing. 

Goldman: Exactly. 

Rovner: Even though they’re not, quote-unquote, “conducting enforcement operations” there. Doesn’t mean they’re not there. So even the American Medical Association, not exactly a left-wing group, issued a statement expressing concern about ICE activity in and around hospital emergency rooms, which it called a, quote, “tactic fueling fear among patients and hospital staff alike.” Are we starting to turn a corner here? I feel like this is, maybe it was a combination of what happened last week, coincided with the big snowstorm in half the country and people were stuck inside watching TV. I do feel like there’s way more awareness than there was even two or three weeks ago of this stuff. 

Ollstein: I think it remains to be seen whether there is a meaningful policy and practice change or just a sort of symbolic or rhetorical change. There’s a different tone being struck. There’s sort of backpedaling on the immediate reaction from government officials we heard, which was to blame the people who were killed for their own killings. There are calls for investigations coming from both sides of the aisle. There are calls for some top officials’ resignations. But again, we’re hearing from people on the ground that things have not actually shifted in the enforcement behavior of these agents. And so I think it really remains to be seen what happens in Congress in terms of passing policies. There’s discussion of putting limitations in the spending bill on what ICE can do. But again, there is a lot of concern that I’ve heard from the advocacy community that they’re going to set up some government official — whether it’s [Homeland Security Secretary] Kristi Noem or [Trump deputy chief of staff] Stephen Miller or, already we’ve seen [Border Patrol official Gregory] Bovino — to be a fall guy and then nothing will actually change substantially beyond that. And so there’s continued anxiety around that. 

Rovner: Yeah, and just a reminder that even if the spending bill doesn’t, for the Department of Homeland Security, didn’t pass and they didn’t even do a continuing resolution, ICE has I believe it’s $75 billion from the budget bill that passed last year. So they have a big chunk of money to keep operating regardless. Talk about collateral damage — it would be all of these other agencies that would have to sort of stop operating if there is some kind of a shutdown. 

Well, meanwhile, it’s not just ICE that’s going after the state of Minnesota. The Centers for Medicare & Medicaid Services earlier this month cut off a chunk of the state’s Medicaid funding going forward. They’re charging that the state is, quote, “operating its program in substantial noncompliance” with rules to detect waste, fraud, and abuse. This is not how this is supposed to work. CMS can sanction states for their anti-fraud efforts being lacking, but there’s supposed to be a lot of due process first, with lots of hearings and appeals and fact-finding and all kinds of mumbo jumbo that we do go through before people actually get sanctioned. That’s apparently not what’s happening here. Although the ICE headlines are overshadowing the other punitive measures the federal government is taking toward Minnesota, I’m kind of surprised this aspect of the story isn’t getting more attention. Might it when other governors realize that this could happen to them, too, even if they didn’t happen to be on the ballot against Trump in the last election, like Minnesota Gov. [Tim] Walz was? 

Goldman: Yeah, I was talking to somebody in the Medicaid space from a different blue state who was saying this feels like a turning point, something that they are scared of happening in their state as well. And, yeah, I think there are a lot of things that we need to see how they’ll play out, but this is definitely raising eyebrows. 

Rovner: Yeah, and I will post in the show notes a link to a piece by Andy Schneider — who’s at Georgetown University and who wrote, when he worked on the Hill, wrote a lot of the Medicaid statute — explaining how this is all supposed to work and quite how different this is. But I would expect to be hearing more about this in the coming days and weeks, particularly if the administration doesn’t back off, because it’s a lot of money and, as we know, Medicaid is a huge, huge piece of every single state’s budget. 

Well, meanwhile, on the abortion front, last week was the annual March for Life, marking the anniversary of the now overturned Supreme Court decision Roe v. Wade, and it’s fair to say that the anti-abortion movement is not happy with the Trump administration’s actions so far on the issue. Let’s start with what the administration did do to prove its devotion to the anti-abortion cause, To mark the movement’s big day in D.C., the Department of Health and Human Services reinstated its first-Trump-term ban on the use of fetal tissue in biomedical research, which President [Joe] Biden had reversed, and it expanded pretty dramatically the so-called Mexico City Policy that bans U.S. funding for international groups that, quote, “perform” or “promote” abortion. Now things like DEI [diversity, equality, and inclusion] and gender-affirming care are included, too. Alice and Rachel, you guys cover this. What should we know about these two new policies? It doesn’t seem like much, because they had both been in effect before, but it’s pretty big. 

Ollstein: So the fetal tissue ban is also, research, is also an expansion of the first-term version, just like the Mexico City Policy. It goes further than before. And so the new version bans not only in-house government research but also government funding of research at outside institutions that use fetal tissue that was donated from abortions, and that has been used in all kinds of really important medical research, development of vaccines, etc. And so there is a lot of concern about that. They also imposed new restrictions on accepting new stem cell lines. There are lots of existing stem cell lines that they just keep propagating over and over from a long time ago, but they’re pausing accepting new ones while, they say, they’re exploring alternatives that they find more ethical. All of this has really rattled the research community. 

And as for the Mexico City Policy, the expansion there is far beyond the issue of abortion. It’s banning funding going to groups that promote what they consider DEI and what they consider gender ideology. And so this is groups that serve the trans community in other countries and have programs for specific marginalized groups. So again, a lot of concern in the public health world because in order to tackle big public health problems, you often need to direct resources to the communities most at risk, and often that is the trans community, that is racial minorities. And so there’s a fear of this really impeding the delivery of services in a way that will impact the broader population. 

Rovner: All right, so now to what the administration didn’t do that makes the anti-abortion movement so unhappy — anything further to restrict the abortion pill mifepristone. In fact, as expected, the Justice Department filed its brief in a closely watched lawsuit out of Louisiana this week, urging the court to pause the suit while the FDA [Food and Drug Administration] finishes its study of mifepristone, a study that abortion opponents say is the FDA purposely using to drag its feet on any action. So what the heck is going on here? Rachel, you start. 

Roubein: Yeah, basically the Department of Justice asked for a stay in this lawsuit in Louisiana, and basically their justification was that: The Food and Drug Administration is reviewing mifepristone. We need time to do that. So that was basically what their ask was, was, like: Put this on pause. We will do this review that, as you said, anti-abortion advocates have been upset and said that it has been moving too slowly. 

Ollstein: So I really saw the legal brief was kind of a Rorschach test that people could see different things and signs in it, because you had the pro-abortion-rights community looking at them saying: Look, they’re saying that the FDA didn’t properly review this in the past, and that’s why they’re doing this rigorous review now. That’s a sign that they’re going to impose restrictions. Also, the anti-abortion side looked at it and they were upset, one, that the Justice Department is arguing that the FDA allowing telemedicine doesn’t harm the states, and the states believe that it does, and so they’re saying: You can’t prove harm. You don’t have standing to bring this case. I think really the common theme in this filing and in some other ones last year related to these state abortion lawsuits is that the Trump administration is defending federal power and federal decision-making, and that can cut both ways. And so they’re saying, Leave it to us. And the anti-abortion groups are saying: We don’t trust you. We don’t want to leave it to you. We want to let these state lawsuits move forward. 

Just to very quickly go back, the Trump administration did one other thing around the March for Life as a bone to the anti-abortion community, throwing them a bone, and that is they are attempting to claw back tens of millions of dollars in covid loans that went to Planned Parenthood affiliates. A lot of these loans were already forgiven by the Biden administration, but they are trying anyways to claim there was fraud going on and to get their money back. This boils down to sort of wonky arguments of whether the specific state Planned Parenthood chapters are considered enough part of national Planned Parenthood that they can’t claim to be a small business. This is going to be a legal fight. Planned Parenthood maintains they did absolutely nothing wrong. The state affiliates are separate from the national group, but— 

Rovner: Which they are, by the way. 

Ollstein: They are. They are. And courts have found that they are in the past. However, the anti-abortion movement was very excited about this. They see it as the first step towards declaring all Planned Parenthoods ineligible for any government funding, something they’re calling debarment, which they’ve been pushing for for a while. So that’s one other thing to keep an eye on. 

Rovner: And a reminder, many, many Planned Parenthoods don’t and never have offered abortion. Well we won’t get as far into the weeds as we could here, but if you press me, I will. All right, we’re going to take a quick break. We will be right back. 

So over at the Department of Health and Human Services, we have yet another mysterious case of stopping funding and then almost immediately restarting it. Earlier this month, the Substance Abuse and Mental Health Services Administration cut off nearly $2 billion worth of grants to drug abuse and mental health providers, only to reverse that decision a day later. Now, nearly the same thing has basically happened with about $5 billion worth of grants from the Centers for Disease Control and Prevention to all 50 state health departments for things like community outreach, emergency preparedness, and disease outbreaks. According to The Washington Post, which broke the story, notices to states were sent out Friday and barely 12 hours later, an HHS official told the Post the funding pause, quote, “had been lifted.” Still, it apparently took several more days for states to be able to access their funding portals. You can’t help but think that at least some of this is an actual effort to destabilize the nation’s public health infrastructure, right? They can’t be that sort of disorganized that they’re going to cut off funding and put it back. There has to be a reason here. Rachel, you’re smiling. 

Roubein: My colleague Lena Sun and I were hearing about this on Saturday, ahead of the big storm. State officials were trying to kind of figure out what’s going on. With the mental health grants, you saw a very kind of concerted push from the advocacy community, from Republicans and Democrats on the Hill, to push for, that was a termination of those grants, to be rescinded, and they were within about a day. This happened sort of over the weekend, and it happened very quickly. So, I can’t say what the result of sort of the change was, because the notices were dated Friday, but state officials didn’t really start getting them till on Saturday. And then we’d heard sort of midday Saturday that the temporary pause was lifted. But it definitely threw, sort of, state and local health departments that we were talking about into sort of a state of confusion trying to figure out sort of what they needed to do and by when. 

Rovner: Yeah, and we have seen this repeatedly from this administration. These are sort of two dramatic cases just this month, but the stopping and starting of grant funding is making it impossible to do any planning and figure out what you can do when. It’s just, it feels like just a matter of, Let’s make it as hard as possible for these people to do their jobs. 

Goldman: Yeah, and— 

Rovner: By “these,” yeah, I’d say by “these people” I mean the grant recipients, not the people who are overseeing the money. 

Goldman: I can’t claim to know exactly what’s going on behind the scenes, but I think, what do you expect to happen when you gut all of the administrative functions of these agencies, which is what HHS did earlier this year? And of course, some of those people have come back, but there’s a lot of instability in HHS’ rank-and-file workforce itself, and so that naturally will trickle down to their grantees. 

Rovner: Right, and particularly at the CDC. Well, adding to that, elsewhere at the CDC, some key databases, mostly concerning vaccines, are not being updated. That’s according to a study in this week’s Annals of Internal Medicine medical journal. The study found what the authors called “unexplained pauses” in nearly half of the 82 databases they studied that are normally updated monthly. Eighty-seven percent of those databases were on vaccination-related topics. Now, this could be political. It could also be due, as Maya was just saying, to the budget and personnel cuts at CDC that we’ve talked about so much over the past year. But it does seem that we’re continuing to fly ever more blind on things like disease surveillance, right? 

Goldman: Yeah, and then when you couple that with the state and local public health divisions are the ones who would be the backstop there, but if their funding is in question now, that is even more concerning for public health surveillance. 

Rovner: Yeah, and of course, we are in the middle of big measles outbreaks in South Carolina and Texas and trying to watch that closely, but it’s hard to do if you only have sort of state-by-state backups to look at. 

All right. Well, before we go, we need to talk about the Affordable Care Act. Remember the Affordable Care Act? Before it was subsumed by all the other headlines? Apparently, the Senate is still working on a bipartisan compromise that could restart lapsed subsidies that have spiked health insurance premiums for millions of Americans. And apparently things aren’t going all that well. And to add to it, here’s the headline on the press release for the latest KFF poll, hot off the presses just this morning — quote, “Health Care Costs Tops the Public’s Economic Worries as the Runup to the Midterms Begin; Independent Voters Are More Likely to Trust Democrats than Republicans on the Issue.” On the other hand, the poll did find that Republicans still trust Republicans more. And while the ACA remains pretty popular overall, it is less popular with Republicans than it was before last fall’s campaign by Republicans to blame all of the health care system’s ills on the 2010 health law. So where does that leave us? We’re with — this is the end of January. People who have been sort of reenrolled in the ACA are starting to get these huge premium notices that they may or may not be able to pay. Has Congress just kind of moved onto the next crisis? 

Ollstein: So some people in Congress are still trying to resolve this crisis, even as new crises pile up. The bipartisan talks are still going on, but there is just not a lot of optimism here. There is not really agreement on lots of aspects of extending the subsidies, and all of this is really discussing, at most, sort of a one-year extension. And so they would just have to have this whole fight all over again. But yes, I would say things are looking more bleak on that front than even a few weeks ago. I don’t know what my fellow panelists think. 

Rovner: And any anybody have optimism for getting these subsidies extended? I’m not seeing anybody raising their hand. Well, we will continue, obviously, to watch this space. 

All right. Lastly, health insurers are starting to get the same heartburn as the pharmaceutical industry. Last week, in back-to-back hearings at the House Energy and Commerce and Ways and Means committees, the heads of five of the biggest health insurers got pretty much filleted by members of both parties. Then this week, the Trump administration kind of shocked the markets by offering a much-smaller-than-expected increase for private Medicare Advantage plans. Those have been the darlings of Republicans for a couple of decades now. Maybe Republicans do really mean it when they say they want to stop giving so much taxpayer money to health insurers? 

Goldman: I was a little bit struck by how surprised everybody was at this, because I think [CMS Administrator] Dr. Mehmet Oz has been hinting that he’s much more amenable to cracking down on reported improper behavior among Medicare Advantage plans than people anticipated the next Trump administration would be. And there’s really this groundswell in the House of Representatives as well among Republicans to sort of rein in improper spending in Medicare Advantage. 

Rovner: Sen. Bill Cassidy has been pretty— 

Goldman: Yes. 

Rovner: —outspoken on it, which surprised a lot of people. Now his, the committee that he’s the chairman of doesn’t have jurisdiction over this, but he is also a member of the Finance Committee, which does have jurisdiction over this. 

Goldman: Exactly. Exactly. And so to me it wasn’t that surprising, I have to say. But it sent shock waves through the markets? Obviously, insurers are saying that if this is finalized as proposed, they’re going to have to cut benefits for seniors even more, they’re going to have to raise premiums and things like that. And of course this could be a bad political move, potentially, for Republicans. But I think— 

Rovner: Because there are lots of Republican voters who are in Medicare Advantage plans— 

Goldman: Absolutely. 

Rovner: —and don’t want to see their benefits cut. 

Goldman: Absolutely, and Medicare Advantage insurers have been saying this over and over again. The Biden administration was also pretty conservative on Medicare Advantage. I guess maybe “conservative” is a funny word choice, but— 

Rovner: Light-handed. 

Goldman: Yes. 

Rovner: Were light-handed. 

Goldman: Yes, I think, and insurers were largely able to weather that. Of course, there are some changes that they’re making this year. We’re seeing some market realignment. So it, another year of that, who knows what would happen. But I think it still remains to be seen how impactful this will actually be for beneficiaries. 

Rovner: Yeah, well, another constituency to get riled up in the run-up to the midterms. All right, that is this week’s news. Now it’s time for our extra-credit segment. That’s where we each recognize the story we read this week we think that you should read, too. Don’t worry if you miss it. We’ll post the links in our show notes on your phone or other mobile device. Alice, why don’t you start us off this week? 

Ollstein: Yeah. So I have this fascinating investigation from The New York Times. The headline is “After Donations, Trump Administration Revoked Rule Requiring More Nursing Home Staff.” So this is a story about these nursing home industry groups making massive donations to Trump’s super PAC and, after that, gaining a lot of access to him and using that access to lobby for the scrapping of a rule that required minimum staffing in nursing homes. And that rule was already not really being enforced, but now they are getting rid of it formally. And so I think the story does a good job of saying, Look, we can’t prove exactly that they got rid of this rule because of the donations, but it is part of a pattern where people who have given a lot of money to the president’s various groups have gotten just an incredible amount of access to him and other top officials. And the story also stresses why we should care about all of this. There’s just been a lot of horrific data coming out of nursing homes of problems caused by understaffing, patients experiencing preventable injuries, infections and other health problems that go unnoticed until it’s too late or it gets way more serious, and even facilities using, basically drugging patients to keep them easy to control and complacent, because there just isn’t enough staff to attend to them. People who have dementia and other things need a lot of care and can get upset and disoriented. And instead of taking care of them, they’re putting them on heavy psychotropic drugs. And so it’s a really sad and serious situation, and this article shows some potential pay to play. 

Rovner: Yeah, I tend to be, in general, skeptical of administrations doing things that we thought they were going to do anyway and someone else happened to give them money. But this draws a pretty clear line. They did do what they were going to do anyway, which was going to sort of not really enforce these regulations. Anyway it’s really good story. Should read it. Maya. 

Goldman: My extra credit this week is “Many Obamacare Enrollees Have Switched to Cheaper Bronze Plans. Here’s Why That Could Be Risky,”on NBC News by Berkeley Lovelace Jr. And it’s one of those stories that, wow, I wish I had written this. It’s a really great explanation of one of the sort of lesser-talked-about side effects of losing enhanced ACA subsidies, which is that people are going into plans that are — they’re still opting to be in insurance, but they’re taking plans that are lower premiums but much higher deductibles, which means that their coverage is less valuable. And they might still have to pay a lot of money out-of-pocket for most services, and then they might not seek those services, which sort of negates the purpose of having health insurance and its effect on public health. And this story shows that Kentucky, Idaho, Massachusetts, New York, Virginia, Rhode Island, California are all seeing decreases in “silver” plan enrollment, which is sort of that lower-deductible, higher-premium tier, and increases in “bronze” enrollment, which is super-high-deductible. So huge thing to watch. 

Rovner: Really, really good explanation. Rachel. 

Roubein: My extra credit is by Stat News. The headline is “HHS Appoints 21 New Members to a Federal Autism Advisory Committee,” by O. Rose Broderick. And the story lays out how the Department of Health and Human Services yesterday, on Wednesday, announced the appointment of new members to a federal committee that will advise Secretary [Robert F.] Kennedy [Jr.] on autism. Broderick reports that many of the new members of the committee, which is called the Interagency Autism Coordinating Committee, have publicly expressed or belonged to groups that have publicly expressed a belief in the debunked claim that vaccines can cause autism. Stat had also reported earlier this week that the members of the committee had met in secret and that some members of the kind of broader autism community were worried about the panel. And just kind of for sort of the big-picture point of view, Kennedy, last year, pledged to find the causes of autism. And during his tenure as HHS secretary, he’s challenged years of public health messaging on vaccines, such as instructing the CDC to contradict the long-settled scientific conclusion that vaccines do not cause autism. Kennedy, in a press release yesterday, called the researchers “the most qualified experts — leaders with decades of experience studying, researching, and treating autism.” 

Rovner: Yet another piece of this. There’s a lot of advisory committees at HHS, and there are many of them worth keeping a close eye on. All right, my extra credit this week is from Science magazine, by Monica Hersher and Jeffrey Mervis. It’s called “U.S. Government Has Lost More Than 10,000 Stem Ph.D.s Since Trump Took Office,” and it puts some actual numbers to the science brain drain that we’ve been talking about. The authors looked at 14 agencies across the federal government, including the NIH [National Institutes of Health], FDA, and CDC at HHS. They noted that those 10,000-plus experts represented only 3% of the more than 300,000 federal workers who’ve left employment since Trump took office, but they represent 14% of the total number of Ph.D.s in science, technology, engineering, math, and health fields. Most quit or retired after taking buyouts rather than being fired, according to the data. But as the authors noted, quote, “these departing Ph.D.s took with them a wealth of subject matter expertise and knowledge about how these agencies operate.” Certainly a win for the Trump administration, which wants to remake the federal government’s approach to science. For the rest of us, we will have to wait and see. 

OK, that’s this week’s show. Before we go, a reminder that our annual KFF Health Policy Valentine contest is open. We want to see your clever, heartfelt, or hilarious tributes to the policies that shape health care. Submit your poem, whether conventional, free-form, or haiku, by noon Eastern on Wednesday, Feb. 4. The winning poem will receive a custom comic illustration in the Morning Briefing on Feb. 13. I will post a link to the formal announcement in our show notes. 

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

Goldman: You can find me on LinkedIn under my name or on X, @mayagoldman_. 

Rovner: Alice. 

Ollstein: Still on X, @AliceOllstein, and on Bluesky, @alicemiranda. 

Rovner: Rachel. 

Roubein: LinkedIn under my name. Bluesky, @rachelroubein. X, @rachel_roubein. 

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

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Congress appears ready to approve a spending bill for the Department of Health and Human Services for the first time in years — minus the dramatic cuts proposed by the Trump administration. Lawmakers are also nearing passage of a health measure, including new rules for prescription drug middlemen known as pharmacy benefit managers, that has been delayed for more than a year after complaints from Elon Musk, who at the time was preparing to join the incoming Trump administration.

