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. 

Credits

Click here to find all our podcasts.

And subscribe to “What the Health? From KFF Health News” on Apple Podcasts, Spotify, the NPR app, YouTube, Pocket Casts, or wherever you listen to podcasts.

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).

Yet anti-abortion activists remain frustrated, in some cases even more so than before Roe was overturned.

Why? Because despite the new legal restrictions, abortions have not stopped taking place, not even in states with complete bans. In fact, the number of abortions has not dropped at all, according to the latest statistics.

“Indeed, abortions have tragically increased in Louisiana and other pro-life states,” Liz Murrill, Louisiana’s attorney general, said at a Senate Health, Education, Labor, and Pensions Committee hearing this month.

That’s due in large part to the easier availability of medication abortion, which uses a combination of the drugs mifepristone and misoprostol, and particularly to the pills’ availability via mail after a telehealth visit with a licensed health professional.

Allowing telehealth access was a major change originally made on a temporary basis during the covid pandemic, when visits to a doctor’s office were largely unavailable. Before that, unlike most medications, mifepristone could be dispensed only directly, and only by a medical professional individually certified by the Food and Drug Administration.

The Biden administration later permanently eliminated the requirement for an in-person visit — a change the second Trump administration has not undone.

While the percentage of abortions using medication had been growing every year since 2000, when the FDA first approved mifepristone for pregnancy termination, the Biden administration’s decision to drop the in-person dispensing requirement supercharged its use. More than 60% of all abortions were done using medication rather than a procedure in 2023, the most recent year for which statistics are available. More than a quarter of all abortions that year were managed via telehealth.

Separately, President Donald Trump’s FDA in October approved a second generic version of mifepristone, angering abortion opponents. FDA officials said at the time that they had no choice — that as long as the original drug remains approved, federal law requires them to OK copies that are “bioequivalent” to the approved drug.

It’s clear that reining in, if not canceling, the approval of pregnancy-terminating medication is a top priority for abortion opponents. This month, Susan B. Anthony Pro-Life America called abortion drugs “America’s New Public Health Crisis,” referencing their growing use in ending pregnancies as well as claims of safety concerns — such as the risk a woman could be given the drugs unknowingly or suffer serious complications. Decades of research and experience show medication abortion is safe and complications are rare.

Another group, Students for Life, has been trying to make the case that the biological waste from the use of mifepristone is contaminating the nation’s water supply, though environmental scientists refute that claim.

Yet the groups are most frustrated not with supporters of abortion rights but with the Trump administration. The object of most of their ire is the FDA, which they say is dragging its feet on a promised review of the abortion pill and the Biden administration’s loosened requirements around its availability.

President Joe Biden’s covid-era policy allowing abortion drugs to be sent via mail ”should’ve been rescinded on day one of the administration,” SBA Pro-Life America’s president, Marjorie Dannenfelser, said in a recent statement. Instead, almost a year later, she continued, “pro-life states are being completely undermined in their ability to enforce the laws that they passed.”

Lawmakers who oppose abortion access are also pressing the administration. “At an absolute minimum, the previous in-person safeguards must be restored immediately,” Senate HELP Committee Chairman Bill Cassidy said during the hearing with Murrill and other witnesses who want to see abortion pill availability curtailed.

Sen. Jim Banks (R-Ind.) said at the hearing that he hoped “the rumors are false” that “the agency is intentionally slow-walking its study on mifepristone’s health risks.”

The White House and spokespeople at the Department of Health and Human Services have denied the review is being purposely delayed.

“The FDA’s scientific review process is thorough and takes the time necessary to ensure decisions are grounded in gold-standard science,” HHS spokesperson Emily Hilliard said in an emailed response to KFF Health News. “Dr. Makary is upholding that standard as part of the Department’s commitment to rigorous, evidence-based review.” That’s a reference to Marty Makary, the FDA commissioner.

Revoking abortion pill access may not be as easy as advocates hoped when Trump moved back into the White House. While the president delivered on many of the goals of his anti-abortion backers during his first term, especially the confirmation of Supreme Court justices who made overturning Roe possible, he has been far less doctrinaire in his second go-round.

Earlier this month, Trump unnerved some of his supporters by advising House Republicans that lawmakers “have to be a little flexible” on the Hyde Amendment to appeal to voters, referring to a decades-old appropriations rule that bans most federal abortion funding and that some Republicans have been pushing to enforce more broadly.

And while the anniversary of Trump’s inauguration has many analysts noting how much of the Heritage Foundation’s Project 2025 blueprint has been realized, the most headline-grabbing portions on reproductive health have yet to be enacted. The Trump administration has not, for example, revoked the approval of mifepristone for pregnancy termination, nor has it invoked the 1873 Comstock Act, which could effectively ban abortion nationwide by stopping not just the mailing of abortion pills but also anything else used in providing abortions.

Still, abortion opponents have decades of practice at remaining hopeful — and playing a long game.

HealthBent, a regular feature of KFF Health News, offers insight into and analysis of policies and politics from KFF Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

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).

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. 

Credits

Click here to find all our podcasts.

And subscribe to “What the Health? From KFF Health News” on Apple Podcasts, Spotify, the NPR app, YouTube, Pocket Casts, or wherever you listen to podcasts.

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).

Now, though, it seems unlikely to become state law. In November, a vote to advance the bill beyond a legislative subcommittee failed. Four out of six Republicans on the Senate Medical Affairs Committee subpanel refused to vote on the measure.

Republican state Sen. Jeff Zell said during a November subcommittee hearing that he wanted to help “move this pro-life football down the field and to save as many babies as we can.” Still, he could not support the bill as written.

“What I am interested in is speaking on behalf of the South Carolinian,” he said, “and they’re not interested in this bill right now or this issue right now.”

While that bill stalled, it signals that abortion will continue to loom large during 2026 legislative sessions. More than three years after the Supreme Court overturned Roe v. Wade, measures related to abortion have already been prefiled in several states, including Alabama, Arizona, Florida, Missouri, and Virginia.

Meanwhile, the South Carolina bill also exposed a rift among Republicans. Some GOP lawmakers are eager to appeal to their most conservative supporters by pursuing more restrictive abortion laws, despite the lack of support for such measures among most voters.

Until recently, the idea of charging women who obtain abortions with a crime was considered “politically toxic,” said Steven Greene, a political science professor at North Carolina State University.

Yet at least 15 states introduced “abortion as homicide” bills during 2024-2025 legislative sessions, many of which included the death penalty as a potential sentence, according to Dana Sussman, senior vice president of Pregnancy Justice, an organization that tracks the criminalization of pregnancy outcomes.

Even though none of those bills was signed into law, Sussman called this “a hugely alarming trend.”

“My fear is that one of these will end up passing,” she said.

Less than a month after the bill stalled in South Carolina, another bill — which would create criminal penalties for “coercion to obtain an abortion” — was prefiled ahead of the Jan. 13 start of the state’s legislative session.

“The issue is not going away. It’s a moral issue,” said state Sen. Richard Cash, who introduced the abortion bill that stalled in the subcommittee. “How far we can go, and what successes we can have, remain to be seen.”

‘Wrongful Death’

Florida law already bans abortion after six weeks of pregnancy. But a Republican lawmaker introduced a bill in October proposing civil liability for the “wrongful death” of a fetus. If enacted, the measure will allow parents to sue for the death of an unborn child, making them eligible for compensation, including damages for mental pain and suffering.

The bill says neither the mother nor a medical provider giving “lawful” care could be sued. But anyone else deemed to have acted with “negligence,” including someone who helps procure abortion-inducing pills or a doctor who performs an abortion after six weeks, could be sued by one of the parents.

In Missouri, a constitutional amendment to legalize abortion passed in 2024 with 51.6% of the vote. In 2026, state lawmakers are asking voters to repeal the amendment they just passed. A new proposed amendment would effectively reinstate the state’s ban on most abortions, with new exceptions for cases of rape, incest, and medical emergencies.

“I think that’s a middle-of-the-road, common sense proposal that most Missourians will agree with,” said Ed Lewis, a Republican state representative who sponsored the legislation to put the measure on the ballot.

Lewis said the 2024 amendment went too far in allowing a legal basis to challenge all of Missouri’s abortion restrictions, sometimes called “targeted regulation of abortion providers,” or TRAP, laws. Even before Missouri’s outright ban, the number of abortions recorded in the state had dropped from 5,772 in 2011 to 150 in 2021.

Meanwhile, Lewis backed another proposed constitutional amendment that will appear on the 2026 ballot. That measure would make it harder for Missourians to amend the state constitution, by requiring any amendment to receive a majority of votes in each congressional district.

One analysis suggested as few as 5% of voters could defeat any ballot measure under the proposal. Lewis dismissed the analysis as a “Democratic talking point.”

‘Gerrymandered’ Districts

Republican lawmakers aren’t necessarily aiming to pass abortion laws that appeal to the broadest swath of voters in their states.

Polling conducted ahead of Missouri’s vote in 2024 showed 52% of the state’s likely voters supported the constitutional amendment to protect access to abortion, a narrow majority that was consistent with the final vote.

In Texas, state law offers no exceptions for abortion in cases of rape or incest, even though a 2025 survey found 83% of Texans believe the procedure should be legal under those conditions.

In South Carolina, a 2024 poll found only 31% of respondents supported the state’s existing six-week abortion ban, which prohibits the procedure in most cases after fetal cardiac activity can be detected.

But Republicans hold supermajorities in the South Carolina General Assembly, and some continue to push for a near-total abortion ban even though such a law would probably be broadly unpopular. That’s because district lines have been drawn in such a way that politicians are more likely to be ousted by a more conservative member of their own party in a primary than defeated by a Democrat in a general election, said Scott Huffmon, director of the Center for Public Opinion & Policy Research at Winthrop University.

The South Carolina legislature is “so gerrymandered that more than half of the seats in both chambers were uncontested in the last general election. Whoever wins the primary wins the seat,” Huffmon said. “The best way to win the primary — or, better yet, prevent a primary challenge at all — is to run to the far right and embrace the policies of the most conservative people in the district.”

That’s what some proposals, including the “abortion as homicide” bills, reflect, said Greene, the North Carolina State professor. Lawmakers could vote for such a measure and suffer “very minimal, if any,” political backlash, he said.

