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

Julie Rovner: Hello, from �������ýҕ�l Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for �������ýҕ�l 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, May 7, 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 Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Good morning, everyone. 

Rovner: And Jessie Hellmann of CQ Roll Call. 

Jessie Hellmann: Thanks for having me. 

Rovner: Later in this episode, we’ll have my interview with Andrew Jones, who reported and wrote the latest KFF Health News “Bill of the Month,” about an emergency room bill for what turned out not to be an emergency but could have been. But first, as always, this week’s news. 

Let’s start this week with the continuing fight over the abortion pill mifepristone. Last month, it appeared that the court fight over the pill was put on the back burner. That was after the Trump administration, to the consternation of abortion opponents, asked a federal district court judge to postpone proceedings while it finished a new safety review of the pill by the Food and Drug Administration. Well, the state of Louisiana, which had brought the suit to roll back the pill’s availability, wasn’t satisfied with that, and appealed the delay to the 5th Circuit Court of Appeals. Last Friday, right before dinner, a three-judge appeals court panel ruled in favor of Louisiana and basically ordered a rollback of abortion pill availability to the rules that were in place before 2021. That’s when doctors had to literally hand the pill to patients, meaning no telehealth and no pharmacy distribution. Shefali, you’re one of our abortion experts. Pick up the story from there. What happened over the weekend, and where are we now? 

Luthra: Over the weekend, there was a lot of confusion. I spent a lot of time talking to abortion providers and people who track abortion law quite closely. And providers were prepared to switch regimens, if they had to, to change to what’s misoprostol-only — using larger doses of the other drug in medication abortions, which is safe, is effective — is less safe, less effective? — but still good, though not gold standard. Meanwhile, we saw an appeal from the manufacturers of medication abortion to the Supreme Court. They also saw a stay from the 5th Circuit. While they might get some more time to figure things out, they never heard from the 5th Circuit. But then, on Monday, the Supreme Court weighed in and said, We are blocking this 5th Circuit ruling for a week. You have a few days — so, until Thursday, today actually — to submit arguments from both sides. And then, by the end of the day Monday, they are supposed to say whether this stay will be extended, whether they will be ruling, whether they might take up this case. And there’s a lot that could happen, right? They could try and make a ruling now, they could send this back to the lower courts. They could say, We want to hear arguments before this term ends, which would be at the end of June. They could say, We want to hear arguments on this in the fall, right before the midterm elections. But what they do could have real significance for whether mifepristone is available by telehealth, and, as a result, how people in states with abortion bans — but also where abortion is legal — get abortions. Because telehealth abortion is increasingly popular. One in 4 abortions are done by telehealth. About half of those are for people in states with bans, but half of them are for people in states where abortion is legal and protected. But going to a clinic and getting a pill handed to you is simply much more inconvenient and often impractical or not really possible, compared to having it mailed to you — if you have child care, if you can’t get off work, if you live really far from a clinic. And so access to this gold-standard regimen of abortion care is now possibly going to be very much in limbo for all these people across the country. 

I don’t know if we have seen much to indicate that this is going to be a campaign issue. We haven’t really heard as much chatter from Democrats as one might expect. But it is possible that if this becomes more of a live issue, if the Supreme Court makes those restrictions more permanent, or if they, in fact, do take this case up in a manner of timing that would be very influential, that this could, in fact, become a meaningful campaign issue, because most voters don’t like abortion restrictions, especially national ones. 

Rovner: Yeah, among the people who are sort of put in a difficult situation here is the Trump administration. The anti-abortion movement clearly wants more action on this issue. Trump was pretty clear, even on the campaign trail in 2024, that he doesn’t want to further restrict abortion; he’s already getting hammered for not following through on his promise to make in vitro fertilization more available. And now anti-abortion groups are planning to put not just money but their large volunteer power up against those candidates who won’t vow to take more aggressive federal action. How angry are they? And what impact could that have on the midterms, where Republicans are already on defense? 

