[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. 

[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. 6, 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: 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 Amanda Seitz. 

Amanda Seitz: Hi, great to be here. 

Rovner: Later in this episode, we’ll have excerpts of my “How Would You Fix It?” interview with New Jersey Democratic Sen. Andy Kim, who’s proposing universal coverage starting with all American children. But first, the freight train of health news continues. 

We’re going to start this week in Michigan with that very closely watched Senate primary to fill the seat being vacated by the retiring Democrat Gary Peters. We’ve known for months the Republican candidate will be former congressman Mike Rogers, who narrowly lost to Sen. Elissa Slotkin two years ago. And now we know he will face Abdul El-Sayed, an MD epidemiologist and former public health director of Detroit. El-Sayed, who ran on a platform emphasizing “Medicare for All” and has even written a book about it, narrowly defeated four-term Democratic congresswoman Haley Stevens, who had a gigantic cash advantage, mostly provided by supporters of Israel. Now, the fight over Israel in Gaza is for some other podcast to get into, but I do think that this underscores the increasing popularity of Medicare for All in the base of the Democratic Party. What does El-Sayed’s primary win tell us? And can someone from the more progressive wing of the Democratic Party win in a very purple state like Michigan? 

Ollstein: Well, I also want to point out, like, this isn’t an outlier. It was really notable to me that during the Maine rushed, redo primary they just had for the Democratic Senate candidate to take on Susan Collins, everyone in that race was endorsing Medicare for All and calling for it. And Maine is also a very purple state with an older electorate, and, you know, not raging progressive. And so I think it is notable that this isn’t just in the big blue cities anymore. This is a growing drumbeat within the party, and, you know, of course it comes as we’re seeing a lot of people lose their health insurance, which we’re going to talk about. We’re seeing costs go way up, and so there’s just this wellspring of frustration that I think is fueling some of this. 

Seitz: Oh, I was just going to say I would caution, though, how big of a win this is for progressive Democrats. You know, they’ve won the battle, and I’ll say it has built quite a strong coalition. But this was a really narrow primary win, and that is not the situation you want to be in when you have two diametrically opposed candidates from the same party running in a primary in a very purple state headed into the midterm elections. 

Rovner: Yeah, well, let us talk a little bit more about Medicare for All because it’s a trendy moniker for something that’s not really all that specific. Some people think it’s just shorthand for “everyone gets government-provided health insurance.” Some think it’s actually socialized medicine. And some think it’s literally just an extension of today’s Medicare program, which is itself a very public-private hybrid. My friend Jonathan Cohn over at The Bulwark, who happens to live in Michigan, has a  that I will link to about how consideration of Medicare for All looks different in 2026 than it did in 2016 or even in 2009, when they were doing the Affordable Care Act. Where do you guys think we are on Medicare for All? I would remind that what was in the 2020 campaign, every candidate, every Democratic running except for Joe Biden said they were for Medicare for All, and yet Joe Biden is the one that came out of the primaries. 

Kenen: I think Kamala Harris was for “Medicare for All Who Wanted It.” She had some strange hybrid of it, but that is part of our past. I mean, Medicare for All is something you hear about from the Democratic Party, a segment of the Democratic Party, in pretty much every election with more or less intensity. And more so [with] Bernie Sanders running against Hillary [Clinton], it was a much more pronounced debate. In Michigan, I don’t think this is the defining issue. I mean, I think that global politics in the Middle East, and given the demographics of Michigan, and what the race is focused on, and points of contention are, it’s pretty easy to talk about wanting everybody to be covered, and it’s a lot harder to get there, as we all know, because we’ve been talking about it for decades. So I think you’ll hear about it from Democrats â€” I’m not sure in Michigan and elsewhere, but I’m not sure how specific a plan or a definition it is, sort of this holy grail that nobody knows quite what it looks like. 