“Most of the politicians passing these laws are more concerned with making the base happy than with actually dramatically reducing the number of abortions that take place within their jurisdiction,” Greene said.

Yet the number of abortions performed in South Carolina has dropped dramatically — by 63% from 2023 to 2024, when the state enacted the existing ban, according to data published by the state’s Department of Public Health.

Kimya Forouzan, a policy adviser with the Guttmacher Institute, which tracks abortion legislation throughout the country and advocates for reproductive rights, said South Carolina’s attempt to pass “the most extreme bill that we have seen” is “part of a pattern.”

“I think the push for anti-abortion legislation exists throughout the country,” she said. “There are a lot of battles that are brewing.”

KFF Health News correspondent Daniel Chang and Southern bureau chief Sabriya Rice contributed to this report.

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).

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.

Credits

Click here to find all our podcasts.

And subscribe to “What the Health? From KFF Health News” on Apple Podcasts, Spotify, the NPR app, YouTube, Pocket Casts, or wherever you listen to podcasts.

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).

But the hospital started restricting certain birth control options and fertility treatments based on its affiliation with the Roman Catholic Church, she said. At the same time, her unit was increasingly short-staffed as other obstetricians left and retired.

At one point, Quinn said, she was seeing up to 50 patients a day.

“That is twice what a normal OB-GYN will see in a day,” she said. “I knew I was going to miss something, because there’s no way somebody can function at that level.”

In spring 2024, Quinn decided to leave — not just Mason City, but Iowa entirely.

At the time, the state Supreme Court was on the verge of approving a law banning abortion as early as six weeks of pregnancy, with very few exceptions.

It was the last straw for Quinn, who got a job in Minnesota and moved her family there. Minnesota has constitutional protections for abortion.

“I could either stay and ruin myself and my career and my mental health and my relationship with my children, or I could go and continue to practice OB, which had always been my dream,” she said.

A few months after Quinn moved away, Iowa’s abortion ban went into effect on July 29, 2024.

A Severe Shortage

After the Supreme Court overturned Roe v. Wade in 2022, multiple states, including Iowa, enacted abortion bans.

Coupled with existing OB-GYN shortages, the laws have put doctors under increasing strain and surveillance, complicating the standard medical treatments for miscarriage, ectopic pregnancy, premature membrane rupture, and other pregnancy problems. Some physicians fear these laws could drive these much-needed doctors from certain states and dissuade other OB-GYNs from moving in and establishing a practice.

Iowa has the lowest number of OB-GYNs per capita among states, according to a KFF analysis of 2021-22 federal data from the Health Resources and Services Administration.

Studies show that insufficient maternity care is linked to low birthweight and increased infant and maternal mortality.

Stress on Those Who Remain

Rural hospitals in Iowa have been struggling to find more OB-GYNs.

The Grinnell Regional Medical Center, a 49-bed hospital in a rural college town, has been trying to recruit an OB-GYN, and a family practice doctor with obstetrical training, for more than a year.

The hospital has seen a dramatic jump in deliveries after a neighboring hospital shuttered its labor and delivery unit in 2024. The additional deliveries have been stressful for its two existing obstetrical-unit doctors, said David-Paul Cavazos, an executive with the center.

Back when patient volume was lower, it was easier for doctors to be on call over the weekend, he explained.

“You just kind of had to hang out at home, be by the phone,” he said. But recently, the on-call doctors have been delivering “five babies on Saturday, six babies on Sunday,” Cavazos said. “It becomes more stressful.”

An Iowa law enacted last May increased Medicaid reimbursement rates for maternity care, so OB-GYNs could be paid more for caring for pregnant patients. The new law also directs federal funding toward a project to set up additional medical residency slots, including OB-GYN residency slots, in the state. Medical residents tend to stay and establish practices in states where they complete their residency.

These things could help, said Karla Solheim, chair of the Iowa section of the American College of Obstetricians and Gynecologists. But the state’s abortion restrictions are still a red flag for some OB-GYNs when deciding whether to practice in Iowa, she said.

“They understandably do not want to put their licenses and their livelihood at risk when it comes to taking care of patients,” Solheim said.

At her previous job in Quad Cities, Solheim performed an abortion on a patient who had life-threatening complications, she said. It spurred many phone calls from hospital administrators.

They peppered her with questions about her decision, Solheim recalled. “Did I have enough evidence? Was her blood count low enough that her life was in danger? Should we have waited until her blood pressure got lower?”

Solheim recently stopped delivering babies to focus on gynecology and outpatient care, saying she had become exhausted working in Iowa hospital units that didn’t have enough obstetricians.

Recent data on residency applications shows that state abortion bans may be influencing the next generation of doctors.

Fewer medical students are applying to OB-GYN residency programs in states that restrict or ban abortion, according to a data analysis from the Association of American Medical Colleges.

For E., a fourth-year medical student in Iowa, the law weighs heavily on her decision of where to apply for OB-GYN residency, and, ultimately, practice. She worries about how Iowa’s law will affect her ability to practice evidence-based care.

E. is her middle initial — KFF Health News and NPR are identifying her that way to prevent her comments from jeopardizing future job opportunities.

“I’m seriously questioning whether Iowa is a state that I want to practice in, in the long term, and it breaks my heart because I know that there is such a need,” she said.

A Mixed Picture

It’s still unclear whether abortion bans are driving doctors out of state.

One recent study in Idaho found that two years after the state enacted its highly restrictive abortion law, 35% of the state’s 268 OB-GYNs had stopped practicing obstetrics.

But another study, analyzing federal data two years after the 2022 Dobbs decision, failed to find significant departures of OB-GYNs from states with abortion bans.

“We were surprised, and we cut the data in every possible way that we could,” said Becky Staiger, an assistant professor at the University of California-Berkeley’s School of Public Health, and the study’s lead author.

While numbers don’t show a systemic exit, it’s possible some OB-GYNs are adapting how they practice so they can stay with their patients, she said.

“We’ve heard anecdotally, and through qualitative research, that they’re really highly committed to those patients,” Staiger said.

She said the analysis also doesn’t capture how OB-GYNs feel about working in states with abortion restrictions.

“What we can’t observe is anything about the quality of care that the providers are able to provide, about provider satisfaction with job, about provider safety,” Staiger said.

This article is from a partnership with Iowa Public Radio and NPR.

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 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. 

Credits

Click here to find all our podcasts.

And subscribe to “What the Health? From KFF Health News” on Apple Podcasts, Spotify, the NPR app, YouTube, Pocket Casts, or wherever you listen to podcasts.

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).

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

Click here to find all our podcasts.

And subscribe to “What the Health? From KFF Health News” on Apple Podcasts, Spotify, the NPR app, YouTube, Pocket Casts, or wherever you listen to podcasts.

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).

Republicans remain divided over how to address the impending expiration of more generous Affordable Care Act plan tax credits, which will send premiums spiraling for millions of Americans starting in January if no further action is taken. The Trump administration floated a proposal over the weekend that included a two-year extension of the credits as well as some restrictions pushed by Republicans, but the plan was met with strong pushback on Capitol Hill and its unveiling was delayed. 

Meanwhile, the Department of Education has declared that a long list of health careers are not “professions,” meaning that students pursuing those tracks — including as nurses, physical therapists, and physician assistants — will no longer be eligible for federal student loans large enough to cover their tuition. 

This week’s panelists are Julie Rovner of KFF Health News, Sarah Karlin-Smith of the Pink Sheet, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call.

Panelists

Among the takeaways from this week’s episode:

• The news of Trump’s health care plan landed as Sen. Bill Cassidy of Louisiana was working on a separate GOP proposal to direct money into health savings accounts. Congressional Republicans suggested they were left out of Trump’s planning and, among other things, opposed his proposed extension of limited ACA premium tax credits.
• Health and Human Services Secretary Robert F. Kennedy Jr. has confirmed that he ordered the change to the Centers for Disease Control and Prevention website to assert the false claim that vaccines may cause autism. That development puts Republicans in a tough spot — particularly Cassidy, a physician who voted for Kennedy’s confirmation after saying he’d secured an agreement that Kennedy would not make changes to the CDC’s vaccine policy.
• Three states have revived the lawsuit challenging the approval of mifepristone, adding to the case the FDA’s recent approval of another generic version. The Supreme Court threw out the first case, ruling then that the plaintiffs — who were doctors — lacked standing to prove harm. Yet the revived case may very well end up at the Supreme Court again.

Also this week, Rovner interviews Joanne Kenen and Joshua Sharfstein of the Johns Hopkins Bloomberg School of Public Health about their new book, Information Sick: How Journalism’s Decline and Misinformation’s Rise Are Harming Our Health — And What We Can Do About It.

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 Yorker’s “A Battle With My Blood,” by Tatiana Schlossberg.  

Alice Miranda Ollstein: CNBC’s “Meta Halted Research Suggesting Social Media Harm, Court Filing Alleges,” by Jonathan Vanian.  

Sarah Karlin-Smith: The Guardian’s “Influencers Made Millions Pushing ‘Wild’ Births — Now the Free Birth Society Is Linked To Baby Deaths Around the World,” by Sirin Kale and Lucy Osborne.  

Sandhya Raman: KFF Health News’ “Kids and Teens Go Full Throttle for E-Bikes as Federal Oversight Stalls,” by Kate Ruder.  

Also mentioned in this week’s podcast:

• The Center for Law and Social Policy’s “Tracking the Harm of DOGE Cuts.” 
• The New York Times’ “Kennedy Says He Told C.D.C. To Change Website’s Language on Autism and Vaccines,” by Sheryl Gay Stolberg.
• The Atlantic’s “RFK Jr.’s Miasma Theory of Health Is Spreading,” by Katherine J. Wu.
•  NPR’s “‘Nobody Wants To Come’: What If the U.S. Can No Longer Attract Immigrant Physicians,” by Yuki Noguchi.
•  Campaign for Accountability’s “AI Chatbots Point Women to Unproven and Unethical ‘Abortion Pill Reversal,’ Report Shows.”

[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 early this Thanksgiving week on Tuesday, Nov. 25, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

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

Alice Miranda Ollstein: Hello. 

Rovner: Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Good morning. 

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

Karlin-Smith: Hi, everybody. 

Rovner: Later in this episode, we’ll have my interview with What the Health? panelist Joanne Kenen and Dr. Joshua Sharfstein, both of the Johns Hopkins Bloomberg School of Public Health, about their new book called Information Sick: How Journalism’s Decline and Misinformation’s Rise Are Harming Our Health and What We Can Do About It. 

