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Julie Rovner Ñî¹óåú´«Ã½Ò•îl Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of Ñî¹óåú´«Ã½Ò•îl Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

At the Trump administration’s request, a federal judge in Louisiana this week agreed to delay a ruling affecting the continued availability of the abortion drug mifepristone. That angered anti-abortion groups that want the drug, if not banned, at least more strictly controlled. But the administration clearly wants to avoid big abortion fights in the run-up to November’s midterm elections.

Meanwhile, the administration’s proposed budget for fiscal year 2027 calls for more than $15 billion in cuts to programs at the Department of Health and Human Services. It’s a significant number, but less drastic than cuts it proposed for fiscal 2026.

This week’s panelists are Julie Rovner of Ñî¹óåú´«Ã½Ò•îl Health News, Lauren Weber of The Washington Post, Alice Miranda Ollstein of Politico, and Maya Goldman of Axios.

Panelists

Maya Goldman Axios Alice Miranda Ollstein Politico Lauren Weber The Washington Post

Among the takeaways from this week’s episode:

• The Trump administration says it is conducting a thorough scientific review of the abortion pill mifepristone at the Food and Drug Administration. Yet advocates on both sides of the abortion debate think the administration is just trying to buy time to avoid a controversial decision about medication abortion before November’s midterm elections.
• It’s budget time on Capitol Hill. With the unveiling of the president’s spending plan for fiscal 2027, Cabinet secretaries will make their annual tour of congressional committee hearings. HHS Secretary Robert F. Kennedy Jr., whose Hill appearances have been few during his tenure, is scheduled to testify before six separate House and Senate committees before the end of the month.
• Back at HHS, Kennedy appears to be trying to reconstitute the Advisory Committee on Immunization Practices in a way that will enable him to restock it with vaccine skeptics without running afoul of a March court ruling that he violated federal procedures with his replacements last year.
• Continuing his efforts to promote his Make America Healthy Again agenda, Kennedy announced this week that he will launch his own biweekly podcast. He also announced efforts to combat microplastics in the water supply and to get hospitals to stop serving ultraprocessed food to patients.

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

Julie Rovner: The Atlantic’s “,” by Katherine J. Wu.

Maya Goldman: Ñî¹óåú´«Ã½Ò•îl Health News’ “Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records,” by Amanda Seitz and Maia Rosenfeld.

Lauren Weber: CNN’s “,” by Holly Yan.

Alice Miranda Ollstein: Politico’s “,” by Simon J. Levien.

Also mentioned in this week’s podcast:

• JAMA Internal Medicine’s “,” by Lauren J. Ralph, C. Finley Baba, Katherine Ehrenreich, et al.
• Ñî¹óåú´«Ã½Ò•îl Health News’ “Immigrant Seniors Lose Medicare Coverage Despite Paying for It,” by Vanessa G. Sánchez, El Tímpano.
• The New York Times’ “,” by Ellen Barry.
• Stateline’s “,” by Nada Hassanein.
• The Washington Post’s “,” by Lena H. Sun.

Click to open the transcript Transcript: Abortion Pills, the Budget, and RFK Jr.

[Editor’s note:ÌýThis transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]Ìý

Julie Rovner:ÌýHello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome toÌýWhat the Health?ÌýI’mÌýJulie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News, andÌýI’mÌýjoined by some of the best and smartest health reporters covering Washington.ÌýWe’reÌýtaping this week on Thursday,ÌýApril 9, at 9:30Ìýa.m.ÌýAs always, news happens fast, and things might have changed by the time you hear this. So here we go.Ìý

Today, we are joined via video conference by Lauren WeberÌýofÌýThe Washington Post.Ìý

Lauren Weber:ÌýHello,Ìýhello.Ìý

Rovner:ÌýAlice MirandaÌýOllsteinÌýof Politico.Ìý

Alice MirandaÌýOllstein:ÌýHi,Ìýeverybody.Ìý

Rovner:ÌýAnd my fellow Michigan Wolverine this national championship week,ÌýMaya Goldman of Axios.ÌýGo,ÌýBlue!Ìý

Maya Goldman:ÌýGo,ÌýBlue.Ìý

Rovner:ÌýNo interview this week, but plenty of news.ÌýSoÌýlet’sÌýget rightÌýtoÌýit.ÌýWe’reÌýgoing to start with reproductive health. On Tuesday, a federal judge in Louisiana ruled for the Trump administration and against anti-abortion forces in a lawsuit over the availability of the abortion pillÌýmifepristone.ÌýWait, what? Please explain,ÌýAlice,Ìýhow the administration and anti-abortion groups ended up on opposite sides of an abortion pill lawsuit.Ìý

Ollstein:ÌýYeah.ÌýSoÌýthis has been building for a while, and it is not the only lawsuit of its kind out there. There are several.ÌýAÌýbunch of different state attorneys general,Ìýwho are very conservative and anti-abortion, have been suing the FDAÌýin an attempt toÌýeither completely getÌýrid of the availabilityÌýof the abortion pillÌýmifepristoneÌýor reimpose previous restrictions on it.ÌýSo right now, at least according to federal rules, not according to every state’sÌýrules,Ìýyou can get it via telehealth.ÌýYou can get it delivered byÌýmail. You can pick it up at a retailÌýpharmacy. YouÌýdon’tÌýhave to get it in person handed to you from a doctor like you used to.ÌýSoÌýthese lawsuits areÌýattemptingÌýto bring back those restrictions or get the kind of national ban that a lot of groups want.ÌýAndÌýsoÌýyou haveÌýother onesÌýpending:ÌýFlorida, Texas,ÌýMissouri,Ìýyou have a bunch of ones.ÌýSoÌýthis is the Louisiana version. And the Trump administration,Ìýit’sÌýimportant to note, they are not defending the FDA or the abortion pill on the merits. They are saying,ÌýweÌýdon’tÌýwant this lawsuit and this court to force us to do something.ÌýWe want to go through our own careful process and do our own internal review of the safety of mifepristone, and then we may decide to impose restrictions. ButÌýthey’reÌýasking courts to give them the time and space to complete that process and saying, you know,ÌýThisÌýis our power we should have in the executive branch. And so,Ìýin this case, the judge,Ìýin ruling for the Trump administration,Ìýbasically justÌýhit pause. ThisÌýdoesn’tÌýget rid of the case. It just putsÌýa stay on it for now, andÌýthat’sÌýimportant.ÌýIn some of these other cases, the Trump administration has asked the courts to throw out the case, but that was not the situation here.ÌýSoÌýthisÌýdoesn’tÌýmean that abortion pills are going to be available forever. ThisÌýdoesn’tÌýmeanÌýnothing’sÌýgoing to happen,ÌýandÌýthey’reÌýgoing to be banned. This just means, you know,Ìýwe’reÌýkicking the can down the road.ÌýÌý