Luthra: They are furious with the Trump administration. I mean, you have the head of SBA Pro-Life America : Trump is the problem. That’s quite blatant for what is ostensibly a close ally to the White House, an organization that has tried to influence policy, that has hoped for those influences to be translated into actual policy. It’s clear that they’ve given up on that. And many of them were very, very frustrated that the administration took on this purported review of mifepristone and kept saying, We will have more information for you later, probably after the elections. And that they, in fact, argued against Louisiana in the courts, and they defended their policy of having mifepristone available for now. And so I think what you’re seeing politically is this real possibility of schisms in the conservative movement. The people who oppose abortion and, right, are an important part of that base, but also, Trump may be unpopular nationally, but he still carries a lot of influence in a large part of the Republican Party. We just saw that in the primaries in Indiana this week. And so I think we really don’t know who wins. Do anti-abortion voters simply stay home? Do they say, Well, this is still our best option. It’s the Republican Party. And also, in the meantime, how much does the movement start thinking instead about trying to pick a possible successor to Trump? And a lot of them really are focusing now on the midterms, but also on 2028. And so do they just say, Well, we’re done with this. We’re not going to win and move on. Or is there something that they might be able to get if they keep threatening to withhold money and voter influence? Open question. I think we’ll see. 

Rovner: Jessie, Sandhya, you guys are on the Hill. I mean, you know, there’s been a lot written this week: Oh, Democrats haven’t said anything about this. I think this came as a bit of a surprise. I think we, most of us, thought that this was going to be kind of back-burnered until after the election. Do you see Democrats picking this up and running with it at some point? It has, it has been, it’s been an effective political issue, but maybe not so much in terms of votes, right?  

Hellmann: I don’t know if Democrats really saw much gain from focusing on abortion in the last round of elections, which feels like such a weird way to talk about it. But they might think that other campaign issues, like the affordability issue, healthcare costs, more generally, might be more of an issue that they want to hit on … especially after the ACA tax credits expired. But we might see more from them as this issue continues to play out in the courts. 

Rovner: And I’m just wondering if, you know, if Republicans start … I mean, we’ve seen people like Bill Cassidy, the chairman of the HELP [Senate Committee on Health, Education, Labor and Pensions] Committee, who’s been very outspoken, you know, and has long anti-abortion bona fides, I mean, going back pretty much his whole career. But it’s interesting that he’s been hammering on this. I’ve seen Republicans on the Hill hammering on this in a way that separates them from the president, which is a little bit surprising. It makes me wonder if Democrats are going to try to exploit that difference or not, or if they can figure out how, or if just, as you say, affordability is so much a bigger issue right now. 

Hellmann: I think the Bill Cassidy race is really interesting. He’s in a heated primary against Julia Letlow, and he seems to think that this mifepristone issue is going to be, like, a wedge issue in that race. He’s the chairman of the HELP Committee, so he spends so much time talking about this. Even when HHS [Department of Health and Human Services] Secretary RFK [Robert F. Kennedy] Jr. was on the Hill a few weeks ago, this is one of the first things that he asked him about, and he didn’t even get to the vaccine issue until later. But I think that maybe in those more conservative primaries, it could be an issue. But then it’ll be interesting to see how he’ll talk about it later on, if he does win that primary. 

Luthra: I think one thing to note about the Cassidy primary that I’m really surprised by — and I think speaks to the complicated state of things, and maybe the fact that people thought this was a resolved issue — is he talks about it a lot on the Hill. If you go through his TV ads that he is running in this very close primary, they’re not about abortion. He has not had a single TV ad about abortion, and it is largely instead about trying to assert his bona fides as a true partner to Donald Trump. And I think that’s really interesting because, again, as we’ve discussed, Trump is not really interested in this issue, and Louisiana primary voters certainly are. But there’s a calculation, right? Do you want to situate yourself as the partner to the president, or do you want to talk about abortion? And maybe you can do both, but maybe it’s actually really difficult to do both of those things. 