However, Congress seems less enthusiastic about the health policy outline released by President Donald Trump last week, which includes a handful of proposals that lawmakers have rejected in the past.

This week’s panelists are Julie Rovner of KFF Health News, Sandhya Raman of CQ Roll Call, Sheryl Gay Stolberg of The New York Times, and Paige Winfield Cunningham of The Washington Post.

Panelists

Among the takeaways from this week’s episode:

• Congress is on track to pass a new appropriations bill for HHS, with the current, short-term funding set to expire next week. The bill includes a slight bump for some agencies and, notably, does not include deep cuts requested by Trump. But with the administration’s demonstrated willingness to ignore congressionally mandated spending, the question stands: Will Trump follow Congress’ instructions about how to spend the money?
• A health package with bipartisan support is set to hitch a ride with the spending bill, after falling by the wayside in late 2024 under pressure from then-Trump adviser Musk. However, the president’s newly released list of health priorities largely isn’t reflected in the package. The GOP faces headwinds in the midterms after allowing expanded Affordable Care Act premium tax credits to expire, a change that’s expected to cost many Americans their health insurance.
• One year into the second Trump administration, its policies are particularly evident in the political takeover of the nation’s public health infrastructure, the growing number of uninsured Americans, and creeping brain drain in U.S.-based scientific research.
• And Health and Human Services Secretary Robert F. Kennedy Jr. has fired members of a panel overseeing the federal government’s vaccine injury compensation program. Kennedy is expected to remake the panel in an effort to expand the list of injuries for which the government will compensate Americans. The current list does not include autism.

Also this week, Rovner interviews oncologist and bioethicist Ezekiel Emanuel to discuss his new book, Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life.

And KFF Health News’ annual Health Policy Valentines contest is now open. You can enter the contest here.

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

Julie Rovner: CIDRAP’s “Minnesota Residents Delay Medical Care for Fear of Encountering ICE,” by Liz Szabo.

Sheryl Gay Stolberg: Rolling Stone’s “HHS Gave a $1.6 Million Grant to a Controversial Vaccine Study. These Emails Show How That Happened,” by Katherine Eban.

Paige Winfield Cunningham: Politico’s “RFK Jr. Is Bringing the GOP and the Trial Bar Together,” by Amanda Chu.

Sandhya Raman: Popular Information’s “ICE Has Stopped Paying for Detainee Medical Treatment,” by Judd Legum.

[Editor’s note: This transcript was generated using transcription software. 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, Jan. 22, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Good morning, everyone. 

Rovner: Sheryl Gay Stolberg of The New York Times. 

Sheryl Gay Stolberg: Hello, Julie. Glad to be here. 

Rovner: And Paige Winfield Cunningham of The Washington Post. 

Paige Winfield Cunningham: Hey, Julie. 

Rovner: Later in this episode, we’ll have my interview with Dr. Ezekiel Emanuel, whose new book, Eat Your Ice Cream, is both a takedown of the wellness industrial complex and a kinder, gentler way to live a more pleasant and meaningful life. But first, this week’s news. 

So, and I don’t want to jinx this, it looks like Congress might pass a spending bill for the Department of Health and Human Services that will become law — meaning not a continuing resolution — for the first time in years. And attached to that spending bill, scheduled for a vote in the House today, is a compromise health extenders deal that was dropped from the final spending bill in 2024 and which we’ll talk about in a minute. But first, the HHS appropriations bill. Sandhya, what are some of the highlights? 

Raman: So I think overall we just see a little bit of a slight increase for HHS compared to last year. Some agencies get a little bit of a bump: NIH [the National Institutes of Health], SAMHSA [the Substance Abuse and Mental Health Services Administration], HRSA [the Health Resources and Services Administration], Administration for Community Living. CDC [the Centers for Disease Control and Prevention] is kind of the same as last year. But then we do see some cuts in some places. Something that was getting watched a little bit was refugee and entrant assistance, given some of the different national news related to refugees and immigrants, and so that’s getting cut by about a billion. And some of the back-and-forth there is, some conservatives wanted more than that, some Democrats didn’t want that to be cut. I think the big thing in health care that we were waiting on on this was whether or not they would prohibit NIH forward funding, which is something the administration has been pushing for, just giving out a lump sum for grants through NIH rather than over a multiyear period. And the concern the Democrats had on that was that if you’re doing the lump sum all at first, fewer groups would get money for research. And so there is a prohibition on that, on doing the forward funding. 

Rovner: But just to be clear, the president, the administration, had asked for deep, deep cuts to the Department of Health and Human Services, and Congress is basically saying: Yep. Nope. 

Raman: Yeah. I think even if you look at what the House had proposed last year, they had cut a lot of programs, or proposed to cut a lot of, and that was not there. I think a lot of times, what we’ve seen is that even in Trump 1, there’d be a lot more proposed cuts in their proposal, when the White House puts out their blueprint, and then Congress comes to more of a medium point, kind of similar to previous years. So I think that was something that a lot of the health groups had celebrated, that they weren’t going to get the steep cuts that they thought could be part of the process. 

Rovner: Of course, the big question here is: Does the administration actually spend this money? We saw in 2025 them refusing to spend money, cutting grants, cutting off entire universities. And this is money that Congress had appropriated and that the administration is supposed to spend. Are they going to do it this time, is Congress? Have they put anything in this bill to ensure that the administration is going to do it this time? 

Raman: There’s a little bit here and there on some of that. I don’t think there’s quite the sweeping things that some Democrats would have wanted to prevent some of that. Just last week, we had the back-and-forth with SAMHSA grants getting pulled and then unpulled. And so there’s a little language related to that in there, just because that was such a big 24-hour issue. And then education funding is coupled with HHS, and there there is specific language saying you can’t transfer the money that would be for education into another department to dismantle it. So— 

Rovner: And, I would say, and basically, you can’t cut the Department of Education unless Congress says you can. 

Raman: Yeah. So there’s some things in there that are like that, but to get appropriations done, it has to be a bipartisan thing to get that to the finish line. So no one is going to get everything they wanted, not even President [Donald] Trump. 

Rovner: Yes, and I will point out that they are not there yet. The House has to pass this. The Senate has to pass this when they come back next week. We’ve got, apparently, a gigantic snowstorm coming towards Washington, D.C. So it’s moving in the right direction, but it’s not there yet. All right. Now onto the health package that’s catching a ride on this spending bill. What’s in it? And how close is it to the package that got stripped from the 2024 bill after Elon Musk tweeted that the bill was too many pages long? 

Raman: I think it’s fairly similar. We have a lot of the same PBM [pharmacy benefit manager] language that we had when that got dismantled, and a lot of these same kind of extenders that we see from time to time whenever we get an appropriations deal, extending things that are pretty bipartisan but just never have a place to ride elsewhere — National Health Service Corps, Special Diabetes Program, things like that. I think that since this time we haven’t had that pushback, we don’t have Elon Musk weighing in and kind of pulling the strings in the way that we did before, these have been very bipartisan provisions that both chambers have been saying that they want to get this done, they want to get this done as soon as possible, even in the beginning of last year. So I don’t sense that something’s really going to derail language targeting PBMs and stuff like that. 

Rovner: I would say the big piece of this is the deal that Congress came up with in 2024 to require more transparency on the part of these pharmacy benefit managers that everybody on both sides is accusing of pocketing some of the savings that they’re getting from drug companies and therefore making drug prices more expensive for employers and consumers. 

Raman: So I think that this has been such a priority that this is their shot to get it done. And it seems like as long as nothing derails appropriations in the next day and a half, then this is their chance to do that. 

Rovner: So what’s not in either of these packages are most of the pieces of the legislation that President Trump called for last week in his self-titled Great Healthcare Plan, with the PBM provisions being a major exception. What else is in Trump’s plan? And what are the prospects for passing it in pretty much any form this year? 

Winfield Cunningham: I would say not great. Yeah. A couple of things that struck me about this plan, which I would note was one page long: This is very Trumpy. Trump obviously loves, he’s a lot more into hauling pharmaceutical CEOs into the White House to make deals than he is crafting detailed policy. Because if you’re actually trying to do health care reform, this is not the way that you would do it. What you would do is actually spend a lot of time on the Hill seeing what Republicans can sign onto, and working with staff to craft detailed policies and etc., etc. But, yeah, so most of this stuff — yet I guess another big thing that struck me was a lot of this actually goes after insurers. There are some things in here that drugmakers don’t like, but Trump goes so far as to propose bypassing insurers entirely and sending money to people. And of course he doesn’t detail how that would work. And then there’s a lot of stuff in here about transparency by insurers. I would note the Affordable Care Act had some insurer transparency provisions already. 

So I think what this plan, if we want to call it a plan, reflects is just Trump’s desire to have something that he can call a “great” health care plan that he’s promised for a long time and which he’s going to talk a lot about. But yeah, I don’t think we’re going to see Republicans in Congress do much on this. Yeah, with the exception of the PBMs, which is pretty notable, and I think actually represents a really big win for the pharmaceutical industry, which has obviously felt under fire in this administration and has struck these deals with the White House, which they really don’t like. But they had been threatened that the administration would go further in trying to do this “most favored nation” price caps. And so it’s interesting because insurers are kind of Trump’s new target. That’s what I kind of read in this. And of course I would mention today that major insurers are testifying on the Hill because they’re under fire for raising insurance premiums. 

Rovner: Although, as we’ve noted many times, they’re raising insurance premiums because the cost of health care is going up. Yes, Sheryl. 

Stolberg: Julie, I think the political context of the Great Healthcare Plan, the so-called Great Healthcare Plan, is important. First of all, Republicans have had trouble for decades coming up with some kind of health plan, even before the Affordable Care Act was passed and signed into law in 2010. They weren’t able to do it then. President Trump famously said “nobody knew” that health care was “so complicated.” He’s in a situation now where Republicans have stripped many Americans of their health insurance by letting the extended Obamacare credits expire, and we’re going into a midterm election season in which his party and he have promised repeatedly that they were going to come up with a plan. He said he had a concept of a plan. I think this plan, so to speak, is not even a concept of a plan, and its primary provision actually lifts from what Sen. [Bill] Cassidy was promoting, which was to steer money away from insurance companies and toward consumers. Trump kind of latched onto that. He doesn’t say that explicitly in this 325-word proposal, but it seems clear to me that that is his idea, and that is just not a workable idea. 

He wants, they want, to move money into health savings accounts. I cracked up my elbow earlier this year. I had surgery to repair it. I saw the bill. The bill was $122,000. I am very blessed to have good health insurance through my company. There is no way that the government is going to steer that kind of money into a health savings account for an uninsured person. These are accounts that are meant to be sort of supplemental to spend on relatively small expenditures. And if you are an uninsured person, there is really no way that you can cover yourself. And that’s basically what this so-called “great” American health care plan is proposing, which I suspect, if most Americans really looked at it, they would say, is not so great. 

Rovner: Yeah. I also, I broke my wrist this summer. I also had surgery, although I had outpatient surgery, and it cost $30,000. So it’s, yeah, health care is really expensive, which, as I said, is why insurance premiums are going up. So, this week marks a year since the start of Trump 2.0, and it would take us the rest of the year to detail all that has changed in health policy. But I did want to hit a few themes, some of which you’ve started to talk about, Sheryl. One is the administration’s effort to basically end the federal public health structure as we know it. The Centers for Disease Control and Prevention in Atlanta has basically been taken over by political appointees, most of them without health experience or expertise. Sheryl, you’re our public health expert here. What does it mean for public health to be basically ceded back to the states? 

Stolberg: Well, I think this is kind of a novel experiment here. The core of the CDC is its infectious disease programs. Now, over the decades, since the 1970s, the CDC has greatly expanded its remit to cover things like chronic disease and gun violence prevention and auto safety, etc. But its core is infectious disease. And we know that infectious disease knows no borders. So what we risk having here is a patchwork of state-by-state vaccine recommendations, where some states will follow the CDC’s recommendations, presumably those that are red states. This was never political before. And we’re seeing some states, like blue states like New York and Massachusetts and other New England states, kind of coming together to put forth their own vaccine recommendations. I think this has implications for what vaccines will be covered and what vaccines will be offered by the Vaccines for Children Program, which was created by [President] Bill Clinton to cover poor kids and make sure they get vaccinated. I don’t think we know how that’s going to play out. 

I saw [Health and Human Services] Secretary [Robert F.] Kennedy [Jr.] yesterday in Harrisburg, Pennsylvania, and he insisted that he’s not taking any vaccines away from anyone. If you want your vaccines, you can get them. But the truth is that for decades, the American public and the medical establishment have relied on the CDC to provide guidance. The CDC doesn’t mandate anything, but it provides really important guidance to the country, and the agency is crippled now. Its guidance is not going to be followed. And I think we’re in uncharted territory here. We’re already seeing measles is on the rise. The country’s about to lose its measles elimination status, which we acquired in 2000. Whooping cough is on the rise. 

Rovner: Basically things we know we can prevent with vaccines. 

Stolberg: Exactly, exactly. 

Winfield Cunningham: One of the things I keep thinking about is, Kennedy says over and over again that if you’re a mom, you should do your own research. And it seems like a lot of the effects here is stepping away from this broad recommendation to now this patchwork of recommendations. So when you go to your pediatrician, you might hear guidance based on AAP’s [the American Academy of Pediatrics’] guidance, for example. States are doing different things. And as a parent, when you go to your pediatrician, it all of a sudden, I think, becomes a lot more confusing, especially if you’re someone who maybe already has a little bit of hesitancy about vaccines. 

I was in with our pediatrician last week and asked her what they’re seeing, and people are coming in with a lot more questions. And interestingly, they actually are changing their policy for mandatory vaccines. They actually had required every patient to be up to date by age 2 with the CDC-recommended vaccines. Now those vaccines that are under shared clinical decision-making, they’re no longer going to require those. And it’s not, and they’re going to continue to recommend them, but I think they’re concerned that patients are going to come in and they’re saying: Hey, the CDC doesn’t necessarily recommend these now. I’m worried about them. So it’s put pediatricians in a difficult place. But, yeah, it’s, as a parent, you’re having to make a million decisions about your children, and this just kind of makes that more complicated and confusing, potentially, for parents. 

Rovner: And takes time away from doctors who would like to counsel about other things, too. 

Stolberg: I just want to add one thing about that. Kennedy says do your own research. And if you read the package inserts on a vaccine, you’re going to see that vaccines have side effects, just like any drug. But that information needs context around it, and the parents who are weighing those side effects need also to be told about the risk of the diseases that those vaccines are intended to prevent. And my kids are grown. I’m wondering how pediatricians are having that conversation, or if they’re having that conversation, in talking to parents about: These are the risks of the vaccine. But should your child get measles, these are the risks. Before vaccination was widespread for measles, 450 kids died on average every year. Many more were hospitalized. So I think those conversations need to be had. 

Winfield Cunningham: And I think it’s hard for pediatricians sometimes to illustrate that, because we’re so far removed from people having examples or knowing anyone who had these. 

Rovner: Not anymore. 

Winfield Cunningham: Not anymore. But largely, right? I have a lot of parent friends, and I don’t know a child who’s had measles. Our pediatrician was telling me that when she was in medical school, it was still common for pediatric hospitals to be filled with babies with rotavirus. She said you could smell it down the hallway. And now, actually, the people in medical school, they’re not experiencing that, because of widespread vaccination. 

Rovner: All right. Well, the second big thing I want to hit on is, as Sheryl already mentioned, people losing their health insurance. Last summer’s big budget bill would cut nearly a trillion dollars from the Medicaid program and make it more difficult for people to maintain their coverage through the Affordable Care Act. Republicans refusing to extend the expanded Affordable Care Act subsidies from the Biden era is already prompting people to drop coverage that they can no longer afford. What does it mean to the health care system as a whole that the number of Americans without health insurance is going to begin to rise again? 

Raman: I think it’s a multipronged thing. There are some aspects of these things that might not be felt immediately, that might be later this year or early next year as different provisions of the [One] Big Beautiful Bill kind of come into play — work requirements, things like that that might affect how many people have insurance. But also, I think it kind of goes back to some of the things that Sheryl and Paige were saying about, just, if fewer people are vaccinated, it increases the risks for everyone. And if fewer people have health insurance, regardless of what they have, it also makes it more difficult. If people are not getting treated for things, they get exacerbated into more serious conditions. So I think there are a lot of issues at play. Some of them have just, we’re kind of waiting to see how the effects are.  

You know, people that may have skipped out on ACA insurance this year, maybe they haven’t needed to go to the doctor yet. We’re in the first month. People might not go every month. But that doesn’t mean they’re not going to be hit with something big, even tomorrow, next month, month after that. And so I think all of these things kind of compound together to make it a lot more difficult of a situation, and just a lot of the complexities, I think it’s kind of in both of them where you’re not sure. Oh, is this renewed? Is this not renewed? It’s, I think, a lot more difficult for the average person to follow this national conversation as much as people that are really plugged in, so that by the time that it trickles down to them, it’s like: Can I sign up for health insurance still? Are the costs high? Am I still eligible? It gets more and more confusing. And then people who might be eligible might kind of be scared away with some of that chilling effect. 

Stolberg: I should say, I think emergency rooms will also bear the brunt of the reduction in insurance, because without, people who don’t have health insurance will forgo going to the doctor until their [conditions are] unable to be ignored. And then they will wind up in the emergency room. 

Rovner: And then those, I was going to say, and then those emergency rooms will end up passing the bills that they can’t pay— 

Stolberg: Exactly. 

Rovner: —onto others who can, or in— 

Stolberg: Exactly. It will drive up costs— 

Rovner: Paige, started— 

Stolberg: —in the end. 

Winfield Cunningham: I think a lot of this is going to become clearer over the next couple of months. We still don’t really know the effects of those extra subsidies expiring. I was actually surprised to see that the ACA marketplace enrollment figures they released, I believe last week, were not actually that much lower than last year. But people aren’t kicked off their plan until they haven’t paid their premium for three months. So I think we need to wait until April or so to see how many people were, say, auto-enrolled in a plan which they can no longer afford, and now they’re kicked off. And maybe it’s fewer people than we think. Maybe it’s more people than we think. But I think we just don’t know that yet, and we’re going to have to wait for a couple months to see. 

Rovner: Yeah, I think you’re exactly right. I had the same reaction to seeing those numbers. Like, Wow, those are pretty high. And then it’s like, yeah, but those aren’t necessarily people who’ve had to pay their bills yet. Those are just the people who I think may have signed up hoping that Congress was going to do something. So, yeah, we will have to see how many people, I think it’s called “effectuated enrollment,” and we won’t get those numbers for a little while. 

Well, finally, dismantling the federal research enterprise. As I said, we’ve talked about this a lot, but I didn’t want to let it sort of go unstated. This administration appears to like to keep people guessing by cutting and then restoring research grants, refusing to spend congressionally appropriated funding until they’re ordered to do it by the court, and firing or laying off workers only to call them back weeks or months later. All that makes it difficult or impossible for researchers and universities to plan their projects and personnel needs. Combined with new limits on federal student loans for a lot of graduate students, are we at risk of losing the next generation of researchers? We’re already talking about seeing people moving to Europe to continue their research. 

Stolberg: Yes. I think the answer to that is an unequivocal yes. I am hearing from scientists who are having trouble filling their postdoctoral slots. Or young scientists. It’s really the next generation, right? People who are here already and who have families are trying as best they can to sort of stick it out, or maybe they’ll go into industry if they have to leave academia because they’ve lost their grant funding, or if they’ve left NIH. But it really is the next generation of researchers. I hate to draw this comparison, but we did see during World War II, the United States absorbed a lot of European researchers. This is how we got Albert Einstein, right? So I don’t know that we’ll see necessarily a reversal of that, of scientists fleeing, but we might see more young people choosing not to go into academic biomedicine. 

Rovner: And we’re already seeing, it’s not just Europe. It’s China and India— 

Stolberg: Yeah. Right. 

Rovner: —offering packages. 

Stolberg: And they’re recruiting. Those countries are recruiting. Yeah, they’re recruiting young scientists, especially China.  

Rovner: Yeah. 

Stolberg: And that’s a good point. David Kessler, the former FDA [Food and Drug Administration] commissioner, has argued that this is really a national security threat for the country. China is a main adversary of the United States, certainly of President Trump. And if we’re at risk of losing highly qualified biomedical researchers to China, then we are giving them an advantage. 

Rovner: Yeah, something else we will keep an eye on, I think, for the rest of the year. OK, we’re going to take a quick break. We will be right back. 

Meanwhile, back to this week’s news. The American Academy of Pediatrics is leading a coalition of public health groups that are suing to reverse the changes to the childhood vaccine schedule made by the CDC earlier this month. The suit claims that the administration violated portions of the law that oversees federal advisory committees that require membership on those panels to be, quote, “fairly balanced,” and not, quote, “inappropriately influenced.” Among other things, the lawsuit asked the court to ban the CDC’s Advisory Committee on Immunization Practices from further meetings. That would basically stop any further changes to the vaccine schedule, I assume? 

