Medical Education Archives - ýҕl Health News /news/tag/medical-education/ Wed, 26 Nov 2025 15:14:42 +0000 en-US hourly 1 https://wordpress.org/?v=6.8.5 /wp-content/uploads/sites/2/2023/04/kffhealthnews-icon.png?w=32 Medical Education Archives - ýҕl Health News /news/tag/medical-education/ 32 32 161476233 What the Health? From ýҕl Health News: Trump Almost Unveils a Health Plan /news/podcast/what-the-health-424-trump-health-plan-almost-november-25-2025/ Tue, 25 Nov 2025 19:10:00 +0000 /?p=2122413&post_type=podcast&preview_id=2122413 The Host Julie Rovner ýҕl Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of ýҕl 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.

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

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

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

Panelists

Sarah Karlin-Smith Pink Sheet Alice Miranda Ollstein Politico Sandhya Raman CQ Roll Call

Among the takeaways from this week’s episode:

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

Also this week, Rovner interviews Joanne Kenen and Joshua Sharfstein of the Johns Hopkins Bloomberg School of Public Health about their new book, .

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

Julie Rovner: The New Yorker’s “,” by Tatiana Schlossberg.

Alice Miranda Ollstein: CNBC’s “,” by Jonathan Vanian.

Sarah Karlin-Smith: The Guardian’s “,” by Sirin Kale and Lucy Osborne.

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

Also mentioned in this week’s podcast:

  • The Center for Law and Social Policy’s “.”
  • The New York Times’ “,” by Sheryl Gay Stolberg.
  • The Atlantic’s “,” by Katherine J. Wu.
  • NPR’s “,” by Yuki Noguchi.
  • Campaign for Accountability’s “.”
click to open the transcript Transcript: Trump Almost Unveils a Health Plan

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

Julie Rovner:Hello from ýҕl Health News and WAMU Public Radio in Washington, D.C., and welcome toWhat the Health?I’mJulie Rovner, chief Washington correspondent for ýҕl Health News, andI’mjoined by some of the best and smartest health reporters in Washington.We’retapingearlythisThanksgivingweek onTuesday, Nov.25,at 10a.m. As always, news happens fast,and things might have changed by the time you hear this. So here we go.

Today we are joined via video conference by Alice MirandaOllsteinof Politico.

Alice MirandaOllstein:Hello.

Rovner:Sandhya Raman of CQ Roll Call.

SandhyaRaman:Good morning.

Rovner:AndSarah Karlin-Smith, the Pink Sheet.

Karlin-Smith:Hi,everybody.

Rovner:Later in this episode,we’ll have my interview withWhat the Health?panelist Joanne Kenen and Dr. Joshua Sharfstein,both of the Johns HopkinsBloomberg School of Public Health, about their new book calledInformation Sick: How Journalism’s Decline and Misinformation’s RiseAre Harming Our Health and What We Can DoAbout It.

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

Ollstein:It’sa total mess. Very few people have confidence that this will get done at all or in time to make a differenceforthe cost of people’s healthcare that has already gone up. So,House Republicanswere, one, upset just process-wise. Theydidn’tlike finding out that Trump was going to release a plan from news reports and social media. They felt left out of the loop.

Rovner:On a Sunday?

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

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

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

Dec.15 is when open enrollment ends, and I think that even if you look at some of the bipartisan stuff that has been floated before—even last week we had another one come out that was a little similar to the stuff being floated on Sunday that would extend open enrollment more to give them a little bit more time. But one thing that we kept hearing yesterday wasjusteven the changes that were being floated yesterday, why theyweren’tbeing supported by people that do want an extension isthere’ssucha short timecrunch to implement these changes inbasically amonth.

Rovner:And now Republicans are talking about doing a whole new health bill,maybe usingbudget reconciliation so theywon’tneed Democratic votes. And I guessI’mthe onethat’sgoing to have to remind them that the ACA[Affordable Care Act]didn’tpass under reconciliation because there were a whole lot of things in it that theycouldn’tput in a budget reconciliation bill. They used budget reconciliation tobasically cuta deal between the House and the Senate after the Senate lost its 60th vote.But the original ACA passed with 60 votes.Soif the Republicans thinkthey’regoing to do somethingreally bignext year with just Republican votes,they’regoing to find outfairly quicklythat a lot of that is not going to be allowed.

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

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

Ollstein:And I will say, something that in part led to the postponement and backlash and chaos this week is that folks on Capitol Hill, RepublicansandDemocrats, have no idea what the White House is going to do about this abortion issue that has been roiling—this whole debate where conservatives are saying that it’s a red line, they have to basically ban all plans on the individual market from covering abortion. Right now,it’sup to states:Halfbanthem, halfdon’t. Somerequirethem,some allow them butdon’trequire them. And conservatives are demanding that there besort of ablanket ban on that coverage, that any federal funding going to these plans, even if they pay for abortion with other money, they consider that a subsidization. And this has beena real stickingpoint. Democrats say theywon’taccept any expansion of abortion restrictions in Obamacare;Republicans say theywon’taccept anything without theadditionalrestrictions, and we stilldon’tknow where the White House is going to come down on this.

Rovner:Because, as I like tosayevery week, healthcare isreally hard. All right. In big news that’skind of lostalready, Reuters is reporting that the White House hasterminatedDOGE, the Department of Government Efficiency, eight months early. In practice, DOGE has been dormant for many months, even before the departure of Elon Musk back to his day jobs at Tesla and SpaceX. But DOGE has left behind a lot of cuts. The nonprofit Center for Law and Social Policy has atracker of all the funding and personnel changesmade by the administration down to the program level, including at HHS[the Department of Health and Human Services]. I willin the show notes.

But if you want a more personal look, you should go read myextracredit this week, which we can all talk about now.It’san achinglyby Tatiana Schlossberg, daughter of Caroline Kennedy and granddaughter of JFK[President John F. Kennedy]. Tatiana, an environmental journalist and mother of two young children,is dying of a rare anddifficult-to-treatform of leukemia. Among other things, she was undergoing rounds ofultimately unsuccessfultreatment while watching huge cuts to healthcare research being madeatthe direction of her cousin RFK Jr., all the while realizing how those cuts willlikely threatenthe survival of patients like her. I heard a lot about this story over the weekend, and I wonder if it might have some impact reaching the public about what the HHS cuts are likely to mean going forward in a way that just the numbers being repeatedhaven’t.

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

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

Ollstein:I think Cassidyis really in a situation of his own. Idon’tthinkhe’sthe newanything. I thinkhe’sthe first Cassidy, andmaybe inthe futurewe’llbe referring to otherCassidys. But I think given his medical background,and not just any medical background, like given his background specializing in hepatitis, which is one of the vaccines that people are most anxious will become unavailable or restricted in the future, and given his direct role in extracting promises in order to confirm RFK and now having those promises pretty blatantly stepped on and there not really being much repercussions. Also,him being up for reelection next year. I thinkit’squite unique,all ofthose dynamics, as much as we see parallels with some other members.

Rovner:Yeah,it’strue.I’llsay Collins isa moderatebecause she comes from a moderate state.Cassidy’sfrom Louisiana, which is not a moderatestate,it’sa very red state.Sohe does find himself in these extremely uncomfortable positions. Well,it’snot just vaccines and not just the CDCthat’sturning against settled science. Over at the National Institutes of Health,atThe Atlantic, leaders have a new pandemic preparedness plan that suggests that rather than study pathogens and develop and stockpile vaccines, the country would be better off eating better and exercising. This kind of goes back to what you were just saying, Sarah.I’mnot sure to where to start with this, other than I guessit’sbetter to be healthy than not. But aswe’vepointed out, even healthy people are susceptible to germs.

Karlin-Smith:Right. Andsoone thing her piece raises is that Kennedy,in particular,hassort of dismissed germ theory, which does not quite believe in the way that most scientists and people do of these roles, of these infectious organisms in disease. And while Katherine’s piece,I think very nicely,talks about there is some element of somebody who is not able to feed themselves enough of the right quantities of food may do worse with an infectious disease, but at the end of the day it’s about your immune system being exposed to these viruses and having some knowledge of how to fight them off.And so younger people, like in the 1918 flu,actually,insome cases would say we’re dying at higher rates even than older people.Obviously again, the pre-vaccine era, this is why so many children under the age of5died young. Itwasn’tthat these were all children born with particularly unhealthy lifestyles or something about them that made them morelikely,it was just that their body needed to somehow learn to experience this antigen.

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

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

Rovner:Well,meanwhile over at the FDA, the sharp knivesremain outamong the top deputies to Commissioner Marty Makary. The latest missive comes from newly appointed drug regulator RichardPazdur, who unlike many of his fellow centerdirectorsisactually aveteran of the agency. ButPazdurhasreportedly warnedthat some of the new FDA efforts to speed the approval of drugs, including deals that trade faster reviews for lowered prices, could be illegal and dangerous to the public health. Sarah, what is going on over there?

Karlin-Smith:Yeah, soit’sbeen an untraditional year at FDA in terms of how this commissioneroperates, but Makary’swhat’scalled this Commissioner National Priority Voucher program has rolled out in more detail over the past coupleweeks.It’sdesigned to give companies a two-month review, which most FDA reviews tend to be in thesix-[month]to one-yeartimeframe.Sotwo monthsissuperfast. And the criteria for qualifying to try and get that isreally vague, and it essentially at the end of the day resultstothe commissioner in their closecircle kindof picking who they want.That’sraised a lot of questions becauseit’sjust not clear. They havesort of afair andestablishedprocess. Makary has also suggested that if you give commitments to keep the price of the product low, or deal with Trump on hismost-favored-nationpricing deal,we’llgive you this.

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

Rovner:Yeah. Well, moving on to a segment called“Honey I Shrunk the HealthCare Workforce,”youmight’veheard that the Trump administration is busy dissolving the Department of Education and transferring its responsibilities to other agencies. On its way out of existence,however, the department hasdeterminedthata long listof healthcare careersdon’tqualify as professions, including nursing, social work, physical therapy, public health,and physician assistants. This is not justsemantic,it means that people studying for these graduate degreeswon’tbe able to get federal student loans for anywhere near what tuition costs. And this comes at a time when the U.S.badly needsmore, not fewer,of these health professionals for an aging and increasingly less healthy population. In fact, this feels like a way to make healthcare more, notless,expensive, since many of these professionals can do work otherwise done by higher-paid medical doctors. Am I missing something here?

Raman:I thinkyou’reexactly right, especially as over the last few yearswe’veseenin Congress them really ramping up,looking at ways to expand the pipeline of workers. Youcan’tcreate ahealthworker overnight. The more advanced the degree, the longerit’sgoing to take. And I mean, I think it’ll take a little while to see some of the effects of this if it stays in effect, because there’s going to be people that maybe won’t even consider some of these fields rather than if they’re midway through or about to enter one,if they know that it’s not going to be something that their family or themselves can afford. At the same time,aswe’regoing to have the population aging andwe’regoing to needmore and moreof thesefolks, soI thinkit’sa two-pronged thing thatwe’llsee over time.

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

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

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

Ollstein:Yeah.We’recutting off our domestic pipeline andwe’recutting off our international pipeline, and this is coming…there are already shortages. Therewasso much burnout and people retiring early and people quitting during and after the pandemic, and thiscouldn’tcome at a worse time,really. Andthere’smore punches than the one-two punch. People are also concerned about the high-skilled worker visa fees going up and that making it harder to bring in international medical workers for hospitals that are already struggling to pay an extra fee of tens of thousands of dollars is not reallyviableright now.So yeah,there’sa lot of concern.

Rovner:Andit’scertainly not going to bring down medical prices, which I guess ismaybe whatI mean. I know that in the case of the cap on medical school tuition, the hope is to bring down tuition, is to force tuition down by not making the loans big enough. Butit’sone thing to say that having unlimited loans is inflationary and allows tuition to go up;it’sanother thing to say that cutting off the loans is going to make tuition go down.

Raman:Yeah, I meanit’sa complicated process when you also have,I mean,for a variety of degrees, theinternational students are often paying full price,and that subsidizes the cost of some other folks going.Sothere are many pieces of this puzzle, soit’llbe interesting to see what happens next.

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

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

Ollstein:Right.Sothis has gone back and forth, andit’snot a straight,clear-cut revival of the policy under the first Trump administration. I think in partthat’sbecause that one was struck down in court, and sothis trendsof the new. So,basically,after the comment period and when things get finalized, this isgiving,instead of directing all immigration officers to deny permanent residency applications to people who have used Medicaid and have used these social safety-net programs, it’s basically just leaving it up to the individual officer. And there’s language about considering the totality of circumstances, and so there’s a lot of concern in the immigration advocacy community that this will lead to discrimination and decisions made based on basically vibes of if someone seems like they might become a burden on society later, and so I expect there will be lawsuits for sure.

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

Rovner:All right. Well,finally this week,movingon to reproductive health. Remember that lawsuit in Texas that was filed by a group of anti-abortion doctors that wanted to reverse the FDA’s approval of the abortion pillmifepristone? Well, the doctors are no longer part of the lawsuit because the Supreme Court said theydidn’thavestandingto sue, and the case is no longer in Texas, but it is still around. And now the three states that are pursuing it, Missouri, Kansas, and Idaho,are adding to their suit the FDA’s recent approval of a second generic of the original abortion pill. Alice, how is this case still going? And now what happened?

Ollstein:It’svery much still going.It’sjust been bouncing around, and nowit’sbeing considered by a whole different court in a whole differentstateandthey’regoing to start the process all over again. And Iwouldn’tbe surprised if it made it all the way back to the Supreme Court, even thoughit’salready been there with different plaintiffs. So there was a lot of outrage in the anti-abortion community about the recent approval of another generic ofmifepristone, even though the way that works is if it’s chemically identical to the versions that have been already approved, it kind of automatically goes through and it doesn’t really have anything to do with the other things they’re challenging.It’sjust something else thatthey’reupset about.

Rovner:Sothey’readding it to it. Well,we will watch that lawsuit too. And last, we don’t talk enough about AI[artificial intelligence]in healthcare, but a study caught my eye this week from the nonprofit Campaign for Accountability that found a number of chatbots, when asked about medication abortion, gave instructions to call a hotline that urged those with unplanned pregnancies to try“abortion pill reversal,”which is not a thing, although it is pushed by many anti-abortion activists. Thisappears to bea case where the flood of misinformation so outnumbers thereal informationthat the chatbot thinks thatthe misinformationis the right answer. Quantity overquality, ifyou will. This feels likekind of amajor flaw in using AI, not just for abortion questions, but for health information in general,given how much health misinformation is out there.

Raman:I thinkwe’veseen this in other types of healthcare,wherethey’vetried to roll out some of these chatbots to help with different things,especially likemental health, andit’sbackfired fordifferent reasonsbecause ofit might promote something that itshouldn’tfor that group.I think therewas one at one point where it was offering dieting tips to someone with an eating disorder, just things thatmaybe mightbe applicableto someone else but not to that specific group.Sothere aredefinitely thingsthat need to be hammered out in this.

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

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

I am pleased to welcome to the podcast Joanne Kenen and Dr. Joshua Sharfstein, two of the three authors of the newbook Information Sick: How Journalism’s Decline and Misinformation’s Rise are Harming Our Health— And WhatWe CanDo About It. Our regular listeners all know Joanne,she’sthe former health editor at Politico who now teaches at the Johns Hopkins Bloomberg School of PublicHealth and writes for Politico Magazine. Joshua Sharfstein, whoI’veknownalmost aslong asI’veknown Joanne, isdistinguishedprofessor ofthe practiceat Johns Hopkins Bloomberg School of Public Health.He’sa physicianwho’sworked on Capitol Hill and attheFood and DrugAdministration, andalso served as the city of Baltimore’spublic healthcommissioner and the State of Maryland’ssecretary ofhealth andmentalhygiene. Joanne and Josh, thank you so much for joining us.

JoanneKenen:Thanks for having us.

JoshuaSharfstein:Great to be here.

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

Sharfstein:Well,“information sick”is a diagnosis. It’s adiagnosisboth ofindividuals who are confused by information about health that they’re getting, and as a result can’t make good decisions for themselves and their families. Andit’salso a diagnosis for our society, that there’s so much bad information on health out there, there’sso littlegood informationthat as a country,we’reat risk of making some bad decisions on health policy.

Rovner:SoI havekindof ameaculpa. We have spent a lot of hours on this podcast talking about how public health officials should be doing a better job communicatingtothe public, combating mis-and disinformation, but without really addressing the other side, the decline of journalism.Joanne, how much of the problem is how information is communicated to the public by health officials, and how muchisthe changing ways that people areactually communicatingwith each other?

Kenen:That’swhat our book,where they explore it,is this nexus. There’s been lots written about the decline of journalism, there’s been lots written about failures of public health communication, some of which may beoverstated actually, andsome ofit’sclearlymistakes have been made. But the connection is something that we really explored starting in the class we taught a couple of yearsago, andthen putting together the book. People do not get information in the ways that wegrewup getting information. Local news has really been eviscerated in large parts of the country. There’s county after county that does not have any local news, or that has something very meager. And that was trusted,it’sstill trusted where it exists, that was a way people got health information. National news is polarized, with some outstanding exceptions.There’sjust not a lot of policy news that people get. And people instead, particularly younger people, are getting…instead of theirdoctor,they’vegot their TikTok. Andthere’sa lot of wrong stuff. Andit’snot only vaccines,it’spretty much everything.

Rovner:So how much of the problem within the information ecosystem is informationthat’sjust wrongbecauseit’sbeing distributed by non-experts, and how much is from actual bad actors, those with eithera potentialmonetary gain from spreading bad information or those purposely trying to sow discord?

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

Kenen:There’sa communication media element in this,too. Because if you’re a reporter working for a little tiny newspaper that used to have maybe five or six reporters, and someone could have developed some expertise in health, you know, whenyou can,if you’re on a national beat doing it full-time, but you can develop some confidence in knowing what you’re talking about. Ifyou’renow one of two reporters andyou’recovering eight beats and health is one of them, and youdon’thave an editor who can mentor you on health either,there’sa lot of bad reporting. Andit’swhat we call false equivalence a lot. If youdon’tknow if this source is an expert, and that source is a charlatan,or vice versa, you tend to put themboth asequals.Sothey’rein the newspaper story or on the local news where you have somebody saying,“Vaccines are safe,”and somebody else saying,“They’re toxic, damaging, barbaric things that are going to kill us all.”Soyou’regetting something from a news outlet that you should be able to trust, but because of the shrinkage and lack of resources and lack of money and lack ofexpertise, you end up inadvertently feeding the misinformation monster.

Rovner:Soyeah, some of it is deliberate,and some of it iskind of accidentalbecause of the decline of journalism. So,luckily,your bookdoesn’tjust lay out theproblem,you also offer up some potential solutions. Joanne, can you summarize how journalism can do a better job of curing information sickness? And then,Josh, can you talk about how the health community can do its part?

Kenen:Well, I think that in journalism, ifyou’rea young reporter starting out and youdon’thave the resources to do your job, there are some tools and resources.There’smore and moretraining opportunities in health, medicine, climate, other areas.Soyoucanget some free training online, and I would urge anyonewho’sstarting out on this beat…and not just on the beat. I mean ifyou’rea business reporter or a politics reporter or a general assignment reporter,you’rea health reporter,you’regoing to end up doing this.Sothere area number ofprograms through philanthropies and universities, as well as journalism organizations, to bolster local news and bolster health reporting.Soanyone who falls into that category who is listening,doit. Youwon’tcome out with an MPH[master’sof public health], butyou’llcome out withknowledge and confidenceand competence.