Rovner:ÌýI was saying,Ìýjust to be clear. I mean, we know that this FDA quote-unquoteÌý“study”Ìý—Ìýwhether it is or isn’t going onÌý—Ìýis part of, kind of,Ìýa delaying tactic by the administration, because they don’t want to really make abortion a big front-and-center issue in the midterms.ÌýSoÌýthey’reÌýtrying toÌýsort of runÌýthe clock out here. Is that notÌýsort of theÌýinterpretationÌýthat’sÌýgoing on right now?ÌýÌý

Ollstein:ÌýThat’sÌýwhat people on both sides assume is going on.ÌýIt’sÌýreally been fascinating how everyone is being kept in the dark aboutÌýwhat’sÌýhappening inside the FDAÌý—Ìýand if this review is even happening, ifÌýit’sÌýreal, ifÌýit’sÌýin good faith, what is it based on? AndÌýsoÌýit’sÌýbecome this sort of Rorschach test,Ìýwhere people on the left are saying, you know,ÌýThey’reÌýlaying the groundwork to do a national ban. This is justÌýpoliticalÌýcover. They just want to wait until after the midterms, and thenÌýthey’reÌýgoing to go for it. And people on the right are saying, you know,ÌýTheÌýadministration is cowardly, and theyÌýaren’tÌýreally doing anything, andÌýthey’reÌýjust trying to get us to shut up and be patient. WeÌýdon’tÌýknow if either of those interpretations orÌýneither ofÌýthemÌýare true.ÌýÌý

Rovner:ÌýLauren,ÌýyouÌýwant to add something?Ìý

Weber:ÌýI just think it’sÌýpretty clearÌýthis is also just on aÌý[Health and Human Services Secretary Robert F.]ÌýKennedyÌý[Jr.]Ìýpriority.ÌýI mean,Ìýlet’sÌýgo back. The manÌý…Ìýcomes from oneÌýofÌýthe top Democratic political families originally. You know,Ìýthere’sÌýobviously been a lot of chatter around his anti-abortion beliefs. Now, obviously,Ìýhe’sÌýon a Republican ticket. I think some of that plays into this as well. And he already has his hand on the stove on so many otherÌýhot issuesÌýthat,Ìý[if]ÌýI had to guess,ÌýIÌýdon’tÌýthink thatÌýthey’reÌýtrying to rock the boat on this one.Ìý…ÌýI think, some background context too, to some ofÌýwhat’sÌýgoing on.ÌýÌý

Rovner:ÌýWe’llÌýget to some of those hotter issues. But,Ìýmeanwhile, the Journal of the American Medical AssociationÌý[Internal Medicine]Ìýhas aÌýÌýsuggesting that medication abortion is so safe that it could be provided over the counterÌý—Ìýthat’sÌýwithout any consultation with a medical professional, either in person or online. ThisÌýdoesn’tÌýfeel likeÌýit’sÌýgoing to happen anytime soon, though, right? WhileÌýwe’reÌýstill debating the existence of medication abortion in general.Ìý

Ollstein:ÌýThat’sÌýright. I mean, there are a lot of people whoÌýcan’tÌýget this medication prescribed by a valid doctor right now, let alone over the counter. I will say it is common in a lot of parts of the world to get it over the counter,ÌýwhereasÌýin the United States, the most common way to have a medication abortion is with a two-pill combination,ÌýmifepristoneÌýand misoprostol. In a lot of parts of the world, people just use misoprostol alone, and it isÌýeffectiveÌýand it isÌýlargely safe.ÌýIt’sÌýslightly less safe than using both pills together. AndÌýsoÌýI thinkÌýthere’sÌýa lot of international data out there, and people point to that and advocate for this. And I will say there are activist groups in the United States who are setting up networks, underground networks, to get these pills to people with no doctor’s involvement. And so that is already going on. I think that a lot of people would prefer to get it from a doctor if they could.ÌýBut because of bans and restrictions, theyÌýcan’t. AndÌýsoÌýpeople are turning to these activist groups.Ìý

Rovner:ÌýI will point out, as a person who covered the entirety of the fight to have emergency contraceptionÌý—Ìýwhich is not the abortion pillÌý—Ìýmade over theÌýcounter,Ìýit took like, 15 years. It shortened myÌýlifeÌýcovering that story. Lauren, did youÌýwant to add something?ÌýÌý

Weber:ÌýYeah, I just wanted to say I find itÌýreally interesting.ÌýObviously, reproductive issues end up taking 15 years, as you pointed out, to make it over the counter.ÌýBut there are a lot of things that are considered potentially more dangerous that you canÌýorder upÌýinÌýa pretty basic telehealth visit or even just buy in not-so-sketchy ways that the administration is also even looking to deregulate.ÌýSoÌýI think the differencesÌýofÌýaccessÌýofÌýthis compared to other less studied, potentially more unsafe medication is quite striking.Ìý

Goldman:ÌýPart ofÌý[President Donald]ÌýTrump’sÌý“GreatÌýHealthcareÌýPlan”Ìýis making more medications available over the counter.ÌýSoÌýthis is certainly something that they have said they want to do, in general.ÌýThis is a political nightmare, though, to do that for abortion.Ìý