Raman: At the end of the day, what ACIP does is just a recommendation to CDC, and they can choose whether or not to go with that recommendation. So I’m not really sure what would happen next, but it is kind of a whack-a-mole situation where just because you stop this does not mean that changes above that aren’t going to happen. 

Stolberg: Yeah. The Advisory Committee on Immunization Practices is just that. It’s an advisory committee. So this lawsuit takes issue with appointments to that committee and also complains that the committee was not consulted before the decision was made public to change the vaccine recommendations. I’m not exactly sure what the legal authority is for that. There’s apparently a federal law requiring federal advisory committees to be, quote, “fairly balanced” and not “inappropriately influenced.” But this isn’t — it’s an executive action — right? — to appoint committee members. It comes out of the executive branch. So I don’t know of any situation in the past where the judiciary has weighed in and said, You can appoint these people or not these people, or You have to redo a committee. So it’s hard to predict what the courts will say about this. 

Rovner: Meanwhile, it’s not just the ACIP that HHS Secretary RFK Jr. is taking aim at. Following his remaking of that advisory committee, he’s now fired some of the members of a separate panel, the Advisory Commission on Childhood Vaccines, which oversees the federal Vaccine Injury Compensation Program, which Kennedy has said he also wants to revamp. That’s the program that compensates patients who can demonstrate injury from side effects of vaccines. How big a deal could this be if he’s going to go after the vaccine compensation program?  

Stolberg: Julie, this is a big deal, and I’ll tell you why. That committee sets what is known as the table of vaccines. Which injuries does the federal government compensate for? And the federal government does not compensate for autism as a vaccine injury. And I have no evidence of this, but if I were betting, that is where Kennedy wants to go. He does not like the 1986 law that created the National Vaccine Injury Compensation Program because it offered liability protection to pharmaceutical companies. He wants to strip away the liability protection, but as I understand it, he does not want to do away with the law. He does not want to do away with the compensation program. So he may be trying to lay the foundation for the compensation program to be more expansive and cover injuries or allow claims for injuries that are not currently considered vaccine injuries, like autism. 

Rovner: Which of course would collapse the program because it’s paid for by an excise tax on vaccines. That was the original deal back in 1986. The vaccine manufacturers said: We’ll pay you this tax, from which you, the federal government, will determine who gets compensated. And in exchange, you’ll relieve us of this liability, because we’re getting sued to death. And if you don’t do this, we’re going to stop making vaccines entirely. That was the origin of this back in 1986. And I was there. I covered it. 

Stolberg: Yeah, exactly. I have read a lot of this history, and the CDC was really over a barrel. The companies were writing to CDC, saying, We’re going to pull the plug on our vaccines. And the CDC was worried that American kids were going to go without lifesaving vaccines because companies were going to quit making them. So they pushed this bill. [President Ronald] Reagan didn’t like it. He signed it into law anyway. And it’s created this program, which is actually imperfect. A lot of people who actually legitimately have vaccine-injured children have trouble getting compensated through this program., and I think many people on all sides of this issue would say that it does need to be overhauled. But it will be interesting to see who Kennedy picks for those committee slots. 

Rovner: Yeah, I think we’re going to learn a lot more about it. We’re going to learn a lot more about it this year. Well, finally, in vaccine land this week, Texas attorney general and U.S. Senate candidate Ken Paxton on Wednesday announced what his office is calling a, quote, “wide sweeping investigation into unlawful financial incentives related to childhood vaccine recommendations.” His statement says that there is a, quote, “multi-level, multi-industry scheme that has illegally incentivized medical providers to recommend childhood vaccines that are not proven to be safe or necessary.” Actually, one of the reasons that Congress created the Vaccines for Children Program back in the 1990s, Sheryl, as you mentioned earlier, is because most pediatricians lost money on giving vaccines. And today, many people can’t even get vaccines from their doctors, because it’s too expensive for the doctors to stock them. What does Paxton think he might find here? 

Stolberg: This is like stump the panelists. No one knows. 

Rovner: I see a lot of people’s— 

Raman: I’m not sure what he thinks he might find, but I do think that he is one of the attorneys general that is generally on the forefront of trying things, to throw spaghetti at the wall and see if it sticks on a variety of issues. So it might be the sort of thing where if he finds something, then it could be kind of a jumping point for other conservative attorneys general. And of course just that he’s primarying Sen. John Cornyn for Senate, so if it raises his profile for more folks. But I’m not sure if there’s a specific thing that he’s looking for. 

Rovner: So he’s trying to curry favor with the anti-vaxxers in Texas, of which we know there are a lot. 

Raman: That would be my best read. 

Stolberg: Austin is, actually, the state capital in Austin is a hot spot for anti-vaccine activism. Andrew Wakefield, who wrote the 1998 Lancet article that’s been retracted, is in Austin. Del Bigtree, who runs the Informed Consent Action Network, is in Austin. There’s a group that I have written about called Texans for Vaccine Choice that is one of the early parent-driven groups seeking to roll back vaccine mandates, is based in Austin. So there’s a lot of sentiment there that Ken Paxton might be trying to appeal to. 

Rovner: See? You’ve answered my question. Thank you. All right, that is this week’s news. Before we get to my interview with Dr. Zeke Emanuel, a couple of corrections from last week. First, I misspoke when I said House Republicans were becoming a minority in name only. Of course, I meant they were becoming a majority in name only. I also incorrectly said the lawsuit that helped get the Title X family planning money flowing back to clinics was filed by Planned Parenthood. It was actually filed by the ACLU [American Civil Liberties Union] on behalf of the National Family Planning and Reproductive Health Association. Apologies to all. OK, now we will play my interview with Dr. Zeke Emanuel about his new wellness book, and then we’ll come back and do our extra credits. 

I am so pleased to welcome back to the podcast Dr. Ezekiel Emanuel. Zeke is an oncologist and bioethicist by training and currently serves as vice provost for global initiatives and professor of medical ethics and health policy at the University of Pennsylvania. He formerly worked at the National Institutes of Health before he helped write and implement the Affordable Care Act while his brother Rahm was serving as President [Barack] Obama’s White House chief of staff. Zeke’s latest book, Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life, is out now. Zeke, welcome back to What the Health? 

Ezekiel Emanuel: Oh, it’s my great honor and pleasure. 

Rovner: So I feel like the subtitle of this book could be How to Keep Yourself Healthy Without Making Yourself Crazy or Broke and that it’s a not so thinly veiled attack on what many of us refer to as the “wellness industrial complex.” What’s gone wrong with the wellness movement? Isn’t it good for us to pursue wellness? 

Emanuel: It is good for us to pursue wellness. I think that there are probably three things that are seriously wrong with the movement. The first one is that they make wellness an obsession that you have to focus all your energy on, which is totally wrong. Wellness should be a habit that sort of works in the background while you focus on the really important things of life. I think the second thing is they tend to overcomplicate things. Part of that is they’ve got to send out an email every day or every other day. They’ve got to do a video, a podcast, what have you. And so they make it complicated so that they have something to report on. And the third thing is they make it oversimple. They’re reductionist. They talk about diet and exercise and sleep, and leave out other very, very important parts of wellness, maybe the most important part of wellness, which is your social interactions. And almost all these experts ignore it. 

And the last thing I would say — I guess I have four points — the last thing I would say is they have huge conflicts of interest. The wellness industrial complex is between $1- and $2 trillion a year, depending on what you want to include in that bucket, which means that there’s lots of people chasing lots of money trying to sell you lots of crazy items. So there’s money to be had and Them thar hills and people make all sorts of exaggerations. I want to emphasize for your listeners, I’m selling nothing, absolutely nothing. 

Rovner: I will say, I went to your book party. I’ve been to a lot of book parties over the years. Yours is the first one where I actually was not expected to buy the book. You actually gave the book away. 

Emanuel: Yeah, I can’t stand that. Oh, I hate that. 

Rovner: I would say, I assume you were making a point with that. I also ate the ice cream, which was very good. 

Emanuel: Yes. 

Rovner: I feel like your underlying message here is that it’s not enough to make yourself biologically healthy — you have to do things that make you happy, too. Is that a fair interpretation? 

Emanuel: Yes, that’s a very fair interpretation. Look, if you’re going to do wellness right, you’re going to be doing it for years and decades of your life. You cannot will yourself to do something for decades. You can will yourself to do something for a few weeks and a few months, but then, unless it becomes a habit that you actually enjoy, you’re simply not going to continue to do it. And so if you want to eat well, you want to exercise, you want to have social interactions, you actually have to make them something that’s pleasurable for your life, something that you find meaningful, even. That’s, again, I think something that’s seriously missing from a lot of these wellness influencers, because they make a lot of wellness about self-denial, about: You should deprive yourself. You should fast. Maybe you should fast. That’s OK if you can do it and you can work it into your schedule. Actually today is one of my fast days, so I am working it into my schedule. But that’s not for everyone, and it’s not essential to wellness and living a long and happy life. 

Rovner: So what are your six simple rules, in two minutes or less? 

Emanuel: The first one is: Don’t be a schmuck. Don’t take unreasonable risks. Don’t climb Mount Everest. Don’t go BASE jumping. Don’t smoke. Don’t do a lot of other stupid things. The second is: Engage people. A rich social life is the most important thing for a long, healthy, and happy life, and having close friends who you get together with regularly, talk to every week, have dinners with, acquaintances, very, very important. And then casually talking to people who you happen to interact with, either when you get your coffee, you go to the grocery store, you go to the restaurant, you hop in an Uber or a cab. Those are very important social interactions that we tend to ignore and tend to downplay. The third rule is: Keep your mind mentally sharp. And there are important aspects of that. Don’t retire. Take on new cognitive challenges. 

The fourth is: Eat well, and make sure you get rid of the unhealthy eating part and eat important, non-processed items. The fifth is: Exercise. Do the three kinds of exercise: aerobic exercise, strength training, and balance and flexibility with yoga. And the last one is: Sleep well. It’s the one you cannot will yourself to begin doing. You can only sort of prep the bedroom and then hope it happens. 

Rovner: So this whole thing didn’t really need to be book length, but you spent a lot of time reviewing the literature on various aspects of health and wellness, like, you know, a scientist would. Are you trying to make a point here about the current state of science and how the public views it? 

Emanuel: I am. I am a data-driven guy. I like data. I think when you have more than 3 million people that have been surveyed and followed in terms of social interactions and their impact on your wellness and your physical health, that’s worth noting, and it’s worth noting what those studies come to. And they all come to the same basic thing, which is you can reduce your risk of death and mortality in the subsequent six, 10, 12 years, depending upon the study, by about 20% to 30% by greater social interaction, more robust friendships. That’s a pretty impressive number, if you ask me. So I’m trying to emphasize the data and get people to understand and be motivated by the data. And I think I’m pretty clear about moments when I, say, interpret the data differently than a lot of other people do, because I think that’s part of science. 

So, for example, the PSA [prostate-specific antigen] test. Most guidelines say you should get a PSA test. I’m against the PSA test because, yes, it will reduce your risk of dying from prostate cancer, but it does not reduce your overall mortality. I think I don’t much care what’s written on my death certificate. I care about the length and wellness of my life, and the PSA isn’t going to affect that. But others disagree, and then I’m very frank about those kind of disagreements. 

Rovner: So in 2014 you rather famously wrote an Atlantic article called “Why I Hope To Die at 75.” Has writing this book changed your mind about this? And I will say, I’m only a year younger than you, so I have a stake in this, too. 

Emanuel: No, writing this book didn’t change my mind. It did change some things that I do. I will say, what really changed my mind, to the extent that anything changed my mind, was covid and the idea of getting vaccines after 75, I think, is a good thing, especially if whatever’s going around is targeting older people. It seems easy to protect yourself, whether from the flu or something like covid, with a vaccine. So that, I have changed my mind. Researching this book made me put a little more emphasis on, for example, strength training, which I had not done a whole lot of, directly. I’d done it because I ride a bicycle and I strengthen my lower half, my quads and my hamstrings and my gluteal muscles, but I hadn’t really focused on the upper body. 

Rovner: You should do Pilates. It’s great. 

Emanuel: Noted. 

Rovner: Zeke Emanuel. It is always fun to chat with you. And congratulations on the book. 

Emanuel: Thank you, Julie. This has been wonderful and very rapid-fire, more rapid-fire than anyone, because you get right to the heart of things. 

Rovner: Well, we have a lot more that we’re going to talk about this week. Thank you, Zeke. 

Emanuel: Take care, Julie. Bye-bye. 

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 post the links in our show notes on your phone or other mobile device. Sandhya, why don’t you go first this week? 

Raman: My extra credit is called “ICE Has Stopped Paying for Detainee Medical Treatment,”and it’s by Judd Legum for Popular Information, his newsletter. And I thought this was really interesting, because, I think, for me, I look very much at HHS and major health agencies, but his piece kind of looks at how ICE [Immigration and Customs Enforcement] has not been paying third-party providers for medical care for detainees since October and that ICE, last week, the agency kind of quietly announced that it would not be processing any of the claims for medical care until April of 2026. And so doctors are instructed to kind of hold on that. And that’s kind of a downward spiral of providers denying services to detainees because they know they’re not going to get paid for a while. And so I thought this was a really interesting piece looking at that. 

Rovner: Yes, indeed. And kind of scary. Paige. 

Winfield Cunningham: Yeah, mine is a piece in Politico called “RFK Jr. Is Bringing the GOP and the Trial Bar Together,” and it’s by Amanda Chu. And this really caught my eye because it was a look at how RFK’s demonization of food and pharma is motivating trial lawyers representing consumers who are saying they’ve been harmed by these products — one example, of course, is the lawsuit against the maker of Tylenol — and how this really kind of goes against where Republicans have usually been, against trial lawyers representing consumers who say they’ve been harmed by big, bad companies. And so, yeah, it was a really interesting look at that and just at how RFK’s kind of populist, pro-consumer streak has fueled all of this. 

Rovner: The world indeed turned upside down. Sheryl. 

Stolberg: So my extra credit is from Rolling Stone. The headline is “HHS Gave a $1.6 Million Grant to a Controversial Vaccine Study. These Emails Show How That Happened,” and it’s by Katherine Eban. She’s a terrific journalist. And this is about the study in Guinea-Bissau. When CDC pulled back its recommendation for children to be vaccinated at birth against hepatitis B, HHS gave this grant to these Danish researchers to conduct this study in Guinea-Bissau, which would compare vaccinated infants to unvaccinated infants. And there was a huge howl of protest. This study would never be done in this country. The idea of withholding a vaccine from an infant that has been proven to be safe and effective is highly unethical. It evokes memories of the Tuskegee study, in which government doctors withheld treatment for syphilis. So there was this huge uproar, and it turns out that the researchers who got the grant are these Danish statisticians who have a really questionable research history. And the story documents, through emails, how they got basically this no-bid grant by coordinating with some of Kennedy’s allies from his movement, from his vaccine advocacy days. And it was kind of an inside deal, basically. So I just think that this study has generated a lot a lot of complaints. I should say that the researchers have amended the protocol, and now I think they’re going to give shots to one group at age 6 weeks. But still, it’s a very problematic study, and the story exposes how it came to be. 

Rovner: Yeah, it is quite the story. Well, I also have an immigration story. It’s from my former colleague Liz Szabo at the University of Minnesota’s Center for Infectious Disease Research and Policy, and it’s called “Minnesota Residents Delay Medical Care for Fear of Encountering ICE.” And it’s not just undocumented people avoiding medical care, as Liz details. U.S. citizens with serious health needs are also scared of getting caught up in the ICE dragnet that’s now all around the city. And ICE officials have even been entering hospitals and other health facilities — which in previous years they had not been allowed to do. In the dead of winter in Minneapolis, with a particularly severe flu year, this is threatening to become a health crisis as well as an immigration crisis. 

OK, that’s this week’s show. Before we go, it’s almost February. That means our annual KFF Health News Health Policy Valentine contest is open. Please send us your clever, heartfelt, or hilarious tributes to the policies that shape health care. I will post a link to the formal announcement in the show notes. As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your 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? Sandhya. 

Raman: On X and Bluesky, @SandhyaWrites. 

Rovner: Sheryl 

Stolberg: I’m on X and Bluesky, @SherylNYT. 

Rovner: Paige. 

Winfield Cunningham: I’m on X, @pw_cunningham, and Bluesky, @paigecunningham. 

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

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USE OUR CONTENT

This story can be republished for free (details).

Millions of Americans are facing dramatically higher health insurance premium payments due to the Jan. 1 expiration of enhanced Affordable Care Act subsidies. But much of Washington appears more interested at the moment in culture war issues, including abortion and gender-affirming care.

Meanwhile, at the Department of Health and Human Services, personnel continue to be fired and rehired, and grants terminated and reinstated, leaving everyone who touches the agency uncertain about what comes next.

This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• Congress remains undecided on a deal to renew enhanced ACA premium subsidies, as it is on spending plans to keep the federal government running when the existing, short-term plan expires at the end of the month. While some of the bigger appropriations hang-ups are related to immigration and foreign affairs, there are also hurdles to passing spending for HHS.
• ACA plan enrollment is down about 1.5 million compared with last year, with states reporting that many people are switching to cheaper plans or dropping coverage. Enrollment numbers are likely to drop further in the coming months as more-expensive premium payments come due and some realize they can no longer afford the plans they’re enrolled in.
• A key Senate health committee on Wednesday hosted a hearing on the abortion pill mifepristone, focused on the safety concerns posed by abortion foes — though those concerns are unsupported by scientific research and decades of experience with the drug. Many abortion opponents are frustrated that the Trump administration has not taken aggressive action to restrict access to the abortion pill.
• As the Trump administration moved this week to rehire laid-off employees and abruptly cancel, then restore, addiction-related grants, overall government spending is up, despite the administration’s stated goal of saving money by cutting the federal government’s size and activities. It turns out the churn within the administration is costing taxpayers more. And new data, revealing that more federal workers left on their own than were laid off last year, shows that a lot of institutional memory was also lost.

Also this week, Rovner interviews KFF Health News’ Elisabeth Rosenthal, who created the “Bill of the Month” series and wrote the latest installment, about a scorpion pepper, an ER visit, and a ghost bill. If you have a baffling, infuriating, or exorbitant bill you’d like to share with us, you can do that here.

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

Julie Rovner: The New York Times’ “E.P.A. to Stop Considering Lives Saved When Setting Rules on Air Pollution,” by Maxine Joselow.

Alice Miranda Ollstein: ProPublica’s “After Sowing Distrust in Fluoridated Water, Kennedy and Skeptics Turn to Obstructing Other Fluoride Sources,” by Anna Clark.

Joanne Kenen: The New Yorker’s “What ‘The Pitt’ Taught Me About Being a Doctor,” by Dhruv Khullar.

Anna Edney: MedPage Today’s “Worried About Liability After CDC Vaccine Changes? You Shouldn’t Be,” by Joedy McCreary.

Also mentioned in this week’s podcast:

• The Washington Post’s “A Majority in Name Only? House Republicans Are Barely Hanging On,” by Paul Kane.
• HealthAffairs’ “National Health Care Spending Increased 7.2 percent in 2024 as Utilization Remained Elevated,” by Mica Hartman, Anne B. Martin, David Lassman, and Aaron Catlin.
• Politico’s “Lawsuit Dismissed After Trump Admin Quietly Restored Tens of Millions to Planned Parenthood,” by Alice Miranda Ollstein.
• JAMA’s “The US Food and Drug Administration’s Regulation of Mifepristone,” by Sophie Dilek, Joanne Rosen, Anna Levashkevich, Joshua M. Sharfstein, and G. Caleb Alexander.

[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, Jan. 15, 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, everyone. 

Rovner: Alice [Miranda] Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

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

Joanne Kenen: Hi, everybody. 

Rovner: Later in this episode, we’ll have my interview with KFF Health News’ Elisabeth Rosenthal, who reported and wrote the latest “Bill of the Month,” about an ER trip, a scorpion pepper, and a ghost bill. But first, this week’s news. Let’s start this week on Capitol Hill, where both houses of Congress are here and legislating. This week alone, the Senate rejected a Democratic effort to accept the House-passed bill that would renew for three years the Affordable Care Act’s expanded subsidies — the ones that expired Jan. 1.  

The Senate also turned back an effort to cancel the Trump administration’s regulation covering the ACA, which, although it has gotten far less attention than the subsidies, would also result in a lot of people losing or dropping health insurance coverage.  

Meanwhile, in the House, Republicans are struggling just to keep the lights on. Between resignations, illnesses, and deaths, House Republicans are very nearly — in the words of longtime Congress watcher Paul Kane of The Washington Post — a [majority] in name only, which I guess is pronounced “MINO.” Their majority is now so thin that one or two votes can hand Democrats a win, as we saw earlier this week in a surprise defeat on an otherwise fairly routine labor bill. Which brings us to the prospects for renewing those Affordable Care Act subsidies. When the dust cleared from last week’s House vote, 17 Republicans joined all the House’s Democrats to pass the bill and send it to the Senate. But it seems that the bipartisan efforts in the Senate to get a deal are losing steam. What’s the latest you guys are hearing? 