Congress had been talkingfor,Idon’tknow, 15 years or so about tax breaks and other things to prop up journalism.It’snot going to pass now if ithasn’tpassed in the last 15 years, Idon’tsee that happening in the current environment. The consolidation thatwe’reseeing in the media and TV stations isprobably goingto make it worse, not better.Soif we tell our students,“There is a lot of free stuff out there. You can be informed without spending three hours and hundreds a day trying to read everything.”Our podcast is free, KFF is free, ýҕl Health News is free. There are things you can do to get quality information and quality journalists.

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

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

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

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

Kenen:I think that one thing that we learned about a lot as we researched this, it makes sense when we say it to people, they all nod, butunderstandingwhy information has power.There’sa lot that people researching itdon’tunderstand yet, like why once people buy into a mythit’sso hard to get it out of their brain. But what does it do? It appeals to ourfears,it appeals to ouranxieties,it appeals to ourresentments. Social media does not make you feel calm and serene andconfident,it makes people agitated and angry. Andit’snot a coincidence that there was disinformation before the pandemic and there’s disinformation after the pandemic, but the flowering and the sort of exacerbation during the pandemic,it’spartly because we were so vulnerable to it.We were feeling fear and resentment and anxiety, both about health and aboutthe economicdislocation during the pandemic, particularly that first year.Sowe werereally vulnerable,and people who were spreading it, the ones intentionally,in particular, reallywere able to sort of exploit that vulnerability that we had.There’sa lot of research.The role of AI is going to change things for good and bad. I mean,anything you write aboutthis aboutdisinformation issomewhat outof date tomorrow. But I think it’s useful for people to understand that what they’re being opposed to that’s so catchy andgrabsthemisoftenreally badfor them.

Rovner:Yeah, well,bigger societal problem. But thank you forwritingthis book. Joanne Kenen and Joshua Sharfstein,thanksfor joining us.

Sharfstein:Thanks so much.

Kenen:Thanks, Julie.

Rovner:OK,we’reback.It’stime for ourextra-creditsegment.That’swhere we each recognizeastory we read thisweekwe think you should read too.Don’tworry if you miss it;we will put the links in our show notes on your phone or other mobile device. I have already done myextracredit this week. Sarah, how aboutyou gonext?

Karlin-Smith:Itook a lookat a piece inThe Guardian called“,”and it chronicles a movement started by two women using podcasts and Instagram and social media. Andit’snot just amovement,I would say it was a business for them.I think The Guardian piecesays they made about $13 millionbasically convincingpeople to give birth at home with no medical support at all. No midwife, nothing of the sort. And theyoftentimes even seem to discouragepeople when they are in medical distress, or their baby is in medical distress,while birthingfrom going to the hospital. It has led to babies being born with various birth defects or disabilities that they would not otherwise have been born with. It has led to deaths of babies and,possibly,women.

And I think one thing that stood out to me is a lot of women the story talks about seem drawn to this movement for a couple of reasons. One is howhigh costthe U.S.health system is in terms of to get good midwifery care, go to a hospital, see an OB-GYN.Sosome people were drawn to it just because they felt like theycouldn’tafford it, and this seemed like a goodoption. And other people were drawn to it because they had some kind of bad or traumatic experience givingbirththe first time in the traditional medical system and were sort of ripe to be really taken advantage of and exploited.

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

Raman:SoI picked“Kids and Teens Go Full Throttle for E-Bikes as Federal Oversight Stalls,”andthat’sfrom Kate Ruder for ýҕl Health News. And this story looks toseeare these bikes safe for kids? And thatit’sa difficult thingtokind of spellout.There’snot a ton of federal regulations on e-bikes, andit’sa patchworkon the state and county level. And I learned a lot,I think,just because Ididn’trealize thatthere’sno age foroperatingan e-bike at the federal level, butit’skind of piecemealat the state level for other types of motorized vehicles.Soit looks at some of that and just kind of what the gaps are and some of the regulations that have been pulled back in recent months.

Rovner:As somebody who almost got taken out by, like,an8-year-old on a motorized vehicle a couple of weeks ago, I very much felt this story. Alice?

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

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

OK. That is this week’s show. Thanks,as always,to our editor,Emmarie Huetteman, and our producer-engineer,Francis Ying. A reminder:WhattheHealth?isnow available on WAMU platforms, the NPR app, and wherever else you get your podcasts. As well as,of course, kffhealthnews.org. Also,as always, you can email us your comments or questions.We’reatwhatthehealth@kff.org.Or you can find me still onX,oron Bluesky.Where are you folks hanging these days? Sandhya?

Raman:@SandhyaWrites onand on.

Rovner:Alice?

Ollstein:on Bluesky, andon X.

Rovner:Sarah?

Karlin-Smith:or,on X and Bluesky.

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

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]]> 2122413 While Politicos Dispense Blame, These Doctors Aim To Take Shame Out of Medicine /news/article/shame-competence-medicine-doctor-training/ Wed, 05 Nov 2025 09:00:00 +0000 /?post_type=article&p=2104282 The distress that Will Bynum later recognized as shame settled over him nearly immediately.

Bynum, then in his second year of residency training as a family medicine physician, was wrapping up a long shift when he was called into an emergency delivery. To save the baby’s life, he used a vacuum device, which applies suction to assist with rapid delivery.

The baby emerged unharmed. But the mother suffered a severe vaginal tear that required surgical repair by an obstetrician. Soon afterward, Bynum retreated to an empty hospital room, trying to process his feelings about the unexpected complication.

“I didn’t want to see anybody. I didn’t want anybody to find me,” said Bynum, now an at Duke University School of Medicine in North Carolina. “It was a really primitive response.”

Shame is a common and highly uncomfortable human emotion. In the years since that pivotal incident, Bynum has become a among clinicians and researchers who argue that the intense crucible of medical training can amplify shame in future doctors.

He is now part of an emerging effort to teach what he describes as “” to medical school students and practicing physicians. While shame can’t be eliminated, Bynum and his research colleagues maintain that related skills and practices can be developed to reduce the culture of shame and foster a healthier way to engage with it.

Without this approach, they argue, tomorrow’s doctors won’t recognize and address the emotion in themselves and others. And thus, they risk transmitting it to their patients, even inadvertently, which may . Shaming patients can backfire, Bynum said, making them defensive and leading to isolation and sometimes substance use.

The U.S. political environment presents an additional obstacle. Health and Human Services Secretary Robert F. Kennedy Jr. and other top Trump administration health officials have publicly blamed autism, diabetes, attention-deficit/hyperactivity disorder, and other chronic issues in large part on the lifestyle choices of people with the conditions — or their parents. For instance, FDA Commissioner Marty Makary suggested in a Fox News interview that diabetes could be better treated with cooking classes than “.”

Even before the political shift, that attitude was reflected at doctors’ offices as well. A 2023 study found that when treating patients with Type 2 diabetes. About 44% viewed those patients as lacking motivation to make lifestyle changes, while 39% said they tended to be lazy.

“We don’t like feeling shame. We want to avoid it. It’s very uncomfortable,” said , a nurse at the University of Wisconsin-Madison, who has of related studies, published in 2024. And if the source of shame is from the clinician, the patient may ask, “‘Why would I go back?’ In some cases, that patient may generalize that to the whole health care system.”

Indeed, Christa Reed dropped out of regular medical care for two decades, weary of weight-related lectures. “I was told when I was pregnant that my morning sickness was because I was a plus-size, overweight woman,” she said.

Except for a few urgent medical issues, such as an infected cut, Reed avoided health care providers. “Because going into a doctor for an annual visit would be pointless,” said the now 45-year-old Minneapolis-area wedding photographer. “They would only just tell me to lose weight.”

Then, last year, severe jaw pain drove Reed to seek specialty care. A routine blood pressure check showed a sky-high reading, sending her to the emergency room. “They said, ‘We don’t know how you’re walking around normal,’” she recounted.

Since then, Reed has found supportive physicians with expertise in nutrition. Her blood pressure remains under control with medication. She’s also nearly 100 pounds below her heaviest weight, and she hikes, bikes, and lifts weights to build muscle.

, a California psychiatrist, is among a group of physicians trying to bring attention to the detrimental effects of shame and develop strategies to prevent and mitigate it. While this effort is in the early stages, she co-led a session on the spiral of shame at the American Psychiatric Association’s annual meeting in May.

If physicians don’t acknowledge shame in themselves, they can be at risk of depression, , sleeping difficulties, and other ripple effects that erode patient care, she said.

“We often don’t talk about how important the human connection is in medicine,” Woodward said. “But if your doctor is burned out or feeling like they don’t deserve to be your doctor, patients feel that. They can tell.”

In a survey conducted this year, 37% of graduating students at some point in medical school. And nearly 20% described public humiliation, according to the annual survey by the Association of American Medical Colleges.

Medical students and resident physicians are already prone to perfectionism, along with an almost “masochistic” work ethic, as Woodward described it. Then they’re run through a gantlet of exams and years of training, amid constant scrutiny and with patients’ lives on the line.

During training, physicians work in teams and make presentations to teaching faculty about a patient’s medical issues and their recommended treatment approach. “You trip over your words. You miss things. You get things out of order. You go blank,” Bynum said. And then shame creeps in, he said, leading to other debilitating thoughts, such as “‘I’m no good at this. I’m an idiot. Everyone around me would have done this so much better.’”

Yet shame remains “a crack in your armor that you don’t want to show,” said , a family medicine physician at the University of Utah who has taught medical students about the potential for shame as part of a broader ethics and humanities course.

“You’re taking care of a human life,” she said. “Heaven forbid that you act like you’re not capable or you show fear.”

When students are taught about shame, the goal is to help future physicians recognize the emotion in themselves and others, so they don’t perpetuate the cycle, Pippitt said. “If you felt shamed throughout your medical education, it normalizes that as the experience,” she said.

Above all, physicians-in-training can work to reframe their mindset when they receive a poor grade or struggle to master a new skill, said Woodward, the California psychiatrist. Instead of believing that they’ve failed as a physician, they can focus on what they got wrong and ways to improve.

Last year, Bynum started teaching Duke physicians about shame competence, beginning with roughly 20 OB-GYN residents. This year, he launched a larger initiative with , a research and training partnership between Duke University and the University of Exeter in England that he co-founded, to reach about 300 people across Duke’s Department of Family Medicine and Community Health, including faculty and residents.

This sort of training is rare among Duke OB-GYN resident ’s peers in other programs. Dancel, who completed the training, now strives to support students as they learn skills such as how to suture. She hopes they will pay that approach forward in “a chain reaction of being kind to each other.”

More than a decade after Bynum experienced that stressful emergency delivery, he still regrets that shame kept him from checking on the mother as he usually would following delivery. “I was too scared of how she was going to react to me,” he said.

“It was a little devastating,” he said, when a colleague later told him that the mother wished he had stopped by. “She had passed a message along to thank me for saving her baby’s life. If I had just given myself a chance to hear that, that would have really helped in my recovery, to be forgiven.”

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]]> 2104282 Many Fear Federal Loan Caps Will Deter Aspiring Doctors and Worsen MD Shortage /news/article/medical-school-federal-loan-caps-doctor-shortage-trump-law/ Tue, 28 Oct 2025 09:00:00 +0000 /?post_type=article&p=2105108 Medical educators and health professionals warn that new federal student loan caps in President Donald Trump’s tax cut law could make it more expensive for many people to become doctors and could exacerbate nationwide.

And, they warn, the economic burden will steer many medical students to lucrative specialties in more affluent, urban areas rather than lower-paying primary care jobs in underserved and rural communities, where doctors are in shortest supply.

“The growing financial barriers may deter some individuals from pursuing a career in medicine, particularly those from low-income backgrounds,” said Deena McRae, a psychiatrist and associate vice president for academic health sciences at University of California Health.

The new federal loan limits, which are enshrined in the GOP legislation signed by Trump on July 4, professional degree students can borrow at $50,000 a year, up to a maximum of $200,000 — well below the average cost of a four-year medical school education.

For students who graduated this year with an MD degree from a four-year medical school in the United States, the median cost of attendance was $318,825, according to Kristen Earle, director of student financial services at the . And for those who entered a U.S. medical school in the 2024-25 academic year, the median first-year cost was $83,700.

Health care experts and politicians on both sides of the aisle agree that medical schools must find ways to lower their costs, but critics of the loan caps say limiting federal lending isn’t the answer. Congressional Republicans, who voted for the caps, say they are intended to stem a sharp rise in federal student lending over the past two decades that has driven the cost of attendance higher.

“Uncapped loan limits gave no incentives for schools to reduce any of their costs, recognizing that taxpayers, students, or students’ families would eventually foot the bill,” said Sara Robertson, a spokesperson for the GOP-controlled House Committee on Education and Workforce. “Our reforms and loan limits will put downward pressure on costs to provide better outcomes and lower debt for all students.”

The budget law brings back caps for graduate and professional education that Congress eliminated in 2006. Since then, students have been able to get federal loans that cover the total cost of their degree programs. Reimposing the caps, along with other changes to federal student loans, is expected to over 10 years, according to the Congressional Budget Office.

Whether the new federal loan policy will push down tuition costs remains to be seen.

Robertson pointed to a by the National Bureau of Economic Research showing that the more generous federal lending policy since 2006 has led to “significantly higher program prices” in graduate education. The study also found that the additional federal support failed to increase enrollment in graduate programs, including for underrepresented students.

However, by the Association of American Medical Colleges shows that cost-of-living increases, not tuition, drove up the expense of studying medicine in recent years.

Students already in medical school who have taken out federal loans before the new rules take effect on July 1 will be exempted from the cap. But students whose loans are capped under the new law will need to make up the difference, in many cases by taking out private sector loans, which typically have less flexible repayment terms and require a strong credit rating — a heavy lift for students from low-income communities.

Robertson cited a 2017 analysis showing that of graduate students could have obtained a private loan at a lower interest rate than any available federal loan. Federal loans, however, come with advantages that private loans don’t. For instance, federal loans can include monthly repayments calibrated to income, and they offer two debt forgiveness paths, including the program, which erases the balance for those who work in a government or nonprofit organization and make their monthly payments for 10 years.

Critics and proponents agree on at least one thing: Now is the time for medical schools to think creatively about lowering costs for students. This might include reduced tuition, more chances for debt forgiveness, and accelerated programs that allow students to graduate in three years rather than four, reducing costs by 25% and getting them more quickly into paid jobs.

“I hope that coming out of this, medical schools and others find a way to seize the moment and help us figure out how to reduce the total cost of medical school,” said Martha Santana-Chin, CEO of L.A. Care. “Maybe this is an opportunity for us to rethink how the system is working.”

Roughly a fifth of medical schools offering an MD degree have accelerated programs, including the University of California-Davis, according to the .

A data analysis of eight medical schools led by the NYU Grossman School of Medicine, whose core MD curriculum is three years, shows that students in three-year programs derive a lifetime financial gain totaling over $240,000 due to the cost savings of less time in medical school, interest not paid on the corresponding amount not borrowed, and faster progression to a salaried position.

In addition to lowering costs, accelerated medical programs seek to address health care workforce shortages by training physicians more quickly. And with the new loan caps about to make it more difficult for many students to finance their medical education, these programs suddenly have a new timeliness.

Students who spend three years in medical school instead of four have lower debt and get to a higher salary sooner, said Caroline Roberts, a family physician and director of rural education at the University of North Carolina’s School of Medicine. UNC offers a three-year track for students who want to be primary care doctors and work in rural areas of the state, where doctor shortages are a major problem.

Zoe Priddy, who is in her second year of UNC’s three-year program, said that if the federal loan limits had been in place at the time she was making plans to attend medical school, she would have needed a job that paid better than the research lab where she worked after completing her undergraduate degree.

“I would have had to change my trajectory if I still wanted to pursue medicine, and I don’t know if it would have been possible for me,” Priddy said. However, the lower debt associated with the three-year track “eased my decision” to go into pediatrics, a lower-paying specialty, she said.

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]]> 2105108 Doctors With TroubledPasts Are Performing Cosmetic Surgeries Tied to Crippling Pain and Injury /news/article/doctors-clinics-cosmetic-surgeries-pain-injury-discipline-malpractice-lawsuits/ Tue, 30 Sep 2025 09:00:00 +0000 /?post_type=article&p=2091997 Not long after California surgeon Andrew S. Hsu landed a job with a cosmetic surgery chain in Georgia, several of his patients suffered disfiguring injuries, and even his new employer had doubts about his competence, court records allege.

Hsu, a board-certified general surgeon, was one of six out-of-state doctors who joined the Atlanta Goals Aesthetics & Plastic Surgery center during the pandemic. The surgeons received temporary licenses to practice in Georgia, which in response to the sudden need for more medical personnel to address the covid-19 outbreak — even though the center specialized in elective cosmetic surgeries, such as Brazilian butt lifts, or BBLs, and liposuction, paid for in cash or on credit.

The Atlanta center in March 2021 as an expansion of New York-based Goals Aesthetics & Plastic Surgery, which markets “precision body contouring” for about a dozen surgery clinics in eight states, promising patients a “.”

But the Atlanta center’s early days were marred by allegations of substandard patient care. Court records show that at least 20 women filed medical malpractice lawsuits against the facility, or its owner and surgeons. Hsu was named as a defendant in seven suits filed against the Atlanta center, more than any other physician there. An eighth patient sued Hsu alleging negligence in an operation he performed at a Goals office in New York.

Hsu did not respond to requests for comment. Goals declined to comment. Both have denied any negligence.

Cosmetic surgery chains across the country are attracting patients by promising “minimally invasive” operations to reshape their bodies or get rid of stubborn fat — even helping arrange outside financing for people who can’t pay up front. Hundreds of thousands of patients are undergoing such procedures each year, and plastic surgeons can make more than $500,000 each year in in American medicine.

An investigation by ýҕl Health News found that lawsuits filed by injured patients have trailed the industry’s growth, in some cases alleging that surgeons lacked adequate training, had histories of malpractice lawsuits, or had faced disciplinary action by state medical licensing boards — yet crossed into another state and kept practicing.

In the Atlanta lawsuits, Goals has denied any negligence and won dismissal of several of them because patients had signed papers agreeing to outside arbitration — which requires them to resolve disputes privately and outside the court system.

Yet Goals argued in a separate contract dispute that several of its Atlanta surgeons, including Hsu, were indeed prone to problems — either because they lacked adequate training or had troubled pasts, including investigations by state medical licensing boards into misconduct, court records show. One of Hsu’s Atlanta patients said in a separate lawsuit that she suffered in pain for over a year because a piece of a scalpel was left inside her body after a BBL and liposuction.

In a June 2023 court filing in that contract dispute, Goals blamed the problems on a medical staffing firm — Barton Associates, a firm in Massachusetts — it said failed to do adequate background checks on the doctors it supplied. Barton denied the allegations and said it met all terms of the contract.

