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

Mary Agnes Carey: Hello from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Mary Agnes Carey, managing editor of Ñî¹óåú´«Ã½Ò•îl Health News, filling in for Julie Rovner this week. As always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Oct. 15, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

Today we’re joined via videoconference by Paige Winfield Cunningham of The Washington Sun. 

Paige Winfield Cunningham: Hi, Mary Agnes. Great to be with you. 

Carey: Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Good morning. 

Carey: And Joanne Kenan of the Johns Hopkins School of Public Health. 

Joanne Kenen: Hi, everyone. 

Carey: Later in this episode, we’ll have Julie’s interview with Dan Weissmann, host of our sister podcast An Arm and a Leg, about the new and even more confusing Medicare landscape as the 2026 open enrollment begins. But first, this week’s news. 

Yesterday, the Centers for Medicare & Medicaid Services announced it had identified 189,000 people receiving Affordable Care Act plan subsidies who were also enrolled in a second government health program or are dead. CMS officials said that eliminating that duplication would save taxpayers approximately $1.5 billion over the next year. Wednesday’s announcement follows the administration’s move last month to remove 760,000 people from ACA coverage, citing alleged fraud. The cost of healthcare is a top issue for voters in the upcoming midterm elections, and the Trump administration keeps highlighting its efforts to combat waste, fraud, and abuse. How do these two announcements help Republicans in the midterms, especially as early voting is beginning in some states? 

Cunningham: Well, I was at the press conference yesterday where they announced this, and it’s kind of interesting that they’re trying to fit this announcement into their larger effort to combat fraud, because officials actually said yesterday that this doesn’t necessarily reflect fraud. So what they were announcing yesterday is basically they were looking for people who had often moved from one state to another and then didn’t cancel their ACA plan or Medicaid coverage, and so now they’re enrolled in both. And so this is more of an issue of just kind of cleaning up the rolls, making sure that people are only on one plan instead of two. And so I thought they did a pretty good job of explaining yesterday what they were doing there. 

But it was interesting because, as you note, they have this larger anti-fraud effort. It seems like every time I’m tuning in to what [CMS Administrator Mehmet] Oz is doing, he’s talking about fraud. And they’ve partnered with DOJ [the Justice Department] and other agencies to go after fraud in all manner of areas. And I would say, some of the stuff they’re doing on Medicaid is quite unprecedented, right? They’ve deferred huge sums from California and Minnesota. They’re alleging massive fraud. The states say that they’ve provided no evidence of fraud. So there’s a lot of questions there. But I will say on the ACA efforts, when I talk to career staff inside CMS, they say, You know, we did need to do a lot of cleaning up of the rolls in ACA. And there has been an ongoing issue of agent broker fraud, and there are incentives for agents to enroll people without using Social Security numbers because they get commissions every time they do. So I think that’s a real and important effort. 

But I do think it’s interesting they’re trying to kind of roll it all together in this big anti-fraud messaging ahead of the midterms. And I think especially [Vice President] JD Vance, for example, talking about this in starkly political terms, like he will go out there and say blatantly Republicans want to get rid of fraud and Democrats want fraud, which is a ridiculous thing to say because you talk to anybody in the, you talk to any state, red or blue, and they say obviously we don’t want fraud. It’s more of a question of how many resources you put toward trying to get rid of fraud. I don’t have a great sense of how much this is resonating with the public, but they certainly have been kind of tying it to this message of: These are taxpayer dollars that are being misused, and we’re going to right all of these wrongs. 

Kenen: There’s a couple of issues. The crooked brokers is a problem, has been around for a while, and Democratic and Republican administrations have announced they’re cracking down and so forth. And we also know there’s provider fraud, right? Every few years there’s a spectacular bust of some home health agency somewhere, Florida, Brooklyn, wherever — it’s in red states and blue. But the way it’s talked about, it’s often made to sound like it’s the recipients rather than the brokers or the providers. I’m not saying there’s no individual in the entire United States who hasn’t committed some kind of fraud. Obviously, we have crooks among us, but the healthcare fraud is largely not the recipients. But by talking about it, they make it sound like the recipients are bad guys. Not always. I’ve seen CMS releases that have been very precise that this is brokers or something. They’ve been accurate. But the tone, the way they talk about people on Medicaid, the way they talk about work requirements, the way they talk about the ACA, it’s like lazy, fraudulent people who don’t deserve things. So that’s sort of the political thing. The fact that there’s healthcare fraud — there’s always been healthcare fraud, unfortunately, because I don’t know anybody who’s actually in favor of it except the people committing fraud. 

Winfield Cunningham: Yeah, I think on the ACA, it is true. We’re coming off of the pandemic, where a lot of these anti-fraud efforts, particularly on ACA, were paused, and obviously people were allowed to stay on Medicaid longer, so that was a thing. And they keep referencing, they keep trying to blame, the Biden administration for the rolls of the ACA and Medicaid kind of expanding. But you’re right, Joanne. On the Medicaid piece, every state has a fraud control unit that has been operating for a long time, and sometimes when they try to kind of trumpet their efforts, they’re also rolling in a lot of previous efforts to combat fraud that happened under previous administrations. 

Carey: But from the election viewpoint, how does this square with a voter? Right? If you are struggling to afford your healthcare premium, or if you were one of those folks that got that enhanced ACA subsidy that’s now gone, or you’re paying more for your drugs at the pharmacy counter, does that really comfort you that the Trump administration is focusing on waste, fraud, and abuse,-a problem that’s been with us, as we are all noting here, for a while? 

Winfield Cunningham: I do think people respond to tangible things. Which I think the administration has that sense, which is why you saw them announce that they’re sending these $500 checks to it’s like around a million ACA enrollees, and the checks are mostly going to, well, they’re all going to states that rely on healthcare.gov. And most of the states that have really competitive Senate races this year, are voters in those states, are getting those checks. So I don’t know. I don’t ever have a very good political sense, so I can’t say. But maybe if somebody gets a $500 check in the mail, they maybe are feeling better about the administration. But it’s definitely a patch on the existing problem of just marketplace plans being too expensive if you’re not heavily subsidized. 

Kenen: If you lost your health subsidies and you’re now either uninsured or paying a lot in the private market for a plan that might not be very good, I don’t see that health $500 check is going to make you feel whole. It’s like you lost something worth thousands and they’re giving you hundreds. And I’m not sure if this $500 is taxable or not. I don’t know if anyone, if any of you know that I’d be interested. 

Carey: Oh, I do not know that. 

Kenen: I don’t know, but it’s not that much money. I don’t think that the people who are mad about the expired subsidies are going to suddenly decide they don’t matter because they got 500 bucks, right? And in fact, if you go on what Mary Agnes said, this is more in the, the red states are more reliant on — fewer of them are running their own exchanges. I don’t think the $500 check is going to make a big difference in terms of how people vote. I don’t think most people who’ve lost insurance could be, if you were going to vote against the Republicans because of that, I don’t think 500 bucks changes it. 

The other fraud conversation is the president himself, who’s constantly saying that there’s fraudulent elections, that the Democrats cheat, and so on and so forth. That the media lies. So there’s a separate fraud conversation. I think that the healthcare conversation about fraud may reinforce that a little bit, but I don’t know that we know that people make a connection to the political stolen-election dialogue and the healthcare fraud dialogue. I think that they are sort of creating an impression that there are a lot of people who are getting federally subsidized healthcare who don’t deserve it. But I think that translates into support for entitlements, or what used to be entitlements, or now sort of modified entitlements for some. But I don’t know if it really changes your view of your political affiliation and how you’re going to vote. 

Winfield Cunningham: Well, and if you think about just the numbers, I remember talking to ACA enrollees at the end of last year who were going to lose all of their subsidies. You’re talking about your cost going from a $500-a-month premium to $1,500 a month or $2,000 a month. I talked to a lot of people that were looking at that. So $500 is just a patch. Maybe it helps fill in the gap for one month, but you have 11 other months you have to cover these higher premiums. 

Carey: Let’s shift to what happens after the elections. Congress comes back for a lame-duck session on Nov. 9, and with the midterm campaigns behind them, lawmakers might be willing to tackle politically sensitive issues that both parties prefer to defer until after the elections. But depending on who wins and by what margin, and if, it’s predicted, Democrats take at least one chamber, compromise may not be high on the agenda. Must-pass legislation includes funding the government beyond Dec. 11, when the current continuing resolution expires. Healthcare items could certainly hitch a ride on that measure. Lawmakers from key healthcare committees have floated fixes to the No Surprises Act. That’s legislation that protects consumers from high out-of-pocket costs if they seek emergency care from a provider that’s not in their current insurance network. The law’s arbitration system has come under fire on several fronts — more claims than expected, and some payouts for physicians that insurers have said are sky high and refuse to pay. Rep. Frank Pallone of New Jersey — he’s the top Democrat on the House Energy and Commerce Committee — has proposed eliminating arbitration and instead paying doctors at median in-network rates. Rep. Greg Murphy, a North Carolina Republican who is a physician and sits on the House Ways and Means Committee, he expects that panel to have legislation on the issue. And outgoing Senate Health, Education, Labor, and Pensions Committee Chairman Bill Cassidy, a Louisiana Republican, has said that he hopes to introduce legislation as well. Does all this attention to the No Surprises Act mean we’re going to see movement on this? If so, what might that legislation look like? 

Raman: I think it goes back to what you said before, which is really the midterms are going to shape so much of this, Depending on that outcome, if Republicans keep control of both chambers, the air in the room, I think, is really going to push towards getting appropriations done, or done quicker, so they can move on to new things next year, whereas if Democrats get one or more chamber, they’re going to want to push it so that they can have more buy-in doing it next year. And I think so much of that, what would get done regardless, is going to ride on that. There hasn’t been a huge appetite in general to get a lot of these little healthcare things done. And when we did the No Surprises Act before, it took a while. This was multiple years of fine-tuning, trying to get things done. And so rolling, I think, something out really quickly was going to be hard, especially when we have limited time in an election year to move that forward. 

Kenen: I think another thing to look at will be [Sen.] Susan Collins [of Maine], not so much on No Surprises but obviously on appropriations, whether she wins or loses, either way. If she wins, she’s insulated for six years. She’s sort of free to be more independent. She’s a moderate Republican who speaks a lot, again, of her disagreement with [President Donald] Trump but hasn’t been the pivotal vote in all that many situations. The issue that really is relevant to our listeners is she has been a leader in fighting for the NIH [National Institutes of Health] and also against the administration’s efforts to have political appointees oversee, decide, what we’re spending our scientific grants on. She’s fought it on, successfully, twice at least, but those have been short-term achievements. Can she get something more permanent in whatever goes through Approps in lame-duck? 

If she loses, she has nothing to lose. She can be as independent as she wants. If she wins, she’s empowered. So that whole issue of funding is going to be very interesting to watch. I think something is going to happen in the foreseeable future on surprise bills. It was bipartisan. People like it — not everybody, but generally consumers like it. Problems have arisen as often things happen. People have figured out how to find the loopholes, game the system. I think something will get fixed. Whether it gets fixed in December, I’m not sure. It may well go into next year. Things don’t happen all that fast in Congress. You could do a quick deal and get it off the table for everybody, because there’s a certain amount of agreement on the approach, or it could simmer the way everything in Congress tends to simmer. But I’m sort of really watching what happens to Collins, whether she’s got another month in the Senate or whether she’s got six more years in the Senate. 

Carey: Well, she’s been, to your point, Joanne, Collins has been working with [Sen.] Patty Murray [of Washington], who’s the ranking Democrat on Approps, to push back against exactly what you’re talking about, those efforts at the White House to have more political involvement in medical grantmaking. Other senators have also expressed concerns, and maybe they’ll join these efforts. But what could happen in lame duck, if anything, on these Medicare extenders? The stuff we hear about every year, things on price transparency, or for Medicare extenders, community health centers, lab services, hospital and physician payments? Would that be kind of an easy thing, easier than trying to fix the No Surprises Act or to come up with comprehensive legislation pushing back on the grantmaking interference from the White House? Any thoughts on that? 

Kenen: Extenders are by definition extending something, more or less, that already exists. So it’s not certain. Things get complicated, But a lot of the extenders, they get tied up and delayed as part of a pawn in other fights. But the end of the day, they usually eventually go through. Sandhya and Paige are both on the Hill more than I am, so they can tell me if that’s no longer the case, but they’re not— 

Winfield Cunningham: I don’t go to the Hill, Joanne. Everything’s happening at the agency. I don’t go to the Hill. 

Kenen: Right. So extenders are on the Hill, right? So by definition, they get extended. 

Carey: That’s exactly right, yeah. 

Kenen: They’re sort of on an assembly line. People make speeches. People hold them up because they want something else. They’re bargaining chips. They’re lower-profile. They get pushed aside, blah blah blah blah blah. Congress has endless ways of postponing and delaying and arguing. They’re very good at all that. But at the end of the day, extenders eventually get extended. Whereas there are interest groups lined up around something, the providers vs. the insurance industry over how you’re going to address surprise bills. Clearly, there were unintended consequences. The legislation was popular and bipartisan, but we can see it needs to be tightened up. I think you would find bipartisan agreement on tightening it up. You might not see Republicans rushing to embrace a Democratic solution before Thanksgiving or whatever. But I think they’re different animals. They’re different animals. 

Raman: Exactly that, the kicking the can down the line for extenders, it’s the same conversation every year. I think the other issue with surprise billing is that half of these conversations that we have are just, even if they agree on the policy, them trying to figure out offsets and just what happens there. And that becomes contentious at times, just trying to hammer all of that out, find something bipartisan, even when the underlying policy is something that folks agree on wanting to get done. So, just with the limited time, I think it’ll take a little bit longer than just the next couple months. 

Carey: Well, we’ll all be keeping an eye on that. So now we’re going to take a quick break, and we’ll be right back. 

Let’s shift from Capitol Hill to the Department of Health and Human Services, where Secretary Robert F. Kennedy Jr. has opened a new National Institutes of Health clinic that focuses on patients experiencing health problems following vaccination. HHS has also proposed reimbursing physicians for reporting suspected vaccine-related injuries and urges better electronic health records tracking of these events. Sandhya, I know that , and can you tell us a bit, start off our conversation here, on why the agency and the secretary took these steps? Don’t doctors already report these issues? 

Raman: Yes, this is something that is reported. The secretary and others feel that it is vastly underreported, that there need to be other levers in place to make sure that it’s reported to the extent that they’re seeing. And so, this event that they unveiled this all last week was kind of interesting in that it was not something the press was invited to. They didn’t do a big announcement when it happened on Monday. It took several days, and then they put out some pieces related to this happening. They did a ribbon-cutting for this vaccine injury clinic. The clinic is not open yet. This is just kind of the start of this process. But the reimbursement piece is interesting. 

So it stems from a proposed rule, an annual Medicare physician payment rule that came out earlier this year, should be expected to be finalized in November. And under the language that we have right now, it would reimburse physicians and other providers, physicians’ assistants, nurse practitioners, etc., for tending to more severe vaccine-adverse reactions, so maybe not something like mild swelling of the arm or something that’s more common. They would create a new code under the Medicare system for that to allow providers to bill for diagnosing that and reporting it to the vaccine adverse effects system. And there have been some concerns from some of the medical professional groups — we have the Infectious Diseases Society of America, the American Academy of Neurology, American Nurses Association — that kind of have some concerns that this could incentivize certain folks to report more on this, that the system already adequately covers you as a provider reporting these systems and counseling someone for what happens here, and that if it were a really severe reaction, they would use some other kind of billing code because there’d be multiple visits, that kind of thing. So, I guess the next step to watch would be whether or not this gets finalized as is next month, to be put in place next year. But that’s what we’re watching on the reimbursement piece. 

Kenen: One of the issues with defenders of vaccines, nobody says there’s never a side effect or an injury. Nobody who’s on the pro-vax side says nothing ever goes wrong. They do say that most of the side effects are mild, like Sandhya just said, a sore arm or something like that. But they also acknowledge there are rare cases in which something does go wrong. So the current reporting system is anybody could write anything. Some of it is suspected to be made up by people who oppose vaccines to exaggerate the problems. And then there’s also a problem of what causes something, right? A biostatistician would say causation vs. correlation, right? We don’t have to go there. Basically, if I have a vaccine on Monday and I get sick on Tuesday, it doesn’t mean the vaccine made me sick, right? So that gets confused, and it’s very, unless the science is done really, really, really well, it’s going to prove what people want it to prove. So the number of people who file a complaint that they’ve been injured is quite high. The number of people who have actually been injured is quite small. It’s not zero, but much smaller than the anti-vaccination movement says. So sorting: Who’s doing the science? What does the science look like? What kind of peer review is the science going to have? How transparent are they going to be? What are we going to learn from it? Is it predestined? Is it designed to prove that vaccines cause autism, even though we know it doesn’t? There’s just a whole lot of questions about this endeavor. 

Winfield Cunningham: But I think this underscores how Kennedy just brings in a fundamentally different set of assumptions about this than any other health secretary we’ve ever had, which is most medical experts say these supposed injuries are overreported, right? Because as you say, Joanne, people report things and they don’t really know if it’s actually related to a vaccine. But Kennedy has been saying for years that these events are underreported, and he has close allies. I know Aaron Siri is one who’s been pushing him to try to reform the reporting system, so it’s part of this bucket of things he’s trying to kind of do around HHS to change almost the government’s posture toward rare vaccine events. 

Carey: And that’s this week’s news. Now we’ll play Julie Rovner’s interview with Dan Weissmann of An Arm and a Leg podcast, and then we’ll come back and do our extra credits. 

Julie Rovner: I am pleased to welcome back to the podcast Dan Weissmann, host of our sister podcast about why health costs so much, An Arm and a Leg. Welcome back, Dan. 

Dan Weissmann: Julie, thanks so much for having me. 

Rovner: So this week is the start of open enrollment for the 70 million Americans on Medicare. That’s when people can change their private Medicare Advantage plans if they want to, or their private Medicare drug plans, or go back to one or the other. And you guys have just dropped this great episode about how this year is, well, kind of different. Tell us what people on Medicare can expect. Why is Medicare open enrollment so different from, say, your employer’s open enrollment period? And what’s new this year? 

Weissmann: Oh my gosh. OK, let’s start with the big question: Why is — how is Medicare open enrollment different from your employer’s? And basically — taking a deep breath — Medicare is super complicated. You’ve already mentioned a couple of things. The big distinction with Medicare is that you make a big choice, usually when you turn 65, between what we think of as traditional Medicare run by the U.S. government and Medicare Advantage, which is administered by private insurance companies. Generally, you go one way or the other when you turn 65. If you’re in traditional Medicare, things don’t change a whole lot from year to year. You probably have a supplemental plan to cover things that government Medicare doesn’t cover. You might hop from one to the other, but they’re basically different versions of the same thing. 

Medicare Advantage is this whole other world where, wherever you live, there’s a bunch of different carriers usually offering different plans, and then you sort through them. In that way, it’s a little like your employer’s open enrollment, except there’s nobody like your HR person telling you, These are your choices. You’re kind of on your own to figure it out. And what’s different this year is a really big deal. We’re seeing continuation of a trend that started last year, where for many of the people — you mentioned, 70 million people are on Medicare. The numbers we’re seeing this year are about 3.8 million — so that’s almost 5% of those folks — are getting letters from the plan they’ve got now, which maybe they’d want to stick with, saying: Yeah, actually, this plan will not be available next year. You’ve got to find something else. That’s a pretty big change. 

Rovner: So, Medicare Advantage has always been this sort of interesting swap for people. You can, in exchange for getting extra benefits that Medicare doesn’t cover, things like dental and vision and hearing coverage, you have to stay in your Medicare Advantage plan’s network, so you can’t go to any hospital or any doctor like you can mostly with traditional Medicare. The thing about Medicare Advantage, though, is that you can’t go to anybody outside your network. So sometimes people want to go back or they want to change. And what a lot of people don’t seem to know is that while you can change every year from one Medicare Advantage plan to another, if you go back to traditional Medicare, with no limits generally on the networks, you might not be able to buy a supplemental plan that helps you with those thousands of dollars in out-of-pocket costs that regular Medicare exposes you to, and premiums and deductibles and copays. How big a shock was this to the people that you talked to? 

Weissmann: Well, for this story, I think, just to take a step back for a minute, when people choose Medicare Advantage instead of traditional Medicare, they’re often looking at a couple things, and one is those extra benefits that you mentioned. And the other is, yeah, traditional Medicare has big limits. Specifically, in addition to vision and teeth and ears, it only covers 80% of the bulk of regular medical care, things that you’re not going into inpatient care for, like seeing your doctor, physical therapy, getting an infusion, even outpatient surgery. All that you’re on the hook for 20% of, which, if anybody’s seen a medical bill recently, can be a whole heck of a lot more than you could pay on your own. So you would need this supplemental policy to protect you from that. And they’re expensive. They’re not cheap. The average, and it varies depending on the kind of plan you pick and where you live, but, like 200 bucks a month, which is a lot for a lot of people. And you’re also already paying about 200 bucks a month to the government for Medicare, which is also a surprise to a lot of people turning 65.  

So those things make Medicare Advantage seem really, really advantageous, because often those plans also tell you, We’ll take care of a lot of, or even all of, that $200 you’d be paying to the government. So for a lot of people whose incomes are kind of limited after they, say, retire, they’re like, I’m going into this. But then people run into the problems with Medicare Advantage, which is everything we’re familiar with from dealing with private insurance companies in our regular life. They can deny you care. They can tell you you can only see their doctors, and they may not have a lot of doctors, and they may be far away, and they may not be very good, depending whatever you see. So people might want to switch back, but it’s a no-back-seat situation in most states, where you can’t buy one of those supplemental policies for love or money because they might say, You have preexisting conditions, and we don’t have to take you. 

Rovner: Right. They only have to take you once when you first go on Medicare. 

Weissmann: When you go into Medicare for the first time, they have to take you. In a few states, they have what’s called guaranteed issue, and they have to take you anytime. But generally, for most of us, yeah, they don’t have to. And it’s a kind of pre-Obamacare world where they’re like: You have preexisting conditions. No, we’re not going to sell you anything. So that’s a big shock to a lot of people. It was a big shock for me when I first started learning about Medicare. I was like: Really? That’s the deal? So, OK, you can switch from one Medicare Advantage plan to another. You could go back to traditional Medicare. You may not have that option. But what we’re seeing this year happened last year. It happened on a slightly smaller scale. But very significant this year, we think it’s about 3.8 million people getting notes their Medicare Advantage plan is ending. 

Last year was 3 million, which was a big shocker, and so my colleague Emily Pisacreta talked to a lot of people — people who are in that situation and people who are helping people in that situation, community workers, health insurance brokers, all the rest. And one thing that she learned was that in that case, at least in Minnesota, having your Medicare Advantage plan end gave you a little bit of a get-out-of-jail-free card. You could go back to traditional Medicare and buy a supplement, and they couldn’t turn you down. However, what people told us was, for the most part, people didn’t feel like they really had the financial option to go back to traditional Medicare, because those supplements were so expensive for them. And as our colleague Julie Appleby has been chronicling, they’re getting much more expensive year over year. 

So that was a surprise to us. It was kind of a big — the big reveal was like: Oh, man, wait. This is bad. Your traditional —your Medicare Advantage plan could go away, and sometimes in a few cases there were no Medicare Advantage plans available to people in certain counties. But even in the places where there were, again, the people who were in the business of helping people find new plans said: Look, the plans that remained in Medicare Advantage were not as good. They cost you more out-of-pocket. They covered less. The benefits weren’t as good. All those things were true, and yet people chose them because the alternative, the monthly out-of-pocket spend just to maintain that supplement and pay the 200 bucks to the feds, was more than they felt like they could afford. So they were stuck. And this seems, to us it seems like a big problem for Medicare. Because if we’re in a situation where Medicare Advantage retreats in a way, and it’s less available, and what’s there is less good —um, that’s not good, especially if the majority of people in this situation can’t afford anything else. They’re stuck with whatever remains. 

Rovner: And let’s play a little excerpt of what you found in Minnesota. 

Emily Pisacreta: Meanwhile, Kelli Jo Greiner and her colleagues at the state’s Medicare hotline were scrambling, too. 

Kelli Jo Greiner: We had wait times of two hours. Nobody wants to wait for even 10 minutes, let alone two hours. 

Pisacreta: She and her team had to improvise. 

Greiner: We have staff that don’t usually do Medicare counseling. They help with long-term care and other areas, and we even put those folks on the phones to help. 

Pisacreta: And she wrangled a weekly spot on Fox 9 in the Twin Cities to answer big questions. 

Amy Hockert: Medicare Monday is what we’re calling it. A lot of changes coming in 2026. Kelli Jo, thanks for joining us. 

Greiner: Well, thank you. I’m glad to be here again. 

Hockert: All right. Well, let’s roll … 

Pisacreta: Kelli Jo told viewers the most important thing is to be proactive. If you don’t do anything, the system will put you into traditional Medicare, but without a Medigap plan. Oh, and by the way, she told them, your drug plan will probably disappear, too, unless you sign up for a new one. 

Rovner: So, what do you do if you get a letter telling you that your plan is ending? Or if you just plain need help? There is actually — this is the one bright spot — there is a lot of help available. Right? 

Weissmann: There is help available. Yeah. The best thing you can do is go to Google and Google the word “SHIP” and “Medicare” and the name of your state. SHIP is a kind of federally backed program. There’s one in every state. And it’s an acronym, but the words it stands for are slightly different from state to state, so just use “SHIP” and “Medicare” and, in my case, “Illinois,” and you will get a link to essentially a program where you — there’s a hotline you can call. There’s people there who — some of them are volunteers, some of them are staff — and their whole job in life is to walk you through your options for what kind of Medicare you could get. And they’ll know everything about what Medicare Advantage plans are available to you, what supplements cost for you, and they’ll talk through with you your options. I should say, one of the things we found when we talked to people in Minnesota was that those hotlines were jammed last year. But, so try it and do it and don’t give up.  

The other thing is you can look for a health insurance broker, but there’s a caveat there, too — a couple of them. One of them is — some brokers are great. We talked to somebody who did all of this, and didn’t get paid, but helped all of her clients and dozens more people find plans that could work for them. And the reason she, I’m saying she did this for free is because this is another piece of the puzzle in things that are changing. Big carriers like United and Humana are telling brokers they’re no longer going to pay commissions on sales of Medicare Advantage plans. So this is going to make it harder. The woman we talked to said, yeah, she was getting calls from people who couldn’t reach their own brokers because their brokers were no longer doing any of this. They just got out of the business. That’s really tough. And when you, if you can find a broker, you want to ask them things like, Do you sell every plan that’s available in my marketplace? Because you want to make sure that they’re doing the best they can for you. It is really tough. It is really tough. But those are things you can do. 

Rovner: And do it early, because Medicare open enrollment only goes until Dec. 7. So don’t wait until Dec. 6 to make that call. 

Weissmann: Yes, and so a couple of other pieces of advice that we got. One, if you’re in a Medicare Advantage plan, watch the mail like a hawk. By Oct. 1, you’re supposed to get a notice if this is happening to you, about whether your plan is available or there any changes to it. Don’t miss that, because the period to do something about it is limited. And here’s what’s going, and just, you should know what’s going to happen if you don’t do anything in this situation, which is you would end up being automatically enrolled in traditional Medicare. But you wouldn’t have a supplement, because you’re not signing up for it in this. You’re not doing anything about it. And in Medicare Advantage plans, drug coverage is generally bundled with the plan that you have, which means your drug coverage is ending, too. You have to sign up for a new one. So that would be bad to end up Jan. 1 not having a drug plan and being on the hook for 20% of anything that happens when you go to the doctors. Do anything you can to avoid it. 

And, honestly, go to the local library, call your city council member, call representatives of local government and state government, and ask them for help. They may be aware of resources besides SHIP that can be helpful to you. Emily talked to the folks from a senior federation that covers seven counties north of the Twin Cities. It’s an unusual group, and they were super dedicated. That exact kind of group doesn’t exist everywhere, but if you called your state rep or your city council person, they could tell you, Hey, here’s somebody who helps people. This is a really tough situation for so many people. It’s worse than last year. There’s more people getting these letters than did last year, and more brokers are being told that they’re not going to be paid a commission than last year. So start hunting ASAP for any help you can get. 

Rovner: Dan Weissmann, thanks so much for doing this. What a great service. 

Weissmann: Thanks so much for having me. 

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

Kenen: OK, this is actually rather than a traditional print story. Margaret Brennan (Face the Nation) did with this CTO, the chief technology officer of Palantir, Shyam Sankar. Much of it was about all the things we’re hearing about, the debates about the future of AI and the existential threats and its effects of altruism, things that are not relevant to us focusing on health. But there was one real zinger that came out, which is that Sankar told Margaret Brennan that people in the AI world are beginning to smoke cigarettes just to prove how confident they are that AI is going to cure lung cancer quickly. As he said, these engineers or software developers, they’re basically saying, as he said, I’m showing you that my chips are all in. and Margaret Brennan said what I would have said, as her comment was: “What? That makes no sense.” But there you have it. 

Carey: Wow, that is supreme confidence. All right, Sandhya. 

Raman: So I picked — my piece is from Stat. It’s called “,” by her colleague Andrew Joseph. And it’s a really sweet tribute to Helen, who passed away this week from cancer. She’s been a long-standing, very influential reporter on the infectious disease beat. Had really early insights into covid. She covered the 2003 SARS outbreak. And she’s well known and respected throughout folks following healthcare, and even internationally. The WHO [World Health Organization] put out a statement about her passing. And she will be sorely missed. 

Carey: No, it’s a beautiful tribute, and thank you for flagging that. Everyone should read that. Paige. 

Winfield Cunningham: Yeah, mine is a Ñî¹óåú´«Ã½Ò•îl Health news story [“AI, Tech Leaders Are Lobbying Trump Health Officials in a Government-Run Chat Room”] by Amanda Seitz, Maia Rosenfeld, and Darius Tahir. And I was really struck by the story. It was just fantastic reporting. And they gained access to thousands of Slack messages and meeting transcripts and video recordings that kind of shed light on how the administration has given tech companies a direct line to government officials as they’re basically lobbying the government to allow them to bill Medicare for their AI health apps. And instead of doing this through public meetings that anyone can view, it was kind of done behind closed doors through these closed Slack channels. So I thought it was just a really insightful look into kind of that conversation between the administration and the kind of wellness AI tech industry. 

Carey: I agree. It was an amazing piece. My extra credit is from my colleague Amy Maxman, titled “People Say These Peptides Hurt Them. Their Stories Are Muffled in MAHA’s Push for Medical Freedom.” Amy examines how the lack of data in clinical trials leaves consumers in the dark about peptide safety, their efficacy, and their dangers. Experimental peptides are often sold at longevity, wellness, and so-called performance medicine clinics, even though they haven’t been proven safe and effective in clinical trials. If you’re thinking about using peptides, I’d read this first. 

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

Winfield Cunningham: I’m on X, . 

Carey: Sandhya. 

Raman: I’m and , @SandhyaWrites. 

Carey: Joanne. 

Kenen: I’m mostly and on , @joannekenen. 

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

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Oct. 8, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

Rovner: And we welcome back to the podcast Paige Winfield Cunningham, now of the brand-new Washington Sun. 

Paige Winfield Cunningham: Hi, Julie. It’s great to be back. 

Rovner: Later in this episode, we’ll have my interview with Michelle Andrews, who reported and wrote the latest Ñî¹óåú´«Ã½Ò•îl Health News “Bill of the Month,” about a patient who got a bill from a hospital emergency room, although she never actually received any treatment there. But first, this week’s news. 

So Election Day is less than a month away, and a finds that healthcare is voters’ top cost concern going into the midterms, and cost concerns are the top voting issue. When asked about their biggest financial concern, health costs topped things like food, utilities, and rent, and tied with the cost of gas. My big boss, Drew Altman, , theorizes that’s not just because individual health costs have spiked of late, but because health costs are so unpredictable and potentially catastrophic. So, is it fair to call these midterms a healthcare election? 

Winfield Cunningham: When is it not a healthcare election? 

Rovner: That may be. 

Winfield Cunningham: I don’t know. I guess I feel it’s not new that Democrats have the advantage on healthcare. Like, they pretty much always have the advantage on healthcare in polls. But what’s sort of interesting to me is that this administration has really tried to score some political wins here and kind of flip the script. I don’t think they’re necessarily being successful, but President [Donald] Trump is going about this in a very President Trump kind of way, right? They passed the [One] Big Beautiful Bill [Act], which was unpopular, and they’re not talking about that at all. But instead, you see Trump trying to, you know, send ACA [Affordable Care Act] checks to ACA customers and checks to Medicare customers. 

Rovner: Yes, we’ll get to that in a second, yes. 

Winfield Cunningham: And then, you know, they’re talking about their deals with drug companies. We know President Trump loves to cut deals. I think in his own way they’re trying to be, like, Hey, we’re good at healthcare, and, like, we are worried about costs, etc. And we’re doing something. But, of course, much of this is a one-time kind of fix, and not even a fix. That’s probably being too generous. But a one-time check that people are getting. So yeah, I don’t think Republicans are being successful in … presenting themselves as the party people can trust on healthcare per se. 

Ollstein: To Paige’s point, I think the sudden rush to mail out checks to a bunch of people who’ve been impacted by Republican healthcare policies is a sign that they’re sweating the impact of those Republican healthcare policies. I don’t think that it is coming from a place of confidence. It is coming from a sweatier place, I believe. And it’s almost an acknowledgment that those folks need that money because their costs are so much higher, and that’s having a political impact. And I also think, you know, you’re seeing Republicans having to spend a lot of money campaigning in states that were previously considered safe red states. And some of those states have been particularly hard hit by rising health costs and a lot of people losing their insurance. I did a reporting trip to Ohio a little bit ago, and I saw so much evidence of that, and I know it’s happening in other states as well. 

Edney: I also think that everything that Paige and Alice just mentioned are really important, and, you know, these efforts to send out checks and talk about this in certain ways is it’s trying to fill this gap that the Trump administration sort of started by saying, Oh, we’re bringing down drug prices by — I don’t know, whatever mathematical impossibility that they said they brought them down in. And that’s not actually what people are seeing in their pocketbooks. So it’s at front of mind for them because I think maybe there was some expectation that something might happen, but that’s not what they’re seeing in their bills. 

Rovner: So another interesting finding from the poll is that support for that amorphous phrase “Medicare for All” is at its highest point in at least a decade. And while, as usual, support drops dramatically when people are told that it could mean higher taxes or longer wait times for care, support didn’t drop as much as usual when people were told Medicare for All could mean eliminating private insurance companies. It was, of course, the threat of losing your own coverage that doomed the Clinton healthcare plan and that almost sunk Obamacare on the launch pad. Are Americans finally ready for a big change, or do they just think they are until they see the specifics? 

Ollstein: Well, the question has sort of always been, like: How bad does it need to get before people are open to a radical alternative? And I think, really, until now, people have been happy enough — I won’t say happy; I’ll say happy enough — with a partially private, partially public, partially regulated, not partially unregulated healthcare system. Enough people were happy enough to keep these proposals at bay, and now you have so many people who can’t afford insurance, who can’t afford care even if they have insurance. There was some new studies out this week about the number of people with private insurance, what’s considered the good stuff, who still have tons of medical debt and are having to put off payments, you know, on other things and cut back in other areas of life to afford their healthcare. That is changing people’s minds and making people more open. Now, we know that what public sentiment is does not always translate into what Congress is willing to vote for. So I won’t say that it is going to be any kind of foregone conclusion, even if Democrats take back the majorities in Congress, but there’s definitely a shift going on. 

Winfield Cunningham: I was just gonna say to Alice’s point, just the fact that Congress just can’t do anything on healthcare, and you even had quite a lot of Republicans that wanted to extend the subsidies. Like, this is really an area that should have been ripe for bipartisan work, right? I mean, this is like the government subsidizing private plans, something, an idea in theory that Republicans should like and have supported in other ways. 

Rovner: It was a Republican idea! 

Winfield Cunningham: Yeah, exactly. And then also, when I’ve talked to Democrats about, like, what’s your biggest regret about the ACA, or what’s the thing that you wish you had done differently? Many have said to me: The cliff, the subsidy cliff, was not well done. You shouldn’t have a situation where people are going from subsidies to zero subsidies, and they’re still kind of like mid-income people. So this should have been an area that was ripe for bipartisan work last year. And we all saw what happened. It fell apart. So, I mean, even at this point, Congress is just so dysfunctional. They can’t even, they can’t even agree to fix pieces of a law, which now people kind of generally like. So that’s where we’re at. 

Rovner: Well, it’s funny. I would say one of the big ironies I’ve noticed is that, you know, you’ve got a lot of sort of more progressive Democrats this year running on Medicare for All, and Republicans, you know, that are saying: This is communism. This is socialism. We can’t have this. On the other hand, for the first time I can remember, Republicans are coming out very loudly about greedy insurance companies, which, even more ironically, isn’t really the biggest problem. It’s not what’s driving up healthcare costs. You know, the cost of care is what’s driving up healthcare costs. It’s not excessive insurer profits. But I wonder if the Republicans’ beating up on big insurance is like feeding this desire for Medicare for All — ironically. I mean, Republicans are terrified about ending up there, and yet I feel like they’re inadvertently pushing us that way. 