But first, this week’ news. So, for about 24 hours there, it looked like we might have an actual health care plan from President Donald Trump, but, alas, it was not to be. What we all heard about on Sunday felt like a plan with a lot of pieces that could actually be palatable to a lot of Democrats. A two-year extension of the covid-era enhanced tax credits with an income cap higher than the 400% that subsidies are about to revert to, and minimum premiums for those paying zero now. And, not surprisingly, or maybe surprisingly, Republicans on Capitol Hill, particularly those in the House who had been adamant about no extension of the premium subsidies, freaked out, to use a technical term. And now the announcement of the Trump plan has been “delayed.” But there is a deadline this time, Jan. 1, when the enhanced tax credits expire — and, before that, the second week of December, when the Senate is supposed to vote on a subsidy extension. That was the deal that got the government reopened. So where are the Republicans at this point? 

Ollstein: It’s a total mess. Very few people have confidence that this will get done at all or in time to make a difference for the cost of people’s health care that has already gone up. So, House Republicans were, one, upset just process-wise. They didn’t like finding out that Trump was going to release a plan from news reports and social media. They felt left out of the loop. 

Rovner: On a Sunday? 

Ollstein: Congress has been left out of the loop on a lot of things in this administration, and this is yet another one. But they were also opposed to the substance of what was leaked. The few details they have, we still haven’t seen what this actual plan is, but they didn’t like that it was a two-year extension, even with these limitations that conservatives had wanted in terms of cutting off people of higher incomes from getting subsidies and requiring everyone to pay a minimum premium, which research shows will lead to a lot of people losing their insurance. And so even with those limitations, there were a lot of people upset. Meanwhile, on the Democratic side, yes, you had some people being cautiously optimistic about this plan, but then you had other Democratic ranking members in the House on the relevant health committees put out a statement saying, Anything short of a clean extension, without these conservative limitations, anything short of that was unacceptable. And so you really have both sides digging in, and I don’t really see how this gets solved. 

Rovner [laughing]: Sandhya, what are you hearing? 

Raman: I was going to say that in addition to the House being blindsided, I think it puts the Senate in an awkward position. Senate Republicans, they have been gearing up on an HSA [health savings account] proposal as kind of their alternative to extending the premium subsidies. And Sen. Bill Cassidy [R-La.] has said that he wants to do a hearing the week they come back from Thanksgiving to follow up on the [Senate] Finance [Committee] hearing, and this kind of pushes them in a totally different direction after just a few days ago, Trump himself had said, We don’t want to pay the insurance companies, we want the money to go to the consumers directly, kind of in line with one of the HSA proposals going around. So it caused a lot of confusion, and I think it just really further underscores … I don’t think a lot of people are confident this comes together. 

Dec. 15 is when open enrollment ends, and I think that even if you look at some of the bipartisan stuff that has been floated before — even last week we had another one come out that was a little similar to the stuff being floated on Sunday that would extend open enrollment more to give them a little bit more time. But one thing that we kept hearing yesterday was just even the changes that were being floated yesterday, why they weren’t being supported by people that do want an extension is there’s such a short time crunch to implement these changes in basically a month. 

Rovner: And now Republicans are talking about doing a whole new health bill, maybe using budget reconciliation so they won’t need Democratic votes. And I guess I’m the one that’s going to have to remind them that the ACA [Affordable Care Act] didn’t pass under reconciliation because there were a whole lot of things in it that they couldn’t put in a budget reconciliation bill. They used budget reconciliation to basically cut a deal between the House and the Senate after the Senate lost its 60th vote. But the original ACA passed with 60 votes. So if the Republicans think they’re going to do something really big next year with just Republican votes, they’re going to find out fairly quickly that a lot of that is not going to be allowed. 

Ollstein: Just in time, as our Twitter friend says. 

Rovner: Somebody pointed out that it’s been 10 years since Trump said he would have a health plan sometime in the next two weeks. Although as I say, this time two weeks is really going to be important. I feel like poor Sen. Cassidy, who we will talk about later with RFK [Robert F. Kennedy Jr.], also kind of got cut off at the knees by the president because he was all over the Sunday shows talking about his plan to give the money to consumers, which is what President Trump had been endorsing until he wasn’t. So we have no idea where the administration is at this point, right? 

Ollstein: And I will say, something that in part led to the postponement and backlash and chaos this week is that folks on Capitol Hill, Republicans and Democrats, have no idea what the White House is going to do about this abortion issue that has been roiling — this whole debate where conservatives are saying that it’s a red line, they have to basically ban all plans on the individual market from covering abortion. Right now, it’s up to states: Half ban them, half don’t. Some require them, some allow them but don’t require them. And conservatives are demanding that there be sort of a blanket ban on that coverage, that any federal funding going to these plans, even if they pay for abortion with other money, they consider that a subsidization. And this has been a real sticking point. Democrats say they won’t accept any expansion of abortion restrictions in Obamacare; Republicans say they won’t accept anything without the additional restrictions, and we still don’t know where the White House is going to come down on this. 

Rovner: Because, as I like to say every week, health care is really hard. All right. In big news that’s kind of lost already, Reuters is reporting that the White House has terminated DOGE, the Department of Government Efficiency, eight months early. In practice, DOGE has been dormant for many months, even before the departure of Elon Musk back to his day jobs at Tesla and SpaceX. But DOGE has left behind a lot of cuts. The nonprofit Center for Law and Social Policy has a tracker of all the funding and personnel changes made by the administration down to the program level, including at HHS [the Department of Health and Human Services]. I will post a link to it in the show notes. 

But if you want a more personal look, you should go read my extra credit this week, which we can all talk about now. It’s an achingly beautiful New Yorker piece by Tatiana Schlossberg, daughter of Caroline Kennedy and granddaughter of JFK [President John F. Kennedy]. Tatiana, an environmental journalist and mother of two young children, is dying of a rare and difficult-to-treat form of leukemia. Among other things, she was undergoing rounds of ultimately unsuccessful treatment while watching huge cuts to health care research being made at the direction of her cousin RFK Jr., all the while realizing how those cuts will likely threaten the survival of patients like her. I heard a lot about this story over the weekend, and I wonder if it might have some impact reaching the public about what the HHS cuts are likely to mean going forward in a way that just the numbers being repeated haven’t. 

Karlin-Smith: I think, I mean, it’s such a human connection story, and when she talks about not probably being able to live to see her kids grow up and the kind of research NIH [the National Institutes of Health] was funding that maybe would’ve given her a little bit of hope with a clinical trial that was working. One thing I thought about a lot reading this is she talks about how she’s, I guess, 34 or 35, she felt like she was young and healthy, she was very active, ate right. And one of RFK’s way of thinking, I guess, in the way of orchestrating his health goals is this idea that if you eat right and you exercise and you take certain personal responsibilities, you can avoid illness. And there are lots of kinds of illnesses that, unfortunately, you can do the best you possibly can on an individual personal level and you are not unfortunately exempt from getting, and cancers are one of them. And it’s not to say that there cannot be any role for those other things that can maybe help keep you healthy and prevent certain diseases, but it’s interesting to think about her realization around what can happen to you even if you’re trying your best to live a healthy lifestyle, and the juxtaposition of an administration that is, and their policies also, forgetting that this is not just based on what you eat and how often you exercise and so forth. 

Rovner: To quote President Trump, who was talking about something else entirely, “Things happen.” It goes back to the ACA discussion. People who are young and healthy and think they don’t need health insurance because nothing bad is going to happen to them, and a certain number of people … bad things are going to happen no matter how exemplary healthily they live their lives. That’s why we have health insurance. Well, meanwhile, over at HHS, Secretary Kennedy over the weekend confirmed to The New York Times that he was personally responsible for the website changes at the Centers for Disease Control and Prevention that now say scientists “have not ruled out the possibility that infant vaccines cause autism.” Just a reminder, this was a change that Kennedy had promised HELP [Health, Education, Labor & Pensions] Committee chair and gastroenterologist Bill Cassidy he would not make in exchange for Cassidy’s vote to confirm him in the Senate. Yet Cassidy still demurred when asked on the Sunday shows if he regrets being the deciding vote to make Kennedy the secretary. I’m wondering if Cassidy is the new Susan Collins, the main moderate, who continually said during Trump’s first term that she was very, very concerned about many of the president’s policies, but still declined to vote against most of them. Has Cassidy kind of replaced her in that role? 

Ollstein: I think Cassidy is really in a situation of his own. I don’t think he’s the new anything. I think he’s the first Cassidy, and maybe in the future we’ll be referring to other Cassidys. But I think given his medical background, and not just any medical background, like given his background specializing in hepatitis, which is one of the vaccines that people are most anxious will become unavailable or restricted in the future, and given his direct role in extracting promises in order to confirm RFK and now having those promises pretty blatantly stepped on and there not really being much repercussions. Also, him being up for reelection next year. I think it’s quite unique, all of those dynamics, as much as we see parallels with some other members. 

Rovner: Yeah, it’s true. I’ll say Collins is a moderate because she comes from a moderate state. Cassidy’s from Louisiana, which is not a moderate state, it’s a very red state. So he does find himself in these extremely uncomfortable positions. Well, it’s not just vaccines and not just the CDC that’s turning against settled science. Over at the National Institutes of Health, reports Katherine [J.] Wu at The Atlantic, leaders have a new pandemic preparedness plan that suggests that rather than study pathogens and develop and stockpile vaccines, the country would be better off eating better and exercising. This kind of goes back to what you were just saying, Sarah. I’m not sure to where to start with this, other than I guess it’s better to be healthy than not. But as we’ve pointed out, even healthy people are susceptible to germs. 

Karlin-Smith: Right. And so one thing her piece raises is that Kennedy, in particular, has sort of dismissed germ theory, which does not quite believe in the way that most scientists and people do of these roles, of these infectious organisms in disease. And while Katherine’s piece, I think very nicely, talks about there is some element of somebody who is not able to feed themselves enough of the right quantities of food may do worse with an infectious disease, but at the end of the day it’s about your immune system being exposed to these viruses and having some knowledge of how to fight them off. And so younger people, like in the 1918 flu, actually, in some cases would say we’re dying at higher rates even than older people. Obviously again, the pre-vaccine era, this is why so many children under the age of 5 died young. It wasn’t that these were all children born with particularly unhealthy lifestyles or something about them that made them more likely, it was just that their body needed to somehow learn to experience this antigen. 

