{"id":2130316,"date":"2025-12-11T15:40:00","date_gmt":"2025-12-11T20:40:00","guid":{"rendered":"https:\/\/kffhealthnews.org\/?p=2130316&#038;post_type=podcast&#038;preview_id=2130316"},"modified":"2025-12-12T17:56:58","modified_gmt":"2025-12-12T22:56:58","slug":"what-the-health-426-obamacare-aca-extension-rfk-vaccines-december-11-2025","status":"publish","type":"podcast","link":"https:\/\/kffhealthnews.org\/news\/podcast\/what-the-health-426-obamacare-aca-extension-rfk-vaccines-december-11-2025\/","title":{"rendered":"What the Health? From KFF Health News: Crunch Time for ACA Tax Credits"},"content":{"rendered":"\n<div class=\"wp-block-group is-layout-flow wp-block-group-is-layout-flow\"><div class=\"block--iframe\">\n\t<iframe\n\t\tallow=\"fullscreen\"\n\t\tframeborder=\"0\"\n\t\theight=\"188\"\n\t\tsrc=\"https:\/\/play.prx.org\/e?ge=prx_14448_e0cc34d6-e93b-438c-8394-ee68fdc99b78&#038;uf=https%3A%2F%2Fwhatthehealth.feeds.wamu.org\"\n\t\twidth=\"100%\"\n\t><\/iframe>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-people block--people\">\n\t\t<h3 class=\"people-title\">\n\t\tThe Host\t<\/h3>\n\t\t<div class=\"people-card-container single\">\n\t\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t\t<div class=\"author-image-container\">\n\t\t\t<img srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg 1100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=150,150 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=500,500 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=768,768 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=480,480 480w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=100,100 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=120,120 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=170,170 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=300,300 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=315,315 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=630,630 630w\" sizes=\"(max-width: 767px) 100vw, 500px\" \/>\n\t\t<\/div>\n\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Julie Rovner<\/div>\n\t<div class=\"author-affiliation\">KFF Health News<\/div>\n\t\t\t<div class=\"author-x\">\n\t\t\t<a class=\"icon-x author-link\" href=\"https:\/\/twitter.com\/jrovner\" title=\"@jrovner\">\n\t\t\t\t@jrovner\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<div class=\"author-bluesky\">\n\t\t\t<a class=\"icon-bluesky author-link\" href=\"https:\/\/bsky.app\/profile\/julierovner.bsky.social\" title=\"@julierovner.bsky.social\">\n\t\t\t\t@julierovner.bsky.social\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"author-stories-link\">\n\t\t\t<a class=\"author-link\" href=\"https:\/\/kffhealthnews.org\/news\/author\/julie-rovner\/\"> \n\t\t\t\tRead Julie&#039;s stories.\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"author-bio\">\n\t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, &quot;What the Health?&quot; A noted expert on health policy issues, Julie is the author of the critically praised reference book &quot;Health Care Politics and Policy A to Z,&quot; now in its third edition.\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\t<\/div>\n<\/div>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>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\u2019s just the start of what are expected to be major changes in childhood vaccine recommendations overall.<\/p>\n\n\n\n<p>This week\u2019s 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.<\/p>\n\n\n\n<div class=\"wp-block-people block--people\">\n\t\t<h3 class=\"people-title\">\n\t\tPanelists\t<\/h3>\n\t\t<div class=\"people-card-container threewide\">\n\t\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t\t<div class=\"author-image-container\">\n\t\t\t<img srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg 959w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=150,150 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=500,501 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=768,769 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=480,480 480w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=100,100 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=120,120 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=170,170 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=300,300 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=315,315 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/01\/Edney.jpg?resize=630,631 630w\" sizes=\"(max-width: 767px) 100vw, 500px\" \/>\n\t\t<\/div>\n\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Anna Edney<\/div>\n\t<div class=\"author-affiliation\">Bloomberg News<\/div>\n\t\t\t<div class=\"author-x\">\n\t\t\t<a class=\"icon-x author-link\" href=\"https:\/\/twitter.com\/annaedney\" title=\"@annaedney\">\n\t\t\t\t@annaedney\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<div class=\"author-bluesky\">\n\t\t\t<a class=\"icon-bluesky author-link\" href=\"https:\/\/bsky.app\/profile\/annaedney.bsky.social\" title=\"@annaedney.bsky.social\">\n\t\t\t\t@annaedney.bsky.social\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"author-stories-link\">\n\t\t\t<a class=\"author-link\" href=\"https:\/\/www.bloomberg.com\/authors\/AP519FMOg7w\/anna-edney\"> \n\t\t\t\tRead Anna&#039;s stories.\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"author-bio\">\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t\t<div class=\"author-image-container\">\n\t\t\t<img srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/02\/Goldman-Maya_800sq.jpg 800w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/02\/Goldman-Maya_800sq.jpg?resize=150,150 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/02\/Goldman-Maya_800sq.jpg?resize=500,500 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/02\/Goldman-Maya_800sq.jpg?resize=768,768 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/02\/Goldman-Maya_800sq.jpg?resize=480,480 480w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/02\/Goldman-Maya_800sq.jpg?resize=100,100 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/02\/Goldman-Maya_800sq.jpg?resize=120,120 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/02\/Goldman-Maya_800sq.jpg?resize=170,170 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/02\/Goldman-Maya_800sq.jpg?resize=300,300 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/02\/Goldman-Maya_800sq.jpg?resize=315,315 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/02\/Goldman-Maya_800sq.jpg?resize=630,630 630w\" sizes=\"(max-width: 767px) 100vw, 500px\" \/>\n\t\t<\/div>\n\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Maya Goldman<\/div>\n\t<div class=\"author-affiliation\">Axios<\/div>\n\t\t\t<div class=\"author-x\">\n\t\t\t<a class=\"icon-x author-link\" href=\"https:\/\/twitter.com\/mayagoldman_\" title=\"@mayagoldman_\">\n\t\t\t\t@mayagoldman_\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<div class=\"author-bluesky\">\n\t\t\t<a class=\"icon-bluesky author-link\" href=\"https:\/\/bsky.app\/profile\/maya-goldman.bsky.social\" title=\"@maya-goldman.bsky.social\">\n\t\t\t\t@maya-goldman.bsky.social\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"author-stories-link\">\n\t\t\t<a class=\"author-link\" href=\"https:\/\/www.axios.com\/authors\/mgoldman\"> \n\t\t\t\tRead Maya&#039;s stories.\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"author-bio\">\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t\t<div class=\"author-image-container\">\n\t\t\t<img srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/12\/Stolberg_768sq.jpg 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/12\/Stolberg_768sq.jpg?resize=150,150 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/12\/Stolberg_768sq.jpg?resize=500,500 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/12\/Stolberg_768sq.jpg?resize=480,480 480w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/12\/Stolberg_768sq.jpg?resize=100,100 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/12\/Stolberg_768sq.jpg?resize=120,120 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/12\/Stolberg_768sq.jpg?resize=170,170 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/12\/Stolberg_768sq.jpg?resize=300,300 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/12\/Stolberg_768sq.jpg?resize=315,315 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/12\/Stolberg_768sq.jpg?resize=630,630 630w\" sizes=\"(max-width: 767px) 100vw, 500px\" \/>\n\t\t<\/div>\n\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Sheryl Gay Stolberg<\/div>\n\t<div class=\"author-affiliation\">The New York Times<\/div>\n\t\t\t<div class=\"author-x\">\n\t\t\t<a class=\"icon-x author-link\" href=\"https:\/\/twitter.com\/SherylNYT\" title=\"@SherylNYT\">\n\t\t\t\t@SherylNYT\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t\t<div class=\"author-stories-link\">\n\t\t\t<a class=\"author-link\" href=\"https:\/\/www.nytimes.com\/by\/sheryl-gay-stolberg\"> \n\t\t\t\tRead Sheryl&#039;s stories.