Edney: Well, I think they’re also hitting on the zeitgeist of the day. Like, they’re sending this message out because it’s one that’s being well received, and that people are very upset. You know, there was unfortunately the murder of the UnitedHealth[care] CEO Brian Thompson, and I think that that has, like, not abated in the sense that people are really angry, and that any politician who wants to talk about the big, bad insurance companies has free rein to do so. 

Winfield Cunningham: Yeah, I think it’s really easy to get people really riled up about their insurance companies, even though, as you say, Julie, they are not collecting the biggest profits in the healthcare system. But your interaction with the insurer is not personal. You know, you just see this number that you have to pay them every month, and then you see copays you have to pay. Whereas you’re having a personal interaction typically when you’re at the hospital with the doctors and the nurses that are caring for you, and you’re going to see your physician. So there’s much blame to be spread around here in terms of healthcare costs going up, and, like, many villains in this industry. Maybe not. Maybe villains isn’t the right word, but many actors in this industry. But I think it is really easy to get people upset about insurers, in particular. 

Rovner: Yeah, I mean, some of it is that we’ve just invented things that are really cool, like GLP-1 drugs that happen to be really expensive. So that’s not necessarily a villain, but it is definitely one of the things that is driving up, at least at the moment, healthcare costs. 

Well, we need to move on. One of the things that’s pushed healthcare to the top of the concern list, as we’ve mentioned, oh, pretty much every week since the spring, is that while Republicans tried to time the Medicaid and other health spending cuts in their 2025 budget bill to , that message didn’t get to the hospitals, clinics, and state and local governments that are already making cuts in anticipation of lower federal funding to come. Plus, as we’ve said, millions of people saw their Affordable Care Act premiums skyrocket when Republicans declined to continue the expanded premium subsidies. Alice, you managed to see how a lot of this was playing out on the ground on the reporting trip you already referred to. What else did you find out there? 

Ollstein: Yeah, like you said, the effort to put off the more controversial cuts until after the election does not mean that this election will not be about those cuts. Those cuts are coming up in every debate, in every Democratic town hall and speech, and they’re in a lot of ads. And Democrats really see this as one of Republicans’ biggest liabilities going into the election, and they’re really trying to press their advantage there. And polling indicates that it may be working. And, like you said, even though those cuts, a lot of them, aren’t going to hit until 2027, states have to make their budgets now, and so they’re making these deep cuts to services in anticipation of losing all that Medicaid money. Hospitals need to make their budgets now. They are cutting services. They’re closing labor and delivery wards. They’re closing down entire facilities because they see the writing on the wall. And so I thought it was fascinating because I dug up an article my colleagues wrote last year when the bill was being debated and passed, and Democrats were worried that the delayed implementation would make it impossible for them to attack Republicans about it. And, lo and behold, that was not the case. 

Rovner: Yeah. Well, and even though the Medicaid work requirements included in that 2025 bill aren’t required to start until next January, several states have now either started early or started the process of notifying people that their Medicaid coverage will soon be contingent on their proving that they’re working. And — this is my shocked face — people are very confused. I will also post a link to a story from Montana Public Radio about how the rollout there has been, well, pun intended, kind of rocky. I thought AI [artificial intelligence] was going to make this process all smooth compared to the last time. That apparently is not the case. 

Edney: Definitely not. I mean, the article you’re referring to about Montana, I mean, it sounded very confusing. Something that you would think AI could sort of clear up is just getting the dates right when you need to be getting paperwork and stuff in, but even that wasn’t the case. 

Ollstein: And adding fuel on the fire here is that the federal administration has gone beyond what Congress ordered in terms of the harshness of the implementation of these work requirements. Even beyond that, certain states are implementing the work requirements in a harsher way than the federal government is requiring, and they are allowed to do that. And so, some are offering exemptions for certain populations, and some are saying no thanks to that. Some are saying, OK, for the first year you get kind of a grace period if you have a serious illness. We’ll just take your word for it if you testify that you have an illness that prevents you from working, and we won’t require, you know, a doctor note or other proof, just for the first year, and then after that you have to prove. But some states are saying: no one-year grace period. You need your proof now, or we’re kicking you off your insurance. And so I think all of those different layers of harsh enforcement are really hitting a lot of people, and we pretty much only have hard data out of Nebraska so far because they were so early in their implementation, way out in front of any other state. And there, we’ve seen hundreds and hundreds of people lose their insurance, and most of them was for, you know, procedural reasons, not because they were ineligible. And so I think that is a sort of canary in the coal mine of what we could see in other states once implementation becomes mandatory everywhere. 

Rovner: And wait until all these people have to go to their doctor, sort of hat in hand, saying you have to write me a note, or I’m going to lose my insurance. 

Winfield Cunningham: I just tend to think, and I haven’t followed this story quite as closely over the last couple of months, but I tend to think … that a lot of it is going to have to do with the nuts and bolts of what verification looks like, and each state is going to do that differently. And if you believe Dr. [Mehmet] Oz when he talks about this, he makes it sound as though it’s going to be this easy process where people have an app, and they can go into the app, and maybe they have to submit one document one time, but then they can go in and check a box or whatever. But in reality, maybe it’ll look like that in some states. Maybe it won’t look like that in some states. Yeah, if someone just has to go into an app and check something, fine. If someone’s having to log onto a website and get a document from their employer or their educational institution and submit this in a really tedious way, then I do think you’re going to see a lot of people dropping off. So I’m really curious to see what those nuts and bolts look like. 

Rovner: Yeah, I am too. We will clearly see more of this. 

All right, turning to vaccines, because there is always vaccine news. The measles case count in Pennsylvania has now topped 1,000, making it officially the biggest outbreak in 35 years. And some of the complications that doctors are seeing are among people who did not have underlying health conditions, which has been troubling. Even more troubling is a , now at the University of Minnesota’s Center for Infectious Disease Research and Policy. She reminds us that measles causes something called immune amnesia by basically erasing the body’s immunity to other germs, making those who have had measles more susceptible to other infections. So everyone who’s getting measles now is going to be more at risk in the future. And against that backdrop comes a , The New York Times’ Christina Jewett, about Texas Attorney General and Republican Senate candidate Ken Paxton, who is investigating pediatricians in the state for what he claims are potential violations of the state’s deceptive trade practices law. Paxton’s office is demanding reams of paperwork from busy pediatric practices, trying to prove that they are pushing unnecessary vaccines in exchange for financial incentives provided by vaccine makers. Given how little profit is made on vaccines at every level of the distribution chain — so little that many vaccine makers have threatened to get out of the business altogether — this feels like a weird investigation. Do we know what’s behind it? 

Edney: I don’t think that we know for sure by any means, and there’s not even a ton of information on exactly what he’s investigating, but it does seem to fit with things that President Trump has gone after, that Secretary [Robert F.] Kennedy [Jr.] has talked about in the sense that Big Pharma is making money off of these things, pediatricians are being paid off, and we’ve heard this many times from them. You know, that’s a way they’ve tried to go after vaccines, and I think that Ken Paxton would like some backup from the president for other endeavors that he has in life, and so he was looking for some backup. And maybe that’s one of the reasons for this is, you know, to kind of look more aligned with the administration. 

Rovner: Yeah, he may not dress well, but at least he’s pursuing the president’s policies. 

Winfield Cunningham: I don’t have any inside information about it, but it does feel like a play to look quite aligned with an administration that is increasingly not shy about looking vaccine-skeptical. I mean, Trump has been very out there in recent months, signing the executive order, you know, talking about how, I guess, he says for his five kids their shots were spaced out. He has, you know, personal concerns about this. And then the other thing is it seems like this is attractive to Paxton’s base. You know, I mean, there are plenty of MAHA [Make Americans Healthy Again] moms in Texas who have, you know, left traditional pediatrician practices and gone more like the functional health route, where they go to these doctors who are willing to let them space or skip vaccines, so this seems like maybe a good political move for him. I’m not sure. 

Rovner: And I will just say before we leave this: There are lots of places where there’s clearly industry influence over prescribing practices and types of procedures. But I think the one place it’s fair to say that there is not a lot of profit being made is in vaccines. Vaccines are hanging on by a thread. I’ve been doing this for 40 years. I mean, I was there when they passed the Vaccine Injury Compensation Act, and it’s because all of the vaccine makers were threatening to stop making vaccines. It’s just not a place where there is lots of profit. 

All right, we’re going to take a quick break. We’ll be right back. 

Turning to reproductive news, yesterday was the date that the FDA had to report to a federal court in Louisiana how that safety study of the abortion pill mifepristone is going. Alice, what did they say? 

Ollstein: Of course, they waited until, like, 9 p.m. on the deadline, which was very helpful to all of us reporters who were refreshing PACER [Public Access to Court Electronic Records] all day long. But we finally got it. It was not a very fulsome update, I would say. It was just a few pages long. And the main news is that they said we’re going to finish gathering all the data we need by December, but we’re not going to release a report. We’re going to need until March to crunch the numbers and draft our report on whether we deem mifepristone to be safe and effective. Now, I also think it was notable in there that they’re sort of separately studying the drugs’ safety and efficacy and the safety of the telehealth rules around it from 2023 that the Biden administration imposed. And they noted — and I thought this would, you know, maybe additionally piss off the anti-abortion groups who were already pissed off by the punt until March — they said that they will be examining the 2023 rule changes in light of both court challenges, saying that the current rules are too loose, and court rulings saying the current rules are too strict and access to …  

Rovner: Which we rarely talk about! 

Ollstein: Yes, but two different federal courts have ruled that the remaining restrictions on abortion pills are too strict and not justified, and that it would be safe without them. And so you have the FDA acknowledging these competing forces and pressures on it from the courts and from activist groups and from states. And so it really seems like they’re trying to walk this careful line to not piss off anyone, but they’re ending up pissing off everyone. And what I found really notable about the reaction to this filing was you have the pro-abortion rights forces saying, basically, you know, Wake up, sheeple, they’re waiting until right after the midterms and then they’re going to ban everything! And the anti-abortion groups don’t seem to think that’s the case; they do not seem confident that that is what is going to happen. They are blasting the administration not only for not doing more, to date, to impose restrictions on the drugs, but they do not seem to have confidence in this review process at all. So obviously, we don’t know what will happen. They shared very little detail about who’s in charge of this study, exactly what data are they incorporating? So it continues to be somewhat of a black box. 

Rovner: So, what does this all mean for the potential confirmation of Heidi Overton, the White House health policy aide who’s been nominated to head the FDA and had her confirmation hearing, at which she politely declined to answer most of the lawmakers’ questions, and the Senate left town without acting on said nomination? 

Winfield Cunningham: Well, I believe [Sen. Bill] Cassidy has not said yet how he’s going to vote on Overton. I imagine …  

Rovner: Cassidy, the chairman of the relevant committee. 

Winfield Cunningham: The outgoing Sen. Cassidy. Heidi was asked very pointedly, I think, by Sen. [Patty] Murray, “Do you believe this is safe and effective?” She gave a very carefully — you could tell her answers were very, very carefully rehearsed. I’m not sure what’s going to happen there, but I was going to say, as I think about after the election and kind of how all of this unfolds, I really have no idea. I think you could kind of argue it both ways. There are a lot of anti-abortion allies in key places at the Domestic Policy Council in certain offices within HHS. In some ways, this administration looks like a bit of a traditionally Republican administration. A lot of folks in there, when I talk to pro-lifers, they are, like, “We really have allies here.” But on the other hand, I think Trump’s kind of done with this. The White House still says he’s the most pro-life president. This is the pro-life president, they say. But he’s made it very clear that he doesn’t really want federal policymaking here. And then RFK Jr., he’s, like, Catholic, but I don’t think this is a top issue for him as well. So I’m genuinely curious. I do not know how they’re going to handle this. 

Rovner: I did not have on my bingo card Trump going with the anti-vaxxers but throwing the anti-abortion forces under the bus. Which, hey, everything’s a surprise. 

Ollstein: And to that point, you know, Cassidy is very anti-abortion, and so if he votes against Overton, it will not be because of her anti-abortion views. It will be because of vaccines or something else. You know, her general leadership abilities or whatnot, whatever else he’s concerned about. It’s not going to be about abortion. But you have some other people on that panel who could be concerned about her views on abortion that could affect her confirmation going forward. And I think it’s notable that that too is getting punted until after the election, so as not to provide any fodder or controversy for the members who are having to run. But I also think that there’s always another election coming up, and so, yes, they don’t want to rile people up right before the midterms with some sort of big sweeping anti-abortion action. But as soon as this election’s over, they’re going to be thinking about 2028 and not wanting to rock the boat there. And so I think these sort of political pressures are only going to continue. And we have seen in Congress and in the executive branch sort of an effort to tell the anti-abortion forces that are getting more and more and more frustrated: Just wait. Just be patient. You know, we’re going to get to you. We’re going to get to your priorities eventually. And it keeps not happening. So you’ve seen that on the defund Planned Parenthood front. They keep saying, Oh, it’s going to be in the next reconciliation bill. It’s going to be in the next one, the next one, the next one. 2.0, 3.0, 4.0, and it keeps not happening. And so you could see that again on this front as well. But, also, you know, whether as a result of a court ruling or just the FDA on its own, something could happen that really restricts drugs both in states with abortion bans and in states where they’re legally protected. This would affect the whole country. 

Rovner: All right. And sure enough, not only do we have outbreaks here in the U.S. of measles and other vaccine-preventable illnesses, there’s now a scary case out of Russia of a lab worker who died of a so-far-unidentified strain of pneumonia. Oh, and the patient worked at a lab in Siberia studying plague. Russian officials said that they have the situation under control, but I feel like we’ve heard that before somewhere? Um, I don’t know about you guys. I’m kind of watching this one with a wary eye. 

Edney: Yeah, I think that that is the right way to be when we have these very secretive countries, China with covid, and now Russia with the plague. Where these things start doesn’t lead to a lot of information getting out there, so filling the holes is very difficult. It sounds like the U.S. government doesn’t really even know a whole lot, and we’ve had assurances from Russia that everything is under control. But where’s the proof? I guess. It hasn’t really manifested. So I think watching it closely is right. No need to panic. There’s been no verified reports of anyone else dying at that lab, but, you know, certainly something not to turn away from. 

Rovner: Finally this week, we’ve talked in the past about how doctors no longer want to be associated with helping carry out the death penalty by lethal injection. Well, in Tennessee, we saw yet another botched execution with the patient surviving not one, but two injections intended to end her life. Fifty-year-old Christa Pike, who was on death row for her part in the torture and murder of a classmate when she was 18, was awake and talking as of Wednesday after being unconscious for several days. And it’s not clear what will happen to her now. In the meantime, though, Tennessee’s governor has put a moratorium on executions in the state for the rest of the year and ordered an independent review of what happened. This was the second time this year the state has failed to successfully carry out an execution. I will link to a story from Nashville Public Radio’s Catherine Sweeney, who is an official media witness for both unsuccessful executions. I will warn you: It’s really vivid. It also raises the question of whether lethal injection, which was supposed to be a more “humane,” air quotes, alternative to hanging or an electric chair, really is. Particularly given that many doctors and now many drug companies won’t participate on ethical grounds, and states are turning to some pretty questionable and, as we’ve seen, not always successful protocols, are we sort of getting to the end of this? Anna, I see you nodding. 

Edney: Yeah, I think that these botched executions and the most recent one have given a lot for the anti-capital-punishment groups to work with and to make their case about torture and that this isn’t something humane that we should be doing in the United States; we’re one of the few developed countries that does do that. And you brought up the point about medications and how a lot of the pharmaceutical companies don’t even want to give them to the corrections facilities anymore. And the problem is then those facilities need to find the drugs somewhere. They’re maybe going to less reputable places, or keeping them, the ones they do find, on hand for too long past their expiration date. And so it’s clearly not working out, when maybe if you had the perfect protocol and the drug just off the line of a very respectable company, things might work. But that’s not what’s been happening. 

Rovner: Yeah, I think we’re going to watch that space. All right, that is this week’s news. Now we’ll play my “Bill of the Month” interview with Michelle Andrews. Then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast Michelle Andrews, who reported and wrote the latest Ñî¹óåú´«Ã½Ò•îl Health News “Bill of the Month.” Hi, Michelle. It’s been a minute. 

Michelle Andrews: Hi, Julie. It’s great to be here. 

Rovner: So this month’s patient was sent to the emergency room by an urgent care doctor for a particularly severe migraine attack. Tell us who she is, where she’s from, how she ended up at the hospital. 

Andrews: Sure. Her name is Autumn Daniels, and she lives in Champaign, Illinois, and she has a history of severe migraines back to when she was a kid, like a 10-year-old. And so she gets them regularly, more regularly now. And she had had this migraine for seven days, and finally, the urgent care doc said, “If you still are having trouble tomorrow, you need to go to the emergency room.” Because they’d given her some, you know, a shot to help relieve the symptoms, and it hadn’t worked. So she ended up at the emergency room, with her sister, and waited a long time for care. 

Rovner: So once she got there, she got triaged, right — checked by a nurse to see how serious her ailment was compared to others waiting to be seen. Then what happened? 

Andrews: Sure, I just want to say a word about triage because the hospital kind of makes a big deal of that. It’s just checking her temperature, her pulse, and her blood pressure, and asking her, “Do you often get migraines?” So they did this little bit of “care,” in quotes, and then they sent her back out to the waiting room, and she waited, with her sister. And she waited, for four hours, and nothing happened. 

Rovner: So she leaves and goes to another ER where she does get seen and treated, but then she gets a bill from the first ER, too. How much was it, and what did they say it was for? 

Andrews: The bill was for $410, and they said it was for an emergency room Level 1 visit, and they also stuck a procedural code on it that said that it had been an evaluation and management visit, meaning that some medical care had been provided by a healthcare provider. 

Rovner: Which was questionable, right? 

Andrews: Absolutely questionable. 

Rovner: So, is this a new thing? Hospitals billing for patients who don’t get beyond the initial triage? 

Andrews: Well, it’s new for this hospital, which I thought was interesting. Their policy changed, starting in March, I believe it was, where they said, oh, you know: If you come into our hospital, even if you don’t get treated by a provider, we can still bill you because we’re using up our staff time and we have to keep our facility running. And so that’s the justification that they use. Let me just say, I don’t know that other hospitals do it, but I don’t think it’s that rare, from what I understand. 

Rovner: And her insurance company was not buying this, right? 

Andrews: Exactly. They covered her second ER visit, and that was fine, where she got treated. But this whole, you know, You came to the hospital and you left without getting treatment. Sorry, we’re not going to cover that. 

Rovner: Because technically they said she left against medical advice, right? 

Andrews: Exactly, and of course she didn’t actually receive advice. But I did ask some experts in billing about this, and they said, Well, from the insurer’s perspective, what that often means is that, you know, she didn’t get care at the facility by a provider, and so she’s leaving against their advice, basically. 

Rovner: So, what’s the takeaway here? Is there a way to prevent something like this from happening? 

Andrews: I think there is no way to easily prevent it, but you can certainly ask when you arrive at the hospital, at the ER desk, with your throbbing headache, you can say, “Oh, what happens if I wait and I don’t get care?” You can check with your insurance company and ask them. You know, you would do that perhaps if you were someone who often ended up at the ER, but it’s not something most of us are going to think about. And then let me just say, you can, of course, appeal, and you should appeal if you’re not getting the answers or you’re getting billed in a way that you shouldn’t be billed. 

Rovner: Yeah, I love the kicker of your story: If you don’t appeal, the answer is always no. 

Andrews: Always no. Yes, exactly. 

Rovner: But still, I mean, another list of things that you need to do when you’re in an emergency health situation. Awesome. 

Andrews: I know, I know, and I think there was some conversation about well, you know, you signed these papers, and she’s like, Of course I signed the papers. I can’t be held responsible for the papers. I couldn’t — I could barely see. I was vomiting every 10 minutes. 

Rovner: Anyway, thank you for following this. And yet another thing to beware of when you go to the emergency room. Michelle Andrews, thanks for doing this. 

Andrews: Thanks, Julie. 

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

Ollstein: Yeah, I have a story from my colleague Carmen Paun. It’s called “,” and it is how that approach to foreign policy and foreign aid is playing out in the healthcare space, where the CDC [Centers for Disease Control and Prevention] is now closing offices it had in a bunch of other countries that were supporting local health systems there and also helping to monitor for outbreaks of infectious diseases. Nothing bad ever came from overseas, as we know! And so there’s a lot of worry about this. There is a lot of prediction over both the cuts that have come to HIV prevention and a bunch of other things, increased risk of outbreaks, but also just an inability to have early detection going forward. And there’s going to be some big appropriations fights about this that she previews in the story. 

Rovner: Good story. Paige. 

Winfield Cunningham: Yeah, mine is a New York Times story by Reed Abelson and Teddy Rosenbluth called “.” And I thought this was a really, really interesting story. It’s basically talking about how hospitals are running their coding through AI tools, and the AI is basically picking up more complicated conditions and then adding secondary conditions to basically maximize the number of things that they can bill the insurers for. And I had heard rumblings about this, and I remember actually talking to my sister last year, and she was telling me how they haul in the nurses and actually put them through training sessions of how to code for maximal return. And so it’s easy to see how if you’re now just starting to run this stuff through AI, they’re finding ways to just, you know, upcode as much as possible. So something to really watch amid this larger conversation about healthcare costs ballooning. 

Rovner: Indeed. Anna. 

Edney: Mine is from Annie Waldman at ProPublica: “.” Obviously, it’s an awful story about this baby who was given raw milk and contracted a terrible case of E. coli, and she’s going to have lifelong problems from this. It’s not just some simple thing. But I think the really important point that a lot of coverage before I haven’t seen as much of is that this was in California. The state really couldn’t do a whole lot. This farmer had sold potentially contaminated raw milk, and that’s not supposed to be something, even contaminated or not, that is sold. But there really wasn’t a lot that the state could do. When they even went to collect samples, they couldn’t enter the farm. They had to tell her they were coming back tomorrow to collect samples to test the milk. So, I mean, you can imagine all the things you could do to make sure the milk is clean by then. So I think it was an interesting look at why maybe this is proliferating right now. The FDA certainly isn’t doing a whole lot, given the secretary’s support for raw milk, and then it seems to be like the states’ hands are tied as well. 

Rovner: Yeah, it was a really good story. Well, my extra credit this week is an amazing read from Sarah Zhang at The Atlantic. It’s called “,” and it’s about a rare but tragic medical mystery involving mostly young men who fail to wake up normally from anesthesia, even for minor procedures. I won’t spoil the solution to the mystery, but it’s really a testament to smart and persistent moms for figuring out what happened and why, and working to prevent it from happening to more people in the future. You really need to read it. 

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

Ollstein: Mostly on Bluesky , and still on X . 

Rovner: Anna. 

Edney: All the places . 

Rovner: Paige. 

Winfield Cunningham: And I’m mostly on X . 

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

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Oct. 1, 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 Rachel Roubein of The Washington Post. 

Rachel Roubein: Hey, everybody. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: And my Ñî¹óåú´«Ã½Ò•îl Health News colleague Rachana Pradhan. 

Rachana Pradhan: Hi, Julie. 

Rovner: Later in this episode, we’ll have my interview with Dr. Aaron Carroll of AcademyHealth about the undoing of the federal Agency for Healthcare Research and Quality, AHRQ, where most of the staff has been laid off or retired, and hundreds of grants have been canceled midcycle. But first, this week’s news. 

So we haven’t talked about the Make America Healthy Again movement in a while. It was a big week for MAHA here in Washington, D.C., with a gigantic summit at what used to be the Trump [International] Hotel, down the street from the White House. But it was hardly the event you’d expect if you still think of MAHA as moms who want their kids to have access to healthier food grown with fewer pesticides. Rather, this event featured representatives from health companies with business before the federal government, paying sponsorships of up to $300,000 each to sit on panels with officials from said government to talk about everything from the use of psychedelic drugs to fraud-fighting to wearables and AI [artificial intelligence]. The panel featuring Medicare and Medicaid chief Dr. [Mehmet] Oz was somewhat bizarrely moderated by comedian Russell Brand, who’s awaiting trial on sexual misconduct charges back in England. What was this event supposed to accomplish? 

Roubein: I think you kind of hit the nail on the head in terms of just thinking about the MAHA movement and sort of where it’s going next, because you had some people, more sort of MAHA activists, who were upset that it didn’t talk about some of the core issues of the MAHA base, like vaccines, like pesticides. There have been some influential MAHA activists who’ve been upset at the administration and disillusioned that it hasn’t done more to crack down on pesticide use, etc., have been upset at the Trump administration, and have been saying just weeks before the midterm elections that Republicans may lose some of these votes, and some so-called MAHA moms might sit out the elections. And I don’t think this summit did anything to persuade them to go and vote Republican in the midterms. 

Rovner: Yeah, it did seem, it seemed a great get-together if you wanted to sort of commune with the people who regulate your products, on a public stage. But both the president and Health and Human Services Secretary Robert F. Kennedy Jr. have felt free of late to talk about vaccines, although obviously not at this summit. But it seems that the issue that had united most of MAHA that we were just talking about, pesticides and ultraprocessed food, have been back-burnered by the White House. Rachel, you wrote a . What happened to the food agenda? 

Roubein: Pretty notably, one of the big potential parts of the food agenda is this petition that was filed by David Kessler. He’s the former head of the FDA [Food and Drug Administration] under both Republican and Democratic administrations. And his petition, essentially — I talked to food safety experts about it — could have launched a process that could have forced the industry to reformulate some ultraprocessed foods eventually. So that could have been a big deal. The status of it: It was filed August 2025, and Kennedy earlier this year had done a response to it, where he wanted to have food companies produce any detailed safety studies showing that certain ingredients common in ultraprocessed foods are generally safe. And what I had heard from talking to people is that that potential push had been slow-walked at the White House. I obtained a March draft of the letter that Kennedy sent to the White House for review. Now, HHS pushed back on the assertion that it was slow-walked, but this isn’t the first time that administration officials had wanted to and planned to announce something. They had been working on a definition of ultraprocessed foods that they wanted to release back in August, and that was delayed at the last minute, them just putting out more information about this draft definition. 

Rovner: I feel like there’s this tension between the MAHA movement, which started as a grassroots movement to crack down on corporate power, and the White House is sort of wanting to deregulate everything. Those two things seem to be kind of at loggerheads, and it looks for now like the corporations are winning. We saw this with the pesticides earlier in the year, with glyphosate, that the agricultural community fought back and said, You can’t make us stop using it, because we need it to produce food. And now it seems that the food producers are saying: You have a deregulatory agenda. Why are you talking about regulating us more? Is that, am I reading this right that the corporate power is winning, at least so far? 

Pradhan: It’s still a Republican administration, right? Regardless of Secretary Kennedy’s sort of mandate and passions, he’s still working with and for people who do not like to use government to restrict or regulate or ban things. Even, if you think about, we’ve come a long way since this point. But when former first lady Michelle Obama tried to put healthier foods in schools, she was roundly criticized for embodying a nanny state and all these things. And now, the political winds have shifted. But I still think to go up against the party’s kind of traditional views on regulating business and corporate interests, it’s a swamp. What are you going to do? They’re not going to want to regulate a lot. And like you said, Julie, there are ample actions to date that show that there isn’t necessarily a desire to impose more regulations. It’s also an election year. They may not want to antagonize corporate interests when you’re trying to not see huge losses, especially in potentially the House and maybe even the Senate. 

Rovner: Yeah, they have enough people who are mad at them. They don’t want to add to it. 

Pradhan: Exactly. 

Rovner: Well, of course, with every political split comes a new political opportunity. In Michigan, Democratic Senate nominee Abdul El-Sayed, who’s a prominent supporter of “Medicare for All,” is now trying to grab back some of those Democrats who gravitated to MAHA by unveiling something he’s calling the “Building a Healthier America” agenda, focusing on fewer pesticides, cleaner water, and healthier food. Rachel, you . Might it work? Might Democrats be able to sort of reclaim some of these people who drifted to the Republicans along with RFK Jr.? 

Roubein: I think it’s something that particularly some progressive Democrats are looking to, and they might look to do if they win back the House. In the Farm Bill, you saw Republicans and — some Republicans — and Democrats push back against giving pesticide makers immunity liability shields. But I think it remains an open question. And I think it also depends on the different groups, in terms of MAHA. Tony Lyons at MAHA Action has said that they want there to be an alliance with Republicans. But you also see this with Rep. Alexandria Ocasio-Cortez trying to court some MAHA activists her way. So I think it’s an open question in terms of how this movement unfolds and whether there are any deviations towards the left. But it is a hard sell in some ways. Vaccines are a big part of a lot of people in the MAHA base. And when I asked El-Sayed about this, he said they’re, like, We’re going to agree to disagree on vaccines. 

Rovner: Yeah, he’s trained as a doctor and he does believe in vaccines. And he was the head of public health at the city of Detroit. He’s definitely not with the anti-vaccine types. But it’s important to remember that the original anti-vax movement was a combination of people from the far right and from the far left. So there have always been a lot of Democrats in the anti-vax movement, and this has been a group that’s been kind of up for grabs. And we will, I guess we’ll see how it will all shake out. 

Roubein: And some of the things on food Sen. Bernie Sanders has said for a long time, too. So there has always sort of been some of that intersection on certain issues. 

Rovner: Yeah. Well, originally RFK Jr. was running as a Democrat before he took up with the Trump team. All right. Moving on. Today is Oct. 1, the start of the fiscal year. Happy FY 2027, everyone. The Trump administration marked the day a little early, informing Congress last Friday that it was declining to spend more than $800 billion, in what’s called a pocket rescission. That’s when an administration declines to spend money appropriated by Congress so close to the end of the fiscal year that it basically can’t be spent at all and Congress doesn’t have time to disapprove it. The majority of this funding is from HHS, largely for programs to help noncitizens and for what the administration calls, quote, “overfunded and unaligned” HHS research programs. That includes many related to minority health. Congressional spending leaders, including Senate Appropriations Chair Susan Collins of Maine, complained that pocket rescissions are illegal under a law called the Impoundment Control Act, and the Government Accountability Office issued an opinion this week backing that claim up. But, as we know, this administration likes to dare courts to stop it from doing things that just about everybody else acknowledges is illegal. And I guess that’s where we are here? 

Luthra: No, I was just thinking, right? It’s October. Everything that happens now, we also think about in the context of an election, and I think a dynamic that we have talked about a lot is this effort by the administration to just sort of do what it would like to do with funding, even when many people might say that is not how the laws and separation of powers are supposed to work. And I think something really interesting for us to consider is whether those dynamics do, in fact, change in the new year. Given what Rachana mentioned earlier, there is a very good chance that Democrats control both chambers of Congress, not just one. And [does] that possibility of conflict with another branch in Washington change what behavior we see from the White House? I think that’s a really interesting question and something that we should be thinking about as the election gets closer, and then again depending on what the results end up being. 

Rovner: Yeah, one of the really weedy issues here is who gets to sue the administration to say that, Hey, you’re not allowed to not spend money that we’ve appropriated. It was important that they came out and said that this was illegal, because the GAO, under the law, has standing to sue. But they don’t have a confirmed leader at this point, and Susan Collins was asked about this and said they may be a little bit wary to kind of get out in front of Congress. But I think it’s probably fair to say that if Democrats take back the House and Senate, that they would be more likely to want to either — I think that the Congress itself can sue the administration, can go to court and say, Hey, you can’t do this, which obviously the Republican Congress hasn’t wanted to do. But a Democratic Congress might. 

Pradhan: What — has GAO ever been known to sue? 

Rovner: That’s a good question. I can’t remember. We’ve had fights about rescissions before. 

Pradhan: Yeah. 

Rovner: But it’s — Russell Vought, the head of the White House Office of Management and Budget, says publicly that he thinks that the Impoundment Control Act is unconstitutional and therefore they don’t have to obey it. That’s clearly something for a court to determine. That’s clearly something for the Supreme Court to determine. We haven’t gotten there yet, but most of the time, I think, we’ve had lower courts that have warned the administration: Um, hey, there’s this law that says you can’t do that. You have to spend money the way Congress says you should spend money. The last time we had a pocket rescission, I looked it up, was last year when this administration did the same thing. That was the USAID [U.S. Agency for International Development] money. So before that, I’m not sure when. I may go back and have a look. Shefali, to your point, that was my next question anyway. It’s like, I would think that the one thing that is likely to change if the Democrats take Congress — obviously, we have two more years of the Trump administration — but I would think they would be a lot more zealous in guarding their spending power than this Congress has been. 

Luthra: One would imagine. It seems hard to abdicate the power that one might want. That’s how separation of powers, in theory, is supposed to work. 

Rovner: And it is kind of written into the Constitution. 

Pradhan: I do wonder, though, if they think that, if they wouldn’t get a good, friendly decision from a court … 

Rovner: The Supreme Court. Yeah. 

Pradhan: Yeah. That could be far more damaging in the long term, right? 

Rovner: Yes. There is the concern that the Supreme Court would agree with Russell Vought that the Impoundment Control Act … 

Pradhan: Right. 

Rovner: … is unconstitutional. That is a risk that they would run. 

Pradhan: Right. 

Rovner: Well, that will happen. We will see what happens with that. All right. So, obviously these latest cuts aren’t the only ones to HHS that have been made since [President Donald] Trump returned to office in 2025. We will talk more about what’s happened at the Agency for Healthcare Research and Quality in this week’s interview, but I want to talk a little bit right now about the Centers for Disease Control and Prevention, whose workforce we now know is down by almost a third, according to . Quote: “The changes have hindered the C.D.C.’s ability to respond to outbreaks as measles spreads at home and Ebola abroad,” while, quote, “entire divisions have been shuttered, including teams that worked on smoking, sexual violence, child abuse and falls among older adults.” Separately, but not really separately, the CDC’s advisory committee on vaccine practices has ground to a halt after a judge struck down Kennedy’s replacement members as unqualified. Medical societies have stepped in with their own vaccine recommendations for this fall, but the official CDC guidance is already out of date because there’s no ACIP [Advisory Committee on Immunization Practices] to make recommendations. This is all going to come home to roost the next time we have a bad flu season, I imagine. 

Pradhan: Yeah, I think that the Times, the New York Times, story, what I thought was really, kind of what they led with, was that even though last year you had these widespread firings across HHS and different agencies, including the CDC — the CDC at that time we know lost about 1 in 5 workers — but really the true scale of the losses is much higher. It’s about 30% fewer employees. But the CDC has really had a rough go of it. I think it probably was the — it was the poster child for everything that went wrong during the pandemic, in Republicans’ view. And so they’ve been very keen on dismantling a lot of that agency, more so than the FDA and more so than the NIH [National Institutes of Health], for example, even though they’ve also seen a lot of staff reductions. But CDC, I think, has been so crippled for so long, both because of the staff reductions and just the awful morale at the agency because of everything that the current political leadership has done since. Yeah. 

Rovner: I would say, and the politicization of its leadership, things that were long run by career scientists in Democratic and Republican administrations that are now being run by political appointees, who are rather pointedly not scientists … 

Pradhan: Yeah. 

Rovner: … running this very scientifically driven agency. And of course we’ve had a fifth measles death in Pennsylvania now, that apparently the CDC is still not acknowledging the measles deaths in Pennsylvania. So there are still a lot of questions. The CDC does have, unlike several of the other HHS agencies, does have a Senate-confirmed leader. But so far, we haven’t heard very much from her. I guess we are all still sort of waiting to see what happens, but in the meantime, I can just imagine if we have a bad flu season or some other respiratory ailment that could have been prevented if CDC had been up to date with its vaccine recommendations, things could get rather loud and nasty later this winter. 

Roubein: Some of the vaccine recommendations, some of this is very much tied into the lawsuit, just like the high-level ACIP not putting more vaccine recommendations out. And this part has had somewhat of a snowball effect, like the Vaccines for Children Program, giving out free vaccines to uninsured, underinsured kids, that was held up for about a month. That is now going through, but they had to kind of work through: What are the recommendations going to be? And they ended up going with prior recommendations because there is not an ACIP to meet. So some of this has been tied up in legal limbo. And yeah, on the measles deaths, CDC is now acknowledging two out of the five that Pennsylvania has reported. 

Rovner: There we go. We’re finally hearing something. All right, we’re going to take a quick break. We will be right back. 

Turning to reproductive health, the Hyde Amendment — that’s the annual appropriations rider that bars federal funding for abortion in most cases — turns 50 this week, which, as one abortion rights group pointed out, means that the ban itself has now been in effect longer than Roe v. Wade was in force. Shefali, what’s been the impact of the Hyde Amendment on the ground? What does it actually mean for people who are seeking reproductive care? 