Rovner: We call them childhood diseases for a reason, right? 

Karlin-Smith: Right. And I think Katherine Wu does a really good job of talking about the multifold strategies you need to be able to be prepared to fight a pandemic. And being so close to covid still, knowing that bird flu and different strains of bird flu are circulating, it does seem a bit concerning that people may be changing the forms of preparation that we’re preparing for rather than building up. 

Rovner: Well, meanwhile over at the FDA, the sharp knives remain out among the top deputies to Commissioner Marty Makary. The latest missive comes from newly appointed drug regulator Richard Pazdur, who unlike many of his fellow center directors is actually a veteran of the agency. But Pazdur has reportedly warned that some of the new FDA efforts to speed the approval of drugs, including deals that trade faster reviews for lowered prices, could be illegal and dangerous to the public health. Sarah, what is going on over there? 

Karlin-Smith: Yeah, so it’s been an untraditional year at FDA in terms of how this commissioner operates, but Makary’s what’s called this Commissioner National Priority Voucher program has rolled out in more detail over the past couple weeks. It’s designed to give companies a two-month review, which most FDA reviews tend to be in the six-[month] to one-year time frame. So two months is superfast. And the criteria for qualifying to try and get that is really vague, and it essentially at the end of the day results to the commissioner in their close circle kind of picking who they want. That’s raised a lot of questions because it’s just not clear. They have sort of a fair and established process. Makary has also suggested that if you give commitments to keep the price of the product low, or deal with Trump on his most-favored-nation pricing deal, we’ll give you this. 

And FDA does not deal with drug pricing. It has no levers or authority to, if a company says, “Of course Marty, we’ll price this product at a fair price if you give us a two-month review.” They have no levers to enforce that, to determine what a fair price is, and it also raises ethical questions of Should FDA? And potentially again, legal questions, Does FDA have the authority to prioritize an application because a company makes these commitments over another application where a company doesn’t? And is that fair? Particularly, you have to think about normally FDA is prioritizing things based on how devastating the disease is or how quickly it kills things or are there other treatments? And so some of the criteria Makary is using, I think, is striking people as a bit more political in that sense. 

Rovner: Yeah. Well, moving on to a segment called “Honey I Shrunk the Health Care Workforce,” you might’ve heard that the Trump administration is busy dissolving the Department of Education and transferring its responsibilities to other agencies. On its way out of existence, however, the department has determined that a long list of health care careers don’t qualify as professions, including nursing, social work, physical therapy, public health, and physician assistants. This is not just semantic, it means that people studying for these graduate degrees won’t be able to get federal student loans for anywhere near what tuition costs. And this comes at a time when the U.S. badly needs more, not fewer, of these health professionals for an aging and increasingly less healthy population. In fact, this feels like a way to make health care more, not less, expensive, since many of these professionals can do work otherwise done by higher-paid medical doctors. Am I missing something here? 

Raman: I think you’re exactly right, especially as over the last few years we’ve seen in Congress them really ramping up, looking at ways to expand the pipeline of workers. You can’t create a health worker overnight. The more advanced the degree, the longer it’s going to take. And I mean, I think it’ll take a little while to see some of the effects of this if it stays in effect, because there’s going to be people that maybe won’t even consider some of these fields rather than if they’re midway through or about to enter one, if they know that it’s not going to be something that their family or themselves can afford. At the same time, as we’re going to have the population aging and we’re going to need more and more of these folks, so I think it’s a two-pronged thing that we’ll see over time. 

Rovner: Yeah. And I know in my workforce studies, I’ve seen a lot of people who wanted to be doctors who ended up going to nursing school or physician assistant school because it was so much cheaper and it took less time, so it was sort of an easier career path. But this is throwing up another roadblock. It just seems like, why are they doing this? I guess nobody has yet said … I have to tell you, I’ve gotten dozens of emails from organizations representing a lot of these career professionals saying, “What are they doing here?” It seems puzzling. 

Karlin-Smith: Some of these professions, like public health workers, don’t end up making the most money once you come out. So people talk about how well doctors, med school, is really expensive and they don’t make enough … but eventually you recover from that process. And in some of these professions, like public health, it really might not just make it totally unviable for people to go into the field because they don’t have that guarantee they’re going to be able to get a salary that will ensure they can repay their loans afterwards. 

Rovner: Yes. Well and speaking of doctors, Yuki Noguchi over at NPR has a smart story about how the administration’s crackdown on immigration is giving international medical school graduates pause about wanting to come practice in the U.S. This is also a big deal because immigrant physicians are not only a big part of the physician workforce in general in the U.S., but in areas with the biggest doctor shortage they often make up as much as half of the doctors in practice. Since this administration is all about affordability, the combination of these two policies seems likely to create a giant shortage, yes? 

Ollstein: Yeah. We’re cutting off our domestic pipeline and we’re cutting off our international pipeline, and this is coming … there are already shortages. There was so much burnout and people retiring early and people quitting during and after the pandemic, and this couldn’t come at a worse time, really. And there’s more punches than the one-two punch. People are also concerned about the high-skilled worker visa fees going up and that making it harder to bring in international medical workers for hospitals that are already struggling to pay an extra fee of tens of thousands of dollars is not really viable right now. So yeah, there’s a lot of concern. 

Rovner: And it’s certainly not going to bring down medical prices, which I guess is maybe what I mean. I know that in the case of the cap on medical school tuition, the hope is to bring down tuition, is to force tuition down by not making the loans big enough. But it’s one thing to say that having unlimited loans is inflationary and allows tuition to go up; it’s another thing to say that cutting off the loans is going to make tuition go down. 

Raman: Yeah, I mean it’s a complicated process when you also have, I mean, for a variety of degrees, the international students are often paying full price, and that subsidizes the cost of some other folks going. So there are many pieces of this puzzle, so it’ll be interesting to see what happens next. 

Rovner: We will continue to watch this space. OK, we’re going to take a quick break. We will be right back. 

So turning to the “everything that is old is new again,” now we have the return of the public charge rule, which Trump tried to rewrite during his first term to make it harder for immigrants to qualify for permanent residency, only to have it reversed by the Biden administration. Alice, remind us what this is and what Trump 2.0 is trying to do that’s different from what Trump 1.0 did. 

Ollstein: Right. So this has gone back and forth, and it’s not a straight, clear-cut revival of the policy under the first Trump administration. I think in part that’s because that one was struck down in court, and so this trends of the new. So, basically, after the comment period and when things get finalized, this is giving, instead of directing all immigration officers to deny permanent residency applications to people who have used Medicaid and have used these social safety-net programs, it’s basically just leaving it up to the individual officer. And there’s language about considering the totality of circumstances, and so there’s a lot of concern in the immigration advocacy community that this will lead to discrimination and decisions made based on basically vibes of if someone seems like they might become a burden on society later, and so I expect there will be lawsuits for sure. 

There is already a lot of concern, even though this hasn’t gone into effect yet, about having a chilling effect on immigrants who are perfectly eligible and can legally qualify for these programs not using them, avoiding health care, avoiding preventive care, avoiding testing and treatment for infectious diseases. And there were several studies about the impact of this policy in the first Trump administration that showed that it really took a toll on public health. And we live in a society if you pass a policy that impacts one part of the population, it’s going to impact other parts of the population. And so this is predicted to make things harder for citizens as well, both the cost of care and the spread of infectious diseases. 

Rovner: All right. Well, finally this week, moving on to reproductive health. Remember that lawsuit in Texas that was filed by a group of anti-abortion doctors that wanted to reverse the FDA’s approval of the abortion pill mifepristone? Well, the doctors are no longer part of the lawsuit because the Supreme Court said they didn’t have standing to sue, and the case is no longer in Texas, but it is still around. And now the three states that are pursuing it, Missouri, Kansas, and Idaho, are adding to their suit the FDA’s recent approval of a second generic of the original abortion pill. Alice, how is this case still going? And now what happened? 

Ollstein: It’s very much still going. It’s just been bouncing around, and now it’s being considered by a whole different court in a whole different state and they’re going to start the process all over again. And I wouldn’t be surprised if it made it all the way back to the Supreme Court, even though it’s already been there with different plaintiffs. So there was a lot of outrage in the anti-abortion community about the recent approval of another generic of mifepristone, even though the way that works is if it’s chemically identical to the versions that have been already approved, it kind of automatically goes through and it doesn’t really have anything to do with the other things they’re challenging. It’s just something else that they’re upset about. 

Rovner: So they’re adding it to it. Well, we will watch that lawsuit too. And last, we don’t talk enough about AI [artificial intelligence] in health care, but a study caught my eye this week from the nonprofit Campaign for Accountability that found a number of chatbots, when asked about medication abortion, gave instructions to call a hotline that urged those with unplanned pregnancies to try “abortion pill reversal,” which is not a thing, although it is pushed by many anti-abortion activists. This appears to be a case where the flood of misinformation so outnumbers the real information that the chatbot thinks that the misinformation is the right answer. Quantity over quality, if you will. This feels like kind of a major flaw in using AI, not just for abortion questions, but for health information in general, given how much health misinformation is out there. 

Raman: I think we’ve seen this in other types of health care, where they’ve tried to roll out some of these chatbots to help with different things, especially like mental health, and it’s backfired for different reasons because of it might promote something that it shouldn’t for that group. I think there was one at one point where it was offering dieting tips to someone with an eating disorder, just things that maybe might be applicable to someone else but not to that specific group. So there are definitely things that need to be hammered out in this. 

Rovner: Yeah, I feel like we’re having sort of a real-time clinical trial of how AI works with the general public in health care, and I don’t know who is really keeping track of what it is doing.  

OK. That is this week’s news. Now we will play my interview with Joanne Kenen and Joshua Sharfstein about their new book, and then we’ll come back and do our extra credits. 