\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"author-bio\">\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\t<\/div>\n<\/div>\n\n\n\n<p>Among the takeaways from this week\u2019s episode:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>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.<\/li>\n\n\n\n<li>The Advisory Committee on Immunization Practices\u2019 decision to end its recommendation that newborns be immunized against hepatitis B is a major development in the federal government\u2019s 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.<\/li>\n\n\n\n<li>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\u2019s 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.<\/li>\n<\/ul>\n\n\n\n<p>Also this week, Rovner interviews Georgetown University professor Linda Blumberg about what the GOP\u2019s health plans have in common.<\/p>\n\n\n<div\n\tclass=\"wp-block block--newsletter  \"\n\tdata-type=\"kaiser-health-news\/newsletter\"\n\tdata-align=\"center\"\n\tstyle=\"\"\n>\n\t<h4 class=\"newsletter__title\">\n\t\t<a href=\"\/email\/\">\n\t\t\tEmail Sign-Up\t\t<\/a>\n\t<\/h4>\n\t<p class=\"newsletter__description\">\n\t\tSubscribe to KFF Health News&#039; free Morning Briefing.\t<\/p>\n\t\n<form\n\taction=\"\/email-signup\/\"\n\tclass=\"kaiser-hubspot-mini-signup-form\"\n\tmethod=\"post\"\n>\n\t<input type=\"hidden\" id=\"kaiser_hubspot_nonce\" name=\"kaiser_hubspot_nonce\" value=\"dc9818bd64\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/podcast\/2130316\" \/>\t\t\t\t<label\n\t\tclass=\"kaiser-hubspot-mini-signup-form__label--email\"\n\t\tfor=\"kaiser-hubspot-mini-signup-form-email\"\n\t>\n\t\t<span class=\"screen-reader-text\">\n\t\t\tYour Email Address\t\t<\/span>\n\t\t<input\n\t\t\tautocomplete=\"email\"\n\t\t\tclass=\"kaiser-hubspot-mini-signup-form__input--email\"\n\t\t\tid=\"kaiser-hubspot-mini-signup-form-email\"\n\t\t\tname=\"kaiser_hubspot_email\"\n\t\t\ttype=\"email\"\n\t\t\t\t\t\t\tplaceholder=\"Your email address\"\n\t\t\t\t\t\/>\n\t<\/label>\n\t<button class=\"kaiser-hubspot-mini-signup-form__submit\">\n\t\tSign Up\t<\/button>\n<\/form>\n<\/div>\n\n\n\n<p>Plus, for \u201cextra credit\u201d the panelists suggest health policy stories they read (or wrote) this week that they think you should read, too:&nbsp;<\/p>\n\n\n\n<p><strong>Julie Rovner:<\/strong> The Washington Post\u2019s \u201c<a href=\"https:\/\/www.washingtonpost.com\/health\/2025\/12\/08\/h1b-visa-fees-rural-health\/\">Rural America Relies on Foreign Doctors. Trump\u2019s Visa Fee Shuts Them Out<\/a>,\u201d by David Ovalle.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Anna Edney:<\/strong> Bloomberg News\u2019 \u201c<a href=\"https:\/\/www.bloomberg.com\/news\/features\/2025-12-11\/abbott-presses-congress-for-legal-shield-over-preemie-baby-formula-lawsuits\">Abbott Fired a Warning Shot on Baby Formula \u2014 Then Launched a Lobbying Blitz<\/a>,\u201d by Anna Edney.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Sheryl Gay Stolberg:<\/strong> The New York Times\u2019 \u201c<a href=\"https:\/\/www.nytimes.com\/2025\/12\/07\/us\/china-virologist-li-meng-yan-coronavirus.html\">The Married Scientists Torn Apart by a Covid Bioweapon Theory<\/a>,\u201d by Katie J.M. Baker.<\/p>\n\n\n\n<p><strong>Maya Goldman:<\/strong> ProPublica\u2019s \u201c<a href=\"https:\/\/www.propublica.org\/article\/federally-qualified-health-centers-unpaid-bills-lawsuits\">These Health Centers Are Supposed to Make Care Affordable. One Has Sued Patients for as Little as $59 in Unpaid Bills<\/a>,\u201d by Aliyya Swaby.<\/p>\n\n\n\n<p>Also mentioned in this week\u2019s podcast:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Politico\u2019s \u201c<a href=\"https:\/\/www.politico.com\/news\/2025\/12\/07\/sort-of-blackmail-billions-in-rural-health-funding-hinge-on-states-passing-trumps-policies-00679082\">\u2019Sort of Blackmail\u2019: Billions in Rural Health Funding Hinge on States Passing Trump-Backed Policies<\/a>,\u201d by Alice Miranda Ollstein, Ruth Reader, and Liz Crampton.<\/li>\n\n\n\n<li>The New York Times\u2019 \u201c<a href=\"https:\/\/www.nytimes.com\/2025\/12\/04\/us\/politics\/rfk-vaccines-hhs-trump.html\">Kennedy\u2019s Methodical 2-Decade Quest To Dismantle Vaccine Policy<\/a>,\u201d by Sheryl Gay Stolberg and Christina Jewett.<\/li>\n\n\n\n<li>Bloomberg News\u2019 \u201c<a href=\"https:\/\/www.bloomberg.com\/news\/articles\/2025-12-08\/fda-slow-walking-a-long-awaited-abortion-pill-safety-study?accessToken=eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJzb3VyY2UiOiJTdWJzY3JpYmVyR2lmdGVkQXJ0aWNsZSIsImlhdCI6MTc2NTIzNTk3MywiZXhwIjoxNzY1ODQwNzczLCJhcnRpY2xlSWQiOiJUNlQ2WlFLR1pBTjIwMCIsImJjb25uZWN0SWQiOiI4Nzk1QzcyRDQ4Qzk0RjhFQkYwN0U4QTEyNjVCMTE3NiJ9.3ImUclVzJKv828Bsdvj-EIvabF7V7oWG2Dl3Go7YT1Q&amp;leadSource=uverify%20wall\">FDA Slow Walking a Long-Awaited Abortion Pill Safety Study<\/a>,\u201d by Charles Gorrivan, Riley Griffin, and Rachel Cohrs Zhang.<\/li>\n\n\n\n<li>The Associated Press\u2019 \u201c<a href=\"https:\/\/apnews.com\/article\/affordable-care-act-enrollment-subsidies-health-90ad8b27a6693c5aa03a9ca841048479\">Affordable Care Act Enrollment Is Slightly Ahead of Last Year So Far, Despite Expiring Subsidies<\/a>,\u201d by Ali Swenson and Nicky Forster.<\/li>\n<\/ul>\n\n\n\n<section class=\"block--expandable has-label\"\n\t\t\tid=\"podcast-expandable\"\n\t>\n\t\t\t<input type=\"checkbox\" name=\"expandable-radio\" id=\"strong-transcript-crunch-time-for-aca-tax-credits-strong\">\n\t\t<label class=\"expandable__title-label\" for=\"strong-transcript-crunch-time-for-aca-tax-credits-strong\">\n\t\t\t\t\t\t\t<span\n\t\t\t\t\tclass=\"expandable__label  \"\n\t\t\t\t\tstyle=\"background-color: #cb1919;\"\n\t\t\t\t>\n\t\t\t\t\tClick to open the transcript\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span\n\t\t\t\t\tclass=\"expandable__title\"\n\t\t\t\t\tstyle=\"font-size: 36px;\"\n\t\t\t\t>\n\t\t\t\t\t\t<strong>Transcript: Crunch Time for ACA Tax Credits<\/strong>\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\t\t<div class=\"expandable__content--container\">\n\t\t<div class=\"expandable__content\">\n\t\t\t\n\n<p><em>[<\/em><strong><em>Editor\u2019s note:<\/em><\/strong><em>&nbsp;This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>&nbsp;<\/p>\n\n\n\n<p><strong>Julie Rovner:<\/strong>&nbsp;Hello from KFF Health News and WAMU Public Radio in Washington, D.C.&nbsp;Welcome to&nbsp;<em>What the Health?<\/em>&nbsp;I\u2019m&nbsp;Julie Rovner, chief Washington correspondent for KFF Health News, and&nbsp;I\u2019m&nbsp;joined by some of the best and smartest health reporters in Washington.&nbsp;We\u2019re&nbsp;taping this week on Thursday,&nbsp;Dec.&nbsp;11,&nbsp;at 10&nbsp;a.m. As always, news happens fast,&nbsp;and things might have changed by the time you hear this. So here we go. Today, we are joined via video conference by&nbsp;Anna&nbsp;Edney&nbsp;of Bloomberg News.&nbsp;<\/p>\n\n\n\n<p><strong>Anna&nbsp;Edney:&nbsp;<\/strong>Hi,&nbsp;Julie.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Maya Goldman of Axios News.&nbsp;<\/p>\n\n\n\n<p><strong>Goldman:&nbsp;<\/strong>Great to be here.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>And&nbsp;I\u2019m&nbsp;pleased to welcome to the podcast panel my friend and longtime health reporting colleague, Sheryl Gay Stolberg&nbsp;of&nbsp;The New York Times. Sheryl, so glad to have you&nbsp;join&nbsp;us.&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>I\u2019m&nbsp;so glad to be here, Julie.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>So,&nbsp;later in this episode,&nbsp;we\u2019ll&nbsp;have my interview with Linda Blumberg of Georgetown University. Linda has spent years analyzing Republican proposals to fix health&nbsp;care and has some interesting observations to share. But first, this week\u2019s news.