Luthra: It’s a bit more complicated than I think people might initially realize. The Hyde Amendment prohibits the use of federal funds to pay for abortion — functionally, Medicaid. And so Medicaid programs are jointly funded by state governments and federal governments. If you are in a state where the state government does not want to put money into paying for Medicaid coverage of abortion, your abortion will not be covered, especially if you are low-income. Most people who get abortions are people who cannot afford another child. They are parents already. They are largely people who are low-income and rely on something like Medicaid. However, there are states, the Californias, etc., of the world, that have made a point of putting state funds into their Medicaid programs. So in some states, you can get Medicaid to cover your abortion. That’s really helpful. It makes this procedure much more affordable. It can cost hundreds of dollars, sometimes a lot more, depending on where you are in your pregnancy, to get an abortion. But, of course, the fact that this has existed for so long has absolutely made it harder for people, often those who are most financially vulnerable, to get abortions. What you often hear from those patients, though, when I speak to them, is, like, This is something I really can’t afford right now, but I will pay for it anyway because I really can’t afford another child. I think the Hyde Amendment is really striking in that it makes this thing much harder to get. But for a lot of people, it doesn’t necessarily stop them from getting it, because it is just so important to them. 

Rovner: It’s ironic that something that has to, literally Congress has to pass every year — it is a rider on a spending bill. Democrats have tried various ways to get rid of it, always failed. Even when we had a Congress that supported abortion rights, they could not get this out. It is just sort of part of the landscape now, isn’t it? 

Luthra: And part of it is, I think, demonstrative of one of the more effective anti-abortion lines a lot of Republicans have. Abortion public opinion is very complicated. And people support abortion rights in the abstract, but when you get into more specifics, their views become more complicated. And one framing a lot of the GOP has really found success with is saying, We don’t support taxpayer funding of abortion. And that really works because people will hear that and they say: Oh, well, that sounds very extreme. I support this for other people, but, like, my tax dollars, they can’t fund that. And that is the line that has been used to keep Medicaid from paying for abortions, to keep the Hyde Amendment intact, and to keep other federal programs as well from making this more available. And I think it’s perhaps more politically complicated than first blush at abortion polling data might suggest to undo something like this, 

Rovner: I absolutely agree. Well, still, anti-abortion forces remain intent on cutting off the main remaining source of access to abortion, the abortion pill mifepristone. This week, the attorneys general of Louisiana, Alabama, and Arkansas filed suit in federal district court — not at the Supreme Court, which the group’s press release says — to strike down the shield laws in New York, Massachusetts, and California. Those are the laws that enable doctors in those states to provide telehealth appointments to people in ban states seeking to terminate their pregnancies. Shefali, there’s already a lawsuit on mifepristone making its way through the courts, and it’s from Louisiana. How is this one different? 

Luthra: This one is different because it specifically goes after shield laws and it challenges their constitutionality. That is a different argument. It is more sweeping. It could be the thing that finally gets the Supreme Court to weigh in on this issue. Right? It’s a very, very big legal question, something that constitutional scholars have believed, since the enactment of shield laws will ultimately be settled by the Supreme Court. However, I think it’s really important for us to take this suit with context. As you mentioned, there are so many cases making their way through the courts right now around how people get abortions, the provision of mifepristone, shield laws, etc., etc. We don’t know which one will end up at the Supreme Court. We don’t know how courts will rule. This is just one more quiver in the bow that abortion opponents are trying to use to stop this telehealth model that has found quite a bit of success. We will see which one lands. It very well could be this one, but, at this point, we just don’t know. 

Rovner: Yeah, and I should point out that the other Louisiana case is about FDA and its approval of mifepristone to be prescribed via telehealth. So, and of course, we’re also waiting for the administration to do, to finish its FDA safety review, which we expect to see sometime after the election. Speaking of which, abortion is not quite the high-profile electoral issue this year that it was in 2024, but there’s still several abortion-related ballot initiatives to be voted on this year. Shefali, any that you’re watching particularly closely? Or any of the others of you? 

Luthra: I am personally very interested in the Idaho measure and the Missouri one. I spent a bit of time in both of those states learning about what’s happening there over the past month. I think it’s really fascinating. In Missouri, it’s a very strange case. Two years ago, voters amended their constitution and said, We will protect abortion rights. Abortion is now legal in Missouri, a state run by very, very anti-abortion lawmakers. Those same lawmakers were horrified by this finding, and so they have put forth a new ballot measure that would overturn the 2024 result, and it would amend the state constitution to ban abortion. And if that passes, Missouri’s constitution would be the only state constitution to explicitly ban abortion. That’s a really big deal. If this passes, it could set an example to other states where voters have said, We support abortion rights and lawmakers have felt very frustrated by that. Polling right now is a very even split. There is a lot of money. We will see what happens. But I think this is a really interesting case for us to be following. 

Rovner: And it’s super confusing because they just voted on this. 

Luthra: It’s so confusing. And it’s called Amendment 3. If you look at two years ago, the abortion rights measure was also called Amendment 3, and so you might be like: Well, I just voted on Amendment 3. I voted for it. I should vote for it again. And in fact, that would be the opposite. And I’ve spoken to people … 

Pradhan: That’s very confusing. That’s very confusing. How are people supposed to keep up with all this? I can barely keep up with it. 

Luthra: How are they supposed to keep up with all of it? That’s such a good question. 

Pradhan: It’s a lot. 

Luthra: But no, and I’ve spoken to people who work in politics in the area, and they had no idea this was even on the ballot. And I was like, That’s also really striking that abortion has faded from a lot of the political consciousness. But actually there’s this measure that could have really sweeping consequences and really inspire similar action in other states. And the Idaho measure, I think, also very interesting. That would actually not amend the constitution. It would just pass a law that would overturn Idaho’s very, very strict abortion ban, which has sparked all these headlines — women being airlifted to Utah for medical emergencies, doctors leaving, labor and delivery wards shutting down because the law is so strict there. It’s really an open question, but there is some polling that suggests that this could pass. They have gotten a lot of support from Democrats, but also independents, also Republicans. A lot of people in Idaho who were never really politically engaged very deeply are, because this abortion ban has been so sweeping, affected so many of them so personally. If it passes, the legislature could vote to overturn it, and we’ve seen that happen in states around the country. But I think we don’t know, A) if it will pass and, B) if it did how lawmakers might react. There’s a real chance — right? — that they are just so surprised that this happens that maybe you do reconsider the politics of instituting an abortion ban when voters rejected one. But absolutely worth following and seeing what happens in this case, for political reasons but also because a lot of people’s lives could be really, really fundamentally changed as a result of it. 

Roubein: Missouri sounds like such an interesting test case, because I remember back in 2022, after the Supreme Court decision, abortion rights groups were really grasping for a strategy, so they were throwing a bunch of different things at the wall, lawsuits, and then they tried the ballot measures, and it just seemed to work and take off steam. So that’s pretty interesting. 

Rovner: Yeah, and of course, as you pointed out, Missouri has some of the most strident anti-abortion lawmakers in Congress. Josh Hawley, the senator whose wife is one of the lawyers for the anti-abortion, for the main anti-abortion legal group. So Missouri is one of those states that’s got all of the poles represented, and we will have to see how that all comes out. 

Pradhan: Can I make one last addendum on the abortion thing, which is because I’m a Virginia resident? Actually, I was talking to my husband the other day. I said, “Oh, this is how you know that Democrats are in charge,” or we have a relatively new Democratic governor. So now there’s a proposed constitutional amendment on the ballot to amend the state constitution to codify abortion being legal until 28 weeks, so basically through the first two trimesters. Which, you know, Virginia is interesting. I’m biased because I live here, but it’s, of course, trended blue with many prior elections, like leading up to now. But parts of the state are very, very conservative. 

Rovner: Yeah, Virginia is still the South in a lot of ways. 

Pradhan: Yeah. Oh, yeah. And it doesn’t take you long to figure that out once you leave the D.C. area, and there’s a lot of religious-based opposition to abortion. So I’m not sure how it’ll do, whether people will support it or not. 

Rovner: I’m curious whether — if we really are looking at a blue wave, and we certainly see a lot of Democrats in unlikely states who seem to have at least a chance of getting elected because of the frustration, mostly with the economy — whether that will bring along some of these other issues in a way that it might not have. Because, as we say all the time, midterms are about turnout, and it looks like the motivated voters this time are bluer than redder. But I guess that’s another thing that we will have to wait and see. 

All right, that is this week’s news. Now we’ll play my interview with Aaron Carroll of AcademyHealth, and then we will come back and do our extra credits.  

I am pleased to welcome back to the podcast Dr. Aaron Carroll, president and CEO of AcademyHealth, which supports the health services research community. Aaron Carroll, thank you so much for being here. 

Aaron Carroll: Always a pleasure. 

Rovner: So I’ve asked you here to talk about the Trump administration’s effective dismantling of the Agency for Healthcare Quality and Research, which even many of our very nerdy listeners might not have heard of. But first, tell us what health services research is and how it differs from the biomedical research that most people are more familiar with. 

Carroll: I think everybody really gets what we might call discovery research, which is about learning new things at a cellular, molecular, you know, body level — the creation of drugs, the creation of new procedures. You know, everybody sort of understands why we need to do that. But that’s only part of the problem. The bigger problem is how do we actually get that to where people are? So health services research focuses on: How do we improve the access, the quality, and the cost of a healthcare system? Another way I like to think about it is that everything that people hate about healthcare is what health services research focuses on. It costs too much? Yeah, that’s health services research. You can’t get in to see the clinician you want? Wait times are too long? That’s health services research. You feel like you’re not getting the quality that you should, or you’re worried that you know chronic diseases on …? That’s health services research. We spend very little time and very little money, unfortunately, on that type of research. But it’s just as important as discovery research, and I think that one of the reasons why we continue to be so dissatisfied with the healthcare system is because we’re not committed to studying and improving those things in the same way we are discovery. 

Rovner: So how does AHRQ facilitate that, or how has AHRQ facilitated that? 

Carroll: Sure. So, I mean, some of it is by creating and maintaining some of the big databases that people use to study the healthcare system, things like MEPS or other related databases. 

Rovner: MEPS is the Medical Expenditures … 

Carroll: Medical Expenditure Panel Survey. Yes, but I think the bigger way is that they give out independent investigator grants the same way that the NIH does. It just focuses more on health services research, and sometimes they have, you know, different areas that they choose to focus on, depending on the administration, because every administration should get to set priorities or, you know, decide what they think are most important. But they usually give out lots of grants, and I’ve had some over my career, that allow you to do all kinds of research to try to examine how you might improve the way that people receive care or pay for care or get care. 

Rovner: And some of that research has actually created improvements in the healthcare system, is that fair to say?  

Carroll: Absolutely. Yeah, I mean, the reason that, like, we landed on, say, $35 for insulin is because of health services research. It’s because of research that was done that found that that was sort of the inflection point. That when out-of-pocket costs got above that amount, people stopped taking their insulin as they should. And I understand the need for some copays — and obviously, we have a healthcare system. … But it’s, like, finding that kind of stuff out is health services research. And, you know, even some of the grants that were canceled this year would make sense to any, everyday Americans. Like, how do we improve the way that hospitals use antibiotics so we get less resistance, or how do we improve care using telehealth so that kids can get better asthma care or autism diagnoses? These are not discoveries in the sense of new medications, but they are things that we need to learn how to do to make the healthcare system work for everyone. 

Rovner: So I actually covered the creation of not just AHRQ, but of its predecessor agency, the Agency for Health Care Policy and Research, way back in 1989, when I was a baby healthcare reporter. It was not just a bipartisan agency. Its creation was spearheaded by Republicans who wanted to know, basically, which medical interventions worked and whether the U.S. was getting its money’s worth on medical procedures. The reinvention of the agency 10 years later was led by Sen. Bill Frist, a Republican former transplant surgeon who later served as the Senate’s majority leader. So, how did the Trump administration come to view this agency as so “woke” that it basically needed to be disassembled? 

Carroll: I don’t know. And again, if you don’t like the research priorities, it is perfectly reasonable for an administration to say, Let’s change them. And if they decided they wanted to focus on cost, OK. If they decided they wanted to focus on access, OK. There’s so many different ways to do this, but what they’ve done instead is apparently cancel a ton of grants that were already ongoing — and I’d be happy to talk about more specifics about that — but also they just are not spending the money. In fiscal year 2025, there was a significant amount of money that wasn’t spent. Many believe that’s an illegal impoundment, and there’s a case working its way through the courts right now, led by the Society for General Internal Medicine and Public Citizen, and they actually folded in some of the cancellation grants. But in fiscal year 2026, almost no money has been given out for new grants. Today, as we’re taping this, it is the last day of the fiscal year. I have no idea how possibly they’re going to spend the $345 million that was appropriated in 2026. A lot of that is not going to go out the door. In answer to that, they have said that 97% is being on track to be spent. I don’t know how that’s possible. And it’s very, very likely, again, we’re going to see a ton of money unspent, and I imagine lawsuits and more yelling will follow. 

Rovner: So, Congress appropriated this money. The president signed the appropriations bill. What can Congress do, and why isn’t Congress doing something? 

Carroll: So I ask those same questions every day. I don’t understand how Congress is not out of its mind. I mean, this is not something, again, from the “woke” Biden administration. This is this Congress, this House, this Senate passed a budget in a bipartisan manner, that was then signed by the president of the United States — this president — into law. The money’s been appropriated. … In fact, there was specific language in the budget that required HHS to staff up to make sure that they could spend this money. They have not staffed up. They have not spent the money. I don’t know how Congress is not losing their minds. It is an absolute ignoring the law. It is absolutely ignoring Congress’ will. I know there’s a GAO investigation. I know questions have been asked, and I don’t think answers have been given. It makes no sense whatsoever. I don’t know, again, why Congress isn’t screaming and yelling and taking action. Now, what action should they take? Hearings, oversight, make sure that all of this happens. Haul people in to session and find out why are they not following the law, and force the executive branch, as the legislative branch should do, as an equal part of our government, to follow the law. 

Rovner: And it’s not just the grants. I mean, most of the staff has now been basically terminated. 

Carroll: Yeah. Well, that’s what I mean. And there are now minimum staffing requirements in the law, and those are not being followed. I mean, depending upon whose estimates you believe, somewhere between 75% and 90% of AHRQ staff have either been let go or have left the organization. We can’t get exact numbers because they won’t release them. But there aren’t enough people even to process or put the money out the door. Even if they decided today we’ve got to get all the money, it’s not possible. There just aren’t people there to fill out the forms, check the budgets, do all the due diligence, administer the grants, oversee it. There’s no one there, and it’s an absolute abdication of their responsibility to enact the budget and the law as Congress has appropriated and put forth. 

Rovner: Last question: What would it mean — I mean, what would the loss, basically, of what AHRQ has been doing for these last 26 years mean — to the healthcare system and how it runs? 

Carroll: I mean, we spend $40-some billion a year on the NIH — I think about $47 billion. AHRQ, again, is $345 million. So we have been massively underspending on sort of what I would call “delivery” research on how the healthcare system works. And it’s one of the reasons why Americans are getting angrier and angrier every year because they’re, like, Why won’t things get better? Well, we’re not funding it enough. We’re not doing enough. And then, what little we were doing, they canceled in July and refused to spend now. So, what’ll happen? We will remain just as angry, if not angrier, about how much we’re paying for healthcare. We will remain just as angry, if not angrier, about how we can’t get what we need, and we’ll remain just as angry, if not angrier, about the fact that we can spend all this money that we do, $5 trillion-plus, and still feel like we’re not getting the quality, and continue to complain about how unhealthy we all are. AHRQ is the solution to a lot of these problems, and, for some reason, we just won’t use it. 

Rovner: Aaron Carroll, we will stay on top of this. We will revisit it. I promise. 

Carroll: I’m glad to hear that. 

Rovner: Thank you. 

Carroll: Thank you. 

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

Roubein: My extra credit is headlined “” It was in Stat by Elaine Chen. I thought it was a really fascinating story because we’ve all seen the cultural shift toward GLP-1s, and we’ve all heard the drugs praised as a way to address obesity as a medical issue. But Elaine reports that the drugs are now being increasingly marketed as a way to look and feel better. I thought there were some notable examples. The story explored how Novo Nordisk, which is one of the drugs’ makers, has particularly leaned into the shift. For instance, the company had advertisements this summer with slogans that include “live lighter” and “a summer glow-up.” And instead of labeling the drug as a drug for weight management, it sometimes is referring to it as a weight loss drug. And Elaine talked to some doctors and patient advocates that think the drug’s being talked about more as a retail product, run against the industry’s sort of initial goals of trying to convince the greater public that obesity is a disease and that the drug should be covered by insurance. For Novo Nordisk’s part, a spokeswoman told Elaine that how people expect to access and experience care has changed in recent years, and the company recognizes that healthcare needs to become more responsive, relevant, and easier to fit into everyday life. 

Rovner: I would just note, and it’s a very good story, that if the drugmakers lowered the price of the drugs, it would be easier to get it covered by insurance. But that’s just an aside. Shefali. 

Luthra: My story is from The Atlantic by Caitlin Dickerson. The headline is “.” It’s a great story. It is about when parents are deported without their children, what happens to those children? This is the kind of reporting that is really hard to do because you have to spend time with children who have lost their parents. But I think it’s really important, especially as we see this uptick in detaining and deporting, in particular, people with children. I’ve spoken to a lot of mothers who have been deported when they had children here, and the consequences will last probably people’s whole lives. There are health consequences, especially when you have young children. There is PTSD, and I think Caitlin Dickerson has done some of the best reporting on immigration in the past decade, maybe longer. And this is absolutely an essential addition to that canon. 

Rovner: It is indeed. Rachana. 

Pradhan: My story is a trifecta from my colleagues Phil Galewitz, Andrew Jones, and Claudia Boyd-Barrett, who wrote a story about, as of today, hundreds of thousands likely of immigrants who are lawfully present in the United States but who have low incomes are now no longer eligible for Medicaid. This is part of President Trump’s signature One Big Beautiful Bill Act, which will enact greater coverage reductions next year, starting in 2027. But this group of people is now no longer eligible for Medicaid. It includes refugees, some people who have been granted asylum, and also, you know, victims of domestic violence and/or human trafficking. So the story gets into how we have our beloved Congressional Budget Office here in Washington that sort of estimates the impacts of tons of legislation. And they estimated previously that about 100,000 immigrants would be uninsured by 2034 because of this provision. But based on figures that my three colleagues got from state governments or state Medicaid agencies, the figure is likely to be higher of the numbers of immigrants with legal status who are going to now not be able to receive Medicaid. So yeah. So it’s a great read, and I know Julie will put the link in the podcast and in the comments. 

Rovner: I will indeed. Yes, there’s the continuing, you know, “immigration is a health issue, too” theme that we have this week. All right, my extra credit is actually an update to an extra credit from last month. Like last month’s story, it’s from The New York Times, and it’s called “,” by Madaleine Rubin. And it seems that my alma mater — also, full disclosure, the alma mater of my editor and several of our panelists — has rethought the idea of letting incoming freshmen complete their first semester without letter grades to ease them into college life. According to a statement from interim university president Domenico Grasso, there was concern that students would be, quote, “unfairly portrayed as coddled or unprepared for the demands of a rigorous Michigan education.” Yeah, I would add that a lot of the backlash came from my fellow alums, and that even though I attended Michigan well back in the 20th century, even in the olden days, we had the option to take classes pass/fail if we wanted to. Although I would note that under the original proposal here, the students wouldn’t have failed, but they would either have gotten a pass or a “no credit.” Good job rethinking this, guys, and Go Blue. 

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

Luthra: I guess I’m on Bluesky , but you can also email me. 

Rovner: There you go. Rachana. 

Pradhan: @rachanadpradhan, both on and on , and you can always email me at RachanaP@kff.org. 

Rovner: Rachel. 

Roubein: Yes. X: ; Bluesky: ; and Signal is always good too: RachelRoubein.28. 

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

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Sept. 24, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Tami Luhby of CNN. 

Tami Luhby: Hello. 

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

Joanne Kenen: Hi, everybody. 

Rovner: And my Ñî¹óåú´«Ã½Ò•îl Health News colleague Sarah Jane Tribble. 

Sarah Jane Tribble: Good to be here. 

Rovner: No interview this week, but plenty of news. So let’s dive right in. We’re less than six weeks away from the midterm elections, and healthcare, particularly its rising cost, is shaping up as a top issue for voters. Sarah, I want to start with you this week because you’re part of a new polling project that KFF is doing with the AP, looking at rural voters. What did our new poll find about rural voters and their views on healthcare? 

Tribble: Yeah. Well, the big headline is that 48% of rural voters believe the economy is worse off now, and that leads into healthcare because their key pain points are, not surprisingly, gas, groceries, and healthcare. Those all rank right up above 60% of those who are polled. They polled about 2,200 roughly rural Americans across the U.S. in August, mid-August. So this is a very fresh poll, only focused on rural Americans, which, as we know, is a key voting bloc for [President Donald] Trump and the Republican Party. 

Rovner: So … the rural voters tend to be more heavily Republican, right? 

Tribble: Yeah, they tend to skew Republican. Yep. 

Rovner: But there are fewer of them. So, but they’re a key voting bloc. … What did they find in terms of, you know, their continued support for President Trump and Republicans in general? 

Tribble: Yeah. So, you know, it was an interesting survey in the nuance. And what I love about this, and I’ve been covering rural America for four or five years now, exclusively, and there is a lot of nuance in rural America. It’s not a monolith, right? There’s lots of different people. So, while 48% of rural voters believe the economy is worse off now, about half also still approve of Trump’s job performance. And so what we’re finding is the Republicans — I talked to one expert, Tim Slack at the Louisiana State University. He’s a sociology professor. He’s written some books. What he said was he expects Republicans to sit this one out. And we talked to an array of Republicans, and that’s sort of what we heard. And you’ll have to read our story, but that’s pretty much what’s in there. 

Rovner: I will link to the story. But that’s really important because I mean one of the things we know about midterms, it’s not just who supports who and who opposes who, but who actually shows up to vote, right? 

Tribble: Right. Yeah. And what was really interesting for me, personally — and it’s, like, one of my colleagues and I were talking, and he was like, “You have a front-row seat to the elections,” because, you know, rural Americans, they too tend to come out to vote. They skew older, and they tend to be voters, right? But when I talked to the Democrats, they were certainly going to the polls. They definitely knew who they were voting for. But the Republicans I talked to, for the most part, were very sort of like, Well, I’ll definitely vote for this Republican, but maybe not my Senate seat, because I’m not happy with them. So it was a really interesting sort of pause that they would give. 

Rovner: So yeah, it’s an early indication, as we say. Well, healthcare is also playing a role in several high-profile Senate races. Michigan, of course, is a top one, pitting Democrat Abdul El-Sayed, a longtime backer of “Medicare for All,” against Republican Mike Rogers, a former House member who is touting price transparency as his health platform. But health is also showing up in Iowa, where Republican Rep. Ashley Hinson says she’ll fight Big Insurance, while Democrat Josh Turek says he’ll fight Big Pharma. And in Ohio, where Democratic former senator and Affordable Care Act sponsor Sherrod Brown is pushing to rein in insurance company denials, while Republican opponent Jon Husted is both vowing to overhaul the Affordable Care Act and restore the expanded subsidies that expired last year, at least temporarily. So it looks like , but in many different pieces. Am I sort of reading this right? 

Kenen: I think, rather than being a healthcare election in great big capital letters — which we’ve all lived through a number of those, both in the primaries and in the generals — I think it’s falling under this larger affordability issue. Like, I think that it now has a whole bunch of dollar signs instead of vowels. And I think healthcare is a big concern for people. We hear about it every day, but it’s part of this longer, Oh my God, life is just too, too, too expensive. And then there’s also this big … distrust of big things, including Big Pharma, Big Insurance, big everything. Right? At the same time, this is a really fast-moving political environment. Well, we all know that since, you know, by the end of the day, it feels like 20 years. And the issue, which started out as the data center issues; it’s now a larger existential fear of AI, and what is going to be done about it, and who is afraid. So this is a really shifting election. Like, what is going to motivate people? And what happens is even more un- … I mean, elections are unpredictable by definition, and this is going to be … like, if it was right today, the Democrats would be extremely happy. But who knows how many news cycles we go through between today and tomorrow? So yes, it’s a healthcare election, but we’re not calling it a healthcare election. 

Rovner: I was more thinking that it’s … 

Kenen: I mean, existential, getting wiped out is a health issue! 

Rovner: I was more thinking, though, that neither party actually has a health platform. I’m sort of struck by how Democrats and Republicans are all talking about health, but they’re all talking about different pieces of it, because we know that within each party there are differences in what they want to do about healthcare. 

Luhby: Right, and I think that’s one of the main issues. I mean, the Democrats are talking about how they want to extend the expired Affordable Care Act premium subsidies, which caused a lot of premiums to go up for many millions of people, but they also want to reverse the Medicaid cuts and the [One] Big Beautiful Bill. But then you also have the other side, where they’re talking about Medicare for All among the progressives, so they’re sort of split within themselves, and they don’t have exactly a unified message. And the Republicans are on the ropes this year on healthcare, as they have been in other elections. And this year, you know, they don’t want to highlight all of the cuts that they’ve made. So they’re highlighting, you know, their efforts to fight fraud. We saw [Vice President JD] Vance’s announcement earlier this week, and they’re touting, many of them are touting the Rural Health Transformation Fund, the $50 billion fund that was in the Big Beautiful Bill, without saying that the Medicaid cuts are going to affect rural America far more than the transformation fund will help them. 

Tribble: Yeah, one of the interesting findings in the research study — so, this Rural Health Transformation Program is something I’ve been following pretty closely — and one of the interesting findings in it for rural America is they pretty much hadn’t heard of it. 

Rovner: So for all of that effort! 

Luhby: Yeah, that’s surprising because so many of the candidates in that, you know, area are touting it on the trail. 

Tribble: Yeah, well, and at the same time, though, they also pretty much hadn’t heard of Medicaid changes either. Even people I talked to who had kids enrolled in Medicaid said they were pretty much unaware — maybe some cuts were coming. I did talk to a former hospital worker who said, “Yeah, it’s going to hurt a lot of people.” But she was a Democrat. Most of the people I talked to were unaware of Medicaid, and they also were unaware of the Rural Health Transformation Program and its impact. So I don’t know where that leaves the Republicans, but their messaging just isn’t getting out there on at least the RHT. 

Rovner: Well, to pick up on what Tami … oh, Joanne, go ahead. 

Kenen: I think people are just very overwhelmed, like, I don’t think — it’s really hard to know, like, people have these gut feelings and these sort of ideological identities, but everybody’s so overwhelmed by everything right now. I even wonder with the polls, like, who even answers their cellphone for it? We already made the shift from landline to cellphones, right? I mean, everybody is just swamped, and some people have just tuned out, and some people just can’t absorb everything that’s out there. So I don’t think voters are that well informed about the facts. I think a lot of people vote on guts and, you know, sort of gut feelings, and I think that’s always been true to a certain extent. But … you can’t poll on whether people are paying attention to polls. 

Luhby: One thing that an expert told me a couple of years ago that I thought was really, you know, insightful was the fact that people see their gas prices every time they fill up or every time they pass the gas station. They see the increase in grocery prices every time they go to, you know, buy food or go to a restaurant or so. But they only see their healthcare increases when they need care, or maybe once a month for the premium. So, you know, I think you were right, Joanne, when you said that the healthcare is now sort of lumped into a larger issue of affordability. But the affordability crisis that people are really seeing daily or weekly are gas and groceries, not necessarily healthcare. 

Tribble: In my interviews, what I noticed was people — I would like call people, and they were … one guy was at the gas station who was filling up his truck, right? A grandmother talked about how much her groceries were and how her gas and grocery bill every week was $200, which was just a lot for just her, right, in Iowa. And so it’s very salient to them and very tangible, like you said, Tami, that those costs are right in front of them. And, frankly, it should not be overlooked that for a lot of people, they don’t pay attention to diesel prices, but diesel prices have a huge impact on people in rural America, especially, not only because they’re using it for their trucks and the farming equipment, but they just use it more. So these affordability issues, these pocketbook issues and concerns, the messaging on that is not positive for either party right now. 

Kenen: And you don’t have to message. You just have to pull out your wallet, right? I mean, all of us can afford our groceries, but I’m aware. I mean, when you go into the store, you see. I mean, I think even people who are not pressed are shopping differently, and thinking differently. So, I mean, I think people aren’t necessarily paying attention to the messaging, but they are paying attention to the lived experience, which, as Tami said, you see on every gas station every time you drive by. Even if you’re in an EV [electric vehicle], you’re aware of it. 

Rovner: So, also, as Tami said, the administration seems to be pushing its fraud agenda as its big health issue. As you mentioned, Vice President JD Vance had a press conference Tuesday to announce that the administration is canceling the ACA [Affordable Care Act] policies of more than three-quarters of a million people, who the administration suspects are fraudulently enrolled in the program. Now, one of their indications is that these enrollees haven’t filed a claim. But I did a little digging, and, according to our Peterson-Ñî¹óåú´«Ã½Ò•îl Health [System] Tracker, it’s not at all unusual for people not to file a claim. First of all, most people are healthy most of the time. The bottom half of the population only accounts for 3% of healthcare spending. By comparison, the top 5% account for 50% of healthcare spending. Also, those with the cheapest plans tend to have the biggest deductibles, and now the average Affordable Care Act deductible is nearly $4,000. So even if you do have a medical expense, you’re likely not to bother to file a claim that you know isn’t going to be covered. So I know fraud is one of the really big Republican answers to rising healthcare costs this year, but is it really good politics to announce you’re taking away people’s health insurance, like, the month before people go to the polls? 

Luhby: Well, I mean, again, they’re saying that they’re actually not taking away health insurance. If you listen to the press conference, both Vice President Vance and CMS [Centers for Medicare & Medicaid Services] Administrator Mehmet Oz said that a lot of these people are phantom enrollees. That this is all just fraud. That brokers and agents, you know, seeking higher commissions, signed up people who don’t necessarily exist. And they argued that other people may not have known that they had ACA insurance, or they may not be eligible, so therefore they don’t qualify. Now, I’m not necessarily justifying that, but that’s what they’re arguing. They’re not saying they’re ripping it away from, you know, people who, you know, should be on the plans. And then, you know, they are taking some measures against fraud. They’re suspending brokers and agents who are suspected of fraud. They’re going to be more strict with the guidelines. But interestingly, they’re also putting a moratorium on new brokers and agents, which could make it harder for people to sign up in coming months. You know, as you said, Julie, open enrollment. Well, you had said it’s right before the election. It’s also right before open enrollment starts on Nov. 1. So, you know, I think there are probably a lot of brokers and agents, and, of course, the government navigators out there to help people. But, you know, it’s possible that some people may not be able to be helped as quickly because there is now this moratorium. But the discussion of the nonmedical claims, which Dr. Oz also really focused on, is coming from Paragon [Health Institute], which is run by Brian Blase, who was, you know, is a conservative health policy leader and was involved in the first Trump administration, and he’s definitely very involved in this administration as well. 

Rovner: And I actually saw some pushback about that, you know, how they are counting people who don’t file a claim. I saw some pushback from the insurance industry that said, you know, they’re double-counting some of these. If you’ve changed plans, if you, you know, even if you were only in a plan for a month and you didn’t file a claim, they’re looking at that as you having been enrolled in that plan all year. So yes, there definitely is some fraud. We’ve known this since my colleague Julie Appleby helped uncover what was going on back in, I think, 2023, definitely in 2024. The Biden administration addressed this; the Trump administration has also already addressed this. But it seems unlikely that they’re going to revoke, you know, 750,000 policies and all of those are going to be phantom enrollees, or people who didn’t know they had coverage. There’s going to be some number of those people who have insurance and assume they have insurance, or who assumed they had insurance and may go to use their insurance and find they no longer have it. 

Luhby: Right, and that is, I mean, people have definitely been concerned that some, you know, legitimate enrollees will be caught up on this. And you know that was a question that actually came up in the press conference, and they said, “Well, you know, we worked really hard. We sent FedEx letters. We tried to contact them. We knocked on doors. We went to their houses.” You know, I don’t know if they or the insurers actually did that, but yeah, there are people who are concerned that just giving people 30 days to respond and prove they’re real may not be enough. 

Kenen: On the politics level, there’s the two fighting messages, which is, you know, We’re getting rid of the crooks and the fraudsters, right? And then there’s the, more on the Democratic side, They’re taking, they’re ripping health insurance out of people’s hands. And the truth is, there’s, you know, Julie, you all just said, you know, there is fraud out there, and we all know that, and none of us are, I mean, we don’t want to be endorsing fraud. But there’s a policy reason, too. Some of these people who are supposedly not making claims are healthy. You know, like, they just didn’t get sick this year. Doesn’t mean they won’t get sick next year or be in a car accident, or what else? But right now, it’s good for insurance risk pools, it’s good for the ACA, to have healthy people in it. So the idea that we’re going to look for people who don’t have health claims and kick out the healthiest ones is just going to raise costs for the sick ones. It’s what they call the death spiral, right, or the insurance death spiral. So …  

Rovner: And it already is raising costs. We know that. 

Kenen: Right. Right. So, I mean, there’s something like, on a policy basis, yes, go for the fraud. Make sure it’s really fraud. Stop talking about the individual — although the CMS press release was balanced, it was really, it did not talk about crooked recipients. It really did talk … I went back and read it, because politicians talk about it differently. But the CMS press release was about brokers and fraud on the business side. It wasn’t blaming the individuals. But people hear “fraud,” and, you know, get away from that. Figure out where the fraud is and where the need is and what the smart economic policy — knowing what we know about insurance — is, and don’t do things that are going to raise costs as you scream “fraud.” 

Tribble: I guess the question I had actually was, you know, I did not cover this announcement, and, Tami, it sounds like maybe you did, but did they say they were cutting subsidies, or are they canceling the arrangements with the individuals? Like, are they working with the insurance companies, or are they just canceling? I don’t quite understand the actual practical implication of it, basically, what’s happening. 

Luhby: That’s also one thing that’s not 100% clear. 

Rovner: Yeah, I went back and watched, and yeah, it was all a little bit vague. So, we will see how this plays out. But I guarantee there are going to be people who are not fraudulent who are going to get caught up in this, because there always are. All right. 

Kenen: And there’s some people who don’t exist. I mean, there probably really are some phantoms. 

Rovner: And absolutely, I mean, I’m sure there are a lot of phantoms. I don’t doubt that. 

Tribble: And before you leave the topic, Julie, I think it bears pointing out that all of this is happening, this announcement comes just as people are looking at that open enrollment and looking at their premiums and deductibles and copays going up on the marketplace as well. So it’s just an onslaught against these ACA plans at this point. 

Rovner: That’s right. And one of the things we know is that it’s not the greedy insurance companies, as some politicians are saying. Healthcare costs are going up, and therefore premiums across the board in the ACA, in Medicare, in employer health insurance, premiums are going up everywhere. We’re seeing that this year.  

All right, moving on. Over the summer, we talked about a regulation from the White House Office of Management and Budget that would impose a layer of political oversight over the grant process, pretty much across the government. Congress has blocked that regulation, at least until December. But late last week, The Washington Post reported that the administration was preparing an executive order to create a political oversight committee just for grants from the National Institutes of Health, basically trying to ensure that all biomedical research funding advances the president’s priorities. It appears, as of Wednesday, the administration is backing off on that, after Senate Appropriations Committee Chair Susan Collins of Maine, who’s battling to keep her seat and with it the possible Republican majority in the entire Senate, she complained publicly about this. But what would it mean if the administration actually follows through with such an overt politicization of the scientific grant process? 

Tribble: I mean the power to veto the awards that the National Institutes of Health gives, the huge research portfolio that they have, and use politics to veto that, I mean, it’s just a really interesting battle going on because [NIH Director Jay] Bhattacharya, he, you know, he has long been an advocate of some of these policies that, or these research programs, that are focused on minority populations. So it’s interesting to watch play out. It’ll be interesting to see what the next step is for the administration. 

Rovner: Yeah, I mean, according to several news sources, I think this was , there was a big fight in the Oval Office last week with Jay Bhattacharya, the head of NIH, a former researcher who’s received NIH grants, and Russell Vought, the head of the Office of Management and Budget, who’s behind this effort to put a political layer of approval on top of the grant-making process. And, according to the stories, Vought won. Although now … after Susan Collins wrote a strongly worded letter, that I actually snidely said, “Well, this isn’t going to have much impact.” Clearly, it did. So I was wrong. And again, as I point out, Collins is also is embattled right now and needs to keep her seat. And it would behoove the administration for Collins to keep her seat and keep the Republican majority. But, you know, there seems to be a lot of pushing and pulling in this administration about, you know, how much they want to try and basically take away Congress’ ability to determine how this money gets spent. It’s $47 billion for NIH every year, and Congress has long, you know, bipartisanly, maintained that they get to determine how that money is spent, not the administration. They say, You’re going to spend it this way. The administration’s job is to do that. 