Ollstein:ÌýYeah,Ìýand people have been pointing to this and a lot of other policies for a while to argue about something they call abortion exceptionalism, in which people apply a different standard to anything related to abortion, a different safety standard, a different standard of scrutiny than they do to medications for lots of other purposes.ÌýAndÌýyou’veÌýseen that, and that comes up in lawsuits and political arguments about this. And I think,Ìýyou know, people can point to this as another example.Ìý

Rovner:ÌýSo last week, weÌýtalked about the federal family planning programÌýTitleÌýX, which finally got funded after months of delays. But Alice, you warned us that the administration was planning to make someÌýbig changesÌýto the program, and now those have finally been announced. Tell us what the plan is for a program that’s provided birth control and other types of primary and preventive care since the early 1970s.Ìý

Ollstein:ÌýWell, the changes haveÌýsort ofÌýbeen announced. They’veÌýmore been teased. What we are still waiting for is an actual rule,Ìýlike we saw in the first Trump administration, that would impose conditions on the program. AndÌýsoÌýwhat we saw recently, it was part of a wonky document called aÌý“Notice of Funding Opportunity,”Ìýor NOFO, for those in the D.C.Ìýlingo. AndÌýbasicallyÌýit was signaling that when groups reapplyÌý—Ìýthey just got this year’s money,Ìýbut when they reapply for next year’s moneyÌý—Ìýit sets upÌýsort of newÌýpriorities and a new focus for the entire program. And what was really striking to me is, youÌýknow,Ìýthis is a family planning program. It was created in the 1970s and it is primarily about delivering contraception to people who can’t afford it around the country, providing it to millions of peopleÌýwhoÌýdepend on this program, and the wordÌý“contraception”Ìýdid not appear in the entire 70-page document other than an assertion that it is overprescribed and has bad side effects. And instead, they signaled that they want to shift the program to focus on, quote,Ìý“family formation.”ÌýSoÌýthis is really striking to me.ÌýI think weÌýsaw some signs that something like this was coming. You know, about a year ago, there was someÌýTitleÌýXÌýmoney approved to focus on helping people struggling with infertility.ÌýBut that wasÌýsort of justÌýa subset of the program, and now it looks like they want to make that, you know, an overriding focus of the program.ÌýSoÌýI think when the actual rule to this effect drops, and weÌýdon’tÌýknow when that will beÌý—Ìýwill they wait till after the midtermsÌýto, you know, avoid blowback? Who knows? I think there will certainly be lawsuits then.ÌýBut I think right now, this is just sort of a sign of where they want to go in the future.ÌýAndÌýit’sÌýimportant to note that it came very quickly on the heels of a big backlash from the anti-abortion movement over the approval of this year’s funding going out toÌýall ofÌýthe clinics that got it before, including Planned ParenthoodÌýclinics.ÌýTheÌýanti-abortion groups were agitating for Planned Parenthood to be cut off at once, you know, not in the future,Ìýright now.Ìý

Rovner:ÌýJust to remind people that the ban on Planned ParenthoodÌýfunding fromÌýlast year was for Medicaid, not for theÌýTitleÌýXÌýprogram.Ìý

Ollstein:ÌýRight.ÌýÌý

Rovner:ÌýAnd that’s why Planned Parenthood got money.Ìý

Ollstein:ÌýYes, and Planned Parenthood is not allowed to use any Medicaid orÌýTitleÌýXÌýmoneyÌýfor abortions, but the anti-abortion groups say it functions like a backdoor subsidy, and so they wanted it to beÌýcutÌýoff.ÌýSoÌýthey were very pissed that this money went out to Planned Parenthood. And so very quickly after,Ìýthe administration put out this document, saying,ÌýLook, we are taking things in another direction, and it is not the direction of Planned Parenthood.Ìý

Rovner:ÌýLauren,ÌýyouÌýwant to add something?Ìý

Weber:ÌýOh, I just wanted to say Alice has really been owning the beat on all theÌýTitleÌýXÌýcoverage, soÌý…Ìý

Rovner:ÌýAbsolutely.ÌýÌý

Weber:Ìý…Ìýglad weÌýare able toÌýhave her explain it to us.ÌýButÌýjust wanted to throw outÌýaÌýkudos for breaking all the news on that front.ÌýÌý

Goldman:ÌýYeah, great coverage.Ìý

Rovner:ÌýYes.ÌýVery happyÌýto have youÌýforÌýthis. Turning to the budget, which is normally the major activity for CongressÌýin the spring, we finally got President Trump’s spending blueprint last week. It does propose cuts to discretionary spending at the Department of Health and Human Services to the tune of aboutÌý$15 billion,Ìýbut those cuts are far less deep than those proposed last year.ÌýAnd,Ìýas we have noted, Congress didn’tÌýactually cutÌýthe HHS budget last year by much at all.ÌýAnd many programs, like the National Institutes of Health,Ìýactually gotÌýsmall increases. Is this budget a reflection of the fact that the administration is recognizing that cuts toÌýHealth andÌýHumanÌýServices programsÌýaren’tÌýactually popularÌýwith the public or with Congress, for that matter, going into a midterm election?Ìý

Weber:ÌýI thinkÌýit’sÌýthat last little piece you mentioned there, Julie. I thinkÌýit’sÌýtheÌý“going into the midterm election.”ÌýI think youÌýhit the nail on the headÌýthere. Cuts are also not good economically for many Republicans.ÌýYou know, we saw Katie Britt be one of theÌý— theÌýAlabama Republican senatorÌý—Ìýbe one of the most outspoken senators in general about some of the cuts that were floated for the budget for HHS last year.ÌýSoÌýI think whatÌýyou’reÌýhinting at, and whatÌýwe’reÌýgetting at, is thatÌýit’sÌýnot politicallyÌýpopular,Ìýit can be economically problematic, on top of the scientific advances that are not found.ÌýSoÌýI suspect you are rightÌýonÌýthat.Ìý

Ollstein:ÌýThe administration knows that this isÌý“hopes and dreams”Ìýand will not become reality. It did not become reality last year. It almost never becomes reality. And I think you can see the sort of acknowledgement that this is about sending a message more than actually making policy in things likeÌýTitleÌýX, because at the sameÌýtime they put out this guidance from HHS about the future ofÌýTitleÌýX, moving away from contraception,Ìýin theÌýpresident’s budget heÌýproposed completely getting rid ofÌýTitleÌýX, completely defunding it, which he has in the past as well. And so why would they put out guidance for a program thatÌýdoesn’tÌýexist?Ìý