Ollstein: Yeah, so it wasn’t a good sign when the person who has sort of come out as a leader of these bipartisan negotiations, Ohio Sen. Bernie Moreno, at first came out very strong and said, We’re in the end zone. We’re very close to a deal. We’re going to have bill text. And that was several days ago, and now they’re saying that maybe they’ll have something by the end of the month. But the initial enthusiasm very quickly fizzled as they really got into the negotiations, and, from what my colleagues have reported, there’s still disagreements on several fronts, you know, including this idea of having a minimum charge for all plans, no zero-premium plans anymore, which the right says is to crack down on fraud, and the left says would really deter low-income people from getting coverage. And there, of course, is, as always, a fight about abortion, as we spoke about on this podcast before. There is not agreement on how Obamacare currently treats abortion, and thus there can be no agreement on how it should treat abortion. 

And so the two sides have not come to any kind of compromise. And I don’t know what compromise would be possible, because all of the anti-abortion activist groups and their allies in Congress, of which there are many, say that the only thing they’ll accept is a blanket national ban on any plan that covers abortion receiving a subsidy, and that’s a nonstarter for most, if not all, Democrats. So I don’t know where we go from here. 

Rovner: Well, we will talk more about both abortion and the ACA in a minute, but first, lawmakers have just over two weeks to finish the remaining spending bills, or else risk yet another government shutdown. They seem to [be] making some headway on many of those spending bills, but not so much on the bill that funds most of the Department of Health and Human Services. Any chance they can come up with a bill that can get 60 votes in the Senate and a majority in the much more conservative House? That is a pretty narrow needle to thread. I don’t think abortion is going to be a huge issue in Labor, HHS, because that’s where the Hyde Amendment lives, and we usually see the Hyde Amendment renewed. But, you know, I see a lot of Democrats and, frankly, Republicans in the Senate wanting to put money back for a lot of the things that HHS has cut, and the House [is] probably not so excited about putting all of that money back. I’m just wondering if there really is a deal to be had, or if we’re going to see for the, you know, however many year[s] in a row, another continuing resolution, at least for the Department of Health and Human Services. 

Ollstein: Well, you’re hearing a lot more optimism from lawmakers about the spending bill than you are about a[n] Obamacare subsidy deal or any of the other things that they’re fighting about. And I would say, on the spending, I think the much bigger fights are going to be outside the health care space. I think they’re going to be about immigration, with everything we’re seeing about foreign policy, whether and how to put restraints on the Trump administration, on both of those fronts. On health, yes, I think you’ve seen efforts to restore funding for programs that was slashed by the Trump administration, and you are seeing some Republican support for that. I mean, it impacts their districts and their voters too. So that makes sense. 

Kenen: We’ve also seen the Congress vote for spending that the administration hasn’t been spent. So Congress has just voted on a series of things about science funding and other health-related issues, including global health. But it remains to be seen whether this administration takes appropriations as law or suggestion. 

Rovner: So while the effort to revive the additional ACA subsidies appears to be losing steam, there does seem to be some new hope for a bipartisan health package that almost became law at the end of 2024, so 13 months ago. Back then, Elon Musk got it stripped from the year-end spending bill because the bill, or so Musk said, had gotten too big. That health package includes things like reforms for pharmacy benefits managers and hospital outpatient payments, and continued funding for community health centers. Could that finally become law? That thing that they said, Oh, we’ll pass it first thing next year, meaning 2025. 

Edney: I think it’s certainly looking more likely than the subsidies that we’ve been talking about. But I do think we’ve been here before several times, not just at the end of last year — but, like with these PBM reforms, I feel like they have certainly gotten to a point where it’s like, This is happening. It’s gonna happen. And, I mean, it’s been years, though, that we’ve been talking about pharmacy benefit manager reforms in the space of drug pricing. So basically, you know, from when [President Donald] Trump won. And so, you know, I say this with, like, a huge amount of caution: Maybe. 

Rovner: Yeah, we will, but we’ll believe it when … we get to the signing ceremony. 

Ollstein: Exactly. 

Rovner: Well, back to the Affordable Care Act, for which enrollment in most states end today. We’re getting an early idea of how many people actually are dropping coverage because of the expiration of those subsidies. Sign-ups on the federal marketplace are down about 1.5 million from the end of last year’s enrollment period, and that’s before most people have to pay their first bill. States that run their own marketplaces are also reporting that people are dropping coverage, or else trying to shift to cheaper plans. I’m wondering if these early numbers — which are actually stronger than many predicted, with fewer people actually dropping coverage — reflect people who signed up hoping that Congress might actually renew the subsidies this month. Since we kept saying that was possible. 

Ollstein: I would bet that most people are not following the minutiae of what’s happening on Capitol Hill and have no idea the mess we’re in, and why, and who’s responsible. I would love to be wrong about that. I would love for everyone to be super informed. Hopefully they listen to this podcast. But you know, I think that a lot of people just sign up year after year and aren’t sure of what’s going on until they’re hit with the giant bill.  

Rovner: Yeah. 

Ollstein: One thing I will point out about the emerging numbers is it does show, at least early indications, that the steps a lot of states are taking to make up for the shortfalls and put their own funding into helping people and subsidizing plans, that’s really working. You’re seeing enrollment up in some of those states, and so I wonder if that’ll encourage any others to get on board as well. 

Kenen: But … I think what Julie said is it’s … the follow-up is less than expected. But for the reasons Julie just said is that you haven’t gotten your bill yet. So either you haven’t been paying attention, or you’re an optimist and think there’ll be a solution. So, and people might even pay their first bill thinking that there’ll be a solution next month, or that we’re close. I mean, I would think there’d be drop-off soon, but there might be a steeper cliff a month or two from now, when people realize this is it for the year, and not just a tough, expensive month or two. So just because they’re not as bad as some people forecast doesn’t say that this is going to be a robust coverage year. 

Edney: And I think, I mean, they are the whole picture when you’re talking about who’s signing up, but a lot of these people that I’ve read about or heard about are on the radio programs and different things are signing up, are drastically changing their lives to be able to afford what they think might be their insurance. So how does that play out in other aspects? I think will be .. of the economy of jobs, like, where does that lead us? I think will be something to watch out for too. 

Rovner: And by the way, in case you’re wondering why health insurance is so expensive, we got the 2024 national health spending numbers this week, and total health expenditures grew by 7.2% from the previous year to $5.3 trillion, or 18% of the nation’s GDP [gross domestic product], up from 17.7% the year before. Remember, these are the numbers for 2024, not 2025, but it makes it pretty hard for Republicans to blame the Affordable Care Act itself for rising insurance premiums. Insurance is more expensive because we’re spending more on health care. It’s not really that complicated, right? 

Kenen: This 17%-18% of GDP has been pretty consistent, which doesn’t mean it’s good; it just means it’s been around that level for many, many, many years. Despite all the talk about how it’s unsustainable, it’s been sustained, with pain, but sustained. $5.7 trillion, even if you’ve been doing this a long time … 

Rovner: It’s $5.3 trillion. 

Kenen: $5.3 trillion. It’s a mind-boggling number. It’s a lot of dollars! So the ACA made insurance more — the out-of-pocket cost of insurance for millions of Americans, 20-ish million — but the underlying burden we’ve not solved the — to use the word of the moment, the “affordability” crisis in health care is still with us and arguably getting worse. But like, I think we’re sort of numb. These numbers are just so insane, and yet you say it’s unsustainable, but … I think it was Uwe’s line, right? 

Rovner: It was, it was a famous Uwe Reinhardt line. 

Kenen: No, it’s sustainable, if we’re sustaining it at a high — in economically — zany price.  

Rovner: Right. 

Kenen: And, like, the other thing is, like, where is the money? Right? Everybody in health care says they don’t have any money, so I can’t figure out who has the $5 trillion. 

Rovner: Yeah, well, it’s not … it does not seem to be the insurance companies as much as it is, you know, if you look at these numbers — and I’ll post a link to them — you know, it’s hospitals and drug companies and doctors and all of those who are part of the health care industrial complex, as I like to call it. 

Kenen: All of them say they don’t have enough.  

Rovner: Right. All right. So we know that the Affordable Care Act subsidies are hung up over abortion, as Alice pointed out, and we know that the big abortion demonstration, the March for Life, is coming up next week, so I guess it shouldn’t be surprising that Senate health committee chairman and ardent anti-abortion senator Bill Cassidy would hold a hearing not on changes to the vaccine schedule, which he has loudly and publicly complained about, but instead about the reputed dangers of the abortion pill, mifepristone. Alice, like me, you watched yesterday’s hearing. What was your takeaway? 

Ollstein: So, you know, in a sense, this was a show hearing. There wasn’t a bill under consideration. They didn’t have anyone from the administration to grill. And so this is just sort of your typical each side tries to make their point hearing. And the bigger picture here is that conservatives, including senators and the activist groups who are sort of goading them on from the outside — they’re really frustrated right now about the Trump administration and the lack of action they’ve seen in this first year of this administration on their top priority, which is restricting the abortion pill. Their bigger goal is outlawing all abortion, but since abortion pills comprise the majority of abortions these days, that’s what they’re targeting. And so they’re frustrated that, you know, both [Robert F.] Kennedy [Jr.] and [Marty] Makary have promised some sort of review or action on the abortion pill, and they say, We want to see it. Why haven’t you done it yet? And so I think that pressure is only going to mount, and this hearing was part of that. 

Rovner: I was fascinated by the Louisiana attorney general saying, basically, the quiet part out loud, which is that we banned abortion, but because of these abortion pills, abortions are still going up in our state. That was the first time I think I’d heard an official say that. I mean that, if you wonder why they’re going after the abortion pill, that’s why — because they struck down Roe [v. Wade] and assumed that the number of abortions would go down, and it really has not, has it? 

Ollstein: That’s right. And so not only are people increasingly using pills to terminate pregnancies, but they’re increasingly getting them via telemedicine. And you know, that’s absolutely true in states with bans, but it’s also true in states where abortion is legal. You know, a lot of people just really prefer the telemedicine option, whether because it’s cheaper, or they live really far away from a doctor who is willing to prescribe this, or, you know, any other reasons. So the right — you know, again, including senators like Cassidy, but also these activist groups — they’re saying, at a bare minimum, we want the Trump administration to ban telemedicine for the pills and reinstate the in-person dispensing requirement. That would really roll back access across the country. But what they really want is for the pills to be taken off the market altogether. And they’re pretty open about saying that.  

Rovner: Well, rather convenient timing from the Journal of the American Medical Association this week, which published a peer-reviewed study of 5,000 pages of documents from the FDA that found that over the last dozen years, when it comes to the abortion pill and its availability, the agency followed the evidence-based recommendations of its scientists every single time, except once, and that once was during the first Trump administration. Alice, is there anything that will convince people that the scientific evidence shows that mifepristone is both safe and effective and actually has a very low rate of serious complications? There were, how many, like 100, more than 100 peer-reviewed studies that basically show this, plus the experience of many millions of women in the United States and around the world. 

Ollstein: Well, just like I’m skeptical that there’s any compromise that can be found on the Obamacare subsidies, there’s just no compromise here. You know, you have the groups that are making these arguments about the pills’ safety say very openly that, you know, the reason they oppose the pills is because they cause abortions. They say it can’t be health care if it’s designed to end a life, and that kind of rhetoric. And so the focus on the rate of complication … I mean, I’m not saying they’re not genuinely concerned. They may be, but, you know, this is one of many tactics they’re using to try to curb access to the pills. So it’s just one argument in their arsenal. It’s not their, like, primary driving, overriding goal is, is the safety which, like you said, has been well established with many, many peer-reviewed studies over the last several years. 

Rovner: So, in between these big, high-profile anti-abortion actions like Senate hearings, those supporting abortion rights are actually still prevailing in court, at least in the lower courts. This week, [a lawsuit filed by the American Civil Liberties Union and the National Family Planning and Reproductive Health Association against the Trump administration was quietly dropped after the administration also quietly gave Planned Parenthood and other family planning groups] back the Title X family planning money that was appropriated to it by Congress. That was what Joanne was referring to, that Congress has been appropriating money that the administration hasn’t been spending. But this wasn’t really the big pot of federal money that Planned Parenthood is fighting to win back, right?

Ollstein: It was one pot of money they’re fighting to win back. But yes, the much bigger Medicaid cuts that Congress passed over last summer, those are still in place. And so that’s an order of magnitude more than this pot of Title X family planning money that they just got back. So that aside, I’ve seen a lot of conservatives conflate the two and accuse the Trump administration of violating the law that Congress passed and restoring funding to Planned Parenthood. This is different funding, and it’s a lot less than the cuts that happened. And so I talked to the organizations impacted, and it was clear that even though they’re getting this money back, for some it came too late, like they already closed their doors and shut down clinics in a lot of states, and they can’t reopen them with this chunk of money. This money is when you give a service to a patient, you can then submit for reimbursement. And so if the clinic’s not there, it’s not like they can use this money to, like, reopen the clinic, sign a lease, hire people, etc.  

Rovner: Yeah. The wheels of the courts, as we have seen, have moved very slowly. 

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

So while abortion gets most of the headlines, it’s not the only culture war issue in play. The Supreme Court this week heard oral arguments in a case challenging two of the 27 state laws barring transgender athletes from competing on women’s sports teams. Reporters covering the argument said it seemed unlikely that a majority of justices would strike down the laws, which would allow all of those bans to stand. Meanwhile, the other two branches of the federal government have also weighed in on the gender issue in recent weeks. The House passed a bill in December, sponsored by now former Republican congresswoman Marjorie Taylor Greene that would make it a felony for anyone to provide gender-affirming care to minors nationwide. And the Department of Health and Human Services issued proposed regulations just before Christmas that wouldn’t go quite that far, but would have roughly the same effect. The regulations would ban hospitals from providing gender-affirming care to minors or risk losing their Medicare and Medicaid funding, and would bar funding for gender-affirming care for minors by Medicaid or the Children’s Health Insurance Program. At the same time, Health and Human Services Secretary Kennedy issued a declaration, which is already being challenged in court, stating that gender-affirming care, quote, “does not meet professionally recognized standards of health care,” and therefore practitioners who deliver it can be excluded from federal health programs. I get that sports team exclusions have a lot of public support, but does the public really support effectively ending all gender-affirming care for minors? That’s what this would do. 

Edney: Well, I think that when a lot of people hear that, they think of surgery, which is the much, much, much, much, much less likely scenario here that we’re even talking about. And so those who are against it have done an effective job of making that the issue. And so there … who support gender-affirming care, who have looked into it, would see that a lot of this is hormone treatment, things like that, to drugs …  

Rovner: Puberty blockers! 

Edney: … they’re taking — exactly — and so it’s not, this isn’t like a permanent under-the-knife type of thing that a lot of people are thinking about, and I think, too, talking about, like mental health, with being able to get some of these puberty blockers, the effect that it can have on a minor who doesn’t want to live the way they’ve been living, so it’s so helpful to them. So I think that there’s just a lot that has, you know, there’s been a lot of misinformation out there about this, and I feel like that that’s kind of winning the day. 

Kenen: I think, like, from the beginning, because, like, five or six years ago was the first time I wrote about this. The playbook has been very much like the anti-abortion playbook. They talk about it in terms of protecting women’s health, and now they’re talking about it in protecting children’s health. And, as Anna said, they’re using words like mutilation. Puberty blockers are not mutilation. Puberty blockers are a medication that delays the onset of puberty, and it is not irreversible. It’s like a brake. You take your foot off the brake, and puberty starts. There’s some controversy about what age and how long, and there’s some possible bone damage. I mean, there’s some questions that are raised that need to be answered, but the conversation that’s going on now — most of the experts in this field, who are endocrinologists and psychologists and other people who are working with these kids, cite a lot of data saying that not only this is safe, but it’s beneficial for a kid who really feels like they’re trapped in the wrong body. So you know, I think it’s really important to repeat … the point that Anna made, you know, 12-year-olds are not getting major surgery. Very few minors are, and when they are, it’s closer … they may be under 18, it’s rare. But if you’re under 18, you’re closer to 18, it’s later in teens. And it’s not like you walk into an operating room and say, you know, do this to me. There’s years of counseling and evaluation and professional teams. It really did strike a nerve in the campaign. I think Pennsylvania, in particular. This is something that people don’t understand and get very upset about, and the inflammatory language, it’s not creating understanding. 

Rovner: We’ll see how this one plays out. Finally, this week, things at the Department of Health and Human Services continues to be chaotic. In the latest round of “we’re cutting you off because you don’t agree with us,” the Substance Abuse and Mental Health Services Administration sent hundreds of letters Tuesday to grantees canceling their funding immediately. It’s not entirely clear how many grants or how much money was involved, but it appeared to be something in the neighborhood of $2 billion — that’s around a fifth of SAMHSA’s entire budget. SAMHSA, of course, funds programs that provide addiction and mental health treatment, treatment for homelessness and suicide prevention, among other things. Then, Wednesday night, after a furious backlash from Capitol Hill and just about every mental health and substance abuse group in the country, from what I could tell from my email, the administration canceled the cuts. Did they miscalculate the scope of the reaction here, or was chaos the actual goal in this?  

Edney: That is a great question. I really don’t know the answer. I don’t know what it could serve anyone by doing this and reversing it in 24 hours, as far as the chaos angle, but it does seem, certainly, like there was a miscalculation of how Congress would react to this, and it was a bipartisan reaction that wanted to know why, what is it even your justification? Because these programs do seem to support the priorities of this administration and HHS. 

Rovner: I didn’t count, but I got dozens of emails yesterday.  

Edney: Yeah. 

Rovner: My entire email box was overflowing with people basically freaking out about these cuts to SAMHSA. Joanne, you wanted to say something? 

Kenen: I think that one of the shifts over — I’m not exactly sure how many years — 7, 8, 9, years, whatever we’ve been dealing with this opioid crisis, the country has really changed and how we see addiction, and that we are much more likely to view addiction not as a criminal justice issue, but as a mental health issue. It’s not that everybody thinks that. It’s not that every lawmaker thinks that, but we have really turned this into, we have seen it as, you know, a health problem and a health problem that strikes red states and blue states. You know, we are all familiar with the “deaths of despair.” Many of us know at least an acquaintance or an acquaintance’s family that have experienced an overdose death. This is a bipartisan shift. It is, you know, you’ve had plenty of conservatives speaking out for both more money and more compassion. So I think that the backlash yesterday, I mean, we saw the public backlash, but I think there was probably a behind-the-scenes — some of the “Opioid Belts” are very conservative states, and Republican governors, you know, really saying we’ve had progress. Right? The last couple of years, we have made progress. Fatal overdoses have gone down, and Narcan is available. And just like our inboxes, I think their telephones, they were bombarded.  

Rovner: Yeah. Well, meanwhile, several hundred workers have reportedly been reinstated at the National Institute of Occupational Safety and Health — that’s a subagency of CDC [the Centers for Disease Control and Prevention]. Except that those RIF [reduction in force] cancellations came nine months after the original RIFs, which were back in April. Does the administration think these folks are just sitting around waiting to be called back to work? And in news from the National Institutes of Health, Director Jay Bhattacharya told a podcaster last week that the DEI-related [diversity, equity, and inclusion] grants that were canceled and then reinstated due to court orders are likely to simply not be renewed. And at the FDA, former longtime drug regulator Richard Pazdur said at the J.P. Morgan [Healthcare] Conference in San Francisco this week that the firewall between the political appointees at the agency and its career drug reviewers has been, quote, “breached.” How is the rest of HHS expected to actually, you know, function with even so much uncertainty about who works there and who’s calling the shots? 

Ollstein: Not to mention all of this back and forth and chaos and starting and stopping is costing more, is costing taxpayers more. Overall spending is up. After all of the DOGE [Department of Government Efficiency] and RIFs and all of it, they have not cut spending at all because it’s more expensive to pay people to be on administrative leave for a long time and then try to bring them back and then shut down a lab and then reopen a lab. And all of this has not only meant, you know, programs not serving people, research not happening, but it hasn’t even saved the government any money, either. 

Kenen: Like, you know, the game we played when we were kids, remember, “Red Light-Green Light,” you know, you’d run in one direction, you run back. And if you were 8 years old, it would end with someone crying. And that’s sort of the way we’re running the government these days [laughs]. The amount of people fired, put on leave. The CDC has had this incredible yo-yoing of people. You can’t even keep track. You don’t even know what email to use if you’re trying to keep in touch with them anymore. The churn, with what logic? It’s, as Alice said, just more expensive, but it’s, it’s also just … like you can’t get your job done. Even if you want a smaller government, which many of conservatives and Trump people do, you still want certain functions fulfilled. But there’s still a consensus in society that we need some kind of functioning health system and health oversight and health monitoring. I mean, the American public is not against research, and the American public is not against keeping people alive. You know, the inconsistency is pretty mind-boggling. 