Kenen: The other thing is this fight, you know, which Collins has won for now, this panel overseeing your final review of grants, is not the politicization of science. The politicization of science started on Jan. 20 of 2025. NIH grants have been cut. We’ve all seen the wars. You know, like, “wars” is not too strong a word between the administration and leading research universities. The funding that’s been cut. Those are very NIH-funded institutions — Harvard being the one that’s sort of most in the headlines consistently, but it’s not just Harvard. There’s a list of banned words that if, you know, “diversity” and things like that, that you can’t get funded for. So there’s all sorts of politicization of science that has already occurred, that has been, is occurring every single day. This would have taken it to another level. Collins, for now, has won, and she has some — there’s a few other voices speaking up. I noticed that Sen. [Dave] McCormick, from — I believe … I’m saying his name right, Julie, correct me. I’m going to say that again. If it’s wrong, tell me later. I believe Sen. McCormick of Pennsylvania, a Republican of Pennsylvania, has and some statements saying, you know, science is important. Science cures. Science also is great for our economy. Science is a driver of … the ROI [return of investment] on NIH is high. So the politicization isn’t starting. … This was an attempt to escalate it, and we’ll see where it goes. I mean, Collins has been pretty consistent on this. She did get the temporary blockage of related proposals … 

Rovner: The regulation, yeah. 

Kenen: Yeah. So this has been a consistent issue for her, and, you know, I think she’s been successful so far. 

Rovner: Well, I think, and I’m so glad that you said that. You know, this all, the politicization of science started when this administration, you know, took office because I think that’s been one of the undercovered stories, really, of last year and this year, about how the nation’s entire biomedical research establishment is struggling under not just the cuts and the delays imposed by the administration, but the uncertainty and their inability to plan. The Harvard Crimson has two interesting stories this week related to this. In one, the Harvard School of Public Health is considering approaching some major health corporations, including UnitedHealthcare and CVS/Aetna, to help make up for the federal funding cuts that they’ve seen. Just two days later, the Crimson reported that three current and former Harvard researchers, one each from the medical school, the School of Public Health, and the Kennedy School of Government, are all leaving Harvard to go to Canadian universities. We’ve talked about a potential brain drain before, as European universities kind of upped their recruiting of American scientists. Are we actually seeing this exodus start? I mean, biomedical research, as you pointed out, Joanne, you know, the return on investment for biomedical research in this country has been huge. This is an enormous and bipartisan engine of economic development in this country, and people are sort of not paying attention as it’s kind of crumbling. 

Kenen: It’s not just scientists either. I mean, first of all, it’s not just Harvard. There are academics from across the country. I do not have the numbers. I can’t cite you an … accurate number. But scientists, researchers, and the social sciences and humanities too. I mean, there are academics, not just the international ones, who have to go home for some of the students, but the American academics in science and non-science have left the country in numbers that are worth paying attention to. Although it’s not like they’ve all gotten into, like, you know Noah’s Ark. … But the other thing is it’s not just future science. They have cut large numbers of clinical trials that were already underway, which means that we’ve lost the investment we already made, and that people, you know, who’ve been given their time and volunteered for these trials also don’t get, they got cut off from them. So, I mean, I just — it’s not a left-right thing. I just don’t understand the common sense of stopping a cancer trial midway or stopping an Alzheimer’s trial or anything else midway and throwing out the money and the knowledge, because these are not partisan. Republicans and Democrats agree that cancer is bad, you know, like Republicans and Democrats, and I dare say independents, don’t want to get Alzheimer’s or see their loved ones get Alzheimer’s. I’ve just never totally understood why this has been seen by top officials in the Trump administration as a good thing. 

 

Tribble: I mean, I think we need to go back to what you said, Joanne, which is January 2025. There were two executive orders on “woke” things, right? Diversity, inclusion, and all that. And I have not been focused on these particular grants, but I’ve been writing about the Digital Equity Act from a broadband standpoint that affects, you know, tons of rural Americans and their ability to do telehealth, for example, and things like that. And that act has been under fire from President Trump, and they have been using those executive orders as a way to sort of attack not only science and research and the things that we watch here with the federal agencies, but across the board in the administration. If it’s considered a “woke” mandate, they’ve gone after it. So I think we do have to go back to that and look at those executive orders and say that’s the game plan. Right? And so I just wanted to note that. I do think these grants have been undercovered. I think this research has been undercovered. But I also think across the board with this administration, those executive orders have had a large impact. 

Rovner: Yeah, you know, we talk about how executive orders don’t have the power of law. Although, I will say, in this administration, executive orders have had a lot of power to actually do things, as we’ve pointed out, sometimes maybe not legally. You know, sometimes we’ve had courts step in to stop them. But this administration has always been: Do it first and ask permission later. All right, we’re going to take a quick break. We’ll be right back. 

So I am old enough to remember when we were told that Republican pollsters told the White House to stop talking about — and stop HHS [Health and Human Services] Secretary Robert F. Kennedy Jr. from talking about — vaccines, because anti-vax sentiment wasn’t popular with voters. Well, that advice didn’t seem to age well. Last week, we had RFK Jr. giving the keynote at a conference of the group Children’s Health Defense. That’s the anti-vax organization he helped found. In his hourlong-plus speech, Kennedy told the group that it has a “strong and steadfast friend” in Donald Trump, among other things, and promised new studies into the effects of electromagnetic fields and contrails, the water vapor clouds emitted by jets. Meanwhile, Trump himself doubled down on his earlier vaccine comments — this time, urging the drugmakers divide regular doses of vaccines into five separate doses. It’s not clear which vaccines he was talking about. In an effort to reduce autism, this, despite the fact that vaccine doses are carefully tested already, and there is no evidence that any vaccine or combination of vaccines has anything to do with causing autism. Do they care more about the anti-vaccine base and maybe getting them out to vote, or do they just not care that much about the majority of voters who believe that vaccines are, on balance, you know, a good thing? 

Tribble: I mean, I think that they are out campaigning, right? Like they are worried about the midterms, and they have sent Kennedy out to rural areas, in particular, which is why I know about this, to campaign on this. He’s been in Iowa trying to draw that MAHA crowd. So the anti-vax movement is part of the Make America Healthy Again movement, and it’s true that more people tend to believe that they can favor Make America Healthy Again — they tend to be folks who are also in the Make America Great Again camp, too, and have that identity. So if they can gin up the base, then I think they’re going to try to do that before November. 

Rovner: Yeah, back to what we were talking about at the beginning. It’s all a matter of who turns out. 

Kenen: The health part of, not MAGA, but MAHA is not all anti-vax, right? And some surveys have shown that many of them do vaccinate their children. And they’re concerned about pesticides. They’re concerned about ultraprocessed foods. They’re concerned about other things that, you know, many people would actually agree on, although they may identify more with the MAHA movement. So even within MAHA … they don’t all agree with Kennedy on vaccines. But I mean, I agree with Sarah. The timing of this and the intensity of this, as people are dying from measles, which Kennedy says they’re not — I think they see that in certain counties or areas of the country, the rejuvenation of the anti-vax conversation and orders and so forth is probably a voter intensity issue for them. Trump has never called for no vaccines. Trump has never said polio vaccine was a fake. I mean, he hasn’t gone anywhere near. He’s really in that, sort of, we have to change how we vaccinate, rather than we don’t want any vaccinations. He’s the changing the dose, smaller, you know. And of course, he exaggerates it. You know, those of us who have kids, they’ve never had a syringe the size of a vat. We don’t put vats of chemicals into our children. … I mean, how would they fit? I mean, very small babies. You know, you can put the baby in a vat, but you can’t put a vat in a baby. I mean, I agree that the timing is very political, and, you know, there were rumors a few months ago — not even a few months ago — there were rumors a few weeks ago that Kennedy would be out after the elections, and that, you know, Oz might go in. Now, interestingly, Oz has gone on TV and said the measles vaccine is good. Your child, you know, there’s measles out there. Get your kid vaccinated. But he’s not as loud as Kennedy. 

Rovner: Or as visible. Well, meanwhile, as we are taping today, the president’s nominee to lead the Food and Drug Administration, White House health policy aide Heidi Overton, is appearing before the Senate HELP [Health, Education, Pensions, and Labor] Committee for her confirmation hearing. It’s only just starting, so we will pick up on what happened there next week.  

Next up are drug prices. President Trump last Friday held yet another event at which he bragged about lowering drug prices. But I keep wondering: Has he really? Yes, drug prices are down a bit — not the 80% or 90% that Trump likes to say. It’s more like 3%. And analysts say at least some of that is due to the Medicare negotiations that were put in place under President [Joe] Biden, but are just now taking effect. So it’s not at all clear how much is due to the deals the president says he’s striking with these drug companies. Public Citizen actually got hold of some of the documents, and the agreements are pretty vague. I guess the big question is whether the public will believe the president when he says he’s lowered drug prices or whether they’ll believe what they see when they go to the pharmacy counter. Back to, again, back to what we were saying earlier. You know, it’s hard to talk about gas prices going down when every time you get in your car and drive, you see them on a big sign. I mean, I guess drug prices might be a little bit easier because not everybody takes drugs. But I’m wondering whether the people who do are believing him when he says this. 

Luhby: Right, and this has been, you know, one of his mantras in the first administration as well as now. And I fact-checked both his comments on that drug prices have been down this year and that we have the lowest prices in the world now, which is another thing that he loves to say. He loves to say that he’s strong-armed Germany and France and other European countries to lower their drug prices, which …  

Rovner: No, to raise their drug prices. 

Luhby: I’m sorry, to raise their drug prices, right? That we’re benefiting because now other countries are paying more and, you know, shouldering more of the burden. And, you know, the international experts that I’ve spoken to say there’s no evidence of that. So no, generally … you mentioned that the drug prices are down a little bit, 3% That’s from the CPI [Consumer Price Index], from the inflation index. But, you know, most experts don’t use that. People I spoke to said that that’s a very faulty measure. It shows the total cost at the pharmacy, but that’s also what insurers pay. So, you know, whether people are paying less, it’s hard to say. And as we know … what people pay at the pharmacy counter depends on their insurance. I mean, yes, there’s deductible issues and all of that, and copay issues, but, you know, that’s a yearlong contract typically, and it depends. And even today, in fact, showing that on TrumpRx — they looked at, I think, 32 drugs, and only about half of them actually did have lower prices than, you know, another comparable country. So it’s very murky. We did get some details from the Pfizer and Eli Lilly disclosures that Public Citizen got, but it’s also very heavily redacted. And [The] Washington Post, that , said that they omit key financial terms, the negotiated prices for drugs, and other provisions, making it difficult to independently assess the agreement’s values to taxpayers or the companies. You know, and I’m sure also to patients. So, you know, it’s unclear. 

Rovner: And another thing we know is that people who follow the stock prices of these companies have suggested that it’s not going to hurt the companies very much, which suggests that it’s not going to lower the prices very much. I mean, you can’t — again, we don’t know a lot of specifics, but that’s certainly an indicator that the companies don’t think that they’re going to have to lower their prices enough to hurt their profitability. Let’s put it that way. 

Luhby: Right. Some companies have mentioned some headwinds from U.S. pricing and MFN [most-favored-nation], but it’s not been a huge issue for them. 

Rovner: Yeah. 

Luhby: And from the beginning, I mean, you would think that when Pfizer started this out in September, oh, you know, if this was really a huge issue for Pfizer, their stock price would have plummeted, and, you know, that’s not the case. 

Rovner: It has not. Finally, this week, an update on that very sad and strange surrogacy case in California and Alaska and Texas. That’s where a surrogate, who was carrying a baby for a couple, wanted to keep the baby who was born with severe cardiac birth defects. That was after she, the surrogate, refused a request from the couple to terminate the pregnancy after the heart defect was detected in utero. This week, Supreme Court Justice Elena Kagan refused to overturn a lower-court decision allowing the baby to remain in the custody of his biological parents. This may or may not be the last word in this particular case, but I’m sure this is an issue that eventually will get heard by the high court. And good luck to the justices sorting it all out. You know, one of the difficulties that we have seen with some of these cases, with, you know, who really are parents? Is it the people who provide the genetic material or the people who carry the fetus determine what are we going to do when we have artificial wombs? And I think we’re going to go on. And Joanne, did you want to add something? 

Kenen: Yeah, most of these are state laws. Most of these surrogate cases are basically a state law, and maybe we’ll see that change. But I also think it’s important to point out that this child, the baby, was born. It does, in fact, have a heart defect, and the biological parents who got the custody, according to the court, are taking care of the baby — I forgot whether it’s a he or she — in the hospital.  

Rovner: It’s a he. 

Kenen: It’s a he, in the hospital getting the heart care. I don’t think the prognosis is great, but they are doing everything you can to make the baby as healthy and comfortable — from the press reports, I’m not in that hospital room. But this is a family that did not want to have a child with this really serious heart defect born. That is a fact. They wanted the abortion. They didn’t succeed. The courts prevented them from getting the abortion. The woman, the carrier, the gestational carrier, won that. But it is important to note that this couple is doing what I think all of us would, you know, agree: The child is getting medical care. 

Rovner: Yes. They have a baby, and they’re doing everything they can to keep him alive and get him well. 

Kenen: Other decisions get made down the road, and it’ll be their decision, you know. Hopefully, it’ll have as good an outcome as possible. It’s obviously not easy for anyone who has — I have never had a seriously ill child, but I have had friends who have. It’s unfortunate that the extra legal battle gets imposed on top of what’s, obviously, this is a family that, this is a couple who really wanted kids. You know, surrogacy is not cheap or easy or emotionally, you know, it’s difficult. And this is not a happy story for anybody. 

Rovner: It is not. All right. Well, that is this week’s news. 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 post the links in our show notes on your phone or other mobile device. Tami, why don’t you go first this week? 

Luhby: OK. Well, my extra credit is an exclusive Wall Street Journal story titled “,” by Liz Essley Whyte. And, you know, we were talking about where the grant money goes. Well, some of it apparently is going for RFK security. So she noted in the story that the cost of the health secretary’s security jumped from about $10 million in the last fiscal year to $17 million this year. And what she said was striking was that HHS told Congress earlier this year that it was moving about $12 million from its Office of Minority Health to help cover the increased security costs. Now, Liz spoke to some internal unnamed sources, who told her that the secretary’s office had discretionary funds that it could have used instead, but it took the $12 million from the minority health fund to deal with across-the-board budget cuts. Now, I didn’t actually realize that this Office of Minority Health was created by President Ronald Reagan after a landmark report found that Black infants in the U.S. were more likely to die than white babies, and you know, among other disparities. And this, the office actually funds grants and efforts to close these gaps. Its budget, its annual budget, is about $74 million. So the other thing that the story noted, as we were discussing, a little different than NIH, but it said that HHS notified 16 nonprofits and universities in August that grants from the Office of Minority Health had been canceled. They were telling the nonprofits that the cancellations were due to limited funding and new priorities, and those new priorities include the root causes of infertility and reproductive health conditions, including low sperm count and erectile dysfunction. So that’s the story. I will say that an HHS spokeswoman told The Wall Street Journal: Secretary Kennedy faces much more serious, a different security environment, and that his protection reflects the threats he faces, his extensive travel, and the security required for him to safely carry out his duties nationwide. 

Rovner: OK. Joanne. 

Kenen: My friend, colleague, and co-author, Josh Sharfstein at [Johns] Hopkins, flagged this story for me, and he might have used as many exclamation points as I usually use in my email to him. It’s a Slate story. It’s quite a story. A Slate story by Molly Olmstead, and the headline is just called “” This is a long, involved story where each paragraph gets darker and more mind-boggling than the prior paragraph. The medbeds, in case any of you don’t know, are these fictitious things that Trump tweeted about — or maybe it was, I think, it was Truth Social — about a year ago, and then deleted it the next day. There’s never been an explanation. Medbeds do not exist, but they are believed, by people who think they exist, to cure all illnesses and make us all whole, healthy, probably happy … 

Rovner: And long lives!  

Kenen: … etc. Right. It’s — as the author, she calls it — a dark fantasy that we will be pain-free, that we will have forbidden knowledge, etc., etc. … Molly Olmstead decided to trace where did this come from. And her first thought was like QAnon, and then, so there’s a section about QAnon, and then .. she goes back. It wasn’t QAnon. Then she goes through New Age. She went to a yurt in Sedona, and she learned about subatomic tachyon, I’m not pronouncing it, particles, and it turns out it wasn’t even New Age. Without being a spoiler, it actually goes back to some people with rather ahead-of-their-time crazy beliefs in the 1960s! So just go read it. 

Rovner: Yeah, it’s quite the read. Sarah. 

Tribble: First, I just want to say, you know, reporters like the ones you’re mentioning are just amazing. Like, the work they’re doing and that digging into the agency spending and following those trails, and that’s why I picked this other one, John Wilkerson at Stat. My extra credit is “.” Now, the reason I really like this story is John knows Medicare. He knows MedPAC [the Medicare Payment Advisory Commission]. If you’ve ever sat in that room watching MedPAC discuss things, and then you talk to the experts … find out that Medicare Advantage was supposed to save Medicare money, but never has. Right? I say go read this story. It’s a very interesting analysis, basically, of how it could help insurers, but may not actually decrease Medicare Advantage payments at all anyway. So it’s just another ball down that road, but it’s definitely worth following. And kudos to John for writing it in a way that’s a fun read. 

Rovner: My story is also from a colleague who likes to dig for things. It’s from my Ñî¹óåú´«Ã½Ò•îl Health News colleague and cubicle mate, David Hilzenrath. It’s called “The Drugs and Devices Have Been on the Market for Years. But FDA-Ordered Studies Still Aren’t Done.” It’s one of those stories that has been done before but needs to be repeated every so often: that when the FDA approves something with the requirement for postmarket follow-up, that follow-up often does not happen. The FDA has, for generations, tried to walk the fine line between getting promising treatments into the hands of patients as fast as possible while still ensuring that they are safe and effective. An analysis of FDA data found that nearly 600 postmarket studies that were supposed to have [been] done have been delayed, often by years. Which means not just that some products on the market may be causing problems, but even if they’re not, they might not actually be working, which wastes money and keeps patients sick. So, hats off to my colleagues who did this analysis, too. 

All right, that is this week’s show. Thanks to our editor this week, Stephanie Stapleton, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. You can still find me on X , or on Bluesky . Where do you folks hang around these days on the socials? Sarah? 

Tribble: I’m mostly on LinkedIn, actually. So look for me on LinkedIn: . 

Rovner: Joanne. 

Kenen: I’m more on LinkedIn than anywhere else, too: JoanneKenen on . I’m a little bit on , and I still haven’t fixed my Twitter authenticator. 

Rovner: Tami. 

Luhby: You can find me at . 

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

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Sept. 17, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

Rovner: And Tami Luhby of CNN. 

Tami Luhby: Howdy. 

Rovner: Later in this episode, we’ll have my interview with Sabrina Corlette, one of the authors of a new paper from the Georgetown University Center on Health Insurance Reforms, about some possible shorter-term fixes for what ails our dysfunctional healthcare system. But first, this week’s news. 

So I try not to talk too much here about artificial intelligence, partly because we at KFF already have a separate podcast devoted to AI and its implications for the business of health, and partly because I am one of the many, many Americans who doesn’t really understand it. But I feel like we really can’t avoid it this week, with AI leaders all but pleading with Congress for regulation, lest they accidentally, or not, create something that could literally kill all us humans. And while I don’t think any of us has the expertise to comment on whether some future AI might actually be justified in trying to rid the planet of humanity, given what we humans have done to the planet, I’m more interested in reports about humans currently using AI to do things like manipulate viruses to create, you know, a pandemic — but maybe even a more deadly one than the one that we just had. Anthropic, which touts itself as the most ethical and responsible of the big AI companies, said it has already . I feel like maybe this is something members of Congress might want to address in the near-term future? 

Edney: Definitely, I think that, like, the timing for this, given what’s going on in the larger AI world with these warnings that we’re seeing, was certainly very ominous for creating that potential worst pandemic that you’re talking about. And it does seem like it could be part of that discussion and what Congress may want to do; it could be sort of its own thing. It’s unclear how that’s going to be handled, especially, I think, we all are aware of the timing as well, with the midterms coming up and Congress not getting a lot done. And this is a really complicated subject, I think — the kind of issues with this report coming out was these could be just regular research queries. You know, it’s really unclear if this was nefarious. If it is, that’s really bad, and if it wasn’t, let’s not get worked up about something that isn’t there yet. But it does show that there’s the potential for that to happen. So …it’s good to think about it early. 

Rovner: And of course, the House, we should mention, has up and left until after the election. So they couldn’t do anything even if they wanted to. Alice, you wanted to add something? 

Ollstein: Yeah. So I was up on Capitol Hill yesterday, and there did not seem to be a groundswell of interest in rapid action and keeping the members in session to deal with this. I mean, when it comes, you know, to technology, especially, often federal policy is decades behind, you know, where the technology is going and moves so much slower. And I don’t know, even if there was the political will to stay in session and do something, if they would even know what to do or be able to come up with something quickly. This is something that could take years. Meanwhile, the technology itself is just leaping ahead in leaps and bounds, and so I am not optimistic about a robust response from Congress, given their record recently, and given what I witnessed on the Hill. Even though there is bipartisan interest in doing something, but what that something is, there is no agreement. 

Luhby: There’s a legitimate concern of how/what China is doing with AI, and even if we control what’s happening within our borders, we can’t control what’s happening with the development in the world. So that is an overarching problem that Congress can’t solve. 

Rovner: Right. 

Ollstein: I also often hear, you know, Oh, we should really pare back AI on everything except healthcare because it has so much promise in the healthcare space. But there’s also a lot of risk in the healthcare space. I mean, you were mentioning the development of potential viruses and bioweapons, but even beyond that, there’s already reports of AI being used to deny people’s claims, to entrench human biases in decision-making. You know, there’s a lot of risk in the healthcare space, too. It’s not all sunshine and rainbows and the risk is only in other areas. 

Rovner: Well, you are actually anticipating my next question, which is: Meanwhile, from the “AI might not actually kill us, but it’s going to make a lot of people rich” file, my former colleague Christina Jewett, now at The New York Times, has a about how medical AI entrepreneurs are exercising perhaps undue influence at the Department of Health and Human Services, and, according to the story, worrying some officials that AI adoption in medicine is coming faster than the evidence that it’s safe and effective — never mind money-saving. Again, as you were saying, Alice, I can’t imagine technology in medicine running ahead of attempts to regulate it. That’s only happened basically every time for the last 50 years. 

Edney: I think the attempts to regulate it are — the issue is who’s going to do the regulating. The FDA seems sort of split right now, where you have the traditional medical devices director, and this is Christina’s reporting, as you mentioned, Julie, someone … more in the commissioner’s office who is a tech-connected person wanting to wrest the AI part of regulation from the medical device center, where it normally sits. So I think that that question, too, is still being figured out. 

Rovner: And there’s even the, you know, what is AI? Is it a medical device? What kind of evidence would one need to approve it? Who would approve it? I mean, there’s definitely a lot more to come here. All right. Well … 

Luhby: Looking at healthcare’s role in the economy, it’s a major source of jobs right now and in the future, but it may not be, depending on what happens with AI. I was just actually at a doctor’s appointment at a major New York City medical center, and the doctor was speaking to, you know, a human assistant in the room, which I was — and I said to her, “Thank you so much for actually, you know, using humans.” And she sort of said, “Well, we’ll see how long that lasts,” indicating that her medical center may be really pushing doctors to use more AI scribes. And I was thinking, Wow, that’s going to cost a lot of people their jobs. 

Rovner: Although I just went to the doctor, and he was starting to use an AI scribe. He said he was just trying it out. So we will see how this all moves on. All right. 

Well, back to the pocketbook issues that seem to be driving voter anger this fall, even more than AI and data centers, President [Donald] Trump, the day after he floated the idea of sending all U.S. adults a $5,000 check if they return Republicans to power after the midterms, separately is proposing to send a $500 check before the elections to about a million unsubsidized enrollees in the Affordable Care Act plans. Unlike the $5,000, which would pretty clearly have to be approved by Congress — spoiler: probably won’t happen; it would be really expensive — the $500 ACA checks at least seem plausible. They represent unspent user fees the federal government has already collected. Two questions about this: One, is it really legal? And, if it is, and the administration does it, will it make up for the huge increases that most unsubsidized ACA enrollees saw in 2026 after the Biden-era extra subsidies expired? A lot of people saw increases that were a lot more than $500 just this year. 

Luhby: I mean, I think it’s questionable as to whether it’s legal and also whether it’s fair, because you’re also talking about giving this money only to be unsubsidized. And you can argue that, yes, the people who got subsidies already got, you know, a federal gift. But there are a lot of questions about these checks. But as far as whether they will make up for the massive increase in premium payments that a lot of folks have paid — especially for the people who didn’t receive subsidies, which, who are generally the people who make more than, you know, 400% of poverty, or … even a higher percentage, because the changes in the subsidy structure — those people are probably among the most … the ones who had the highest increases in premiums between ’25 and ’26. And there’s another round of double-digit premium increases on the way in 2027, or for 2027. So Cynthia Cox, one of our favorite experts at KFF, questioned whether $500 would even cover one month of a premium increase, much less one year. But, you know, as we know, healthcare costs are on the top of voters’ minds, and the Trump administration feels like it has to do something to say that it is helping to lower them ahead of the midterm elections. 

Rovner: Yeah, and this would be, I guess, something that they, in theory, could do. Well, moving on, it may be time to revisit one of the few bipartisan pieces of consumer health legislation of the past decade: the No Surprises Act. That law has successfully spared millions of patients from ending up in the middle of payment disputes between health insurers and medical providers. What it hasn’t done such a good job at, though, is settling those disputes in a cost-effective way. Instead, to quote from the Georgetown study that’s the subject of this week’s podcast interview with Sabrina Corlette, “the dispute resolution process created by the law has cost the health system an estimated $22 billion in just four years.” As a result of that, groups from across the ideological spectrum, from the liberal Families USA to the conservative Paragon Institute, as well as Republicans and Democrats on some key committees in Congress, are that something needs to change. Now this arbitration process that’s gotten so out of whack was the very last thing settled and almost scuttled this law on the launchpad. Is there a suitable alternative available, or will the magnitude of how badly this arbitration process is skewing in favor of providers who are getting enormous payouts going to force some sort of compromise? 

Edney: It seems like there needs to be a compromise. I was a little surprised that that’s being acknowledged. I think when this was first being talked about and coming to light, it seemed like the lawmakers were like, “Well, the law is working for patients,” and, like, “Well, you know, it’ll be OK.” But as you know, those numbers are coming in, that’s … billions of dollars. That’s a huge amount. And, you know, there are options. I think a lot of it was talked about and not agreed upon. But maybe benchmarking these to what Medicare pays or something along those lines when there’s a dispute could be more palatable, given, you know, what’s going on now that they’ve seen the results of what ended up being put into law. 

Rovner: Of course, that was, I mean, that was the hope when they were doing this is that they would set some sort of upward bound of, you know, yes … 

Edney: Right. 

Rovner: And sure, if you’re trying to lowball the provider, we’re going to make sure the provider gets at least something, you know, that’s reasonable if they’re not in-network. Except what’s happening is, with these arbitrations, these providers are getting things that are way more than anticipated, and that’s turning back into these premium increases that we were just talking about. I mean, it’s all sort of one big circle here. 

Luhby: Right, and that’s one thing that, you know, as Politico reported this morning, that’s one thing that employers and insurers want to make sure that people know, and that congresspeople know, is that these increases, these, you know, these payouts that they have to provide for the doctors are going to increase premiums. And you know, as we just discussed, healthcare is on the top of voters’ minds. Already, you know, various consulting groups have said that employer coverage, which is the most prevalent type of coverage, the premiums again are going to increase by a lot for 2027. And, you know, again the employers and insurers are pointing fingers at this arbitration, you know, provision and what doctors are doing and how they’re manipulating it as one of the drivers of these increased healthcare costs and premiums. 

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

Moving to immigration, this week nearly half the states filed suit in federal court to block the Trump administration’s new, quote, “public charge rule.” That’s what gives immigration officials more leeway to block people from entering the country who they think could eventually qualify for government aid. Tami, you wrote about this. What are the states arguing, and what are they asking for? 

Luhby: Well, the main concern here — they want the rule to be blocked, but it looks like it’s supposed to go into effect tomorrow. And at this point, we know that the judge — there are two lawsuits: there’s states and cities — and the judge — it shouldn’t be probably the same judge, but we don’t know for sure yet. And the judge who has been assigned to the state lawsuit is not holding an initial hearing until, I think, it’s Oct. 9, or it’s early October, so it does look like the new rules will go into effect on Friday. But basically, what the concern is is that this is going to end up causing a lot of immigrants, particularly their families, particularly their U.S. citizen children, who may be eligible for benefits like Medicaid, like CHIP [Children’s Health Insurance Program], like housing vouchers, food stamps, school meals, WIC [Special Supplemental Nutrition Program for Women, Infants, and Children]. There’s, you know, a huge number of safety net programs that these immigrants and their families may choose to drop out of or not enroll in, and this is going to cause, obviously, you know, major concerns for hunger, for health, and housing. And the cities and states are arguing that they’re going to be harmed because they’re going to have to pick up the tabs. And, you know, these people will still need to, you know, obviously have healthcare and housing and food when it comes to it, so they’re concerned about their public costs as well as their local economies. 

Rovner: Yeah, and I mean that’s a really important point, which is that this is not just about people coming into the country. This is about people who are already here. Alice, I know you’ve done some reporting on the whole public charge issue, and we’ve got a really good Ñî¹óåú´«Ã½Ò•îl Health News story that I will link to this week that’s called “A Generation of Kids Suffer as Trump Destabilizes Immigrant Families.” This is really reaching much beyond — you know, they originally, he said we’re just going to deport the worst of the worst — but this is reaching much, much further into immigrant communities here legally in the United States, right? 

Ollstein: Yeah, and I think there are just a lot of downstream consequences of this that we saw the first time they did this in the first Trump administration, and that, you know, folks are predicting will happen again that impacts everyone in the community. So for one, immigrants tend to be younger than the general population, and so removing them from these, you know, insurance systems could raise other people’s premiums — you know, the people who remain, because the costs will be higher. It’ll be an older, sicker population sharing those costs. Also, you are seeing that when these rules go into effect, people who remain eligible for the insurance programs, just out of confusion or fear, don’t enroll, and so it impacts even the people it doesn’t officially apply to, through a chilling effect, which, again, you know, leads to those same higher premiums and worse risk pool. But also, you have, you know, you mentioned risks of infectious diseases; if you deter people from getting preventive care, from getting vaccines, from getting checkups, that puts the whole community at risk. 

Rovner: Yeah. 

Luhby: And even DHS [Department of Homeland Security] itself acknowledges that there’s going to be a chilling effect. They estimated that 950,000 people may opt to leave or not enroll in — they examined six public benefit programs: Medicaid, food stamps, CHIP, federal assistance — and I think nearly a million people who, you know, are eligible for these safety net programs who may not participate. 

Rovner: Well, I guess that is one way to cut the budget. 

Turning to reproductive health, Alice, there’s movement on that story you’ve been following about testing wastewater [drinking water] for remnants of abortion pills. Now, what’s the latest? 

Ollstein: Yeah, so this was a story my colleagues and I broke recently that the EPA [Environmental Protection Agency] itself is now going to do some testing on this front. Of course, they’re not testing just for abortion pills; they’re testing for a bunch of different pharmaceutical medications. But putting abortion pills on that bigger list is, you know, something that anti-abortion groups have been clamoring for years and are . Of course, they’re still pushing for a separate process where EPA would require utilities around the country to monitor for certain drugs, including abortion pills. And so they’re still pushing on that front. But they consider this a step towards, you know, potential restrictions. Now, it’s important to know that the test the EPA is using only will show if any amount is detectable in the water; it will not determine the concentration. And so even if they say, “OK, we found traces of this,” it doesn’t mean it has any impact on plants, animals, humans. It does not mean that. So whatever they come up with, it’s important for people to keep that in mind. Environmental experts we talked to stress that this is sort of a bad-faith push. There is no evidence that there’s any actual environmental harm here. Pharmaceutical contamination of water is a real thing, but there are medications that are way more of a threat in their minds than this one. 

Rovner: Yeah, but this is what they’ve been pushing as yet another way to try to go after abortion pills. Well, meanwhile, while the FDA continues to restudy the safety of mifepristone, at the urging of anti-abortion groups, in California, the attorney general is wrapping up a lawsuit against two anti-abortion nonprofits for their proffering of that purport to stop a medical abortion partway through. Unlike mifepristone, which has been studied in many clinical trials in the U.S. and internationally, there is no evidence that giving the hormone progesterone can save a pregnancy partway through a medical abortion. Alice, how big an impact could this case have, and when do we expect to hear from the judge? 

Ollstein: So this could really set a precedent. There are a lot of legal battles around the country. There’s another one the New York attorney general is in the middle of that is similar to this one. But it’s getting into this interesting space between protecting patients versus free speech and what clinics, even, you know, less-regulated crisis pregnancy centers, like the ones that are at issue in this case, what they can tell people and whether states are able to regulate that in the name of protecting patients from potential harm. Like you said, this hormone regimen, where after you take mifepristone, which is an anti-progesterone, you know, they’re saying, Oh, if you change your mind and you don’t want to have an abortion after all, you can take a high dose of progesterone to counteract the effects and save the pregnancy. Again, this has been very little studied, and the studies that have happened are methodologically weak. They don’t have control groups. They don’t have random sampling. They’re very, very small numbers. Whereas, like you said, the medical studies of mifepristone itself have been covered millions over the years, and so there’s just a lot more evidence of the safety record. And so, this could be really interesting coming out of California, in terms of these clinics, which have really become a major front in the anti-abortion movement’s larger battle. These centers are very prevalent around the country and have only grown in number since Roe v. Wade was overturned, and so they’re really seen as sort of the forefront of spreading the anti-abortion movement’s message. 

Rovner: Well, speaking of lawsuits that might set a precedent, the family of Tierra Walker, a 37-year-old pregnant woman who died in Texas of multiple complications after being repeatedly denied an abortion, has filed a malpractice suit against her doctors and is also suing Texas Attorney General and Republican Senate candidate Ken Paxton. Paxton, you may remember, personally threatened individual legal action against doctors who performed abortions, even on women whose medical conditions apparently qualified for exceptions to the state’s ban. What does it mean that they’re actually going after Paxton personally — or, I guess, in his role as attorney general in this case? 

Ollstein: Yeah, they’re going after state officials, and they’re going after the hospital, the doctors. There’s a lot of different charges in this one case. There’s medical malpractice charges. There’s [Americans with Disabilities Act] ADA-like discrimination, refusing-of-care charges. There’s the constitutional charges about the law itself. And so this is really sort of getting into new territory. It’s something I covered in my book, that doctors largely have reported that when they’re operating under abortion bans, they’re more afraid of providing what, even what they consider a medically necessary abortion. They’re more afraid of the legal consequences of providing it than the legal consequences of not providing it. And this is an attempt, and there have been some others to try to change that calculus. So I know there’s an ongoing case in Georgia as well, a medical malpractice case. But it’s sort of attempting to make doctors also afraid of the legal consequences of not providing what could be a lifesaving abortion, and we’ll see what the outcome is in this instance. 

Rovner: And we’ll talk more about this, and we’ll talk more about your book in the coming weeks as we get ready for its launch. Well, finally, this week the House may be gone, but the Senate is still here, and two Senate committees held confirmation hearings this week for Chris Klomp, the Medicare official who’s been nominated to be deputy HHS secretary, as well as a hearing for Nicole Saphier, the radiologist and former Fox News contributor, who is the latest nominee for U.S. surgeon general. At both the Finance Committee, which will vote on Clomp, and the health committee, which will vote on Saphier, there were lots of questions about the administration’s position on vaccines. This comes as Pennsylvania announces its third and fourth measles-related death this summer, and as HHS Secretary RFK Jr. [Robert F. Kennedy Jr.] gives a keynote address here in Washington today at his former nonprofit, the anti-vax group Children’s Health Defense. Interestingly, both Klomp, who is not a doctor, and Saphier, who is a doctor, sort of, kind of endorsed the measles vaccine, but neither appeared enthusiastic enough to satisfy HELP [Health, Education, Labor & Pensions] Committee Chair Bill Cassidy, who’s also on the Finance Committee, of their sincerity. Cassidy delivered some of his strongest critiques yet of the damage the administration is doing by promoting vaccine hesitance. Yet I wonder if Cassidy would plan to vote against either of these nominees, or if any Republicans plan to vote against either of these nominees. 

Edney: I think that’s a great question. And Cassidy clearly has not done that in situations where the stakes — you know, it seemed like, you know, he had more reason almost, I mean, there was more, at least, like, outwardly publicly, you know, conflicting with his stance, and he didn’t do it. So he is leaving Congress, so that could change things for him. But I’m not sure that I would expect some sort of vote that really spoke out against Trump at this point. 

Rovner: He voted to confirm the new CDC [Centers for Disease Control and Prevention] director, about whom he had basically the same questions. 

Edney: Yeah, “Boy Who Cried Wolf,” I think is what that was. 

Rovner: All right. Well, that is this week’s news. Now we’ll play my interview with Sabrina Corlette, and then we’ll come back with our extra credits. 

I am pleased to welcome to the podcast Sabrina Corlette. Sabrina is a research professor, founder, and co-director of Georgetown University’s Center on Health Insurance Reforms. She’s also the co-author of a brand-new paper called “A Three-Part Strategy for Better Health Insurance” that includes a series of policy changes Congress could make in the short term that could help patients better navigate our messed-up healthcare system. Sabrina Corlette, thanks for joining us. 