No public database exists to help patients learn the full practice histories of physicians, including cosmetic surgeons. And patients are largely left on their own to decipher which certificates hanging on a surgeon’s wall, or ballyhooed in web advertising, signify appropriate training and which do not. Disputes among medical specialty groups over whose members are to perform cosmetic operations — and deliver the best results — add to the confusion.

No government agency tracks injuries or other complication rates at clinics offering cosmetic surgery or any other type of operations. And in many jurisdictions, including Georgia, gaining access to court records — a possible red flag for spotting problems — is laborious and costly.

Charleetra Hornes, 52, who lives in the Atlanta suburbs and is suing the Goals center for medical malpractice, said she knew nothing of its alleged early troubles and chose the company because its advertising promised “” for recovery and that she would remain awake during the operation.

She said she paid $6,650 for a “double BBL,” in which fat is suctioned from the stomach, purified, and injected into the buttocks and hips to create what Goals calls a “”

Goals went ahead with her surgery on July 2, 2022, even though she had tested positive for covid that day, according to the suit. Hornes alleged that two days before the surgery Goals assigned her to surgeon Thomas Shannon, who has worked for Goals in Georgia and Texas.

Though staff gave her pills to manage the discomfort, Hornes said, she suffered “excruciating pain” during the procedure, according to the suit.

That night, she spiked a fever that sent her to the emergency room. She spent two weeks in the hospital recovering from injuries, including a “severe burn on her side,” according to the suit.

“I’ve been disfigured and burned up, and it’s not fair,” she said in an interview.

In June 2024, Hornes sued Shannon, the Goals center, and Barton Associates, alleging malpractice. On Sept. 2, a Georgia judge dismissed Shannon from the case, ruling that Hornes failed to serve him with the complaint in Texas before the statute of limitations ran out. He did not respond to requests for comment.

In a separate order issued on the same day, the judge also dismissed the other defendants, citing the statute of limitations issue and that Hornes had previously signed an arbitration agreement. Some cosmetic surgery chains and other medical practices ask patients to sign such agreements.

Hornes wishes she had learned more about the Atlanta surgery center, instead of accepting what she calls its “flashy” come-ons. “I wish I would have taken it more seriously,” she said in an interview, “because it was life-altering.”

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ýҕl Health News identified more than 200 lawsuits filed against multistate cosmetic surgery companies, mostly over the past seven years, including cases involving a dozen deaths, using databases of court records.

Lawsuits by themselves don’t prove wrongdoing. Many cases are settled under confidential terms that keep critical details under wraps. Yet medical authorities and most physician licensing boards regard malpractice cases and settlements as a useful possible patterns of substandard health care that may harm patients.

Court files show that surgeons who were sued numerous times for malpractice — and in some cases disciplined by state medical boards for misconduct — have managed to get hired by cosmetic surgery chains.

Goals, owned by physician Sergey Voskin, has contracted with eight surgeons with three or more malpractice cases filed against them, including in the Atlanta area, court records allege. Gerald Hickson, founding director of the Vanderbilt Center for Patient and Professional Advocacy and an expert on medical malpractice issues, called that number of suits a “warning” of possible problems, despite their outcome.

Earlier this year, a Pennsylvania woman identified in court filings as “P.C.” sued Goals, Voskin, and surgeon Peter Driscoll, alleging Driscoll came on board despite an “extensive history of malpractice allegations, licensing suspensions and discipline” in and , according to medical board records cited in the suit. Companies hiring doctors have ready access to the nonpublic , which details disciplinary problems in a doctor’s past. But it’s not clear from court records whether anybody made these standard background checks. Goals did not respond to a request for comment.

The suit also accuses Goals of consumer fraud for touting its surgeons as “double if not triple board certified plastic surgeons.” According to the complaint, Driscoll was board-certified by the American Board of Otolaryngology, a specialty that focuses on treatment and surgery of head and neck areas. Driscoll is in the specialty, according to the American Board of Medical Specialties website.

The woman alleges that Driscoll sexually harassed her and made “unwanted and unwelcome sexual contact” during a BBL procedure in June 2022 at a Goals office in New Jersey.

According to the suit, staff members overheard Driscoll watching pornography in an office bathroom multiple times, but Goals did not terminate him at the time. New Jersey’s State Board of Medical Examiners in February 2023 related to the incident, and the woman’s lawsuit is pending in federal court in New Jersey. Goals and Voskin have denied the allegations in the suit and filed a motion to dismiss or compel arbitration of the case. Driscoll, who has not filed a response with the court, could not be reached for comment.

Performance Issues Not ‘Disqualifying’

Other cosmetic surgery chains have faced multiple malpractice actions targeting surgeons or other health care providers who staff their clinics, court records show.

The surgeon roster at Mia Aesthetics, a Miami-based chain that operates 13 cosmetic surgery offices nationwide, lists four doctors with three or more malpractice actions since 2020, court records show.

Nearly a dozen injured patients have filed lawsuits criticizing the credentials of doctors and nurse practitioners affiliated with Belle Medical, including the family of a 70-year-old Utah woman with five children who died in the car two days after liposuction as her husband rushed her from home to a hospital, according to court records.

Her husband alleges he called Belle Medical’s office the day after the procedure to say his wife was having difficulty breathing and heart palpitations and couldn’t walk more than a short distance, which the lawsuit argued were “textbook symptoms of pulmonary embolism, or blood clot in the lung.” According to the suit, nobody at Belle Medical advised the family to seek immediate medical care. An autopsy found she died from “bilateral pulmonary emboli,” according to the suit.

Backed by Peterson Partners, a Utah private equity and investment firm, Belle Medical operates in Utah, Idaho, and Oklahoma, offering liposuction and other cosmetic surgery. Neither Belle Medical nor Peterson Partners responded to requests for comment. In court filings, Belle Medical has argued that its medical providers are independent contractors who are solely responsible for any procedures they perform.

Private equity-backed Sono Bello, the largest of the cosmetic surgery chains with more than 100 locations nationwide, has defended more than a dozen lawsuits alleging the company contracted with inadequately trained doctors or practitioners previously disciplined by medical licensing boards. In May 2023, Ohio’s medical board revoked the license of a Sono Bello contract surgeon after three of her patients died, two of them following procedures at a Sono Bello office in the Cleveland area, according to medical board records.

Robert Centeno, Sono Bello’s medical director for the East region, told ýҕl Health News that many surgeons have past performance issues, which he called “not, in fact, disqualifying.”

“The vast majority of our colleagues are extremely professional and committed to their profession,” he said in an interview. “And while there may be a momentary lapse or issue with their practice, most of our surgeons take those sanctions, take that counseling, that advice, and improve their practices and go on to be very, very productive members of the medical community.”

Asked about malpractice lawsuits filed against the company, Centeno said that Sono Bello has “performed over 300,000 procedures to date,” which he described as “more procedures for more patients completed safely than anyone else in the industry. It would be natural and understandable to know that at some point during that process, that a patient has actually sued us,” Centeno said.

‘Unable To Perform’

In early 2020, as the pandemic slowed business in New York City, Goals sought to expand to Atlanta — a hot market for its BBLs. In a , Goals promised patients “amazing contours” and boasted of having “some of the most experienced, and aesthetically forward surgeons in the industry.” BBLs and liposuction make up 95% of its business, marketed to mostly Black and Hispanic women, Goals owner Voskin testified in a deposition filed this year in the Driscoll case. Many Atlanta patients suing the company paid roughly $6,000 to $8,000 for their surgeries, court records show.

Goals initially staffed the Atlanta center through Barton Associates. Many hospitals and medical offices rely on such firms to find temporary doctors and other staff. Under the deal, Barton charged Goals $1,400 for each procedure and paid about $600 of that to the surgeon, according to Goals’ court filings.

In 2023, Barton sued Goals in a Massachusetts court, alleging it was owed $487,000 in fees. Goals admitted that it “temporarily ceased payment” to Barton. But it fired back with a counterclaim accusing Barton of failing to check the qualifications and backgrounds of surgeons as required by the agreement.

Goals named five surgeons Barton sent to the center, including Hsu, and pointed to the spate of malpractice cases in Atlanta to bolster its argument.

Goals said it “became immediately apparent” that another surgeon was “fundamentally unable to perform his duties.” The surgeon was “abrasive, vulgar and could not conduct himself in accordance with reasonable professional standards that were expected in a medical workplace,” according to Goals’ counterclaim.

A second surgeon Barton presented as “highly skilled” turned out to have “an extensive history of complaints about his professional conduct” in two other states, according to the counterclaim.

Barton and Goals settled the case and counterclaim in April 2024 under confidential terms. Barton did not respond to requests for comment. Barton denied Goals’ allegations in earlier court filings and said that it “complied fully” with the terms of its contract with the surgery company.

In its counterclaim, Goals argued that shortly after Hsu joined the staff in 2021, it learned he had “multiple issues” in California and “was about to lose his medical license as a result,” according to a court filing.

Goals provided “significant legal and other assistance” to keep that from happening and Hsu “required substantial training in order to do acceptable work on patients,” the company argued in court filings.

Seven women filed malpractice suits in 2023 alleging they sustained injuries from BBLs and liposuction Hsu performed at the Atlanta office between mid-February 2021 and the end of June 2021, court records show. Barton, the staffing firm, also is a defendant in these cases and has denied wrongdoing. Hsu has denied wrongdoing in the cases and sought to enforce arbitration agreements.

Hsu’s emergency Georgia medical license, approved in January 2021, expired in April 2022, state records show. Hsu is licensed in and , where he has also worked for Goals.

Two suits accuse Hsu of leaving a piece of metal inside the bodies of women, a calamity patient safety experts believe

In one Atlanta case, a patient who alleged she had experienced constant pain since her surgery at Goals in 2021 said she discovered why more than a year later when a chest X-ray ordered after a car crash showed a piece of scalpel blade in her upper abdomen, according to her court filings. The action against Hsu and Barton Associates was settled early this year, court records show.

In the second case, a New Jersey woman who had a BBL at Goals’ Harlem office in New York City in February 2022 alleged she overheard Hsu say in the operating room that he had “left something inside of her,” which turned out to be a metal liposuction cannula tip that had broken off in her stomach. A judge dismissed her lawsuit due to an arbitration clause. She filed a notice of appeal, but the case was settled in August.

The California medical board’s investigation of Hsu ended in October 2023 with . The state accused him of “repeated negligent acts” in treating six patients dating to 2016, including three people who died. None involved cosmetic surgery like his work at Goals.

The board revoked his license but stayed the action and imposed a four-year probation, tacking on a $24,000 penalty to cover costs of the investigation. The order also required Hsu to find a practitioner to help oversee his practice and prohibits him from serving on any on-call panel for general surgery. In settling the case, Hsu did not admit any wrongdoing.

Goals has featured Hsu in a , and that he is a “highly skilled surgical specialist,” who provides “top-notch surgical care.”

Fellowship Training

How much training cosmetic surgery chains demand of surgeons varies, judging by physician service contracts obtained by ýҕl Health News through court filings. Some contracts simply require that the doctor hold a valid state medical license, while others specify that a doctor to perform cosmetic surgery and have not been disciplined by licensing boards or been hit with major malpractice awards.

Sono Bello takes a different route. The company sponsors a six- to eight-week training course for surgeons, which it calls a “fellowship,” and .

Sono Bello accepts applicants from more than half a dozen surgical specialties and focuses its training on liposuction and a type of .

Court records show that Sono Bello has defended at least a dozen lawsuits from patients who argued some surgeons lacked sufficient training or had other problems, or alleged they were misled by some advertising that described surgeons who completed the fellowship as “board certified plastic surgeons.”

Sono Bello’s credentialing process came under attack in a 2023 malpractice lawsuit filed by Shirley Webb, a 79-year-old Nevada woman who spent months in hospitals and rehabilitation care recovering from sepsis after a tummy tuck and liposuction performed by surgeon Charles Kim in Las Vegas in December 2022.

Kim, a colorectal surgeon, took the Sono Bello fellowship from July 2022 to October 2022, court records show. In a deposition, Kim, who is board-certified in general surgery, stated that Sono Bello knew hehad been disciplined by Nevada’s state medical licensing board for alleged malpractice in which a patient he operated on died. Kim paid a $4,000 fine and received a letter of reprimand in settling the medical board case without admitting wrongdoing.

Kim also testified in the medical malpractice case that Sono Bello was aware he had previously settled four medical malpractice cases, court records show. Christopher Chung, Sono Bello’s chief medical officer, said the company verified that Kim’s state medical license and other credentials “were up to date and in good standing” before it hired him. “We reviewed his surgical log, which detailed the voluminous and complex surgeries he had performed at the hospital where he was then employed, and received positive references from his employer and other surgeons,” Chung said in an emailed statement.

A medical expert hired by Webb’s legal team opined that Sono Bello’s use of the term “fellowship” is deceptive because the program is not accredited, or recognized by any subspecialty certifying board, professional society, or hospital. A medical fellowship is typically a training program that lasts at least a year. “We strongly disagree with the suggestion that our website is misleading. We accurately state that our physicians are board-certified surgeons — because they are,” Sono Bello spokesperson Mark Firmani said in response.

In her lawsuit, Webb testified that Sono Bello’s advertisements on television and online led her to believe the company employed only board-certified plastic surgeons.

Had she been told of Kim’s background in advance, “I wouldn’t have had the surgery done,” Webb testified in a 2024 deposition.

The parties settled the suit early this year under confidential terms.

Have you had liposuction, a “Mommy Makeover,” a tummy tuck, a Brazilian butt lift, or another type of cosmetic surgery? We’d like to hear about your experience. Click here to contact our reporting team.

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]]> 2091997 How To Pick the Right Cosmetic Surgeon /news/article/how-to-pick-the-right-cosmetic-surgeon/ Tue, 30 Sep 2025 09:00:00 +0000 /?post_type=article&p=2092010 The debate over which doctors are best qualified to perform cosmetic surgery — and who gets the best results for patients — has raged for decades.

Here’s why: A state-issued medical license grants a physician what a Federation of State Medical Boards called the “privilege of practicing the full breadth of medicine.”

That policy leaves the door open for any licensed doctor to perform cosmetic surgery after scant training, such as a weekend course in liposuction, and some doctors have done just that.

The federation adds that doctors “have a professional and ethical duty to put their patients’ best interests before their own and only offer treatments to patients that they are able to provide competently.”

But what credentials surgeons should hold and be permitted to advertise — the use of the term “board-certified,” in particular — remains contentious. And, for patients, figuring out which of those credentials and marketing claims to trust, and how to steer clear of doctors with troubled pasts, can be a challenge.

Here are tips for picking a cosmetic surgeon:

Do a background check.

The Federation of State Medical Boards operates an with information about a doctor’s practice history, including disciplinary actions. The federation also for each state medical board. Many states compile profiles of doctors with details about their training and practice history. Some include medical malpractice payments to patients who filed suit.

Understand board certification.

In the field of cosmetic surgery, the American Board of Medical Specialties recognizes only the , which requires a minimum of three years training in plastic surgery as well as a written and oral exam.

Board-certified members of the American Society of Plastic Surgeons decry what they see as doctors with less training infringing on their territory, by citing unrecognized certifying boards to buff their credentials, among other things. The society posts a directory of its members .

“A lot of people say they do plastic surgery,” said society president Scott Hollenbeck. “It’s confusing to patients.” The plastic surgery board “is the only one that is legitimate.”

Not so fast, say more than 400 surgeons nationwide who are certified by an alternative board called the .

The group says it accepts only doctors who have completed a residency training program in a surgical specialty, taken a one-year fellowship in cosmetic surgery, and passed a test of their competence and knowledge.

Yet the group has struggled to gain broad acceptance, it says, because of pushback from the plastic surgeons.

Jeffrey Swetnam, an Arkansas cosmetic surgeon and president of the American Board of Cosmetic Surgery, told ýҕl Health News that plastic surgeons have long sought to beat back competitors. Swetnam said that plastic surgery training focuses on a broad range of reconstructive operations, including cosmetic procedures, while members of his group focus exclusively on cosmetic operations.

“This whole deal is a money grab, a turf war over money,” he said.

In April, for example, Florida’s medical board rejected a request by cosmetic surgeons that they be permitted to advertise board certification without adding the caveat that their board is not recognized by the American Board of Medical Specialties.

In some cases, state medical licensing boards have disciplined doctors for allegedly misstating their credentials.

One was Kenneth Adams, a board-certified emergency medicine specialist, who opened Premier Liposuction in Las Vegas after taking a two-day course in liposuction and fat transfer, according to Nevada’s medical licensing board. In a civil complaint in April 2024, the board accused Adams of practicing “beyond the scope of his license.”

The complaint alleged that Adams’ advertising “misleads the public that his certification in Emergency Medicine provides the necessary training to perform liposuction surgery to inflate his credentials and induce patients to seek his services.”

Adams settled the case in November. The settlement prohibited him from performing liposuction, fined him $3,000, and issued him a letter of reprimand.

The American Board of Medical Specialties for checking a doctor’s board certification in recognized specialties, including plastic surgery.

Check for court action.

Some jurisdictions have posted dockets online, which can be searched by name to find lawsuits, though many charge for access and copies, costs that can add up fast. Gerald Hickson, a physician researcher at Vanderbilt University and expert on medical malpractice cases, said a pattern of lawsuits is a red flag. He said that most doctors don’t get sued often, regardless of their specialties.

Consider word of mouth.

It may sound old-fashioned, but some experts, including Hickson, recommend checking with friends and neighbors when picking a doctor. He added that patients need to use “common sense” when interacting with a medical practice to make sure it is right for them.

“Don’t shop for surgery like it’s a sale item,” adds cosmetic surgeon Swetnam. “Invest the time to choose a surgeon based on their training, outcomes, experience, and integrity — not just their title.”

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]]> 2092010 Health Care Cuts Threaten Homegrown Solutions to Rural Doctor Shortages /news/article/rural-northern-california-health-care-shortages-residency-program-funding-cuts/ Thu, 18 Sep 2025 09:00:00 +0000 /?post_type=article&p=2090273 CHICO, Calif. — Olivia Owlett chose to do her primary care residency in this Northern California college town largely because it faces many of the same health care challenges she grew up with.

Owlett is one of four residents in the inaugural class of a three-year family medicine residency program run by the local nonprofit . She is the kind of doctor the organization seeks to draw to the far north of California, a region with .

That’s because Owlett knows in her gut what a lack of health care means, having seen family members drive hours to see a specialist or simply forgo care in her hometown of Wellsboro, a hamlet in Pennsylvania. She did rural training at medical school in Colorado. And because her husband attended Chico State, the couple has a strong social network here, making them likely to remain.

“With the growing family medicine residency program here, it’s a great opportunity to bring more doctors into the area, and I’d love to be a part of that,” Owlett said.

Owlett exemplifies what leaders in rural Northern California want more of: doctors trained locally who stay to work in the area. They have ambitious plans to attract more Owletts and expand the medical workforce, but recent state and federal spending cuts will pull dollars out of an already frayed health system, exacerbating the shortage of care and making their efforts more challenging.

“We need help up here, and cutting funding is not going to help us,” said Debra Lupeika, associate dean for rural and community-based education at the University of California-Davis School of Medicine and a family physician at the tribal Rolling Hills Clinic in Red Bluff, about 40 miles northwest of Chico. “We are in dire straits. We need doctors.”