I am pleased to welcome to the podcast Joanne Kenen and Dr. Joshua Sharfstein, two of the three authors of the new book Information Sick: How Journalism’s Decline and Misinformation’s Rise are Harming Our Health — And What We Can Do About It. Our regular listeners all know Joanne, she’s the former health editor at Politico who now teaches at the Johns Hopkins Bloomberg School of Public Health and writes for Politico Magazine. Joshua Sharfstein, who I’ve known almost as long as I’ve known Joanne, is distinguished professor of the practice at Johns Hopkins Bloomberg School of Public Health. He’s a physician who’s worked on Capitol Hill and at the Food and Drug Administration, and also served as the city of Baltimore’s public health commissioner and the State of Maryland’s secretary of health and mental hygiene. Joanne and Josh, thank you so much for joining us. 

Joanne Kenen: Thanks for having us. 

Joshua Sharfstein: Great to be here. 

Rovner: So first, explain the title. What does “information sick” mean? 

Sharfstein: Well, “information sick” is a diagnosis. It’s a diagnosis both of individuals who are confused by information about health that they’re getting, and as a result can’t make good decisions for themselves and their families. And it’s also a diagnosis for our society, that there’s so much bad information on health out there, there’s so little good information that as a country, we’re at risk of making some bad decisions on health policy. 

Rovner: So I have kind of a mea culpa. We have spent a lot of hours on this podcast talking about how public health officials should be doing a better job communicating to the public, combating mis- and disinformation, but without really addressing the other side, the decline of journalism. Joanne, how much of the problem is how information is communicated to the public by health officials, and how much is the changing ways that people are actually communicating with each other? 

Kenen: That’s what our book, where they explore it, is this nexus. There’s been lots written about the decline of journalism, there’s been lots written about failures of public health communication, some of which may be overstated actually, and some of it’s clearly mistakes have been made. But the connection is something that we really explored starting in the class we taught a couple of years ago, and then putting together the book. People do not get information in the ways that we grew up getting information. Local news has really been eviscerated in large parts of the country. There’s county after county that does not have any local news, or that has something very meager. And that was trusted, it’s still trusted where it exists, that was a way people got health information. National news is polarized, with some outstanding exceptions. There’s just not a lot of policy news that people get. And people instead, particularly younger people, are getting … instead of their doctor, they’ve got their TikTok. And there’s a lot of wrong stuff. And it’s not only vaccines, it’s pretty much everything. 

Rovner: So how much of the problem within the information ecosystem is information that’s just wrong because it’s being distributed by non-experts, and how much is from actual bad actors, those with either a potential monetary gain from spreading bad information or those purposely trying to sow discord? 

Sharfstein: Well, one of the challenges is that there isn’t really good information because social media companies, in particular, have not been very forthcoming about what is on their site. It’s very clear that there are bad actors, as you say, including nations that are deliberately putting out information to confuse Americans, and including people who are really trying to make a quick dollar selling things that really shouldn’t be on the market. But there’s also a big gray area because sometimes information gets seeded, but people are passing it on, believing it to be true. And so it’s not all one or all the other, but the quantity of information that’s out there that is not reliable is staggering — so much so that this idea of a public health communication is, to some experts in the field, almost laughable because it will get washed away by the tidal wave of misleading information and make it very hard for people to know what to believe. 

Kenen: There’s a communication media element in this, too. Because if you’re a reporter working for a little tiny newspaper that used to have maybe five or six reporters, and someone could have developed some expertise in health, you know, when you can, if you’re on a national beat doing it full-time, but you can develop some confidence in knowing what you’re talking about. If you’re now one of two reporters and you’re covering eight beats and health is one of them, and you don’t have an editor who can mentor you on health either, there’s a lot of bad reporting. And it’s what we call false equivalence a lot. If you don’t know if this source is an expert, and that source is a charlatan, or vice versa, you tend to put them both as equals. So they’re in the newspaper story or on the local news where you have somebody saying, “Vaccines are safe,” and somebody else saying, “They’re toxic, damaging, barbaric things that are going to kill us all.” So you’re getting something from a news outlet that you should be able to trust, but because of the shrinkage and lack of resources and lack of money and lack of expertise, you end up inadvertently feeding the misinformation monster. 

Rovner: So yeah, some of it is deliberate, and some of it is kind of accidental because of the decline of journalism. So, luckily, your book doesn’t just lay out the problem, you also offer up some potential solutions. Joanne, can you summarize how journalism can do a better job of curing information sickness? And then, Josh, can you talk about how the health community can do its part? 

Kenen: Well, I think that in journalism, if you’re a young reporter starting out and you don’t have the resources to do your job, there are some tools and resources. There’s more and more training opportunities in health, medicine, climate, other areas. So you can get some free training online, and I would urge anyone who’s starting out on this beat … and not just on the beat. I mean if you’re a business reporter or a politics reporter or a general assignment reporter, you’re a health reporter, you’re going to end up doing this. So there are a number of programs through philanthropies and universities, as well as journalism organizations, to bolster local news and bolster health reporting. So anyone who falls into that category who is listening, do it. You won’t come out with an MPH [master’s of public health], but you’ll come out with knowledge and confidence and competence. 

Congress had been talking for, I don’t know, 15 years or so about tax breaks and other things to prop up journalism. It’s not going to pass now if it hasn’t passed in the last 15 years, I don’t see that happening in the current environment. The consolidation that we’re seeing in the media and TV stations is probably going to make it worse, not better. So if we tell our students, “There is a lot of free stuff out there. You can be informed without spending three hours and hundreds a day trying to read everything.” Our podcast is free, KFF is free, KFF Health News is free. There are things you can do to get quality information and quality journalists. 

Rovner: And Josh, what’s the role of the public health community in this changing information environment? 

Sharfstein: There’s a big role. And I would first echo Joanne’s point that there are new and emerging sources of journalism that are really important. The nonprofit sector is growing, and there are some large organizations, like KFF, there are some specific ones, like The Trace that covers gun violence. There are new outlets for specific communities that are really doing high-quality work, and we should all be supporting them. And in a sense, I’ll start there, because I think journalism and health and public health are facing a similar kind of challenge, and we should be supporting each other in addressing it. 

Within the health sector, the first thing is getting the diagnosis right. That’s the right thing to do for a patient; it’s the right thing to do here. Information is not just something that is provided by a public health official or communicated by a health care official. It’s actually a determinant of health. How people get information, what that information says, is incredibly important for their health. And we have to realize that that fundamental determinant is in jeopardy right now. And then I would say that there are several things that are really important. The first is to engage, to not just say, “Well, that’s just not my job. I’m not going to learn the whole new TikTok thing.”| People have to realize where this information is coming from and do their best themselves and through partnerships to get better information out on these channels, and engage with the channels to try to find ways for the algorithms not to take people down a conspiratorial rabbit hole at every opportunity. The second thing, particularly for health care organizations, is to train clinicians so that they’re not just stunned and defenseless when people come in and say, “I’m not going to do chemotherapy. I’m instead going to do some unproven nutritional treatment instead.” And help their clinicians leverage the great relationships that they have with patients to be able to talk people down from the most severe manifestations of being information sick. 

And the third element that I would highlight is that health care and public health have an opportunity, and really a responsibility, to win the battle in real life. Like, the online world is a mess. And a lot of the different techniques that we looked at, like fact-checking and debunking and pre-bunking and all these different ideas, have promise, but really have not won the situation. It’s a mess online. But in the real world, it’s possible to have networks of clinicians and faith leaders and business leaders and political leaders who are standing arm in arm and saying, “This vaccine really does matter and will keep people in our community safe.” And for health departments, this is a real opportunity to reconnect with some of those community roots and do great work literally in each other’s presence. In Baltimore here, there was a network of community health workers that played a really important role in bolstering vaccine confidence during the pandemic. It’s one of the reasons that Baltimore did quite well in terms of covid mortality. So I think that there’s a big agenda here, and of course it’s an agenda at a very difficult time for both health care and public health in 2025. 

Kenen: I think that one thing that we learned about a lot as we researched this, it makes sense when we say it to people, they all nod, but understanding why information has power. There’s a lot that people researching it don’t understand yet, like why once people buy into a myth it’s so hard to get it out of their brain. But what does it do? It appeals to our fears, it appeals to our anxieties, it appeals to our resentments. Social media does not make you feel calm and serene and confident, it makes people agitated and angry. And it’s not a coincidence that there was disinformation before the pandemic and there’s disinformation after the pandemic, but the flowering and the sort of exacerbation during the pandemic, it’s partly because we were so vulnerable to it. We were feeling fear and resentment and anxiety, both about health and about the economic dislocation during the pandemic, particularly that first year. So we were really vulnerable, and people who were spreading it, the ones intentionally, in particular, really were able to sort of exploit that vulnerability that we had. There’s a lot of research. The role of AI is going to change things for good and bad. I mean, anything you write about this about disinformation is somewhat out of date tomorrow. But I think it’s useful for people to understand that what they’re being opposed to that’s so catchy and grabs them is often really bad for them. 

Rovner: Yeah, well, bigger societal problem. But thank you for writing this book. Joanne Kenen and Joshua Sharfstein, thanks for joining us. 

Sharfstein: Thanks so much. 

Kenen: Thanks, Julie. 

Rovner: OK, we’re back. It’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read too. Don’t worry if you miss it; we will put the links in our show notes on your phone or other mobile device. I have already done my extra credit this week. Sarah, how about you go next? 

Karlin-Smith: I took a look at a piece in The Guardian called “Influencers Made Millions Pushing ‘Wild’ Births — Now the Free Birth Society Is Linked To Baby Deaths Around the World,” and it chronicles a movement started by two women using podcasts and Instagram and social media. And it’s not just a movement, I would say it was a business for them. I think The Guardian piece says they made about $13 million basically convincing people to give birth at home with no medical support at all. No midwife, nothing of the sort. And they oftentimes even seem to discourage people when they are in medical distress, or their baby is in medical distress, while birthing from going to the hospital. It has led to babies being born with various birth defects or disabilities that they would not otherwise have been born with. It has led to deaths of babies and, possibly, women. 

And I think one thing that stood out to me is a lot of women the story talks about seem drawn to this movement for a couple of reasons. One is how high cost the U.S. health system is in terms of to get good midwifery care, go to a hospital, see an OB-GYN. So some people were drawn to it just because they felt like they couldn’t afford it, and this seemed like a good option. And other people were drawn to it because they had some kind of bad or traumatic experience giving birth the first time in the traditional medical system and were sort of ripe to be really taken advantage of and exploited. 

Rovner: Yeah, it was quite a story. Sandhya, why don’t you go next? 