&nbsp;<\/p>\n\n\n\n<p>We will start again with the continuing saga of the expiring enhanced tax credits for the Affordable Care Act.&nbsp;Starting Jan.&nbsp;1, millions of people who get their insurance from the Obamacare marketplaces will face huge increases in what they have to pay in premiums.&nbsp;Some will find those increases so big&nbsp;they\u2019ll&nbsp;have no choice but to drop their insurance altogether. And next Monday, Dec.&nbsp;15,&nbsp;is the deadline for people to sign up for coverage that starts in January. So,&nbsp;the Senate is set to vote today on two different options. The first, backed by all the&nbsp;chamber\u2019s Democrats, calls for a straight,&nbsp;three-year extension of the enhanced payments that were first implemented in 2021.&nbsp;Those extra payments made insurance so much more affordable that enrollment&nbsp;basically doubled&nbsp;from about&nbsp;12 million people&nbsp;in the&nbsp;marketplaces to about 24 million. That bill,&nbsp;though,&nbsp;is unlikely to achieve the 60-vote majority it would need to advance. The Senate is also scheduled to consider a Republican alternative,&nbsp;sponsored by Finance Committee&nbsp;Chairman&nbsp;Mike Crapo of Idaho and Health Committee Chair Bill Cassidy&nbsp;of Louisiana. It&nbsp;wouldn\u2019t&nbsp;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&nbsp;use for&nbsp;routine health expenses to be coupled with&nbsp;a high-deductible insurance&nbsp;policy.&nbsp;\u201cHigh-deductible\u201d&nbsp;meaning&nbsp;many thousands of dollars.&nbsp;It\u2019s&nbsp;not&nbsp;expected to achieve 60 votes either.&nbsp;So,&nbsp;assuming&nbsp;both of these&nbsp;plans fail to&nbsp;muster&nbsp;the&nbsp;needed 60 votes, where does that leave us?&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong>I think that&nbsp;leaves us looking for what the next turn of the key will be. I mean, will they be able to come to some&nbsp;agreement on extending the tax credits&nbsp;\u2014&nbsp;likely&nbsp;\u2014&nbsp;or the subsidies&nbsp;\u2014&nbsp;likely after.&nbsp;Like you said, enrollment has been underway,&nbsp;and people are enrolling even though they&nbsp;don\u2019t&nbsp;really know what the fate of these will be. So,&nbsp;it\u2019ll&nbsp;be interesting to see how the marketplace reacts given what happens.&nbsp;But I don\u2019t think there\u2019s a&nbsp;really clear&nbsp;idea yet, except that everyone thinks that something might start moving once these votes are dispensed with.&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>I think what&nbsp;happens is that a lot of Americans are going to lose their health insurance.&nbsp;We know that the number of Americans insured on the Obamacare&nbsp;exchange is more than double after the enactment of these extended tax credits in 2021.&nbsp;I think there&nbsp;were 11 million;&nbsp;now there are 24 million. And people, as you said in the outset,&nbsp;have to&nbsp;decide now. And&nbsp;maybe they\u2019ll&nbsp;sign up now.&nbsp;But if they lose these credits,&nbsp;I think that a lot of folks&nbsp;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\u2019s midterms.&nbsp;They know this, and that\u2019s why they\u2019re scrambling to come up with some kind of alternative that does not have Obamacare in its name.&nbsp;But we also know that the alternatives that&nbsp;they\u2019re&nbsp;proposing&nbsp;won\u2019t&nbsp;go&nbsp;very far&nbsp;in terms of offsetting&nbsp;out-of-pocket&nbsp;costs for people who are struggling to pay for health&nbsp;care.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Things are starting to bubble up in the&nbsp;House,&nbsp;too. I mean,&nbsp;we\u2019ve&nbsp;seen this.&nbsp;&#8230; 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.&nbsp;<\/p>\n\n\n\n<p><strong>Goldman:&nbsp;<\/strong>Yeah, absolutely. And&nbsp;we\u2019ve&nbsp;seen a&nbsp;couple&nbsp;different&nbsp;proposals in the House. So,&nbsp;there are some moderates that are Republican moderates that are proposing&nbsp;a&nbsp;straight,&nbsp;two-year extension. I think, like Anna said,&nbsp;we\u2019ll&nbsp;see what happens after the Senate votes today,&nbsp;if&nbsp;that brings people to the table or not. I think one thing that struck me this week is&nbsp;The Associated Press reported that&nbsp;<a href=\"https:\/\/apnews.com\/article\/affordable-care-act-enrollment-subsidies-health-90ad8b27a6693c5aa03a9ca841048479\" target=\"_blank\" rel=\"noreferrer noopener\">ACA sign-ups<\/a>&nbsp;are&nbsp;actually slightly&nbsp;ahead of where they were at this time last year.&nbsp;But of course, that&nbsp;doesn\u2019t&nbsp;mean that&nbsp;that\u2019s&nbsp;going to result in more overall enrollment. There&nbsp;is still a lot that needs to be ironed out there.&nbsp;One thing that&nbsp;I\u2019m&nbsp;wondering is:&nbsp;Is health coverage just something that people are&nbsp;biting&nbsp;the bullet&nbsp;on at this point? And they\u2019re like,&nbsp;<em>Well, I know it\u2019s&nbsp;really expensive, but I still need to have health insurance.<\/em>&nbsp;And is that going to&nbsp;&#8230;&nbsp;even if people do drop off,&nbsp;we\u2019re&nbsp;so far away, politically speaking, from the November elections, that,&nbsp;is that&nbsp;actually going&nbsp;to resonate still? I&nbsp;don\u2019t&nbsp;know.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah. I mean, one of the things that&nbsp;&#8230; I saw that AP story,&nbsp;too,&nbsp;that enrollment is&nbsp;actually higher&nbsp;than it was last year at this time.&nbsp;But you&nbsp;have to&nbsp;worry if&nbsp;there\u2019s&nbsp;going to be what they call the death spiral,&nbsp;where only the people who need insurance the most sign up. You&nbsp;have to&nbsp;wonder whether these are the people who would sign up no matter what. And&nbsp;it\u2019s&nbsp;the healthier people for whom&nbsp;it\u2019s&nbsp;a bigger question mark&nbsp;\u2014&nbsp;whether they&nbsp;actually need&nbsp;the health&nbsp;insurance at this much higher price&nbsp;\u2014&nbsp;who are&nbsp;probably waiting&nbsp;right now. If&nbsp;you\u2019re&nbsp;sick,&nbsp;you\u2019re&nbsp;probably going&nbsp;to sign up no matter what. So,&nbsp;in some ways, I wondered if that was more of a warning signal than anything else.&nbsp;<\/p>\n\n\n\n<p><strong>Goldman:&nbsp;<\/strong>That\u2019s&nbsp;a great point.&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>I think the death spiral&nbsp;is a real concern, especially with the plan that Cassidy and Crapo are putting forward. It would drive people into either catastrophic plans or&nbsp;\u201cbronze\u201d&nbsp;plans, which are lower costs, but&nbsp;high-deductible. And the people who are going to get into those plans are healthy people. That is going to deprive the&nbsp;risk&nbsp;pools for sick people of the&nbsp;healthy. And we know what happens when the&nbsp;risk&nbsp;pools become imbalanced like that.&nbsp;Then insurance costs really skyrocket for the people who need it most.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>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.&nbsp;We\u2019ve&nbsp;talked&nbsp;about abortion.&nbsp;But it looks&nbsp;like there are other things that Republicans want to do that Democrats are not going to want to accept.&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>Such as ending support for IVF&nbsp;[in vitro fertilization]&nbsp;coverage like they did in the&nbsp;defense&nbsp;bill&nbsp;this week?&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah, which&nbsp;we\u2019ll&nbsp;get to in a little while.&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>OK.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah. I mean, I could see a bipartisan deal.&nbsp;I\u2019m&nbsp;just dubious partly&nbsp;\u2014&nbsp;and&nbsp;we\u2019ve&nbsp;said this, I think, every week for the last five or six weeks&nbsp;\u2014&nbsp;that Republicans&nbsp;won\u2019t&nbsp;vote for an extension without permanent abortion restrictions,&nbsp;and Democrats&nbsp;won\u2019t&nbsp;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.&nbsp;Does anybody&nbsp;actually see&nbsp;a bipartisan deal happening?&nbsp;I guess how scared do Republicans&nbsp;have to&nbsp;get before&nbsp;they\u2019re&nbsp;willing to do something that the Democrats would agree to?