Sabrina Corlette: Oh, it is such a delight, Julie. Thank you for having me. 

Rovner: So, I think a lot of us have been predicting that rising costs, lowering access, and increasing confusion is frustrating patients to the point that the nation is likely headed for another major healthcare debate, probably after the next presidential election. But this paper focuses on smaller changes that could be made in the nearer future. What made you decide to look at that? 

Corlette: Well, I’ll be honest, Julie, one inspiration was the KFF [Health News] “Bill of the Month” series. You know, I follow that series, and I just saw story after story about patients encountering just the craziest billing situations, coverage challenges, and it just struck me — particularly in this last year, where we had this big debate over Medicaid and the Affordable Care Act marketplaces, and a number of groups and lawmakers were defending a status quo that, quite frankly, nobody was happy with — and so I got together with some of my colleagues, you know, what are some concrete things that would have a tangible impact on people’s experience with their health insurance that can be done quickly, would not require a lot of money — because as you know, Julie, all too well, anytime you want to improve coverage, immediately employers and others say, “Well, this is just going to raise premiums.” So we wanted to come up with something that could immediately improve coverage without raising costs, and learn from some state actions that, you know, are quite frankly happening on a bipartisan basis. So, things that felt achievable. 

Rovner: Right. So, your first part is looking at immediate ways to reduce healthcare costs. What are some of those proposals? 

Corlette: Yeah. Sort of a marquee proposal in here is to bring down deductibles. Deductibles have risen 43% over the last decade or so, and they’re just [an] insurmountable cost barrier for so many American families. So that’s No. 1. But as you know, Julie, if you were to try to lower deductibles across the board, it’s like pushing on a balloon, right? Immediately, premiums are going to go up. So the second part of that proposal is to reduce spending on excessive hospital prices that are, you know, many, many multiples of the Medicare rates. And we’ve seen real progress on that at the state level, with states as diverse as Indiana and Vermont starting to rein in most hospital prices. 

Rovner: And we’ve seen both Democrats and Republicans pointing their fingers at hospitals. We’ve talked about that a lot on the podcast — that hospitals are clearly one of the big drivers right now. That seems to be getting through to policymakers, if not to patients. 

Corlette: That’s right. Yep. 

Rovner: That’s the cost part. Next is reducing unnecessary complexity, which I know is something that everybody would appreciate. What are a couple of the things that we could do there? 

Corlette: Yeah, I mean the main thing that we looked at there was the prolific use of what’s called prior authorization, which is, like, before you can get a healthcare good or service, you have to run it by your health plan and get their advance approval. And that’s just, you know, it used to be that that was really used for certain experimental or very, very high-cost types of services, and now it’s just endemic. And so we propose a number of reforms to — not eliminate that practice because, you know, you do need some checks on the system — but to really try to streamline it and reduce the burden for not only patients but physicians as well. 

Rovner: So last is protecting patients from corporate abuses — again, something that seems to have some bipartisan backing and that people get really furious about? 

Corlette: Yeah, and here the list is pretty long, but I’ll just [home] in on one element, which is reining in some of the more egregious financial practices of private equity, which has really entered the healthcare space in a big way in the last decade or so. And so trying to limit some of the transactions that they engage in that sort of strip assets from a healthcare provider to line the pockets of the investors and really drain away the infrastructure of the, say, the hospital or health system, so that it’s not able to provide as high-quality care. 

Rovner: Things like buying the hospital and then selling the real estate out from underneath, so the hospital now has to pay rent. 

Corlette: Exactly. 

Rovner: And you want to fix the dispute resolution system from something that Congress already tried to fix on a bipartisan basis, which is stopping surprise bills, right? 

Corlette: Oh my gosh, yeah. I mean, you know, that’s one of those issues, again, I think could be very bipartisan. And it’s not every provider in the system, but largely private equity-backed physician group practices really taking advantage of the dispute resolution process under the No Surprises Act to the tune of $22 billion in costs. All that is being passed on in the form of higher premiums for employers and policyholders. So, yeah, we propose some significant reforms to that process. 

Rovner: So, all of these things together are what we health policy types like to refer to as low-hanging fruit, in that it would be less controversial, say, than “Medicare for All.” But we’ve seen that even incremental changes like these that have bipartisan support can be really hard to push through. How optimistic are you that this Congress and this administration, both of which have said they want to do stuff about healthcare and healthcare costs, might be able to actually get any of this stuff done? 

Corlette: Well, I think you and I both, Julie, have been doing this work for long enough. It’s true, nothing is easy. But I will also say that if you look at the polling, Americans now rank healthcare costs higher than groceries and housing as their No. 1 cost concern. I, quite frankly, think that if you’re a politician and you’re not listening to that data and thinking about ways you can reduce costs for people, then you’re committing political malpractice. 

Rovner: We will see if any of this gets picked up. But thank you for doing the paper, Sabrina Corlette, and thank you for joining us. 

Corlette: Thank you for having me. 

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

Edney: Sure. This is a story from a few of my colleagues: “.” And they took a look at some recently released data about prior authorizations and denials, and, essentially, you know, seeing how often people are able to overturn those when they try. Not a lot of people know that they can try to appeal that. And so I really encourage everybody to take a look at it. Check out where your insurer is. I think that that was interesting for me because, you know, they did it by insurer, so you can see what their stance is and how often they’re denying things. 

Rovner: Yeah, and that reminder that we always have with the “Bill of the Month.” It’s, like, don’t pay the first bill, and if you get a bill, don’t be afraid to appeal it. Tami. 

Luhby: My extra credit is a Washington Post story titled “,” by Erica Sloan. The story stood out to me, personally, because I was actually diagnosed with low ferritin 14 years ago, but it took time for the doctor to figure out why I was feeling so tired. So I, actually, I had blood tests, and then I actually went to a sleep doctor because I was figuring, Well, I must not be, you know, sleeping well at night. Maybe I have sleep apnea. But he actually asked to see the blood tests, and he was the one who pointed out my low ferritin levels. So, for those who don’t know, ferritin is a protein that stores iron in the body. And the story cautioned people — the ferritin face, I think, is what got, you know, is trying to get people into the story because apparently this is a thing, although I had not heard of it before this. 

Rovner: A thing on social media. 

Luhby: Yeah, a thing on social media, and I don’t think I actually ever had ferritin face. I asked my husband. But the story cautioned people from trying to diagnose themselves with iron deficiency based on social media and influencers. But the attention, they said, is raising awareness about iron deficiency, which is really important and which is the, you know, the step before anemia. So I thought the story was important because it highlights how common iron deficiency is — nearly one-third of U.S. adults are affected — but how, I was surprised, it’s not part of regular screenings. And the article goes on to explain how to test for iron deficiency, which is to check your ferritin level, and how to treat it, which is to eat more iron-rich food, like spinach, beans, red meat, fortified cereals — or, if your iron levels are very low, to take iron supplements, which I also personally know are not the most fun because they can cause GI [gastrointestinal] issues. So, and if you’re curious about what ferritin face is, which I was, is apparently it falls under the, you know, “looking tired” umbrella: a dull complexion, dry skin, cracked lips, under-eye circles. But, you know, I think those are symptoms of many things other than iron deficiencies. 

Rovner: And yet still news you can use. Alice. 

Luhby: Yes. 

Ollstein: I have a story from KFF [Health News]. It is by Ashley Mizuo, and it’s called “Indigenous Groups Are Exempt From Medicaid Work Rules, but Native Hawaiians Aren’t.” And it examines how, you know, lacking official federal recognition of your tribal status is making Indigenous Hawaiians, who are facing a lot of the same challenges as other Native groups in the mainland U.S., are not exempt from these new Medicaid work requirements that are starting on Jan. 1. And that could be a big barrier to care, and they already have a lot of barriers to care, including sometimes needing to travel from one island to another in order to access services. And so this could really prevent a lot of people who have a lot of health challenges from getting care they need. And so it, you know, looking at a sort of niche overlooked consequence of these new rules. 

Rovner: My extra credit is also about an overlooked consequence. It’s a local story from KJZZ Phoenix public radio called “,” by Camryn Sanchez. And in a situation reminiscent of people in Arkansas losing their Medicaid back in 2018 because the state couldn’t stand up a system allowing them to report their work hours, it seems Arizona can’t figure out how to keep eligible SNAP [Supplemental Nutrition Assistance Program] beneficiaries on that program. Turns out that the state agency that runs the program reported that nearly 9 in 10 interviews with applicants were abandoned, dropped, or otherwise incomplete. The agency itself said it dropped more than 3 million calls due to call-center error or lack of call-center capacity. As a result of that, 53.7% of Arizonans attempting to recertify their food benefits were denied for failing to complete the interview. It is just a really wow story, and, you know, the point that, really, it is incumbent on the states to make these things available. That’s part of why they are supposed to be there. 

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

Edney: on X or . Also on . 

Rovner: Alice? 

Ollstein: on Bluesky and on X. 

Rovner: Tami. 

Luhby: I’m just at these days. 

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

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Sept. 10, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

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

Joanne Kenen: Hi, everybody. 

Rovner: And my colleague Amanda Seitz of Ñî¹óåú´«Ã½Ò•îl Health News. 

Amanda Seitz: Hi, great to be here. 

Rovner: Later in this episode, we’ll have my interview with Lauren Sausser, who reported and wrote the latest Ñî¹óåú´«Ã½Ò•îl Health News “Bill of the Month.” It’s about a breast cancer screening that’s not necessarily considered covered preventive care. But first, this week’s news. 

So, welcome to the sprint to the midterms. As we have talked about all year, affordability — or, to be more specific, unaffordability — is the topic that seems to be most on voters’ minds this fall. And healthcare is at or near the top of that list of things that voters are finding increasingly unaffordable. So the news from the past few weeks that healthcare costs are likely to go up even more next year, not only pushing up premiums but in many cases prompting employers to cut back on coverage, is probably not going to make consumers any happier. These are some of the steepest increases in healthcare costs that we’ve seen since the early 2000s —that’s when frustration prompted the debate that became the Affordable Care Act. What’s driving these increases, and what is it likely to lead to? 

Kenen: There’s multiple causes, right? We’re in an era — we’ve had high inflation overall. We … have had the number of insured people drop, which means there’s more uninsured, uncompensated care, which means the rest of us who do have insurance end up paying for it. Some people would argue that the consolidation — in fact, many people would argue — that the consolidation in the healthcare sector has added to costs. Private equity has been part of that consolidation, and their business model is, you know, there’s still research …  

Rovner: Their business model is to take money out of healthcare, basically. 

Kenen: And you know, I mean, some people would say that, you know, it’s not just profit; it’s also greed. That’s not true across the healthcare system. That’s not true about everybody. But I think you could see it. 

Rovner: It’s certainly a good place to make money these days. 

Seitz: I think, as far as what’s to come, too, Julie, we got a very significant signal this morning of how nervous the White House is about all of this. Axios is reporting that [President Donald] Trump wants to send $500 checks to a million enrollees across 30 states just ahead of the Nov. 3 midterm elections. So it just shows the timing here could not be worse. And that is kind of always the case when it comes to the election and open enrollment. But with those big increases we’re expecting, it’s only going to get worse in the coming weeks because people haven’t actually begun to preview those health insurance costs, what they’ll look like for next year. It’s not … it’s typically available around October for most employers and for the Medicare and ACA marketplace. So those prices are going to be landing in people’s inboxes and mailboxes right as they’re making choices about who they’re going to vote for, and it’s just not very good timing for this administration. 

Rovner: Darn that fall! Well, one of the things we’ve seen is it’s not just prices; employers are also dropping popular but expensive benefits like GLP-1 coverage or coverage for infertility treatment. Could that eventually drive prices down because providers of those benefits will have no choice if nobody has insurance for their products or services? Or are they just going to become unaffordable for all but the very rich in our K-shaped economy? 

Seitz: I think that’s certainly a concern, and again, going back to … this is just such a visible example of the affordability issue that people are talking about. People are paying more, and they’re getting less. And that is a frustration across our economy, but healthcare is such a blatant example of that happening. And there are questions: Will care be out of reach for people? I mean, we’re seeing that happen, obviously, in certain markets. In rural marketplaces, for example, it’s now, you know, in some places a luxury to have a doctor nearby that you can go to. So I certainly think that’s a concern. 

Kenen: I mean, it’s partly the way we’ve always measured prevention. It’s not that prevention doesn’t save money over the long haul. You know, there’s a lot of …. there’s dispute among the economists. There’s a lot of data that prevention in the long haul is a good investment, but that prevention isn’t, like, if I’m a health plan, I have no necessarily, you know, economic interest in making sure that you’re healthy in 20 years. You’re my client. You’re my customer now. Maybe next year. Maybe the year after that. So what’s good for the overall health system and the public’s health, and arguably the economy in the long term … it’s bad short term when, you know, an insurer, a company that decides not to cover GLP-1s. Although I sort of wonder if we’re going to get to the point where it’s just put in the water supply as more and more things are discovered about it. I’m being a little facetious, but only a little. … It’s a smart short-term sticker-price move. It’s not necessarily a wise move in the long run, and it’s going to get people mad because people who are, you know, who have struggled with weight, who’ve done the right things, and who still have trouble losing weight, or who have diabetes. I mean, I’m not sure if they’re dropping it for diabetes or they’re dropping it for obesity. I don’t know enough about it. 

Rovner: I think they’re mostly dropping it — yeah, I don’t think they can get away with dropping it for diabetes — I think they’re dropping it for weight loss. 

Kenen: Right. But I mean, as it becomes more restricted, but it’s turning out not to just be weight loss. I mean, it’s like people who get on it for weight loss are finding out that their livers get healthier. You know, there’s increasing research and causative signs about addiction. There’s, you know, it’s a really interesting drug, which we don’t totally understand. But it’s expensive, and that’s what, you know, people … the American healthcare system, or even the American business sector, isn’t always really thinking about the long term, particularly when the sticker shock is so big right now. 

Rovner: So another level of frustration — and something that we didn’t see the last time rising health costs were a top-tier political issue — is this whole trend of , or sometimes not-so-elective procedures, because so many patients now have multi-thousand-dollar deductibles, which we didn’t see the last time healthcare costs were spiking. That means many more patients could be blocked from getting needed care in the first place or, best-case scenario, fighting for months after that prepayment turned out to be too much. Ask me how I know about that latter part. I can’t help but think this is just going to increase the anger for voters. 

Raman: I mean, I really think so. We even, you know, last year I feel like there was so much outcry from folks when we were trying to see if Congress was going to extend the enhanced tax subsidies for the ACA. And, you know, all this talk about people maybe picking lower-tier plans because that is what they could afford. And I think we could see similar things now, where even if someone is still getting employer-sponsored insurance, maybe picking lower coverage than they want, not getting covered for as many things as they want. And, you know, feeding in with the prepayments, just so much more top of mind how much cost is going to be an issue in healthcare for folks. 

Rovner: Yeah, it’s one thing to have skin in the game. I say it’s another thing to have, you know, a limb in the game. Sorry, go ahead, Amanda. 

Seitz: Yeah, and I also think it will bring, that approach could backfire a little because it will bring a little bit more scrutiny to what providers are charging. A lot of times people get the bill after insurance has picked up a lot of the costs. Now you’re inviting them to look at it, you know, in advance and ask some questions that they might not have before afterwards. 

Rovner: Yeah. So what, if anything, are lawmakers proposing to do? Republicans seem to have retreated into the “let’s root out fraud” mode. President Trump is promising to send checks. Democrats seem to be proposing a lot of what I call “more of the same,” including rolling back the Republican cuts to the Affordable Care Act and Medicaid, and expanding Medicare benefits to things it doesn’t now cover, like dental and vision care. I feel like none of these things are really kind of meeting the moment of the intensity of the frustration. 

Seitz: I think it’s difficult to meet the moment in some ways because everyone knows that they won’t agree on anything. So, you know, it’s this sort of piecemealed approach of maybe what will stick, like trying to throw things at the wall and see what will stick. 

Kenen: There could be, like, a real bipartisan accord if, like, Trump agreed to put the $500 check into the mail-in ballot. [Hearty laughter] 

Rovner: Maybe you’re on to something, Joanne. 

Kenen: Probably not. Hypothetical. I think the one thing that, I mean, there’s a little bit of confounding is that people are upset about all prices, not just healthcare. There’s sort of an outrage, and not everybody is sick, and not everybody is, you know, facing a $10,000 prepayment. So it’s, I mean, I think people are aware and angry and angrier about healthcare, but it’s just sort of an affordability crisis, which healthcare is a component. And in some ways, it makes it easier for Congress to just sort of shout about it right now, before the elections. They’re really good at that, right? I mean, they’re all experts in shouting. 

Rovner: They’ve had lots of practice. 

Kenen: Yes, and, you know, I don’t really see … there’s going to be a fight on the left about single-payer, “Medicare for All,” but … I don’t think we yet know, outside of a couple of states, how … I haven’t really seen a unifying Democratic narrative on healthcare. You know, I see a fight about single-payer, but I don’t really see where they’re going. And … are they going to agree that the fight should be against the Republicans or against each other? That’s always a Democratic problem. Whereas the Republicans, I also don’t, you know, they tend to be, you know, more market-based, and they’re talking fraud, fraud, fraud, fraud, fraud. And, you know, there was just recently a big fraud bust on a Medicaid provider, not Medicaid beneficiaries. The way they talk about it, that can get confused. We all know there’s fraud. … Fraud is not the major driver of the healthcare costs in this country. But none of us would ever say there’s no fraud. There is. And we would all rather see less money spent on fraudsters and more money spent on making people healthy. But I think the Republicans right now are just going to keep shouting fraud. 

Rovner: Moving on, another trend we didn’t see as much in the early 2000s, when health prices were last spiking, was healthcare providers suing their patients over their unpaid bills. Our former podcast pal Sarah Kliff over at The New York Times has a really eye-popping story this week about how Kansas Republican Sen. Roger Marshall, who was an OB-GYN before being elected to Congress, and the headline tells you most of what you need to know: “ — a senator, I would add, who has voted to repeal both the Affordable Care Act and to cut Medicaid. I want to call this a scandal, but is it really? He’s not accused of doing anything illegal. His lawyers went after people who owed him money. Why has this story raised so very many eyebrows? 

Kenen: It’s an amazing story. You know, not only was he, and his response to these people … he wasn’t just, like, chasing them. They were arrested, and he was charging them 18% interest, and these people were, you know, most of them that we read about in that story were poor. So …  

Rovner: And some of them owed, like, $100! 

Kenen: Right. And it’s unclear whether they even knew they had court dates. And his response was just like, you know, a political one for the ages, which is … I think it was his spokesman, not him, saying, you know, he didn’t jail them, he didn’t issue the subpoenas and the warrants or whatever it was; the court did. But he brought the case, so it just doesn’t … is it going to, like, affect his eventual reelection? No, but is it just sort of, say, something’s really broken here? Yeah. 

Rovner: Yeah, and I mean, these weren’t people having tummy tucks. These were people who were delivering babies, in some cases, really difficult deliveries. 

Kenen: In one case, they had lost the babies. 

Rovner: That’s right. 

Kenen: Twins, I think it was twins. Yeah. 

Rovner: I think it was. Sandhya, sorry. 

Raman: There were two things that kind of, you know, caught my eye with this. A) is that, you know, doctors do have discretion in how they go after this issue. I mean, even if one is allowed to go after folks for this, they don’t have to. There are other options. But two, you know, I think one of the reasons this really resonates is that right now with Sen. Bill Cassidy, you know, losing his primary, not going to be in the Senate next year, Sen. Roger Marshall is probably one of the top contenders to lead the HELP [Health, Education, Labor, and Pensions] Committee, if Republicans maintain control of the Senate. So he’s going to have a lot of power over health policy and setting the agenda for what that committee does. And, you know, when so much of the conversation has been, like we talked about before, you know, affordability and things like that, I think that that has, you know, really struck a chord with some folks as well. 

Seitz: I also think that, you know, I did see some people saying, Listen, he is entitled. He did this work. He is entitled to get paid for it. And certainly, people might sympathize with that. But in this particular case, Sen. Marshall has leaned in to this idea that he was this upstanding community doctor who helped deliver babies of poor women on Medicaid. So when you’re a U.S. senator and you’re using that sort of imagery, but people have a completely opposite experience, it is fair game for them to speak out about that. 

Kenen: No, I mean it’s also, it’s true. Not all OBs take Medicaid. It’s a good thing that he took Medicaid. But in that bio, he left out that he was also, what, the co-owner of a hospital making millions of dollars. So, like, going after some — putting somebody in jail for two days over, you know, an obstetrics bill is probably something he’s going to have to discuss at home. 

Rovner: Well, while we are on the “Eyebrow-Raising Story” beat, The Wall Street Journal last week had a — he of the hoodies and shorts — apparently not being all that interested in “senatoring” these days. Among the anecdotes in the story, all of which were provided by former staffers, is one where he declined to meet with the folks from the Children’s Hospital of Philadelphia, which is not just one of the top children’s hospitals in the country, it’s one of the top hospitals in the country. They wanted to talk about Medicaid cuts. He reportedly said he wasn’t worried about Medicaid cuts, and they were just looking for an excuse to visit Washington. In more than 40 years of covering healthcare in Congress, I cannot remember an elected official dissing a major hospital in their own district. Have any of you ever seen …?  

Kenen: Particularly a children’s hospital! 

Rovner: And yes, particularly a children’s hospital. I mean, this is just so out of the ordinary. It’s hard for me to express. 

Kenen: Yeah, but that’s his middle name now: “out of the ordinary.” 

Seitz: It also just shows, like, you know, there’s so much when you talk to voters, they talk about how their elected officials don’t really care about them. And that was so on display in this article. 

Rovner: And, I mean, is there something different about hospitals these days? I guess that’s sort of what, the other thing that made it jump out to me. I mean, hospitals are sort of increasingly the bad guys in raising … costs. It used to be … the Republicans are all going after the big, greedy insurance companies. We’ve seen studies recently that said it’s not the insurance companies who are making more money these days; it’s the hospitals that are making more money these days, and premiums are going up because hospitals are charging so much. I’m just wondering if hospitals are kind of losing their luster a little bit on Capitol Hill. 

Seitz: I think so, and I think part of that is the consolidation, right? You have, no longer do you have, in all cases, community hospitals that really run … where you have, like, this great relationship with your local doctor and everyone knows who’s providing their healthcare. it’s become more corporate, and I think that makes it an easier target for sure. 

Rovner: Well, finally, on the “Scandalous Story” beat this week, while we were gone, The Guardian and The Associated Press that contradict testimony that HHS [Health and Human Services] Secretary Robert F. Kennedy Jr. gave to Congress when he denied that his 2019 trip to Samoa was related to vaccines. A letter he wrote to the Samoan prime minister before he went specifically said he wanted to study what happened with the MMR vaccine in the island nation, where two children died after receiving an improperly mixed version of the vaccine, and later a measles outbreak, after vaccinations declined, sickened thousands and killed 83 more people. In response to this story, Sen. Ron Wyden, who’s the ranking member of the Senate Finance Committee, has called for a criminal investigation into whether Kennedy lied to Congress. Of course, it seems unlikely that the current Justice Department would take up such a case. But if Democrats do take back the Senate, could they use this to try to oust the secretary? 

Raman: I think they could use it to bring him in. I mean, he wasn’t under oath when making these remarks about this during the hearing. But I think, I mean, that’s the main pull for Democrats in this presidency is if they do gain control of one or more chambers to be able to do more oversight on the things that they’re not getting answers to through other means. So I mean, we could see that … 

Rovner: I believe it is still a crime to lie to Congress, even if you’re not under oath. Just throwing that out there. 

Raman: I mean, I don’t know what they can do with this other than hold oversight, because I don’t see the DOJ or other enforcement kind of going after this. 

Rovner: Yeah. I guess I’m just wondering, I mean, of all the things that we know that Secretary Kennedy has not been completely truthful about, is this the one that they’re going to sort of want to run into the ground? 

Seitz: I totally agree. It might not. You know, there’s a lot of maybe half-truths that have been given at this point, and it’ll be interesting to see which ones the Democrats do go after, even if they do get power, which is very up in the air right now. 

Rovner: Right. 

Kenen: And there are rumors that Kennedy is — I mean, these rumors always happen at this time of year before an election — there’s, you know, rumors that he’ll be out anyway, but, you know, who knows? Because right now, you know, Trump seems to be embracing him again. There was some distance. Now there’s, you know, these things go up and down, and it’s not unique to Republicans. There are always rumors about Cabinet secretaries changing after the midterm, but this is sort of one of the ones that is circulating in D.C. that there could be a change. 

Rovner: No, we will see. All right. Speaking of HHS, Politico did a deep dive into what’s happened with personnel and has found that the number of political appointees in the agency has reached the highest level since the Clinton administration — even while career staffing has dropped by more than 20% — and that HHS actually now has the most non-Senate-confirmed political appointees in the federal government. That includes several departments that are far larger, like Defense. In some parts of HHS, even though hiring has resumed, those quitting still outnumber those coming in. And at the same time, agencies are failing to carry out policies and spend money appropriated by Congress. At some point, is Congress going to notice this and try to do something about it? I feel like I ask this question every single week. 

Seitz: I mean, this was such smart reporting because I think all of us have, at some point, been, like, you know, where’s this anti-vaccine ally of Kennedy’s? Why is he in this agency? So we’ve all noticed, like, this just influx of advisers — usually is how they label them. But in many ways, this wasn’t surprising. I mean, the CDC [Centers for Disease Control and Prevention], FDA, NIH [National Institutes of Health], the career staffers have really been cut out of the decision-making on so many things, whether it be autism research, tobacco, vaccines, the MAHA Report that relied more on AI than any actual in-house expertise. So, you know, RFK has been very vocal on how much he does not trust the people working in these agencies. So, like I said, in many ways it’s not surprising, but it is certainly … shocking to see those sort of numbers. 

Rovner: Yeah, I found the numbers really — I mean, anecdotally, and we’ve been talking about this for months. I mean, you know, this agency or that agency where everybody has left, or — I forgot, there’s still, you know, thousands of people who are being paid and are on administrative leave and not working. I mean, particularly at the CDC, there’s entire offices of people, of career people, that are simply out in limbo while these, you know, political appointees are doing all the policymaking.  

Well, one thing that Congress has appeared to notice is an interagency agreement in which HHS would let the Department of Defense tap into billions of dollars appropriated to the NIH for the DOD to use to study military biodefense programs. The agreement was . It’s quite an eye-popping story. I will link to it. Democratic Rep. Rosa DeLauro of Connecticut and Sen. Patty Murray of Washington, the ranking Democrats on the House and Senate Appropriations committees, are both furious. But it remains unclear what they can or will do. Is there anything they can do about this? I mean, it appears to be something that, you know, HHS has done with DOD, and it seems to be kind of a fait accompli. 

Raman: I mean, this whole situation has been kind of unusual. You know, we had the Democrats last week, you know, speaking out about how they’re very worried about this. We had the White House and the Republican leader of the House Appropriations Committee, you know, pushing back and saying that no money is changing hands and that it’s a partnership. And I think there’s still a lot of missing pieces that we’re still trying to figure out. I think a lot of groups have been trying to say, you know, are certain programs going to be cut to fund this, or there other things that are, you know, going to get de-emphasized, or is this just like a regular partnership? Because they do, you know, these two do work a lot on various biodefense issues over the years. That’s not unusual. I think one clue we might be able to look at is next week the Appropriations Committee is looking at the law that governs these interagency agreements, and so while it doesn’t explicitly say this agreement, I think that could come up a lot, and maybe, you know, pull out some leads in terms of what maybe is happening more here, and, you know, is money changing hands? Is it not? But that’s what I would kind of look to next. 

Rovner: Yeah, I do feel like Congress has sort of thrown up its hands about, Hey, we have the power of the purse, not you, administration. All right, we’re going to take a quick break. We’ll be right back. 

So, abortion is kind of receding as a leading issue for voters this fall, obviously in favor of affordability. But there’s some still pretty epic fights raging, particularly over the abortion pill mifepristone and whether it should remain available via telehealth. That’s a change made by the Food and Drug Administration during the Biden administration during the pandemic that was later made permanent. On Wednesday, a federal appeals court in New Orleans heard oral arguments in a case brought by Louisiana, charging that the FDA policy undermines its state’s ban and should be rolled back. Meanwhile, states where abortion remains legal argue that banning telehealth prescribing would violate their ability to make abortion available, which is what the Supreme Court’s Dobbs decision said they should be able to do. Sandhya, you listened to the arguments; they were pretty arcane. What is this case going to turn on? 

Raman: So it was interesting, but I will agree with you that there was a lot of arcane legalese here. So, Louisiana, during their arguments, was asking the court to, you know, pause what the FDA has done, but also to pause that their own decision because the Supreme Court right now has put a pause on letting any of the regulation change while the litigation plays out. So a pause of a pause. And so there was a little bit of talk of, you know, what can we do here as a court and, you know, the authorities there. I thought what was, you know, pretty interesting was that, you know, the FDA didn’t really say a lot in responses to the judges. They basically just said that Louisiana didn’t have standing. They didn’t answer a lot of the questions asked of them. You could tell the judges were kind of frustrated about that. And, you know, I think a little bit is understandable. You know, we’re in this position where the FDA is defending an abortion policy put in place by the former Democratic administration. They’re in an unusual spot. We still have the, you know, review of mifepristone happening at FDA that could, you know, decide something on the safety. We don’t know yet, depending on what it is that they’re going to look for. But I think it’ll be interesting to see what they say, just because it seemed like the judges were frustrated with many responses from different people. But whatever outcome we get here will definitely be appealed by whoever to the Supreme Court. I mean, we’ve seen that with other cases; it’s almost, you know, guaranteed here. 

Rovner: And of course, we’re still waiting for that FDA study that they’ve been promising that we expect, I guess, after the midterms, conveniently, because the administration didn’t want to further inflame both sides before the midterms. 

Well, along these same lines, while we were on break, Senate HELP Committee Chairman Bill Cassidy, who’s a strong abortion opponent from Louisiana, released the result of an investigation by Republicans on his committee that criticized the FDA’s handling of mifepristone regulation. Will this investigation and report have any ongoing impact — given that this is also being played out in the courts, maybe in confirmation hearings for Heidi Overton, the current White House health aide who’s been nominated to head the FDA? 

Raman: I think it’ll definitely come up in her confirmation hearings. I’m not sure how much this specific report is going to play a huge difference, because, I mean, we’ve had over the last several months a lot of different Republicans going and asking FDA for specific things to speed up this review, to do it in the first place, to do specific things, and it doesn’t seem like that has moved the needle and changed much. You know, they’ve kind of stuck to whatever it is that they had in mind on that. So, I mean, it could be something that they cite, but I don’t know that it’s going to have a drastic effect when they already have that underway. 

Rovner: I’m interested. We’re seeing a whole bunch of hearings for Senate confirmations for HHS officials, but not yet for Heidi Overton, who’s been working in the White House as a health official. Amanda, do you expect that we’re going to see anything about her before the election, or maybe they’re going to try to hold it over? 

Seitz: Yeah, I heard some chatter that there might be a possibility, but then of course we got the notice for the deputy secretary and for the surgeon general, and not her yet. So we will see. I, you know, I think obviously the hearings next week will be far less controversial people, and I think that’s, you know, key right now. 

Rovner: Yeah, I should say that Chris Klomp, who’s … at CMS now, but who’s basically been acting as deputy secretary and has been nominated to be deputy secretary. I don’t think anybody expects there to be a whole lot of controversy associated with that one. 

Seitz: Though I will say it’ll be interesting to see. I mean, certainly he’s going to get questions about vaccines, and I’m very curious to see how he responds to that, as well as the surgeon general. You know, those are not normally questions that these folks are fielding, but they’re going to have to answer them, and it’s going to be really, like, telling how they walk that line. 

Kenen: Klomp is one of the probably least controversial people at HHS. People think, people in both parties and in the private sector and the health sector think he’s very competent, and that, you know, apparently he’s a — I don’t know him personally — but he’s apparently, you know, someone one can talk to. So I don’t think this is a fireworks-y thing, other than the mandatory, you know, both parties always want to score some points, and they will be point-scoring. But you know, he’s — I think there are a lot of Democrats who are actually pretty glad he’s there. 

Rovner: Yeah, I’ve met him. He’s very smooth, and I mean that in a good way. I don’t mean that in a slick way. I mean he’s just, he’s one of these people who clearly is good at his job. 

Well, meanwhile, still on reproductive health, our friends at ProPublica are reporting, using federal health statistics, that the , those that implant outside the uterus, has doubled since 2020 compared with the six years before. Some of that was likely due to the pandemic, when healthcare was harder to access. But the rate has continued to grow, and it’s grown much faster in states that have implemented abortion bans. Other ProPublica reporting has shown how women with pregnancy complications, like ectopic pregnancies, have had trouble getting care in states with bans. I guess at some level this shouldn’t be that surprising, but it still kind of jumped out at me. 

Seitz: It’s such important work because it’s been so hard to measure the impact of these bans. You know, we heard anecdotally over and over again from doctors how difficult it was to treat patients in these states. We obviously heard the horrific stories of women being turned away or dying in some cases. But a lot of people have sort of dismissed that and said, “Oh, you know, this was a bad doctor, or someone who wasn’t following the law or wasn’t reading it close enough, or a bad hospital attorney.” This gives us such a clear picture of how drastically the overturning of Roe v. Wade has been in raw numbers that you really can’t refute, and I thought that was very important. 

Kenen: This is the one, not the one thing, but this is one thing that there’s no debate about: An embryo cannot develop outside the womb. It cannot. It cannot. It can’t. I mean, it’s … it got lost, basically. I mean, I think I’ve mentioned before. … I have had an ectopic pregnancy. I’ve had a heterotopic pregnancy. And it’s nothing … you know, in my case, it was very much a planned, wanted baby, and it was very upsetting for me. But I was, I got treatment. But, you know, for people to mess around with this who don’t understand it, I mean, there was one lawmaker, and I forgot who it was, and I also forgot whether it was state or federal, who said, “Why can’t they just move it where it belongs?” You know, you can’t. I mean, trust me, I would have chosen that. … This is, like, it’s not abortion. This is just a medical problem that no baby is going to come out of an ectopic pregnancy, and a woman can die. So the fact that this is, like, still being — that women are dying is, like, if you’re pro-life, you’re supposed to care about life. And, you know, partly because of some misunderstandings, and partly because there’s some politics, and partly just because of some — you don’t know you have one. I mean, I didn’t know I had an ectopic pregnancy. And it just shouldn’t — women should not die in 2026 in the United States of America or anywhere else. This is not an abortion. 

Rovner: Even the anti-abortion movement makes the semantic case that treating ectopic pregnancies is — they don’t consider treating ectopic pregnancies an abortion. 

All right. Well, finally, this week, an update on the political fight over the measles outbreak in Pennsylvania, which has pitted HHS Secretary RFK Jr. against the state’s Democratic governor and possible presidential candidate, Josh Shapiro. The Lancaster County coroner has now reported to the CDC that the two measles-related deaths in the state in August were both infants, both from Amish families, but only one died “from” measles. (She puts in air quotes.) The other died “with” measles. I feel like we’re already back to covid. Does this actually make a difference? 

Kenen: It depends. Like, I thought, one of the best summaries of this case, and it was actually some of the facts that have come out in the public … Paul Offit had a very — from Children’s Hospital, speaking of Children’s Hospital … 

Rovner: Children’s Hospital of Philadelphia, yes. 

Kenen: … and one of the leading vaccine researchers in the country, and someone who’s very good at explaining things. He had, like, a 10-paragraph … I think it was in MedPage, the other day … it was a little bit. … We’ve learned more about these cases since then, so I don’t know that he’s updated that. But the, you know, the basic idea was that in this “with measles,” in this particular case, might actually have been, like, without the measles, the baby might not have died, or the child might not have died. 

Rovner: This was a baby who died from a ruptured spleen. 

Kenen: And that the spleen could have been damaged because of the measles. And he didn’t say it’s definite. He said a number of tests needed to be performed to be sure one way or the other, and to the best of what had come out publicly before that, those tests had not … we didn’t know if those tests had been performed. So yes, it is possible that this was, the baby died because of the spleen damage, but that the spleen could have been because of the measles, and apparently we’re not really sure of it. But yeah, it matters because it’s part of the mix. You know, a baby died, a child died, a baby died, and getting in a fight about “with” doesn’t … it’s a risk factor. Period. 

Rovner: Well, one small silver lining: The Pennsylvania Department of Health says it has seen a surge in measles vaccines being given, nearly twice as many this August as is typical. Is that how this is going to go? People won’t get vaccinated until they see cases of the things they could have already been vaccinated to prevent? 