California’s far northern region is a collection of sparsely populated counties stretching from just north of Sacramento all the way up to Oregon and from the Pacific coast to the Nevada border. The shortages are so pervasive that support for one of the costliest solutions — a proposed $200 million health care training campus — transcends partisanship.

“It’s about what are the priorities, right? And health care certainly is a priority — should be a priority,” said California Assembly Republican Leader James Gallagher, who represents Chico and the surrounding area. “I think it’s been pretty bipartisan, this kind of stuff.”

Republicans in Congress, including the nine GOP lawmakers in California’s delegation, voted in July to cut nearly a trillion dollars from Medicaid. Area Rep. Doug LaMalfa said the “those eligible for benefits continue to receive them.” Meanwhile, the Democratic-controlled California legislature has its health care coverage for immigrants who lack legal status.

California’s health care shortage is driven by the struggles of rural hospitals; an aging physician workforce; the inherent appeal to up-and-coming doctors of more urban areas; and the financial pressures of doing business in a region with a high proportion of , especially Medi-Cal, the state’s version of the Medicaid program, for people with low incomes and disabilities.

Almost everyone who lives up here is affected by the shortages, ranging from people with complex medical needs to those with simple, straightforward ones.

When Lupeika’s 24-year-old daughter, Ashley, injured her shoulder this summer, she couldn’t get an MRI for nearly a month, despite her severe pain.

Ginger Alonso, an assistant professor of political science and public administration at Chico State, said she drives 70 miles to Redding for OB-GYN care.

The long waits or distances people must travel often lead them to delay or forgo care. As a result, they show up at emergency rooms, urgent care, or community clinics with illnesses that are more severe than they would have been had they received medical attention sooner.

“We see sicker patients, bottom line,” said Tanya Layne, a primary care physician in Chico who recently closed her private practice for financial reasons and works at an urgent care clinic in town, owned by Enloe Health, which also runs the sole hospital in town.

Patients walk through the door with undiagnosed cancers, uncontrolled asthma, raging diabetes, and severely high blood pressure, Layne said.

In many northern counties, specialists in acutely short supply include neurologists, gastroenterologists, rheumatologists, endocrinologists, OB-GYNs, oncologists, and urologists.

“We have whole areas with no specialists at all, or where specialists are so overworked that the waits are really long, and people are forgoing care,” said Doug Matthews, a Chico-based colorectal surgeon and regional medical director of Partnership HealthPlan, which provides Medi-Cal coverage in 24 northern counties.

The health care shortage in the region grew more acute after the catastrophic 2018 Camp Fire devastated the town of Paradise, 15 miles east of Chico, shuttering and sending dozens of doctors out of the region.

In response, local leaders created , which launched a four-year residency in psychiatry last year followed by the family medicine program this year. The group also runs a program to expose high school students to potential careers in health care, and it is behind early plans for the $200 million “interprofessional” health care campus that would train future doctors, nurses, physician assistants, and others.

The startup cost would likely need to come from California’s state legislature, but lawmakers are limited by severe budget pressures. Nevertheless, James Schlund, a radiologist and board member of the organization, is discussing it with officials from UC Davis and Touro University.

“We are building the coalition,” Schlund said, “to go to the legislature with an empty bucket and ask them to fill it with money at the hardest of possible times.”

Meanwhile, medical and political leaders in Chico and Redding, the two largest cities in California’s far north, are each exploring building a medical school, possibly in collaboration and under the auspices of UC Davis, which considers rural medicine integral to its mission.

A medical school, paired with more residency slots, would keep graduating students in the area long enough for them to establish roots, buy homes, and start families, boosting the supply of local physicians, said Paul Dhanuka, a gastroenterologist and member of the Redding City Council.

But some say the region’s small population makes it a challenge to train more residents.

“The number of residents you can accommodate is limited by the ability to get the right kinds of patients with the right kind of cases that give the residents the training they need,” said Duane Bland, a physician who runs the family practice residency program at Mercy Medical Center in Redding.

Dhanuka said that in sparsely populated areas, a low number of childbirths limits how many residents can be trained in family medicine. But that is not the case with other specialties such as surgery, psychiatry, cardiology, and gastroenterology. And, he said, across the whole northern region, “there are multiple hospitals as well as clinics which absolutely are looking for more residency participation.”

Residency programs are largely funded with federal dollars through Medicare, and that funding is not at imminent risk — though the number of residency slots paid for by Washington has not significantly increased in about 30 years.

However, some graduate medical education is state-funded, and in California many of those slots rely on revenue generated from a tax on Medi-Cal health plans, which California voters earmarked for that and other purposes last fall by passing . That revenue is projected to under changes in the budget law and a similar rule proposed by the Centers for Medicare & Medicaid Services.

its ER and hospital services in October after losing its federal designation as a “critical access” hospital, which afforded it higher payments and more regulatory flexibility.

A $50 billion rural health care fund in the budget law will offset a little more than a third of the money that rural areas are expected to lose because of the Medicaid cuts, from KFF. And it’s not clear how, or to which states, that money will be distributed.

Civic and medical industry leaders in Chico and Redding say the message needs to get out that a robust health care system will serve the interests of everyone, across political lines.

“Health care is such a human need, because we all hurt the same, regardless of race, color,” Dhanuka said. “We can address this. And we don’t need to take sides on this.”

This article was produced by ýҕl Health News, which publishes , an editorially independent service of the .

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

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]]> 2090273 Parents Fear Losing Disability Protections as Trump Slashes Civil Rights Office /news/article/disabilities-students-education-department-discrimination-trump-cuts-north-carolina/ Mon, 15 Sep 2025 09:00:00 +0000 /?post_type=article&p=2086206 Devon Price, a 15-year-old boy with autism, has attended the largest school district in North Carolina for 10 years, but he cannot read or write. His twin sister, Danielle, who is also autistic, was bullied by classmates and became suicidal.

Under federal law, public schools must provide children with disabilities a “,” to give them the same opportunity to learn as other kids.

The twins’ mother, Emma Miller, and tens of thousands of other parents in the U.S. have elevated complaints to the Education Department alleging that schools and states have ignored mistreatment of their children. Those complaints are in limbo as President Donald Trump’s administration has set about dismantling the federal agency.

Trump once . Earlier this year, Health and Human Services Secretary Robert F. Kennedy Jr.’s inaccurate remarks about people with autism were criticized as perpetuating offensive stereotypes.

Now people like Miller are worried their children will be left behind.

“I want justice for my twins, and to sound the alarm so other special needs children are not suffering or being deprived,” said Miller, 53, who lives with her twins in Wake Forest, North Carolina.

The Education Department, which was created in 1979 and helps oversee schools and colleges in the U.S., has the authority to protect students from discrimination based on race, sex, religion, or disability. Its Office for Civil Rights investigates allegations at schools and negotiates corrective actions.

As the school year begins, families throughout the country are unsure what authority will be left to intervene on their behalf if the office is shuttered, said Hannah Russell, an advocate who works with parents in North Carolina trying to obtain educational services for their children with disabilities.

“Without the Department of Education there is no accountability,” said Russell, a former special education teacher. “Everybody is scared.”

Miller described her twins as her “miracle babies” who survived despite each . Danielle Price spent the first five months of her life in a neonatal intensive care unit, and her brother, Devon, the first seven months.

She has spent years fighting for them, repeatedly taking on local and state school officials. But even when she notched victories, she said, her children did not get the help they were promised.

Miller said her children are high-functioning and verbal. She said they could have thrived academically if the school system had given them proper services.

“My children have suffered,” Miller wrote in a complaint she filed in September 2024. “The most vulnerable group of children [is] being denied a basic education.”

‘Unusual and Unprecedented’

Miller says her daughter began to self-harm after classmates teased and tormented her and staff secluded her away from her bullies. The Wake County Public School System assigned Devon to a classroom with an instructional assistant who was not a licensed teacher, a violation of policy, according to state documents.

Last year, Miller filed a complaint against Wake County schools with the federal Office for Civil Rights. She alleged the district did not reevaluate her kids to determine their special education needs, did not respond for months to her records requests, and retaliated against her by wrongly withdrawing the twins from the school district.

Wake County schools violated policy when staff did not address the effects of bullying on Danielle, says an April 2024 letter from the North Carolina Department of Public Instruction.

The school system’s education plan for Danielle “was not appropriate considering the student’s unmet social-emotional needs, which resulted in the student’s increased anxiety,” the letter says.

State officials concluded in June 2024 that the school system failed to develop, review, and revise an education plan for Devon, assigned him to a teacher assistant instead of a licensed teacher, and did not provide technology that could help him learn, according to documents.

While the decisions validated Miller’s concerns, she said that the district continues to violate her children’s rights and that the state is now ignoring her pleas for help.

“No one is taking responsibility,” she told ýҕl Health News. “It has been a nightmare.”

But after she appealed to the federal government last year, the Education Department sent her a letter in March saying it would not look into the complaint.

For decades, parents and advocates for people with disabilities have said the system makes it difficult for them to win against school districts, because the process is often time-consuming, confusing, and, if a family hires a lawyer, expensive. Now they say families could soon face even bigger hurdles.

On March 11, the day the Education Department sent Miller’s denial letter, it was firing nearly half its 4,133 employees. Education Secretary Linda McMahon said the move was “a significant step toward restoring the greatness of the United States education system.”

Officials shuttered seven of the 12 regional offices of the agency’s Office for Civil Rights, leaving a skeleton staff to investigate thousands of complaints filed each year, according to attorneys and advocates for the disabled.

Trump, acting on a campaign promise to shrink the federal government, later signed an to eliminate the Education Department, which he said had failed children and built a bloated bureaucracy.

The president instructed officials to “return authority over education to the States and local communities while ensuring the effective and uninterrupted delivery of services, programs, and benefits on which Americans rely.”

Parents and advocacy groups say that would allow local authorities to police themselves at a time when schools remain , some selective colleges accept male applicants at than female applicants, and students with disabilities are from the covid pandemic, more so than their peers. Also, they note, the federal laws protecting disabled and disadvantaged children emerged because of .

Under , children with disabilities should be reevaluated by schools every three years to help determine their individual needs. But Miller said Wake County officials for nearly a decade refused her requests to have her kids reevaluated. She said it finally happened in late 2024.

“I never expected getting an education for my children would be such a problem,” Miller said.

The Education Law Center, the NAACP, and other advocacy groups have sued to stop Trump’s plans, alleging the changes are illegal and pose a threat to the education of students from vulnerable groups. Some 20 states and the District of Columbia sued to halt the plan, but the Supreme Court ruled in July that the Trump administration could move ahead while the case proceeded through the courts.

Russell said she has heard North Carolina school districts are promising to provide accommodations for students with disabilities, such as extra time on tests.

But families who cannot afford to hire an attorney could find themselves at a disadvantage when disagreements arise over services that cost districts more money, Russell said.

The Trump administration has decimated the Office for Civil Rights’ ability to properly investigate a backlog of thousands of complaints, said Robert Kim, who leads the Education Law Center.

The office reported receiving nearly , the highest number ever. About 8,400, or 37%, involved allegations of disability discrimination.

Black children and those with disabilities may suffer the worst consequences, since they disproportionately face harsh discipline at school, including physical restraint and isolation in seclusion rooms, Kim said.

The Education Department says children with disabilities but 75% of those secluded and 81% of those physically restrained.

Black children constitute about 15% of students but 42% of those who are mechanically restrained using a device or equipment.

“Something unusual and unprecedented is happening,” Kim said about what he sees as a shift in the federal government’s responsibility to keep children safe and provide a high-quality education.

The Education Department’s press office declined an interview request for this story in an unsigned email that was copied to agency officials Madison Biedermann, Savannah Newhouse, Julie Hartman, and Ellen Keast.

White House spokesperson Kush Desai did not respond to a request for comment.

In a , McMahon said her agency is performing all of its duties: “We will carry out the reduction in force to promote efficiency and accountability and to ensure resources are directed where they matter most — to students, parents, and teachers.”

‘Nothing but Problems’

Danielle and Devon Price entered 10th grade at Wake Forest High School in August. Their mother said she is uncertain what will happen to them.

Danielle wants to go to college, but her math skills are at a fourth-grade level, school records show.

Like many youths with autism, Danielle struggles with changes in routine, and her mother said she became despondent when school officials repeatedly changed her classes to keep her away from a boy who bullied her. Soon after that, Danielle started to self-harm, Miller said, adding that her daughter receives intensive therapy.

“It has been nothing but problems” with Wake County schools, she said. “It is like no one cares.”

Wake County school officials declined to answer questions about Miller’s complaints, citing privacy laws.

In a written statement, district spokesperson Matthew Dees said that “the school district has worked hard to reach agreement with Ms. Miller on many issues” and remedied complaints that were substantiated.

“The district disputes the remaining allegations in the various complaints she has raised, including the many accusations against various staff,” Dees added.

Under federal law, parents have 180 days from the time of the last alleged violation to file a complaint with the Education Department. Miller submitted her complaint Sept. 12, 2024, exactly 180 days after she says her twins were last denied a “free appropriate public education.”

But the Office for Civil Rights said that was too late. Officials declined to waive the time limit for Miller, who had asked for an exception, according to its March denial letter.

She said she spent months fighting with Wake County school officials and did not turn to federal government sooner because she hoped she could resolve the issues locally.

Miller fears for her children’s future unless something changes at school.

“I’m a single parent, and one day I won’t be here,” she said. “My kids are going to be adults soon, yet my son doesn’t know how to read and write. I’m like, ‘Wow.’ There really is no help here.”

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

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]]> 2086206 Push To Move OB-GYN Exam Out of Texas Is Piece of AGs’ Broader Reproductive Rights Campaign /news/article/obgyn-abog-ama-policy-position-certification-exams-abortion-ban-states-aaplog/ Tue, 24 Jun 2025 09:00:00 +0000 /?post_type=article&p=2051776 Democratic state attorneys general led by those from California, New York, and Massachusetts are pressuring medical professional groups to defend reproductive rights, including , , and for health care in response to recent increases in the number of abortion bans.

The American Medical Association adopted a June 9 recommending that medical certification exams be moved out of states with restrictive abortion policies or made virtual, after to protect physicians who fear legal repercussions because of their work. The petition focused on the American Board of Obstetrics and Gynecology’s certification exams in Dallas, and the subsequent AMA recommendation was hailed as a win for Democrats trying to regain ground after the fall of Roe v. Wade.

“It seems incremental, but there are so many things that go into expanding and maintaining access to care,” said Arneta Rogers, executive director of the Center on Reproductive Rights and Justice at the University of California-Berkeley’s law school. “We see AGs banding together, governors banding together, as advocates work on the ground. That feels somewhat more hopeful — that people are thinking about a coordinated strategy.”

Since the Supreme Court eliminated the constitutional right to an abortion in 2022, , including Texas, have implemented laws banning abortion almost entirely, and many of them impose criminal penalties on providers as well as options to sue doctors. restrict access to gender-affirming care for trans people, and six of them make it a felony to provide such care to youth.

That’s raised concern among some physicians who fear being charged if they go to those states, even if their home state offers protection to provide reproductive and gender-affirming health care.

Pointing to the recent fining and in New York who allegedly provided abortion pills to a woman in Texas and a teen in Louisiana, a coalition of physicians wrote in a letter to the American Board of Obstetrics and Gynecology that “the limits of shield laws are tenuous” and that “Texas laws can affect physicians practicing outside of the state as well.”

The campaign was launched by several Democratic attorneys general, including Rob Bonta of California, Andrea Joy Campbell of Massachusetts, and Letitia James of New York, who each have established a reproductive rights unit as a bulwark for their state following the Dobbs decision.

“Reproductive health care and gender-affirming care providers should not have to risk their safety or freedom just to advance in their medical careers,” James said in . “Forcing providers to travel to states that have declared war on reproductive freedom and LGBTQ+ rights is as unnecessary as it is dangerous.”

In their petition, the attorneys general included a letter from Joseph Ottolenghi, medical director at Choices Women’s Medical Center in New York City, who was denied his request to take the test remotely or outside of Texas. To be certified by the American Board of Obstetrics and Gynecology, physicians need to at its testing facility in Dallas. The board of its new testing facility last year.

“As a New York practitioner, I have made every effort not to violate any other state’s laws, but the outer contours of these draconian laws have not been tested or clarified by the courts,” Ottolenghi wrote.

Rachel Rebouché, the dean of Temple University’s law school and a reproductive law scholar, said “putting the heft” of the attorneys general behind this effort helps build awareness and a “public reckoning” on behalf of providers. Separately, some doctors have urged medical conferences to boycott states with abortion bans.

Anti-abortion groups, however, see the campaign as forcing providers to conform to abortion-rights views. Donna Harrison, an OB-GYN and the director of research at the American Association of Pro-Life Obstetricians and Gynecologists, described the petition as an “attack not only on pro-life states but also on life-affirming medical professionals.”

Harrison said the “OB-GYN community consists of physicians with values that are as diverse as our nation’s state abortion laws,” and that this diversity “fosters a medical environment of debate and rigorous thought leading to advancements that ultimately serve our patients.”

The AMA’s new policy urges specialty medical boards to host exams in states without restrictive abortion laws, offer the tests remotely, or provide exemptions for physicians. However, the decision to implement any changes to the administration of these exams is up to those boards. There is no deadline for a decision to be made.

The OB-GYN board did not respond to requests for comment, but after the public petition from the attorneys general criticizing it for refusing exam accommodations, the that in-person exams conducted at its national center in Dallas “provide the most equitable, fair, secure, and standardized assessment.”

The OB-GYN board emphasized that Texas’ laws apply to doctors licensed in Texas and to medical care within Texas, specifically. And it noted that its exam dates are kept under wraps, and that there have been “no incidents of harm to candidates or examiners across thousands of in-person examinations.”

Democratic state prosecutors, however, warned in their petition that the “web of confusing and punitive state-based restrictions creates a legal minefield for medical providers.” Texas is among the states that have from providing gender-affirming care to transgender youth, and it has to get records from medical facilities and professionals in other states who may have provided that type of care to Texans.

The Texas attorney general’s office did not respond to requests for comment.

States such as and have laws to block doctors from being extradited under other states’ laws and to prevent sharing evidence against them. But instances that require leveraging these laws could still mean lengthy legal proceedings.

“We live in a moment where we’ve seen actions by executive bodies that don’t necessarily square with what we thought the rules provided,” Rebouché said.

This article was produced by ýҕl Health News, which publishes , an editorially independent service of the .

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

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This story can be republished for free (details).

]]> 2051776 What the Health? From ýҕl Health News: Trump’s ‘One Big Beautiful Bill’ Lands in Senate. Our 400th Episode! /news/podcast/what-the-health-episode-400-big-beautiful-bill-senate-june-5-2025/ Thu, 05 Jun 2025 18:30:00 +0000 /?p=2044702&post_type=podcast&preview_id=2044702 The Host Julie Rovner ýҕl Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of ýҕl 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.

After narrowly passing in the House in May, President Donald Trump’s “One Big Beautiful Bill” has now arrived in the Senate, where Republicans are struggling to decide whether to pass it, change it, or — as Elon Musk, who recently stepped back from advising Trump, is demanding — kill it.