Goldman:ÌýI think,Ìýalso, this is the second budget thatÌýthey’reÌýputting out in this administration, right? So now they are just a little more used toÌýwhat’sÌýgoing on, and they have more of their feet under them.Ìý

Weber:ÌýAsÌýa preview for listeners,Ìýtoo,ÌýI’mÌýsure we will have Kennedy asked about this budget when he appears in a series of so many hearings next week and the week after. And there were a lot of fireworks last year with him and various members of Congress about the budget.ÌýSoÌýI am sure that we will hear a lot more on this front in theÌýweeks to come.Ìý

Rovner:ÌýYeah, I would say that’s one thing that the budget process does, is when theÌýpresident finally puts out a budget, the CabinetÌýsecretaries travel to all of the various committees on Capitol Hill to, quote,Ìý“defend theÌýpresident’s budget,”Ìýwhich is sometimes or,ÌýI guess in the case of Kennedy, one of the few chances that they get to actually have him in person to ask him questions. But in the meantime, you know, we have the budget, then we have the president himself, who at an Easter lunch last weekÌý—Ìýthat was supposed to be private, but ended up beingÌýlive-streamedÌý—Ìýsaid, and I quote,Ìý“It’s not possible for us to take care of dayÌýcare, Medicare, Medicaid, all these individual things.” The president went on to say that states should take over all that social spending, and the only thing the federal government should fund is, quote,Ìý“military protection.”ÌýDidÌýI justÌýhearÌýa thousandÌýDemocratic campaign ads bloom?Ìý

Goldman:ÌýI think thisÌýis a prime example of when you should take Trump seriously, butÌýnot literally. IÌýdon’tÌýthink thatÌýthere’sÌýany world, at least in theÌýforeseeable future, where the federal governmentÌýisn’tÌýfunding Medicare.ÌýBut,Ìýyou know, you certainlyÌýhave toÌýwatch atÌýthe margins.ÌýIt’sÌýlike,Ìýit’sÌýnot a secret that this is something thatÌýthey’reÌýinterested in cutting backÌýspending on.ÌýIt’sÌýsuper politically difficult to do that, and they know that, and that’s part of why, whichÌýI’mÌýsureÌýwe’llÌýtalk about in a little bit,Ìýthey bumped up the payment rate for 2027 to Medicare Advantage plans.ÌýÌý

Rovner:ÌýWhich we will get to.Ìý

Goldman:ÌýYeah, so I mean,Ìýit’sÌýcertainly an eye-opening statement, and you should remember it. But IÌýdon’tÌýthink thatÌýwe’reÌýin immediate jeopardy here.Ìý

Rovner:ÌýThis is theÌýpresident who ran in 2024,Ìýyou know, saying that he was going to protect Medicare and Medicaid. I mean,Ìýit’sÌýbeen, you know, against some of the recommendations of his own administration. I was justÌýsort of shockedÌýto see these words come out of his mouth. Lauren,Ìýyou wantedÌýto sayÌýsomething?ÌýÌý

Weber:ÌýI mean,Ìýit’sÌýnotÌýthat surprising, though. I mean, look at what theÌýOneÌýBigÌýBeautiful BillÌý[Act]Ìýdid to Medicaid.ÌýHe’sÌýalready pushed through massive Medicaid cuts, which areÌýessentially beingÌýoffloaded to the states.ÌýSo, I mean, I think this ideology has alreadyÌýborneÌýout and will continue to bear out, and obviouslyÌýit’sÌýhappening amid the backdrop of a war. So that plays into, obviously, the commentary as well.ÌýÌý

Rovner:ÌýWell, meanwhile,ÌýRepublicans are still talking about doing another budget reconciliation bill, the 2.0 version of last year’sÌýBigÌýBeautifulÌýBill, except this time it’s essentially just to fund the military andÌýICEÌý[Immigration and Customs Enforcement]ÌýandÌýborderÌýcontrol, because Democrats won’t vote for those things, at least they won’t vote for additional military spending.ÌýWhat are the prospects for that toÌýactually happen?ÌýAnd would Republicans really be able to do it if those programs are paid for with more cuts to Medicare and/or Medicaid, as someÌýhave suggested?Ìý

Goldman:ÌýYou know, my co-worker Peter Sullivan wrote about this last week, and there was a lot ofÌýblowbackÌýfrom politicos, from advocates, from, you know,Ìýkind of acrossÌýthe spectrum of groups there. I think that it would be extremely politically unpopular, especially going into the midterms, to use healthÌýcare as an offset. But I would say that Republicans areÌýpretty goodÌýat rhetoric, right?ÌýThat’sÌýone of the things thatÌýthey’reÌýknown for right now, andÌýthere’sÌýalways a way to spin it.Ìý

Rovner:ÌýAlice and I spoke to a group earlier this week, and I went out on a limb and predicted that IÌýdidn’tÌýthink Republicans could get the votes for another big budget reconciliation this year. I mean, look at how close it was last year. The idea of cutting any deeper seems to me unlikely, just given the margins that they have.Ìý

Goldman:ÌýAndÌýI think thatÌýis something that youÌýdo inÌýbetween election years.ÌýThat’sÌýnot something you do in anÌýelection year.Ìý

Rovner:ÌýThat’sÌýtrue, yesÌý…Ìýyou do tend to see these bigger bills in the odd-numbered years rather than the even-numbered years, but …Ìý

Ollstein:ÌýAndÌýI thinkÌýit’sÌýimportant to remember that the reason Republicans are in this bind and that they feel like theyÌýhave toÌýkeep reconciliation nearly focused on funding immigration enforcement is because Democrats refuse to fund immigration enforcement.ÌýAndÌýsoÌýthey feel pressured to put all their effort and political capital towards that, andÌýdon’tÌýwant to mess that up by adding a bunch of otherÌýhealthÌýcare things that could cause fights and loseÌýthemÌývotes.ÌýÌý