Edney: Well, there’s a lot of rank-and-file, but we’re seeing a lot of heads of parts of the agencies where, like at the FDA, with the drug center, or many of the different institutes at NIH that really don’t have anyone in place that is leading them. And I think that that, to me, like this is just my humble opinion, is it kind of seems like the message as anybody can do this part, because it’s all coming from one place. There’s really just one leader, essentially, RFK, or maybe it’s Trump, or they want everyone to do it the way that they’re going to comply with the different, like you said, everyone wants research, but I, Joanne, but I do think they only want certain kinds of research in this case. So it’s been interesting to watch how many leaders in these agencies that are going away and not being replaced. 

Rovner: And all the institutional memory that’s walking out the door. I mean, more people — and to Alice’s point about how this hasn’t saved money — more people have taken early retirement than have been actually, you know, RIF’d or fired or let go. I mean, they’ve just … a lot of people have basically, including a lot of leaders of many of these agencies, said, We just don’t want to be here under these circumstances. Bye. Assuming at some point this government does want to use the Department of Health and Human Services to get things done, there might not be the personnel around to actually effectuate it. But we will continue to watch that space. 

OK, that’s this week’s news. Now we will play my “Bill of the Month” interview with Elisabeth Rosenthal, and then we will come back and do our extra credits. 

I am pleased to welcome back to the podcast Elisabeth Rosenthal, senior contributing editor at KFF Health News and originator of our “Bill of the Month” series, which in its nearly eight years has analyzed nearly $7 million in dubious, infuriating, or inflated medical charges. Libby also wrote the latest “Bill of the Month,” which we’ll talk about in a minute. Libby, welcome back to the podcast. 

Elisabeth Rosenthal: Thanks for having me back. 

Rovner: So before we get to this month’s patient, can you reflect for a moment on the impact this series has had, and how frustrated are you that eight years on, it’s as relevant as it was when we began? 

Rosenthal: We were worried it wouldn’t last a year, and here we are, eight years later, still finding plenty to write about. I mean, we’ve had some wins. I think we helped contribute to the No Surprises Act being passed. There are states clamping down on facility fees, you know, and making sure that when you get something done in a hospital rather than an outpatient clinic, it’s the same cost. The country’s starting to address drug prices. But, you know, we seem to be the billing police, and that’s not good. We’ve gotten a lot of bills written off for our individual patients. Suddenly, when a reporter calls, they’re like, Oh, that was a mistake or Yeah, we’re going to write that off. And I’m like, You’re not writing that off; that shouldn’t have been billed. So sadly, the series is still going strong, and medical billing has proved endlessly creative. And you know, I think the sad thing for me is our success is a sign of a deeply, deeply dysfunctional system that has left, as we know, you know, 100 million adult Americans with medical debt. So we will keep going until it’s solved, I hope. 

Rovner: Well, getting on to this month’s patient, he gives new meaning to the phrase “It must have been something I ate.” Tell us what it was and how he ended up in the emergency room. 

Rosenthal: Well, Maxwell [Kruzic] loves eating spicy foods, but he’s never had a problem with it. And suddenly, one night, he had just excruciating, crippling abdominal pain. He drove himself to the emergency room. It was so bad he had to stop three times, and when he got there, it was mostly on the right-lower quadrant. You know, the doctors were so convinced, as he was, that he had appendicitis, that they called a surgeon right away, right? So they were all like, ready to go to the operating room. And then the scan came back, and it was like, whoops, his appendix is normal. And then, oh, could he have kidney stones? And it’s like no sign of that either. And finally, he thought, or someone asked, Well, what did you eat last night? And of course, Maxwell had ordered the hottest chili peppers from a bespoke chili pepper-growing company in New Mexico. They have some chili pepper rating of 2 million [Scoville heat units], which is, like, through the roof, and it was a reaction to the chili peppers. I didn’t even know that could happen, and I trained as a doctor, but I guess your intestines don’t like really, really, really hot stuff. 

Rovner: So in the end, he was OK. And the story here isn’t even really about what kind of care he got, or how much it cost. The $8,000 the hospital charged for his few hours in the ER doesn’t seem all that out of line compared to some of the bills we’ve seen. What was most notable in this case was the fact that the bill didn’t actually come until two years later. How much was he asked to pay two years after the hot pepper incident? 

Rosenthal: Well, he was asked to pay a little over $2,000, which was his coinsurance for the emergency room visit. And as he said, you know, $8,000 … now we go, well, that’s not bad. I mean, all they did, actually, was do a couple of scans and give him some IV fluids. But in this day and age, you’re like, wow, he got away — you know, from a “Bill of a Month” perspective, he got away cheap, right? 

Rovner: But I would say, is it even legal to send a bill two years after the fact? Who sends a bill two years later? 

Rosenthal: That’s the problem, like, and Maxwell — he’s a pretty smart guy, so he was checking his portal repeatedly. I mean, he paid something upfront at the ER, and he kept thinking, I must owe something. And he checked and he checked and he checked and it kept saying zero. He actually called his insurer and to make sure that was right. And they said, No, no, no, it’s right. You owe zero. And then, you know, after like, six months, he thought, I guess I owe zero. But then he didn’t think about it, and then almost two years later, this bill arrives in the mail, and he’s like, What?! And what I discovered, which is a little disturbing, is it is not, I wouldn’t say normal, but we see a bunch of these ghost bills at “Bill of the Month,” and in many cases, it’s legal, because of what was going on in those two-year periods. And of course, I called the hospital, I called the insurer, and they were like, Yeah, you know, someone was away on vacation, and someone left their job, and we couldn’t … you know, the hospital billed them correctly. And the hospital said, No, we didn’t. And they were just kind of doing the usual back-end negotiations to figure out what a service is worth. And when they finally agreed two years later what should be paid, that’s when they sent Maxwell the bill. And the problem is, whether it’s legal really depends on your insurance contracts, and whether they allow this kind of late billing. I do not know to this day if Maxwell’s did, because as soon as I called the insurer and the hospital, they were like, Never mind. He doesn’t owe anything. And you know, as he said, he’s a geological engineer. He has lots of clients, and as he said, you know, if I called them two years later and said, Whoops, I forgot to bill for something, they would be like, Forget it! you know. So I do think this is something that needs to be addressed at a policy level, as we so often discover on “Bill of the Month.” 

Rovner: So what should you do if you get one of these ghost bills? I should say I’m still negotiating bills from a surgery that I had six months ago. So I guess I should count myself lucky. 

Rosenthal: Well, I think you should check with your insurer and check with the hospital. I think more with your insurer — if the contract says this is legal to bill. It’s unclear to me, in this case, whether it was. The hospital was very much like, Oh, we made a mistake; because it took so long, we actually couldn’t bill Maxwell. So I think in his case, it probably was in the contract that this was too late to bill. But, you know, I think a lot of hospitals, I hate to say it, have this attitude. Well, doesn’t hurt to try, you know, maybe they’ll pay it. And people are afraid of bills, right? They pay them.  

Rovner: I know the feeling. 

Rosenthal: Yeah, I do think, you know, they should check with their insurer about whether there’s a statute of limitations, essentially, on billing, because there may well be and I would say it’s a great asymmetry, because if you submit an insurance claim more than six months late, they can say, Well, we won’t pay this. 

Rovner: And just to tie this one up with a bow, I assume that Maxwell has changed his pepper-eating ways, at least modified them? 

Rosenthal: He said he will never eat scorpion peppers again. 

Rovner: Libby Rosenthal, thank you so much. 

Rosenthal: Oh, sure. Thanks for having me. 

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

Edney: Sure. So my extra credit is from MedPage Today: “Worried About Liability After CDC Vaccine Changes? You Shouldn’t Be.” I appreciated this article because it answered some questions that I had, too, after the sweeping change to the childhood vaccine schedule. There was just a lot of discussions I had about, you know, well, what does this really mean on the ground? And will parents be confused? Will pediatricians — how will they be talking about this? You know, will they stick to the schedule we knew before? And there was an article in JAMA Perspectives that lays out, essentially, to clinicians, you know, that they should not fear malpractice .. issues if they’re going to talk about the old schedule and not adhere to the newer schedule. And so it lays out some of those issues. And I thought that was really helpful. 

Rovner: Yeah, this was a big question that I had, too. Alice, why don’t you go next? 

Ollstein: Yeah, so I have a piece from ProPublica. It’s called “After Sowing Distrust in Fluoridated Water, Kennedy and Skeptics Turn to Obstructing Other Fluoride Sources.” So this is about how there’s been this huge push on the right to end public water fluoridation that has succeeded in a couple places and could spread more. And the proponents of doing that say that it’s fine because there are all these other sources of fluoride. You can get a treatment at the dentist, you can get it in stuff you buy at the drugstore and take yourself. But at the same time, the people who arepushing for ending fluoridated public drinking water are also pushing for restricting those other sources. There have been state and federal efforts to crack down on them, plus all of the just rhetoric about fluoride, which is very misleading. It misrepresents studies about its alleged neurological impacts. But it also, that kind of rhetoric makes people afraid to have fluoride in any form, and people are very worried about that, what that’s going to do to the nation’s teeth? 

Rovner: Yeah, it’s like vaccines. The more you talk it down, the less people want to do it. Joanne. 

Kenen: This is a piece by Dhruv Khullar in The New Yorker called “What ‘The Pitt’ Taught Me About Being a Doctor,” and it was really great, because there’s certain things I think that we who — like, I don’t know how all of you watch it — but like, there’s certain things that didn’t even strike me, because I’m so used to writing about, like, the connection between poverty, social determinants of health, and, like, of course, people who come to the ED [emergency department] have, you know, homelessness problems and can’t afford food and all that. But Dhruv talked about how it sort of brought that home to him, how our social safety net, the holes in it, end up in our EDs. And he also talked about some of it is dramatized more for TV, that not everybody’s heart stops every 15 minutes. He said that sort of happens to one patient a day. But he talked about compassion and how that is rediscovered in this frenetic ED/ER scene. It’s just a very thoughtful piece about why we all love that TV show. And it’s not just because of Noah Wyle. 

Rovner: Although that helps. My extra credit this week is from The New York Times. It’s called “E.P.A. to Stop Considering Lives Saved When Setting Rules on Air Pollution,” by Maxine Joselow. And while it’s not about HHS, it most definitely is about health. It seems that for the first time in literally decades, the Environmental Protection Agency will no longer calculate the cost to human health when setting clean air rules for ozone and fine particulate matter, quoting the story: “That would most likely lower costs for companies while resulting in dirtier air.” This is just another reminder that the federal government is charged with ensuring the help of Americans from a broad array of agencies, aside from HHS — or in this case, not so much.  

OK, that’s this week’s show. As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. We also had help this week from producer Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, at 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? Alice. 

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

Rovner: Joanne. 

Kenen: I’m mostly on Bluesky or on LinkedIn @JoanneKenen. 

Rovner: Anna. 

Edney: Bluesky or X @annaedney. 

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

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Congress returned from its holiday break to the same question it faced in December: whether to extend covid-era premium subsidies for health plans sold under the Affordable Care Act. The expanded subsidies expired at the end of 2025, leaving more than 20 million Americans facing dramatically higher out-of-pocket costs for insurance.

Meanwhile, the Robert F. Kennedy Jr.-led Department of Health and Human Services announced an overhaul of the federal vaccine schedule for children, reducing the number of diseases for which vaccines are recommended from 17 to 11.

This week’s panelists are Julie Rovner of KFF Health News, Sarah Karlin-Smith of Pink Sheet, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.

Panelists

Among the takeaways from this week’s episode:

• The conservative movement to end abortion access nationwide has ensnared a last-ditch effort in Congress to help millions afford their health plans. As lawmakers consider a compromise to revive enhanced federal tax credits for ACA plans, some Republicans are arguing that the tax credits should be barred from subsidizing any plan that covers abortion care — even though the federal dollars would not be used to pay for abortions anyway. That change would force some states to choose between dropping their requirements for insurance coverage for abortion care or forgoing that federal assistance.
• President Donald Trump this week urged Republicans in Congress to be “flexible” about abortion restrictions. Meanwhile, his health policies so far are not yielding notable benefits for Americans, with most of the savings from his high-profile pharmaceutical deals going to the federal and state Medicaid programs. And the $50 billion federal funding boost for rural health — intended to counterbalance nearly $1 trillion in expected Medicaid spending cuts — is unlikely to make a meaningful dent, in no small part because rural facilities are barred from using the money for general expenses.
• While Kennedy announced an overhaul of federal recommendations for childhood vaccines, the action’s impact on vaccination rates and insurance coverage will depend in large part on how various states react, since states are the ones that impose mandates — such as for school enrollment — and regulate some insurers. Nonetheless, it is likely to result in a patchwork of state policies, which is problematic for public health efforts.
• Federal health officials also unveiled new nutritional guidelines, turning the decades-old food pyramid upside down. Some of the recommendations adhere to scientific findings, such as cutting added sugar from one’s diet. Others are more controversial, particularly the suggestion that Americans should eat more red meat and the softening of guidelines on saturated fats.

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: KFF Health News’ “Advertisements Promising Patients a ‘Dream Body’ With Minimal Risk Get Little Scrutiny,” by Fred Schulte. 

Alice Miranda Ollstein: SFGate’s “A Calif. Teen Trusted ChatGPT for Drug Advice. He Died From an Overdose,” by Lester Black and Stephen Council.  

Sarah Karlin-Smith: ProPublica’s “The End of Aid: Trump Destroyed USAID. What Happens Now?” by Anna Maria Barry-Jester and Brett Murphy.  

Lauren Weber: The Washington Post’s “How RFK Jr. Upended the Public Health System,” by Rachel Roubein, Lena H. Sun, and Lauren Weber.  

Also mentioned in this week’s podcast:

• NBC News’ “Trump Has Announced Deals With Drugmakers To Cut Costs. Will They Save People Money?” by Berkeley Lovelace Jr.
• Stat’s “Panel Behind New Dietary Guidelines Had Financial Ties to Beef, Dairy Industries,” by Isabella Cueto and Sarah Todd.
• The Washington Post’s “U.S. Vaccination Rates Are Plunging. Look Up Where Your School Stands,” by Lauren Weber, Caitlin Gilbert, Dylan Moriarty, and Joshua Lott.
• The Guardian’s “Abortion May No Longer Be a Top Priority for Democratic Voters Ahead of 2026 Midterms, Polls Show,” by Carter Sherman.

[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, Jan. 8, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go.

We are joined via videoconference by Lauren Weber of The Washington Post.

Lauren Weber: Hello, hello.

Rovner: Alice Miranda Ollstein of Politico.

Alice Miranda Ollstein: Hi.

Rovner: And Sarah Karlin-Smith of the Pink Sheet.

Sarah Karlin-Smith: Hi, everybody.

Rovner: No interview this week, but tons of news to catch up on, so let us get right to it. So, we start 2026 in health care the same way we ended 2025, with a fight over expiring subsidies for the Affordable Care Act. By the time you hear this, the House will likely have approved a Democratic-sponsored bill to reinstate for three years the expanded ACA subsidies that were in effect from 2021 through the end of 2025.

That vote was made possible by four Republicans crossing party lines in December to sign a discharge petition that forces a floor vote, over the objection to the House leadership. Interestingly, a preliminary vote on the bill on Wednesday drew not just the four moderate Republicans who signed the original discharge petition but five more, for a total of nine. The consensus of political reporters is that the bill is DOA [dead on arrival] in the Senate, which voted an identical proposal down in early December.

But I’m wondering how much heat Republicans were exposed to over the break by constituents whose out-of-pocket costs for insurance were doubling or more, and whether that might change the forecast somewhat. What are you guys hearing?

Weber: So, it seems that there are still some big hurdles to cross. And based on what senators told my colleagues over the past couple days, there’s not even an agreement on what current law is and does, and thus, they can’t agree on how it should change. And so, I’m talking specifically about the still-unresolved abortion issue.

This is the question of whether plans that cover abortion should receive any federal subsidy, even if those subsidies do not directly pay for an abortion. The Republicans are arguing that it’s an indirect subsidy, even though these are going into separate accounts. So, one of the Republican senators who is trying to craft a deal — that’s Bernie Moreno of Ohio — he was saying that they still don’t agree whether, under current law, federal funding is going to abortion.

So, it’s like you don’t even have a shared reality that senators are operating under, and that makes it really hard to come up with a proposal. They say they’re going to have text by Monday, but we’ll see if that actually happens.

Rovner: Yeah. Well, before we get too deeply into the abortion issue, which we will do in a minute, I want to talk a little bit more about that. I won’t even call it an emerging compromise. I’ll call it a potential compromise in the Senate.

Ollstein: Some bullet points were shared.

Rovner: Some bullet points. We know what the bullet points are. They would extend the additional subsidies for two more years, not three, with a couple of changes, including capping income eligibility for those subsidies at 700% of poverty up from 400% that it reverted back to on Jan. 1. It would also replace zero-premium plans with $5-per-month plans. That’s to crack down on brokers who fraudulently sign up people who don’t even know they have insurance so the brokers can collect commissions. And it would allow people to choose whether their enhanced subsidies should go into Republican-favored health savings accounts or directly toward their premiums.

Assuming — and this is obviously a big assumption — they could get past this abortion issue, what are the chances for a compromise that looks something like this? I mean, it sounds like something that could satisfy both Democrats and Republicans, particularly Republicans who are feeling pressured by their own constituents who’ve now seen there — are either dropping their insurance or seeing their out-of-pocket cost just goes wild.

Ollstein: I’ve heard some criticism from the Democratic side about getting rid of zero-premium plans specifically. They’re saying the Republicans want to run on affordability and helping out people who are struggling. How does eliminating the ability to get a zero-premium plan align with that?

And so I expect there will be some clashes over that. But I also think, again, senators aren’t even agreeing on what the current reality is, and that applies there, too. There have been all of these allegations of widespread fraud, and some experts and lawmakers have been pointing out that just because someone who is enrolled doesn’t actually use their benefits, that doesn’t necessarily mean there’s fraud going on.

It does seem like there is some fraud going on. You mentioned the perverse incentives for brokers, but a lot of this is circumstantial evidence rather than direct evidence.

Rovner: Also, one of the ironies here is that if you have somebody who’s healthy, who signs up for health insurance and doesn’t use it, that’s a good thing for the risk pool. You don’t want only sick people.

Ollstein: It helps everyone.

Rovner: There’s a lot of things making my head explode. Well, one of the things that Alice, I know, is making your head explode, too, is this disagreement about reality about abortion. And I would point out that President [Donald] Trump spoke to the retreat of the House Republicans this week and urged some flexibility, put that in air quotes, on this Hyde Amendment issue. Alice, remind us why this is an issue here. Doesn’t the Affordable Care Act already ban federal funding of abortion just like all other federal programs?

Ollstein: Yes. Yes, it does. So basically, this is part of a larger project on the right to expand the definition of Hyde.

Rovner: We should probably go back to the very beginning of what is …

Ollstein: Yes.

Rovner: … the Hyde Amendment because it only applies to annual appropriations, and that’s why it’s been important. I will let you take it from there.

Ollstein: Sure, sure. So, this is a budget rider that dates back to the 1970s that says that there can be no federal funding of abortion, except in a few instances, of there’s a risk to the mother’s life, and rape and incest. And so that has been renewed over and over under administrations of both parties, under Congress majorities of both parties.

And now, what they’re fighting over is, already federal funding that goes to these plans in the form of these subsidies, it does not go to pay for abortion directly. But conservatives are now arguing that if it goes to a plan that covers abortion using other funding, then that functions as an indirect subsidy. This is the same argument they’ve made about Title X, where any federal funding going to a program that uses other funding to pay for abortion, they now consider that sort of an indirect subsidy, even though it’s coming out of different buckets of money.

And so, what they’re pushing for is basically a nationwide restriction on any plan that gets a federal subsidy paying for abortion. So, this would have the most impact in the states where all plans on the ACA market are required to cover abortion, in states like California, New York, and Massachusetts, big states with many, many millions of people. And so that would have a huge impact and force those plans to either drop abortion coverage or forgo the federal subsidy. So, that would have a really big impact.

And Democrats say this is not necessary. There’s already restrictions that prevent federal funding to go to pay for abortion. And that is what the senators and everyone can’t agree on right now.

Rovner: That’s right. And that’s a big fund. Well, we’ll see where that goes. In the meantime, what the president was talking about when he called for flexibility on Hyde was actually health care writ large.

This clearly reflects what we know the president’s pollster has been telling him: that Republicans are currently at a distinct public disadvantage when it comes to health care, and not just the Affordable Care Act. Trump says that Republicans should, again, air quotes, try to “own” the health care issue. And he has spent a good bit of his first year working on health issues. At least he’s been talking about them a lot, but it turns out that his high-profile drug-price deals are not mostly being felt by consumers here in the U.S.