&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>I&nbsp;don\u2019t&nbsp;see a bipartisan bill happening in time. I mean, Cassidy said at this hearing last week, literally pleading with his&nbsp;colleagues saying,&nbsp;<em>We&nbsp;can talk about grand plans,&nbsp;Bernie&nbsp;[Sanders, I-Vermont]&nbsp;can talk about&nbsp;\u201cMedicare for All,\u201d&nbsp;and we can talk about this, but we got to do something in three weeks.<\/em>&nbsp;Well, now&nbsp;it\u2019s&nbsp;two weeks,&nbsp;and&nbsp;they\u2019re&nbsp;not going to come to some compromise, especially not one involving abortion or undocumented immigrants by Christmas.&nbsp;It\u2019s&nbsp;not going to happen.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah. Congress loves to give itself deadlines and then not meet them.&nbsp;<\/p>\n\n\n\n<p><strong>Goldman:&nbsp;<\/strong>Absolutely. And&nbsp;I think we&nbsp;have Republicans with their grand plans,&nbsp;and you&nbsp;can\u2019t&nbsp;implement a full HSA&nbsp;[health savings account]&nbsp;expansion in the time that&nbsp;they\u2019ve&nbsp;allotted.&nbsp;That\u2019s&nbsp;just not&nbsp;practicable.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah.&nbsp;I think this&nbsp;is a war of talking points at this point. All right. Well, the ACA may be this week\u2019s news, but I&nbsp;don\u2019t&nbsp;want to&nbsp;miss out on&nbsp;the vaccine news from late last week after we taped. As&nbsp;predicted, HHS Secretary RFK Jr.\u2019s&nbsp;[Health and Human Services Secretary Robert F. Kennedy Jr.]&nbsp;handpicked CDC&nbsp;[Centers for Disease Control and Prevention]&nbsp;advisory committee on vaccine practices voted to roll back the universal recommendation for a first dose of the hepatitis B vaccine for infants,&nbsp;right after birth. Instead, the panel recommended making the vaccine the subject of&nbsp;\u201cindividual-based&nbsp;decision-making.\u201d&nbsp;What\u2019s&nbsp;the difference between that and&nbsp;actually recommending&nbsp;the vaccine?&nbsp;Is this a really big change?&nbsp;Anna, Sheryl,&nbsp;you guys&nbsp;have been watching this closely.&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong>Yeah, I think that&nbsp;it\u2019s&nbsp;a big change&nbsp;in the sense that it can be&nbsp;pretty confusing&nbsp;for parents.&nbsp;And it injects this idea of the vaccine&nbsp;possibly being&nbsp;harmful&nbsp;\u2014&nbsp;although&nbsp;that\u2019s&nbsp;not something&nbsp;that\u2019s&nbsp;seen in the data&nbsp;\u2014&nbsp;and also&nbsp;that&nbsp;maybe it\u2019s&nbsp;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,&nbsp;and people think,&nbsp;<em>Oh, well, we&nbsp;don\u2019t&nbsp;really have to worry about this anymore.<\/em>&nbsp;But&nbsp;that\u2019s just&nbsp;not the case. Obviously, as&nbsp;we\u2019ve&nbsp;seen with other diseases of late, these things can come back.&nbsp;<\/p>\n\n\n\n<p>And&nbsp;so&nbsp;I think&nbsp;it\u2019s&nbsp;not going to change&nbsp;at the moment, at least, necessarily insurance coverage for having the vaccine, but it does leave open this door that,&nbsp;<em>Well,&nbsp;maybe you&nbsp;should talk to your doctor, see if&nbsp;it\u2019s&nbsp;really the best thing.<\/em>&nbsp;And&nbsp;there\u2019s&nbsp;just a lot coming at you as a new parent or a parent with a new child on the way,&nbsp;and a lot of medical advice to wade through,&nbsp;and things like that. So,&nbsp;this adds an extra piece to that for which a lot of the medical societies and doctors, Sen.&nbsp;Cassidy included, have said,&nbsp;<em>This&nbsp;isn\u2019t&nbsp;something that&nbsp;we\u2019ve&nbsp;had a big question mark on.<\/em>&nbsp;It\u2019s been&nbsp;actually really,&nbsp;really helpful&nbsp;in the health of children.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah. Hepatitis B cases in children and teens have gone down 99%.&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>That\u2019s&nbsp;right,&nbsp;since 1991.&nbsp;I was going to say, I think this is a&nbsp;really big&nbsp;deal.&nbsp;And it\u2019s a&nbsp;really big&nbsp;deal for a couple of reasons.&nbsp;One,&nbsp;it\u2019s&nbsp;not&nbsp;science-based.&nbsp;There\u2019s&nbsp;no evidence that delaying the vaccine makes it any safer for children.&nbsp;Two, it\u2019s a&nbsp;really big&nbsp;deal because of the debate that Kennedy and his allies have created around what was once not given any thought.&nbsp;And&nbsp;it\u2019s&nbsp;also a big deal because,&nbsp;as doctors will tell you, in theory, one could argue, as Kennedy and his group do, that this is a disease&nbsp;that\u2019s&nbsp;transmitted sexually,&nbsp;or&nbsp;it\u2019s&nbsp;transmitted through intravenous drug use. And for infants, the real risk is mother-to-child transmission. Well,&nbsp;first of all,&nbsp;that\u2019s&nbsp;not entirely true. The virus can last and live on household items like&nbsp;scissors,&nbsp;or&nbsp;tables,&nbsp;or whatever. We know that newborns are the ones that are most at risk.&nbsp;<\/p>\n\n\n\n<p>And we also know that the best time to capture or vaccinate a newborn is when&nbsp;they\u2019re&nbsp;there in the hospital,&nbsp;and they have access to medical professionals who can administer the vaccine. And unlike countries like Denmark, which follow&nbsp;up their babies, our babies&nbsp;don\u2019t&nbsp;get that kind of follow-up. And&nbsp;so&nbsp;the likelihood is that kids will not get vaccinated when&nbsp;they\u2019re&nbsp;older. Parents will forget about it,&nbsp;and they will have missed that critical opportunity to be protected against an infection that can cause chronic liver disease and death.&nbsp;<\/p>\n\n\n\n<p><strong>Goldman:&nbsp;<\/strong>Yeah. And there was a lot of discussion during the meeting on,&nbsp;<em>Oh, well, we need to do a better job of screening the mothers for hepatitis B,&nbsp;and you should still get the newborn vaccine if you test positive, et cetera, et cetera.<\/em>&nbsp;But that\u2019s not ACIP\u2019s&nbsp;[Advisory Committee on Immunization Practices]&nbsp;job to say that we should be screening mothers,&nbsp;so they&nbsp;don\u2019t&nbsp;have any authority there to enforce that. And a CDC staff member said,&nbsp;<em>We\u2019re&nbsp;working on that.<\/em>&nbsp;But,&nbsp;like Sheryl said, we&nbsp;don\u2019t&nbsp;have the same&nbsp;kind of system that they have in other countries,&nbsp;where you can get those follow-up appointments,&nbsp;and get women in for prenatal care that they need.&nbsp;And&nbsp;so&nbsp;I agree,&nbsp;it\u2019s&nbsp;going to be a huge, huge issue.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah. Well, speaking of those other countries,&nbsp;later on&nbsp;Friday after the meeting,&nbsp;in news that some might have missed, President&nbsp;[Donald]&nbsp;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&nbsp;\u201cpeer&nbsp;nations.\u201d&nbsp;Sheryl, you had a big story last week about&nbsp;<a href=\"https:\/\/www.nytimes.com\/2025\/12\/04\/us\/politics\/rfk-vaccines-hhs-trump.html\" target=\"_blank\" rel=\"noreferrer noopener\">RFK\u2019s plans for vaccine policy<\/a>. What are they?&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>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.&nbsp;Ultimately,&nbsp;he&nbsp;would like to end all mandates for childhood vaccination.&nbsp;That\u2019s&nbsp;not within his purview.&nbsp;That\u2019s&nbsp;in the purview of the states.&nbsp;But he wants to revisit the entire childhood vaccine schedule. And you can&nbsp;see in&nbsp;what he has done by installing his allies, some of whom presented at this ACIP meeting last&nbsp;week,&nbsp;he\u2019s&nbsp;put them in key places. People like Mark&nbsp;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&nbsp;Blaxill&nbsp;now works for&nbsp;the CDC.&nbsp;He\u2019s&nbsp;a smart,&nbsp;Harvard-educated&nbsp;businessman, not a doctor, but he presented on hepatitis B. We saw Aaron Siri, Kennedy\u2019s lawyer,&nbsp;presenting on the childhood vaccine schedule.&nbsp;<\/p>\n\n\n\n<p>This is a committee that is supposed to be&nbsp;comprised&nbsp;of medical experts&nbsp;\u2014&nbsp;people who are physicians&nbsp;who\u2019ve&nbsp;administered care. And what we are seeing is Kennedy installing these people and others,&nbsp;sprinkling them throughout the department,&nbsp;or bringing them in,&nbsp;to carry out his vision. And he was&nbsp;very clear&nbsp;about that vision in an interview with me. I mean, he&nbsp;firmly believes, as he said&nbsp;\u2014&nbsp;he was careful&nbsp;\u2014&nbsp;he said that autism has gone up over these past decades,&nbsp;and&nbsp;it\u2019s&nbsp;the same time as the childhood vaccines have become&nbsp;&#8230;&nbsp;we\u2019ve&nbsp;had more widespread use of vaccines.