Goldman:ÌýThe moneyÌýhas got toÌýcome from somewhere.Ìý

Rovner:ÌýAndÌýhealthÌýcare is where all the money is.ÌýSpeaking of Medicare and Medicaid,Ìýwhere most of the money is,Ìýthere is news on those fronts,Ìýtoo.ÌýMaya, as you hinted on Medicare, the administration is out with its payment rule for private Medicare Advantage plans for next year. And remember,Ìýwe talked about how HHS was going to really go after overbilling in Medicare Advantage and cut reimbursement dramatically?ÌýWell, you can forget all that. The final rule will provide plans with a 2.48% pay bump next year.ÌýThat’sÌýcompared to the less than 1% increase in the proposed rule.ÌýThat’sÌýa difference of aboutÌý$13 billion.ÌýThe final rule alsoÌýeliminatedÌýmany of the safeguards that were intended to prevent overbilling. What happened to the crackdown on Medicare Advantage?ÌýAre theirÌýlobbyists really that good?Ìý

Goldman:ÌýTheir lobbyists areÌýpretty good. This was a year where there wereÌý—ÌýI think CMSÌý[the Centers for Medicare & Medicaid Services]Ìýsaid there were a record number of public comments on their proposed rate, flat rate increase, flat rate update. But I thinkÌýit’sÌýalso not that surprising. Historically, the final rate announcement for Medicare Advantage isÌýalmost alwaysÌýa little higher than the proposed because they incorporateÌýadditionalÌýdata from the end of the previous year thatÌýwasn’tÌýavailable when first rate is proposed, theÌýinitialÌýrate isÌýproposed.ÌýButÌýcertainlyÌýthey backed away fromÌýa big changeÌýto risk adjustment, or,Ìýlike, the way to adjust payment based on how sick aÌýplan’sÌýenrollees are. You get more payÌý…ÌýÌý

Rovner:ÌýBecauseÌýthat’s where the overbilling was happening,Ìýthat we’d seen a lot of these wonderful stories that plans were basically, you know, inventing diagnoses for patients who didn’t necessarily have them or didn’t have a severeÌýillness, andÌýusing that to get additional payments.Ìý

Goldman:ÌýRight.ÌýAnd they did move forward with a plan to prevent diagnoses that are not linked to informationÌýthat’sÌýin a patient’s medical chart from being used for risk adjustment. But a lot of plansÌýhadÌýsaid, like,ÌýYeah, this is,Ìýthat’sÌýthe right thing to do, andÌýit’sÌýnot going to be that impactful for us. You know, overall, this is a win for health insurance. I think one thing to note is that Chris Klomp, the director of Medicare, said,ÌýWe’reÌýstill really focused on trying to right-size this program.ÌýThat’sÌýstill a priority for us as anÌýadministration, but we also want to safeguard it. AndÌýsoÌýI think insurersÌýare notÌýoff the hook entirely.ÌýThere’sÌýstill going to be a lot of scrutiny, but their lobbyists areÌýpretty good. And you know, no one wants to be seen as the candidate that cuts Medicare.Ìý

Rovner:ÌýAnd we haveÌýseen this before, that when Congress cutsÌý“overfunding”Ìýfor Medicare Advantage, the plans,Ìýseeing that theyÌýcan’tÌýmake its big profits,Ìýdrop out or they cut back on those extra benefits. And the beneficiaries complain because they’re losing their plans, or they’re losing their extra benefits, and they don’t really want to do that in an election year either, because there are a lot of people, many millions of people, who vote who are on these plans. So,Ìýin some ways, the plans have the administration over a political barrel, in addition to how good their lobbyists are.ÌýÌý

Well, apparently, oneÌýgroup that HHS is still cracking down on are legal immigrants with Medicare. Most of the publicity around the health cuts in last year’s budget bill focused on the cuts to Medicaid.ÌýButÌýwe at Ñî¹óåú´«Ã½Ò•îl Health News have a story this weekÌýabout legal immigrantsÌýwho’veÌýpaid into the Medicare system with their payroll taxes for years and are now being cut off from their Medicare coverage. This isÌýapparently theÌýfirst time an entire category of beneficiariesÌýareÌýhaving their Medicare taken away.ÌýI’mÌýsurprised thereÌýhasn’tÌýbeen more attention to this, orÌýifÌýit’sÌýjust tooÌýmuchÌýall happening at once.Ìý

Ollstein:ÌýI mean,Ìýthere’sÌýa lot happening at once, and even just in the space of immigrants’Ìýaccess to health care, there is so much happening at once. AndÌýsoÌýthis is obviously havingÌýa huge impactÌýon a lot of people, but so are 100 other things. And I think, you know, the zone has been flooded as promised. And really, state officials who are also dealing withÌýa thousandÌýother things, Medicaid cuts, you know, theseÌýfederal changes,Ìýwork requirements,Ìýare grappling with thisÌýas well.Ìý

Rovner:ÌýLauren,Ìýyou wantedÌýto add something?Ìý

Weber:ÌýYeah. I mean, I thought it was, there was a striking quote in the story from MichaelÌýCannon, whoÌýbasically said,ÌýTheÌýreason thisÌýisn’tÌýresonating is because thisÌýwon’tÌýupset the Republican base. And I thinkÌýthat’sÌýa striking quote to beÌýconsidered.Ìý

Rovner:ÌýMichaelÌýCannon, libertarian health policy expert,ÌýjustÌýkind of anÌýobserver to this one. ButÌýyeah, I thinkÌýthat’sÌýtrue. I mean, or at least the perception is that these are not Republican voters, although, you know, asÌýwe’ve seen, you know, Congress has tried to take aim at people they think aren’t their voters, and it’s turned out that those are their voters.ÌýSoÌýwe will see how this all plays out.ÌýÌý