The savings he’s negotiated are mostly going to the state and federal Medicare and Medicaid programs, as well as to people willing and able to pay out-of-pocket for their prescription drugs. And while the administration is making much of its December announcement about the first distribution of rural health funding that was authorized in last summer’s budget bill, that $50 billion in funding won’t make much of a dent compared to the nearly $1 trillion in cuts that were created for Medicaid in that same bill. So, my question from all of this is: Can Republicans use things like this to own the health care issue or at least cut into Democrats’ advantage between now and the midterms?

Weber: Well, I think it depends on what they end up doing with it. He brought up in that same meeting with legislators wanting to own IVF [in vitro fertilization], which is something he floated during his campaign that got a lot of shock from [the] conservative Republican base. So, what does he mean? What is he saying on that? We don’t have particulars.

Bottom line is, voters don’t necessarily know the in-the-weeds policy. So, if he gets out there and says enough things, who knows that they can own the health care issue? But I would say for now that it is solely in the Democrats’ camp and is helping lead them with an advantage for midterms for now.

Rovner: Sarah, he keeps saying on drug prices that he’s done all this stuff, and he has done a lot of stuff, but it hasn’t had a big dent in what people pay for their drugs, right?

Karlin-Smith: Right. And I think the one reason drug pricing has been a popular health policy topic for politicians to focus on is because people really can feel it directly compared to how they feel other health costs. And so, I think that there’s only a certain amount of time where people will just accept Trump saying, Oh, we’re saving you money, without them actually seeing it on the back end. And the problem right now is these most-favored-nation deals where he’s struck privately with a lot of drug companies to get Medicaid, really mostly at this point, in theory lower prices.

It’s not clear how much money it’s actually going to save Medicaid because Medicaid actually gets some of the best deals that the U.S. gets. Most people on Medicaid actually don’t really directly pay copays for most of their products, either. The other problem is they’ve then rolled out a number of other drug-pricing models to try and pair this concept, again, of getting the prices a lot of other countries get for drugs in the U.S., but they then exempted all these companies they’ve struck these private deals with.

So, it’s not really clear who is left in terms of drug companies and drug products. Then you might get cheaper prices under some of these other demonstrations, which by their nature, these are demonstration pilot programs that are not going to reach every Medicare beneficiary they’re pushing for. So, I think it’s going to be a big problem because many people are not actually going to see savings.

For people that have a decent amount of income and can afford some of these direct-to-consumer products where health insurers have often been denying it — like the weight loss, common popular weight loss drugs — some people may feel a little benefit there. But if you’re somebody who’s underinsured or uninsured, even if there’s really good discounts on a direct-to-consumer buying market, you’re probably also still not going to be able to afford these weight loss drugs.

Rovner: Yes, Lauren.

Weber: Just to go back to the rural health fund disbursement, I just have so many thoughts on this, because I mean, at the end of the day, rural hospitals are also the equivalent of rural jobs programs for rural America. And typically, rural hospitals fall in red America. And so, this attempt to prop them up, it sounds flashy, right? I mean, it’s billions of dollars. But when you break it down by the 50 states, it’s hundreds of millions, like tops like $281 million depending on the state.

That’s not going to cover the deficit that the bill has created for those folks. And I understand that it’s meant by the administration to be a flashy way of, Oh, we’re supporting rural health care, but the crushing Medicaid cuts that these rural hospitals are going to face, when they already operate on such thin margins, will be devastating. I mean, it will be devastating for already health care deserts that we already see, and this money is not going to be enough to stop the blood flow there in rural America.

Rovner: And Alice, you guys at Politico pointed out that even this $50 billion was not exactly distributed based on need, right? It was distributed based on deals.

Ollstein: Yes. And to build on Lauren’s point, not only is it not enough to make up for the Medicaid cuts, but there are restrictions. States can only use a little fraction of the money to keep these rural hospitals’ lights on, basically. The money is supposed to be for these transformative projects. It’s very tech focused. It’s very, Let’s try these pilot programs and completely revamp the way rural health care is delivered. Meanwhile, there are all these rural hospitals on the brink of closure, and states aren’t allowed to spend a lot of the money on just paying the salaries of the people who work there, paying for keeping the buildings in good shape. And so, we could see benefit from this money, but we could also, in the meantime, see a bunch more rural hospitals close, as they have been. And once they close, it’s really hard to come back.

And so, to your point, the way the money was distributed is getting a lot of criticism from all around the country because, one, a lot of it was split evenly between states regardless of the size of their population. And so, you saw, for instance, Alaska get more than California despite having a tiny, tiny sliver of its population. And I had people arguing with me online saying, Well, what about the rural population? Yes, California has a huge rural population. It’s not just LA and San Francisco. So, even if you only count the rural population, it’s much, much, much bigger than Alaska.

Also, there were these policy incentives in the program where states that adopted Trump-administration-friendly policies — like restrictions on what people can buy with SNAP [Supplemental Nutrition Assistance Program], on implementing the presidential fitness test, on deregulating short-term insurance plans, which Democrats have criticized and called junk plans — these would get the states more money if they adopted these policies. So, we’ve been digging into that and digging into the struggles on the state level on that front.

Rovner: All right. Well, that’s the rural health news. We’re going to take a quick break. We will be right back.

So, the other big news out of HHS [the Department of Health and Human Services] was on the vaccine front where Secretary Robert F. Kennedy Jr. made unilaterally a major change to the federal government’s childhood vaccine schedule, reducing the number of diseases with explicit vaccine recommendations from 17 to 11. No longer recommended for all children will be vaccines to protect against flu, covid, rotavirus, hepatitis A, and the germs that cause meningitis. Sarah, you’re the mom here on this panel today. How is this schedule change actually going to affect parents and children and doctors?

Karlin-Smith: I think a lot of it is going to depend [on] how the pediatrician health community reacts to this, because there’s been a lot of pushback from the medical public health community that this is not an appropriate or scientifically based change. So, doctors may still guide parents to hopefully making the decision to get these vaccines, but parents who may be a little hesitant, maybe feel more comfortable backing out.

Despite sometimes the rhetoric you hear from this administration, states are really the ones that end up creating policies that end up with actual mandates for people to get vaccinated for school and so forth. So, states may build off this and change their mandates, and that may impact access, but they may also not. So, people may still have to, for school purposes, get some of these shots as well.

Rovner: And I should point out that the American Academy of Pediatrics is fighting this, I would say tooth and nail, but also in court. I mean, they’re actually suing, saying that Kennedy didn’t even have the authority to make this change without going through a much more detailed regulatory process.

So, the administration says that all the vaccines currently on the schedule will remain, quote, “covered by insurance,” but I’m not positive that’s necessarily going to be the case in the long term, right? Isn’t mandatory insurance coverage linked to the recommendations of the CDC [Centers for Disease Control and Prevention]? And if these are no longer actually recommended, are they no longer required to be covered?

I know the insurance industry, we’ve talked about this, has said that they’re going to continue to cover all the vaccines at least through 2026. But I’m wondering about the legality. I tried to track this back, but I couldn’t find it all the way.

Ollstein: We could see a patchwork because a lot of states are moving to change their own laws about insurance coverage and have it be based on something other than these federal recommendations. I think that obviously patchworks are challenging when you’re talking about infectious diseases, which do not respect state or national boundaries, but Sarah can say more.

Rovner: Go ahead, Sarah.

Karlin-Smith: Yeah. To build on Alice’s comment, and the thing that gets really confusing really fast always with U.S. health care is states can regulate certain insurance plans and states cannot regulate certain insurance plans, the ERISA [Employee Retirement Income Security Act] plans. So, you could end up, even if states want to mandate coverage, depending on the type of health care coverage you get in your state, you may live in that state, work in that state, and you’re not going to get covered. So, that adds to the patchwork and always adds to the confusion when trying to explain that issue to people.

But the administration has claimed basically because the vaccines, they’re no longer universally recommended — they’re moving to what’s called the shared decision-making recommendation, where people are supposed to consult with their doctor and figure out whether these vaccines are appropriate for them and their children — that that still, under the way laws and regulations are written, requires the mandatory coverage for health care and no copays and so forth.

And I’ve talked to people who’ve looked at this, and there is precedent for that with other vaccines. I think there’s some concerns, however, that that could be challenged by people in court who don’t want these vaccines to be covered. There’s also concern when it comes to like the HPV [human papillomavirus] vaccine, which they’re now only recommending one shot of instead of two.

In that case, because they’ve really fully eliminated the recommendation for a second shot, if somebody felt like they wanted that two-series shot, I don’t think that would be covered. And the other question is, while they didn’t use the CDC’s Advisory Committee on Immunization Practices to make these changes for the most part. And they are largely advisory, but they do have certain legal authority when it comes to vaccines for children’s program, and their legal authority from Congress very much relates to the coverage and reimbursement. So, it’ll be interesting to see, again, if this all aligns.

Rovner: And we should point out that the Vaccines for Children Program, which many people have never heard of, is actually responsible for vaccinating something like half of all children in the United States. It’s a huge program that’s just basically invisible but really, really important.

Karlin-Smith: Right. And so, I think there’s going to be legal questions that they didn’t vote on those reimbursement questions here.

Rovner: Yeah. There’s a lot that’s going to have to be sorted out here. Well, one of the arguments that HHS officials are making is that they compared the U.S. vaccine schedule to that of, quote, “peer nations” like Denmark, but those peer nations have something the U.S. does not: universal health insurance. That can make a really big difference in vaccine uptake and in just the prevalence of disease, right?

Karlin-Smith: Yeah. And so, one thing that people have tried to look at and explain in recent days is the U.S. isn’t actually that different from most of its peers. Denmark, some have made the case, is actually the outlier. And if you look at Germany, Japan, Canada, Australia, the amount of pathogens, viruses the U.S. is vaccinating against is actually much more in line with most of the peer population. And then when you have a country like Denmark, which has universal health insurance …

Rovner: And a very small population.

Karlin-Smith: Right. I mean, it’s very different, but they’ve made in some cases the calculus that if we don’t vaccinate for rotavirus, and we are able to treat the however many kids each year will need to be hospitalized and treated, and you have a certain comfort — I don’t think that most parents would like the idea of knowing your kid is going to get sick and need to be hospitalized maybe or treated — but there’s a lot more comfort that they would get care, and quick care, and would do better there. But they certainly are not, and there’s data to show, [they] don’t do as well as the U.S. does in terms of the amount of people that get some of these diseases.

The other thing with some of the vaccines I noted that like some of these comparison countries don’t cover is they’re newer and they’re still more expensive. So, sometimes one of the reasons these countries are choosing not to recommend them more broadly is because they’re making decisions based on the fact that they have universal health care — the taxpayers pay for it — and then deciding that at this point, the pricing is not affordable. They’re not making a decision saying if the cost was zero, that the risk-benefit calculus isn’t favorable for people.

Rovner: Right. And it’s all about the risk-benefit calculus. So, one thing we know is that the rise in vaccine hesitancy is leading to outbreaks of previously rare diseases in the U.S., including measles and pertussis, or whooping cough. Lauren, you’ve got a really cool story this week with a tool that can help people figure out if they and their families are at risk. So, tell us about it.

Weber: Yeah. My colleagues at The Washington Post, including Caitlin Gilbert, and I set out last year to tell people across the country what their vaccination rate is at their school. And so, we requested records from all 50 states and were able to get school-based records for about, I think, 36 of them and county-based records for vaccination records for 44 states. So, we have a nifty tool where you can look up in your local community what your vaccination rates are.

But taking a step back, what we found in our reporting is that before the pandemic, rates weren’t looking that great. Only half of the country was making 95% vaccination against measles, which is herd immunity. After the pandemic, that dropped to 28%.

And what we found in digging in a lot deeper is that schools, which were once considered kind of this bulwark against infectious disease, because they’re the ones who would enforce whether or not you needed your shots to attend school, are somewhat stepping away from that responsibility in the politically charged environment that is America today. I spoke to a superintendent in Minnesota, which has seen a large drop in vaccination for measles, who said, Look, I’m a record keeper. It’s not my job to promote a medical decision.

And you see that attitude across the country in school nurses and so on where maybe they’re not being empowered by their superintendent or principal to draw the line, or they’re valuing the child going to school over getting vaccinated. And so, there’s a lot of talk about at the state level that we have these mandates for vaccination, but if they’re not enforced and there’s no mechanism to enforce them, our investigation found that you had these slipping rates.

And a lot of folks are really concerned. Because look to South Carolina. You have hundreds of kids quarantined and missing school; you have hundreds of people infected. And, in general, measles cases were at their highest in 33 years last year. So, we have this rise of infectious disease amid an administration headed by a man who has disparaged vaccines for years and is working to roll back policy around them.

Rovner: Is there any talk from Capitol Hill on … we’ve talked so much about Sen. Bill Cassidy [R-La.], who’s a doctor, who was the deciding vote for RFK Jr. and said that he got RFK Jr. to promise not to change the vaccine schedule, which he just did. But it’s not just Cassidy. There’s 534 other members of Congress. Is anybody pushing back on any of this?

Weber: I mean, Cassidy tweeted after the vaccine change that he was appalled. I’m a physician. My job is to protect children. This is a problem. At the end of the day, the person who runs HHS is a man who has repeatedly linked the rising number of vaccines, which are rising because we have more vaccines that can fight more pathogens, to chronic conditions that experts say is not based in evidence.

And so, no, I do not see a massive Capitol Hill pushback. I mean, you have frustration and irritation, but I don’t see Cassidy hauling Kennedy in for a hearing. Hasn’t happened yet, really, besides those couple that were mandated. So, we’ll see how this continues to play out.

But the reality is amid all of this talk of vaccine schedules, the people on the front lines of this are these school nurses or pediatricians who are met with a wave of parents who are so confused. I talked to so many pediatricians who said, Look, we refer to the AAP, the American Academy of Pediatrics, but it’s really hard when the president and the head of the health system is saying something different to convince parents that may be confused. And oftentimes, if you’re confused, it’s easier to not take action, to not get your child vaccinated than to do so. And…

Rovner: And because pediatricians don’t already have enough to do.

Weber: Right. Many are scared that these trends that we identified in our investigation will continue to worsen in the years to come.

Rovner: Well, also this week we got the new food pyramid recommendations from HHS and the Department of Agriculture. Food, obviously another big priority for RFK Jr., who, as we know, is a fan of red meat and whole-fat dairy. Unlike the vaccine schedule, though, the changes to the food pyramid appear, at least at first blush, to hew to fairly consensus opinions in the nutrition world that whole foods are better than processed foods, protein is good, added sugar and refined carbohydrates are bad.

Still, when you get into the details, there are some things that are likely to cause nutrition scientists, some, shall we say, indigestion. What are some of the more controversial recommendations here other than Dr. [Mehmet] Oz saying in Wednesday’s press briefing that you might not want to drink alcohol for breakfast?

Ollstein: So, the alcohol piece has gotten pushback because it’s weakening the previous recommendation that really no amount of alcohol is safe. We talked before about a report about alcohol as a carcinogen that was buried last year, a government report that had been worked on for years that was supposed to come out that got buried by the Trump administration. And so that I think is reflected in these new recommendations. And I saw a lot of conservatives celebrating this and saying, Happy hour’s back, everyone! But look, there’s real science that shows the dangers of even moderate alcohol consumption, and that’s getting sidelined here.

Rovner: The previous recommendations were that, I would say the previous recommendations were like no more than one drink a day for women and two for men, and they took that away? I think that was the actual change here.

Ollstein: There was a push to say that no amount is safe, basically, that even small amounts are potentially harmful to health.

Rovner: And that didn’t happen.

Ollstein: Correct, correct. The other concern I was hearing is about the emphasis on red meat when that is something that Americans eat too much of already.

Rovner: Although I know there’s an irony here that I think the new recommendations state, you still shouldn’t have more than 10% of your calories from saturated fat. But saturated fat isn’t nearly as bad as we used to think it was, Sarah. I see you nodding.

Karlin-Smith: Yeah. I think the saturated fat and the focus on the sources of fat and protein is one of the biggest controversies here because there is lots of research and evidence that saturated fat can lead to heart disease and other medical complications. And people have long been pushed toward plant-based proteins, leaner proteins, and the role of dairy, and whether you should be doing high-fat dairy as well.

And there’s been some good reporting from Stat and others of recent days that there was a lot of conflicts on the committee who was making these recommendations around their relationships with these various industries. They tried to avoid contradicting the science too much in how they made their push for more red meat and more saturated fat. But it’s probably another area where, if you read it in full, you’re going to get confused and you may not end up making the right decisions because some of the recommendations there are kind of contradictory.

Rovner: Although we’ll point out that the difference between the nutrition guidelines and the vaccine schedule is very large because the new nutrition guidelines are just that. They’re guidelines. They do determine what gets served in school lunches and things like that, but it’s not quite nearly of the level that the vaccine schedule is.

Well, finally this week, turning to reproductive health, the Wyoming Supreme Court struck down two abortion bans, kind of remarkable for one of the reddest states in the nation. Interestingly, one of the reasons the bans were struck down is because the state tried to thwart the Affordable Care Act back in 2012. Alice, explain what these two things have to do with each other.

Ollstein: Yes. So, the state adopted some laws saying that people have the right to make their own health care decisions, and that was squarely aimed at the Affordable Care Act. However, the judges found that it also applied to the right to have an abortion.

Rovner: Oops.

Ollstein: They said, Based on the text of this law, it doesn’t matter what you meant it to say. It matters what it actually says. And we find that it applies here.

That’s actually not the only state where that’s happened over the past few years. There have been other conservative states that have inadvertently protected the right to abortion through these right-to-control-your-own-health care provisions. So, I think we’ve seen over the past few years that state constitutions can be more protective of abortion than the federal Constitution in certain circumstances. But I think it’s also notable that Wyoming had one of the first laws specifically banning abortion pills, and that was also struck down.

So, nothing changes in practice, because these laws were already enjoined and were not being enforced, but it is a big deal. And it could lead to more efforts to hold the ballot referendums that we’ve seen over the past few years. There are set to be a few more this fall, but there could be even more following decisions like this in the courts.

Rovner: Yeah. Along those lines, there’s a really interesting piece in The Guardian that suggests that abortion is waning as a top issue for Democrats, but not so much for Republicans, most of whom still consider it a deal breaker for a candidate not to agree with them. What happened to all that enthusiasm for abortion rights that we saw in 2023 and 2024 to some extent?

Ollstein: Look, there’s a lot going on right now. So, it may be that just other issues are overshadowing this. And also, it’s a long way to go before the elections. We do not know what’s going to happen.

If various court cases lead to a big change, another big change in abortion access, this could rear its head once again. As we’ve discussed many times, this is not really ever over or settled.

Rovner: All right. Well, it is January. All right. That is this week’s news, or at least as much as we had time for.

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

Weber: Yeah. I have to shout out another investigation my colleagues and I completed led by Rachel Roubein and Lena Sun and I. [“How RFK Jr. Upended the Public Health System”] We dug into the first year of Kennedy in office. In interviews with nearly a hundred folks and documents, we uncovered some of his previously undisclosed shaping of vaccine policy. We got ahold of an email in which a top aide asked to replace the membership of ACIP and reconsider the universal hep B vaccine recommendation and revisit the use of multidose flu shot vials. We also analyzed how while Kennedy has talked about food twice as much as vaccines while in office, one of his advisers, Del Bigtree, told us, Look, food is more popular with the American mom. And I think some of these revelations shape and put into context what we’re seeing now, which is this culmination of changing the vaccine schedule and continued policy to upend public health infrastructure in this country.

Rovner: That’s a really good piece. Alice.

Ollstein: So, I have a very depressing piece out of San Francisco called, “A Calif. Teen Trusted ChatGPT for Drug Advice. He Died From an Overdose.” This is yet another death of a young person after heavily using some of these LLMs [large language models] for advice. Some of the chat logs show that he was able to very easily circumvent the protections that were put in place.

ChatGPT is not supposed to give people advice on using drugs recreationally, but that is very easily circumvented by pretending it’s a hypothetical question or various other means. And this article does a good job showing that it’s really a garbage-in-garbage-out scenario. ChatGPT is drawing from the entire internet. And so somebody’s dumb post on Reddit by a person who has a substance abuse issue, for instance, could be informing what advice the bot gives you. And so I think this is especially important to keep in mind as, just this week, ChatGPT is launching, making a big push, launching a whole health-care-focused chatbot and encouraging millions of people to use it.

And so this article … quotes experts who argue that it’s not possible to prevent this bad advice from getting in there, just because these chatbots are trained on huge volumes of text from the entire internet. It’s not possible to weed out things like this. And so I think that’s important to keep in mind.

Rovner: So, what could possibly go wrong? Sarah.