Ollstein: But that also makes sense. I mean, it’s not really in their interest to put out detailed policy plans that people can pick apart at this phase of things. And so it makes sense that we’re in the grand, sweeping, dreams phase of things, and not in the â€¦ 

Rovner: We’re in the slogan phase. 

Ollstein: Exactly, exactly right. Because, you know, as soon as Democrats put out an actual bill, a draft bill, then the vultures will descend and point out all the downsides, and that doesn’t help them heading into, you know, a major midterm election. So we imagine that work is going on behind the scenes, because they want to have something ready to go if and when they have control in Congress. But what exactly that is, we don’t know. 

Kenen: But I also think there’s pressure for the Democrats to be â€” in the best-case scenario, if you had a united Democratic Party where they all wanted Medicare for All and they all agreed on what that meant, you don’t press a button and get there. It would be some kind of incremental phase, and it’s not going to be, like, OK, today we have this and tomorrow we have Medicare for All. So I think, in the short term, less controversial and maybe more urgent is affordability and access right this minute. We are going to talk about the coverage decline and affordability and just access on a day-to-day … even if you are able to afford your care and even if you have pretty good insurance, getting into a doctor when you need to has become really frustrating. Even if you’re sick and already know that doctor. So even if you’re a pretty health-savvy consumer, the way all of us are, we see this in our friends and family, and we understand the system â€” sort of, like “the system” in quotes. So I mean, I think there’s the Medicare for All, you know, Democratic dream, and it â€” I don’t mean it’s not sincere; I mean, that’s what many people want â€” but I also think you’re going to see a lot more nuts and bolts: What has happened in the last two years, and how do we fix it? 

Rovner: I’m interested in the fact that Republicans who are already sort of ginning up their talking points against the, you know, wave of progressive candidates like El-Sayed, although he’s not as progressive as, you know, the [Zohran] Mamdanis and, you know, some of the other avowed socialists. They’re talking about socialism and communism, and they’re talking about all kinds of things. They don’t seem to be talking about healthcare, which suggests to me that Republicans are kind of aware that things are not going well, and that, Joanne, as you point out, I mean, you know, it used to be let’s see if we can fix the health system without messing up the people who are happy. There are fewer and fewer people who are happy right now with how the health system is falling apart. 

Kenen: Including the doctors, right?  

Rovner: Right. Oh, absolutely. 

Kenen: Nobody’s happy. 

Rovner: Well, well, let us move on to all of the ways in which the healthcare system is falling apart. Item one is a new Gallup-West Health poll that found nearly a quarter of workers surveyed said they were staying in a current job that they otherwise wanted to leave only to retain their health insurance. That was up 8 percentage points since the last time they’d asked in 2021. Now “job lock,” as this is called, is something that HIPAA was supposed to address back in 1996. The “P” in HIPAA stands for Portability. It was the Health Insurance Portability [and Accountability] Act. How is this still a thing 30 years later, that people feel stuck because they can’t change health insurance? 

Ollstein: This was also a big driving force behind the argument for Obamacare. The argument was: We’re going to free up all these people by creating this individual market, we’re going to unleash American ingenuity, and we’re going to have entrepreneurs and people starting their own businesses and experimenting and trying things that they wouldn’t feel able to do because they’re so afraid of â€¦  

Rovner: Shark Tank for All! 

Ollstein: â€¦ losing their health insurance. And so I think the way the Trump administration has targeted some key pieces of Obamacare, you know, they obviously, as we know, failed to get rid of the whole thing, but they are chipping away at the subsidies, which has caused a lot of people to drop their coverage; they’re going after the Medicaid expansion piece of Obamacare, and so I think that’s driving some of this return to, you know, clinging to the job you have in order to maintain your health insurance. Although, going back to the point that nobody’s happy, employer health insurance, while it may be better than a lot of the other options, is, you know, people aren’t thrilled either. The costs are still quite high for both employers and employees. 

Rovner: And employers are looking for ways to cut back. Go ahead, Joanne. 