Well,Ìýat the same time thatÌýthis is all going on, the folks over at the newsletterÌý“HealthcareÌýDive”Ìýare reporting that the Centers for MedicareÌý&ÌýMedicaid Services are trying to embark on all these new initiatives on fraud,Ìýand work requirements,Ìýand artificial intelligence with a diminished workforce.ÌýWhile CMS lost far fewer workers in theÌýDOGE [Department of Government Efficiency]Ìýcuts last year than many other of the HHS agenciesÌý—Ìýit was in the hundreds rather than theÌýthousandsÌý—ÌýCMS has long been understaffed,Ìýgiven the fact that it manages programs that provide health insurance to more than 160 million Americans through not just Medicare andÌýMedicaid, but also the Children’s Health Insurance Program and the Affordable Care Act. I know last week, FDAÌýCommissioner MartyÌýMakaryÌýsaid he wants to hire more workers to replace the 3,000 who wereÌýRIF’edÌýor took early retirement there at the FDA.ÌýAnd CMS does have lots of job openingsÌýbeing advertised.ÌýButÌýit’sÌýhard to see how replacing trained and experienced workers with untrained, inexperienced onesÌýareÌýgoing to improve efficiency, right?Ìý

Goldman:ÌýTangentially, I was talking to a health insurance executive yesterday who was saying that his team is so much bigger than CMS, and they cover a fraction of the market, and they’re often the ones coming to CMS and proposing ideas and working with CMS on it. IÌýdon’t,ÌýI think thatÌýis a dynamic that far predates this administration, butÌý…Ìý

Rovner:ÌýOh, absolutely.Ìý

Goldman:ÌýButÌýit’sÌýcertainly interesting. AndÌý…ÌýCMS hasÌývery ambitiousÌýplans, and not that many people to carry them out. But, you know, I think one thing that I also want to note is that when I talk to trade associations and stakeholders about thisÌýCMS, they are generally like, pretty support-Ìý…Ìýlike,Ìýthey say that they think they’re being heard, and they think that CMS and the career staff are doing, you know, the same kind of caliber of work that they’ve been doing, which I think is notable.Ìý

Rovner:ÌýAnd as we have mentioned many times, you know, Dr.Ìý[Mehmet]ÌýOz, the head of CMS, is very serious about his job and doing a lot ofÌýreally interestingÌýthings.ÌýIt’sÌýjust,Ìýit’sÌýhard, you know, in the federal government, if youÌýdon’tÌýhave the resources that you want toÌý…Ìýif youÌýdon’tÌýhave the resources to match your ambitions.ÌýLet’sÌýput it that way.ÌýÌý

Well, meanwhile, on the Medicaid front,Ìýwe’reÌýalready seeing states cutting back, and some of the results of those cutbacks.ÌýÌýonÌýhow psychiatric units are at risk of being shut down due to the Medicaid cuts, since they often serve a disproportionate number of low-income peopleÌýand alsoÌýtend to lose money.ÌýAndÌýThe New York Times has aÌýÌýof an Idaho Medicaid cutback of a program that had provided home visits to people living in the community with severe mental illness, until those people who lost the services began to die or to end up back in more expensive institutional care. Now the state has resumedÌýfundingÌýtheÌýprogram, butÌýobviously will end up having to cut someplace else instead. I know when Republicans in Congress passed the cuts last year, they said that people on Medicaid who were not the able-bodied working-age populationsÌýwouldn’tÌýsee their services cut. ButÌýthat’sÌýnot how this is playing out, right?ÌýÌý

Weber:ÌýI justÌýthink the story by Ellen Barry, who you should always readÌýonÌýmental health issues inÌýThe New York Times,Ìý“,”Ìýis such anÌýillustrative example of unintended consequences from these cuts.ÌýAnd the reason thatÌýthey’reÌýbeing reversedÌý—Ìýby Republican legislators, no lessÌý—Ìýin Idaho, is becauseÌýit’sÌýmore expensive to have cut the money from it than it is efficient. I mean, what they found was, isÌýthat after they cut the money to the schizophrenia program, they saw this massive uptick in law enforcement cases and hospitalizations, uninsured hospitalizations,Ìýthat this avoided. And I thinkÌýit’sÌýa real canary in the coalÌýmineÌýsituation, becauseÌýwe’reÌýonly starting to see these states cut these things off. And this wasÌýa pretty immediateÌýmultiple-death consequence. And I thinkÌýwe’reÌýgoing to see a lot of stories like this, of a variety of programs that we allÌýdon’tÌýeven have any idea thatÌýexistÌýin the safety net across the country thatÌýareÌýbeingÌýchipped away at.ÌýÌý

Rovner:ÌýWell, turning toÌýother news from the Department of Health and Human Services,Ìýwe’reÌýgetting some more competition here atÌýWhatÌýthe Health?ÌýHealthÌýsecretary Kennedy has announcedÌýhe’llÌýbe unveiling his own podcast,ÌýcalledÌýThe Secretary KennedyÌýPodcast, next week. He promises to,Ìýaccording to the trailer posted online on Wednesday, quote,Ìý“name the names of the forces that obstruct the paths to public health.”ÌýOKÌýthen,Ìýwe look forward to listening.ÌýÌý

Meanwhile, in actual secretarial work, theÌýsecretary this week also unveiled changes to the charter of the Advisory Committee onÌý[Immunization]ÌýPractices after a federal judge last month invalidated both the replacement members that he’d appointed lastÌýyearÌýand the changes made to theÌýfederally recommended vaccine schedule.ÌýSoÌýwhat’sÌýgoing to happen hereÌýnow?ÌýWill this get around the judge’s ruling by watering down theÌýexpertiseÌýthat members of this advisory committee are supposed to have in vaccines? And why hasn’t the administrationÌýappealedÌýthe judge’sÌýruling yet?Ìý

Goldman:ÌýYou know, I don’t have actual answers to this, but I do wonder and speculate that this is going to end up being some kind of legal whack-a-mole situation where theÌýsecretary and HHSÌýsays,ÌýOK, you don’t like it that way?ÌýWe’llÌýdo it this way, and thenÌýthey’llÌýdo it another way, and advocates will sue, andÌýwe’llÌýsee how this plays out going forward in the courts.ÌýI think thisÌýis not the end of the story.ÌýEven though the judge’s decision was a big win for vaccine advocates,Ìýit’sÌýjustÌýwe’reÌýin the midpoint, if that.Ìý