Adding fuel to the fire, the Congressional Budget Office estimates the bill as written would increase the number of Americans without health insurance by nearly 11 million over the next decade. That number would grow to approximately 16 million should Republicans also not extend additional subsidies for the Affordable Care Act, which expire at year’s end.

This week’s panelists are Julie Rovner of ýҕl Health News, Jessie Hellmann of CQ Roll Call, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.

Panelists

Jessie Hellmann CQ Roll Call Alice Miranda Ollstein Politico Lauren Weber The Washington Post

Among the takeaways from this week’s episode:

  • Even before the CBO released estimates of how many Americans stand to lose health coverage under the House-passed budget reconciliation bill, Republicans in Washington were casting doubt on the nonpartisan office’s findings — as they did during their 2017 Affordable Care Act repeal effort.
  • Responding to concerns about proposed Medicaid cuts, Iowa Sen. Joni Ernst, a Republican, this week stood behind her controversial rejoinder at a town hall that “we’re all going to die.” The remark and its public response illuminated the problematic politics Republicans face in reducing benefits on which their constituents rely — and may foreshadow campaign fights to come.
  • Journalists revealed that Health and Human Services Secretary Robert F. Kennedy Jr.’s report on children’s health may have been generated at least in part by artificial intelligence. The telltale signs in the report of what are called “AI hallucinations” included citations to scientific studies that don’t exist and a garbled interpretation of the findings of other research, raising further questions about the validity of the report’s recommendations.
  • And the Trump administration this week revoked Biden-era guidance on the Emergency Medical Treatment and Active Labor Act. Regardless, the underlying law instructing hospitals to care for those experiencing pregnancy emergencies still applies.

Also this week, Rovner interviews ýҕl Health News’ Arielle Zionts, who reported and wrote the latest “Bill of the Month” feature, about a Medicaid patient who had an emergency in another state and the big bill he got for his troubles. If you have an infuriating, outrageous, or baffling medical bill you’d like to share with us, you can do that here.

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

Julie Rovner: ýҕl Health News’ “Native Americans Hurt by Federal Health Cuts, Despite RFK Jr.’s Promises of Protection,” by Katheryn Houghton, Jazmin Orozco Rodriguez, and Arielle Zionts.

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

Lauren Weber: The New York Times’ “” by Emily Badger and Margot Sanger-Katz.

Jessie Hellmann: The New York Times’ “,” by Isabelle Taft.

Also mentioned in this week’s podcast:

  • NOTUS.org’s “,” by Emily Kennard and Margaret Manto.
  • The Washington Post’s “,” by Lauren Weber and Caitlin Gilbert.
click to open the transcript Transcript: Trump’s ‘One Big Beautiful Bill’ Lands in Senate. Our 400th Episode!

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

Julie Rovner: Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for ýҕl Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, June 5, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go.

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

Alice Miranda Ollstein: Hello.

Rovner: Lauren Weber of The Washington Post.

Lauren Weber: Hello, hello.

Rovner: And Jessie Hellmann of CQ Roll Call.

Jessie Hellmann: Hi there.

Rovner: Later in this episode we’ll have my interview with my colleague Arielle Zionts, who reported and wrote the ýҕl Health News “Bill of the Month,” about a Medicaid patient who had a medical emergency out of state and got a really big bill to boot. But first the news. And buckle up — there is a lot of it.

We’ll start on Capitol Hill, where the Senate is back this week and turning its attention to that “Big Beautiful” budget reconciliation bill passed by the House last month, and we’ll get to the fights over it in a moment. But first, the Congressional Budget Office on Wednesday finished its analysis of the House-passed bill, and the final verdict is in. It would reduce federal health care spending by more than a trillion dollars, with a T, over the next decade. That’s largely from Medicaid but also significantly from the Affordable Care Act. And in a separate letter from CBO Wednesday afternoon, analysts projected that 10.9 million more people would be uninsured over the next decade as a result of the bill’s provisions.

Additionally, 5.1 million more people would lose ACA coverage as a result of the bill, in combination with letting the Biden-era enhanced subsidies expire, for a grand total of 16 million more people uninsured as a result of Congress’ action and inaction. I don’t expect that number is going to help this bill get passed in the Senate, will it?

Ollstein: We’re seeing a lot of what we saw during the Obamacare repeal fight in that, even before this report came out, Republicans were working to discredit the CBO in the eyes of the public and sow the seeds of mistrust ahead of time so that these pretty damaging numbers wouldn’t derail the effort. They did in that case, among other things. And so they could now, despite their protestations.

But I think they’re saying a combination of true things about the CBO, like it’s based on guesses and estimates and models and you have to predict what human behavior is going to be. Are people going to just drop coverage altogether? Are they going to do this? Are they going to do that? But these are the experts we have. This is the nonpartisan body that Congress has chosen to rely on, so you’re not really seeing them present their own credible sources and data. They’re more just saying, Don’t believe these guys.

Rovner: Yeah, and some of these things we know. We’ve seen. We’ve talked about the work requirement a million times, that when you have work requirements in Medicaid, the people who lose coverage are not people who refuse to work. It’s people who can’t navigate the bureaucracy. And when premiums go up, which they will for the Affordable Care Act, not just because they’re letting these extra subsidies expire but because they’re going back to the way premiums were calculated before 2017. The more expensive premiums get, the fewer people sign up. So it’s not exactly rocket science figuring out that you’re going to have a lot more people without health insurance as a result of this.

Ollstein: Honestly, it seems from the reactions so far that Republicans on the Hill are more impacted by the CBO’s deficit increase estimates than they are by the number of uninsured-people increase estimates.

Rovner: And that frankly feels a little more inexplicable to me that the Republicans are just saying, This won’t add to the deficit. And the CBO — it’s arithmetic. It’s not higher math. It’s like if you cut taxes this much so there’s less money coming in, there’s going to be less money and a bigger deficit. I’m not a math person, but I can do that part, at least in my head.

Jessie, you’re on the Hill. What are you seeing over in the Senate? We don’t even have really a schedule for how this is going to go yet, right? We don’t know if the committees are going to do work, if they’re just going to plunk the House bill on the floor and amend it. It’s all sort of a big question mark.

Hellmann: Yeah, we don’t have text yet from any of the committees that have health jurisdiction. There’s been a few bills from other committees, but obviously Senate Finance has a monumental task ahead of them. They are the ones that have jurisdiction over Medicaid. Their members said that they have met dozens of times already to work out the details. The members of the Finance Committee were at the White House yesterday with President [Donald] Trump to talk about the bill.

It doesn’t seem like they got into the nitty-gritty policy details. And the message from the president seemed to mostly be, like, Just pass this bill and don’t make any major changes to it. Which is a tall order, I think, for some of the members like [Sens.] Lisa Murkowski of Alaska and Susan Collins of Maine, and even a few others that are starting to come out and raise concerns about some of the changes that the House made, like to the way that states finance their share of Medicaid spending through the provider tax.

Lisa Murkowski has raised concerns about how soon the work requirements would take effect, because, she was saying, Alaska doesn’t have the infrastructure right now and that would take a little bit to work out. So there are clearly still a lot of details that need to be worked out.

Rovner: Well, I would note that Senate Republicans were already having trouble communicating about this bill even before these latest CBO numbers came out. At a town hall meeting last weekend in Iowa, where nearly 1 in 5 residents are on Medicaid, Republican Sen. Joni Ernst had an unfortunate reaction to a heckler in the audience, and, rather than apologize — well, here’s what she posted on Instagram.

Sen. Joni Ernst: Hello, everyone. I would like to take this opportunity to sincerely apologize for a statement that I made yesterday at my town hall. See, I was in the process of answering a question that had been asked by an audience member when a woman who was extremely distraught screamed out from the back corner of the auditorium, “People are going to die!” And I made an incorrect assumption that everyone in the auditorium understood that, yes, we are all going to perish from this earth.

So I apologize. And I’m really, really glad that I did not have to bring up the subject of the tooth fairy as well. But for those that would like to see eternal and everlasting life, I encourage you to embrace my Lord and Savior, Jesus Christ.

Rovner: And what you can’t see, just to add some emphasis, Ernst recorded this message in a cemetery with tombstones visible behind her. I know it is early in this debate, but I feel like we might look back on this moment later like [Sen. John] McCain’s famous thumbs-down in the 2017 repeal-and-replace debate. Or is it too soon? Lauren.

Weber: For all the messaging they’ve tried to do around Medicaid cuts, for all the messaging, We’re all going to die I cannot imagine was on the list of approved talking points. And at the end of the day, I think it gets at how uncomfortable it is to face the reality of your constituents saying, I no longer have health care. This has been true since the beginning of time. Once you roll out an entitlement program, it’s very difficult to roll it back.

So I think that this is just a preview of how poorly this will go for elected officials, because there will be plenty of people thrown off of Medicaid who are also Republicans. That could come back to bite them in the midterms and in general, I think, could lead — combine it with the anti-DOGE [Department of Government Efficiency] fervor— I think you could have a real recipe for quite the feedback.

Rovner: Yes, and we’re going to talk about DOGE in a second. As we all now know, Elon Musk’s time as a government employee has come to an end, and we’ll talk about his legacy in a minute. But on his way out the door, he let loose a barrage of criticism of the bill, calling it, among other things, a, quote “disgusting abomination” that will saddle Americans with, quote, “crushingly unsustainable debt.”

So basically we have a handful of Republicans threatening to oppose the bill because it adds to the deficit, another handful of Republicans worried about the health cuts — and then what? Any ideas how this battle plays out. I think in the House they managed to get it through by just saying, Keep the ball rolling and send it to the Senate. Now the Senate, it’s going to be harder, I think, for the Senate to say, Oh, we’ll keep the ball rolling and send it back to the House.

Ollstein: Well, and to jump off Lauren’s point, I think the political blowback is really going to be because this is insult on top of injury in terms of not only are people going to lose Medicaid, Republicans, if this passes, but they’re being told that the only people who are going to lose Medicaid are undocumented immigrants and the undeserving. So not only do you lose Medicaid because of choices made by the people you elected, but then they turn around and imply or directly say you never deserved it in the first place. That’s pretty tough.

Rovner: And we’re all going to die.

Ollstein: And we’re all going to die.

Weber: Just to add onto this, I do think it’s important to note that work requirements poll very popularly among the American people. A majority of Americans here “work requirements” and say, Gee, that sounds like a commonsense solution. What the reality that we’ve talked about in this podcast many, many times is, that it ends up kicking off people for bureaucratic reasons. It’s a way to reduce the rolls. It doesn’t necessarily encourage work.

But to the average bear, it sounds great. Yes, absolutely. Why wouldn’t we want more people working? So I do think there is some messaging there, but at the end of the day, like Alice said, like I pointed out, they have not figured out the messaging enough, and it is going to add insult to injury to imply to some of these folks that they did not deserve their health care.

Ollstein: And what’s really baffling is they are running around saying that Medicaid is going to people who should never have been on the program in the first place, able-bodied people without children who are not too young and not too old, sort of implying that these people are enrolling against the wishes of the program’s creators.

But Congress explicitly voted for these people to be eligible for the program. And then after the Supreme Court made it optional, all of these states, most states, voted either by a direct popular vote or through the legislature to extend Medicaid to this population. And now they’re turning around and saying they were never supposed to be on it in the first place. We didn’t get here by accident or fraud.

Rovner: Or by executive order.

Ollstein: Exactly.

Rovner: Well, even before the Senate digs in, there’s still a lot of stuff that got packed into that House bill, some of it at the last minute that most people still aren’t aware of. And I’m not talking about [Rep.] Marjorie Taylor Greene and AI, although that, too, among other things. And shout out here to our podcast panelist . The bill would reduce the amount of money medical students could borrow, threatening the ability of people to train to become doctors, even while the nation is already suffering a doctor shortage.

It would also make it harder for medical residents to pay their loans back and do a variety of other things. The idea behind this is apparently to force medical schools to lower their tuition, which would be nice, but this feels like a very indirect way of doing it.

Weber: I just don’t think it’s very popular in an era in which we’re constantly talking about physician shortages and encouraging folks that are from minority communities or underserved communities to become primary care physicians or infectious disease physicians, to go to the communities that need them, that reflect them, to then say, Look, we’re going to cut your loans. And what that’s going to do — short of RFK [Robert F. Kennedy Jr.], who has toyed with playing with the code. So who knows? We could see.

But as the current structure stands, here’s the deal: You have a lot of medical debt. You are incentivized to go into a more lucrative specialty. That means that you’re not going into primary care. You’re not going into infectious disease care. You’re not going to rural America, because they can’t pay you what it costs to repay all of your loans. So, I do think — and, it was interesting. I think spoke to some of the folks from the study that said that this could change it. That study was based off of metrics from 2006, and for some reason they were like, The financial private pay loans are not really going to cut it today.

I find it hard to believe this won’t get fixed, to be quite honest, just because I think hating on medical students is usually a losing battle in the current system. But who knows?

Rovner: And hospitals have a lot of clout.

Weber: Yeah.

Rovner: Although there’s a lot of things in this bill that they would like to fix. And, I don’t know. Maybe—

Weber: Well, and hospitals have a lot of financial incentive, because essentially they make medical residents indentured servants. So, yeah, they also would like them to have less loans.

Rovner: As I mentioned earlier, Elon Musk has decamped from DOGE, but in his wake is a lot of disruption at the Department of Health and Human Services and not necessarily a lot of savings. Thousands of federal workers are still in limbo on administrative leave, to possibly be reinstated or possibly not, with no one doing their jobs in the meantime. Those who are still there are finding their hands tied by a raft of new rules, including the need to get a political-appointee sign-off for even the most routine tasks.

And around the country, thousands of scientific grants and contracts have been summarily frozen or terminated for no stated cause, as the administration seeks to punish universities for a raft of supposed crimes that have nothing to do with what’s being studied. I know that it just happened, but how is DOGE going to be remembered? I imagine not for all of the efficiencies that it has wrung out of the health care system.

Ollstein: Well, one, I wouldn’t be so sure things are over, either between Elon and the Trump administration or what the amorphous blob that is DOGE. I think that the overall slash-and-burn of government is going to continue in some form. They are trying to formalize it by sending a bill to Congress to make these cuts, that they already made without Congress’ permission, official. We’ll see where that goes, but I think that it’s not an ending. It’s just morphing into whatever its next iteration is.

Rovner: I would note that the first rescission request that the administration has sent up formally includes getting rid of USAID [the U.S. Agency for International Development] and PEPFAR [the President’s Emergency Plan for AIDS Relief] and public broadcasting, which seems unlikely to garner a majority in both houses.

Ollstein: Except, like I said, this is asking them to rubber-stamp something they’re already trying to do without them. Congress doesn’t like its power being infringed on, especially appropriators. They guard that power very jealously. Now, we have seen them a little quieter in this administration than maybe you would’ve thought, but I think there are some who, even if they agree on the substance of the cuts, might object to the process and just being asked to rubber-stamp it after the fact.

Rovner: Well, meanwhile, Health and Human Services Secretary Kennedy continues to try to remake what’s left of HHS, although his big reorganization is currently blocked by a federal judge. And it turns out that his big MAHA, “Make America Healthy Again,” report may have been at least in part written by AI, which apparently became obvious when the folks at decided to do something that was never on my reporting bingo card, which is to check the footnotes in the report to see if they were real, which apparently many are not. Then, Lauren, you and your colleagues . So tell us about that.

Weber: Yeah. NOTUS did a great job. They went through all the footnotes to find out that several of the studies didn’t exist, and my colleagues and I saw that and said, Hm, let’s look a little closer at these footnotes and see. And what we were able to do in speaking with AI experts is find telltale signs of AI. It’s basically a sign of artificial intelligence when things are hallucinated — which is what they call it — which is when it sounds right but isn’t completely factual, which is one of the dangers of using AI.

And it appears that some of AI was used in the footnotes of this MAHA report, again, to, as NOTUS pointed out, create studies that don’t exist. It also kind of garbled some of the science on the other pieces of this. We found something called “oaicite,” which is a marker of OpenAI system, throughout the report. And at the end of the day, it casts a lot of questions on the report as a whole and: How exactly did it get made? What is the science behind this report?

And even before anyone found any of these footnotes of any of this, a fair amount of these studies that this report cites to back up its thesis are a stretch. Even putting aside the fake studies and the garbled studies, I think it’s important to also note that a lot of the studies the report cites, a lot of what Kennedy does, take it a lot further than what they actually say.

Rovner: So, this is all going well. Meanwhile, there is continuing confusion in vaccine land after Secretary Kennedy, flanked by FDA [Food and Drug Administration] Commissioner Marty Makary and NIH [National Institutes of Health] Director Jay Bhattacharya, announced in a video on X that the department would no longer recommend covid vaccines for pregnant women and healthy children, sidestepping the expert advice of the Centers for Disease Control and Prevention and its advisory committee of experts.

The HHS officials say people who may still be at risk can discuss whether to get the vaccine with their doctors, but if the vaccines are no longer on the recommended list, then insurance is less likely to cover them and medical facilities are less likely to stock them. Paging Sen. [Bill] Cassidy, who still, as far as I can tell, hasn’t said anything about the secretary’s violation of his promise to the senator during his confirmation hearings that he wouldn’t mess with the vaccine schedule. Have we heard a peep from Sen. Cassidy about any of this?

Ollstein: I have not, but a lot of the medical field has been very vocal and very upset. I was actually at the annual conference of the American College of Obstetricians and Gynecologists when this news broke, and they were just so confused and so upset. They had seen pregnant patients die of covid before the vaccines were available, or because there was so much misinformation and mistrust about the vaccines’ safety for pregnant people that a lot of people avoided it, and really suffered the consequences of avoiding it.

A lot of the issue was that there were not good studies of the vaccine in pregnant people at the beginning of the rollout. There have since been, and those studies have since shown that it is safe and effective for pregnant people. But it was, in a lot of people’s minds, too late, because they already got it in their head that it was unsafe or untested. So the OB-GYNs at this conference were really, really worried about this.

Rovner: And, confusingly, the CDC on its website amended its recommendations to leave children recommended but not pregnant women, which is kind of the opposite of, I think, what most of the medical experts were recommending. Jessie, you were about to add something.

Hellmann: I just feel like the confusion is the point. I think Kennedy has made it a pattern now to get out ahead of an official agency decision and kind of set the narrative, even if it is completely opposite of what his agencies are recommending or are stating. He’s done this with a report that the CDC came out with autism, when he said rising autism cases aren’t because of more recognition and the CDC report said it’s a large part because of more recognition.

He’s done this with food dyes. He said, We’re banning food dyes. And then it turns out they just asked manufacturers to stop putting food dyes into it. So I think it’s part of, he’s this figurehead of the agency and he likes to get out in front of it and just state something as fact, and that is what people are going to remember, not something on a CDC webpage that most people aren’t going to be able to find.

Rovner: Yeah, it sounds like President Trump. It’s like, saying it is more important than doing it, in a lot of cases. So of course there’s abortion news this week, too. The Trump administration on Tuesday reversed the Biden administration guidance regarding EMTALA, the Emergency Medical Treatment and Active Labor Act. Biden officials, in the wake of the overturn of Roe v. Wade three years ago, had reminded hospitals that take Medicare and Medicaid, which is all of them, basically, that the requirement to provide emergency care includes abortion when warranted, regardless of state bans. Now, Alice, this wasn’t really unexpected. In fact, it’s happening later than I think a lot of people expected it to happen. How much impact is it going to have, beyond a giant barrage of press releases from both sides in the abortion debate?