Rovner: Well, one thing I haven’t seen mentioned in this latest round of debate over abortion is the potential impact on the rest of the drug industry. Once again, justices are being asked to step in and override the presumably evidence-based findings of the Food and Drug Administration. The last time we got this close to a Supreme Court ruling on an FDA approval of mifepristone was in 2024, when the justices were able to punt by pointing out that the doctors group that brought the suit didn’t have standing. But it doesn’t look like that’s as viable an out this time, because it’s the state that’s suing. Why haven’t we heard more from drugmakers, who we know are freaking out about not being able to rely on FDA decisions to make, you know, business plans worth billions of dollars? 

Raman: I think we will. I think it really depends on what we see in the next week, in terms of is this getting escalated, that the Supreme Court would hold arguments, or where we are? If I think back to 2024, I feel like a lot of more of the involvement from the pharmaceutical industry — when they were speaking out more, holding briefings, maybe submitting those briefs — was when we got to the Supreme Court stage. So I think it’s a matter of time. And right now it’s, you know, kind of figuring out their options and what they’re going to do. But a ruling could have a huge impact on so many other drugs. So I doubt that they’d be quiet as we get further along. 

Rovner: Yes, I would expect, I mean, we’re going to see a flurry of briefs by the end of the day today, and I would expect that the drug industry would be among those who are going to be filing those briefs. So we will know more. 

Luthra: In fact, we actually already have a brief from PhRMA [. 

Rovner: Oh good. 

Luthra: It came in either last night or this morning, and it says exactly what you’d say, that they are concerned that pharmaceutical development will suffer if Louisiana wins, that this is really problematic for drug research and development. And we are seeing some op-eds from biotech CEOs, etc., in places like Stat just highlighting that they are very concerned about the ramifications for the industry. So I think so I’m just totally right, like, as this case picks up steam, that chorus will get louder and louder, because this is just too consequential for the industry to not talk about. 

Rovner: Right, this is about much, much more than abortion. All right. Well, speaking of the FDA, Commissioner Marty Makary’s job is, quote, “on thin ice” — that was, were the exact words used in stories from Bloomberg, NOTUS, and The Wall Street Journal, all in the past few days. On the one hand, we’ve heard these rumors before, as things at FDA have been chaotic, to say the least, but this week’s flurry of rumors appears to be over Makary’s overruling of FDA scientists who recommended approval of mango- and blueberry-flavored vapes. Makary was reportedly concerned about attracting children to vaping by approving fruit flavors. This has been a long-standing argument. While the scientists who recommended approval wanted to help adults actually quit smoking, which is demonstrably worse for their health than vaping. As it turns out, the flavored vapes were approved on Tuesday, apparently after President Trump intervened personally by calling Makary. So this raises two questions. First, is this more politicization of FDA policy? It certainly looks like it, even if the ultimate decision here was what the FDA scientists actually wanted. 

Raman: I mean, if you look back to when President Trump was on the campaign trail, he did talk about wanting to save vaping and how that was a big issue for certain voters and stuff. So it has been something that’s been in the back burner. These kind of approvals and authorizations take a very long time. And they’ve, you know, a lot of folks have been complaining for a long time about how long some of these things take. They can be backlogged for years. And we had very different opinions with some of the appointees during the Biden administration about how to handle flavored nicotine and tobacco products. I do think that the short turnaround between some of those conversations over the weekend and then suddenly this getting authorized is a little unusual, but it’s kind of hard to say where they were in the process before that, if they were dotting the i’s, crossing the t’s, or if this shoved things forward a lot more. So it’s hard to tell, but I think it really does build into your earlier point about how folks are just not sure for how long that he remains as FDA commissioner. I mean, there have been things building for months, but it really has heated up in the last couple weeks or so. And I think something that raises for me there is just if he does get out at some point soon, that would make another thing that the Senate has to get through and, you know, find agreement on which could get even more complicated if, depending on what happens with … 

Rovner: … with the abortion case. 

Raman: Yeah, and Cassidy’s race! 

Rovner: Oh, Cassidy’s primary! That’s right. Yes. 

Raman: Yeah. So I think there’s a lot of interconnected things that will be really interesting to watch here as this plays out. 