Rovner:ÌýAnd Lauren, speaking of vaccines, your colleague LenaÌýH. Sun hasÌýÌýon HHS and vaccine policy.Ìý

Weber:ÌýYeah, LenaÌýSun is always delivering.ÌýShe found out that the acting director of the CDCÌý[Centers for Disease Control and Prevention]Ìýat the time delayed publication of a report showing that the covid-19 vaccine[s]Ìýcut the likelihood of emergency department visits and hospitalizations for healthy adults last winter by about half. So even though Kennedy is not talking more about vaccines, it appears that, based on this reporting,Ìýthat some of his underlings are not necessarily touting the benefits ofÌývaccine, so to speak.ÌýAnd I’m very curious, going back to Kennedy’s podcast, I found the rollout of that so interesting because the teaserÌýwas veryÌýleaning intoÌýthe KennedyÌýthat got elected, you know, someone who speaks about, you know, dark truths that are hidden from the public,Ìýand so on. And then the press team had these statements of,Ìýlike,ÌýKennedy will investigate the affordability of healthÌýcosts and foodÌýand nutrition.ÌýAnd I think this dichotomy of who Kennedy is and who theÌýWhite House and the press secretary and HHS want Kennedy to be before the midterms really could come to a head in this podcast.ÌýSoÌýI think we will all be listening to hear how that goes.Ìý

Rovner:ÌýYeah, we keep hearing aboutÌýhow theÌýsecretary is being, you know,Ìýsort of putÌýon a leash, if you will. And, you know, told to downplay some of his anti-vaccine views and things like this. And that seems quiteÌýat oddsÌýwith him having his own podcast. Alice,Ìýdo you wantÌýto …?Ìý

Weber:ÌýI guess, it depends onÌýwho’sÌýediting the podcast and who they have on.ÌýI’mÌýjust veryÌý…Ìýyou could even tell from the trailer to how his press secretary presented it, there was an interesting differential in framing, and I am curious how that plays out as we seeÌýguests on it.Ìý

Ollstein:ÌýI mean,Ìýit’sÌýalso worth noting that this is an administration of podcasters. I mean, you haveÌýKashÌýPatel,Ìýyou have so many of these folks who have a history of podcasting,Ìýclearly have a passion for it, justÌýcan’tÌýlet it go while working aÌýfull-time, high-pressureÌýgovernment job.ÌýÌý

Rovner:ÌýWe shall see.ÌýMeanwhile, HHS, together with the Environmental Protection Agency, is wagingÌýwarÌýon microplastics, thoseÌýnearly tooÌýimpossibleÌýtoÌýdetect bits of plastic that are getting into our lungs and stomachs and body tissues throughÌýair and waterÌýand food. The plan here seems to be to find ways to detect exactly how much microplastics we are all getting in our water and what the health impacts might be, since weÌýdon’tÌýhave enough information to regulate them yet.ÌýI would think this would be one of those things thatÌýpleasesÌýboth MAHAÌý[Make America Healthy Again]Ìýand the science community, right? Or is it just,Ìýas one MAHAÌýsupporterÌýcalled it,Ìýtheater?Ìý

Goldman:ÌýI think thisÌýisÌýa great exampleÌýof the,Ìýyou know, part of theÌýreason whyÌýMAHAÌýis so interesting to such a wide swath of people.ÌýLike,Ìýthere’sÌýa lot of legitimate concern, not that other concernsÌýaren’tÌýnecessarily legitimate, butÌýthere’sÌýa lot of concern over,Ìýfrom the scientific community, over microplastics.ÌýI’mÌýhonestly surprised thatÌýwe’reÌýthis far into the administration with this announcement. I would have thought that thisÌýisÌýsomething they would have done sooner, but they obviously had other prioritiesÌýas well.Ìý

Rovner:ÌýWell. Finally, this week, speaking of other priorities, HHS Secretary Kennedy and CMS Administrator Dr.ÌýOz are declaring war on junk food in hospitals. Again, this seems like a popular andÌýfairly harmlessÌýcrusade;ÌýhospitalsÌýshouldn’tÌýbe serving their patientsÌýultraprocessedÌýfood.ÌýExcept,Ìýalmost as soon as the announcement came out, I saw tons of pushback online from doctors and nurses who worried about patients for whom sugary food or drinks are actually medically indicated, or who,Ìýbecause of medications they’re taking, or illnesses they have, can only eat, or will only eat, highly palatable, often processed food. Nothing in healthÌýcare is as simple as it seems, right?ÌýÌý

Weber:ÌýI thinkÌýwhat’sÌýalso interesting is one of my favorite examples in the memo they put out was they hope that every hospital, as an example, could serve quinoa and salmon. And IÌýjust amÌýcurious to see how fast that gets implemented. AndÌýit’sÌýa veryÌývalidÌý—Ìýa lot of people complain about hospital food.ÌýIt’sÌýa very valid thing to push for better food. But I also question, as I understandÌýit,Ìýthis seems more like a carrot than a stick when it comes to the regulation they put out.Ìý

Rovner:ÌýAs it were.Ìý

Weber:ÌýAs it were.ÌýAndÌýsoÌýI’mÌýcurious to see how it gets implemented. That said, there are hospitals that have taken it upon themselvesÌý—Ìýthe NorthwellÌý[Health]Ìýexample in New York is a good exampleÌý—Ìýto really improve their hospital food. And frankly,Ìýit’sÌýa money maker. If your food’s better, people come to your hospital, especiallyÌýinÌýan urban area where there is hospital competition.ÌýSoÌýyou know, like most MAHAÌýtopics, there’s a lot of interesting points in there, and then there’s a lot of what’sÌýthe realityÌýand what’Ìýactually goingÌýto happen. AndÌýsoÌýI’Ìývery curious to see how this continues to play.Ìý

Rovner:ÌýIÌýdidÌýa bigÌýstory,Ìýlike,Ìý10 years ago on a hospital chain that had its ownÌýgardens,ÌýthatÌýliterally grewÌýits own healthy food.ÌýSoÌýthis is not completely new but,Ìýagain, interesting.Ìý