Raman: So I picked “Kids and Teens Go Full Throttle for E-Bikes as Federal Oversight Stalls,” and that’s from Kate Ruder for KFF Health News. And this story looks to see are these bikes safe for kids? And that it’s a difficult thing to kind of spell out. There’s not a ton of federal regulations on e-bikes, and it’s a patchwork on the state and county level. And I learned a lot, I think, just because I didn’t realize that there’s no age for operating an e-bike at the federal level, but it’s kind of piecemeal at the state level for other types of motorized vehicles. So it looks at some of that and just kind of what the gaps are and some of the regulations that have been pulled back in recent months. 

Rovner: As somebody who almost got taken out by, like, an 8-year-old on a motorized vehicle a couple of weeks ago, I very much felt this story. Alice? 

Ollstein: So speaking of things that are bad for young people, this story is from CNBC reporter Jonathan Vanian. It is about through a lawsuit … so parents, school districts and state attorneys general have been suing social media companies, primarily Meta, which owns Facebook and Instagram, for negative mental health, emotional health impacts on young people. And through the discovery process in these lawsuits, they uncovered that Meta did research back in 2019 and found that people who stopped using these apps, even for just a week, experienced less depression, anxiety, loneliness, and social comparison. And they buried that finding and did not disclose it. And so this is coming out in the lawsuit. And they uncovered a quote from a Meta employee who said, “If they didn’t release the research, they risked looking like tobacco companies,” who found through their own research about the addictive and damaging properties and did not disclose them, and how that was a bad look later. So this is important to keep in mind as we all marinate our brains in it. 

Rovner: That’s right. And another lawsuit that we will keep an eye on.  

OK. That is this week’s show. Thanks, as always, 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 else 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? Sandhya? 

Raman: @SandhyaWrites on X and on Bluesky. 

Rovner: Alice? 

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

Rovner: Sarah? 

Karlin-Smith: @SarahKarlin or @sarahkarlin-smith, on X and Bluesky. 

Rovner: We’ll be back in your feed next week. Until then, have a great holiday and be healthy. 

Credits

Click here to find all our podcasts.

And subscribe to “What the Health? From KFF Health News” on Apple Podcasts, Spotify, the NPR app, YouTube, Pocket Casts, or wherever you listen to podcasts.

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 longest federal government shutdown in history is over, after a handful of House and Senate Democrats joined most Republicans in approving legislation that funds the government through January. Despite Democrats’ demands, the package did not include an extension of the expanded tax credits that help most Affordable Care Act enrollees afford their plans — meaning most people with ACA plans are slated to pay much more toward their premiums next year.

Also, new details are emerging about the Trump administration’s efforts to use the Medicaid program — for low-income and disabled people — to advance its immigration and trans health policy goals. And President Donald Trump has unveiled deals with two major pharmaceutical companies designed to increase access to weight loss drugs for some Americans.

This week’s panelists are Emmarie Huetteman of KFF Health News, Anna Edney of Bloomberg News, Shefali Luthra of The 19th, and Sandhya Raman of CQ Roll Call.

Panelists

Among the takeaways from this week’s episode:

• Though the shutdown deal did not include an extension of the enhanced ACA subsidies, it came with a plan for a Senate vote by next month — on what exactly, it is unclear. Senate Republicans appear to be coalescing around providing money via health savings accounts rather than through the subsidies, while House Republicans seem more fragmented. The clock is ticking; the existing credits expire on Jan. 1, and open enrollment has begun.
• Even as the Trump administration is likely to be tied up in court over its efforts to use Medicaid to crack down on health care for immigrants and trans people, they’ve had a real chilling effect. Immigrants, for instance, are skipping medical care, and hospitals are cutting back on offering gender-affirming care for trans people for fear of losing federal funding.
• Trump’s newly announced GLP-1 price deals could help Medicare enrollees afford the weight loss drugs, potentially opening up access to a new population of patients — and customers. And a steady stream of policy reversals, unexplained dismissals, and negative news coverage is leading to worries that the FDA’s credibility is being undermined by internal drama. Also in question is whether it’s interfering with the agency’s work. Drug companies would likely say yes, and some within the FDA are trying to combat these concerns.
• A major anti-abortion group is leaning into the current electoral moment, targeting key states and preparing for sizable political contributions ahead of next year’s midterm elections. Abortion opponents see an opportunity to capitalize on voters’ changing motivations and reposition themselves to fit into the post-Trump Republican Party.

Also this week, KFF Health News’ Julie Rovner interviews KFF Health News’ Julie Appleby, who wrote the latest “Bill of the Month” feature, about a doctor who became the patient after a car accident sent her to the hospital — and $64,000 into debt. Do you have an outrageous medical bill? Tell us about it!

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

Emmarie Huetteman: KFF Health News’ “Immigrants With Health Conditions May Be Denied Visas Under New Trump Administration Guidance,” by Amanda Seitz.

Anna Edney: Bloomberg News’ “Bayer Weighs Roundup Exit as Cancer Legal Bill Nears $18 Billion,” by Tim Loh, Hayley Warren, and Julia Janicki.

Shefali Luthra: The 19th’s “Detransition Is Rare, but It’s Driving Anti-Trans Policy Anyway,” by Orion Rummler.

Sandhya Raman: BBC’s “Canada Loses Its Measles-Free Status, With US on Track To Follow,” by Nadine Yousif.

Also mentioned in this week’s episode:

• KFF’s “KFF Health Tracking Poll: Public Weighs in on Health Care Debate and Government Shutdown,” by Audrey Kearney, Alex Montero, Mardet Mulugeta, Ashley Kirzinger, and Liz Hamel.
• KFF Health News’ “Trump’s HHS Orders State Medicaid Programs To Help Find Undocumented Immigrants,” by Phil Galewitz.
• NPR’s “Trump Pushes an End to Medical Care for Transgender Youth Nationally,” by Selena Simmons-Duffin.
• Stat’s “FDA’s Top Drug Regulator Resigns Amid Investigation,” by Lizzy Lawrence and Adam Feuerstein.
• Stat’s “Under Vinay Prasad, Employees at a Key FDA Center Fear Speaking Out, Look for the Exits,” by Lizzy Lawrence.

[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.]  

Emmarie Huetteman: Hello and welcome to “What the Health?” from KFF Health News and WAMU. I’m Emmarie Huetteman, a senior editor for KFF Health News, filling in for host Julie Rovner this week. I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Nov. 13, at 10 a.m. As always, news happens fast, and things might’ve changed by the time you hear this. So, here we go. 

Today, we’re joined via video conference by Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Good morning. 

Huetteman: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everyone. 

Huetteman: And Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Huetteman: Later in this episode, we’ll have Julie’s interview with KFF Health News’ Julie Appleby, who wrote our latest “Bill of the Month” story about a doctor who became the patient after a car accident sent her to the hospital and $64,000 into debt. But first, this week’s news. 

The longest federal government shutdown in history is over. Late Wednesday, six House Democrats joined most Republicans in approving legislation that funds the government through January. That vote came after a handful of Senate Democrats broke ranks with their party last weekend and brokered a deal to end the shutdown. Although the Trump administration was still fighting earlier this week not to fully fund food stamps, the White House has said those benefits would be fully restored within hours of the shutdown’s end. That said, food banks and other safety-net programs have warned the shutdown’s consequences could linger, especially for those who were forced to redirect rent money, dip into savings, and make other sacrifices to feed their families. Notably, despite Democrats’ demands, the deal does not include an extension of the expanded tax credits that help people afford Affordable Care Act plans. That means those enhanced subsidies are still slated to expire at the end of the year. Sandhya, you were on Capitol Hill last night. What was included in the deal? And now that the shutdown’s over, can we expect a vote on extending the tax credits? 

Raman: So part of that deal was that sometime in the middle of next month, the Senate is going to be able to vote on a health bill of Democrats’ choosing to extend the Affordable Care Act enhanced subsidies that are set to expire at the end of the year. There’s been a decent amount of talk already in both chambers about what a health care bill could look like, because it would need to be bipartisan to pass. There’s some multiple camps right now. 

I think in the Senate, Republicans are coalescing around putting money into flexible savings accounts instead of doing an extension of the credits as something that they would want to do instead. There are other Republicans that are still open to extending the credits with some reforms attached. The House, we figured out last night, was a little bit more fragmented. They’re less united in the way the House is around doing something with the flexible spending accounts. So a lot of them are still anti-extending the credits at all. They are working on a health package, but it remains to be seen what they want to do with that, given the short amount of time they have. But I think a lot of them are also looking for the same reforms that the Senate is on the Republican side, if they do sign on to extend them. 

Huetteman: Yeah, short is right. We’re already looking at that Dec. 31 deadline to extend the existing credits. And of course, we’re already in the open enrollment period at this point. People are already getting their plans for next year. Polls show that most Americans blamed Republicans for the shutdown. A tracking poll from my KFF colleagues out last week showed most Americans want Congress to extend the tax credits. Republicans are aware of this heading into the midterms next year, no? 

Raman: I think that’s definitely been a big factor when talking to folks, especially ones that I think have been more interested in extending the credits are set up for our competitive races next year. There has been talk at different times of doing a one-year extension. But that puts us pretty close to the midterms, which might not be in everyone’s best interest depending on how things shake out. So, I think it’s definitely in a lot of folks’ minds, just because it is a lot more popular than it has been in previous years. But there are a lot of the more conservative folks that just have been anti-ACA for so long, that they don’t want to extend something that was … The enhanced subsidies were started by Democrats during covid. They think it’s a covid-era thing that needs to be phased out. 

Huetteman: Yeah, and also notably, you might’ve noticed I said that they only funded the government through January. Does that mean we’re getting ready to do this again in a couple of months? 

Raman: There’s a chance. So part of the deal got done this week is that they did three of the 12 spending bills that they do every year to fund the government. But they usually do them in order of which ones are easiest to get done. So we still have to come to agreements on some of the bigger ones, including Labor, HHS [Health and Human Services]. Education is what funds most of the health activities, and that’s usually a tougher one. So, I think it depends on a few things. Are folks sticking to their word? Do they get that health care vote that they were promised? Do other things shake out that make people at odds with each other over the next bit? But we could possibly be in the same situation if we don’t make inroads on funding the government for a yearlong situation before then. 