Karlin-Smith: I took a look at some ProPublica pieces on the impact of the U.S.’ USAID cuts [“The End of Aid: Trump Destroyed USAID. What Happens Now?”]. One of the stories that I looked at was “Trump Officials Celebrated With Cake After Slashing Aid. Then People Died of Cholera.” It’s just a really deep dive into the decisions that these political leaders made to cut off aid and support for various countries. This one, in particular, was looking at South Sudan, even though they were warned that they would make certain disease outbreaks and other humanitarian situations worse. And it just goes through the hardship of that, as well as the fact that Trump administration officials were making claims throughout this time, once there was pushback, that they were going to not cut off certain life-supporting aid and so forth. And that was not actually the case. They did cut it off, and they did it in ways that were extremely abrupt and fast, that there could not be any safety valve or stopgap to prevent the harm that occurred.

Rovner: Yeah. It’s quite the series and really heavy but really good. My extra credit this week comes from my colleague Fred Schulte, who’s moved on from uncovering malfeasance in Medicare Advantage to uncovering malfeasance in cosmetic surgery. This one is called “Advertisements Promising Patients a ‘Dream Body’ With Minimal Risk Get Little Scrutiny.”

And if you’ve ever been tempted by one of those body-sculpting commercials promising quick results, little pain, and an immediate return to your daily routine, you really need to read this story first. It includes a long list of patients who either died of complications of allegedly minimally invasive techniques or who ended up in the hospital and with scars that have yet to heal. Many of the lawsuits filed in these cases are still in process, but it is definitely “buyer beware.”

OK, that is this week’s show. Hope you feel at least a little bit caught up. As always, thanks to our editor, Emmarie Huetteman, and this week’s producer engineer, Zach Dyer.

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 find me still on X, @jrovner, or on Bluesky, @julierovner. Where are you folks hanging these days? Lauren.

Weber: I am on X, @LaurenWeberHP, and same thing on Bluesky these days.

Rovner: Sarah?

Karlin-Smith: Mostly Bluesky and LinkedIn at @sarahkarlin-smith.

Rovner: Alice.

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

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

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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. 

Credits

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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.

USE OUR CONTENT

This story can be republished for free (details).

Roy, a co-founder and the chair of the Foundation for Research on Equal Opportunity, said health care affordability has become a more salient issue for the GOP under President Donald Trump, with more people from working-class backgrounds voting Republican.

Before Trump, he said, the party’s support was more concentrated among those covered by employer-sponsored insurance or Medicare, the public program for those who are 65 or older or have disabilities — voters less likely to be concerned about affording medical care.

An abbreviated version of this interview aired on What the Health? Episode 423: “The GOP Circles the Wagons on ACA.”

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.

USE OUR CONTENT

This story can be republished for free (details).

The Senate is scheduled to vote in the coming days on a Democrat-led plan to extend the temporary additional subsidies that have lowered out-of-pocket costs for Affordable Care Act health plans. But even with the vote approaching, Republicans in the House and Senate are divided over what, if any, alternative plan they should offer.

Meanwhile, anti-vaccine forces at the Centers for Disease Control and Prevention and the Food and Drug Administration have both agencies in disarray.

This week’s panelists are Julie Rovner of KFF Health News, Paige Winfield Cunningham of The Washington Post, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• Republican lawmakers are struggling to reach consensus on a health care plan as the Senate prepares to vote on the fate of enhanced ACA premium subsidies. Many broadly oppose Obamacare and argue Democrats deserve the blame for the rising cost of health care, while some Republicans facing tough reelection fights next year are advocating for renewing the more generous subsidies. New polling shows that even most supporters of President Donald Trump favor keeping the subsidies.
• It’s not just ACA plan-holders who are learning their out-of-pocket costs will rise next year. Premium payments for those who rely on the Federal Employee Health Benefits Program are going up again, with those plans among the many reporting out-of-pocket cost increases.
• The federal Advisory Committee on Immunization Practices is meeting this week. Earlier this year, Health and Human Services Secretary Robert F. Kennedy Jr. replaced the panel’s members, adding noted vaccine critics. At this meeting, the panel is discussing past recommendations on the birth dose of the hepatitis B vaccine and on the childhood vaccine schedule.

Also this week, Rovner interviews Aneri Pattani of KFF Health News about her project tracking the distribution of $50 billion in opioid legal-settlement payments.

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

Julie Rovner: The New York Times’ “These Hospitals Figured Out How To Slash C-Section Rates,” by Sarah Kliff and Bianca Pallaro.

Joanne Kenen: Wired’s “A Fentanyl Vaccine Is About To Get Its First Major Test,” by Emily Mullin.

Paige Winfield Cunningham: The New York Times’ “A Smartphone Before Age 12 Could Carry Health Risks, Study Says,” by Catherine Pearson.

Alice Miranda Ollstein: The Independent’s “Miscarriages, Infections, Neglect: The Pregnant Women Detained by ICE,” by Kelly Rissman.

Also mentioned in this week’s podcast:

• Politico’s “Why Republicans Aren’t Eager To Cut an Obamacare Deal,” by Alice Miranda Ollstein and Robert King.
• KFF’s “2025 KFF Marketplace Enrollees Survey,” by Lunna Lopes, Grace Sparks, Mardet Mulugeta, Isabelle Valdes, and Ashley Kirzinger.
• KFF Health News’ “After Shutdown, Federal Employees Face New Uncertainty: Affording Health Insurance,” by Phil Galewitz.
• The Washington Post’s “Why Health Savings Accounts Aren’t the Fix Republicans Hope For,” by Paige Winfield Cunningham.
• KFF Health News’ “Trump Wants Americans To Make More Babies. Critics Say His Policies Won’t Help Raise Them.” By Stephanie Armour and Amanda Seitz.

[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. 4, 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 Paige Winfield Cunningham of The Washington Post. 

Paige Winfield Cunningham: Hi, Julie. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

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

Kenen: Hi, everybody. 

Rovner: Later in this episode, we’ll have my interview with my KFF Health News colleague Aneri Pattani about her project tracking how the $50 billion in opioid settlement money is being spent. But first, this week’s news. 

So, another week, another scramble by Republicans to find a health plan they can agree on before next week’s likely Senate vote to extend the ACA’s enhanced tax credits. That’s the vote that was promised to Democrats in exchange for their votes to reopen the government last month. So far, Republicans can’t seem to reach agreement on whether to extend the credits — which, if allowed to expire, could balloon premium payments for lots of voters, including lots of Republican voters — or whether to stick to their guns in opposing the Affordable Care Act in general. Alice, you wrote a new take on why Republicans might just be happy to let the extra credits expire. Tell us about it. 

Ollstein: Yeah. So there’s less one overarching reason, and more of a grab bag of reasons. It depends who you ask. But suffice it to say, there are a lot of Republicans who would be fine with letting these subsidies die. If you wanted to nail down the most common reason we’re hearing right now, it’s just that they oppose Obamacare. They’ve always opposed Obamacare. They’re not about to suddenly become different people and start supporting it now. They voted a bazillion times to repeal it. They didn’t vote to create these subsidies in the first place, or to extend them the first time. And they’re not eager to suddenly start now. They say this is a problem of Democrats’ making. Democrats created this entire structure, and set the expiration date. We can talk about why they did that. 

Rovner: Because they didn’t have the votes to make it any longer. 

Ollstein: Yeah. And because it kept the cost down of the overall bill. They say, Why should we bail out the Democrats? Now, of course, there are other Republicans who say, Look, this is going to hurt us politically. We’re the party in power, and people are going to start getting these higher bills, and guess who they’re going to blame? They’re going to blame the party in power. And so there are a lot of divisions up on Capitol Hill right now, and [we’re] not really seeing any consensus emerge. It seems like the Democrats are going to put forward a clean extension that will fail and not pass. And the Republicans are either going to put up something that also won’t pass or they won’t put up anything. It’s not really clear yet. 

Rovner: And just to clarify, because I feel like we have to say this every week, the base tax credits that were created by the Affordable Care Act are not going away. It’s just these extra tax credits that were put into place in 2021 that are set to expire at the end of the year. But Alice, I would say I was really struck by something in your story where you said Republicans are more afraid of being punished by primary voters than punished by general-election voters if they vote to extend the subsidies as opposed to if they let them expire. 

Ollstein: Yeah. So you have an interesting primary versus general election problem, which of course plagues both parties in every single election. But yes, there is a lot of fear of being primaried from the right, and being attacked for supporting Obamacare in any way, shape, or form, even if it’s a short-term extension with conservative reforms, which is what a lot of folks are talking about. There is more fear of that than of being attacked for allowing people’s premiums to rise by letting the subsidies expire. Of course, it totally varies by district. You have people in these very, very red districts who that’s what they’re more afraid of. And then you have these swing district folks who are more afraid of being punished by voters for letting the subsidies expire. So it’s just really all over the place. You also have an interesting individual versus collective divide, where for some members it could be better just for their own personal political survival to let the subsidies die — even if the GOP as a whole party is worried about this. 

Winfield Cunningham: And well, just in the issue of [the] primaries thing they’re worried about is if they vote for extending the subsidies without the Hyde [Amendment] language, then the anti-abortion groups are all going to come out and say that they voted for taxpayer funding of abortion, which is not the message that you want to be up against if you’re running in a primary with [an] opponent to the right of you. 

Rovner: And just a reminder that the whole Affordable Care Act very nearly died over whether or not these subsidies could be used to pay for plans that include abortion coverage. And that was just Democrats fighting about it. But for Republicans, this is harder. Because it’s important to remember that the Hyde Amendment, as we think of it, is something that is renewed every single year in a spending bill in the Labor HHS [Health and Human Services] appropriations bill. Putting Hyde language into something like this would make it permanent. And that’s something that is a complete nonstarter for the Democrats. Joanne. 

Kenen: There are two things that occurred to me. The KFF poll that came out this morning on how people feel about these subsidies. It was really striking at how many Republicans actually do blame the Democrats. So as long as Republicans don’t think it’s their lawmaker’s fault, and they’re willing to accept that this is all [Joe] Biden legacy, or [Barack] Obama legacy, or whatever one is not theirs, that also makes it easier politically. But also the math. If you’re in a really, really, really, really red district, and you have a 25% margin, and some of your voters lose their insurance and get mad at you, you still can win. Whereas [with] the swing voters, it’s a lot tougher. 

Rovner: And yet we saw Marjorie Taylor Greene [Republican representative from Georgia], who of course is now leaving Congress. 

Kenen: There’s a lot of other things going on with Marjorie Taylor Greene. 

Rovner: That’s true. There are. But this was the thing that she mentioned.  

So about that poll that came out this morning, I have some numbers. Seventy-two percent of Republicans, and 72% of self-described MAGA [Make America Great Again] supporters say they favor extending these additional tax credits. And more marketplace enrollees would blame President [Donald] Trump or Congressional Republicans if the additional subsidies expire than would blame Democrats, as Joanne just said. Is there any sign that folks are shifting as more people actually see how big these payment increases could be come January? I was on a call-in radio show earlier this week, and there was just a string of people from all kinds of different states with actual numbers of I’m paying $400 a month now, and it’s going up to $1,800 a month. At some point … even if, as you guys say, it’s only a minority of their voters, they’re going to have to respond to that. 

Kenen: In a House race, some of them can lose some voters. They want a big win. They want to be the less vulnerable, the better. But we also are so baked in that everybody blames everything on the other side. One of the problems has nothing to do with specifically this particular issue. It’s that health care costs keep rising, and insurance — including outside. My premiums are going up next year, and actually my employer — I’m at Hopkins — they’re paying the bulk of it. But the cost of insurance is going up quite a bit again, and again, and again. So there [are] other issues about affordability — which is with the word of the day, or the word of the year, or whatever, that remains to be seen — that there’s a whole lot of layers of why costs are going up. Obviously, this is an acute piece of it. People who are losing subsidy is a tax credit is a big piece of it. But the whole issue of even if you’re not in the ACA, you’re going to see higher costs. 

Rovner: And we’ll get to that in a second. But before we do, Paige, you wrote one of my other favorite stories of the last two weeks on why the Republican’s favorite alternative — giving money that’s now going directly to insurance companies to the consumers directly — instead might not be the best answer. Tell us about that. 

Winfield Cunningham: The HSA [health savings account] idea comes up over and over. You guys all probably recall that both the House and Senate reconciliation bills in 2017 would’ve increased the amount of money people can contribute. I actually was going to say, from what I’m hearing on the Hill, it seems most likely that the Senate and maybe the House Republicans are going to vote on that bill I wrote about in the story, the [Louisiana Republican Sen. Bill] Cassidy proposal, which would basically take those extra subsidies and dump them into these tax-free individual accounts, these HSAs. 

Rovner: HSAs stand for health savings accounts for those who don’t know. 

Winfield Cunningham: Health savings accounts. That’s right. And just on the politics of it, I was going to say, I think what they do — and I know it’s risky to predict anything on the Hill, so who knows? — but it’s seeming most likely right now that they vote on this bill to put the subsidies in the HSAs. It gives them something next year. They can say, We passed a health care bill. Democrats didn’t join us in it. And then they go on to blame Obamacare for ruining health care and spiking costs, and that’s on the politics of it. But on the policy of it, I think that Republicans always run into problems because, fundamentally, they are less willing than Democrats to spend money on health care. And so what they revert to is just, Oh, let people use their own money, tax-free, the way that they want to so that they can shop around for health care.” 

And in that way, you’re going to create incentives to lower costs, and people aren’t going to get unnecessary care. But the problem is that this is more of a little boost for people versus an overall solution for health care. Because if you don’t have the money to put into HSAs to begin with, then you’re not going to be able to afford the tens of thousands of dollars every year that you’re going to need if you develop cancer, or diabetes, or something like that. And then, of course, Republicans try to get their measure scored at the CBO [Congressional Budget Office]. And the CBO says, Guess what? Your bill’s actually going to result in fewer people having health coverage. And that doesn’t play politically very well either. But you see them returning to this again, because no one knows how to really solve the health care cost problem. And so Republicans return to their free-market solutions. But yeah, it’s more of a Band-Aid than anything else. But I wouldn’t be surprised if that’s what they end up voting on next week or the week after. 

Rovner: Well, and as Joanne previewed, it’s not just Affordable Care Act premiums that are going up. My colleague Phil Galewitz has a story this week about an average 12% premium increase for federal workers and retirees, which I will link to in the show notes. Medicare Part B premiums are also rising next year from $185 a month to nearly $203 a month, starting in January, with even bigger boosts for those who earn more than $109,000 per year and are subject to the income-based additional premiums. And as we reported in October, KFF’s annual employer survey finds average family premiums in the private sector rising an average of 6%. Is Congress and the administration missing the forest for the trees here, focusing on this fight about the ACA when the real problem is rising health spending and prices across the board? 

Ollstein: Well, part of Republicans’ argument against the subsidies is that the subsidies expiring is only a small sliver of the overall insurance affordability problem. Now, of course, it compounds the other problems. So, people are both seeing their base premiums rise, but they’re also being exposed to more of that cost. They’re less shielded from it because of the subsidies expiring. And so, these are things that augment each other and make it worse for a lot of people — like you said, including a lot of Republican voters. We saw huge increases in Obamacare enrollment in some of these Republican states that never expanded Medicaid, especially like Florida. 

Rovner: And Georgia and Texas. 

Ollstein: Yep. Yep. 

Rovner: Right. Well, speaking of Medicare, while we’re hearing a lot about the Affordable Care Act these days and how much federal money is being shoveled to big insurance companies, the administration this week also quietly changed some Medicare Advantage rules that will — let me check my notes here — quietly shovel more federal money to big insurance companies, many of the same ones that are getting the ACA money. This is something that’s gone on for years now. Republicans complain about overpaying for ACA, which was passed with only Democrat support, but not for Medicare Advantage, which was passed with mostly Republican support. Well, Democrats complain about overpaying for a Medicare Advantage, but not for the ACA. I can’t help but think that we’re not going to solve the health spending problem until both parties realize they’re being at least a little bit hypocritical here. 

Kenen: The Medicare Advantage overpayment. Medicare Advantage, its predecessor was Medicare Part C or whatever it was called in the ’90s, and then it was relaunched as part of the Medicare drug bill in 2003, and I think it went into effect in 2006. That provision may have been a year earlier, I don’t remember. But roughly 20 years ago. 

Rovner: Yeah, that sounds right. 

Kenen: And it was designed to create competition. And a lot of people like Medicare Advantage. That’s a choice people are making. 

Rovner: Yes, they like it because the federal government is overpaying for it, so they offer extra benefits. 

Kenen: But the idea was [to] create two layers of competition: an alternative to compete with traditional Medicare, and then competition within the Medicare Advantage market, these private insurance plan markets. But from the beginning, Medicare Advantage was created to save money. But just to spell this out, they’re paying more per patient to the private insurers who run these Medicare Advantage plans than they are to traditional Medicare. This has been going on for approximately 20 years, and there’s no sign that they’re going to stop it. They are, in fact, giving our tax dollars to private insurance to cover Medicare patients — with high satisfaction rates in many cases — but for more money than they would have if they were just in plain old vanilla Medicare, which itself is pretty expensive when you add up all the things that the consumer — the patient — has to pay. So no, if you were coming at this for the first time — which we are not, and most of our listeners probably are aware of this — but it’s pretty high on the What? list of American health care. 

Rovner: Yeah. In the meantime, let us turn to vaccines. As we are taping this morning, the Centers for Disease Control and Prevention’s Advisory Committee on Vaccine [Immunization] Practices is getting underway with its latest meeting. You may recall that Health and Human Services Secretary RFK Jr. [Robert F. Kennedy Jr.] fired all the vaccine experts on the panel and replaced them with anti-vaccine activists, and vaccine skeptics. This meeting includes a discussion of the hepatitis B vaccine, which is currently recommended to be given at birth and which has been shown to lower the incidence of chronic hepatitis B, which in turn can cause cancer, and other liver disease in adolescents by 99% since 1991. 

Vaccine opponents say there’s no point in giving a birth dose because hepatitis B is largely sexually transmitted, particularly if the mother’s already been tested and found negative. But those who back the vaccine say hepatitis B can also be spread through household contact, and its record of success is so strong, there’s no need to change it. Meanwhile, the panel’s also going to be looking at the entire childhood vaccine schedule writ large at this meeting. Right, Paige? 

Winfield Cunningham: Yeah. I was listening to some of the meeting this morning, and the members said that this is going to be a discussion of risks first versus benefits, which is true with any vaccine. But they had actually planned on voting on the hep B vaccine back in September, and then they said they needed to collect more data. And what I was struck by this morning is, there was this safety presentation by actually this anti-vaccine activist. And I didn’t get to watch all of it, but it sounds like they weren’t able to come up with any real evidence or examples of serious negative side effects for giving newborns this vaccine. And that’s what you hear over and over again when you talk to pediatricians and pediatric vaccine experts that they’ve administered thousands of these doses to newborns in the hospital. And it’s just a really, really safe vaccine. 

So later today, they’re supposed to vote on removing that recommendation to get the vaccine if the mother is negative. Although it’s maybe under what’s called shared clinical decision making, which is where they would recommend that it would be a conversation between the doctor and the patient. But I think the other thing that’s interesting is the whole argument for lightening this requirement is made from a very individual perspective. The Kennedy supporters have argued that this is a one-size-fits-all policy, and there’s this deep frustration that you should be recommended to get this vaccine if you’re negative for hep B, because it is highly unlikely that your baby would get the virus. But that’s just not how public health recommendations are made. They’re made by looking at, on the whole, what happens to infection rates if you institute this universal recommendation. And so that’s just not a perspective that I think a lot of members of this panel seem to be holding, at least from the discussion as it’s playing out today. 

We’ll see what happens later on today. But there was a lot of resistance by [H.] Cody Meissner, one of the panel members who voted against changing the vaccine recommendations for a couple other vaccines in September. He’s really been pushing back strongly against this suggestion that there’s any downside to giving newborns this vaccine. We’ll see how it plays out for the rest of the day. 

Kenen: And remember, it sort of gets lost in the conversation. It’s a recommendation. It’s not a requirement. There are families that opt out, or decide to wait. When you have an itsy-bitsy newborn, it is upsetting to parents. That’s part of the emotional underplaying here, that the first thing they experience is a shot. The recommendations are science-based, but parents can in fact either delay it, or not have it. So, the recommendation is because this protects a kid from a really bad disease. And that’s why the recommendation has been there. But it gets talked about as though it’s binding, and it is not binding. 

Rovner: And Paige, they’re going to talk about the rest of the childhood vaccine schedule also at this meeting, right? 

Winfield Cunningham: Yeah. Tomorrow they’re supposed to discuss broadly the schedule at large, and I’m sure the idea will come up that we have too many vaccines. I would note that the agenda was posted last night, and it prompted a stronger condemnation by Sen. Cassidy than we’ve ever seen before. Of course, he’s been the lone Republican who has called out Kennedy for some of these anti-vaccine views. And he wrote this morning that ACIP is totally discredited and not protecting children because Aaron Siri, who’s the top attorney for the anti-vax moment, apparently is going to be giving this two-hour presentation tomorrow to the panel. But I think Joanne makes a really strong point. I don’t know that practically there’s going to be a huge effect from them tweaking the recommendations today, but I think the bigger effect is that parents do have a very emotional response to vaccines. And when they hear that the recommendation was rolled back, if they already had some fears about giving their newborn a shot, this may stoke those fears. And that’s what a lot of experts are worried about. 