All right, that is this week’s news. NowÌýit’sÌýtime for ourÌýextra-creditÌýsegment.ÌýThat’sÌýwhere we each recognize a story we read thisÌýweekÌýwe think you should read,Ìýtoo.ÌýDon’tÌýworry if you miss it. We will post the links in our show notes on your phone or other mobile device. Alice, why don’t you start us off this week?Ìý

Ollstein:ÌýIÌýhave a piece from my co-worker SimonÌý[J.]ÌýLevien, and it is calledÌý“.”ÌýThis is aboutÌýthousands of doctors around the country who are from other countries that are placed on, you know, a list by the Trump administration of places where they want to scrutinize and limit the number of immigrants coming from there. And so these are people who are already here, already practicing, have poured years into their training, have been living here, and,Ìýin some cases, are the only folks willing to work in certain areas that have a lot of medical shortages, and they just can’t practice because their paperwork isn’t getting processed in time. AndÌýsoÌýthey’reÌýsort of inÌýthis scary limbo, andÌýthat’sÌýputting these hospitals and clinics that they work in in aÌýreally toughÌýbind. AndÌýsoÌýthey’reÌýhammering the Trump administration to give them answers about what their fate is. You know,Ìýthey’reÌýnot trying to deport them yet, butÌýthey’reÌýnot allowing them to continue working either.ÌýÌý

Rovner:ÌýFor anÌýadministration that’s been pushingÌýreally hardÌýto improve rural health care, this does not seem to be a way to improve rural health care.ÌýMaya.Ìý

Goldman:ÌýMy extra credit this week is calledÌý“Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records.”ÌýIt’sÌýa greatÌýKFFÌýHealthÌýNewsÌýscoopÌýfrom Amanda Seitz andÌýMaia Rosenfeld. It’s a really great example of the administration, you know, sort of moving in silence,ÌýdoingÌýthese small regulatory announcements that could haveÌýbigÌýimpact.ÌýBasically, theÌýOffice of Personnel Management is asking for personally identifiable medical information from health insurers, and its reasoning is to analyze costs and improve the health system, but they could getÌývery detailedÌýmedical information from federal employees, including things like, did they get an abortion? Are they undergoing gender-affirming care? And,Ìýobviously,Ìýthere is a strongÌýconcern thatÌýthat could be used against them.ÌýÌý

Rovner:ÌýYeahÌý…Ìýthis was quite a scoop. Really,ÌýreallyÌýinterestingÌýstory. Lauren.Ìý

Weber:ÌýMineÌýwasÌýa pretty alarmingÌýstory by Holly Yan at CNN:Ìý“.”ÌýAnd basically there’s this type of drug test that the scientists have found is not that effective, and it’s led to things like bird poop being scraped off a man’s car appearing on a drug test as cocaine, a great-grandmother’s medication testing positive for cocaine, and a toddler’s ashes registering as meth orÌýecstasy, and horrible legal and other consequences of thisÌýkind of misdiagnosis in the field. And the reason these drug tests are often done is becauseÌýthey’reÌýcheaper.ÌýThere’sÌýa more expensive, moreÌýaccurateÌýversion, but these are cheaper.ÌýThey’reÌýdone in the field.ÌýBut the potential side effects and horrible, wrongly accused effects are quite large, and soÌýColorado has passed this law to try and move away from this. AndÌýit’sÌýcurious to see if otherÌýstates will follow suit.Ìý

Rovner:ÌýYeah, this was something I knew nothing about until I read this story. My extra credit this week is fromÌýThe Atlantic byÌýKatherineÌý[J.] Wu,ÌýandÌýit’sÌýcalledÌý“.” And it’s about how some of the very top career officials from the NIHÌý[National Institutes of Health],Ìýthe CDC,Ìýand other agencies have, after having been put on leave more than a year ago, finally been reassigned toÌýfar-flungÌýoutposts of the Indian Health Service in the western United States. They got news of their proposed reassignments with little description of their new roles and only a couple of weeks to decide whether to move across the country or face termination. Now,Ìýif these officials’Ìýskills matched those needed by the Indian Health Service, this all might make some sense.ÌýBut whatÌýthe IHSÌýmostÌýneedsÌýare active clinicians:Ìýdoctors and nurses and social workers and lab technicians.ÌýAnd those who are now being reassigned are largely managers, includingÌý—Ìýand here I’m reading from the story,ÌýquoteÌý— “the directors of several NIH institutes, leaders of several CDC centers, aÌýtop-rankingÌýofficial from the FDA tobacco-productsÌýcenter, a bioethicist, a human-resources manager, a communications director,Ìýand a technology-information officer.”ÌýTheÌýNative populations who areÌýostensibly beingÌýhelped hereÌýaren’tÌývery happyÌýabout this, either. Former Biden administration Interior Secretary Deb Haaland, a Native AmericanÌýwho’sÌýnow running for governor in New Mexico, called the reassignment proposals, quote,Ìý“shameful”ÌýandÌý“disrespectful.”ÌýAlso, and this is myÌýaddition, not a very efficient use of human capital.Ìý

OK, that’s this week’s show.ÌýThanksÌýthis week to our fill-in editor,ÌýMary-EllenÌýDeily, and our producer-engineer,ÌýFrancis Ying.ÌýA reminder:ÌýWhat the Health?Ìýis now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course,Ìýkffhealthnews.org. Also,Ìýas always, you can emailÌýusÌýyour comments or questions.ÌýWe’reÌýat whatthehealth@kff.org.ÌýOr you can find me on XÌý, or on BlueskyÌý.ÌýWhere doÌýyou guysÌýhangÌýthese days? Maya.Ìý

Goldman:ÌýI am on LinkedIn under my first and last name,Ìý, and onÌýXÌýatÌý.Ìý

Rovner:ÌýAlice.Ìý

Ollstein:ÌýI’mÌýonÌýBlueskyÌýÌýand onÌýXÌý.Ìý

Rovner:ÌýLauren.Ìý

Weber:ÌýStillÌý@LaurenWeberHPÌýonÌýbothÌýÌýandÌý.Ìý

Rovner:ÌýWe will be back in your feed next week.ÌýUntil then, be healthy.

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