Rovner: Well, there’s also, before we get off of this, there’s a broader question here about harm reduction. Sandhya, we just talked about this a few weeks ago, after the federal government said it would stop paying for test strips to detect fentanyl and other potentially fatal substances added to illicit drugs. So harm reduction is bad when it comes to fentanyl strips, but good for flavored vapes? 

Raman: I think we’ve had a lot of conflicting messaging on this. Flavored vapes, I guess, are a little bit more complicated, because you could be an adult and just go straight into flavored vapes, and it is a little bit more complicated than that. 

Rovner: And it is a legal product. 

Raman: Yes, it is a legal product. You know, it’s regulated very differently. But I think, since you did bring up harm reduction, the interesting thing there that has been happening is just that there’s been so much differences of opinion, despite that guidance. You know, we had the Office of National Drug Control Policy this week put out their drug control strategy plan for the year, and that had language in favor of the testing strip. So we’ve had a lot of conflicting messages between different parts of the administration over the same issue, which is really confusing folks on the ground. 

Rovner: It is. Well, in other news from the FDA this week,  that the agency blocked the publication of several studies that found very few serious side effects from vaccines for covid-19 and shingles. This included top FDA officials ordering the withdrawal of studies that had already been accepted by medical journals. This is far from the first that we’ve heard of this sort of thing from the FDA and from the Centers for Disease Control and Prevention. But it does increase the doubts that this administration is, quote, “following the science,” does it not? 

Raman: I mean, we saw the same kind of reaction in terms of why this happened from HHS, you know, saying that the studies were making really broad claims, and they were not supported by whatever the underlying data that they had was. I think that this and the CDC vaccine study getting pulled are both highly unusual, but the fact that they’re both happening in a short period of time, you know, kind of increases that. I think it’ll be interesting, you know, we saw with the CDC study that it ended up getting leaked, and then people were able to look at it and make their own conclusions. What happens with this? But having these studies about vaccine efficacy being pulled when the administration is trying to pull back on their vaccine messaging is, like, a less salient issue for the midterms is interesting. So I’m curious what happens next there. 

Rovner: Yeah, me too. OK, we’re going to take a quick break. We will be right back. 

OK, we’re back, and of course, we have more personnel news. Last Thursday, just after we taped, thank you very much, President Trump pulled the nomination of Casey Means to become the next surgeon general after it had become clear she did not have the votes to even move out of committee. In her place, the president nominated Dr. Nicole Saphier, a Fox News contributor who did finish her medical residency and is a practicing radiologist specializing in breast imaging, and — apparently this is now a requirement for a high job at the Department of Health and Human Services — she’s a podcast host. Just this week, there’s been a  that were critical of some of the health stances taken by President Trump and HHS Secretary RFK Jr. But I imagine that might actually help her nomination, which has generally been pretty well received, by making her look like she’s at least as interested in accurate medical advice as she is in currying favor. Or am I misreading this? 

Raman: I don’t know that the tweets are going to have a huge effect either way, when there’s so many other things going on. And I feel like it’s so interesting that her book from, you know, long before this administration, was called Make America Healthy Again. So it seems like if anyone is committed to this movement, it would be someone with a book titled that six years ago. 

Rovner: Although she’s not really a MAHA person, right? 

Raman: Yeah, yeah. But it just is such a funny coincidence. But I think that right after they pulled the Means nomination, it was interesting — kind of goes back to what Jessie said was that — we had the president; we had her brother, Calley Means; and then we had Secretary Kennedy as well digging in on Cassidy and blaming him for that nomination falling through. But they did back the new nominee. So it’s interesting what is going to happen there. But just how political just getting this across is, even though there weren’t other votes in the Senate to get Casey across the finish line. 

Rovner: Yeah. Shefali, you were going to add something? 