&nbsp;We\u2019ve&nbsp;also had more widespread drinking of pumpkin spice lattes,&nbsp;as Kennedy\u2019s critics note, but Kennedy has said&nbsp;<em>vaccines must be a potential culprit.<\/em>&nbsp;I thought&nbsp;that&nbsp;was&nbsp;very interesting&nbsp;that he put that word in&nbsp;\u2014&nbsp;potential. It was a wiggle word. But frankly, what he thinks is that vaccines are responsible,&nbsp;and he has said as much in other interviews.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>And yet, while this is going on at this&nbsp;very high&nbsp;level,&nbsp;we\u2019re&nbsp;now having a huge and growing measles outbreak in South Carolina,&nbsp;in addition to the one that&nbsp;we\u2019ve&nbsp;already had in Texas.&nbsp;This is really having an impact on parents\u2019&nbsp;willingness to have their children vaccinated. I mean, that,&nbsp;I think at this point,&nbsp;cannot be denied just by&nbsp;the evidence.&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong>Yeah. Fewer parents are getting their kids vaccinated for school.&nbsp;They\u2019re&nbsp;getting more waivers and things like that,&nbsp;too. So,&nbsp;we do see that this is&nbsp;definitely giving&nbsp;parents who&nbsp;maybe had&nbsp;concerns,&nbsp;or&nbsp;have felt some kinship with the MAHA&nbsp;[Make America Healthy Again]&nbsp;movement as&nbsp;it\u2019s&nbsp;grown, the&nbsp;ability to do what they feel is right, less so following&nbsp;the science.&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>Peter Hotez, who is at Baylor University, told me that he was not surprised when there was a&nbsp;measles outbreak in Texas, and&nbsp;in particular in&nbsp;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.&nbsp;<\/p>\n\n\n\n<p><strong>Goldman:&nbsp;<\/strong>I think&nbsp;it\u2019s&nbsp;also,&nbsp;it\u2019s&nbsp;not just people that are very in line with the MAHA movement at this point. I think if&nbsp;you\u2019re&nbsp;not paying as close of attention as we are, the messages that&nbsp;you\u2019re&nbsp;seeing are,&nbsp;<em>Vaccines are bad. We need to&nbsp;look into&nbsp;vaccines. I&nbsp;don\u2019t&nbsp;know, should I get a vaccine? Should I give my children vaccines?<\/em>&nbsp;And I think&nbsp;that\u2019s&nbsp;really taking hold.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Another story that&nbsp;we&#8217;re&nbsp;going to follow&nbsp;into&nbsp;2026. All&nbsp;right,&nbsp;we\u2019re&nbsp;going to take a quick break. We will be right back.&nbsp;&nbsp;<\/p>\n\n\n\n<p>Turning to reproductive health, the last big bill Congress is trying to finish before leaving for the year is the National Defense Authorization&nbsp;[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&nbsp;personnel&nbsp;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.&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>I think this&nbsp;is daylight between Trump and Mike Johnson,&nbsp;clearly.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>I have to say, I was surprised.&nbsp;Since when&nbsp;can the speaker just take something out of a bill that was passed by both the House and the Senate?&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>Also, not to mention that members of Congress have this coverage.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>That&#8217;s right, which they only got&nbsp;fairly recently.&nbsp;I\u2019m&nbsp;surprised that there\u2019s, I would say, less&nbsp;pushback. There obviously is&nbsp;pushback. There&nbsp;are people who are&nbsp;really furious&nbsp;about this, but&nbsp;in the manner of how things work in&nbsp;Congress,&nbsp;this is&nbsp;literally the&nbsp;second time&nbsp;he\u2019s&nbsp;done it. And his spokespeople admit that he did it. And he says,&nbsp;<em>Well, I only want this if&nbsp;it\u2019s&nbsp;done ethically.<\/em>&nbsp;And a reminder,&nbsp;he\u2019s&nbsp;from Louisiana, which is the state that has current restrictions on the destruction of excess embryos from IVF&nbsp;that\u2019s&nbsp;made IVF difficult to obtain in that state.&nbsp;It\u2019s&nbsp;one person exerting his will over the rest of the Congress.&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>Yeah. I think&nbsp;that\u2019s&nbsp;the most interesting thing about it is the daylight between Johnson and Trump&nbsp;and also&nbsp;Kennedy on this&nbsp;issue.&nbsp;Because while Trump and Kennedy profess to be anti-abortion,&nbsp;it\u2019s&nbsp;not really a top-of-mind issue for either one of them.&nbsp;But it is for Johnson. And I guess I&nbsp;can\u2019t&nbsp;imagine Trump vetoing the&nbsp;defense bill, so&nbsp;I guess this&nbsp;is going to go through.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah, without it. Again.&nbsp;Well, speaking of who it\u2019s a priority for, much&nbsp;[to]&nbsp;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&nbsp;underlines a story from your colleagues at Bloomberg, Anna,&nbsp;suggesting that FDA commissioner Marty Makary is&nbsp;<a href=\"https:\/\/www.bloomberg.com\/news\/articles\/2025-12-08\/fda-slow-walking-a-long-awaited-abortion-pill-safety-study?accessToken=eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJzb3VyY2UiOiJTdWJzY3JpYmVyR2lmdGVkQXJ0aWNsZSIsImlhdCI6MTc2NTIzNTk3MywiZXhwIjoxNzY1ODQwNzczLCJhcnRpY2xlSWQiOiJUNlQ2WlFLR1pBTjIwMCIsImJjb25uZWN0SWQiOiI4Nzk1QzcyRDQ4Qzk0RjhFQkYwN0U4QTEyNjVCMTE3NiJ9.3ImUclVzJKv828Bsdvj-EIvabF7V7oWG2Dl3Go7YT1Q&amp;leadSource=uverify%20wall\" target=\"_blank\" rel=\"noreferrer noopener\">\u201cslow-walking\u201d&nbsp;the safety study<\/a>&nbsp;of the abortion pill that was promised to anti-abortion lawmakers, that he&#8217;s apparently slow walking that until perhaps after the midterms.&nbsp;<\/p>\n\n\n\n<p>I hasten to add that HHS&nbsp;spokesman&nbsp;Andrew Nixon denies the studies being deliberately delayed. But just the story has angered anti-abortion forces so much&nbsp;[that]&nbsp;they\u2019re&nbsp;now calling for Makary\u2019s firing. And Missouri Republican Sen.&nbsp;Josh Hawley,&nbsp;who\u2019s&nbsp;been at the forefront of the fight against the abortion&nbsp;pill, and I believe the person who got the promise for this study,&nbsp;has called the allegations unacceptable and is demanding answers by this Monday. Combined with&nbsp;what\u2019s&nbsp;going on with the carousel of center directors at the FDA, how much longer can Makary last under this continuing onslaught?&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong>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&nbsp;seem to be&nbsp;coming at Makary and going&nbsp;wrong,&nbsp;and&nbsp;calling into question his ability to manage the FDA. I think specifically&nbsp;\u2014&nbsp;you were just mentioning this with abortion, Sheryl&nbsp;\u2014&nbsp;that&nbsp;it\u2019s&nbsp;not top of mind for Trump or RFK. So,&nbsp;I\u2019m&nbsp;not sure that this is the thing that does him in unless Sen.&nbsp;Hawley or something breaks on that end.&nbsp;Maybe there&nbsp;are some senators who will be upset enough as more, or&nbsp;if,&nbsp;more details come out.&nbsp;<\/p>\n\n\n\n<p>I think that&nbsp;definitely Makary&nbsp;appears to be fighting for his job.&nbsp;I think there have been some&nbsp;great stories&nbsp;in&nbsp;The Washington Post and&nbsp;The Wall Street Journal talking about these discussions at the White House every few weeks,&nbsp;where&nbsp;<em>should we keep doing this? Do we need to think of&nbsp;maybe putting&nbsp;someone different in leadership?<\/em>&nbsp;He\u2019s&nbsp;still there.&nbsp;And so,&nbsp;it seems that RFK is backing him&nbsp;pretty publicly.&nbsp;Obviously,&nbsp;that can change at a moment\u2019s notice.&nbsp;So,&nbsp;something to keep a&nbsp;really close&nbsp;eye on.&nbsp;<\/p>\n\n\n\n<p><strong>Goldman:&nbsp;<\/strong>Something that we\u2019ve been talking about on my team related to that is that it\u2019s going to be&nbsp;really hard&nbsp;to get anyone else approved through the Senate for any of these positions.&nbsp;And they can install an acting director, but there are limits to how long that can last. And&nbsp;so&nbsp;I think that that is maybe partially helping with some job security for a lot of these people at these high levels.&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>I think it would be&nbsp;very hard&nbsp;to get someone else installed given the broken promises that Kennedy has made to Cassidy.