Kenen: And we’re just seeing more and more parents across the board opting out of vaccines. So this is one more, and they’re opting out of recommended vaccines. And again, these recommendations have been tested over and over again. These are not things that somebody just pulled out of the air yesterday. And that’s the fight. 

Rovner: So normally, ACIP recommendations go from the committee to the head of the CDC, who generally approves any changes that the committee recommends. But the CDC currently has no director after Susan Monarez was fired just before the last ACIP meeting for refusing to rubber-stamp the panel’s recommendations in advance. And the acting head of the CDC, Jim O’Neil, is neither a doctor nor a public health professional. He’s actually the HHS deputy secretary. Are we reaching a point where the CDC’s official recommendations are going to be ignored, or even refuted by the rest of the medical community? I see my mailbox is full of all of these briefings by the American Academy of Pediatrics and other agencies basically saying, You know what the CDC is saying right now? They’re wrong. Ive been doing this 40 years, and I have never seen anything quite like this before. 

Winfield Cunningham: Yeah, this is one of those things where there’s about 4,000% more people who want to talk to reporters about this than you even have time to talk to. But yeah, the American Academy of Pediatrics said this week that they’re going to maintain the current hep B recommendation regardless of what the panel does. And I think increasingly, when I talk to public health experts, they are just seeing CDC and ACIP as discredited and not legitimate. And I think the decision by the panel to invite some of the folks with anti-vax history to present both today and tomorrow is just going to heighten that criticism, and add fuel to the fire. 

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

So, we’ve talked about the vaccine news from the CDC, but there’s vaccine news from the Food and Drug Administration, too. Vinay Prasad, who was the top FDA vaccine regulator, then he wasn’t, then he was again, sent a memo on the day after Thanksgiving asserting, without full evidence, that the covid vaccine caused the deaths of at least 10 children, and that as a result, the agency will change the way it regulates vaccines. There’s not a lot of detail yet, but apparently the information comes from the FDA’s adverse event database, which anybody can file to without proof. It’s supposed to be an early warning system for possible vaccine side effects. 

So, doctors can put in reports, parents can put in reports if they see something that might need looking into. In response to this, 12 former FDA commissioners from both parties published an open letter in the New England Journal of Medicine pronouncing themselves, “Deeply concerned by sweeping new FDA assertions about vaccine safety and proposals that would undermine a regulatory model designed to ensure that vaccines are safe, effective, and available when the public needs them most.” The FDA regulates 25% of all products in the United States. At some point, aren’t the companies that it regulates going to stand up and say they can’t function if the FDA can’t function? I see frowning around the table. 

Kenen: Yes. People want products that are safe, right? Well, many people want products that are safe. Some people prefer to do their own research, as they say. But basically, medications, vaccines, over-the-counter products, even all sorts of stuff, it’s food and drugs. This is a regulatory agency that is supposed to protect us. What’s come out about these supposed 10 deaths? It’s not that these kids may not have died, but from what? That’s the question. Was it the vaccine? I am not a biostatistician, and none of us are, but there’s some really easy questions to ask. First of all, was it caused by the vaccine? Because VAERS [Vaccine Adverse Event Reporting System] is not reliable. You don’t know that’s really what caused the death. So, we don’t know much about why the FDA is saying these deaths were caused by the vaccine. 

But beyond that, 10 out of how many people had children [who] got the vaccine and it was safe — if it was even 10. And this whole thing I’m saying is: We don’t know how they’re defining the causation of those 10. How many lives were saved? How many kids, if there wasn’t vaccination, might have died? The whole sort of context of it, when you hear 10 dead kids, it’s scary. But they’re not in a vacuum. There [are] many questions about what does that number mean? 

Rovner: I’m really curious though. We were just talking about the CDC and how the American Academy of Pediatrics, and other public health groups are stepping up. The companies that are regulated by the FDA basically can’t be in business unless the FDA functions properly. I’m not seeing the kind of reaction that I would expect to see from those regulated companies. Maybe they’re afraid of getting punished by the FDA if they speak up? 

Winfield Cunningham: I don’t know. There’s a lot at stake here for them, obviously. I’m waiting on more details from the FDA about what this is going to mean. Talking to my colleagues who cover FDA more closely, it sounds like the thought is that this requirement for extra studies and evidence would apply to new drugs going forward. But my overall question, going at what Joanne said, is that the measurement of whether a vaccine should be recommended, did it cause any adverse events? Did fewer people die, or were harmed with the vaccine than without the vaccine? So let’s say hypothetically, maybe they’re right. What if the covid vaccine did cause 10 deaths? Even under that umbrella, you may not even have a strong case for rolling it back, because presumably, I don’t know how many deaths giving kids the covid vaccine prevented. I assume it’s more than 10. So if that basic way of evaluating the effectiveness of a vaccine is changes, that I think is going to be really significant. 

Rovner: And we do know that there are risks with vaccines. That’s why we have the vaccine compensation program that RFK Jr. is also trying to roll back, but there’s no news on that this week. I am curious. I’m seeing a lot of FDA reporters talking about this, and also about the continuing personnel carousel with people leaving and coming back, and leaving and coming back, and FDA not meeting its deadlines, and trying to basically oust career people. We’ve talked about Marty Makary at FDA and RFK wanting to maybe bring somebody in to try to right the ship. If the FDA truly falls apart, that would be a very bad thing, I would think, for everybody involved. 

Kenen: You’re right, Julie. We’re not seeing the industry pushback. We don’t know what’s being talked about, or planned, or done behind the scenes because we do live in a vituperative, retaliatory environment. I agree with the point you make: Where are they, and why aren’t we hearing from them? The FDA and the CDC have lost tons of people? It’s not just the people leaving and coming back. There are a lot of people just leaving, and many years of experience. Either they’ve been forced out, or some have just quit because they don’t feel like they can do their jobs. At the top leadership levels as well as rank and file, there’s just been a lot of tumult, and a loss of expertise. 

Rovner: And we will keep an eye on that. Finally this week, still more reproductive health news. The Supreme Court — remember the Supreme Court? — heard a case this week that made unlikely allies of pregnancy crisis centers, those anti-abortion agencies, and the American Civil Liberties Union. Alice, please explain. 

Ollstein: This was a case that was pretty narrow and wonky on the surface, but could have much broader implications. This is about [the] New Jersey attorney general’s attempt to obtain documents and investigate this chain of crisis pregnancy centers. These are faith-based, anti-abortion clinics. Some offer legitimate health services, some don’t. It’s a real variety around the country of these kinds of places. So, the New Jersey government was attempting to figure out if they were presenting misleading information both to their patients, and to their donors. And he was seeking the records of their donors. Now, the center wanted to challenge that investigation and stop it, and they wanted to do that in federal court, where they thought they would have a better chance than in state court. But this is drawing interest from groups like the ACLU [American Civil Liberties Union] and even a bunch of other progressive groups, because they say that upholding New Jersey’s ability to demand these documents could put all kinds of nonprofits around the country at risk, including those that are more progressive. 

There could be demands for their donors from red state governments. That was the concern there. And that did come up during the arguments. The ACLU and some of these progressive groups wrote amicus briefs. But I would say the point might be moot, because based on how the arguments went, it really does seem like the court is going to rule for the crisis pregnancy centers. And so those fears, in particular, might not be as immediate, although of course that opens up a whole other set of implications potentially for crisis pregnancy centers around the country and states’ ability to regulate them. 

Rovner: Yeah, we will see. Well, and there was lower federal court action this week, too. The on-again, off-again, on-again defunding of Planned Parenthood, at least in some states, is off again, right? What’s the latest on that? 

Ollstein: It’s not off again quite yet. There’s a window where the government can appeal — and probably will — and a higher court could step in and say, No, Planned Parenthood has to stay defunded. But this is one of several cases about this. So this one is coming from Democratic state attorneys general. There’s another one pending coming from Planned Parenthood and some of its affiliates. And so there’s just going to be ping-ponging back-and-forth in the courts for a while on this of whether the defunding that was passed this past summer is allowed to be upheld. Now, a bunch of states have put up their own money to backfill the lost money. They say that’s been a burden on them. They also say it’s a burden on the states to have to do the work of implementing the defunding, and ensure that no money goes to Planned Parenthood clinics. Again, this is for non-abortion services, things like STI [sexually transmitted infection] testing, contraception for Medicaid recipients. I expect this will continue to go back and forth for a while. But a point that I really wanted to make in my coverage of it is that even if Planned Parenthood prevails in the end, it’s too late for a lot of places. A lot of clinics have already shut down, and you can’t just reopen them at the drop of a hat even if the federal money is restored. 

Winfield Cunningham: The only thing I’d add on that is that on July 1, the ban actually ends because Congress only did a one-year ban. And it seems highly questionable at this point that Republicans are going to be able to get together enough votes to do another reconciliation bill, and pass another ban. So maybe it ends on July 1. Alice said there’s been irreparable harm to them in having to close a lot of clinics, but the issue could to some degree be moot in July. 

Rovner: Yeah. We saw this back in, I think it was 2016, when Texas put in an early version of an abortion ban that was ultimately struck down. But so many clinics had closed at that point that they just never did reopen. So sometimes it’s easier to cut off money than to restart it. All right. Well, on the let’s-have-more-babies beat, this week computer billionaire Michael Dell and his wife Susan announced they’re donating $6 billion to help seed those Trump accounts for newborns. Basically, the Dells will be providing $250 each to 25 million children in addition to the $1,000 that President Trump is proposing. 

But at the same time, my colleagues Stephanie Armour and Amanda Seitz have a story showing how the administration’s cuts to other programs that help care for moms and kids — including Medicaid, the Children’s Health Insurance Program, and Head Start — along with cuts to reproductive rights, like we were just talking about with Planned Parenthood, are doing more to deter women from having children than encouraging them to have more. Not to mention the increasingly out-of-reach costs for housing, food, and child care. This feels like a bit of an uphill battle here if the U.S. really wants to increase the birth rate, right? 

Ollstein: Well, we’ve also seen in other countries that these kinds of arguably quite small financial incentives don’t really move the needle. Giving birth alone, let alone raising a child for more than a decade, costs just an unbelievable amount of money, as the parents on this very panel can attest. 

Kenen: It doesn’t stop when you think it should either. 

Ollstein: And so even a few thousand dollars isn’t going to change a lot of minds on that front. It could make it easier for the people who already have decided to go ahead and have kids, but the experience of other countries that have piloted some of these programs have found that it doesn’t really make people want to have kids who are deciding not to. 

Rovner: Yeah. I think first they would like to be able to buy houses, many of them. All right, that is this week’s news. 

Kenen: Which is one of the costs as a parent that you end up helping with if you can, right? 

Winfield Cunningham: Or you just put three children in one bedroom for a while, as we did. We live in a bigger house now, though. 

Rovner: All right. That is this week’s news. Now we’ll play my interview with KFF Health News’ Aneri Pattani, and then we will come back and do our extra credits.  

I am pleased to welcome back to the podcast my KFF Health News colleague Aneri Pattani. Aneri has been tracking where those billions of dollars states are getting from the pharmaceutical industry for its culpability in the opioid crisis are going. Aneri, welcome back. 

Aneri Pattani: Thanks for having me. 

Rovner: So it’s been a while since we last had you on. Remind us how much money we’re talking about, how these settlements came to be, and what the money is supposed to be spent for. 

Pattani: Right. So we’re talking about more than $50 billion here. It’s a good chunk. And it’s coming from lots of different companies that either made or distributed opioid painkillers. Purdue Pharma is really well-known, but there’s also Johnson & Johnson, Walgreens, CVS, several others. Basically, thousands of states, and counties, and cities sued these companies for aggressively marketing the pills, and claiming that they were not addictive when we know they were. The companies basically settled, and now they’re going to be paying out for nearly two decades. Governments are supposed to take that money and basically use it to address the problem, right? Do things that fix the current addiction crisis, or prevent a future one from happening. 

Rovner: So is there anyone who’s supposed to be keeping track of where this money is going, and how it’s being spent? I covered the similar settlements from the tobacco industry in the late 1990s and early 2000s. And there were lots of stories about that money being used for things that were completely unrelated to getting people to stop using tobacco products, things like paving roads and whatnot. 

Pattani: Yeah. And essentially, no. There’s not an entity to track this money, either. People are always surprised when I tell them there’s no federal agency or national entity in charge of overseeing this opioid settlement money, or making sure that it’s spent correctly. There are some guidelines out there. There are some states that have their own efforts, but they tend to be kind of small. With the tobacco settlement, we saw the campaign for tobacco-free kids came in as this nonprofit to collect annual data and have some public information and accountability on the funds. And with the opioid settlement money, we essentially tried to replicate that. We teamed up with researchers at the Johns Hopkins Bloomberg School of Public Health, and Shatterproof, which is this national nonprofit that works on addiction issues. And we gather data and create databases to show the public how this money is being spent across the country. 

Rovner: So we are the database. Tell us about the database that we have built here at KFF Health News. 

Pattani: We just published our second database. We do this hopefully every year. So far, we’ve done it two years. And basically this year we had more than 10,500 examples of how states or cities or counties have spent this money. We get all the information from public records — either they’re already online, state budgets, we put in record requests — and then we categorize each of the expenditures into things like prevention, or treatment. And that way we can give the public a bird’s-eye view of how this money is being spent. 

Rovner: And just to be clear, these 10,000 are not necessarily inappropriate ways. This is how the money is being spent. 

Pattani: Exactly. They’re just anywhere that we can find an example of the money being used. We’re collecting it. It doesn’t mean it’s being used well. It doesn’t mean there’s research, or evidence to support it. It just means it’s being used. 

Rovner: So tell us about some of the things that you have found using the database. 

Pattani: I always want to start with the good news. And the good news is that lots of the money is going to stuff that addiction experts say is needed: treatment, housing for people with addiction, buying overdose reversal medications. But there’s also the not-so-great news, which is that there are spending examples that lots of people find questionable. There are two big buckets of those. The first is law enforcement gear. We saw money being spent on gun silencers, drones, police cruisers, where the folks who are making those decisions say, Well, police and law enforcement are the front lines of the addiction crisis. But you have a lot of folks saying, We already invest a lot in that. It hasn’t made a difference, and we need to be investing in medical and social services instead. Then you have my second questionable category, which is things aimed at preventing youth from developing addictions in the first place. 

So I think really well-intentioned a lot of times. But researchers have looked at some of these examples and said, It’s just not going to do what you think it is. So one Connecticut town threw a ’50s-style sock hop where they had kids and seniors take pledges to be drug-free. A West Virginia community hired a drug-awareness magician. And there’s just no evidence that that’s actually going to do anything. 

Rovner: But I bet it was entertaining. 

Pattani: It was entertaining to read about it, too. 

Rovner: So this money is obviously more important than ever in fighting addiction because of cuts to other government programs that were doing some of this work, right? 

Pattani: Absolutely. Medicaid is the biggest payer of addiction care in the country. With the cuts that are coming forth for that, a lot of people are anticipating having trouble getting treatment. And so there’s a real need, but the opioid settlement money is also not anywhere near enough to fill that gap. We talked about … it’s more than $50 billion, but spread over two decades. Medicaid paid $17 billion for addiction care in one year alone. So it’s not going to make the gap. And some people are worried that all the opioid settlement money will be poured into trying to fill up the federal gaps, leaving nothing for trying something new or being innovative. 

Rovner: So, some of this money is supposed to be used to compensate individuals who have been hurt by the opioid crisis. But that’s not always happening either, is it? 

Pattani: Unfortunately not. Most of the people who were personally harmed are not getting any money. The way a lot of these settlements worked out is that they were directly with states. And so there wasn’t really an avenue for individuals to get paid. The few settlements that can pay people are giving out small amounts. I talked to one guy in Maine. He had been prescribed painkillers, was addicted for then 10 years of these ups and downs. He was part of the Mallinckrodt settlement. He got a few hundred dollars from them. It wasn’t even enough for one month’s rent. Purdue Pharma, which just settled, is one of the bigger ones. Some individuals may get up to $16,000 from them. But you’re talking about $16,000, you take out the lawyer’s fees, you take out other things, it’s really minimal. And so I think that’s why people care so much about the money that the governments are getting, and how they use it, because that is the one opportunity to improve services, to improve the system of care. 

Rovner: What’s next for this project? 

Pattani: I am already filing public-records requests for how the money is being used for our next year of tracking. We will have another annual report out next year talking about how this money continues to be spent, and hopefully providing some accountability for where it’s going. 

Rovner: Aneri Pattani, thank you for staying on top of it. 

Pattani: Thank 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’ll put the links in our show notes on your phone, or other mobile device. Paige, why don’t you go first this week? 

Winfield Cunningham: I was struck by a story that is quite personal to me because I have an 11-year-old, and it is called “A Smartphone Before Age 12 Could Carry Health Risks, Study Says” at The New York Times by Catherine Pearson. She addresses this question that I think a lot of parents have, which is what is the correct age for kids to get a smartphone? She cites this study published this week that showed … there was a correlation between having a cell phone by age 12 and having higher risk of depression, obesity, and insufficient sleep. And it seems like this is piled onto the mounting pile of evidence that giving your kid a smartphone has a lot of negative drawbacks. 

The thing my husband and I have been talking about is: A lot of parents, they know the negative effects of phones, but they start feeling a lot of pressure from other parents. Because if other kids at their school have the smartphone, then their kid is feeling left out of things. So, I really feel like for things to change, parents and schools are going to have to band together, and recognize that this is having a real toll on kids. And we’ve already seen some schools — I know at least in northern Virginia — have instituted a no-cell-phones policy. And I just have to think that that’s probably going to have long-lasting health benefits. I thought this was a really important article for discussing that. 

Rovner: Yeah, I did, too. Joanne. 

Kenen: This is from Emily Mullen in Wired: “A Fentanyl Vaccine Is About To Get Its First Major Test,” So it’s still quite preliminary. There are some scientific questions … that they still have to establish that it’s safe and effective. … Yes, it’s a vaccine, which as we’ve been talking about, is a whole other issue. So first of all, if it works in these trials, and it doesn’t interfere with painkillers, or anesthesiology, or things like that of people who may need that, there are a lot of questions about who gets it, and when. It’s going to be a whole bioethics debate, and a political debate. And there’s a debate over harm reduction, per se, but it’s actually really an interesting scientific tool that even if we fight about if it does work — and this is a trial to see — could be another tool in saving lives if we can ever agree on all the fighting about who would get it and when. But it’s interesting. 

Rovner: And get it through ACIP. 

Kenen: Right. It wouldn’t be for kids. It would be for — 

Rovner: For adults. 

Kenen: It could be for teens, I suppose. But it’s an interesting scientific development with potential. If we can stop the fighting, it could save lives. 

Rovner: Alice. 

Ollstein: I have a pretty harrowing story from The Independent by Kelly Rissman [“Miscarriages, Infections, Neglect: The Pregnant Women Detained by ICE”]. It is about the rise in detentions of pregnant women for immigration violations. And reports from attorneys and human rights groups of really abysmal conditions that women are being held in that in some cases they’ve documented have caused miscarriages. People are not getting adequate food. They’re being kept in very cold, or very hot conditions. They’re not being given access to medical care when requested, and/or they’re being subject to medical exams that they don’t consent to. They’re not being provided translators, so they don’t know what’s going on. Really scary stuff. And something I thought the article should have mentioned, but didn’t, is that ICE [Immigration and Customs Enforcement] has dismantled some of its own internal oversight offices that maybe would’ve looked into and addressed some of this stuff in the past. So I think there’s an ongoing lawsuit over those oversight bodies. That’s one place to pay attention to on this unfolding story. 

Rovner: Well, I have actually a little bit of good news for a change from the reproductive health realm. It’s from our former podcast panelist Sarah Cliff, along with Bianca Pillaro at The New York Times, and it’s called “These Hospitals Figured Out How To Slash C-Section Rates.” It’s about just that: how some hospitals are bucking the trend of rising surgical baby deliveries with some deceptively small changes, including using more midwives, changing financial incentives to deliver via C-section, and reminding doctors and nurses that labor often takes longer for first time moms. It’s one of those relatively small but ultimately really important cultural shifts that can make health care both safer and cheaper. See? There are people working to make the system better.  

All right, that is this week’s show. Thanks as always to our editor, Emmarie Huetteman, and our producer engineer, Francis Yang. 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, at 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? Alice? 

Ollstein: I’m mostly on BlueSky @alicemiranda, and also on X @AliceOllstein. 

Rovner: Joanne. 

Kenen: I’m on X @Joanne Kenen. And I’m using LinkedIn. more, also @JoanneKenen. 

Rovner: Paige. 

Winfield Cunningham: I’m on X @PW_Cunningham, and I’m also on BlueSky @Paige Cunningham. 

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

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