Seitz: It depends on who they trust, right? I mean, I think that is the unfortunate thing about this entire — I mean, there are so many unfortunate things about this entire case, and the first being that two babies are dead. But the other unfortunate thing is that people are now thoroughly confused, and it’s hard to discern, really, what happened. Even as a reporter who’s following this. Imagine being just, you know, a parent trying to decide what to do with your kid. So I think you’ll see some people that do go: OK, I don’t want to take this risk. I think you’ll see some that double down and go: You know, I’m not sure that the government’s being honest with me. And the nation’s health secretary also suggested that the Pennsylvania state government’s not being honest with me. So, unfortunately, I think we’re going to see all kinds of reactions to all of this. 

Rovner: And which government is not being honest with me — the federal government, or the state government, or the local government? Because now we’ve got the local coroner involved in this. So it’s, yeah, it is truly — I feel like this is a real microcosm of what’s going on with vaccines around the country. 

Kenen: In some ways it’s, what some people in public health would say, the best possible scenario is that people do wake up to the fact. Now we haven’t had a lot of measles for many years. We have now had more measles, and people are learning about the danger of measles, and maybe that will change behavior and reverse some of the anti-vaccination movement. On the other hand, you also have people saying that, not just in this case, but that it wasn’t measles that killed so-and-so. You know that there have been cases where someone died, but no, it wasn’t measles. You know, it was bad care. It was lack of vitamin A. It was, you know, malpractice. It was bad luck. It was something else, right? So you have sort of … you hear in public health is, like, Oh the tragedy is it’s going to take measles deaths for people to rediscover the importance of vaccine, and we may be seeing a little of that. But the other, the simultaneous narrative is, you know, it’s not measles that’s killing you; you don’t need the vaccine, that’s worse. So there’s … two narratives. Right now we see the, you know, the pro-vaccine may be inching up, but I don’t think we know yet where we’re going to be in a few more months. The, you know, there’s a lot of measles out there. 

Rovner: Yeah, clearly more of this to come. All right, that’s this week’s news, or at least as much as we have time for. Now we will play my “Bill of the Month” interview with Lauren Sausser. Then we will come back with our extra credits. 

I am pleased to welcome back to the podcast my colleague Lauren Sausser, who reported and wrote the latest Ñî¹óåú´«Ã½Ò•îl Health News “Bill of the Month.” Hi, Lauren. 

Lauren Sausser: Hi. 

Rovner: So this month’s patient was doing what just about every medical expert recommends: getting preventive screenings for breast cancer. Tell us who she is, what kind of medical care she got, and why she needed something extra. 

Sausser: OK. So, the patient this month, her name is Stephanie Halver. She lives in Washington state, and her primary care physician recommended that she get a breast MRI in addition to her annual mammogram because of her age, partly. Stephanie is over 40. She has dense breast tissue, and she also has a family history of breast cancer. Her mother and her aunt were both diagnosed in the past. 

Rovner: So she was at high risk, and her doctor recommended this MRI in addition to the regular mammogram, and her insurance company preapproved it. So, how was there a fight over the bill, and how big was the bill? 

Sausser: So, this actually took me a minute to figure this out. So, Stephanie had gotten a preapproval letter from her insurer before she went to schedule the MRI. But then, several months later, she got a bill, a significant bill for over $1,000, and she didn’t understand why this was not covered in the same way that her annual mammogram was covered. And to figure that out, we have to go back to the Affordable Care Act, which says that insurers have to cover some screenings, some cancer screenings, at zero cost to patients. Mammograms are in that list. Colonoscopies are in that list. Breast MRIs are not in that list. So the question is, who comes up with this list? It’s a group that you probably have heard of before, called the U.S. Preventive [Services] Task Force, which looks at all the available scientific evidence and uses a really rigorous process to figure out which screenings are best suited for the entire population. So, anyway, at this point in time, the U.S. Preventive [Services] Task Force — which, I should say, is not an active group of scientists since Kennedy disbanded the group essentially last year. 

Rovner: Yes, and we talk about this on the podcast all the time. 

Sausser: OK, so you all are up to speed about that. But as the current guidelines are written, breast MRIs — the group does not, has not found enough evidence that they’re necessary for a large group of people. Now, interestingly, I recently spoke to the former head of the task force, and he concedes that that does not mean that breast MRIs are not the right choice for some people. There’s this tension between, you know, what’s good for a population and what’s good for individual patients. In this case, Stephanie Halver’s primary care doctor appropriately recommended a breast MRI, but because breast MRIs are not included in the task force recommendations, her insurer does not have to cover that at zero cost. Now, as you mentioned, she had that preapproval letter, so why did she get the bill? Well, in this case, Stephanie had a really high deductible. It was over $5,000. That’s not super high anymore, but it was high. So in this case, the cost of the MRI was just applied toward her deductible. So she got a bill for it. If it had happened later in the calendar year and she’d met her deductible at that point, she might not have gotten a bill, or maybe wouldn’t have gotten a bill that was for essentially the full amount of the MRI. 

Rovner: So it was covered. It just wasn’t covered as a no-out-of-pocket-cost preventive service? 

Sausser: Exactly, exactly. 

Rovner: Now … we’ll add one more level of complication to this. I know in your research you discovered that some states are actually requiring breast MRIs to be covered in certain situations, and Washington is one of those states. So why wasn’t it covered for her? 

Sausser: So yeah, this added another level of complexity because when Stephanie was researching, you know, why, how did this bill happen? I live in Washington state. There’s a state law in Washington state that requires insurers to cover this procedure — or this test, I should say. Those state laws don’t regulate the type of insurance that she has. So a lot of people, like Stephanie, like you and me, get their health insurance through their employer. Those employer-sponsored plans are regulated federally through the Department of Labor, and so state laws generally don’t touch that type of insurance. Now, if Stephanie had had a federal marketplace plan or some other type of insurance, it’s possible that that state law would have applied. But in her case, because she had insurance through her job, that state law didn’t benefit her. 

Rovner: This is why we needed the Affordable Care Act in the first place because state laws don’t cover many — all of those employer plans that are federally regulated, which is most employer plans, although it’s not all. 

Sausser: Right, and it’s really, it’s confusing for people. … Insurance regulation is so piecemeal, and these self- —they’re also called these self-insured plans. If you work for a very large employer, chances are the plan is self-insured, and that means, at a very basic level, that the employer, not the insurance company, is actually the one that decides which benefits will be paid for and how they will be paid for, and, in this case, Stephanie did check with her HR [human resources] department, which confirmed that breast MRIs are not covered in the same way that mammograms are covered. 

Rovner: So, what’s the takeaway here? If you’re a patient and you find yourself in a similar situation, and your doctor recommends this care, I mean, is there a way to, like, save some money? 

Sausser: There is. One thing that you can do is shop around for the best price. So you’re going to pay more for a breast MRI probably through a hospital than you are through sort of a freestanding imaging center. The other thing that you might consider doing is, if you have a very high deductible — let’s say, you know, $10,000 or $20,000 — you might consider paying cash because you’re probably going to be quoted a lower cash price than if the provider bills the MRI through your insurance. The other thing is that you could consider scheduling this after you’ve met your deductible. So let’s say that Stephanie had decided to wait till the end of her plan’s calendar year, and she had met her deductible at that point. She probably wouldn’t have had to pay very much for this MRI. There are also advocacy groups that can help patients who are struggling to pay the bill, find a lower-cost alternative. There are programs through Medicaid that help patients get screened. The takeaway, to answer your question, is don’t ignore your doctor’s recommendation. If you need a breast MRI, there are probably ways to lower your cost if you know going into it that you may be on the hook for all or part of the bill. 

Rovner: Well, as always, it’s buyer beware in the healthcare marketplace. Lauren Sausser, thank you very much. 

Sausser: Of course. Thanks for having me. 

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

Raman: So my extra credit this week is called “.” It’s from my colleagues at Bloomberg Government, Erin Durkin and Claire Hebert. So something some folks might not know is that Medicaid is a significant funding source for special-needs services in K through 12 public schools. And so they took a look at Indiana, which has, you know, been aggressively cutting Medicaid enrollment, seeing some of the biggest drops in child health insurance compared to other states, and just looking at some of the effects there, you know, in part by the tax law that Republicans passed last year, and just Indiana laws that also made similar changes. So it’s a good deep dive into this. 

Rovner: It is. Joanne. 

Kenen: This is a story from ProPublica in collaboration with the Oregon paper, The Oregonian, I believe it was: “.” It’s by Audrey Dutton. It’s about Idaho, which is, there’s a community that’s been there for, like, 100 years that did not believe in medical intervention. They believe that if a baby is dying, then that’s, you know, what God wanted. It is not … there’s an astonishing, a disturbing number of cases. They are under Iowa state, excuse me, Idaho state law. They are not prosecuted. They are under state law. They are allowed to let their children die. And there are some voices in that story about the police who have to go and how disturbing it is for them, and that ProPublic also had a retired pediatrician review the medical records. Many, many of these are avoidable deaths — something that would have responded to antibiotics. Something that would have, you know, simple, not terribly invasive surgery. There was a quote from a midwife that really stuck with me, talking about watching a child die, and she said, “It’s not pretty. They don’t just close their eyes.” It’s a very, very powerful story. 

Rovner: Amanda. 

Seitz: Yeah, I have two extra credits this week, but they both touch on the same topic. The first is “,” by Daniel Payne at Stat News. This story looks at how, ahead of all these Medicaid cuts, rural hospitals are sort of clinging on for dear life by getting the backing of a larger hospital system. They’re often out of town, and, actually, one of the hospitals my own mom works at, so that was kind of cool. But the article does a great job of raising the balance here — that while this approach is saving hospitals from closing, it changes the care that people are getting, and it could make it more expensive. And then my second article is by our Ñî¹óåú´«Ã½Ò•îl Health News colleagues Noam [N.] Levy and Hannah Norman. They published an article: A NY Hospital Tried To Close Its Birthing Center. This City United To Fight Back.” That looks at how this hospital in a small town of Troy, New York, was instructed to close its birthing center by the multibillion-dollar health system that’s out of town that it’s owned by. And there was this sort of herculean, bipartisan pushback over the proposed closure that stretched from, like, the local city to the state. Both of these articles just do a really great job, I thought, of showing the local impact of hospital consolidation and corporatization of those systems. 

Rovner: Well, my extra credit this week is from NBC News. It’s part of its “Disabled and Denied” series called “,” by Mike Hixenbaugh. And it’s about a new AI program being used in Nebraska. I guess we’re all looking at different states this week. And this program is being used in other states, too, to help determine how much Medicaid funding should be allocated to those living with disabilities — which sounds fine until he discovered that the algorithm basically penalizes families who’ve managed to care for their disabled loved ones at home. Because they’ve never been institutionalized, they’re suddenly deemed more able than they actually are, and funding that’s been allowing them to live is being cut dramatically. In one case, parents in their 70s caring for a pair of severely disabled sons in their 40s are facing a loss of more than $200,000 in Medicaid funding. That’s jeopardizing their ability to continue to keep their sons at home. The entire story is pretty wrenching. I really can’t recommend it strongly enough. 

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

Seitz: I am also on X . 

Rovner: Joanne? 

Kenen: I’m mostly on and . 

Rovner: Sandhya. 

Raman: I’m on and on @SandhyaWrites. 

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

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Aug. 27, at 10:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go.  

Today we are joined via video conference by Margot Sanger-Katz of The New York Times. 

Margot Sanger-Katz: Hello, everybody. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello! 

Rovner: And Rachel Roubein of The Washington Post. 

Rachel Roubein: Hi. 

Rovner: Later in this episode, we’ll have my interview with Dean Rosen about his time working for Kansas Republican Sen. Nancy Landon Kassebaum, who died last week at the age of 94, and how she represented a type of lawmaker we don’t see that much anymore. But first, this week’s news. So we’re taking the next week off for a needed break for our entire team, which makes this the last podcast of the technical summer. And I thought I’d do something just a little bit different. I’m going to break the discussion up into what I’m calling “The Themes of the Summer” — things we’ve talked about nearly every week. I hope it gives some of you the realization that I get from putting this together every week, that we’re looking less at a long list of separate events and items and more at pieces of a much larger picture that we don’t often see. 

So, theme No. 1 this week is declining health coverage. When Republicans passed their big budget bill last summer, they thought they were being clever by backdating most of the Medicaid cuts so they wouldn’t happen before the 2026 midterms. Well, the problem for them is that states and health systems are already making their own cuts in anticipation of those federal cuts to come, and people are already starting to feel them. This week’s evidence is from a Stat News piece called “,” and it includes ways that access is shrinking overall, particularly in heavily rural states like Maine and Louisiana, as the number of people without insurance goes up and the money from the government goes down. Is it really possible that Republicans didn’t see this coming? Or did they really believe they could take a trillion dollars out of the nation’s healthcare system and not have people notice? 

Sanger-Katz: I think that many of them were not paying very close attention. I think it may be accurate to say that they were indifferent to this possibility and are, in fact, surprised now to see the way that it is working out. I just, you know, for context, this bill that made these very large cuts to Medicaid and some smaller cuts to Obamacare funding was part of this huge package that included, you know, major tax cuts and tax reforms that were a big priority for Republicans, changes to energy policy, changes to other social welfare programs, changes to education policy, and, you know, they called it the One Big Beautiful Bill. And I think the bigness of it is easy to forget, in retrospect. But I think for a lot of lawmakers, they were really focused on the parts of the bill that they really cared about. For many of them, it was the tax part of the package. And the president and their leadership repeatedly told them not to worry about the Medicaid changes, characterized them as not being cuts. And I think, you know, a good, responsible lawmaker ought to do some diligence about that. But I think that many of them maybe took their eye off of the healthcare parts of the bill, were focused more on these other parts of the bill, and now are really starting to see what is happening in their home states as these policies are starting to roll out. 

Roubein: And I also think it’s true that, like, some of the full impacts, as I think Daniel Payne pointed out in his Stat piece, won’t be felt for years to come, particularly as the Medicaid work requirements do kick in next year. So once there are more concrete human faces and examples, that tends to come to more the forefront and, like, you know, the political mind. So yes, those changes a lot of them are not fully going into effect till after the midterms. 

Rovner: I do think that one thing that lawmakers really didn’t appreciate was how much this might impact not just people who would be losing coverage, but people who would be losing access. I mean, people who still have coverage, but, you know, if a hospital can’t keep its door open, or a clinic can’t keep its door open, or a doctor can’t, you know, keep the practice going, that’s going to impact people with insurance as well as people who are losing their insurance. I mean, that’s, I think, that’s part of why this piece went to explore some of these more rural places, where people are going to feel this first. Shefali, I see you nodding. 

Luthra: Yeah, one thing I’ve been thinking about a lot is you do hear Republicans, especially someone like [Maine Sen.] Susan Collins, really trying to tout the rural health fund that was part of this, right, and that was meant to, at least rhetorically, offset these massive healthcare cuts. Obviously, you look at math, you look at numbers, and one doesn’t really undo the other. But …  

Rovner: Yeah, the rural health fund is, what, $150 billion of $1 trillion … ? 

Sanger-Katz: $50 billion, I think. 

Rovner: Or, oh, it was even less. 

Luthra: And so, yeah. I mean, I think what maybe people didn’t fully appreciate is that voters are less compelled, perhaps, by [lawmakers] saying I voted for this funding, and more compelled by what they see happening around them, which is these massive cuts resulting in major changes to what is often the biggest employer, what is often the only source of healthcare for miles, something that is very intimate, very much of the community. And that’s why this is just such a potent issue, especially in a lot of these really close Senate races now. 

Roubein: I mean, we’ve seen in the past how rural healthcare can impact politics. With Medicaid expansion, Republicans were really, really, really against it, and then you saw some begin to change their mind — North Carolina being a notable example, and just all of the ballot measures in red states — Oklahoma, for instance. 

Rovner: Idaho. 

Sanger-Katz: I think it’s worth just pointing out how much is still to come. I think a lot of what we’re seeing right now is hospitals and other healthcare organizations that were kind of in a difficult financial situation going into this change in policy. They’re looking around, they’re already in the red, and they see they’re not going to get more money in the future; they’re going to get less money. And so I think a lot of them are accelerating changes that they were hoping to stave off. But the real cuts in almost all cases have not come yet. So, you know, the work requirements, as Rachel noted, are going to reduce the number of people who are covered by Medicaid. So that means that a lot of these healthcare organizations are going to have to absorb uncompensated care that was previously paid for. But then, further down the road, there are actually much larger cuts that are coming to state Medicaid budgets that are done in these kind of complicated, a little bit obscure, formulaic ways. But there are these reductions on how much the state can directly pay hospitals for care. There are reductions in how much states can raise through Medicaid taxes that then get transferred back. And there, I think, have been very valid criticisms of these funding mechanisms for Medicaid. They are this kind of Rube Goldberg complicated ways of financing the program, but they’ve been around for decades, and these healthcare organizations and these state budgets have really been built on the foundation of these funding streams. And so, as that money starts to go away, I think, then we may see even larger impacts because, again, the things that are happening now are healthcare organizations looking down the road and thinking, Ooh, it’s going to get messy. Maybe I should start adjusting now. But down the road, it will start getting messy for them, and I think there are going to be potentially some much harder choices for some of these organizations. 

Rovner: Well, continuing along that theme, , we talked earlier this summer about a new rule from the Centers for Medicare & Medicaid Services to enforce the administration’s ban on the use of the Medicaid or CHIP [Children’s Health Insurance] Program to pay for gender-affirming care for minors. But it seems that the mechanism CMS is using could open the door to denying coverage for other drugs too, or at least some uses of other drugs. Now, this isn’t in the Stat story, but, Shefali, when I read it, I wondered if one goal here is to cut back on the use of drugs like misoprostol, which is used for a lot of things, but also for medication abortion. 

Luthra: That’s a really good question, and I think one that we still don’t really know. And obviously, a lot of states’ Medicaid doesn’t cover abortion to begin with. That really only happens in states that have actively made an effort. But, I mean, misoprostol is not only used for abortion; it is used for miscarriage management. And I think it’s just something really important for us to keep in mind what happens when you see these sorts of approaches to just, like, carving out individual forms of healthcare. And obviously, it’s very interesting as well because drugs used for gender-affirming care are also used for other things. RFK [Robert F. Kennedy] Jr. really loves hormone therapy for many people, just not trans people. And so I think there’s just a lot of questions that we don’t really have answers to about just how sweeping the implications of something like this could be. 

Rovner: Yeah, we will see as it goes. Well, it’s not just Medicaid. that CMS is clawing back billions of dollars in Affordable Care Act premium subsidies from insurers who have allegedly phantom enrollees, people with zero premium plans who don’t file claims. And while that is a known problem, a lot of those people might be actual enrollees who just haven’t needed their insurance yet, as in young, healthy folks who have health insurance just in case, or because their parents told them that they should, and, by the way, they could get a plan with a zero premium. And stripping these people from the rolls is likely to boost premiums overall by making risk pools sicker, in general. I feel like this administration might not be familiar with the bizarre and sometimes illogical way the health insurance market works? 

Sanger-Katz: I think there’s a delicate balance going on here, where if there are people who are enrolled in these plans who are fake, are not real people, do not know that they have insurance, never plan to use their insurance, you know, that is a waste of federal dollars to subsidize those premiums and just give that money to insurance companies. But I don’t think that there’s very strong evidence that there are a lot of these people. And I also think that the mere fact that someone has not used their health insurance yet, in a year, is not by itself evidence that they are a fake person or that their enrollment is fraudulent. As you said, Julie, there are a lot of reasons why people in this market may not have used their insurance. You know, a lot of the people who have become newly enrolled are relatively young and healthy. That is good for the risk pool, but it may mean they don’t have a lot of healthcare needs. There’s also, just because of the nature of the individual market, you know, one expert pointed out to me, there’s just a lot of churn. You know, someone loses their job, they sign up for a plan, then they get a different plan, or, you know, people who are in this market may only be in this market for a short period of time, and that may also explain why there’s a higher share of them who don’t make any claims, because they haven’t sort of gotten through the whole year, they haven’t had a healthcare need yet. So I think deciding to just disenroll people on this basis does risk disenrolling people who are legitimately insured, who are not phantoms, and who are not committing any kind of fraud. To the degree that there is fraudulent enrollment, and I think there’s evidence that there’s some of it, there are, you know, I think that is a valid concern, and I think the federal government is certainly within its rights to try to address that and make sure that these federal tax subsidies are being appropriately spent. 

Rovner: Yeah, I think “delicate balance” is exactly the right word. I mean, that’s, you know, with the work requirements too. I mean, the idea is to make sure that people are doing things. But if you make the administrative requirements so burdensome, then you’re going to throw off people who are legitimately enrolled. 

Moving on to the next theme of the summer: the resurgence of measles, and the continuing fight over vaccine policy. Until this week, the Trump administration had boasted that while measles cases have been rising pretty precipitously — they’re at the highest level in more than three decades — the U.S. was actually doing better than most other countries with outbreaks, and besides, no one had died of measles yet this year. Well, that worked until Tuesday, when the Pennsylvania Department of Health announced two measles-related deaths in Lancaster County — although we have few details other than that both people were unvaccinated and one was an infant. The announcement touched off a rather nasty war of words between Pennsylvania governor (and possible 2028 presidential candidate) Democrat Josh Shapiro and HHS Secretary Robert F. Kennedy Jr., who said that the state was not cooperating with federal health officials, and maybe the people didn’t actually die of measles after all. This isn’t really going to get more people vaccinated, I would suggest — this just sort of fighting back and forth, right? 

Luthra: It’s a good question. It certainly doesn’t help. I think one thing I was thinking about this morning, and this is not measles-specific, but there’s a really great New Yorker piece from this week looking at the actual vaccine data over the past year and a half, and obviously people are affected by public rhetoric, but the declines in vaccination are not as big as one might have feared when RFK Jr. was initially nominated and really made a point of highlighting anti-vaccine beliefs. And so obviously, like, this is, the fact that people are dying is very bad. The fact that they’re sowing confusion … 

Rovner: The fact that people are getting measles is very bad! 

Luthra: Yes, it’s very, very bad. It’s not, none of it is good. But that was actually really striking to me that amidst all of this, like, really terrible news, there is a bright spot, which is that things could be a lot worse. That is something that I hadn’t thought about. 

Roubein: I mean, if, I think … I’ve been thinking about this today, like, if you kind of step back from the really high-level view, I think Americans who are watching this are confused. They are not sure who to trust. There are, you know, Republicans are saying one thing, Kennedy allies are saying one thing, the Department of Health [and Human Services] and Gov. Shapiro, Democrats are saying another thing. You’re seeing a, you know, a war of words between, like, Republican and Democratic county commissioners on this, you know, just from a public health messaging standpoint. 

Rovner: Yeah, it has not been a great job of communication all the way around. I think there, I mean, there are even, you know, public health defenders who are saying, Why don’t we know more about these two deaths yet? There’s been not a lot of information, and that has, of course, as we saw, you know, during covid, the more noninformation you have, the more people try to fill in their own information, whether it’s true or not.  

Well, even before the Pennsylvania news, we had a somewhat excruciating pair of appearances on CBS’ Sunday show Face the Nation this week. First, CMS Administrator Dr. [Mehmet] Oz needed three separate tries to be able to say that, no, President [Donald] Trump was incorrect when he said in his Oval Office vaccine event that the measles, mumps, rubella combination shot was lethal. Spoiler: It is not. Then Florida Republican congressman Byron Donalds, who’s now the Republican candidate for governor, said the measles outbreak there has been caused by illegal immigration rather than residents not getting their children vaccinated. What happened to the idea we heard last winter that being anti-vax wasn’t good politics? I think this speaks to what you were just saying, Shefali. You know, I think in January and February we thought that Republicans were going to sort of leave this alone and focus on other things. 

Sanger-Katz: Well, I think one thing that we’ve learned recently is that while a lot of the president’s advisers and political staff, I think, were concerned that an anti-vaccine message was damaging, what we’ve seen is that the president himself sincerely has anti-vaccine views and has been saying them out in public. And so I think it does put other Republican political figures in a difficult bind, and certainly puts folks like Dr. Oz, who work in the administration, in a difficult place. Whatever his genuine views are, whatever his political advisers and his public health advisers are telling him, he works for President Trump, and President Trump has made it pretty clear what he thinks. And so I think that’s why we are now seeing this kind of new round of muddled messaging around vaccines, when I do think for a little while there was kind of a pullback on the most overt anti-vaccine rhetoric, and, you know, we saw RFK talking less about it, for example, in public. Now, I think we’re in a little bit of a new phase, where the president is leading the way back. 

Roubein: Yeah, I mean, I think that’s exactly right, and I mean, Trump has, you know, privately questioned why his administration had yet to release new vaccine recommendations, , with Lena [H. Sun] and my colleague Dan [Diamond]. And that’s, you know, some of what, a lot of what drove the executive order that we saw from just a few weeks ago to reduce the childhood vaccine schedule. Trump says he wants to break up the MMR shot. That’s not something that is currently available, but, you know, he has driven that by pushing some of his advisers. 

Rovner: Yeah, absolutely. Well, meanwhile, demonstrating just how expensive it is to track, trace, and quarantine people after a confirmed case of measles. One Denver outbreak that ended up being just 10 cases still cost state and local agencies nearly a half a million dollars, almost 7,000 hours of work from 189 staff members, not to mention 91 people being quarantined and 500 days of school being missed. We may call public health invisible when it works, but it is certainly not cheap. 

Roubein: Yeah, I mean we don’t talk about the economics of it very often. I mean, public health officials always say that they are underfunded, but just, in general, the talk of the economics here is generally not a huge part of the conversation. 

Sanger-Katz: And measles is just such a difficult disease to contain because it is so contagious. It is one of the most contagious infectious diseases out there. And so that means that any person who has measles just has the potential to spread it to so many people. And I think that really strains these traditional public health approaches of trying to track, trace, and quarantine because you have to find so many contacts. 

Rovner: Yeah, just a reminder, I mean, measles can linger in the air after the infected person has left for, I think it’s like, two hours. So it’s, you know, anybody who’s been in a place where somebody with measles has been is potentially at risk if they’re not vaccinated. 

Sanger-Katz: I mean, we remember how hard this was with covid. Of course, in the early days, no one was vaccinated, so there were more people who were susceptible to covid. But measles is substantially more contagious even than covid. 

Rovner: Yeah. Well, as yet, as the debate continues to rage over vaccines, the evidence continues to pile up that vaccines are actually, on balance, a very good thing. Just this week, we have two more studies. of 4 million teens and young adults that found that those who received that controversial mRNA-based covid vaccine were less likely than those who just got covid to develop myocarditis or other heart problems. That was something that people were worried about with young people getting this vaccine. appears to confirm that the shingles vaccine, Shingrix, appears to not only have a protective effect against dementia, something we reported earlier this year, but also against cardiovascular disease. How do we get to a place where vaccines have become controversial again? I assume, I mean, I want to go back, Margot, to what you were saying that it does seem that President Trump himself has anti-vax views that I think we didn’t appreciate until this year. I mean, I think most of us thought that this was all being driven by RFK Jr., who’d obviously made a career of being anti-vax. But when he backed off, we saw the president basically fill right in, and that’s kind of where we are? 

Sanger-Katz: And I also think this is a reminder to us, both of these studies and others that have come out recently, that, you know, vaccines have some risks. They do. But infectious disease can be really dangerous for people, and it can have lingering and downstream effects that are not obvious. It’s not just that you get sick in the moment that you get sick, but having that disease affects your body in ways that may show up much later. And I think some of these longer-term studies that are following people — you know, not just in the weeks and months after they get a vaccine, but what happens years later to their heart or to other major organ systems —really shows that preventing people from getting serious illness is good for their long-term health. 

Rovner: Yeah. 

Roubein: And I mean, Secretary Kennedy, just to go back to last year, he did drive changes. He fired CDC’s [the Centers for Disease Control and Prevention’s] vaccine advisers, who had made changes to vaccines. The health department did release a new childhood, slimmed-down childhood immunization schedule earlier this year. A lot of those changes, though, have been on hold from a federal judge. 

Rovner: Yeah, he also fired the head of the CDC, who refused to rubber-stamp his vaccine changes. So, he was busy before he got sort of unbusy with this. All right, we are going to take a quick break. We will be right back. 

OK, our next theme of the summer are the continued cutbacks by the Trump administration to federal health programs, including some of those that have been specifically funded by Congress. First up is a story from Ñî¹óåú´«Ã½Ò•îl Health News this week about how, at the same time President Trump can’t stop talking about the increasing rates of autism and what a problem it is, the administration is scaling back enforcement of civil rights protections for people with autism, research into the education needs of people with all sorts of disabilities, and even data collection efforts. So, on the one hand, the president keeps pressuring RFK Jr. to find a definite cause of autism, but at the same time, this administration is doing less to help those who are already diagnosed? 

Luthra: I think what I find really interesting every time we talk about this is the really, really long tail of funding cuts, because this is something on, like, a broad macro scale that began at the beginning of this administration, right? Just massive funding cuts and freezes across the board and have continued. And because of the way grant-making works, because of the way research works, we keep seeing the consequences. We keep getting more people reporting, “Oh, my funding didn’t come,” or “This was held up,” or “This project I was working on no longer can.” And what I think is also really interesting is we see how slow the ability to respond is because of the long tail of funding cuts. I mean, courts take a long time, finding new funding when you suddenly lose yours actually is very difficult. And this is something that we’re just going to keep coming back to. We are going to be seeing the consequences of these funding cuts for months and years, as we’ve been talking, but also for much longer as the consequences in terms of research, of cures developed or not developed, becomes even more clear. 

Rovner: Yeah, although sometimes I think it’s going to be hard to connect the dots to get from, you know, from you cut this so this didn’t happen. It’s almost going to be like proving a negative at some point. 

Well, another big theme this summer has been drug prices, particularly prices for those expensive GLP-1 weight loss drugs. As part of the administration’s push to make those drugs less expensive for the end users, CMS offered states the option to participate in its direct negotiations with the drug manufacturers if they would offer them through their Medicaid programs. Only, , so far only one state has taken up the offer, and more states are actually cutting back on their GLP-1 coverage through Medicaid that they have been offering because it’s been such a financial strain on their programs. Several state officials told Politico that they worry about the long-term financial sustainability of the program. I know it’s also a worry for the Medicare GLP-1 program, which is basically at this point a year-and-a-half-long pilot for drugs that, as far as we know, need to be taken indefinitely. Is it fair to say that the president has not really been able to keep his promise to make these drugs cheaper and much more widely available, or that if he has, people may end up getting them yanked out from underneath of them? 

Sanger-Katz: I think it’s complicated. I think it’s hard to know how much credit the president should get. But I will say that the prices for these drugs — the kind of cash-pay prices, that he was able to negotiate allegedly, and that he was able to announce certainly a few months ago — were substantially lower than what individuals and insurers, including some public insurers, were paying for those drugs. So we are now seeing a kind of cash price for the main anti-obesity drugs that is much more affordable than it had been in the past. I think some of that was driven by market pressures and would have happened regardless of the president’s intervention. But I think certainly his pushing these companies, his threatening of these companies, his cajoling of these companies probably maybe did induce them to sort of do it at the same time, to do it faster, and to do it more prominently. 

Rovner: Well, some of it already had happened, before he got in. The self-pay cost had already gone down because so many insurers had stopped covering it. 

Sanger-Katz: It had gone down, but it then went down again.  

Rovner: It did. 

Sanger-Katz: The prices that are available now that the president announced are lower than what we had seen in the past, and they are a major discount even compared to the previously lowered prices that had been public. So I think that is a real thing. Whether or not those prices were meaningfully lower than the price that the Medicaid programs in states were already paying is a little bit of an unanswered question. But my understanding from talking to some Medicaid officials is that Medicaid was already getting very similar prices, even before the president announced these discounts. And that’s because Medicaid has, by law, gets the best price for drugs. They get discounts that are not available to other purchasers. And Medicaid budgets are quite tight. You know, as we were just discussing, all of these state Medicaid programs are facing very substantial cuts that are coming down as the rollout of the big tax-and-spending bill is implemented. And the states that went early and did cover GLP-1 drugs for obesity, I think that they saw that interest and uptake really exceeded their expectations. There were a lot of people in the Medicaid population who stood to benefit from these drugs, and that when so many of them enrolled at once and started taking these drugs at once, it did create, I think, an unanticipated budget strain. So I think states are in a difficult position. This pilot is offering them this cash price for their Medicaid programs, and I think a lot of them are looking at that, and they’re saying, “Well, this is, like, a good price. It’s not that much better than what we could have gotten before, and we weren’t doing it before because we didn’t think that we could afford it.” And so I think those circumstances really haven’t changed. It will be interesting to see what happens over time. It does seem like there is huge potential public health benefit for Medicaid populations if these programs can find a way to cover these drugs. You know, the evidence about the health benefits of these drugs for people who have obesity are just really tremendous, and we’re seeing them over numerous, different health conditions and body systems. And, you know, in my own reporting on North Carolina’s Medicaid program, which was one of the early ones to cover these drugs, you know, I just talked to a lot of people who were really excited about having this opportunity to take this drug. People who had really struggled with their weight and related illnesses, and, you know, were glad that the state was offering it to them. And now, you know, North Carolina has had, is one of the states that’s had to roll back. 

Rovner: Yep. All right. Well, finally, this week, a word about Dolly Parton, possibly the only person in America who was pretty literally loved by everyone. The country and pop music superstar and actress who was known for her genuine kindness and generosity was, in fact, also an important healthcare philanthropist. A lot of people probably remember she gave a million dollars to Vanderbilt University in 2020 to help develop the aforementioned mRNA-based covid vaccine. What people might not remember is that she also used her own money to fund pediatric infectious disease research, underwrite a women’s healthcare center in the East Tennessee county where she was raised, and help train pediatric health professionals. There are celebrities who lend their name and their time and sometimes their money to causes to help burnish their personal PR, and then there are those who clearly do it because they want to give back. I think it’s fair to say that Dolly Parton was one of the latter, and I think she’s going to really be remembered for a lot of the work that she did on bringing healthcare to more people, right? 

Luthra: Yeah, yeah. It’s very sad. 

Rovner: It is. And healthcare owes her a debt. All right, that is this week’s news. Now we’ll play my interview with Dean Rosen, and we’ll come back and do our extra credits. 

I am pleased to welcome to the podcast Dean Rosen. Dean is a partner at Mehlman Consulting, where he landed after a long career on both sides of Capitol Hill, during which he helped shape some of the most important health legislation of the 1990s and early 2000s, including President George W. Bush’s HIV/AIDS program, PEPFAR; the Medicare prescription drug law; and the 1997 Balanced Budget Act. But before all those things, Dean was the top health aide to Sen. Nancy Landon Kassebaum, the Kansas Republican who passed away last week at the age of 94. After Republicans took over Congress in the wave election of 1994, Kassebaum chaired the then-Senate Labor and Human Resources Committee, now the HELP [Health, Education, Labor, and Pensions] Committee, and stewarded the surprisingly difficult path to law of what was originally a very bipartisan bill, the Health Insurance Portability and Accountability Act of 1996, or HIPAA. Dean Rosen, welcome. 

Dean Rosen: Thanks, Julie. I’m honored to be here, and I’m a longtime fan of What the Health? — so this is a real great opportunity. Excited to be with you. 

Rovner: Great. So, HIPAA, which was known at the time as Kassebaum-Kennedy for its bipartisan Senate sponsors — your boss and the late Edward M. Kennedy, a Democrat of Massachusetts — is today mostly known for its medical records confidentiality provisions. But that’s not how it started out, right? It was really an effort to do something bipartisan in the wake of the failed Bill Clinton very partisan health plan. Talk about how it kind of came to be. 

Rosen: Yeah, that’s exactly right. It sort of started in the Senate and then moved to the House and then moved to a traditional conference committee, which we don’t seem to do very much of, either, anymore these days. But when it started off, it really did start, as you said, as a health insurance portability bill, and just a really, in some ways, minimalist solutions-oriented legislative proposal that was designed to try to get at what was really, I think, the core concern, or one of the core concerns, at the time, which was people’s ability to get and maintain health insurance if they had preexisting conditions.  

And really what happened was the Clinton plan had kind of imploded spectacularly, as you know, despite the fact that there were huge Democratic majorities in the House and the Senate — not filibuster-proof, but close in the Senate — and the Democrats just couldn’t … get it done. And they couldn’t get any Republican support. They couldn’t get enough Democratic support. And then in the 1994 election, something unexpected happened. I guess polling was a little less sophisticated at the time, but you had the “Republican Revolution” led by [who] was to be Speaker [Newt] Gingrich in the House, and you had the Senate — which had changed hands before, but the House, which had not changed hands and had been in Democratic control for 40 years — switch, and Republicans were ascendant. Bill Clinton was still president. I think probably some of the fact that there was such a gain of seats had something to do with the failure of health reform. And Republicans were getting ready to move a very aggressive deregulatory agenda. And Ted Kennedy, who was a liberal lion of the Senate, who you know was a champion of universal coverage and other liberal causes, moved from the majority side of the dais and having the gavel at the Senate Labor Committee, now the HELP Committee, to the minority side. And Sen. Kassebaum, who had hired me just a few months before that, all of a sudden became the first woman to chair a major committee in the Senate, a standing committee in the Senate. And really, what started it, was that Sen. Kennedy and his team came over and met with us, and somewhat surprisingly, said, “Hey, I know I’m for universal coverage, but I’m willing to do something that’s much more modest,” and shared with Sen. Kassebaum and me and the team a chart that they had put together showing where, not had there been disagreement, but where actually there had been agreement among the major plans, ranging from the most liberal, the Clinton plan, to some of the most conservative plans. And the heart of that, Julie, was health insurance portability, preexisting condition protections at access, and that was the bill that started off in the Senate, and that’s the one that gained traction and passed until we got to the House. 