Kenen: I was also wondering, as I read those numbers about job lock â€” and we should also remember, even though it wasn’t in that particular story, there’s also something called “marriage lock,” where people stay in marriages they don’t really want to be in because they wouldn’t have, they fear they wouldn’t have coverage. But one thing I just sort of wondered about is I wonder how many people realize that they might, in fact, qualify for the Affordable Care Act. I think people are still confused about the ACA, as well as they’re confused about a whole laundry list of things that we could spend a year talking about. People aren’t always paying attention, so some of the people who are afraid that if they change jobs or think they have to stay in their job think that Obamacare is for somebody else. So I don’t know. 

Rovner: They wrongly think they’re in job lock. 

Kenen: Right, right. So, but it still affects the behavior. If you feel that way â€” you’re anxious and insecure and unhappy â€” then you’re anxious, insecure, and unhappy. Whether you are aware of there’s an alternative or not, it doesn’t affect how you feel now, which is, you know, grumpy. That’s not the right word, but you know what I mean. 

Rovner: I know what you mean. 

Seitz: Yeah, well, and I think that that’s what I found fascinating, too, is like when we look back at 2022, there was a lot of head-scratching as to how Democrats performed so well in the midterm elections. But you look back at that time, and people â€”it was the peak of the Great Resignation â€” people were leaving their jobs. They were able to get big raises for the first time in a while. Unemployment was extremely low, so you had, like, an electorate that was pretty happy and didn’t have that anxiety. And now you’re staring down a situation where people are afraid to leave their jobs. They’re afraid to lose their health insurance, and the social safety net is deteriorating at the behest of the Trump administration. And I think that’s not a very good situation to have a lot of Americans in, as you head to a midterm election. 

Rovner: Well, item two: Several outlets, , reported last week that hospital systems are seeing what the Times’ Reed Abelson described as, quote, an “unexpectedly sharp rise in uninsured patients and the costs associated with treating them.” We are starting to hear this in earnings reports from for-profit chains and anecdotally from nonprofits. Now, this was something that we saw coming. People can no longer afford their ACA plans and drop them, or as they can no longer afford the premiums without the expanded subsidies and had to buy down to less-generous plans with larger deductibles, which they then can’t cover when they end up in the hospital. This would suggest the Trump administration’s claim that the drop in ACA coverage is all due to fraudulently enrolled people with zero claims might not actually be the case. 

Seitz: I question how much, like, the Trump administration realizes they’re playing with fire here. And I think in part because during the first Trump administration, you saw a few hundred thousand people disenroll from the ACA. They kind of let it to languish, but there was also a lot of question about the ACA marketplaces’ ability to survive. This time around is so much different. You’re talking about millions of people losing coverage within the first year. The Trump administration came in; they had record enrollment in the program. So these are real losses. These are real hospitals, and these are going to be real headlines of real people experiencing these real misfortunes. And you’re going to have either taxpayers eating the cost of the care through emergency Medicaid, or you’re going to have people winding up with really big medical bills that they can’t pay. And again, those are going to be real stories. And the Trump administration is going to find that they can’t just continue to yell fraud to cover all that up. 

Ollstein: Yeah, to Amanda’s point, I think this message could definitely backfire politically. Nobody likes to be told that they are a fraudster or don’t exist when they are losing their health insurance. And this is hitting red-state hospitals just as much as blue states, if not more. And so, I think going into the midterm election, sticking by this line and not admitting who is being harmed is definitely risky. 

Rovner: Yeah, it’s worth pointing out that, I mean, it does hit red states harder because the red states that didn’t expand Medicaid ended up with bigger enrollment in the ACA when they expanded the subsidies â€¦ 

Seitz: Florida’s the biggest. 

Rovner: â€¦ and so those people are now losing coverage. Yeah, Florida, Georgia, Texas. Those are the places where the hospitals are going to see it first when people are showing up who can’t pay their bills. 

Kenen: And those are the states that already have a lot of rural hospital closures. There are rural hospital closures and hospital closures across the country, but the rate of closures is much more acute in the states that did not expand Medicaid. So now you’re going to have more hospitals in jeopardy. It is not a healthy situation. 