Ollstein: Yeah, so, OK, it’s important for people to remember that what the Biden administration, the guidance they put out was just sort of an interpretation of the underlying law. So the underlying law isn’t changing. The Biden administration was just saying: We are stressing that the underlying law means in the abortion context, in the post-Dobbs context, blah, blah, blah, blah, blah, that hospitals cannot turn away a pregnant woman who’s having a medical crisis. And if the necessary treatment to save her life or stabilize her is an abortion, then that’s what they have to do, regardless of the laws in the state.

In a sense, nothing’s changed, because EMTALA itself is still in place, but it does send a signal that could make hospitals feel more comfortable turning people away or denying treatment, since the government is signaling that they don’t consider that a violation. Now, I will say, you’re totally right that this was expected. In the big lawsuit over this that is playing out now in Idaho, one of the state’s hospitals intervened as a plaintiff, basically in anticipation of this happening, saying, The Trump administration might not defend EMTALA in the abortion context, so we’re going to do it for them, basically, to keep this case alive.

Rovner: And I would point out that ProPublica just won a Pulitzer for detailing the women who were turned away and then died because they were having pregnancy complications. So we do know that this is happening. Interestingly, the day before the administration’s announcement, the put out a new, quote, “practice advisory” on the treatment of preterm pre-labor rupture of membranes, which is one of the more common late-pregnancy complications that result in abortion, because of the risk of infection to the pregnant person.

Reading from that guidance, quote, “the Practice Advisory affirms that ob-gyns and other clinicians must be able to intervene and, in cases of previable and periviable PPROM” — that’s the premature rupture of membranes — “provide abortion care before the patient becomes critically ill.” Meanwhile, this statement came out Wednesday from the , quote, ,“Regardless of variances in the regulatory landscape from one administration to another, emergency physicians remain committed not just by law, but by their professional oath, to provide this care.”

So on the one hand, professional organizations are speaking out more strongly than I think we’ve seen them do it before, but they’re not the ones that are in the emergency room facing potential jail time for, Do I obey the federal law or do I obey the state ban?

Ollstein: And when I talk to doctors who are grappling with this, they say that even with the Biden administration’s interpretation of EMTALA, that didn’t solve the problem for them. It was some measure of protection and confidence. But still, exactly like you said, they’re still caught in between seemingly conflicting state and federal law. And really a lot of them, based on what they told me, were saying that the threat of the state law is more severe. It’s more immediate.

It means being charged with a felony, being charged with a crime if they do provide the abortion, versus it’s a federal penalty, it’s not on the doctor itself. It’s on the institution. And it may or may not happen at some point. So when you have criminal charges on one side and maybe some federal regulation or an investigation on the other side, what are you going to choose?

Rovner: And it’s hard to imagine this administration doing a lot of these investigations. They seem to be turning to other things. Well, we will watch this space, and obviously this is all still playing out in court. All right, that is this week’s news, or at least as much as we could squeeze in. Now we’ll play my “Bill of the Month” interview with Arielle Zionts, and then we’ll come back and do our extra credits.

I am pleased to welcome back to the podcast ýҕl Health News’ Arielle Zionts, who reported and wrote the latest ýҕl Health News “Bill of the Month.” Arielle, welcome back.

Arielle Zionts: Hi. Thanks for having me.

Rovner: So this month’s patient has Medicaid as his health insurance, and he left his home state of Florida to visit family in South Dakota for the holidays, where he had a medical emergency. Tell us who he is and what happened that landed him in the hospital.

Zionts: Sure. So I spoke with Hans Wirt. He was visiting family in the Black Hills. That’s where Mount Rushmore is and its beautiful outdoors. He was at a water park, following his son up and down the stairs and getting kind of winded. And at first he thought it might just be the elevation difference, because in Florida it’s like 33 feet above sea level. Here it’s above 3,000 in Rapid City.

But then they got him back to the hotel room and he was getting a lot worse, his breathing, and then he turned pale. And his 12-year-old son is the one who called 911. And medics were like, Yep, you’re having a heart attack. And they took him to the hospital in town, and that is the only place to go. There’s just one hospital with an ER in Rapid City.

Rovner: So the good news is that he was ultimately OK, but the bad news is that the hospital tried to stick them with the bill. How big was it?

Zionts: It was nearly $78,000.

Rovner: Wow. So let’s back up a bit. How did Mr. Wirt come to be on Medicaid?

Zionts: Yeah. So it is significant that he is from Florida, because that is one of the 10 states that has not opted in to expand Medicaid. So in Florida, if you’re an adult, you can’t just be low-income. You have to also be disabled or caring for a minor child. And Hans says that’s his case. He works part time at a family business, but he also cares for his 12-year-old son, who is also on Medicaid.

Rovner: So Medicaid patients, as we know, are not supposed to be charged even small copays for care in most cases. Is that still the case when they get care in other states?

Zionts: So Medicaid will not pay for patient care if they are getting more of an elective or non-medically necessary kind of optional procedure or care in another state. But there are several exceptions, and one of the exceptions is if they have an emergency in another state. So federal law says that state Medicaid programs have to reimburse those hospitals if it was for emergency care.

Rovner: And presumably a heart attack is an emergency.

Zionts: Yes.

Rovner: So why did the hospital try to bill him anyway? They should have billed Florida Medicaid, right?

Zionts: So what’s interesting is while there’s a law that says the Medicaid program has to reimburse the hospital, there’s no law saying the hospital has to send the bill to Medicaid. And that was really interesting to learn. In this case, the hospital, it’s called Monument Health, and they said they only bill plans in South Dakota and four of our bordering states. So basically they said for them to bill for the Medicaid, they would have to enroll.

And they say they don’t do that in every state, because there is a separate application process for each state. And their spokesperson described it as a burdensome process. So in this case, they billed Hans instead.

Rovner: So what eventually happened with this bill? He presumably didn’t have $78,000 to spare.

Zionts: Correct. Yeah. And he had told them that, and he said they only offered, Hey, you can set up a payment plan. But that would’ve still been really expensive, the monthly payments. So he reached out to ýҕl Health News, and I had sent my questions to the hospital, and then a few days later I get a text from Hans and he says, Hey, my balance is at zero now. He and I both eventually learned that that’s because the hospital paid for his care through a program called Charity Care.

All nonprofit hospitals are required to have this program, which provides free or very discounted pricing for patients who are uninsured or very underinsured. And the hospital said that they screen everyone for this program before sending them to collections. But what that meant is that for months, Hans was under the impression that he was getting this bill. And he was, got a notice saying, This is your last warning before we send you to collection.

Rovner: So, maybe they would’ve done it anyway, or maybe you gave them a nudge.

Zionts: They say they would’ve done it anyways.

Rovner: OK. So what’s the takeaway here? It can’t be that if you have Medicaid, you can’t travel to another state to visit family at Christmas.

Zionts: Right. So Hans made that same joke. He said, quote, “If I get sick and have a heart attack, I have to be sure that I do that here in Florida now instead of some other state.” Obviously, he’s kidding. You can’t control when you have an emergency. So the takeaway is that you do risk being billed and that if you don’t know how to advocate yourself, you might get sent to collections. But I also learned that there’s things that you can do.

So you could file a complaint with your state Medicaid program, and also, if you have a managed-care program, and they might have — you should ask for a caseworker, like, Hey, can you communicate with the hospital? Or you can contact an attorney. There’s free legal-aid ones. An attorney I spoke with said that she would’ve immediately sent a letter to the hospital saying, Look, you need to either register with Florida Medicaid and submit it. If not, you need to offer the Charity Care. So that’s the advice.

Rovner: So, basically, be ready to advocate for yourself.

Zionts: Yes.

Rovner: OK. Arielle Zionts, thank you so much.

Zionts: Thank you.

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

Hellmann: My story is from The New York Times. It’s called “,” which I don’t know how I feel about that headline, but the story was really interesting. It’s about how police departments are using DNA technology to find the mothers of infants that had been found dead years and years ago. And it gets a little bit into just the complicated situation.

Some of these women have gone on to have families. They have successful careers. And now some of them are being charged with murder, and some who have been approached about this have unfortunately died by suicide. And it just gets into the ethics of the issue and what police and doctors, families, should be considering about the context around some of these situations, about what the circumstances were, in some cases, 40 years ago and what should be done with that.

Rovner: Really thought-provoking story. Lauren.

Weber: With credit to Julie, too, because she brought this up again, was brought back to a classic from The New York Times back in 2020, which is called “” And here are the questions: I will read them for the group.

Rovner: And I will point out that this is once again relevant. That’s why it was brought back.

Weber: It’s once again relevant, and one of them is, “Do you have paper mail you plan to read that has been unopened for more than a week?” Yes. I’m looking at paper mail on my desk. “Have you forgotten to pay a utility bill on time?” If I didn’t set up auto pay, I probably would forget to pay a utility bill on time. “Have you received a government document in the mail that you did not understand?” Many times. “Have you missed a doctor’s appointment because you forgot you scheduled it or something came up?”

These are the basic facts that can derail someone from having access to health care or saddle them, because they lose access to health care and don’t realize it, with massive hospital bills. And this is a lot of what we could see in the coming months if some of these Medicaid changes come through. And I just, I think I would challenge a lot of people to think seriously about how much mail they leave unopened and what that could mean for them, especially if you are living in different homes, if you are moving frequently, etc. This paperwork burden is something to definitely be considered.

Rovner: Yeah, I think we should sort of refloat this every time we have another one of these debates. Alice.

Ollstein: So I wanted to recommend something I wrote [“”]. It was my last story before taking some time off this summer. It is about the intersection of Trump’s immigration policies and our health care system. And so this is jumping off the Supreme Court allowing the Trump administration to strip legal status from hundreds of thousands of immigrants. Again, these are people who came legally through a designated program, and they are being made undocumented by the Trump administration, with the Supreme Court’s blessing. And tens of thousands of them are health care workers.

And so I visited an elder care facility in Northern Virginia that was set to lose 65 staff members, and I talked to the residents and the other workers about how this would affect them, and the owner. And it was just a microcosm of the damage this could have on our health sector more broadly. Elder care is especially immigrant-heavy in its workforce, and everyone there was saying there just are not the people to replace these folks.

And not only is that the case right now, but as the baby boomer generation ages and requires care, the shortages we see now are going to be nothing compared to what we could see down the road. With the lower birth rates here, we’re just not producing enough workers to do these jobs. The piece also looks into how public health and management of infectious diseases is also being worsened by these immigration raids and crackdowns and deportations. So, would love people to take a look.

Rovner: I’m so glad you did this story, because it’s something that I keep running up and down screaming. And you can tell us why you’re taking some time off this summer, Alice.

Ollstein: I’m writing a book. Hopefully it will be out next year, and I can’t wait to tell everyone more about it.

Rovner: Excellent. All right. My extra credit this week is from my ýҕl Health News colleagues Katheryn Houghton, Jazmin Orozco Rodriguez, and Arielle Zionts, who you just heard talking about her “Bill of the Month,” and it’s called “Native Americans Hurt by Federal Health Cuts, Despite RFK Jr.’s Promises of Protection.” And that sums it up pretty well. The HHS secretary had a splashy photo op earlier this year out west, where he promised to prioritize Native American health. But while he did spare the Indian Health Service from personnel cuts, it turns out that the Native American population is also served by dozens of other HHS programs that were cut, some of them dramatically, everything from home energy assistance to programs that improve access to healthy food, to preventing overdoses. The Native community has been disproportionately hurt by the purging of DEI [diversity, equity, and inclusion] programs, because Native populations have systematically been subjected to unequal treatment over many generations. It’s a really good if somewhat infuriating story.

OK. That is this week’s show. Before we go, if you will indulge me for a minute, this is our 400th episode of “What the Health?” We launched in 2017 during that year’s repeal-and-replace debate. I want to thank all of my panelists, current and former, for teaching me something new every single week. And everyone here at ýҕl Health News who makes this podcast possible. That includes not only my chief partners in crime, Francis Ying and Emmarie Huetteman, but also the copy desk and social media and web teams who do all the behind-the-scenes work that brings our podcast to you every week. And of course, big thanks to you, the listeners, who have stuck with us all these years.

I won’t promise you 400 more episodes, but I will keep doing this as long as you keep wanting it. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me on X, , or on Bluesky, . Where are you folks these days? Jessie?

Hellmann: @jessiehellmann and , and .

Rovner: Lauren.

Weber: I’m on X and on , shockingly, now.

Rovner: Alice.

Ollstein: on Bluesky and on X.

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

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]]> 2044702 What the Health? From ýҕl Health News: 100 Days of Health Policy Upheaval /news/podcast/what-the-health-395-medicaid-cuts-gop-trump-100-days-may-1-2025/ Thu, 01 May 2025 18:40:00 +0000 /?p=2024848&post_type=podcast&preview_id=2024848 The Host Julie Rovner ýҕl Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of ýҕl 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.

Members of Congress are back in Washington this week, and Republicans are facing hard decisions on how to reduce Medicaid spending, even as new polling shows that would be unpopular among their voters.

Meanwhile, with President Donald Trump marking 100 days in office, the Department of Health and Human Services remains in a state of confusion, as programs that were hastily cut are just as hastily reinstated — or not. Even those leading the programs seem unsure about the status of many key health activities.

This week’s panelists are Julie Rovner of ýҕl Health News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, Alice Miranda Ollstein of Politico, and Margot Sanger-Katz of The New York Times.

Panelists

Joanne Kenen Johns Hopkins University and Politico Alice Miranda Ollstein Politico Margot Sanger-Katz The New York Times

Among the takeaways from this week’s episode:

  • How and what congressional Republicans will propose cutting from federal government spending is still up in the air — one big reason being that the House and Senate have two separate sets of instructions to follow during the budget reconciliation process. The two chambers will need to resolve their differences eventually, and many of the ideas on the table could be politically risky for Republicans.
  • GOP lawmakers are reportedly considering imposing sweeping work requirements on nondisabled adults to remain eligible for Medicaid. Only Georgia and Arkansas have tried mandating that some enrollees work, volunteer, go to school, or enroll in job training to qualify for Medicaid. Those states’ experiences showed that work requirements don’t increase employment but are effective at reducing Medicaid enrollment — because many people have trouble proving they qualify and get kicked off their coverage.
  • New reporting this week sheds light on the Trump administration’s efforts to go after the accreditation of some medical student and residency programs, part of the White House’s efforts to crack down on diversity and inclusion initiatives. Yet evidence shows that increasing the diversity of medical professionals helps improve health outcomes — and that undermining medical training could further exacerbate provider shortages and worsen the quality of care.
  • Trump’s upcoming budget proposal to Congress could shed light on his administration’s budget cuts and workforce reductions within — and spreading out from — federal health agencies. The proposal will be the first written documentation of the Trump White House’s intentions for the federal government.

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

Julie Rovner: ýҕl Health News’ “As a Diversity Grant Dies, Young Scientists Fear It Will Haunt Their Careers,” by Brett Kelman.

Joanne Kenen: NJ.com’s “” and “,” by Ted Sherman, Susan K. Livio, and Matthew Miller.

Alice Miranda Ollstein: ProPublica’s “,” by Jessica Schreifels, The Salt Lake Tribune.

Margot Sanger-Katz: CNBC’s “,” by Bertha Coombs.

Also mentioned in this week’s podcast:

  • MedPage Today’s “,” by Cheryl Clark.
  • Stat’s “,” by Elizabeth Cooney.
  • CBS News’ “,” by Alexander Tin.
  • The New York Times’ “,” by Christina Jewett.
click to open the transcript Transcript: 100 Days of Health Policy Upheaval

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

Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for ýҕl Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, May 1, at 10:30 a.m. As always, news happens fast and things might change by the time you hear this. So, here we go.

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

Alice Miranda Ollstein: Hello.

Rovner: Margot Sanger-Katz of The New York Times.

Margot Sanger-Katz: Good morning, everybody.

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

Joanne Kenen: Hi, everybody.

Rovner: Later in this episode we’ll have a special report on the first 100 days of the second Trump administration and what’s happened in health policy. But first, as usual, this week’s news.

So Congress is back from its spring break and studying for midterms. Oops. I mean it’s getting down to work on President [Donald] Trump’s, quote, “big, beautiful” budget reconciliation bill. For those who may have forgotten, the House Energy and Commerce Committee is tasked with cutting $880 billion over the next decade from programs it oversees. Although the only programs that could really get to that total are Medicare and Medicaid, and Medicare has been declared politically off-limits by President Trump. So what are the options you guys are hearing for how to basically cut Medicaid by 10%, which is effectively what they’re trying to do?

Sanger-Katz: I think it’s a bit of a scramble to decide. My sense is, there’s been for some time a menu of changes that would pull money out of the Medicaid program. There’s also kind of a small menu of other things that the committee has jurisdiction over. And as far as I can tell, all of the various options on that menu are kind of just in a constant rotation of discussion with different members endorsing this one or that one. The president weighs in occasionally or voices from the White House, but I think the committee is waiting on scores from the Congressional Budget Office, so they have to hit this $880 billion number. And so it’s kind of a complicated puzzle to put together the pieces to get to that number and they don’t know what they need. But I also think that they are facing some really difficult politics inside their own caucus in trying to decide what to do and how they can message it in a way that kind of checks everyone’s boxes.

There are some people who have made promises to their constituents that they’re not going to cut Medicaid. There are some people who have said that they only want to do things that would target fraud and abuse. There are some people who have said that they want to make major structural changes to the program. And all of those people are sort of disagreeing about the exact mechanisms.

Rovner: The phrase I keep hearing is that the math doesn’t math.

Sanger-Katz: Yeah. I also think some of them are going to be surprised when the Congressional Budget Office gives them the scores. I think that the leadership has been reassuring a lot of these members, when they voted on these earlier budget bills that were more vague, more theoretical. I think that there were promises that were made to them that, Don’t worry about this. We’re going to solve your problems. This isn’t going to be a huge political headache for you. And I think the reality is is a) The cuts are going to have to be big. That’s what $880 billion means. And b) I think that they are going to be estimated to have pretty big effects on health insurance coverage, because if you’re going to cut $880 billion from Medicaid, that probably means that fewer people are going to be covered. I think some members are going to be surprised by that.

And the other thing is, I think they’re going to start to see in the analyses and hear from local people that some states are going to get hit harder than others. I think there are some states that these members come from where the cuts are going to disproportionately fall. Now we could talk more about the options on the menu. I think some of them will hurt some states more and others will hurt other states more. And I think that is part of the politicking and debate that’s happening as well, where each of these legislators is trying to figure out how they can hit this target, keep their promises, and also protect their own districts to the best of their ability.

Rovner: It seems like one of the things at the top of every Republican’s list that would be quote-unquote “acceptable” would be work requirements. And I heard numbers this week that the CBO is estimating something like more than $200 billion over 10 years in work requirements, which would be pretty strong work requirements. But Alice, you’re our work requirements queen here. We know that the stronger those work requirements are, the more people end up falling off who are still eligible, because most people on Medicaid already work, right?