Rovner: So, Sen. Kassebaum was one of those legislators who actually believed in passing laws, even if it meant compromising — so you only achieved a few of your goals at a time. Why are there so few people like that on either side anymore? 

Rosen: Yeah, well, you know, I think I would say also about HIPAA that it … she was an incrementalist. I think she was one of the reasons … she was considered a moderate Republican in the day, and I think now even more moderate. But she was at her heart a conservative in the sense of she believed that the best legislating was done sort of inch by inch, step by step, as opposed to in one bill. And you sort of saw that proof come to be when the Clinton plan failed, because it tried to really do everything in the healthcare system; it was huge. I think to your question: Today, it’s harder because there’s just less overlap, and the incentives are such that, you know, as one current member of Congress, very senior, told me a couple years ago, if you’re a Republican, you’re looking over your right shoulder. If you’re a Democrat, you’re looking over your left shoulder. And I think that the venerable, you know, Cook Political Report says that in this election, there are only truly 18 toss-up seats in the House out of 435. And so, what it means is that, you know, 5% of the country is going to decide who controls the House ultimately, and the incentives are not to put together bipartisan bills, big or small, healthcare or not healthcare. But the incentive is, frankly, to play to your base, particularly in a midterm election. Now, that’s not always the case. You do have examples of bipartisanship, but I think it’s harder because of those incentives, which we’ve seen become more and more true as politics has changed, and, frankly, as the country’s changed. 

Rovner: You wrote a really lovely tribute to the senator about going to the White House for the signing of HIPAA by Bill Clinton, which I think just showed sort of the generosity of spirit of Sen. Kassebaum. Tell us about it? 

Rosen: Yeah, so, you know, after Nancy passed away, there’s a group of us who’ve been keeping up through chat over the years, and her family, actually granddaughter and stepdaughter, had informed us all before they informed the press over the weekend that she had passed away. And I suddenly was sitting there over the weekend and realizing, Julie, that it had been — she had died 30 years to the day since HIPAA was signed by Bill Clinton. And, you know, to your point of bipartisanship, that bill passed the House with only two dissenting votes and the Senate unanimously. So not only was it bipartisan, but it passed unanimously. 

So we went over to the White House — to kind of tell a little bit of the story — I’d never been to the White House before. This was, like, my first job on Capitol Hill. I was much younger then, and — obviously — and the senator made sure I was on the invitation list. And this was, you know, Sen. Kassebaum was not really known as a legislator who was someone who passed, you know, tons of major bills. This was really, if you read all the obituaries, the health insurance portability law is one of the two bills they mention — the other one being a general aviation bill, and her work internationally, which was significant around apartheid. But they mention this health insurance bill as her signature achievement. So we go to the White House. It’s a hot August day, and as I said, I realized that she died 30 years to the day after this bill was signed. And I was reflecting on the fact of something that I never really shared publicly before, that at the signing ceremony, it’s traditional — as you know, you’ve probably been to many, many, many of these — that the presidents will sign these bills, they’ll use multiple pens, as Bill Clinton did, and he handed one of the pens to Sen. Kennedy, and he handed another one to Sen. Kassebaum — we’re standing over each of his shoulders. And we’re walking out of the Rose Garden, and Sen. Kassebaum came over to me, and it was just the two of us, and she said, “Here, I want you to have the pen. You wrote the bill.” And, you know, I guess as a staff person you do, but I didn’t think of it that way. I thought of the fact that she was giving away to me really one of the most tangible symbols of her signature bill, and I said, “I can’t take this. This is your bill. This is one of your crowning achievements. You worked so hard to get this done.” And she insisted that I keep it.  

And as I said in the piece that I wrote, you know, it struck me that that was just essential Nancy Kassebaum, that not only in the legislation could she find ways to work with Ted Kennedy, who, she said, in subsequent interviews, coming from Kansas — and folks will appreciate this with Wicked being out — that I think a lot of Kansans thought that Ted Kennedy was the Wicked Witch of the East. But working with Ted Kennedy to get something passed into law, and then coming over to me with no ceremony, with no one around, with no political advantage, and just saying, “Here, I’d like to give you credit, as opposed to taking credit for myself,” I think said a lot about her character, and I shared that story with her family, and they gave me permission to share it publicly. I think it just goes to her character and who she was, which, as I said, I think is, much more important than the legislative achievement, was just the kind of person that it takes to get things like that done in Washington today, and, frankly, in Washington then. 

Rovner: Any chance we’re going to get back to seeing those kinds of legislators on Capitol Hill? We’re both in this for the long run. 

Rosen: Yeah, you know, I have to say, you know, I prefer to be somebody, Julie, who looks forward. I mean, you know, you can look back and wring your hands and be pessimistic. But, you know, I came to Washington as a [Ronald] Reagan Republican, and Reagan always said that he felt like American optimism was the heart of the country, and that our best days were ahead. And I really do feel optimistic about the country. We’ve survived a lot over the last 250 years, and you’ve got examples of bipartisan legislation. You’ve got, you know, Dr. [John] Joyce and [Rep. Greg] Murphy, and [Rep. Kim] Schrier, a bipartisan bill in the House that takes on the difficult and expensive issue of Medicare physician reform. You’ve got a bill by Sen. [Chuck] Grassley and [Catherine] Cortez Masto and others in the Senate that got introduced a couple weeks ago on fraud and abuse at a time when that issue could be really political. 

So to me, I do see people of goodwill in both parties who want to get things done. I think we’ve got to recognize, as we talked about a moment ago, that the broader incentives in our country and in our political environment and in our institutions are pulling people apart. And I think it is going to take people of goodwill to find things to do where they can compromise without losing their principles and find ways to make progress. And I do see hopeful signs of that. You know, I’m not sure we’re going to get back to the day where there’s tremendous overlap and a huge number of moderates in either party, but I think it makes it even more important that people of goodwill who come to Washington as citizen legislators and want to solve things find ways to do that. And in this divided government, where we’ve seen 12 change elections of the last 14 and extremely narrow historic margins, it’s going to take both sides to get things done. 

Rovner: We will keep watching, Dean Rosen. Thank you so much. 

Rosen: Thanks, Julie. Thanks for having me. 

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

Roubein: My extra credit is from The New York Times. The headline is “,” by Noah Daly and Andrew Jacobs. And the story is about how Americans are traveling abroad, often to Latin America, for psychedelics, a form of medical tourism, and the authors write that this could carry substantial risks. There’s no official tally of injuries, deaths, or adverse events at the overseas psychedelic clinics. But The New York Times interviewed more than two dozen patients and researchers, who cited just a litany of troubling episodes. Basically, the field of psychedelics is in its infancy, so researchers have found this sort of patchwork of standards and rules. And, just for context, here in the United States, the FDA hasn’t approved a psychedelic as of yet, but the idea has really gained traction in recent years for mental health conditions, but particularly, this spring, when President Trump signed an executive order that was aimed at accelerating research into the drugs and also fast-tracking federal reviews of psychedelic medicines. But advocates for these drugs do have concerns about adverse events at overseas clinics because they don’t want it to, you know, kind of spark a backlash that could hamper this trajectory. The Times did speak to a practitioner who said that his prescribing practices were informed by a patient’s self-reported medical history. But I thought this was a really interesting look at what’s happening overbroad given there’s been so much chatter about psychedelics in the United States. 

Rovner: Something else to worry about. Margot. 

Sanger-Katz: I wanted to recommend an article in Stat from Anil Oza. Headline is “.” And this story outlines that a number of people who had submitted comments on a rule about science funding suddenly found their comments removed from the public record. And it appears that the reason is because they were making reference to Russell Vought, the OMB [Office of Management and Budget] head, who, you know, was behind this rule. He has a child with cystic fibrosis who has benefited from a [National Institutes of Health] NIH-funded drug, and I think a lot of them were making reference to that as part of a personal plea for him not to implement this policy. But it’s a little bit puzzling why OMB removed them, on what basis. They haven’t been transparent about it, and there have been basically no explanations. And I think, you know, Secretary Kennedy, during his confirmation hearings, talked about radical transparency in the HHS process and policymaking. And I think this is one of many examples where that really hasn’t happened. There has been a reluctance, I think, by HHS to go through notice-and-comment rulemaking in situations where it is not necessary. There has been a reluctance sometimes to answer questions from the public, from reporters, and I do think that the kind of deletion without explanation of these comments is part of that broader pattern. There is obviously this personal sensitivity here that is part of it, and there may be some valid reason why this public official’s child should not be in the federal record. But it would be nice if someone would explain. 

Rovner: Yeah, and also props not just to Stat, but to the people who actually have been tracking these comments and noticed that they were taken down. Shefali. 

Luthra: All right. My story is from LJ Dawson. It is a collaboration between Ñî¹óåú´«Ã½Ò•îl Health News and The Washington Post. The headline is “.” This story combines many of my interests, like European vacations, Greece, and fertility treatment. And I think it’s a really, really, like, interesting and useful look into just how expensive this can be for Americans, especially if insurance doesn’t cover it, and the lengths to which people go to become pregnant. And the family that the story follows, they live in Florida. They could only get pregnant through IVF [in vitro fertilization]. They were quoted close to $40,000 for a round, and they were like, This is nowhere near what we can afford. They realized it was much cheaper to travel to Greece, to literally go on vacation in Greece and get IVF done there. And this is a thing that people genuinely do. Like, I know many people who have looked into the costs of IVF in different European countries, including Scandinavian ones. And I think it’s just a really helpful, dramatic look at what happens when people really, really would benefit from a medical treatment for achieving their fertility goals, their reproductive goals, etc., but it is simply not affordable. And I think this is also interesting because there has been so much chatter about making IVF more affordable, but, in fact, it is more expensive than ever and more in demand than ever because people are having children later, more likely to need fertility treatment, and we don’t really have a good solution yet in sight. 

Rovner: No, except that our system is way too expensive. Well, you may have noticed that in my themes of the summer, I left out the unusual spate of foodborne illnesses. Well, fear not. My extra credit this week is also from The Washington Post. It’s by Tamar Haspel. It’s called “.” And it makes a pretty good case that lettuce and its leafy green cousins are not only the foods most likely to result in foodborne illness, but it’s also not got much to offer nutritionally. It doesn’t store very well, and the land that we use to cultivate it could be better used for, well, better food. I have to say, I stopped buying lettuce a long time ago, mostly because it doesn’t keep very well, and I live by myself. And while I do eat plenty of salad, it’s mostly cucumbers, peppers, and tomatoes. Now, you guys all do you, but I can just say that I haven’t contracted cyclospora this summer. 

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

Luthra: I’m on Bluesky . 

Rovner: Margot. 

Sanger-Katz: I am all the places , and on Signal at sangerkatz.01. 

Rovner: Rachel. 

Roubein: Several places: on X, ; Bluesky, ; ; Signal; etc. 

Rovner: As I mentioned at the top, we’re taking next week off. You should too, if you can. It’s going to be a busy fall. We will be back in your feed on Sept. 10. Until then, be healthy. 

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Aug. 20, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

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

Joanne Kenen: Hi, everybody. 

Rovner: Later in this episode, we’ll have another “How Would You Fix It?” interview, from his car, with businessman and entrepreneur Mark Cuban, who’s now devoting most of his professional attention to the mess that is U.S. healthcare. But first, this week’s news. So, we finally have a nominee to lead the Food and Drug Administration, which has been without a Senate-confirmed commissioner since Marty Makary resigned in May — officially, over a dispute about flavored vapes. The winner of the search is Heidi Overton, a 37-year-old physician and former protégé of Makary’s from Johns Hopkins, who currently oversees the health portfolio at the White House Domestic Policy Council. What do we know about Dr. Overton, and what are her prospects for confirmation? We’ve already seen HELP [Health, Education, Labor, and Pensions] Committee Chairman Bill Cassidy say on social media that he has “concerns” about her, but he’s voted for nominees about whom he’s had concerns as recently as — checks notes — earlier this month. 

Kenen: I mean, Cassidy’s saying he has concerns is not indicative of where this ends up. At the end of the day, President [Donald] Trump has gotten most of his choices through a Senate that often begins hesitant to recalcitrant and usually gives him what he wants. So … sometimes it doesn’t. I mean, it’s not 100%. So, Cassidy is in a different position politically since he’s about to leave the Senate, and partly because President Trump. So we just don’t know where Cassidy is. But it’s not a great start. But it doesn’t mean … it’s the end. 

Rovner: What do we know about Heidi Overton, though? Everything I’ve read about her, she’s either pro-MAHA [Make America Healthy Again] or the MAHA people don’t like her, or she’s, you know, of Marty Makary or not of Marty McCarry. 

Ollstein: Yeah. So my colleagues and I wrote about this yesterday, and a lot of the leading MAHA activists view her as having been a roadblock in the White House to their efforts around pesticides, around vaccines, and other things, and so they are up in arms about the pick. They are, you know, saying she’s … part of the swamp and not part of, you know, the movement that they want to see sweep aside some of these government practices. And I think that her time in the White House and her previous work for the America First Policy Institute could really come back to haunt her. She wrote a lot of papers and op-eds with some controversial takes and policy positions, and I think everybody is sort of scrambling to go over that. People are also talking about her lack of managerial experience. You know, managing a huge agency with a huge staff, and you know, obviously, we have seen recent examples of people who lack that experience being appointed. So that’s also not a deal-breaker necessarily. But all of these things could add up to be problematic for her in the confirmation process. And then what I focused on was her anti-abortion record, which, you know, both could help and hurt her depending on whose votes we’re talking about. 

Rovner: That’s right. I mean, we saw [Sen.] Patty Murray, senior member of the HELP Committee, come out and, you know, and say, Not somebody that I could ever vote for. And also, I mean, she was at the signing of the vaccine executive order that the president had. So that puts her — whether, whatever she says in her confirmation hearings — that sort of puts her with the “Let’s change the vaccine schedule” group. I mean, she seems to fit in nowhere. I guess that’s sort of my question here. 

Luthra: That’s what’s so interesting about her is that there are these sorts of different interests and constituencies that have concerns about her, but sometimes they feel as if they could be contradictory. You obviously have, I mean, Patty Murray — I don’t know if she was ever going to vote for whoever Trump picked — but then you have Susan Collins in a very difficult reelection race, where abortion is a concern. You now have these concerns about vaccines. You have people saying maybe she’s not MAHA enough. And I mean, I think to Joanne’s point, Trump has gotten most people he has wanted. However, this does feel like this could get very complicated, just given how many people may be bringing different criticism from different vantages that could ultimately add up. 

Kenen: I’m not sure we’ve ever seen anything on the Senate floor where she’s going to be called anti-abortion and pro-pesticide. If it gets to the floor, I mean, it’s a weird one. But at the end of the day, you know, does it go through? You know, if you made me bet, my bet would be yes, but I wouldn’t want to bet a whole lot of money. 

Rovner: Well … we’re going to talk about reproductive health later in the podcast, but I do want to talk about abortion right now in the context of this nomination because, Alice, as you point out, Overton is known to be a fairly strident abortion opponent, and if she is confirmed, she’ll take over the study of the safety of the abortion pill mifepristone, which, as we have mentioned many, many, many times, the administration has sort of backbenched, if you will. Given that the new attorney general, Todd Blanche, has raised the specter of invoking the 1873 Comstock Act to bar the mailing of abortion pills, or anything else used for abortions, what is the outlook for medication abortion if Overton actually becomes the FDA commissioner? 

Ollstein: Well, it’s hard to say because we’ve really seen decision-making centralized in the White House, and so often it doesn’t matter what the Cabinet secretaries want to do. It’s about what the White House wants. And the White House, I think, has made it pretty clear that this is not a top, you know, restricting abortion is not a top priority for them. They are certainly sensitive to the politics of it, and so there is speculation that, you know, there’s a delay until after the midterms for anything meaningful on this front, so as not to risk the kind of backlash we saw in 2022 after the fall of Roe v. Wade. But I think it’s also pretty clear that this is just not a top priority for the White House. That doesn’t mean they won’t allow some of these, you know, former activists to do what they want to do — so Blanche, and now Overton potentially. But I think it’s not really a given either way. 

Rovner: Yeah. All right. Well, meanwhile, in administration news that we’ve talked about before but is still relevant, we’re just over a month from the end of the fiscal year, and grant money is still being held up at the National Institutes of Health, according to our podcast pal Paige [Winfield] Cunningham at NOTUS. Despite pressure from Congress, the agency is still delaying funds for already-approved grants while it conducts searches for keywords that could signal that the grant does not adhere to the administration’s political priorities. And it’s not just keywords. Reading from : “In multiple flagged grants, officials expressed concerns that they weren’t worth funding because their only practical use might be to support the writing of new laws.” Now, this is going on against the backdrop of a proposal from the Office of Management and Budget that would officially insert political approval into grant funding. That’s something the Senate has voted to at least temporarily block, but the House hasn’t weighed in on it yet. This could not only have huge implications for federally funded research going forward, but you could argue it’s having implications now. We’re seeing researchers, you know, taking opportunities overseas because they don’t know what their, you know, grant funding continuation is going to look like, and students not going to graduate school or not pursuing research careers. I mean, this is … even some of these sort of small things are having these bigger potential ripples as they go outward, right? 

Kenen: Colleagues who are grant-funded, NIH-funded, or other government-funded. I mean, they try to track the ever-changing rules. First of all, it’s very murky. It is changing. They keep adding things. Basically, they don’t want — not just the banned words — they don’t want research that can be bad, that can be used for policy …  

Rovner: For things they disagree with, for policies they disagree with. 

Kenen: They don’t say it … right. Guidance doesn’t come out and say “policy that you know we don’t like.” It just says “policy.” But it’s really vast and confusing. It’s not new. What Paige wrote about is an update. I mean, this is still happening. It’s been happening since the beginning of the Trump administration. NIH is the biggie. There are some smaller agencies, like Agency for Healthcare Quality and Research [sic], AHRQ, right? 

Rovner: Research and Quality. 

Kenen: Agency for Healthcare Research and Quality. That’s pretty much defunct now. But those grants, the money stopped going out the door many months ago. So …  

Rovner: And the National Science Foundation. I mean, NIH is sort of the biggest of them. Yeah. 

Kenen: It has to have the word “science.” … NIH is the biggie, right? I mean, and it’s also the bench science, the science that the drug industry … people don’t understand, they say, Let the drug industry do it. They can’t do this kind of basic bench research. They take this research and develop drugs, but the fundamental cellular level is NIH, or NIH-funded. And it’s really, I mean, clinical trials have been stopped in the middle — really promising research that is not partisan. … Disease doesn’t care. It’s cliché, and it’s also true. It just stopped, and work has been lost. But people haven’t done things that are several years in. … The deadline, also, for fiscal year spending is, if it’s not out the door, which is Sept 30, anything that’s out that door is, like, that’s done. It’s it. Bye-bye. The money isn’t gonna, unless it would go through a whole new process next year, which is unlikely in these grants, that’s the end of that. 

Rovner: Yeah, and that’s, I mean, my point in wanting to bring this up again — and you’re right, it is sort of an update of what we’ve seen — is that every time one of these top administration officials comes to Congress, they say, You’re supposed to be spending the money that we have appropriated, and they say, Oh yeah, not a problem. We’re going to spend the money that you’ve appropriated. And yet we keep seeing these stories that they are not spending money that Congress has appropriated. 

Kenen: Yeah, and historically NIH has been reasonably bipartisan. There have been years when there have been fights. There’s obviously stem cells and sort of certain issues have been, you know, very hot potato. But the basic enterprise of U.S. science, health science, has been largely bipartisan. Again, not every appropriation season, not every bill. But if you look at the overall arc, it’s bipartisan. 

Rovner: It was Republicans who doubled NIH funding in the 1990s — who led it.  

Kenen: [Arlen] Specter. 

Rovner: It was Newt Gingrich, actually. I mean. 

Kenen: Yeah, Gingrich, too, was very into health tech and things like that before his time. I mean, the War on Cancer was federal, right? That was [President Richard] Nixon. So, but we’re now in a …  

Rovner: Different place. 

Kenen: Yeah, frozen. 

Rovner: Yeah. Meanwhile, Mike Stobbe at the AP is at the Centers for Disease Control and Prevention — again, where money’s been appropriated, but there is literally nobody at home. At the agency’s Office on Smoking and Health, and offices on Alzheimer’s disease, epilepsy, and sickle cell data collection, funds are allocated, but all the staffers have either been laid off or are still on administrative leave. So they’re being paid, but they are banned from working. This is yet another immediate challenge for new CDC Director Erica Schwartz, who had her first meeting with CDC staff yesterday. What do we expect her to take on first? 

Luthra: I don’t envy her. It, frankly, seems very difficult to figure out what your priorities are or should be, if you perhaps don’t have staff. It does seem like, from the reporting, perhaps a priority that she has outlined might be morale. And we know that morale has been very low in a lot of government agencies and the executive — especially places like the CDC, where you have a lot of career people who are mission-oriented, really believe in doing things for public health, and have seen that really attacked. And so I don’t know if that is enough to actually translate into things that are supposed to happen actually happening. But that seems like probably a place where it makes sense to start, right?, is just to help people feel confident that they actually will be able to do the work that they signed up to do. 

Rovner: Yeah, and you know, as you say, CDC is perhaps the most mission-oriented of all the HHS agencies. And because they’re in Atlanta, and you know not in the Washington area the way most of the rest of HHS is, they do often feel cut off. So she does have … she has a lot on her plate. And speaking of the CDC, the agency put out a rather cryptic press release this week on vaccine uptake among kindergartners entering school, noting that “CDC continues to encourage parents to discuss vaccination options with their doctors.” Meanwhile, the data linked to in the press release shows a small increase in parents opting out of having their children vaccinated nationwide. But that masks a much larger increase in some states. In Idaho, for example, just 75% of kindergartners entering school have had the MMR [measles, mumps, and rubella] vaccine. That’s obviously well below the 95% needed to provide herd immunity for measles. As my friend Jonathan Cohn put it in his piece for The Bulwark. “The scientific term for that is yikes.” Yikes indeed. 

Kenen: And it’s even within states … and some rural counties … there’s a lot of variation. The trend … for a number of years now has been dropping vaccine rates. Period. So I mean, whether CDC wants to engage in this as their first issue, they’re going to be asked about it. … They track it … can’t avoid it, because they have to approve and recommend, and, you know, insurance coverage, all sorts of things are imminent. So decisions have to be made. … Back to school’s already started in some parts of the country. 

Rovner: And so … I would say new CDC Director Schwartz was rather pointedly not in the room when the president signed the executive order on vaccines, even though now-FDA nominee Heidi Overton was. 

Kenen: She cannot put her head in the sand on this one. She’s going to have to … 

Rovner: “She” Schwartz?  

Kenen: Yeah. So she’s she says, I mean, what we know so far is she’s been quite, you know, she went to the CDC, and the reports are that she came out and said, you know, I’m going to stick to the science, and the science supports vaccines.  

Ollstein: I thought what was really interesting about the recent reports is that, you know, the executive order the Trump administration signed doesn’t actually change anything legally, but it’s designed to put pressure on states to change their recommendations. And it’s been fascinating to me to see that even the reddest states really aren’t going for it yet. But that doesn’t mean that everything’s fine and everyone’s getting vaccinated. What we are seeing is, you know, individual parents making these moves away from vaccination. And so even without the state officially changing its requirements, the environment is just shifting, and using the bully pulpit in this way is changing people’s behavior — building on trends that were already happening: distrust and misinformation, and all of that. And so … even a small, small decline in the vaccination rate can have huge negative effects. I mean, the difference between having 97% vaccination vs. 91% — it may not seem like a big deal, but that’s the difference between herd immunity and people really being vulnerable. 

Rovner: And lots and lots more cases of measles, as we are seeing already this year. I mean, it’s, you know, talk about things that were completely predictable. Well, meanwhile, as my Ñî¹óåú´«Ã½Ò•îl Health News colleagues Amanda Seitz and Stephanie Armour point out this week, all of this public pronouncing by the president and other health officials about the supposed dangers of vaccines comes as HHS Secretary RFK Jr. blows past deadline after deadline to uncover the promised cause of the rising cases of autism. The story notes that the secretary “has looking for root causes in a research effort that’s offered no public status updates and few details about who, or even which agency, is leading the effort.” We do know that one of the people working on the project is Reyn Archer — he’s a noted vaccine critic, son of a former House Ways and Means Committee chairman, and was head of the Title X Family Planning Program during the George H.W. Bush administration in the early 1990s — even as he was publicly opposing legalized birth control, which of course is what the Title X program does. He later served as Texas’ state health commissioner under then-Gov. George W. Bush, although he was eventually fired for making racist remarks to a subordinate. I had not heard his name since, until now. But he’s going to uncover the root causes of autism, am I right? That’s the plan? 

Kenen: More power to him. I mean, autism. It’s not like there’s no research, and the conclusion is that it’s multi-causal. That there’s not one cause. That’s the current state of the science, which can always evolve. But the current belief is there’s probably a genetic component, but it’s a mix of factors that we don’t fully understand. But vaccines is not one of them. 

Rovner: Or at least so every study, every big study, we have seen continues to say. Well, moving on, lots of news about healthcare prices this week, which remain a pressing issue for both Republican and Democratic voters as the midterms draw near. One interesting story this week noted that prescription drug prices fell year over year by more than 3% — that’s the largest drop since the early 1960s — but it’s not entirely clear why. The Trump administration, of course, says it was their efforts, particularly to bring down the price of those popular but very expensive GLP-1 weight loss drugs. Analysts say it’s more likely the result of the Biden-era Medicare drug price negotiations, which involved more widely used medications. Whichever, I imagine if you’re not seeing your prices drop at the pharmacy, and those drops may well be absorbed by insurers and middlemen and all the people we talk about, will this good news even have much of an impact when people go to the polls? 

Luthra: I can’t imagine it necessarily would be that meaningful because overall the macro trends remain pretty bad. Health insurance is still getting very expensive. Employers are really struggling — those that offer it — they are largely passing more costs to consumers. And so people are getting to have to pay more for healthcare, even if their drug prices may be decreasing in the aggregate. And so it’s just hard to really suggest that this good news could really outweigh those other factors, especially when you think about the broader sort of angst that exists around costs and costs continuing to go up. 

Rovner: Yeah, well, in wonky news that could actually have a larger impact on what people pay for medical care, the Trump administration is actually going after some deep-pocketed healthcare providers. Stat News reports, in separate stories, first that the — that’s the parent of UnitedHealthcare, the insurer, and Optum, the services and tech arm — for allegedly underpaying taxes by funneling money through a foreign subsidiary. And second, the for potential antitrust violations. State attorneys general are also looking at Epic’s alleged anticompetitive practices. Cracking down on some of the monopolistic practices of the largest payers in the healthcare system actually could end up saving the system money, right? I mean, this was … something that we saw a fair bit of during the Biden administration, particularly from the Federal Trade Commission, and not so much of during the Trump administration, which has seemed to have been more favorable, if you will, to big companies. 

Luthra: I guess there’s still that question about providers, and obviously bringing down prices and addressing consolidation in payers, amongst things like electronic health record companies, can be effective, but we probably also would want to see meaningful movement in terms of provider consolidation as well, and that just seems potentially like a bigger hill to climb. 

Rovner: But this is a start. One would say, particularly this administration, going after United, which is sort of the the biggest … United’s power threatens the federal government’s bargaining power at this point. I was interested to see, you know, this story, if nothing else, made public, because obviously somebody leaked it. We will see how these all shake out. Well, finally, Costco, home of the cheap rotisserie chicken and the $1.50 hot dog and soda, is entering the Medicare market, . According to the Journal, Costco will partner with the nonprofit SCAN Group to offer Medicare Advantage plans in two states and a Medicare supplement, Medigap, plan in a third state. Could this eventually make a dent in the private Medicare market? Costco already does big business selling discount prescription drugs, eyeglasses, and hearing aids. I get my dog’s flea and tick medication at Costco. It costs half of what it does at my vet’s office. One presumes this could be, you know, a leader. We’ve not seen this before, right? 

Kenen: The head of SCAN, which is a pretty reputable insurance company … 

Rovner: Nonprofit insurance company. 

Kenen: Nonprofit insurance, and I should say I know … personally the current CEO, president, whatever his post is. I mean, but you know, I’ve written a lot about aging over the years, and it’s basically considered … one of the higher-quality, more reliable elderly-focused health plans. And he has something interesting to write when he announced it or wrote about on LinkedIn about how he personally, like, is a big Costco guy. But he talked about trust, which we’re all talking all the time about how there’s a lack of trust in healthcare. There’s a lot of trust in Costco, and he talked about how branding, SCAN, and Costco, you know … obviously it’s a business decision he made, but he’s also, like, this big Costco guy and who worries — I know him through conferences on trust, actually, that’s where I met him — and he’s thinking, OK, Costco, in addition to, like, giving you way too much of whatever it is you thought you needed, it can also fix the trust crisis in America. Right? 

Rovner: Hey! 

Kenen: And they’re efficient, right? I mean, I don’t know if all four of us are Costco people, but the, you know … 

Rovner: I am. 

Kenen: I saw her. I ran into her buying her veterinarian [unintelligible, through laughter] … I was in the photo section. … It is a trusted brand, and it’s an interesting — and they have national reach in there, you know. 

Rovner: And you will hear in my conversation with Mark Cuban that trust is a really big deal in healthcare right now. I mean, we obviously talk about this every week. I mean, I’m, obviously this is a very small step, but I’m really interested in where it turns out. 

Kenen: It’s a smart business move, and it’s a talker, too. Like, people are gonna see this headline and pay attention to it because it’s, like, just a thing. 

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

So, a good bit of reproductive health news this week. Glad to have both Alice and Shefali here. We will start in Idaho, where a federal district court judge ruled that the state’s abortion ban cannot be used to prosecute doctors who perform abortions to protect the pregnant person’s health, not just her life. Of course, abortion opponents vehemently oppose health exceptions, as they’re called, because they say health includes mental health, and that becomes a loophole so big that it basically eviscerates the ban. The state’s attorney general, former congressman Raúl Labrador, said he would appeal and was confident the decision would be overturned. I would imagine that he’s probably right. Is the Supreme Court eventually going to have to spell this out? I wouldn’t be that surprised if they wanted to. 

Ollstein: I think this gets into some of the same EMTALA [Emergency Medical Treatment and Active Labor Act] territory, where we have seen the Supreme Court sort of back away from in recent years. But again, we just keep circling around and around the same question, which is, when is an abortion OK for a medical emergency purpose? How close to dying does a woman have to get before a doctor can perform an abortion? And we’ve seen again and again in Idaho that doctors are scared and confused, and even when they think that they should have the right to perform the procedure, you know, they’re still putting women on these dangerous life flights to other states in order to get care, leading to hours and hours of delays and potential complications. And so, you know, this court case and this court ruling was sort of aimed at clarifying that and giving doctors the confidence to be able to intervene when they feel it’s medically necessary. But now we’re seeing the state challenge that, and we’re just going around and around. And, you know, there have been similar cases in other states, just a whole mix of rulings, one way or the other, and that just creates more of a patchwork where, you know, some somebody’s ability to get care varies completely between states — and even within states, between hospitals, based on how much you know institutional backing doctors feel like they have. You know, will their hospital’s lawyers go to the mat for them or not? Do they work in a private practice vs. a big hospital system? All of these things come into play, 

Rovner: And, of course, we’ve also seen doctors, particularly in Idaho, leaving the state because they’re afraid that they can’t practice. I mean, they can’t adequately care for their patients. Shefali, I see you nodding. 

Luthra: Yeah, and what’s interesting about this case, other than the fact that Idaho will actually have an abortion ballot measure this November, is that we do have a federal judge here saying, in particular contexts, I see a right to an abortion. And I was talking to some abortion legal scholars about this, and they made the point that, in a way, this runs afoul of the Dobbs decision, because you do have a federal judge saying people are actually entitled to abortions, and that is a right that they have, even if it is much narrower than what Roe v. Wade guaranteed. And obviously, this is going to be appealed. This is going to continue to be litigated. We may not see immediate change for people’s ability to get healthcare in Idaho or other places with very strict bans, but it does underscore how unsettled these legal questions remain — how there remains a lot of debate over whether Dobbs was actually a correct interpretation of constitutional law. And I think it really takes us back to the argument we heard from some of the conservative majority that this would now settle every question about abortion. Obviously, it has not. Obviously, many more questions will continue to be argued and litigated in the courts. 

Rovner: Yeah. Well, meanwhile, in other breaking news, a federal judge here in Washington blocked the Trump administration’s changes to the teen pregnancy prevention program that funds classes on contraception and abstinence, among other things. But they’re still not necessarily getting the money appropriated by Congress, right, Alice? 

Ollstein: So a judge in D.C. is blocking the administration from using its very strict new guidance going forward when it doles out money for the program, but it’s not ordering the administration to give back the money that was already cut earlier this summer from all of these grantees around the country. And, by the way, the money was cut both from grantees like Planned Parenthood, where you would say, “Oh, well, that sort of makes sense that the administration would go after their money.” But they’re also cutting funding from, you know, faith-based programs, abstinence-only programs in very red states, and prompting a fair amount of backlash that I’ve been covering. You know, places like Texas and South Carolina and West Virginia have also lost funding. And, of course, all the programs in those states had to abide by state restrictions around what can be taught. And so they were already following these very conservative guidelines. But that’s not conservative enough for the administration, which put out this guidance saying, you know, while abstinence-only was an option before, now it is basically mandatory. And so that guidance is on hold, but, again, the judge said that he didn’t know if he had the authority to order them to give back the money, or if some other jurisdiction could handle that. And so, this is just a preliminary injunction, which means there’s going to be months and months of litigation going forward. 

Rovner: Finally, this week, a story from the “Who Could Ever Have Imagined This?” files: A California couple hired a surrogate in Alaska to carry their pregnancy. After the fetus was diagnosed with a life-threatening heart condition, the couple exercised their option in the surrogacy contract to terminate the pregnancy. But the surrogate refused to have an abortion, and she traveled to Texas, where abortion is illegal, and gave birth to a baby boy last week. News reports say the baby, who is now in the custody of the couple who are biologically his parents, had the first of several surgeries needed to treat the heart condition. But this is a genuinely wrenching situation. Who gets to decide what here and under which state’s laws? Bioethicist Arthur Caplan told Houston Public Media that there are so many ethical issues here, he could spend an entire semester’s course teaching it. 

Luthra: And I think what is important about this case as well is, I mean, it’s obviously just like so, so, so sad, and this poor family is just having to deal with something really heartbreaking that no one should have to navigate under the national spotlight in Texas. It is really energizing conservatives who want to ban surrogacy, and we have already heard from lawmakers in the state legislature say they will be looking at surrogacy specifically when they convene next year. I have talked to anti-abortion activists in the state who are very hopeful that this case will give them new impetus to ban, at the very least, commercial surrogacy. They would love to ban all forms of surrogacy. And it is seen by a lot of anti-abortion folks who oppose fertility treatment, including IVF [in vitro fertilization], as something maybe easier to target. And I think it’s politically really complicated, because Americans don’t know as many people who get pregnant through surrogacy as they do people who might use IVF. But when I was talking to, again, legal experts about this, one point they made is that if surrogacy restrictions do take off in a meaningful way, often, the intellectual framework and arguments being made are ultimately the ones that would be used for IVF restrictions as well. And so, there is a possibility of a real slippery slope and more of that opening the door to fertility treatment restrictions that could affect a lot of people. 

Kenen: I think there’s a lot of public misunderstanding about what a gestational carrier is. When surrogacy became, not common, but sort of emerged in the public eye, there were a couple of really high-profile court cases. This was in the late ’80s. The “Baby M” was the most famous. And these were situations, at that point, where the woman carrying the child, it was her egg. So in the Baby M case, it was a couple that couldn’t have children. She was-— I don’t even know if that was — that wasn’t probably IVF. That was probably some other kind of artificial insemination. But the woman who decided she didn’t want to give up the baby after carrying it — it was, in fact, her biological child — and the practice became not to let, to separate the surrogate carrier from the egg donor. It’s not 100%. It’s not that it never happens, particularly if there’s family situations where maybe an aunt carries, etc. In this case, we’re really, based on public record, because I did a little reading on it this morning, it’s not clear, of the “biological parents,” it’s his baby. It’s not 100% clear on the public record that it’s actually her egg, the wife’s egg. But it is not the carrier’s egg. The woman suing to keep the child, saying she wants to have the baby, it is not her, it was not her egg. State law varies. Most states say that the surrogate in this kind of situation does not have maternal rights; that it’s the couple that hired her. Texas is, I believe, more blurry. There are a few states that it is more ambiguous, and also remember that this is a really tight, unusually and unexpectedly tight Senate race in Texas, where a very anti-abortion state, obviously, and also in this case the couple says they didn’t even ask for the abortion, but that’s he-said-she-said-they-said, we don’t know. I don’t know, at least, right? But abortion is a huge political driver in Texas; it’s a close race. [Ken] Paxton, who is the state attorney general, who is taking the side of the surrogate mother, is also the Senate candidate. You know, this is, you know, we’re 2½ months out, whatever, from the election. Three, I guess, closer to three still. But it’s very political in a state that probably has more politics around abortion than probably any other state. 