Rovner: Well, related to this, we have the impending cuts to Medicaid. A federal judge appointed by Bill Clinton declined to block the Medicaid work rules from taking effect as scheduled Jan. 1. This was in a lawsuit filed by Democrat-led states. But there could still be some delay, right? I know doctor groups are completely freaked out by having to potentially write notes for tens of thousands of patients who may or may not be too medically frail to work. There’s still a lot of sort of panic, if you will, in the states about what’s going to happen to people if they can’t meet these work requirements. 

Ollstein: Yeah, and I want to make sure people know that the judge [who] ruled in this case, he said you shouldn’t take this ruling to mean that I think the states are wrong in challenging this policy. They could very well prevail eventually and strike it down. He just said, basically, this isn’t ripe. You don’t have enough evidence right now of harm to the states because the policy hasn’t officially started yet. Although it has in a couple states that weren’t part of the lawsuit, which we can get into. But this particular piece of the story is not over. Also, people should know that what was being challenged in court was not the entirety of the work requirements; it was just the piece requiring sick people on Medicaid to prove that they are too sick to work, prove beyond just having a diagnosis of cancer or an autoimmune disease or something. Just the diagnosis is not enough; they have to have some kind of proof. It’s not totally clear what kind of proof will count. And, to your point, they’re worried that it’s going to end up being individual doctors’ notes, which will completely overwhelm the system. Doctors don’t have the capacity to see all these people to document this and provide care. 

Rovner: And doctors don’t have the training to determine, you know, who’s disabled and who isn’t. That’s why we have these, you know, special masters for disability programs. Your average doctor is not really in a position to say, “Well, so-and-so can work this month but not next month.” Really, I mean, doctor groups really are legitimately worried about that this is going to fall to them. 

Kenen: And also, like, an awful lot of the people on Medicaid who would be affected â€¦ this is the Medicaid expansion population. It’s not all of Medicaid. But a lot of this population has chronic disease. And chronic disease is often sort of on and off, right? You’re doing OK for a while. You can work, and then kaboom, you have an exacerbation. You have a setback. You have an episode. Whatever your disease is, there are different things that happen, and then you can’t work. And doctors don’t know â€” I mean, mental illness is clearly one of the things where people could be stable for a long time and then crash and then recover and stabilize again. Cancer, you can be doing fine, on chemo for a certain amount of time, and then your body just says, you know, I’ve had enough chemicals pumped into it. Or you have â€¦ every chronic disease is pretty much â€¦ every one I can think of is an up-and-down, on-and-off â€¦ like how bad do you feel or how good you feel at any given time. And they certainly don’t have â€” then you’re out of compliance. You know, well, you’re healthy enough to work. Why aren’t you working? You know, bye-bye healthcare. So it’s really a complicated mess. The only little thing that may buy the states some time, in addition to whatever happens in the court, is for the first year and only the first year, people will be allowed to self-attest, meaning I’m just going up and saying I’m, you know, here’s my diagnosis, and I’m too sick to work. That is not likely to be extended. It’s unclear how that will play. I’ve written about it in somewhat detail about one state. I’m not exactly sure how it’ll run out in all 50, but it is part of the current rule that, this controversial rule that was dropped on June 1, that made this all sort of more complicated and more difficult. That self-attestation would be available on Jan. 1 for a limited period of time. 

Ollstein: But not in every state. So CMS [the Centers for Medicare & Medicaid Services], the federal government, said states can accept self-attestation. Several states are saying no thanks. We’re going to start requiring proof right away. No self-attestation allowed. So this is yet another sort of natural experiment where we’re going to see, you know, the differences between these states with these different policies, and how many people lose coverage as a result. 