Huetteman: Oh goodness. Well, it sounds like we’ll be back again having this conversation soon. Meanwhile, months after the president [Donald Trump] signed into law the One Big Beautiful Bill with big changes to Medicaid, new details are emerging about how the Trump administration is using the Medicaid program to promote its policy goals. My KFF Health News colleague Phil Galewitz recently reported on how the Trump administration has ordered state Medicaid agencies to investigate the immigration status of certain enrollees — providing states with lists of names to re-verify — and effectively roping the health program into the president’s immigration crackdown. 

Also, NPR reports the Trump administration plans to dramatically restrict access to medical care for transgender youth. New proposals that could be released as soon as this month would block federal money from being spent on trans care. Policy experts say that would make it difficult, if not impossible, to access that care, in large part because government funding is a huge source of revenue, and losing it could force hospitals to end the programs entirely. Both of these programs are pretty striking: enlisting Medicaid to perform spot checks of immigration status, and also potentially blocking funding for trans care. Have we seen other presidential administrations use Medicaid like this? And since we’re talking about funding, is there a role for Congress here? 

Luthra: My understanding is that this approach, specifically with gender-affirming care and with immigration, doesn’t really have a precedent. And what I think is really important about these is these are decisions that will be litigated, challenged, argued in court. But, even if and as that happens, there’s a real chilling effect that I think is really important. Already, we know that a lot of immigrants are very afraid to sign up even for benefits they are entitled to, because they’re worried it could count against them. We already know that a lot of immigrants with health needs are skipping their health care because they are so worried about what happens if ICE [Immigration and Customs Enforcement] shows up at a hospital. This only threatens to add to that. On the vantage of gender-affirming care, already we have seen some major hospitals and health providers drop the offering, even in anticipation of this policy coming into effect. So I think what’s really important is to understand that no matter what happens, already, people’s health is really being affected, and people are suffering as a result. 

Raman: I think we’ve seen little sprinkles of some of these things that have happened in the past, but this is elevated at such a level that it’s different. Even in the first Trump administration, there were some things put in place with the public charge to crack down on what benefits immigrants could be entitled to. But I think, as with a lot of the things that we’re seeing, it’s really been amped up. I think one thing that Shefali was saying that made me think of was, we’ve already seen a lot of this chilling effect with a lot of things in abortion and reproductive care, where even if laws or regulations don’t go into effect, they’re being talked about or litigated. It already has that effect of people not wanting to show up or not knowing what’s available to them. So we have a little bit of that to look at as well. 

Huetteman: Yeah, absolutely. All right, well, we’re going to take a quick break. We’ll be right back with more health news. 

We’re back. In an Oval Office announcement last week, President Trump unveiled agreements with the pharmaceutical giants Eli Lilly and Novo Nordisk to offer some Americans lower prices on their weight loss drugs. Under the deals, the Trump administration says, most eligible patients on Medicare and Medicaid, or those who use the planned TrumpRx website, would pay a few hundred dollars a month for some of the most popular GLP-1 drugs. That’s compared to current price tags, which can be $1,000 or more. Anna, these are only some of the most recent deals between the Trump administration and drugmakers. What does this mean for Americans who take these weight loss drugs, and what do the companies get in exchange? 

Edney: Yeah, I think for Americans who take these or are hoping to take these, I think, is probably where it really opens up. Because … Medicare was not covering these. Now that they’ve come to the table and made a deal, it might open it up to some Medicare beneficiaries. I don’t think you’re going to see everyone on Medicare who wants it be able to get it. I think it’ll be a little stricter on what BMI [body mass index] and comorbidities and things that they need to meet, but it will open access to some Americans. Medicaid, I think, it might not be as beneficial for people’s pocketbooks because they’re already paying extremely low out-of-pocket prices, and Medicaid already negotiates very low prices. That might not be the big change that it was hyped up to be. 

But on the Medicare side, certainly, the companies benefit from that, too, because that opens a new patient population to them. And through TrumpRx — that’s the other place where they made this deal for lowered prices on the GLP-1s — a lot of people have employer coverage that they might be trying to already get these drugs through, and then they’re not paying a whole lot out-of-pocket. But there are employer coverage plans that aren’t covering GLP-1s because they’re just so expensive. So it could be a place where some people might go to try to comparison shop and get their GLP-1s that they didn’t have access to before. 

Huetteman: I also noticed, in looking at the Trump administration’s fact sheet on this, that they were heralding that the companies had agreed to some extra American manufacturing. Let’s say concessions. Am I correct about that? Is this connected to tariffs by any chance? 

Edney: Yeah, I think that that’s been going on in conjunction with some of these deals. As you usually hear the companies say, And we’re opening a new factory in Virginia or somewhere. And certainly they’re trying to avoid the tariffs. As with a lot of these things, some of it, in some cases, they have been factories that the companies were already planning to open, and then they just pumped up for this purpose. I think for so many of this — and even for the prices, the lower prices that these companies are negotiating — we just haven’t seen the details that will matter on what the company’s got, and what the American people actually benefit from for all of this, and what these factories will mean or will be making. These are things that might not come online for several years. So you can say you’re building something, but will we see it once Trump is out of office? 

Huetteman: Exactly. And a lot of the framing has been: We’re helping Americans by bringing this work back to America, so that Americans can do the work, so that Americans can benefit from the drug prices. But it seems like there’s at best a lag on that sort of benefit. Right? 

Edney: Definitely. Definitely a lag on being able to bring some of that stuff online. I think with a lot of the Trump administration’s health policies — and I use that word loosely — it is that it is a lot of negotiation and handshakes. And so we don’t really know how solid those efforts will be in the years to come. 

Huetteman: Well, we can definitely keep an eye on that. In other news: Drama, drama, drama at the Food and Drug Administration. With a steady stream of controversial policy reversals, unexplained dismissals, and just plain unflattering stories, concerns are growing that mismanagement at the FDA is undermining the usually cautious agency’s credibility. In some of the latest developments, Stat reported the FDA’s top drug regulator resigned after being accused of using his position to punish a former associate. Stat also reported that dozens of scientists are considering leaving the already diminished FDA office that regulates vaccines, biologics, and the blood supply to get away from a toxic work environment. What are the ramifications of problems at the FDA? Is the internal drama interfering with business there? 

Edney: I think the pharmaceutical industry would say yes, definitely. They’re feeling like their applications for new drugs aren’t getting reviewed in time. They’re worried that they’re not going to be reviewed in time. And this starts with the administration letting go hundreds of workers in those offices, but also, is now … There’s just been such chaos at the top. You had Vinay Prasad, who is the head of vaccines and biologic drugs there, who has been let go and then brought back. And then now we have the head of the drug center, George Tidmarsh, who resigned under investigation for basically using his position to fulfill a vendetta against an old colleague who pushed him out of some companies. And so I think, certainly, there’s a lot of potential for disruption, as people are trying to avoid retaliation, avoid getting in the crosshairs of all of this. 

And recently, the FDA has now put Rick Pazdur, who was the head of their cancer center, in charge of the drug center to try to show some stability to encourage the pharmaceutical industry. Because he is someone who’s really pushed for innovation, pushed for trying to get drugs to the market faster. And he’s been at the FDA for, I think, 26 years. So, they’re trying to show some stability with that. But we’ll have to see how that goes because he’s also been highly criticized in the past by Prasad, and they’ll be working closely together at the head of those two centers. 

Huetteman: Well, finally, in reproductive health news, a federal judge ruled late last month that the FDA violated federal law by restricting access to mifepristone. While the government’s restrictions remain in place for the politically controversial medication, which is used to manage miscarriages as well as abortions, the judge did order the FDA to consider the relevant evidence in order to “provide a reasoned explanation for its restrictions.” And a major anti-abortion group, Susan B. Anthony Pro-Life America, announced plans for it and its super PAC [political action committee] to spend about $80 million in at least four states to support anti-abortion candidates in the midterm elections next year. Shefali, what does this say about how abortion opponents see this moment? What are they looking to gain in the midterms and beyond? 

Luthra: It’s so interesting to me to see how much anti-abortion groups are really — and, in particular, SBA — leaning into this moment. And they really see this as a reversal of last year’s election, where Trump certainly won. But we do know from polling that voters largely opposed abortion restrictions, supported abortion rights. I think some really useful context is to consider that the president, despite being backed by abortion opponents, has not really been the champion many of them would’ve hoped for. He hasn’t actually done very much on abortion, has not taken the very meaningful steps that you might’ve expected in a post-Dobbs landscape [Dobbs v. Jackson Women’s Health Organization] to remarkably restrict it, beyond the normal things any Republican president does. And so I think what we’re seeing here is an effort to reposition the anti-abortion movement beyond this presidential administration. Thinking ahead to what does it look like if there is a post-Trump GOP? 

How do you build out a movement that is a more staunch ally to the anti-abortion movement going forward? One other thing that I think is really noteworthy is: A lot of abortion opponents are looking at polling that says that voters who support abortion rights aren’t prioritizing it in the same way they might have a year ago. And they’re really hoping that things can revert to how they used to be. Or the voters who were these single-issue abortion voters were on their side, were supportive of restrictions, and then might be mobilized by these kinds of really seismic investments in elections. 

Huetteman: Yeah, absolutely. I’m thinking about now how there was such a reaction about a month ago — check me on the timing — when a generic version of the abortion pill was put out. What was the reaction like then, and what does that say about how they feel the Trump administration is reacting to their needs? 

Luthra: A lot of abortion opponents were really livid about this, and approving this generic was pretty standard. It was not that complicated of a process. This drug has been available for so long in other forms. But it underscored that a lot of people who oppose abortion feel like they’re really just waiting. The HHS and the FDA have promised this review of mifepristone that they say could ultimately lead to restrictions. But all it has really been has been a promise this review is ongoing, is coming. There will eventually be results, but there haven’t been any. So to be waiting for some kind of policy that people keep telling you is coming, and then at the same time, to see actually the FDA moving to make abortion medication more available — not less — is really frustrating for a lot of people who hope that this administration would be an ally to them. 

Huetteman: Absolutely. OK. That’s it for this week’s news. Now, we’ll have Julie’s interview with KFF Health News’ Julie Appleby. And then we’ll do our extra credits. 

Julie Rovner: I am pleased to welcome back to the podcast, KFF Health News’ other Julie, Julie Appleby, who reported and wrote the latest KFF Health News “Bill of the Month.” Julie, welcome back. 