&nbsp;They\u2019re&nbsp;going to be very wary.&nbsp;And also, Makary is in the arc,&nbsp;or the spectrum,&nbsp;of people who could fill that job.&nbsp;He\u2019s&nbsp;actually&nbsp;kind&nbsp;of&nbsp;moderate, if you will.&nbsp;And I talked to someone close to Kennedy who said that Kennedy still has confidence in him. So,&nbsp;his ouster,&nbsp;I think,&nbsp;would require the White&nbsp;House bigfooting&nbsp;Kennedy. And&nbsp;I\u2019m&nbsp;not sure&nbsp;that&nbsp;that would happen.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>And they have, as&nbsp;we\u2019ve&nbsp;noticed, other things to deal with right now.&nbsp;Finally&nbsp;this week, remember that&nbsp;$50 billion&nbsp;Congress&nbsp;included for&nbsp;rural health in last summer\u2019s big budget bill to offset the&nbsp;nearly&nbsp;$1 trillion&nbsp;in cuts to Medicaid?&nbsp;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&nbsp;<a href=\"https:\/\/www.politico.com\/news\/2025\/12\/07\/sort-of-blackmail-billions-in-rural-health-funding-hinge-on-states-passing-trumps-policies-00679082\" target=\"_blank\" rel=\"noreferrer noopener\">Trump administration policies<\/a>&nbsp;\u2014&nbsp;things like barring people from using food stamps for junk food,&nbsp;or legalizing&nbsp;short-term&nbsp;insurance plans that many states worry could destabilize the individual insurance market. Now, I&nbsp;wouldn\u2019t&nbsp;call this outright coercion, but I remember that the Supreme Court&nbsp;basically did&nbsp;just that when they ruled that the ACA\u2019s Medicaid expansion had to be voluntary. Is this really going to fly,&nbsp;that the Trump administration could say,&nbsp;<em>You&nbsp;can\u2019t&nbsp;have this money unless you do other things that we want you to do?<\/em>&nbsp;<\/p>\n\n\n\n<p><strong>Goldman:&nbsp;<\/strong>If&nbsp;I&#8217;m&nbsp;remembering correctly, all states that have all&nbsp;right&nbsp;to&nbsp;applications will get a baseline of money,&nbsp;and states can get more money for certain things that they apply for. And&nbsp;so&nbsp;I think that&nbsp;maybe that&nbsp;makes this a little different. But I think states will be&nbsp;very upset&nbsp;if they&nbsp;don\u2019t&nbsp;get the money that they&nbsp;want,&nbsp;that they are asking for. And&nbsp;it\u2019ll&nbsp;be interesting to see if there is legal action on the back&nbsp;end,&nbsp;too.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah. I mean, clearly this&nbsp;$50 billion&nbsp;for rural health is not enough to even begin to make up for the cuts that are coming to Medicaid. So,&nbsp;we\u2019re&nbsp;talking about&nbsp;small amounts&nbsp;of money.&nbsp;It\u2019s&nbsp;just,&nbsp;I&nbsp;don\u2019t&nbsp;remember seeing conditions that were quite this blatant. And&nbsp;you\u2019re&nbsp;right, Maya, it\u2019s&nbsp;not&nbsp;all of&nbsp;the money, but it is some segment of the money. But for them to just literally come out and say,&nbsp;<em>We\u2019re&nbsp;going to give you money if you do what we want.<\/em>&nbsp;I would think at some point Congress gets to say,&nbsp;<em>Hey, not what we had in mind.<\/em>&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>But Congress&nbsp;won\u2019t&nbsp;say it. Not this Congress.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah, not this Congress. So&nbsp;maybe a&nbsp;future Congress. All right. Well, that is this week\u2019s news. Now, we will play my interview with Linda Blumberg of Georgetown University, and then we will come back and do our extra credits.&nbsp;&nbsp;<\/p>\n\n\n\n<p>I am pleased to&nbsp;welcome to&nbsp;the podcast Linda Blumberg.&nbsp;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&nbsp;really complicated&nbsp;question about health policy.&nbsp;Linda, welcome to&nbsp;<em>What&nbsp;the Health?<\/em>&nbsp;<\/p>\n\n\n\n<p><strong>Linda&nbsp;Blumberg:&nbsp;<\/strong>Thanks so much for having me here.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>So,&nbsp;to the unpracticed eye, it looks like Republicans in the House and Senate are just now&nbsp;coming up with&nbsp;all these new and different health plans. But,&nbsp;in fact, most of them are variations on what Republicans have been pushing, not just for years, but for decades in some cases.&nbsp;Is there anything&nbsp;really new,&nbsp;or is this just a long list of golden oldies?&nbsp;<\/p>\n\n\n\n<p><strong>Blumberg:&nbsp;<\/strong>I think this&nbsp;is&nbsp;basically a&nbsp;list of things that have been brought out before. Now, they&nbsp;have to&nbsp;present them and talk about them in the context of the Affordable Care Act, which they&nbsp;didn\u2019t&nbsp;have to do many years ago.&nbsp;They\u2019re&nbsp;working around in terms of what&nbsp;they\u2019re&nbsp;impacting on&nbsp;the Affordable Care Act,&nbsp;and how these other pieces would fit in with what they want to do there. But&nbsp;they\u2019re&nbsp;essentially the&nbsp;same things&nbsp;they\u2019ve&nbsp;been talking about for a long time.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>So,&nbsp;you\u2019ve&nbsp;been analyzing these plans for years now.&nbsp;And while they may look different on the surface, you say they all have one thing in common:&nbsp;that they work to segment rather than pool risk. Can you explain that in&nbsp;layman\u2019s terms?&nbsp;<\/p>\n\n\n\n<p><strong>Blumberg:&nbsp;<\/strong>Sure. When I talk about segmenting health&nbsp;care risk, what I\u2019m talking about is policies,&nbsp;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.&nbsp;That is the opposite of pooling risk more broadly, which&nbsp;actually takes&nbsp;health&nbsp;care costs and spreads them to a greater extent across people, both healthy and sick.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>So basically,&nbsp;protecting&nbsp;sick people, which is the idea of health insurance in general, right?&nbsp;<\/p>\n\n\n\n<p><strong>Blumberg:&nbsp;<\/strong>Well, from my perspective, yes. The situation is because there is&nbsp;\u2014&nbsp;what we in economics call&nbsp;\u2014 a&nbsp;very skewed distribution of health&nbsp;care spending, that means that in any particular year, at any&nbsp;particular moment in time, most people are pretty healthy and don\u2019t use much medical care,&nbsp;and the great bulk of health&nbsp;care spending falls on a small percentage of the population. And so,&nbsp;when&nbsp;you\u2019re&nbsp;only looking in the short term, when&nbsp;you\u2019re&nbsp;not looking broadly across time,&nbsp;or across somebody\u2019s life, then people who, when you segment health&nbsp;care risk, you&nbsp;can create savings for people when&nbsp;they\u2019re&nbsp;super healthy. The problem is that it increases the cost even more when they are not healthy,&nbsp;and none of us are healthy forever.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>And just to be clear, the percentage of people who use&nbsp;the majority of&nbsp;health&nbsp;care is really,&nbsp;really tiny, isn\u2019t it?&nbsp;<\/p>\n\n\n\n<p><strong>Blumberg:&nbsp;<\/strong>Yeah. So,&nbsp;for example, there is a rule of thumb that around the top 5% of health&nbsp;care spenders account for&nbsp;basically half&nbsp;of all health&nbsp;care spending, and the bottom half of spenders account for less than 3% of health&nbsp;care spending. But that is at a particular moment in time,&nbsp;again. And&nbsp;I think the problem&nbsp;is when we think about health&nbsp;care spending as&nbsp;W<em>ho\u2019s&nbsp;going to&nbsp;win?&nbsp;Who\u2019s&nbsp;going to lose?<\/em>&nbsp;in terms of money,&nbsp;right now,&nbsp;at a particular moment in time.&nbsp;Instead of thinking about what happens to us over the course of our lifetime, which is,&nbsp;then,&nbsp;when we spread the costs much more broadly,&nbsp;we\u2019re&nbsp;more protected. We have access to adequate affordable health&nbsp;care under broad-based pooling of health&nbsp;care&nbsp;risk. When we segment it,&nbsp;we\u2019re&nbsp;really making people much more&nbsp;vulnerable&nbsp;to not being able to get the care they need when they need it.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>And how do things like health savings accounts,&nbsp;and giving consumers more power to go out and negotiate on their own, how do those&nbsp;actually segment&nbsp;risk?