Luthra: Oh, I just think that the tweets, I mean, they are really striking, and I think you’ve hit on something that is a fascinating tension. This is someone who has criticized the president’s talking points around Tylenol in pregnancy; who has said that, you know, maybe there is not a link between Tylenol and pregnancy and autism. Maybe I don’t want to be told just tough it out when I am in pain. She also, fascinatingly, is quite anti-abortion, and has talked about that a lot as well. And I think there’s just a lot of really complicated worldviews that she brings. And on the one hand, like, maybe some of that ends up being appealing to lawmakers because, as we’ve discussed many times on this podcast, the stances that are more anti-vax, anti-medicine, anti-science are not necessarily that popular with voters, and lawmakers are reacting to that. That’s why it’s been so difficult to confirm a surgeon general nominee. And maybe this finally changes that. Maybe deleting those tweets does suggest that someone would rather remain in good standing with the president. I don’t think we really know until … if she gets the job and then see what happens. But it is really fascinating to see the third person picked, where there’s still an unfilled position, possibly being someone a bit more aligned with some things that are, in fact, conventionally accepted medicine. 

Rovner: Well, we will see. And of course, this is … yet another nomination that has to go through Bill Cassidy’s HELP Committee. And regardless of what happens in his primary, even if he loses his primary, he’s going to be the chairman of that committee until the end of this year. So we will have to see. 

All right. Moving on to the Affordable Care Act, we have more evidence this week about the impact of last year’s big budget bill and the expiration of those covid-era additional premium subsidies that they’re having on enrollment.  that analysts and state officials are expecting a drop of about 20%, dropping from 24 million in 2025 to about 19 million. Insurance company Cigna announced last week that it’s dropping out of the ACA marketplace. It currently sells in 11 states. And hospitals are reporting their first-quarter results that are already experiencing the fallout — from lower admissions to more uncompensated care. That includes not just people who’ve dropped insurance, but people who had to buy insurance with higher deductibles that they may not be able to pay. Republicans in the Trump administration have tried to downplay the reductions, but as the year wears on and the results get more obvious, aren’t they going to have to have some counterargument to this? 

Hellmann: A 20% decrease in enrollment could be really bad for the marketplaces, especially if the people who are leaving are healthy. It’s going to lead to a sicker risk pool, which is going to possibly lead to higher premiums in the future. So you would think that the administration would have to respond to that. But they have also showed that they’re not really a friend to the ACA, and the first Trump administration also did a lot of things to undermine it. So I’m not sure that they’re going to try to find a way to fix these problems. And they also had a recent marketplace rule that some experts actually think could weaken the health of the marketplaces even more.  

Rovner: Yeah … I know the Republicans … one of the big Republican talking points is that a lot of these people were what they call phantom enrollees. They didn’t even know they were enrolled. They didn’t file any claims. But, as you point out, a lot of people have insurance and don’t file any claims because they are healthy. Those are kind of the people that the insurers want. Obviously, not phantom people who don’t know they’re enrolled. That’s fraud. But people who … have insurance and don’t use it are a good thing for the insurance industry. Shefali, you’re nodding. 

Luthra: No, I was just thinking about all the years I’ve had health insurance and didn’t file a claim. Like, of course you would want that. That’s awesome. It doesn’t mean I wasn’t covered. It meant that I relied on the peace of mind of having health insurance. And I would be very sad if I started filing claims for insurance and suddenly all the healthy people were gone. That would be terrible. 

Rovner: Yeah, we will … again, I think we’re going to get more evidence as the year wears on, and this is going to become a big, I think, campaign issue, obviously. 

Well, I want to talk about global health, at least briefly. A lot of people are watching that Dutch-flagged cruise ship with passengers sickened and some dying of hantavirus. Now, hantavirus is not normally spread person-to-person, but it is fairly clear that that’s what’s happening in this case, and it appears the outbreak is being fairly effectively handled by the World Health Organization. But of course, the U.S. left the WHO when Trump returned to office, so the U.S. is not only not helping with this, it’s out of the loop, even though there are more than a dozen Americans who’ve been on board, and reportedly seven who could have been exposed to this who have disembarked and already returned to the U.S. This is kind of why the U.S. was part of the WHO, right? When you have an international incident like this? 