Ollstein: Yes. The only places in the country that have implemented work requirements for Medicaid have found that it does not increase employment, but it does kick people off the program who should qualify, either because they are working or they have a legitimate reason, they’re a full-time caretaker, they’re a student, they have a disability to not be able to work, and they lose their coverage anyway because they can’t navigate the bureaucracy. And I think what Margot is really getting to is, the fundamental dilemma that Republicans are facing right now as they try to put this together is that the proposals that are most politically palatable to them, like work requirements, won’t get them anywhere near the amount of money they need to cut, that they’ve promised to cut, that they’ve passed a bill pledging to cut in this space. And so that will mean that other things will have to be considered.

And again, I feel like I say this every time, but we really have to be paying very close attention to semantics here. What one person considers a cut when they say the word “cut” is not necessarily what all of us would consider a cut. What some people in power are labeling waste, fraud, and abuse is people getting health care under the law legitimately. They think they shouldn’t, but they do. And so I think we really need to scrutinize the exact language people are using here.

Rovner: There does seem to be kind of a zeroing in on what we call the expansion population, the population that was added to Medicaid under the Affordable Care Act, which were people who were not the traditional welfare moms and kids and people with disabilities and seniors in nursing homes. These were people who were otherwise low-income but didn’t have health insurance, which is kind of the point. That’s why we say most of these people are already working. You’re not going to live on your Medicaid benefits. There’s no cash involved. The cash goes to the people who provide the actual health care or in some cases the insurers. But that seems to be when — you were talking about semantics — you see Republicans talking about protecting the most vulnerable. That sounds like they really do want to go after this expansion population. But Margot, as you said, a lot of this expansion population is in red states, right?

Sanger-Katz: Yeah. I think there’s another dynamic that’s going on right now that is important to keep track of, which is we’re at the sort of beginning of this process. So both the House and Senate have passed budgets. Those lay out these numbers, and they’ve laid out this very high number. It’s a high threshold for the Energy and Commerce Committee in the House. They have to find this $880 billion. After they do that, the entire House has to vote on the entire reconciliation package, which includes not just these changes to Medicaid but also a series of tax changes, changes to defense and homeland security spending, probably reductions in SNAP [the Supplemental Nutrition Assistance Program] and education funding. Then the whole thing goes to the Senate and the Senate has to do its own version.

And the budget itself is a very weird document. Usually what you see with these budgets is that what the instructions are for the House and the Senate match. In this case, they do not. So the House still has to find these very large Medicaid cuts that I think will be politically problematic for certain House members. But the Senate actually doesn’t. It’s very unclear what the Senate’s plan is and whether they are going to try to go as far. And so I think it creates a difficult dynamic where I think some of these House members may not want to take a hard vote on major budget cuts, that could be politically costly to them, if it’s not even going to become law. And so I think that there’s a lot of kind of meeting of reality that is happening right now, which I think doesn’t mean that they won’t come up with a plan. It doesn’t mean that they won’t pass a plan, and it doesn’t mean that they won’t pass a plan that will affect those budgets of their home states.

But I do think that they are in a little bit of a politically uncomfortable position right now, where they’re being asked to vote for something that is going to be unpopular in some quarters and where they don’t even really know if the Senate is going to hold their hand and go along with it.

Ollstein: Just one point. We talk a lot about red states and blue states, but it’s important to remember that blue states have a lot of districts represented by Republicans, and that’s arguably the reason they even have a House majority. And so if they pass something that really sticks it to New York and California, there’s a lot of Republican House members who might be at risk.

Rovner: Yes. And they’re already making noise. And that’s what I was going to say. The last time Republicans went hard after Medicaid after the expansion was during the effort to repeal the Affordable Care Act in 2017, obviously, and we have a brand-new poll out today from KFF, shows that, if anything, Medicaid is even more relevant to Republicans than it was eight years ago. Today’s poll found that more than three-quarters of those polled say they oppose major cuts to Medicaid, including 55% of Republicans and 79% of independents. Those are pretty big numbers. I guess it helps explain why we’re seeing so many Republicans who are looking — there’s so much hand-wringing right now when they’re trying to figure out how to get to these numbers. Go ahead, Joanne.

Kenen: The other thing, it’s not just people who have increasingly, across party lines, grown in their affection for Medicaid, which is paying for all sorts of things. It’s paying for long-term care. It’s paying for almost half the births in this country. It’s paying for postpartum care. It’s paying for kids. It’s paying for the disabled. It is paying for a lot of drug and opioid treatment and substance abuse. It is paying for a lot of things. But in addition to the politics of individuals and families relying on — they call it an entitlement for a reason. People feel entitled to it. But once you give it to them, they don’t want to give it away. And it’s hard for politicians. They don’t want to give it up, and it’s hard for politicians to take it away. But the other thing is it’s also incredibly important to health care providers, specifically hospitals, because nursing homes are not going to get cut the way hospitals are vulnerable.

Rural hospitals, urban hospitals — this is just a, particularly in areas where hospitals are already closing and rural states, it would be devastating to hospitals. You’re beginning to hear them talk more and more and more. Ultimately, I think this is going to come down to three syllables: Donald Trump. We are hearing all sorts of things, right?. He is really good at getting what he wants in the House, even if it’s politically difficult. Someone says, I can’t vote for it, they go back, Speaker [Mike] Johnson goes back in wherever he goes back with them and they come out and vote for it, right? It can take a day, it can take a few hours, but Trump hasn’t lost anything on the floor on the budget so far. We’ve gotten to this point. If Trump decides that he’s going to bite this bullet and go for the $800 [billion], he can probably get it through the House if he really decides that that’s what he wants. Unless they really convince him that it’ll cost the Republicans in the House, and then he has to believe them. He has to think that he really is vulnerable and that the Republicans can lose. And there’s all sorts of questions about what elections are going look like in two years.

But I think that the providers, they’re lobbying in ways that we can see and they’re lobbying in ways that we can’t see. So that’s a part of it. And then the other thing is that there’s a really interesting dynamic with the expansion of states. The states that have not expanded Medicaid tend to be mostly, not all, in the South, Republican states. Their people are not covered. The people who fall in the gap are still not covered. So they don’t have such a dog in this fight. But as we’ve already mentioned, places with a lot of working-class Republicans, the irony is to order, to get states to accept Medicaid expansion in the first place under the ACA, the federal government gave a lot of money — 90%, right? There was more originally. They’re still paying 90%. And that cost the federal government a lot, but states don’t want to give that money up. It’s free dollars.

And another layer of weird dynamics is a lot of the conservative states that did expand Medicaid did so with what they call a trigger. If the payment changes, the Medicaid expansion collapses. It’s gone. So there’s this weird dynamic of the states who were most skeptical of Medicaid expansion, ended up making it safe by putting in those triggers because no one wants to pull or press the trigger.

Sanger-Katz: Can I say one more thing—

Rovner: Yes, go ahead.

Sanger-Katz: —about the state-by-state dynamics? Because I’ve actually been thinking about this a lot and doing a lot of reporting on this. Joanne is a 100% right. There are these states that have these triggers. They are predominantly Republican states. So those are states where, again, you’re going to see a lot of people losing coverage, because the state is just going to automatically pull back on all of the coverage for these working-class people who are getting Medicaid because they have a low income. But that’s not universally the case. a couple of weeks ago. There are three Republican states that actually have constitutional amendments that they have to cover this population. So even more so than the blue states—

Rovner: We talked about your story, Margot.

Sanger-Katz: Yeah? I love it. I love it. But even more so than the blue states, these are states that are really locked in. Those state governments and those state hospitals, to Joanne’s point, are going to face some really, really tough choices if we see the funding go away. And then another option that’s on this menu — and again we don’t know what they’re going to choose — but one possibility that I think a lot of the kind of right-leaning wonks are really pushing is to get rid of something called provider taxes, Medicaid provider taxes. And we don’t need to get into, fully into the weeds of how these work, because they are sort of complicated. But what I will say is that because of the way that Medicaid is financed and because of the history of how these taxes have proliferated and expanded across the country, there are quite a few Republican-led states that would be disproportionately harmed by that policy.

So I just think all of this is a little messy. I think there’s not an easy way — even setting aside the point that Alice made that of course there are Republican lawmakers from blue states. But even if you’re only concerned about the red states, say you’re only concerned about getting the Senate votes and not the House votes, I still think it’s pretty tricky to come up with one of these policies that’s sort of just taking the money out of states where you don’t need votes.

Rovner: Well, they’re supposed to, the committee is supposed to, start marking up its bill next week. I am dubious as to whether that is actually going to happen on time, but we shall see. Obviously much more on this to come. But I want to move on to news from the Trump administration. Last week we talked about threatening letters sent by the interim U.S. attorney in Washington, D.C., to some major medical journals, including the New England Journal of Medicine. This week we have another story from our friends over at about the administration going after medical student and residency accreditation agencies for their DEI [diversity, equity, and inclusion] efforts, because both organizations have long had robust programs to require medical schools and residency programs to recruit and retain racial and ethnic minorities who are underrepresented in medicine. Now, this isn’t about being woke. Racial and ethnic representation in the health care workforce is an actual health care issue, right?

Kenen: There’s data. There’s a fair amount of data that shows that this kind of representation, patients having providers that they feel can identify with and understand them and come from a similar background. They’re not always a similar background, but there’s this perception of shared understanding. And there’s a ton of data. Not one or two little studies. There’s a ton of data that it actually improves outcomes. I’m actually working on a piece about this right now, so I’ve just read a bunch of it.

Rovner: I had a feeling you would know this.

Kenen: And it’s been pointed out, there was some research in The Milbank Quarterly, too. And I should disclose that Milbank is one of my funders at Hopkins, but they don’t control what I do journalistically. When the courts ruled against DEA in admissions, DEI in admissions, they were looking at sort of the intake, who comes in. And they really weren’t looking at the data of what happens to health care when the workforce is diverse. So there’s a lot of numbers on this, and they looked at one set of numbers and they didn’t look at another pretty solidly researched for many years, like: What is the impact on patients and what is the impact on American health? So if you’re talking about making America healthy again and you want everybody to be healthy, there’s really a good case to be made for a diverse, a competent, well-trained — we’re not talking about letting people in because they’re a token but getting people in who could become qualified doctors, nurses, respiratory therapists, whatever, right? And that data was sort of ignored. The outcomes, the down-the-road impact on health was ignored in that court case.

Rovner: Also, the practical implications of this are kind of terrifying. Yanking accrediting responsibilities from these groups could make a big mess out of training the health care workforce. These groups have decades of experience devising and enforcing guidelines for medical education, much more than just DEI — what you have to teach, what they have to learn, what they have to be competent in. If the administration takes away these organizations’ recognition, it could raise real questions about the uniformity of medical education around the U.S., not to mention deprive lots of programs of lots of federal funding, because programs have to be accredited in order to draw federal funding. This could turn into a really big deal.

Kenen: If they go away, what happens?

Rovner: There would be alternate accrediting bodies.

Kenen: But I have — when I read about the threats on the current accreditation bodies, I did not see, in what I read last night, I did not see: Then what? That blank was not filled in as far as I am aware.

Rovner: I don’t think there is a then what. There are some efforts to stand up alternate accrediting bodies, but I don’t think they exist at the moment. And as I said, these are the bodies that have been doing it for now generations of medical students and medical residents. All right, well we also learned this week that the Government Accountability Office, the GAO is investigating 39 different cases of potentially illegal funding freezes, except the agency’s director told a Senate committee, the administration is not cooperating. I think I’ve said this just about every week since February, but there is a law against the administration refusing to spend money appropriated by Congress. And it feels pretty clear in many of these cases that the administration is violating it.

Why aren’t we hearing more about impoundments and rescissions? The administration says they’re going to send up a rescission request, which is what they are supposed to do when they don’t want to spend money. They have to say: Hey, Congress, we don’t think we should spend this money. Will you vote to let us not spend this money? And yet all we do is talk about all of these cases where the administration is not spending money that’s been appropriated.

Ollstein: You’re seeing it in grants, and you’re also seeing it in the mass layoffs of agency employees who are in many cases working on congressionally mandated programs, some of them signed into law by President Trump himself in his first term. I’m thinking of the 9/11 health program, some of the firefighter health and safety programs through NIOSH [the National Institute for Occupational Safety and Health]. So this is something I’ve been looking into. But when the enforcement mechanism is really the court’s rule and hope that the rulings are followed, and when they’re not, we’re really running into what people are calling a constitutional crisis, where the normal checks and balances are not working. And we’re finding out that a lot of it has really been on an honor system this whole time.

Rovner: Margot.

Sanger-Katz: I was just going to say, I think this is a huge constitutional issue that this administration is facing down. There’s this question about who gets to decide how the money is spent? The Constitution seems to say that it’s Congress. The administration is saying, no, the executive has a lot of authority to just ignore those appropriations requests. There are several cases in the courts right now on this issue related to various programs that the administration has declined to fund. But courts move pretty slowly. There have been some preliminary rulings. I think the preliminary rulings have tended to say that the money should be continuing to flow. But this is one of these issues that is absolutely a thousand percent headed to the Supreme Court and hasn’t gotten there yet. And I think the intensity of the constitutional crisis that Alice is warning about will really become more evident when the court decides.

But I feel like I can’t talk about this issue without also talking about Congress. Because the Constitution is very clear that Congress has the power of the purse. And Congress has passed these appropriations bills over many years that include very specific funding levels. There’s a whole process. There’s a lot of people that do a lot of work. And Congress has been very weak in asserting its constitutional authority to ensure that this money is spent. We have heard very little, a few little peeps about specific things. But in general I would say the congressional leadership, and the leaders of the Appropriations Committee who have made this their lives’ work, have just not been screaming and yelling and jumping up and down about how their constitutional power has been usurped by the executive.

And so I think that is also part of the reason why this is continuing to go on, because you see this acquiescence where Republicans in Congress are basically saying to Trump: Okay. Like, please send us a rescission package, but like we’ll go along with this for now. So I do think that we’re sort of waiting on the Supreme Court to try to issue some really definitive legal ruling, and that that is when we’re going to probably have the bigger conversation about who really gets to decide what money is spent.

Kenen: Susan Collins, who’s the chairman of the Senate Appropriations Committee, did put out a statement yesterday that is stronger than her usual, what we’ve heard to date. But it wasn’t a line in the sand, like, I’m not going let you do this, and I’m going to go to the Supreme Court. So it was more of a toe in the water than I had seen from her before.

Rovner: I watched that hearing, because I wanted to. This was the first hearing in the Senate Appropriations Committee this year, so the first time they’ve had a formal chance to speak. And it was on biomedical research and the state of biomedical research. And I was the one that was yelling and screaming because neither Susan Collins nor Patty Murray, the ranking Democrat, they both talked about how terrible these cuts are, without saying that they could do something about it. It’s like, you’re the Senate Appropriations Committee. This is your power that they’re taking away, and you’re both saying this is awful without suggesting that You’re taking this from us. So I got a little bit of exercise just watching it.

Kenen: They put out a statement highlighting—

Rovner: I know. I heard her, listened. She read the statement.

Kenen: But what they, how they framed it in the statement was a little bit more pointed. But no, I agree it was not a call to arms.

Rovner: No.

Kenen: It was a statement that I hadn’t seen yet.

Rovner: I watched it live. It didn’t come across as: Hey, this is our responsibility. We passed these bills. You’re supposed to spend this money. I’ve seen a little bit of that coming from the House. I was surprised to not see it coming more from the Senate. We do have to move on. Meanwhile, HHS [Department of Health and Human Services] Secretary Robert F. Kennedy Jr. continues to make headlines for his questionable takes on science and medicine. In an interview this week on the “Dr. Phil” show, Kennedy said that parents, quote, should do their “own research” before having their children vaccinated. And he said that, quote, “new drugs are approved by outside panels,” which they most certainly are not. Those outside panels make recommendations that the FDA [Food and Drug Administration] usually follows but sometimes doesn’t. Yet there’s still not much in the way of opprobrium coming from Republicans inside and outside the administration. Is it just not news anymore when the secretary of health and human services says kind of outlandish and false things? Is it baked in?

Kenen: Well, we’re waiting. So far. They approved him, and Sen. Bill Cassidy of Louisiana said, I’m going to be in close contact with him, and we’re going to be talking, and I’m going to make sure nothing terrible happens. And lots of things have happened. So at this point, yeah, he’s doing what he wants without — they have said they are going to call him, but I haven’t seen a date set for the hearing.

Rovner: There’s not a date set for the hearing.

Kenen: Right. So at some point, at some place, he will eventually be asked about something or other maybe. But at this point, no. He’s MAHA-ing his way through HHS and cuts galore and really things that they were started before he took his job, stuff that Elon Musk started. But now that the team of FDA, C— well, not CDC [the Centers for Disease Control and Prevention] but FDA and NIH [National Institutes of Health] leadership is there, it’s going Kennedy’s way. They’re not standing up and saying, It’s my institute, and I’m going to run it the way I see fit. It’s very, particularly FDA, people who thought that he was the least radical of the officials to be appointed.

Rovner: He, Marty Makary, the FDA commissioner.

Kenen: Yes. Some of what he said about vaccines just this week has shocked people who thought he would be a little bit more, not a traditionalist but more traditional in how the FDA did its business.

Rovner: More science-based, might be a fair way to put it. Well, I want to talk about the continuing cuts at HHS because things are, in a word, confusing. Last week we talked about the cancellation of the Women’s Health Initiative. That’s a decades-old project that has led to a long list of changes in how women are diagnosed and treated for a wide range of conditions. Late in the week, former California first lady and longtime women’s health advocate Maria Shriver announced on social media that she convinced her cousin, RFK Jr., not to cancel the study. But this week that Women’s Health Initiative officials around the country have not been officially notified that the cancellation has been rescinded, so they’re kind of frozen in place and can’t really plan anything.

Similarly, on April 25, that the FDA had reversed a decision to fire scientists at its food safety lab. But that was days after FDA Commissioner Marty Makary insisted that no scientists had been terminated. Quoting from on Makary’s claims, quote: “‘That just made me so mad … he said no scientists were cut,’ said one laid-off FDA scientist, a chemist who had worked at the agency for years.’” Which kind of leads to the question: Are they just confused at HHS, or are they trying to sort of obfuscate what’s really happening there? I’m hearing department-wide about claims made by spokespeople about funding that’s been, quote, “restored” but that’s still not flowing, according to the people who are trying to get it. Margot, I see you nodding.

Sanger-Katz: I think there’s just a great deal of confusion. There’s a lot of people missing, too. So I think that just some of the kind of basic mechanics of how you turn things on and off is a little bit broken. But I also think that there are disagreements among the decision-makers about what they want to turn on and off. And we have seen this throughout the Trump administration, not just at HHS but in other places where top officials have said that they’re going to restore funding that was cut or a court has ordered them to restore funding that has been cut, and then, lo and behold, the money doesn’t turn back on. So I just think there’s — this is why it’s a good time to be a journalist. I think it really bears a lot of reporting and follow-up and checking on whether they’re doing the things that they say they’re doing. Some of these things might just be confusion — it’ll take a minute. And some of them, maybe they’ve changed their minds.