&nbsp;<\/p>\n\n\n\n<p><strong>Blumberg:&nbsp;<\/strong>So,&nbsp;the more you take the dollars that are being spent on health&nbsp;care and remove it from the health insurance pool&nbsp;\u2014&nbsp;the amount of money that is going to pay for claims through health insurance,&nbsp;&nbsp;whether it\u2019s public or private insurance&nbsp;\u2014&nbsp;the more you take it out of the insurance pool and you put it on the individuals, the more we\u2019re separating the risks and putting heavier costs on people when they need care. So,&nbsp;a health savings account gives us some&nbsp;cash,&nbsp;or&nbsp;allows us to put some cash into an account to use when&nbsp;we\u2019re needing&nbsp;care. But it also comes with health insurance plans that are much&nbsp;higher&nbsp;deductibles and much larger out-of-pocket costs.&nbsp;<\/p>\n\n\n\n<p>And&nbsp;so&nbsp;what we see in practice is that the people who have these&nbsp;accounts, they&nbsp;tend to not&nbsp;&#8230;&nbsp;First of all, they tend to be much wealthier people&nbsp;because&nbsp;they\u2019re&nbsp;tax advantages&nbsp;for wealthy people, not for people who are&nbsp;[of]&nbsp;much more modest means. And when they go to get care,&nbsp;there\u2019s&nbsp;usually not that much money in the account to help them pay for these much larger deductibles and out-of-pocket costs. And&nbsp;so&nbsp;they\u2019re&nbsp;paying for&nbsp;a lot more when they need&nbsp;the care. The insurance kicks in at a much higher level of&nbsp;spend. And&nbsp;so&nbsp;the&nbsp;financial burden, even though&nbsp;they\u2019ve&nbsp;paid lower premiums when they need&nbsp;the care, the financial hit is on the individual.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>So why shouldn\u2019t 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.&nbsp;Right?&nbsp;<\/p>\n\n\n\n<p><strong>Blumberg:&nbsp;<\/strong>Well, it would,&nbsp;at a particular moment in time, but the problem is we don\u2019t stay healthy&nbsp;all of&nbsp;the time.&nbsp;And so,&nbsp;I\u2019m&nbsp;not born with a stamp on my head that says,&nbsp;<em>You\u2019re&nbsp;going to be a low spender,&nbsp;and so&nbsp;you\u2019re&nbsp;going to be better off over here.<\/em>&nbsp;All I need is a broken leg. All I need is somebody in my family to develop diabetes. God&nbsp;forbid,&nbsp;a kid gets hit by a&nbsp;car,&nbsp;or&nbsp;develops a brain tumor. Stuff happens from&nbsp;out of the blue. And then,&nbsp;if&nbsp;that\u2019s&nbsp;the case, if&nbsp;I\u2019m&nbsp;in a situation that could really make it so that I&nbsp;can\u2019t&nbsp;access,&nbsp;or my loved ones&nbsp;can\u2019t&nbsp;access,&nbsp;the care that they need when they need it.&nbsp;And by the way, as&nbsp;we age, everybody tends to use&nbsp;more and more&nbsp;care.&nbsp;<\/p>\n\n\n\n<p>So,&nbsp;you can save money at a moment of time by segmenting risk in these ways, but if you do it,&nbsp;you\u2019re&nbsp;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&nbsp;care spending,&nbsp;it\u2019s&nbsp;a situation where what you save when&nbsp;you\u2019re&nbsp;healthy from segmenting risk is&nbsp;really pretty&nbsp;small compared&nbsp;to the extra amount you&nbsp;have to&nbsp;spend for pooling risk. Because if you take these dollars,&nbsp;and you spread them over everybody, then the increment that you&nbsp;have to&nbsp;spend&nbsp;in order to&nbsp;make sure&nbsp;you\u2019re&nbsp;protected,&nbsp;and everybody else is protected when they need medical care,&nbsp;is not that big.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Is there some ideological&nbsp;reason why&nbsp;Republicans&nbsp;seem to be&nbsp;coalescing around these risk-segmentation ideas?&nbsp;<\/p>\n\n\n\n<p><strong>Blumberg:&nbsp;<\/strong>I\u2019m&nbsp;not a psychologist, so the motivation escapes me.&nbsp;Because I do think people are better off over the course of their lifetimes when we spread risk broadly.&nbsp;I think part of the issue&nbsp;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&nbsp;really wealthy&nbsp;people, if they get sick and have a high-deductible plan,&nbsp;or they have a much&nbsp;more narrow&nbsp;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.&nbsp;They can pay for&nbsp;various different&nbsp;medications.&nbsp;<\/p>\n\n\n\n<p>If they have&nbsp;a very serious&nbsp;illness,&nbsp;or injury&nbsp;that\u2019s&nbsp;longer lasting, they may not&nbsp;\u2014&nbsp;even wealthy people&nbsp;\u2014&nbsp;may not be able to cover the costs,&nbsp;or it may really have&nbsp;a big impact&nbsp;on them.&nbsp;But by and large, wealthy&nbsp;people&nbsp;are able to&nbsp;insulate&nbsp;themselves to some degree, even&nbsp;with very&nbsp;pared-down coverage. Whereas somebody&nbsp;who\u2019s&nbsp;middle-income, who\u2019s&nbsp;lower-income,&nbsp;who\u2019s&nbsp;not super wealthy, is not going to be able to access that care. So,&nbsp;if your focus is on protecting the assets of those with a lot of wealth, this is&nbsp;a positive&nbsp;in that regard.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>So how does this ongoing debate about these enhanced premium subsidies play into this whole thing?&nbsp;<\/p>\n\n\n\n<p><strong>Blumberg:&nbsp;<\/strong>When&nbsp;we\u2019re&nbsp;talking about the enhanced premium tax credits, which seem to be,&nbsp;by the end of this week,&nbsp;will&nbsp;be going by the&nbsp;wayside,&nbsp;those are&nbsp;actually pooling&nbsp;mechanisms,&nbsp;too. And I think it\u2019s important for people to understand that financial assistance for lower-&nbsp;and middle-income people, one of the great things that it does&nbsp;\u2014&nbsp;as a secondary effect of just giving those people insurance coverage&nbsp;\u2014&nbsp;is it brings a lot more healthier people into the pool. People who are healthy, young, who&nbsp;wouldn\u2019t&nbsp;have been able to afford health insurance coverage before,&nbsp;and so would have&nbsp;remained&nbsp;uninsured and did before these credits were in place. It brings them into the pool. It lowers the average medical expenses&nbsp;of people insured.&nbsp;And by pooling risk in that way, it&nbsp;actually lowers&nbsp;the premium.&nbsp;Because as the average cost of the individuals enrolled goes down, the premiums go down,&nbsp;too.&nbsp;<\/p>\n\n\n\n<p>And so one of the things besides these other strategies,&nbsp;which would tend to segment risk further, as we talked about, the strategy that they are denying&nbsp;\u2014&nbsp;which is continuing these enhanced subsidies&nbsp;\u2014&nbsp;is also going to further segment risk because it\u2019s going to push healthier people out of the pool that can\u2019t afford it anymore. Same with, by the way, the&nbsp;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&nbsp;actually helping&nbsp;to subsidize American citizens who are less healthy. And&nbsp;so&nbsp;by saying,&nbsp;<em>Listen,&nbsp;we\u2019re&nbsp;not going to let you in.&nbsp;We\u2019re&nbsp;not going to give you subsidies to make it affordable for you to come in.<\/em>&nbsp;We\u2019re&nbsp;actually pushing&nbsp;the average cost of the health insurance coverage upward for no good reason, honestly.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Linda Blumberg, thanks very much.&nbsp;<\/p>\n\n\n\n<p><strong>Blumberg:&nbsp;<\/strong>My pleasure. Good to see you.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>OK,&nbsp;we\u2019re&nbsp;back.&nbsp;It\u2019s&nbsp;time for our&nbsp;extra-credit&nbsp;segment.&nbsp;That\u2019s&nbsp;where we each recognize the story we read this&nbsp;week&nbsp;we think you should read,&nbsp;too.&nbsp;Don\u2019t&nbsp;worry&nbsp;if you miss it;&nbsp;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\u2019t you go first?&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong>Yeah, thank you. I had a&nbsp;story&nbsp;just published today.&nbsp;It\u2019s&nbsp;in Bloomberg:&nbsp;\u201c<a href=\"https:\/\/www.bloomberg.com\/news\/features\/2025-12-11\/abbott-presses-congress-for-legal-shield-over-preemie-baby-formula-lawsuits\" target=\"_blank\" rel=\"noreferrer noopener\">Abbott Fired a Warning Shot on Baby Formula \u2014 Then Launched a Lobbying Blitz<\/a>.\u201d&nbsp;And I took a deep look at this issue of preterm infant&nbsp;formula.&nbsp;So,&nbsp;for&nbsp;preemies&nbsp;that are born&nbsp;really early, there\u2019s this big debate right now on whether formula is harming them,&nbsp;or whether it\u2019s something else that\u2019s causing one a day,&nbsp;essentially,&nbsp;to die from this awful disease, necrotizing enterocolitis.&nbsp;And&nbsp;so&nbsp;Abbott is struggling because they don\u2019t make a lot of money&nbsp;off of&nbsp;this formula, but they\u2019re being sued for billions and billions of dollars.