Raman: Yeah, and I was just listening in to [an] infectious disease briefing this morning, where they were detailing how this situation is unusual. Usually, at this point in a crisis like this, we would have had more communication from the CDC, from the NIH [National Institutes of Health], just about the state of play, different briefings, or just going and helping with the situation. And we haven’t seen that, and just how striking that is right now. 

Rovner: And of course, I mean, so many people are having PTSD [post-traumatic stress disorder] from covid, and remembering, you know, cruise ships with people with covid. Public health experts say that’s not going to happen here with hantavirus. It’s just this one strain of hantavirus that spreads person to person. It’s hard to spread it. But with so little trust in science and so much misinformation, you got to wonder whether even this incident that shouldn’t cause a panic might anyway. 

Raman: Yeah, I think that has been kind of the concern is that this is something that the experts are worried about, and they’d like to learn more about, because there is a new case that they can learn from, to provide more public health information. But to not panic over this, just because the things that you said: This is not likely to cause another major pandemic in the same way as covid. 

Rovner: Well. Finally, this week, HHS Secretary RFK Jr. has struck out on another cause. Now he wants to get people off of their antidepressants. At a MAHA meeting on Monday, he unveiled a series of steps for doing that, from encouraging non-drug interventions for mental health conditions, to paying doctors to counsel patients for how to taper off the medications. He says he doesn’t want to tell people to stop taking their drugs, which can be lifesaving in many cases, although he’s also said he doesn’t want people not to be allowed to take vaccines, too. So where is this headed? Is this … this is a big, I guess, some MAHA people think people are overmedicated with antidepressants and ADHD [] drugs. 

Raman: I think it has a lot of the same playbook that we’ve seen with vaccines. He’s talked about over-medicalization as an issue for a while now. It was in the last MAHA report about a year ago, and even before that, he’s brought it up. My sense from attending that event this week was not that they were really looking at changing prescription guidelines, but I guess it’s hard to tell where we’ll see further along down the line. But it was more of just like an exploratory stage, you know, training physicians about different things related to tapering and things like that. But sometimes that’s the start of things changing down the line, and it is interest[ing], that kind of brings back his focus to very much the psychiatric drugs, the ADHD, depression, anxiety, and just wanting to lessen the medications there. So. 

Rovner: I can’t help but wonder if, because he’s been told to back off of the vaccine issue, because it doesn’t play that well with the public, that he’s going to pick this up as his next crusade.  

Raman: There was a huge emphasis on informed consent, which is, I feel, another big talking point with vaccine. So there is a lot of similarities in how it’s approached. So, I would look for more of those kind of clues there. 

Luthra: I think it’s also worth noting, even if this is early rhetoric that we know from research that rhetoric does influence prescribing behavior. We saw that study that showed after the “don’t take Tylenol when you’re pregnant” kerfluffle, prescriptions of Tylenol went down for people who are pregnant. And this is not really the first time RFK has talked about SSRIs, specifically. He’s talked about them with regard to pregnancy, in particular, and that’s already a very stigmatized, very fraught time for people, even though the consensus is, if you are depressed, stay on your medications. And I think this is something absolutely worth keeping an eye on, even if this is largely rhetorical, discouraging use of medications. Does that translate into changes, especially around something that is fraught and is often stigmatized and misunderstood, like antidepressants, which, as you mentioned, Julie, are lifesaving and very important for people with severe depression. 

Rovner: Indeed, and for people with severe anxiety. All right, that’s this week’s news. Now we’ll play my “Bill of the Month” interview with Andrew Jones, and then we’ll come back with our extra credits. 

I am pleased to welcome to the podcast KFF Health News’ Andrew Jones, who reported and wrote the latest “Bill of the Month.” Andrew, welcome. 

Andrew Jones: Thank you so much for having me. 

Rovner: So tell us about this month’s patient — who she is, where she’s from, and what happened that landed her in the emergency room. 