Rovner: Just what we needed: another thorny issue to throw into this mix. All right, that is this week’s news, or at least as much of it as we could get to. Now we will play my in-the-car interview with Mark Cuban, and then we’ll come back and do our extra credits. 

I am so pleased to welcome businessman and entrepreneur Mark Cuban to “How Would You Fix It?” Mark is probably best known to most people as a former shark on the TV show Shark Tank and the former [co-]owner of the Dallas Mavericks NBA team. But he’s also the co-founder of the Mark Cuban Cost Plus Drugs company, which sells generic medications directly to consumers at transparent prices and big discounts. More recently, he’s been talking about even bigger reforms to the healthcare system, which is why I’m so excited to have him here. Mark Cuban, thank you so much for joining us. 

Mark Cuban: Thanks for having me. 

Rovner: I’m curious: Your background’s been mostly in tech and in sports. How did you come to make healthcare such a priority? 

Cuban: I got a cold email from my now co-founder, Dr. Alex Oshmyansky, and he wanted to build a compounding pharmacy that made sterile injectables that are on the FDA short-supply list — which it’s crazy that there is a short-supply list for generic injectables. So that was great, but it wasn’t big enough. And as I looked into it, it was right around the time that “pharma bro” [Martin Shkreli] was going to jail, and I was like, “How can this dude jack up the price of a generic medication to the detriment of so many people?” And then it became obvious that nobody knew what a medication costs, nobody knew why it cost what it costs, and nobody understood why everybody paid a different price for the same medication. That list led to us launching costplusdrugs.com in January of 2022, and it’s just been growing like a weed ever since. 

Rovner: For decades now, the big debate in health policy has been whether the system should be more run by the government or more run by the private sector. Is that even the right way to focus on this anymore? Now everything is sort of hybrid and a mess. 

Cuban: Yeah, no, it’s not, because if the government doesn’t have data, and the government can’t trust the vendors that they’re working with, it doesn’t matter that it’s the government doing all the negotiating. And you see that in other countries. For instance, we get emails from countries around the world — from Canada, England — asking to buy generics from us ’cause our prices for generics, particularly specialty generics, are less expensive than what they sell for in countries that have single-payer or universal care. And so, while I’m not opposed to single-payer or universal healthcare at all, and kind of the analogy I use is: If healthcare costs $1 per person per year — yeah, great, taxpayers would pay that. But it would be a set $1 and it’d be obviously inexpensive. But when you don’t know all the costs, when there’s no transparency, it’s impossible to determine if it’s a better solution or not. 

Rovner: Are there segments of the healthcare industry that would work better if the private sector ran them, and better if the government ran them? I’m thinking, you know, hospitals, doctors, drugs.  

Cuban: I don’t think it’s like that at all. I think it depends on how much transparency there is. The fundamental issue is transparency and trust. If you don’t know … like, there are a lot of hospitals, and you know this better than anybody, that don’t know their costs. And if you just hire the same people and just say, “Look, we’re going to pay Medicare pricing to Mayo Clinic, and Mayo Clinic doesn’t know all their costs,” or “We’re going to take an urban hospital and continue to pay them Medicare and Medicaid because that’s most of their business,” and they don’t know their cost, they just know their cash balance, it doesn’t matter who runs it. 

Rovner: So, what do you fix first? 

Cuban: Transparency. You have to be able to publish contracts so that any contract that’s signed with a federal agency, the federal government, a state agency, a city, not only are the terms of the contract published, but the prices are published, so that Tricare would be required to publish their prices. By seeing the actual contract, you can see where the city-state agency is getting ripped off. Because right now there’s confidentiality requirements, and the companies, like the big insurance conglomerates, they say, you know, we can’t do this. We can’t show this, it’s proprietary information, which is nonsense. You’ve got hundreds of thousands of companies. You’ve got hundreds of agencies and states and cities that negotiate the same contracts. So lots of people know, but they do it to make it more complicated. And so, as a result, nobody knows how the deals are structured. And if you don’t know how the deals are structured, it’s impossible to negotiate better ones. And if they’ll sue you for discussing it with their peers, then nobody … it’s like Fight Club. The No. 1 rule [of] Fight Club is you can’t talk about Fight Club. The No. 1 rule of healthcare contracts is you can’t talk about healthcare contracts. 

Rovner: Yeah, and we’ve, you know, Congress has passed laws. The president has pushed a lot of these transparency rules, and basically, the health industry has said, “Yep, sorry, we can’t do it,” or “We’re going to do it in such a way that you can’t find it out anyway.” 

Cuban: Correct. 

Rovner: “We’re going to send you reams and reams and reams of data, and you can go digging if you would like.” 

Cuban: Correct. And so you take that to the next step. The big healthcare companies — first of all, they’re vertically integrated. They have hundreds, if not thousands, of subsidiaries. People don’t even know what the subsidiaries are when they do business with them, right? And so, when that happens, there’s just no way for any of the states, cities, federal government to enforce the laws. The big healthcare companies have more lawyers, move faster, are better able to find loopholes than the government and the agencies that enforce it are able to enforce it. And so, what ends up happening. You see all these fines. This PBM, this insurance company, whatever got fined for A, B, or C, and then they just go right back to doing business with them. So when I talk to governors, one of the first things I say in terms of reform is A) publish the contracts, and B) if you are doing business with a vertically integrated healthcare company, and they are fined by any federal agency or any state government, they get one mulligan. If they are fined a second time, they can’t do business with you for five years. That will act as the enforcement mechanism to keep them in line. And then the third thing that I always push is that anybody is able to go out and make a cash purchase, whether it’s medical or pharmacy, as long as it’s less expensive than their out-of-pocket, and have it by law count towards their deductible and max out-of-pocket. When you do that, you give them the opportunity to shop. When something is shoppable — not everything is — but you give them the opportunity to shop, and that helps force down prices. 

Rovner: So, I’ve been doing this since the 1980s, and it’s always been the Democrats beating up on the big insurance companies, and the Republicans basically defending them. Now that Republicans are beating up on the big insurance companies, are we kind of inevitably going towards a government-run single-payer? 

Cuban: No. Like, if you look up, if you look at the Break Up Big Medicine bill that was introduced by Josh Hawley, a Republican, and Elizabeth Warren, to me that’s the first step. So the good news: It was introduced on a bipartisan basis. Because if you break up these big, huge conglomerates, everything changes. The price of everything drops like a rock. But the problem is, nobody else, no senators have supported it, and nobody in the House has introduced a comparable bill. Everybody just chickened out. And so that’s the first step. Put aside the economics. Put aside that we don’t know the cost. Put aside that we have no transparency. All those things are important, but making sure we have health care for everybody is more important. That’s the difference. I think that also should be an American dream. As an entrepreneur, I’m a big fan of the American dream. But being able to be healthy and not be afraid that you can’t afford what you need or your family needs, that’s wrong in our American dream. And you know, when we talk about healthcare as a right, doctors freak out because they presume that they’re going to be paid Medicare rates, and they lose control of their life, right? And they talk about opting out and not doing it, you know. And so you need to get all these stakeholders accounted for. And until you start to do that and put together a plan that people will accept, we’re not going to ever be in a position to take care of people like so many of us hope to do. 

Rovner: And yet that would require both parties to basically lay down their arms.  

 

Cuban: Yes, which I think is possible. I think it’s doable because the No. 1 thing that, in every poll, people are concerned about healthcare costs. It’s not the quality of healthcare. Nobody really complains about the quality. Our doctors are great. Our systems are great. It’s the economic side. And who defines the economic side? Those humongous healthcare conglomerates. And what’s the best way to get to a point where we have transparency at the contract level, you know, flexibility and understanding, etc., all the things I mentioned? You break up those huge conglomerates that have thousands of subsidiaries that do $150-plus billion in intercompany transfers, that game the medical loss ratio. I mean, all these things happen because those big companies have more control over the economics of our healthcare system than the government does. 

Rovner: Well, I hope we actually get to that point, and I hope you’re around to help with some of these stakeholder conversations. 

Cuban: Oh, hopefully I’m not going anywhere. 

Rovner: Thank you so much. 

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

Luthra: Sure. My story is from The 19th by my colleague Barbara Rodriguez. The headline is “.” And I love this whole genre of story. The GLP-1 market is exploding because these drugs can be so expensive to get from your healthcare provider. You see advertisements everywhere, all over social media, people promising to sell you a GLP-1. And as Barbara’s story gets into, often they are not actually GLP-1s. It is something fake. It is not actually going to help you lose weight, but it is going to take your money. And I just think that this is such an exploding market. So much has changed that we can’t read enough about how the, just the growth of options, or not legitimate options, is affecting people, and I’m really glad she did this story. 

Rovner: Yeah, it was a really good story. Alice. 

Ollstein: I have a story from The Texas Observer by Mary Tuma, and it’s called “.” So this is taking a deep dive on the situation in Texas, but the article does a good job of pointing out that this is a trend across several states that implemented abortion bans, where there was, you know, efforts to pause or revamp, or obscure, or change in some way the groups in every, that exist in every state that study maternal deaths. And there is just a suspicion that this is an attempt to hide from the public the impact of the abortion ban on maternal mortality. You have a lot of experts quoted in this piece. You have the family members who have lost their wives and mothers to pregnancy-related deaths, and so this is just an ongoing fight. And, you know, doctors say we really need this data and this analysis to know how to better provide care in the future. It’s not just a political football; it’s actual medical knowledge that we need to build. 

Rovner: Yeah, I think ProPublica did this for Georgia, I think, last year, so yet another in these series. Joanne. 

Kenen: There’s a story in Politico by Owen Dahlkamp: “.” This is not unique to health law, but given how complicated health law is and how much health law Congress deals with in any given year, it’s quite relevant to health law. So staffers are using AI to actually draft legislation, not just to research something. And I mean, it’s hard to get away from AI now. It’s, like, even pops up on people’s phones, right? But drafting legislation is very precise and complicated, and AI is apparently not very good at it. So the House counsel, which is the Office of Legal Counsel, which actually has to make sure the legislative language is correct and doesn’t accidentally reveal the wrong thing, they’re having a hard time. Although they have now created their own tool to try to correct the AI slop, but they’re getting overwhelmed. There’s, you know, we’ve all seen stories, we’ve all gotten pitches about, you know, so-and-so introduced a law. What the general public doesn’t understand is introducing a law, you know, it’s good for a press release — introducing a bill, excuse me. Introducing a bill does not mean a whole hell of a lot, except that you’re satisfying some constituent or constituent group, right? But congresspeople and senators like to say they introduce this and they introduce that and they introduce the other thing. So the number of bills being introduced was already rising spectacularly, and now with the slop, there’s like the slopth degree of it. So it’s messy. 

Rovner: It is messy, and it does, I mean, it sort of prevents the real work of actually drafting legislation that’s going to become law from getting done. 

Kenen: There’s going to be something, like, really bad that comes out that somebody in the poor OLC office doesn’t catch, and it’s going to repeal, like, you know, the flag. 

Rovner: Yeah. We will see. All right my extra credit this week is from Mother Jones by Sophie Hurwitz. It’s called “.” And you may have heard that ICE [Immigration and Customs Enforcement] is spending $20 million to buy these gloves, which administer an electric shock at the touch of a button on the wrist for their officers. What makes them better than a Taser or other non-[lethal] device? Well, one Missouri police officer whose force uses them said the gloves “allow their wearer to inflict pain without leaving the sort of marks that could look bad to witnesses or leave an officer vulnerable to lawsuits.” In other words, they make it easier for people to inflict pain on others, whether warranted or not, without likely recourse. How very 2026. 

OK, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our fill-in producer-engineer this week, Zach Dyer. We also had production help from Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X , and on Bluesky . Where are you guys hanging these days? Alice? 

Ollstein: on Bluesky and on X. 

Rovner: Shefali. 

Luthra: on Bluesky. 

Rovner: Joanne. 

Kenen: Mostly on and on . 

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

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Aug. 13, at 10:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Great to be here. 

Rovner: And Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

Rovner: Later in this episode, we’ll have my “Bill of the Month” interview with Paula Andalo. But first, this week’s news. We’ll start this week with vaccine policy — more specifically, vaccine policy being made from the Oval Office. On Monday, President [Donald] Trump, surrounded by HHS [Department of Health and Human Services] Secretary Robert F. Kennedy Jr., and other health officials, signed an executive order calling for “gold-standard” childhood vaccine recommendations. The order calls for the current federal childhood vaccine schedule to be divided into three parts: one with a shorter list of shots recommended for all children, another list for high-risk populations, and a final list of vaccines to be given as a result of “shared decision-making” between doctors and parents. The president also wants to separate the combination measles, mumps, and rubella vaccine into three separate shots, which don’t actually exist in the U.S. at the moment. That would necessitate more visits for parents and more individual sticks for kids. While the order itself has no force of law, it does direct each executive department and agency to “take [any] appropriate steps to advance them, to the fullest extent allowable by law.” So, what’s the immediate impact of this? Besides a whole lot of confusion, because when RFK Jr. tried to do essentially this, back last year, it was blocked by a federal judge. 

Edney: Yeah, I think confusion is the main impact of this right now. You know, this comes in the news every so often because President Trump has not wanted to let this go, even though we kind of thought he was — or at least RFK Jr. was — directed to let it go because of the midterms and how that was looking. But this is something that President Trump has really had on his agenda and not let go. And I think that there is not really a possibility for an immediate impact, say, with breaking up the shots. Like it doesn’t, like you said, it doesn’t exist here. Merck, which is a company that makes these MMR shots, said that could take up to 10 years. It’s not just a simple thing for them to do. So, in the meantime, you have some parents who are wondering, Well, is this bad? Like, what should I be doing? How … you know. So I think confusion is the No. 1 impact here. 

Rovner: Yeah, I want to break this down into sort of what it means for health and what it means for policy and what it means for politics. So, in terms of health, the U.S. is already in the midst of its worst measles outbreak since 1991, and we’re seeing more cases of other vaccine-preventable diseases, including whooping cough and even tetanus. And pediatricians are already slammed. How are they ever going to make room for all these extra appointments and parent discussions of these vaccines that used to be sort of generally recommended and now are going to have to be the subject of individual discussions? Anna, you’re the mom on the panel. 

Edney: Yeah, I was thinking that from the parents’ side, but yes, from the pediatricians’ side as well. I mean, they’re already overwhelmed. They already have a huge list of patients trying to get in for many things. And from the parents’ side and the child’s side, this is, like you had mentioned, more sticks. … The children will have to be given more shots in this case, and a lot of times that can mean missed shots because going once kind of gets everything done. We all like to have a one-stop shop versus having to go to a bunch of different times. And so, besides the confusion, [it] could decrease vaccine adherence because people just might miss those shots. You know, they’re going into the first year of childhood, so many parents, even in the first couple weeks or months, are back at work and are having to carve out time for this. So it could, you know, it could really overwhelm the physician, the pediatricians’ offices, with these conversations, and you know, kind of just lead to actually less protection for children. 

Rovner: And hence, I’d say, the increase in vaccine-preventable diseases that we’re actually seeing. Go ahead, Maya. 

Goldman: I was just going to say there are also all these other logistical concerns — like we mentioned, these shots don’t even exist yet in the U.S. So that’s, you know, step one. But then you need more storage at the pediatrician’s office for a shot that’s three separate shots instead of one combination. You need more people working at the office to accommodate all the extra appointments that are already in a shortage of pediatricians in a lot of places in the country, and healthcare support workers. And so it’s just this huge cascade of side effects. 

Edney: Yeah, and I think we should add to that: When President Trump talked about this from the Oval Office, he linked wanting to separate these shots to the rise in autism, and there is evidence that’s showing that that is an issue, and that the shots should be separated for that reason. 

Rovner: And just last week, we had another large-scale study that showed no increase in autism due to childhood vaccines. I want to talk about policy, too. There’s one particularly ominous phrase in the EO [executive order] that says that states, who set the rules on which vaccines are required for school attendance, are “advised to review” the recommendations and “consider updating relevant laws and regulations that define the scope of immunization requirements.” On a brief call with reporters on Monday, one administration official suggested that newly sworn-in Attorney General Todd Blanche could go after states that don’t provide enough exceptions to their immunization policies with violating federal religious freedom laws. Is this really good policy or good politics? I mean, most states — I did go back and look — most states have exceptions, have medical exceptions; obviously, if a kid can’t take a shot, a kid can’t take the shot. Most of them also have religious exceptions. But it’s not clear how broad this administration wants those exceptions to be, and what it might do about states that don’t allow exceptions. I would note that one of the few states that has almost no exceptions is West Virginia, which is a very red state. 

Raman: I think this is really the area to watch on this. I mean, a lot of the other pieces of this executive order are broader, and I think a little bit more, you know, messaging to the political base based on some of these logistical issues that we’ve outlined. But this is a direct action to three different agencies, you know, to look at these exemptions. And this is already something that they’ve been investigating … there are already some lawsuits about some of these exceptions in the five states that don’t have, as you know, the same exemptions as other states. So I think here is really the area to look, especially with Blanche now confirmed, and just keeping an eye on some of the existing cases that are already there challenging some of these exceptions. Because this is really where we could see movement, or, just even on the state level, for them passing additional laws. You know, that was something mentioned in the presser too, that they were going to encourage states to do this. So I think state level is somewhere to really look, especially … vaccine requirements come down to schools, and those are on a state-by-state level done by [the Department of] Education, not HHS. So that’s where I would be watching. 

Rovner: Yeah, there’s more to come, I suspect, here. Before we leave this, though, I want to talk a little bit about the politics. I mean, Anna, you mentioned this. There were polls that showed that going after vaccines was not very popular with Democrats or Republicans, and that Secretary Kennedy was told earlier this year to focus on other things instead. Why is Trump bringing this up two months before the midterms? I mean, who — what politics is this aimed at? I guess is my question, because I certainly don’t know. 

Edney: From the reporting that I’ve read, and you know, , and Politico. This is just something that Trump himself believes and does not want to let go. He’s talked to the HHS secretary about it time and time again, saying, you know, basically needling him to get on it, even though others have told him not to do that. And so it seems like something that the president really wanted to happen. And just given this discussion we just had, I think it’s pretty evident that most of it is kind of a “We let him do his thing.” He got to talk about it in the Oval Office, and, like, hopefully he’ll shut up about it now, and nothing will actually happen. I think that that is a possibility. 

Rovner: We’ll see if nothing actually happens. But one more thing before we leave the vaccine wars topic, a story from last week that caught my eye: Texas Attorney General Ken Paxton, who is also Texas Republican Senate candidate Ken Paxton, announced in his AG role that he has opened an investigation into the American Academy of Pediatrics. That’s the group that’s led the charge to preserve the immunization schedule, according to, you know, science. Paxton, in a press release, says his office is looking into “concerns that the organization may be promoting and recommending childhood vaccines for financial gain.” Now, given that most pediatricians lose money on giving vaccines, that feels like a bit of a stretch. Or am I missing something here? 

Goldman: Yeah, I think, what I interpreted from that announcement was, you know, he’s concerned about the organization of AAP, which has some big funders in the pharmaceutical companies. So maybe he’s claiming that the organization is worried they’re going to lose that funding, as opposed to individual pediatricians making money off vaccines. But I think it’s really from AAP’s perspective: damned if you do, damned if you don’t, right? This is something that they have done the science on, looked into, and that’s what their basis is. Be very interesting to see if this actually goes to court and if there’s, you know, a legal argument to be made here. I think this is, like, something that is just starting to unfold. 

Raman: What struck me was it’s similar to what we’ve seen in other areas as well. It’s the same kind of rationale we’ve had going after some of the transgender medical professional groups. You know, saying that they’ve made various recommendations about gender-affirming care for financial gain, and questioning some of those decisions. So in that way it’s not unique, especially since Texas has kind of led the charge on some of those. But I do think it’s interesting that we’re going after some of the same organizations for this again and again. 

Rovner: Yeah, I’m wondering sort of the political benefit for Paxton of going after the American Academy of Pediatrics, but we shall see. All right, speaking of politics, the Centers for Disease Control and Prevention got a new director this week — at least according to its website; I have not seen that she’s actually been sworn in — a year after its old director was ousted for refusing to rubber-stamp Secretary Kennedy’s handpicked vaccine advisers’ recommendations. Erica Schwartz, a former deputy surgeon general, told the Senate HELP [Health, Education, Labor, and Pensions] Committee during her confirmation hearings that she supports the vaccine schedule and would “never betray the science.” She’s about to get tested on that, isn’t she? 

Raman: I think it was a really interesting choice they didn’t swear her in before they held that event and bring her out there. You know, we did have [Jay] Bhattacharya as the acting official, but they could have easily brought her in there to speak on that, and they didn’t. I think that was a conscious decision. 

Goldman: I was just going to say they waited until she got confirmed. 

Rovner: I would say she got confirmed last week, and the event was on Monday, so they could have sworn her in in time for the event. 

Goldman: Right, they did the event after they confirmed her, but before they swore her in. 

Rovner: Right. 

Goldman: To shore up support in the Senate. 

Rovner: Fair point. Yes, rather than rub it in [Sen. Bill] Cassidy’s face right before he voted to confirm her; that is an excellent point in terms of the timing. Well, meanwhile, things at the CDC are still apparently not great. It’s been almost exactly a year, not just since the last director was ousted, but since a gunman literally shot up the building, killing a security officer because the gunman’s father said he believed that the covid vaccine had made him suicidal. Secretary Kennedy went to visit the CDC campus in Atlanta for a memorial for the officer last week and held a fireside chat with CDC staff, who were, shall we say, not very impressed with his fireside manner. Among other things, according to a transcript of the meeting, he repeated that scientists are not trustworthy. All this comes at a time when CDC is fighting an Ebola outbreak in Africa, several foodborne outbreaks here in the U.S., and the aforementioned spike in vaccine-preventable diseases. It’s not a great time for the CDC, is it? 

Goldman: It’s really not. And there’s a this week by an anonymous CDC staffer that sort of outlines all of the different things that, you know, I’ve even forgotten the CDC has gone through in the last year — thinking about Ebola and funding cuts and just, this person said, that they can still see damage from the bullet holes when they’re sitting in their office it hasn’t been fixed. And you really have to feel for these workers that are trying to do their best but not being given the resources or support to do it. 

Rovner: Yeah, and I will say, you know, after decades of covering the CDC, the people who work for CDC are, you know, among the most mission-driven people in healthcare. I mean, they toil in sort of the, you know, most difficult parts of the healthcare system and are, like, constantly fighting uphill battles and not getting a lot of support, I would suggest, from the current administration. Well, meanwhile, the never-ending Medicaid news keeps on coming. This week, the Trump administration issued final rules banning certain gender-affirming care for minors. Now, this is separate from its rules for hospitals, right, Sandhya? You wrote about this, yes? 

Raman: Yeah. So the rule this time is related to Medicaid for under 18, and for states that also fund the CHIP [Children’s Health Insurance Program], under 19 they would also have to comply with this rule. And kind of what struck me was that we, you know, just on this podcast, I think, maybe a month or so ago there was this, you know, is the administration going to pull this back or not? And there had been reporting saying that they were, and then HHS said, Yes, we are still going ahead with this rule. So indeed, they did. I think this is part of the broader framework, like you said, of different things related to them wanting to emphasize biological sex in their various rulemaking. 

Goldman: Yeah, I think an important distinction about this particular policy is that it strips federal funding, federal Medicaid funding, from states to cover gender-affirming care for minors. So states can still use their own state dollars if they choose to. Private insurance can still cover this, no problem. This is not a ban on gender-affirming care, but it will certainly make things more difficult for children on Medicaid who need this care, want this care. And, especially as states are facing so many other cost pressures, it’s going to be hard to come up with money to patch this hole if they want to do that. 

Rovner: And, to be clear, we’re not talking about surgery here. I mean, we’re talking about all kinds of care, including counseling, right? 

Goldman: Counseling actually is not included in this one. 

Rovner: Oh, OK. 

Goldman: They can still use federal Medicaid funding to cover counseling. 

Rovner: But not other forms of nonsurgical gender-affirming care. 

Goldman: Yes, hormone therapy, puberty blockers, exactly, which are recommended for kids with gender dysphoria by most major medical associations. 

Rovner: Including the aforementioned American Academy of Pediatrics. All right, next in the Medicaid realm: those work requirements that begin next January. We’ve talked at some length about how the federal government is going to give people an extra year to self-attest that they are too sick to work before they have to get proof from a medical professional. But points out that some states aren’t taking that option. Eight Republican-dominated states, including Arkansas, Idaho, Ohio, and Indiana, are declining that grace period and making their work rules even stricter than the administration is otherwise requiring. What’s the likely impact of this? That in January they’re going to have to start proving immediately that they’re either too sick to work or they could lose their Medicaid. 

Edney: Well, I think the, usually, at least the point of doing a rollout, I guess, is giving states time to figure it all out and giving people time to understand what they need to do. So those states are choosing not to do that. So it seems like this could create a lot more chaos than even was anticipated in the first place, and maybe potentially a lot more people coming off the rolls than when maybe they shouldn’t have been, just because of paperwork errors or misunderstandings and things like that. 

Rovner: And much like pediatricians who are worried about having to break up vaccine appointments into multiple appointments, doctors are kind of freaked out about having to see all these patients so they can, you know, write them notes to excuse them from the work requirements, which is another burden that I don’t know that Congress really fully accepted when it was deciding, and the administration was deciding, how to implement these work rules. 

Edney: You know, that’s not something they normally do assess, whether someone can go back to work. So I’m sure they would probably prefer not to be doing that, but if they, you know, without the time and the ability to figure this out, it could be even tougher, and people will be trying to rush to get in there to get this done. 

Rovner: Well, I guess we’ll be watching these as “the early states,” when this all begins. All right, we’re going to take a quick break. We’ll be right back. 

So, the vaccine executive order from the president very much overshadowed what I think HHS Secretary Kennedy had hoped would be the big HHS story this week: the unveiling of proposed new standards for food additives that have been deemed “generally recognized as safe,” or GRAS. The rules, which have been a long time coming, as in several administrations long, wouldn’t so much make it harder for companies to use food additives like thickeners and stabilizers that are often seen in highly processed foods, but it would require companies to tell the FDA how it’s using those substances. And it stops well short of what former Republican FDA commissioner David Kessler had been urging in a citizen petition, that he filed more than a year ago, that would have made companies actually prove that those products are safe before they can put them in the food supply. Why are these rules so timid? Isn’t, you know, making the food supply safer Kennedy’s, one of his biggest MAHA [Make America Healthy Again] goals? 

Edney: It seemed to me that the way the FDA put it was that they needed Congress basically to step in to boost their ability maybe to do more. Sometimes that’s an excuse not to do more. Sometimes it really is true that they could really open themselves up to challenges from Big Food and court challenges that they don’t want to fight. And so they do the thing that they think they’re able to, and then tell Congress, you know, we need you to go the rest of the way. 

Rovner: Interesting, because they don’t seem to be afraid of court challenges or, you know, stepping on Congress’ toes on lots of other things. I mean, is this really just emblematic of the power of Big Food? I mean, we’ve already seen, you know, Kennedy be sort of squashed by the power of Big Pesticide. 

Edney: Yeah, I think that that’s absolutely the case — that Big Food, you know, they put their lobbying to work, and they talked about how this could stop them from being able to innovate and being able to get newer things into our food, and that basically we should trust them — what they’re putting in there is safe. And so that has had some sway. Particularly, there have been a lot of industries that have been able to go to the White House and make those cases and kind of water down things that RFK or, like you said, former FDA commissioner [Marty] Makary had said they were going to do. 

Goldman: I’ve also seen some statements from, quote-unquote, “Big Food” lobbying groups arguing that this is an affordability issue. You know, if they have to comply with all these extra rules and regulations and pre-market reviews, that could tank the president’s affordability agenda, is something that I saw. 

Rovner: I would say we’re all still waiting for the new definition of highly processed food, so we will see what that ends up. On another subject regulated by HHS, Secretary Kennedy also announced major action to start the process of decertifying the organ procurement organization that coordinates organ transplants for the region that includes Kentucky and parts of Indiana, Ohio, and West Virginia. OPOs are the go-betweens between medical professionals who care for patients who become organ donors and those who care for the transplant recipients. There’s been a lot of attention to some pretty big failings in the organ transplant network over the past couple of years. This case cites instances where potential donors were not yet dead. That’s a big problem. But you have to wonder if the public is going to wonder whether dramatic action like this is warranted because the OPO really is deficient, or whether it’s political, since we’ve seen this administration going after some states and some organizations for what they say is fraud that looks like it might more be about electoral politics. 

Raman: I think this is a little different. With this organization, Network for Hope, we’ve had a lot of action over the past year or so on this organization in general. We had congressional hearings about it. We had letters from lawmakers with concerns about this, and it’s not the first time that they’ve moved to decertify. You know, there was a division of University of Miami Health System that they decertified last year. Again, documented problems about this, and even if you listen to some of the statements from Democratic lawmakers, they are not against this. I think that, you know, it’s a recognized problem across political lines, which is a little different than some of the issues where fraud is being, you know, viewed more through one lens than another. 

Rovner: There is a point at which HHS is supposed to regulate organizations. I mean … when they find evidence of an organization not doing what it’s supposed to, they’re supposed to take action. That’s kind of how the government works. Sorry. 

Edney: You know, The New York Times has done a lot of great reporting on the organ procurement system and showing many, many flaws. But I think for this one, specifically, when I read about what made HHS look into it, it is shocking and a little scary. So I do understand. You know, what happened was there was a man who overdosed and he wasn’t quite dead, but they were starting the procurement process, and he was waking up. And it just seemed like they kept going on this a little too far. He survived; they didn’t get any organs out of him. But if you sign that form that says you’re an organ donor, it’s not something you want to think about: If something happens to you and you’re not quite dead, that they might decide to go ahead. And then HHS did find that this had happened on many occasions. So I think that it seems like something that the government should have stepped in on. 

Rovner: Yeah, there were some pretty serious deficiencies here. All right, well that is this week’s news, or at least as much as we could get to. Now we’ll play my “Bill of the Month” interview with Paula Andalo, and then we will come back and do our extra credits. 

I am pleased to welcome back to the podcast my colleague Paula Andalo, who reported and wrote the latest Ñî¹óåú´«Ã½Ò•îl Health News “Bill of the Month.” Hi, Paula. 

Paula Andalo: Hi. How are you? 

Rovner: So this month’s patient is kind of a success story, right? Someone with a nonemergency condition and no health insurance who was nonetheless able to shop around for the best price? Tell us who he is, where he lives, and what kind of care he needed. 

Andalo: Yeah, his name is Ronmel Rangel, and he’s from Venezuela. He moved to the U.S. in 2019 to live with one of [his] daughters that live[s] in Portland, Maine, and he has been living there since. 

Rovner: And then he got sick and needed …  

Andalo: So it was interesting because 25 years ago he had an inguinal hernia and he had surgery in Venezuela. And at the end of last year, he began to feel a pain on the other side of the body. Again, it was a hernia, so he needed surgery. 

Rovner: So he’d been through this before. 

Andalo: Yeah, yeah, in a different health system. So he doesn’t have insurance, although he’s a green-card holder, so he can have insurance. But when he moved here — now he’s 64, so it was six, seven years ago — and he was looking around, you know, the Obamacare and all the stuff. But he realized that for his age, the prices were crazy. He’s a pretty healthy person, so he decided to not have insurance. Instead, he began to see a doctor in a concierge medicine. You know these kind of practices that charge as little as $70 per month to unlimited visits and some small procedures like stitches or …  

Rovner: But not hernia repair. 

Andalo: Not hernia. So at that moment he needed surgery. 

Rovner: Right. So he did the medical tourism thing, looking both here in the U.S. and in some other countries, where he had family that he could stay with. And, a bit surprisingly to me, at least, he found the best price here in the U.S.? 

Andalo: Yeah, it was like a miracle. Yeah, he looked in Oklahoma, but it was far away. Also, he has a daughter living in Santiago, in Chile, and he looked there, and it was very expensive, adding also the cost of traveling to Chile. So, he finally found his place in Maryland. In Rockville, Maryland, in a place called Affordable Surgery Center. He had his procedure in April. 

Rovner: And how much did he end up paying — I guess both for the travel and for the hernia repair? 

Andalo: Well, the first estimate that he had was in his state in a big health system, and at that moment the estimate was $23,000 for a laparoscopic procedure. In this center in Maryland, the total cost, including anesthesia, was $2,900. 

Rovner: Wow. 

Andalo: So, adding the cost of tickets for him and his wife and one night of hotel, etc., it was less than $5,000. 

Rovner: Wow. So that’s a whole lot less, even than he could have gotten at home in Maine. 

Andalo: Yeah, exactly. 

Rovner: So what’s the takeaway here, other than that medical tourism doesn’t have to mean a trip to another country to find the most cost-effective care? 

Andalo: Well, the takeaway is that you can shop around, especially if you have an elective procedure, so you have time. Because if you have an emergency, you don’t have time. But with these kinds of procedures that are pretty common, and there are different options to do it, you can shop around and look for the best place. He had the help of his family doctor — that was very helpful, you know, helping him with lists of places. But he has had time to shop around, to look for prices, and to take care of his hernia. 

Rovner: And I guess it’s important to remember that the most expensive isn’t always the best, but the cheapest also isn’t always the best. 

Andalo: Exactly. So one advice is, the expert says, that you need to look at the reviews of the place and do your homework to realize that if it’s a good place. Although the research says that sometimes higher prices doesn’t mean better care, but in these kinds of procedures, you can pay much less if you shop around. 

Rovner: Well, nice to have a happy ending for a change. Paula Andalo, thank you so much. 

Andalo: Thank you. 

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

Goldman: Sure. My extra credit this week is an article titled “.” This one is in The New York Times by Mark Arsenault. I am a University of Michigan alum, just like Julie, and so this one caught my eye. But it’s also very interesting to hear what, you know, universities are taking student mental health seriously to the point where they’re making big policy changes or, at least in this case, piloting policy changes to try to get at the root of the problem. I have my own skepticism that this is, you know, the root of the problem. Academic pressures are certainly a big stressor for students adjusting to college, and so maybe this could help. But I think that this is a multifaceted problem, and I’m interested to see how they’re going to measure the success of this. But this isn’t the first university to have done it. There are a couple others: MIT, Brown. The University of Michigan is a massive school with a lot more students, though, so I think it’ll be interesting to see if other schools of that ilk follow suit. 

Rovner: I would just point out that I went to the University of Michigan in the 1970s, and even then we could take classes pass/fail if we wanted to. It’s not really all that new. But yes, I’ve seen a lot of rolled eyes this week about this story. Anna, why don’t you go next? 

Edney: Mine is from CBS News by Julia Ingram: “.” I thought it was a smart thing to look at, that this farm had not been inspected since 2019. And not just that, but that the FDA has been really lagging on all of their foreign food safety inspections, not even meeting 10% of the goal that Congress had set for them about a decade ago. And I thought that was just a great way to get into this story and talk about inspections and how the FDA is struggling. They’ve struggled for a while to meet these kinds of mandates, but showing how it’s now gotten even worse since there have been lots of cuts within the agency. 

Rovner: Yep, that we’ve been talking about, and these are the result of those cuts. Sandhya. 

Raman: My pick this week comes from NOTUS, and it’s from Margaret Manto, and it’s called “.” I am from West Virginia, so was a reason why I was really intrigued by reading this story. But it’s really good. It looks at the work of a pediatrician in the small town of Summersville, and West Virginia has some of the highest childhood vaccine rates in the U.S. And the county where Summersville is has some really high rates compared to some of the more populous counties that are around it. This is a county that voted three times for President Trump. And just looking a lot at the changing climate regarding, you know, vaccination and attitudes there, and, you know, rural health more broadly. 

Rovner: It’s a really good story. Well, my extra credit this week is from the journal Health Affairs by my soon-to-be boss here at KFF, Mollyann Brodie. It’s a to one of her, and my, health policy heroes, Bob Blendon, the Harvard health policy professor who passed away earlier this summer. Molly was lucky enough to have studied under Bob, which I never got to do. But I still feel like one of his students, as he was always so generous with his time and so very quotable, and contributed so much to my personal understanding of the intersection of health policy and politics, which I try to share with all of you every week. We miss Bob already. May his memory be a blessing, and may he live on in those that he taught. 

All right, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. We also had production help this week from Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X , or on Bluesky . Where are you guys hanging these days? Maya? 

Goldman: I’m mostly hanging out on under my name. 

Rovner: Anna? 

Edney: , , @annaedney. 

Rovner: Sandhya. 

Raman: I’m on and on @SandhyaWrites. 

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