&nbsp;So&nbsp;they really want Congress, any agency, the White House, whoever, to intervene in some way.&nbsp;<\/p>\n\n\n\n<p>They\u2019re&nbsp;throwing everything at the wall to see what can stick. And I\u2019ll just say one tidbit that I&nbsp;found that&nbsp;was&nbsp;really interesting.&nbsp;There\u2019s&nbsp;a lot of debate. There was an NIH&nbsp;[National Institutes of Health]&nbsp;report on this disease recently that moved in Abbott\u2019s 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&nbsp;Abbott,&nbsp;and&nbsp;lists them as a client. So&nbsp;that\u2019s&nbsp;an interesting conflict of interest there,&nbsp;maybe a&nbsp;hook to get&nbsp;you guys&nbsp;to go read it. Thanks.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Oops.&nbsp;I\u2019m&nbsp;definitely going&nbsp;to go read it.&nbsp;Maya, why don\u2019t you go next?&nbsp;<\/p>\n\n\n\n<p><strong>Goldman:&nbsp;<\/strong>Yeah,&nbsp;I\u2019m&nbsp;excited to read that, Anna.&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong>Thank you.&nbsp;<\/p>\n\n\n\n<p><strong>Goldman:&nbsp;<\/strong>My extra credit this week is from ProPublica.&nbsp;It\u2019s&nbsp;by Aliyya Swaby and&nbsp;it\u2019s&nbsp;called&nbsp;\u201c<a href=\"https:\/\/null\/\" target=\"_blank\" rel=\"noreferrer noopener\">These Health Centers Are Supposed&nbsp;To Make Care Affordable. One Has Sued Patients for as Little as $59 in Unpaid&nbsp;Bills.<\/a>\u201d&nbsp;There are a lot of details in the story, but&nbsp;I think the headline&nbsp;tells you the gist of it. But what stuck out to me about this is I think in health journalism and health policy, we&nbsp;often talk about the safety net as if&nbsp;it\u2019s&nbsp;magic and going to catch everyone, or at least I find myself slipping into that mindset sometimes. And I think&nbsp;it\u2019s&nbsp;really important&nbsp;to&nbsp;look into&nbsp;how people on the ground are&nbsp;actually experiencing&nbsp;these services. And&nbsp;it\u2019s&nbsp;also a reminder, unfortunately, that there are bad actors everywhere.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Alas. Sheryl.&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>So,&nbsp;my extra credit this week is&nbsp;actually more&nbsp;of a science&nbsp;policy story than a health&nbsp;policy story, but it is a fascinating yarn.&nbsp;It\u2019s&nbsp;titled&nbsp;\u201c<a href=\"https:\/\/www.nytimes.com\/2025\/12\/07\/us\/china-virologist-li-meng-yan-coronavirus.html\" target=\"_blank\" rel=\"noreferrer noopener\">The Married Scientists Torn Apart by a COVID Bioweapon Theory<\/a>.\u201d&nbsp;It\u2019s&nbsp;in The New York Times by my colleague Katie J.M. Baker. And this is the story of two Chinese virologists who were married,&nbsp;and the woman came to believe that&nbsp;covid&nbsp;was a bioweapon created in a lab,&nbsp;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\u2019s ally, and an exiled&nbsp;Chinese billionaire who had reason to want to blame the Chinese government,&nbsp;and who brought her to the United States, placed her in a series of safe houses once she arrived,&nbsp;and arranged for her to meet some of Trump\u2019s top advisers.&nbsp;<\/p>\n\n\n\n<p>And she has now gone underground,&nbsp;and her husband&nbsp;actually moved&nbsp;to the United States to try to find her. And&nbsp;she\u2019s&nbsp;basically in&nbsp;hiding.&nbsp;She\u2019s&nbsp;cut off contact with her family.&nbsp;And it\u2019s heartbreaking,&nbsp;and poignant,&nbsp;and also,&nbsp;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.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah, it is quite the story. All right. My extra credit this week is from&nbsp;The Washington Post.&nbsp;It\u2019s&nbsp;called&nbsp;<a href=\"https:\/\/www.washingtonpost.com\/health\/2025\/12\/08\/h1b-visa-fees-rural-health\/\" target=\"_blank\" rel=\"noreferrer noopener\">\u201cRural America Relies on Foreign Doctors. Trump\u2019s Visa Fee Shuts Them Out,\u201d<\/a>&nbsp;by David Ovalle. And&nbsp;we\u2019ve&nbsp;talked about this issue before. These fees were&nbsp;mainly aimed&nbsp;at tech companies,&nbsp;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&nbsp;don\u2019t&nbsp;want to practice. This story centers on an overworked kidney disease practice in North Carolina&nbsp;that\u2019s&nbsp;still waiting on a U.S.-trained doctor that it hired months ago,&nbsp;who is stuck in India.&nbsp;We\u2019ve&nbsp;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&nbsp;it\u2019s&nbsp;making that even worse.&nbsp;&nbsp;<\/p>\n\n\n\n<p>OK, that is this week\u2019s show.&nbsp;Thanks to our editor, Emmarie Huetteman,&nbsp;and our producer-engineer,&nbsp;Taylor Cook. A&nbsp;reminder:&nbsp;<em>What&nbsp;the Health?<\/em>&nbsp;is now available on WAMU platforms, the NPR app, and wherever you get your podcast, as well as,&nbsp;of course,&nbsp;<a href=\"https:\/\/kffhealthnews.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">kffhealthnews.org<\/a>. Also, as always, you can email&nbsp;us&nbsp;your comments or questions.&nbsp;We\u2019re&nbsp;at whatthehealth@kff.org, or you can find me still on X&nbsp;<a href=\"https:\/\/jrovner\/\" target=\"_blank\" rel=\"noreferrer noopener\">@jrovner<\/a>&nbsp;or on Bluesky&nbsp;<a href=\"https:\/\/bsky.app\/profile\/julierovner.bsky.social\" target=\"_blank\" rel=\"noreferrer noopener\">@julierovner<\/a>. Where are you folks hanging these days, Maya?&nbsp;<\/p>\n\n\n\n<p><strong>Goldman:&nbsp;<\/strong>I am on X&nbsp;<a href=\"https:\/\/x.com\/mayagoldman_\" target=\"_blank\" rel=\"noreferrer noopener\">@mayagoldman_<\/a>&nbsp;and on LinkedIn under my name.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Anna?&nbsp;<\/p>\n\n\n\n<p><strong>Edney:&nbsp;<\/strong><a href=\"https:\/\/x.com\/annaedney\" target=\"_blank\" rel=\"noreferrer noopener\">X<\/a>&nbsp;or&nbsp;<a href=\"https:\/\/bsky.app\/profile\/annaedney.bsky.social\" target=\"_blank\" rel=\"noreferrer noopener\">Bluesky<\/a>&nbsp;@AnnaEdney,and&nbsp;LinkedIn as well.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Sheryl.&nbsp;<\/p>\n\n\n\n<p><strong>Stolberg:&nbsp;<\/strong>And&nbsp;I\u2019m&nbsp;on&nbsp;<a href=\"https:\/\/x.com\/SherylNYT\" target=\"_blank\" rel=\"noreferrer noopener\">X<\/a>&nbsp;and&nbsp;<a href=\"https:\/\/bsky.app\/profile\/sherylnyt.bsky.social\" target=\"_blank\" rel=\"noreferrer noopener\">Bluesky<\/a>&nbsp;@sherylnyt,&nbsp;and LinkedIn under my own name.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>We will be back in your feed next week. Until then, be healthy.&nbsp;<\/p>\n\n\t\t<\/div>\n\t<\/div>\n<\/section>\n\n\n\n<div class=\"wp-block-credits block--credits\">\n\t\t<h3 class=\"credits-title\">\n\t\tCredits\t<\/h3>\n\t\t<div class=\"credits-card-container twowide\">\n\t\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Taylor Cook<\/div>\n\t<div class=\"author-affiliation\">Audio producer<\/div>\n\t\t\t\t\t\t<div class=\"author-bio\">\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Emmarie Huetteman <\/div>\n\t<div class=\"author-affiliation\">Editor <\/div>\n\t\t\t\t\t\t<div class=\"author-bio\">\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\t<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><em><a href=\"https:\/\/kffhealthnews.org\/our-podcasts\/\"><u>Click here to find all our podcasts.<\/u><\/a><\/em><\/p>\n\n\n\n<p><em>And subscribe to &#8220;What the Health? From KFF Health News&#8221; on <a href=\"https:\/\/podcasts.apple.com\/us\/podcast\/what-the-health\/id1253607372?mt=2\"><u>Apple Podcasts<\/u><\/a>, <a href=\"https:\/\/open.spotify.com\/show\/32EdsB662C3oyIrqLMmBXI?si=TQhRjzzLTgWtK3crfbOFtA\"><u>Spotify<\/u><\/a>, <a href=\"https:\/\/app.npr.org\/aggregation\/fis-1269164038\"><u>the NPR app<\/u><\/a>, <a href=\"https:\/\/www.youtube.com\/playlist?list=PL5Qew-7pSXbAucCUQnyRx6qpLglzrxzFb\" target=\"_blank\" rel=\"noopener\">YouTube<\/a>, <a href=\"https:\/\/play.pocketcasts.com\/web\/podcasts\/a379e280-3f57-0135-9028-63f4b61a9224\"><u>Pocket Casts<\/u><\/a>, or wherever you listen to podcasts.<\/em><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dec. 15 is the deadline to sign up for Affordable Care Act plans that begin Jan. 1, and Congress remains at odds over letting expanded tax credits for the plans\u2019 premiums expire and increasing the cost of insurance for millions of Americans. 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