Jones: Silvana Toska. She’s from Davidson, North Carolina. It’s just north of Charlotte. She’s a professor of political science there, and a mom of two. And while she was outdoor at an event last fall, she got bit by an insect, and she ended up with such a bad systemic allergic reaction that she got anaphylaxis. What anaphylaxis means is that her lungs began to be difficult to breathe. And so she broke out in hives, and she immediately decides, with her husband, to go to an urgent care, where she gets treated with two doses of epinephrine. And then the doctor says you need to be under watch for a couple of hours, so you need to go to the ER, which is kind of where our story starts. 

Rovner: So she doesn’t drive off to the ER, she goes in an ambulance to the ER, right? 

Jones: That’s correct. Yeah. They put her in the back of an ambulance, and they ship her off to the ER. Her husband and her two kids follow. 

Rovner: So by the time she got to the ER, she was already feeling better from the medication that they gave her at the urgent care. That’s what’s in an EpiPen, right? 

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Rovner: The epinephrine. So what happened when she got to the ER? 

Jones: So, not a whole lot, actually. Like you said, she’s feeling fine at that point. A doctor comes in. The doctor sees her for less than five minutes, asks her about her condition, does a quick checkup, doesn’t actually make physical contact with her, which I thought was very interesting. And then the doctor steps out. And she basically spends an hour and a half doing nothing, trying to keep her kids entertained. And she gets a dose of Pepcid to keep the allergic reaction at bay. But after the doctor came in again, just to say that she could leave, she left, and it was an incredibly uneventful ER visit. 

Rovner: And then, as we say, the bill came. So how much is the ER charge for her couple of hours of follow-up … at which not very much happened? 

Jones: Yeah. So that empty hour and a half, essentially, for that time, she was charged $6,746.50. And at the end of the day, she was responsible for a $150 copay and $3,100.24 — a bill that she got on Christmas Day that year. 

Rovner: Awesome. So what was the justification for such a big bill for such — I won’t say “little care,” but what seemed to be little care? 

Jones: Yeah, well, she was actually charged for something that wasn’t little. It was called “critical care.” She was coded for critical care, her time there was. And the experts that I spoke to said that while Toska had every right to think that it was an outrageous price to charge, it was probably an appropriate charge for the situation, those codes were. And that’s partly because of a coding system that really isn’t hyper-specific to individual cases. Toska needed to be in the ER setting because of the anaphylaxis. It can return and cause a critical situation. And while she was coded based on what might have happened, rather than what did happen, it ended up not working in her favor as far as the bill went. And so people all over the U.S. experience this. Another expert I spoke to said that people are brought on that train of care when they arrive to the ER. There’s really no way to get off once it starts moving. And you don’t know what it’s going … what the dreaded bill is going to be once it stops. And there definitely could be reform in the way that U.S. healthcare system does ER coding, although there would have to be some, you know, pretty titanic changes for that to happen. But I’ll say that if listeners ever find themselves concerned about a bill, they should definitely call their insurance company, ask if there was an attempt to negotiate, and they should call the hospital to check the accuracy of the coding. Toska did do both of those things and, unfortunately, nothing changed. But I can say that that was the right thing to do. There was some great back-and-forth. There was a letter that explained why they did that and, ultimately, what happened to her comes down to a coding system that did not work in her favor. And she told me that recently she experienced another allergic reaction, but instead of going to the ER, she just took some Benadryl instead. 

Rovner: And you know, I guess the takeaway here is that when a medical professional tells you to go to the ER, it’s not usually because they’re going to make money from sending you to the ER. It’s because something could happen that you should be in the ER for it. I guess that’s sort of why we have medical insurance, right? 

Jones: Absolutely, absolutely. Yeah. I mean, she really had no other choice. It was the right thing for her to do. But again, because of a coding system that wasn’t specific to her situation, it ended up — I see, you know, testimonies all the time from people who see this very outrageous bill for a little care. Toska is the first time I’ve seen a bill where there was essentially no care that she could see. And so I think it’s fair for her to have this discussion in her mind and with her family, and here in this article about: Is our coding system fair? But ultimately, when a provider says you need to go to the ER to make sure that you know your situation is taken care of, that’s what you have to do. 