Julie Appleby: Thanks for having me. 

Rovner: So this month’s patient is actually a doctor, so she knows how the system works. But, as so often happens, she was in a car accident and ended up in an out-of-network hospital. Tell us who she is and what kind of care she needed. 

Appleby: OK. Her name is Lauren Hughes, and she was heading to see patients at a clinic about 20 miles from where she lives in Denver back in February when another driver T-boned her car, totaling it. She was taken by ambulance to the closest hospital, which turned out to be Platte Valley Hospital, where she was diagnosed with bruising, a deep cut on her knee, and a broken ankle. Physicians there recommended immediate surgical repair because they wanted to wash out that wound on her knee. And also, she needed some screws in her ankle to hold it in place. 

Rovner: So then after the surgery and an overnight stay, she goes home, and then the bills start to come. How much did it end up costing? 

Appleby: Well, she was billed $63,976 by the hospital. 

Rovner: And the insurance company denied her claim. What was their argument? 

Appleby: Yeah, this is where it gets complicated, as many of these things often do. Her insurer, Anthem, fully covered the nearly $2,400 ambulance ride and some smaller radiology charges from the ER. But it denied the surgery and the overnight stay charges from the hospital, which did happen to be out-of-network. Four days after her surgery, Anthem notified Hughes in a letter that after consulting clinical guidelines for her type of ankle repair, its reviewer determined that it wasn’t medically necessary for her to be fully admitted for an inpatient hospital stay. So, the note said that if she’d needed additional surgery or had other problems such as vomiting or fever, an inpatient stay might’ve been warranted. But they didn’t have that in this case. And generally, people don’t stay overnight in the hospital after broken ankle surgery. 

Rovner: Of course, she had no car and she … 

Appleby: Right? Her car was totaled. She had no way to get home. She had nobody to pick her up. And it turns out, there’s a couple more little quirks. So the surgery charges were denied because this quirk that under Anthem’s agreement with the hospital, all claims for services before and after a patient are approved or denied together. So, since the hospital stay was generally not required after the ankle surgery, the surgery charges itself were denied as well. Even though Anthem said they always felt that that was medically necessary — that she needed the ankle surgery — it all came down to this overnight hospital stay. 

Rovner: So, isn’t this exactly what the federal surprise billing law was supposed to eliminate — being in an accident, getting taken to an out-of-network hospital for emergency care? How did it not apply here? 

Appleby: Right. Well, that’s where it’s so interesting because initially, that’s what everybody thought: The No Surprises Act would cover it. And the No Surprises Act from 2022, it’s aimed at preventing these so-called surprise bills, which come when you go to an out-of-network hospital or provider. And in those cases, it limits your financial liability for emergency care to the exact same cost sharing as if you had been in an in-network hospital. 

So in this case, it applies to emergency care, and we saw that it did actually cover some of her emergency room charges, and that kind of thing. But generally though, emergency care is defined as treatment needed to stabilize a patient. So once she was stabilized before the surgery, she enters this post-stabilization situation. And if your provider determines that you can travel using nonmedical transport to an in-network facility, you might lose those No Surprises Act protections. Generally, you’re asked to sign some paperwork saying you want to stay at the out-of-network facility, and you want to continue treatment, and you waive your rights in that case. Hughes does not remember getting anything like that. And this case didn’t come down to the No Surprises Act. It was a question of medical necessity. Your insurer has broad power to determine medical necessity. And if they review a situation and determine that it’s not medically necessary, and you’re post-stabilization, that trumps any No Surprises Act protections. 

Rovner: So what eventually happened with this bill? 

Appleby: So what eventually happened was that the hospital resubmitted the charges as outpatient services. And that seemed to be the crux of the matter here. It was that inpatient overnight hospital stay. If she was kept [on] an observation status — which is a lower level of care, hospitals get paid a little bit less — that would’ve seemed to solve the problem. And that’s what happened here. Platte Valley resubmitted the bill, and her insurer paid about $21,000 of that bill. There was another $40,000 that was knocked off by an Anthem discount. And in the end, Hughes only owed a $250 copayment. 

Rovner: Wow. 

Appleby: Yeah. 

Rovner: Of course, you left out the part where we actually called and made it … 

Appleby: Well, there was that, too. And she was very savvy, as you mentioned. She also got her HR department at her employer involved. She wrote letters. She was not going to give up on this. That’s one of the advice that she gave is not to wait — not to delay too long if you get a notice of not medical necessity — but to quickly and aggressively question insurance denials once they’re received. Make sure you understand what’s going on. Try to get it escalated to the insurers and the hospital’s leadership. All of those things. And I think another takeaway for folks is — and this is harder because, look, you’re in the emergency room, you don’t know what’s going on — but it might be worth asking, Hey, am I post-stabilization? Am I being admitted as an inpatient? Am I being held for an observation stay? Is there some kind of difference with that in terms of my insurance coverage? And you could perhaps try to put this to the hospital billing department. But it’s even better if there’s a way you can call your insurer. But that’s not always realistic in these kinds of emergency situations. 

Rovner: Yeah, and just out of curiosity, if somebody totals my car and I end up [in] an ambulance needing surgery, I’m going to assume that the other driver’s insurance is going to pay my medical bills. Why didn’t that happen? 

Appleby: Well, in this case, the way it was explained to me is the other driver had the minimum coverage needed in the state of Colorado. And so it did pay nearly $5,000 toward some of these charges. But that’s about all it paid. 

Rovner: Wow. Well, now, obviously, as you said, Lauren Hughes is a doctor. Savvy about the way the system works, or doesn’t in this case. Even then, it took her months and called us to work this all out. How should somebody with less expertise handle a situation like this? Is there somebody they can turn to help, assuming that they’re not cognizant enough to start asking questions about their admission status while they’re still in the emergency room waiting for surgery? 

Appleby: Right. Again, that is so complicated. If you can, call your insurer and see what they have to say. And again, it may be after hours. It may be not possible. Perhaps see if you can chat with the hospital billing department. But again, some of this is going to be after the fact. And remember, the billing in this situation came down to how the hospital coded the billing. They coded it as an inpatient hospital stay, and that’s after the fact. And there’s not a lot you can do about it. But in the end, it was resubmitted as an outpatient service, and that made all the difference in this case. 

Rovner: Wow. Another complicated one. Or I guess you can just write to us. Julie Appleby, thank you very much. 

Appleby: Thanks for having me. 

Huetteman: All right, now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week that 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. Anna, how about you go first this week? 

Edney: Sure. This story is from a few of my colleagues at Bloomberg. “Bayer Weighs Roundup Exit as Cancer Legal Bill Nears $18 Billion.” And I thought this was an interesting story, not just because there is the possibility that the world’s most-used weed killer could be going away because it’s just folding under so many legal challenges related to cancer. But it’s also just a deep dive to look at this herbicide that has affected all of our lives and how it came to be, what’s going on with it now, why it’s not working. And also at this company, Bayer, that in the middle of these legal challenges, bought the company that owned Roundup. So I just think it’s an interesting look at the whole situation and something that we’ve probably all consumed before in certain ways, through just fruits and vegetables and different seeds and things. 

Huetteman: Definitely. Shefali, how about your story? 

Luthra: Sure. So I picked a four-part series by my colleague at The 19th, Orion Rummler. The headline for the piece I picked is “Detransition Is Key to Politicians’ Anti-Trans Agenda. But What Is It Really Like?” I think this is a really smart package of stories because, as Orion notes, people who have “detransitioned” — transitioned and then transitioned back — are a really central part of the modern conservative movement’s efforts to target trans health and, in particular, trans health for young people. Saying, look at these people who transitioned and then came back and regretted it. But there hasn’t been a lot of journalism actually looking at people who navigate this experience beyond those who are these political tokens. So Orion does exactly that. He talked to people who have had the experience of transitioning and then detransitioning in some way. 

He notes that this is a pretty rare experience to have this journey with one’s gender, but that the people he interviewed, he profiled, said that they felt really frustrated with how the conversation has unfolded. In fact, their transitioning was an important part of their journey to discover their gender, and that they are deeply concerned that restrictions on trans health could be harmful to them and their loved ones as well. I think this is really valuable journalism, and I’m so excited that Orion did it, and I hope everyone reads it. 

Huetteman: That’s really interesting. Thank you for sharing that one. Sandhya, what do you have this week? 

Raman: So I pick, “Canada Loses Its Measles-Free Status, With US on Track To Follow,” and it’s by Nadine Yousif for the BBC. So this week, the Pan-American Health Organization, Canada is no longer measles-free. And so that means that the Americas region as a whole has lost its elimination status. I thought this was important because in the U.S., we’re at a 33-year high with measles. And Mexico has also seen a surge in cases. And just an interesting way to look at what’s happening a little broader than just the U.S. lens, as all these places are seeing fewer people vaccinated against measles. 

Huetteman: Thanks for sharing that story, Sandhya. My extra credit this week is a great scoop from my KFF Health News colleague Amanda Seitz. The headline is, “Immigrants With Health Conditions May Be Denied Visas Under New Trump Administration Guidance.” Amanda got her hands on a State Department cable that expands the list of reasons that would make visa applicants ineligible to enter the country, including now age or the likelihood they might rely on government benefits. And it gives visa officers quite a bit of power to make those calls.  

Now immigrants, they’re already screened for communicable diseases and mental health problems. But the new guidance goes further and emphasizes that chronic diseases should be considered. And it calls on those visa officers to assess whether applicants can pay for their own medical care, noting that certain medical conditions can “require hundreds of thousands of dollars’ worth of care.” 

All right, that’s this week’s show. Thanks this week to our editor, Stephanie Stapleton, and our producer-engineers, Taylor Cook and Francis Ying. “What the Health?” is available on WAMU platforms, the NPR app, and wherever you get your podcasts. And, as always, on 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 LinkedIn. Where are you folks these days? Sandhya? 

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

Huetteman: Shefali? 

Luthra: I’m on Bluesky @Shefali. 

Huetteman: And Anna? 

Edney: X or Bluesky @AnnaEdney. 

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

Credits

Click here to find all our podcasts.

And subscribe to “What the Health? From KFF Health News” on Apple Podcasts, Spotify, the NPR app, YouTube, Pocket Casts, or wherever you listen to podcasts.

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).