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

Mary Agnes Carey: Hello from �������ýҕ�l Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? ��’m Mary Agnes Carey, managing editor of �������ýҕ�l Health News, filling in for Julie Rovner this week. As always, ��’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 ��’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. ��’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 ��’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, ��’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 ��’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, ��’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. ��’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, ��’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, ��’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 �������ýҕ�l 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: ��’m on X, . 

Carey: Sandhya. 

Raman: ��’m and , @SandhyaWrites. 

Carey: Joanne. 

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

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