Rovner: Andrew Jones, thank you very much. 

Jones: Julie, thank you. 

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 links in our show notes on your phone or other mobile device. Jessie, why don’t you go first this week? 

Hellmann: My extra credit is from Nature. It’s titled “.” They [Max Kozlov, Alexandra Witze, and Dan Garisto] did an analysis showing that more than 100 independent advisory panels have been terminated. These are panels that advise agencies on biomedical environmental policy and other types of health policy. They’re typically staffed by researchers and other experts from outside of the government. And now so many of these groups are being canceled, there’s concern that this could result in less transparency and more of agencies making decisions within their own ranks. And then they also found that groups that are still in existence are meeting less and less. They’re not issuing public reports. An example of this that we all know about is the Advisory Committee on Immunization Practices, which is tied up in a big legal dispute right now. And the White House defended all of this, is saying that these panels are a waste of taxpayer dollars that don’t meaningfully inform policymaking. So I thought that was a good read on something that doesn’t get a ton of attention. 

Rovner: Yeah. Well … of course, these panels are intended to bring in the public to make public policy. That’s kind of why they’re there. They’ve always been sort of a bipartisan thing. Anyway, really interesting story. Sandhya. 

Raman: So my extra credit is from The Cut, and it’s called “,” and it’s by Juno DeMelo. And this was a story that, you know, they talked to a lot of pediatricians about how their jobs have changed given the increasing vaccine skepticism. And some of these pediatricians are talking about having to really sell to their patients and their families why pediatric vaccines are necessary, or just devoting a lot more time, having a longer appointment just to explain why this is necessary. Sometimes it takes multiple appointments, which is just different with what they’ve had to do from the past. And, you know, the fatigue from having to go into all the science, instead of just presuming the child will get the vaccine and being able to discuss other things — safety and signs to watch and growth, and all of that. And so I think it was a good look at some of the things that drilled down on that. 

Rovner: Yeah, it was. These policy changes have impacts way down the line. Shefali. 

Luthra: My story is from ProPublica. It is by Duaa Eldeib. The headline is “.” It’s about families opting out of vitamin K shots, which are useful for blood clotting for newborns, and babies dying. And I think the story is remarkable for several reasons. It’s really got remarkable examples, and we see who these children are who are dying. We know how old they are, we know the color of their hair. We know what their symptoms were and what happened to them. There isn’t government data tracking vitamin K shots and whether they are rejected, but the story does a really good job painting a picture anyway. It has interviews with hospitals who have seen more and more parents saying we don’t want this because we are concerned. And it contextualizes this within the rising anti-establishment approach to medicine, more skepticism around well-researched and appropriate interventions. There is data showing how many children die from this spontaneous bleeding that can often happen if you’re deficient in vitamin K. And together, it uses those different points to create a picture of a troubling and avoidable public health trend that’s resulting in kids dying. 

Rovner: Yeah, more fallout from the anti-vax movement. My extra credit this week is from my KFF Health News colleague Stephanie Armour, and it’s called “HHS’ Healthy Food Agenda Puts Hospitals on Notice About Patients’ Meals.” It’s a story about something that we’ve talked about before in the podcast, the new HHS policy that threatens hospitals’ Medicare and Medicaid reimbursement for facilities that don’t conform to last year’s new dietary guidelines. But there’s some pretty vivid detail here about how those guidelines actually fail to address the needs of many hospitalized patients who may be limited in their ability to eat or drink and might actually need Jell-O or ginger ale or Ensure, all of which are now at least theoretically banned. And the administration is also asking patients to report hospitals that are violating the new rules. Again, another thing that was not on my 2026 bingo card. 

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

Raman:&�Բ�����;��’m&�Բ�����;�Dz�&�Բ�����; and on  @SandhyaWrites. 

Rovner: Jessie. 

Hellmann:  on  and  and also on . 

Rovner: Shefali. 

Luthra: On Bluesky . 

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