Kenen: Or like the AID [U.S. Agency for International Development] global AIDS money, which they said they were restoring, and it’s questionable still. It’s unclear how much. We certainly know not all of it’s been restored, and it’s unclear. I haven’t done any firsthand reporting on this, but from reading, it’s just uncertain how much. Some is getting through but not what they said they were going to do. I sent an email to some at the CDC yesterday asking, and I had to say: Excuse me. I’m not being facetious. It’s just hard to keep track. Is your division still there? So yes, he was still there. I couldn’t find a master list of which CDC departments are still functioning and which are not. What Elon Musk said was, We’re going to move fast and break things, which is the Silicon Valley mantra, and that We can always fix it. We’ve seen them moving fast, and we’ve seen them breaking things, but we’re waiting on the fixing it.

Ollstein: And I think it’s been interesting that Secretary Kennedy has said publicly now, on more than one occasion, that these cuts, these program eliminations, certain ones are a mistake. He didn’t even know they happened. He said this in interviews. And then with some of the ones that they’re claiming, they’re restoring, the national firefighters union, the IAFF [International Association of Fire Fighters], said that when they met with HHS leadership, they were told that the HHS blamed mid-level bureaucrats for incorrectly canceling some of these programs. All of this sort of begs the question: Who’s in charge over there? Who’s making these decisions? Is the secretary even in the loop on them? Is this all coming from DOGE [the Department of Government Efficiency]? Yeah, and so I think Margot’s absolutely right about we just really need to keep reporting and not take what they say at face value. And we should do that for any administration.

Sanger-Katz: The president is scheduled — any day now, we don’t know — to release his, what they’re calling the skinny budget. So this is a document from the White House that says what their spending priorities are for the next fiscal year. We think it’s just going to deal with discretionary spending, but I think it will give us some really good clues about what parts of the various cuts in HHS and other parts of the government were sort of part of the plan or will continue to be part of the plan going forward and which of the cuts were made randomly or haphazardly or at the behest of someone who hadn’t talked to the White House. I definitely am very interested to see that document when it comes out, because I think it is the first time that we’ll really see, written down in one place, what it is that the White House is intending to cut in the federal government.

Rovner: Yeah, the appropriations committees are very interested in seeing that document, too, so they say. Also the other thing that getting a budget will trigger is having to have some of these people come to Capitol Hill to justify their budget and having Congress get a chance to ask questions.

Finally, in this week’s news, we haven’t talked about abortion in a while. Not that there isn’t news there, it’s just been eclipsed by all of the bigger news. So I want to catch up. Well, speaking of funding being restored, Alice, you were the first to report that the Trump administration has quietly resumed Title X family planning funding to Oklahoma and Tennessee, even while it’s still frozen for some other states. Not so coincidentally, Oklahoma and Tennessee had their Title X money cut off during the Biden administration, because they were out of compliance with the Title X rules requiring women with unintended pregnancies to be counseled on all of their options, including pregnancy termination. I guess this shouldn’t be surprising except for the fact that the grant notices to these states said the money was being restored pursuant to settlement agreements that apparently don’t exist?

Ollstein: Yes, these states are still not complying with the Title X requirements. That’s what they went to court about. Those cases have not been settled. These states weren’t even expecting this money and were surprised about it and now have to come up with how to actually administer it, because the money was going to other groups in those states that were providing services. And so, it’s really thrown everyone for a loop. And this is coming at a time when grants for a lot of other Title X providers who say they are following the rules have been indefinitely frozen. They’re allegedly being investigated for violating orders on DEI and immigration, but they have heard nothing about where that investigation stands, whether the money is coming. And in the meantime, a lot of people, hundreds of thousands, according to the National Family Planning and Reproductive Health Association, that represents all these providers, are said to lose services. And again, this is access to birth control for low-income people, STI [sexually transmitted infection] testing, a lot of things people need.

Rovner: So, when we last visited Texas, abortion opponents and women who’d had pregnancy complications were fighting over a bill that was supposed to clarify that the state’s 2022 ban would allow pregnancy terminations in emergency medical situations. Well, apparently they reached a rapprochement, because the Texas Senate this week passed a bill by a 31-0 vote. Alice, what broke the logjam? And will this bill ultimately get signed by the governor? Is there a deal here?

Ollstein: Well, we’ll have to see. Medical experts have been very skeptical about the provisions here and don’t trust Texas lawmakers to have patients’ best interest in mind, given the impact of previous policies on this front. And so just given the makeup of the state legislature and the officials in power, it’s definitely very possible it will become law. There could be court challenges. We’ll just have to see how it plays out.

Rovner: Well, this is obviously not any kind of sign that Texas is going soft on abortion, because the Senate also this week passed a bill that would basically extend the state’s bounty hunter abortion law, that lets private individuals sue doctors or others who help people get abortions, would extend that to manufacturers, mailers, and deliverers of abortion pills. Alice, this would be a pretty big step in the state’s efforts to curtail abortions, right?

Ollstein: Yeah, I think we should think about bills like this like a lot of other bills that are already in place, in that it’s not possible to fully enforce them. It’s not possible to prevent — short of opening everyone’s mail and surveilling everyone in the state — it’s not really possible to prevent medication abortion being mailed. And in the case that’s already in court about a New York doctor who is providing pills to patients in Texas and other states under a shield law, New York has said: We are not turning over this doctor. We are not going to enforce. What she’s doing is legal in our state. It’s legal in the place where she is doing the action, so you can’t have her.

So I think the main issue here is the chilling effect. It’s a law that makes people more afraid potentially to go and order these pills online or over the phone. And so they’re hoping that that deters people, because, I think, it’s totally possible that, like the New York doctor, we’ve already seen, they pick a few cases to make an example of people and to further that chilling effect, because it’s not possible to go after everybody.

Sanger-Katz: It just really highlights, I think, the challenges of President Trump’s approach to this issue, which is, he basically said: Let’s just leave it to the states. Let’s not have a lot of federal policy on abortion. Now, there are things that are being done through the Title X funding and everything that affect reproductive health. But in general, there just does not seem to be an appetite for big sweeping regulations that would make abortion substantially harder to get everywhere or any kind of law that would ban or restrict abortion nationwide. And the problem is is if you’re a Texas legislator and you were trying to prevent abortions in Texas, it’s a really frustrating situation, because the state boundaries are just so porous. And particularly because of these abortion pills that can be easily smuggled in through various ways, through mail or someone walking across the border or someone going and coming back, there are still a lot of abortions that are happening in Texas.

And so I think if you’re someone whose public policy goal is to restrict or stop abortions in Texas, you start having to have to think creatively about even some of these kinds of enforcement mechanisms that, as Alice said, are kind of hard to achieve and probably are going to have a selective enforcement approach. But I think they just haven’t really been able to achieve their goals. And you look at the national abortion statistics and when you look at some of the data on even the state of residency of people who are getting abortions of various types, there just haven’t been big declines. Even in Texas, even in this very big state that has very restrictive laws, there are a lot of women from Texas who are continuing to get abortions. And I think that’s why we’re seeing the state legislature continue to reach for more ambitious ways to curtail it.

Rovner: Yes. Much to the frustration of the people who are making the anti-abortion laws in Texas. All right. That is this week’s news. Now I want to spend a few minutes trying to synthesize all that’s happened in health policy in the now 102 days since Donald Trump began his second term. I’ve asked each of the panelists to give us a just quick summary of some specific topics. Joanne, why don’t you kick us off with how public health has changed in these last couple of months?

Kenen: Yeah. Basically if you — when I started writing it down, I couldn’t fit it on a page. If you name anything in public health, it’s been cut or reduced or put in jeopardy. We’ve talked extensively about what’s going on. And by public health, I’m talking about federal down to cities, because they’ve lost their money. So, whether you’re in a red state or a blue, you have less to spend, you’re not allowed to talk about certain things. HIV money has been affected. Global health has been affected. Obviously measles — we did not have whatever the number of measles cases, I believe it’s over a thousand by now. I haven’t seen the last number. Data has vanished. And that data, there are some nonprofits that are trying to collate it and make it available, but years and years and years of data, which was the foundation of data-based, reality-based, and measuring gains and losses in public health, that’s been obliterated. Things are being stopped at NIH. That’s the future of public health, right?

If you’re stopping training, if you’re stopping universities, if you’re stopping postdocs, if you’re stopping graduate school funding, that’s not just public health today but public health as far as we can see in the future. The anti-smoking, anti-tobacco-use, the suicide helpline is in danger. Mental health, opioid treatment is being rolled back. Pretty much if you think of public health, it’s really hard to think of anything that has not been affected.

Rovner: Thank you. That was a pretty good summation. Margot, if you had to write a one-page elementary school book report on DOGE and what’s happened at HHS, what would it be?

Sanger-Katz: Well, I think it’s highly overlapping with a lot of what Joanne was talking about. I think we’ve seen these outsiders who came into the government and just started kind of hacking and slashing. They have eliminated a lot of functions of HHS that have existed for a really long time, not just individual people who have lost their jobs but whole offices that have disappeared, whole functions that existed for a long time and don’t exist anymore. I do think — I was talking about the skinny budget — we’re going to find out the president’s plan for this. I will give Secretary Kennedy some credit for releasing a sort of blueprint for what his goals were in trying to reorganize HHS. It seemed like they did have an idea in some cases of what they were trying to do — consolidate duplication, centralize certain functions, de-emphasize and reemphasize other priorities.

Rovner: Cut NIH from 27 institutes to eight.

Sanger-Katz: Right. Eliminate regional offices in various ways. But I think it is worthwhile to think about the DOGE effort in terms of what its goals are and whether those goals are really aligned with particular goals around health policy. In some cases, I do think Secretary Kennedy has directed them to do things that are in line with his goals for health policy, but I think a lot of this cutting was really just cutting for cutting’s sake, trying to hit certain budgetary target numbers, trying to reduce funding to some percentage of contracts, some percentage of grants. And of course, there has also been, from the White House, a desire to target particular political enemies of the president. So we’ve seen, all the NIH grants canceled to universities where he’s having feuds over other issues, huge categories of research funding just drying up because they’re at odds with various political priorities of the president.

So there are multiple power centers that are all kind of wrestling over this future of HHS. You have the secretary himself, you have the White House, and you have this DOGE entity, which was kind of on the outside now and now is on the inside. And I think part of what we have seen is a real wrestling around that. And just very, very large reductions across all of the functions of what the department does.

Kenen: Some of these things that Margot and I are talking about do have, in fact — they’re about chronic disease. So if Kennedy is trying to reorient our health system to fight chronic disease, then why are you cutting diabetes programs and why are you cutting long-term women’s health studies? These are chronic disease. Diabetes is the great example of a chronic disease that we really could do better on prevention, making sure people don’t get it. But not everybody — we could make gains there. And yet some of these key programs that are supposedly in line with his priorities are also on the cutting-room floor. And I will stop there.

Rovner: And I have said, and I made this point before, but I will make it again here because I think it’s relevant, which is that I feel like HHS is part of the Jenga tower that holds up the nation’s health care system writ large, and that they’re kind of yanking pieces out willy-nilly. And I do worry that the whole thing is going to come crumbling down at some point. Obviously it hasn’t yet, but we’re going to see what happens when they take away a lot of these things. Like I said, yanking the ability of accreditation agencies to do their jobs, things that happen in the background that are going away, that won’t happen anymore. And we’re going to have to see what happens with that.

Sanger-Katz: And I do think some of this really long-term research, both the collection of government data and also the funding of these very large longitudinal studies, I think those are the kinds of cuts that you don’t really see the effects of those right away. It’s the things that you don’t know in the future. And I think that we see a lot of cuts of that sort, where you see the DOGE team come in and they say: Oh, data. Oh, analysis. Like, we can do this better with our own tools. We have technical expertise. We don’t need this whole office of people that are doing data. And across the government, you’re seeing this real loss of long-term data collection and analysis, data sets and studies and surveys that have been conducted for decades, and there are just going to be holes in those. And we may not know the effects of those losses for some time.

Rovner: I think that, too. Well, Alice, I don’t want to leave without touching on reproductive health. I’m actually a little surprised at all this administration has not done on abortion, as Margot was talking about, and other reproductive issues. So what have they done?

Ollstein: Yeah, so I kind of have organized my thoughts into three buckets. So, it’s things they’ve done that the anti-abortion movement likes, things that the anti-abortion movement wants them to do that they haven’t done yet, and things that they’ve done that have actually pissed off the anti-abortion movement. These are not equal buckets — they’re just three categories.

So, OK. What they have done: The anti-abortion movement was very pleased that the Trump administration rolled back a lot of Biden policies making abortion more accessible for veterans and service members. Also got reimposed the Mexico City policy, which restricts international aid for family planning programs that talk about abortion or refer people to abortion services. Of course, that’s been overshadowed by the just total decimation of foreign aid in general, but it’s still meaningful. I would say that the Trump administration switching sides in a legal battle over emergency room abortions was one of the biggest developments. We are still waiting to find out if they’re also going to switch sides in ongoing litigation over FDA regulation of abortion pills. That’s TBD but could be very big no matter which way they go. And the freeze on Title X funding that we’ve already discussed. The anti-abortion movement has been pleased by that because a lot of that has hit Planned Parenthood. Of course, it’s hitting providers beyond Planned Parenthood as well.

So I also find it interesting that they have not done a lot of what the anti-abortion movement wants in terms of reimposing restrictions on abortion pills, saying they can’t be sent by mail, can’t be prescribed by telemedicine. So there’s a big push underway to pressure the administration to make those changes. Could still happen, but it has definitely not been something that they’ve prioritized at the beginning of the administration.

And in this much smaller category of things they’ve done that have angered the anti-abortion movement, I’m thinking mainly of an executive order that didn’t actually do anything but purported to promote IVF [in vitro fertilization]. And he ordered his administration to study ways to make IVF more accessible and affordable. And a lot of anti-abortion groups view IVF as it’s currently practiced as akin to abortion, because some embryos are discarded. So, I sort of think of it like Trump has governed so far on abortion, a lot like he campaigns, trying to please the moderates and the conservatives and not really pleasing everyone fully and being a little all over the place.

Rovner: Thank you. That was a great summary, and we’re on to the next hundred days. All right. That’s the news for this week. Now it is time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will put the links in our show notes on your phone or other mobile device. Joanne, why don’t you go first this week?

Kenen: Yeah. This is a pair of articles [“” and “”] published by New Jersey Advance but in conjunction with papers in, The Oregonian in Oregon, MLive in Michigan, and in Alabama, and it’s by Ted Sherman, Susan Livio, and Matthew Miller. And it’s a really deep two-part investigation into, basically, greed at nursing homes. I don’t think they use the word “greed,” but that’s what it is. Feeding people, like, a food budget of $10 or less a day. Splitting the ownership so that there’s various interconnected businesses, so it looks like the nursing home doesn’t have enough money, because they’re actually paying somebody else for services provided at the nursing home that has the same owner, so it’s sort of financial gamesmanship. And just not taking care of people. Really well documented. They had thousands of pages of CMS [Centers for Medicare & Medicaid] files. They had university professors and data experts helping them analyze it. There’s never been an analysis, they say, this extensive. And it just shows tremendous abuse and just asks a What next? question and Why is this allowed to happen? question.

Rovner: It’s a really good piece. Margot.

Sanger-Katz: I want to highlight a piece from CNBC called “.” I have some cautions about this study because the full study has not been made public. It has not been published in a peer-reviewed journal, and I still have lots of questions about it. Nevertheless, I read the story and I thought about it a lot and I have been thinking about it a lot since. And so I still feel like it is worth reading and talking about. This study was done by Aon, which is a big benefits consultant, and they pooled all this data from lots of employers who are covering these anti-obesity drugs for their workers. And basically what they say they found in the story is that among those people who continued to take the drug, who had what they called very high adherence to the drug, for two years, they actually found that their health improved so much that they saved their employers health plan money over that two-year period, even when compared to the very high cost of these drugs.

So I would say this is a pretty surprising result. These drugs are expensive, and I think there was always an expectation that they were going to reduce people’s health care needs because they prevent diabetes and cardiac events and all of these other serious diseases. But I think there was always an expectation that the payback period would be much longer because the cost is so high. One more thing that jumped out at me in this study is there are some published studies from the clinical trials of Wegovy, the first anti-obesity drug that got approved by the FDA, that found that cardiac events among people taking those drugs were significantly diminished. But I think in a clinical trial where everything is perfect, you always expect those results to look a little bit better.

This study, again, we can’t totally look under the hood, but they found 44% reduction in major cardiac incidents among working-age people who are taking these drugs in just two years. If that holds up, I think it just is additional evidence that these drugs are really, really promising for public health. Reducing heart attacks and strokes is just — and that’s compared to the standard of care. That’s compared to other people who had employer insurance who were of similar health, who were presumably taking statins and blood pressure drugs and the other things that you do to prevent cardiac events. So, I think, let’s not overinterpret this study. There could be something weird about it. But I do think it’s another promising indication that these drugs have the potential to have big public health impact and to potentially be a little less expensive for the system than we have been thinking of them.

Rovner: And of course there are still efforts to lower the prices, which would obviously increase the benefit.

Sanger-Katz: The big question I have is what percentage of people who are prescribed the drug are in this very adherent group, right? Because the companies are spending a lot of money giving people drugs who then stop taking them for various reasons or take them in a way that doesn’t produce these big health results. It could still be hugely expensive relative to the savings. But at least in this group that was taking the drugs, it seems like they’re getting healthier pretty quickly.

Rovner: Interesting.

Kenen: But if people aren’t taking it, if — adherence is often meant, like: Oh, I take it some days and not others, I forget to take my cholesterol drug, whatever. But if people stop taking it because there are side effects, then the cost also drops off.

Rovner: Right. Yeah. We’ll see. Alice.

Ollstein: So I chose a sad story from ProPublica. It’s called, “” And this is about a program through USDA [the U.S. Department of Agriculture] to offer to fund vouchers for farmers to be able to access mental health care. Farmers are notoriously very high-risk for suicide. There are a lot of challenges in that population. And this allowed people to, sometimes for the first time in their lives, to get these services. And the federal money has run out. There’s no sign it’s getting renewed. And while some states have stepped in and provided state money to continue these programs, Utah and some others have not, and people have lost that access. And the article is about the sad consequences of that. So, highly recommend.

Rovner: All right. My extra credit this week is from my ýҕl Health News colleague Brett Kelman, and it’s called “As a Diversity Grant Dies, Young Scientists Fear It Will Haunt Their Careers.” It’s about a unique early-career grant program at the NIH, now canceled by the Trump administration, aimed at boosting the careers of young scientists from backgrounds that are underrepresentative, which includes not just race, gender, and disability but also those from rural areas or who grew up poor or who were the first in their family to attend college. It’s not only a waste of money — canceling multi-year grants in the middle essentially throws away the money that went before — but in this case it’s yet another way this administration is telling young scientists that they’re essentially not wanted and maybe they should consider another career or, as many seem to be doing, seek employment in other countries. As the old saying goes, it feels an awful lot like eating the seed corn.

All right. That is this week’s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Special thanks as always to our editor, Emmarie Huetteman, and our producer, Francis Ying. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X, , or on Bluesky, . Where are you guys hanging these days? Joanne?

Kenen: I’m at Bluesky, , or I use more than I used to.

Rovner: Margot?

Sanger-Katz: I’m in all the places, including on Signal. If you guys want to send me tips, I’m @sangerkatz.01.

Rovner: Excellent. Alice?

Ollstein: on Twitter and on Bluesky.

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

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