Kenen: But it’s going to be way more than we thought at the beginning. I mean, the difference in this medical frailty rule versus what CMS was telling states until a few weeks ago versus, kaboom, on June 1, it is a much more cumbersome process. I mean, nobody thinks the old estimates of coverage loss are accurate anymore. I mean, there’s always a lot of guesswork in that, right? None of us know exactly how many people will lose coverage, but it looks like a lot more than we thought. 

Rovner: So we already have one of these natural experiments going on in Nebraska, which volunteered to implement its work rules first. The state is now getting ready to disenroll the first Medicaid patients who have failed to meet the requirements. Clearly, some of those people are still eligible, including a pregnant woman reported on by Nebraska Public Media who showed up for an appointment and was denied coverage because apparently the state missed the fact that she was pregnant and therefore eligible. I imagine we’re expecting more of this, right, Alice? We’ve seen this movie before? 

Ollstein: Yes, so we’re getting a sneak preview in Nebraska of what could happen in the rest of the states that expanded Medicaid come Jan. 1. A couple other states are also starting early, although they have different rules about when the penalties kick in and when the enforcement kicks in. But yes, you know we’re seeing a lot of confusion, people losing coverage who are technically eligible for coverage, and basically everything that providers and community groups and patient advocates predicted would happen. 

Kenen: And we know from Georgia, which does have work requirements already, they’re not a full-expansion state. They have their own version of a partial expansion, but it’s still, the law still applies to them. And they’ve had a lot of people losing coverage who probably are still eligible. We know from Arkansas’ experiment in, I believe was 2018, tons of people â€” I think it was 17,000 or 18,000 â€” who lost coverage, and most of them actually qualify. In fairness, the technology since 2018 and 2027 â€¦ and learning from Arkansas’ mistakes. â€¦ I think it’s important to be aware of how flawed and problematic Arkansas was. I don’t think it necessarily means that everything will be exactly that bad because, you know, there’s more broadband access in rural America, etc. We don’t have to go into all that. But it’s not a great precedent in terms of smooth rollouts. 

Seitz: And we also know it from the Medicaid unwind during the pandemic, too. We saw these errors and the initial estimates of how many people would be removed from coverage after the federal government said, OK, you can’t allow continuous enrollment anymore. They blew past those initial estimates. So, to your point, Joanne, earlier about how we are going to see much greater disenrollment than was initially predicted.  

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

We are back, turning to abortion. Alice, you were part of a  about U.S. Attorney General nominee Todd Blanche and something he promised to anti-abortion groups. Tell us what he said. 

Ollstein: Yes, so this was on a private call that the White House Faith Office did with what they said were thousands of faith leaders around the country. And they, you know, said over and over on this call, this is private, this is off the record, this is not for the news, and then they posted it on YouTube for some reason and on some other places online. Explain that. Anyways, it’s been taken down since our story published, but we have the audio saved. So Blanche was basically promising that not only would he take action to restrict mail delivery of abortion pills and curbing abortion access in other ways, if confirmed, he sort of went beyond that and said that policies are already in the works. There’s already discussions going on between the White House, DOJ [Department of Justice], FDA, all of these different agencies sort of pledged to stop the ability of patients in red states to order abortion pills online and get them delivered by mail, which is, you know, a key line of access that patients have turned to in this post-Roe era of bans. It was not clear from the audio that we obtained how he plans to go about doing that. I also imagine if, you know, the FDA does come out and change its policy, that his remarks could be used to challenge that and say, you know, this was not based on science. This was based on ideology and religious opposition to abortion, which is not what the FDA is supposed to base its drug access policies on. So this was really fascinating, particularly because it did not really jive with what he said publicly in his confirmation hearing, where he sort of hemmed and hawed and said, “Oh, I can’t speak to that because there’s ongoing litigation,” and sort of made â€” yes, this was more specific promise of action than we’ve heard from him publicly. 

Rovner: And just to be clear, I think I have this right: Even if the FDA doesn’t change its policy, the DOJ could decide We’re going to enforce the Comstock Act â€” that 1873 law that bans the mailing of abortion drugs. And that would sort of leave FDA out of the entire equation, right? I mean, in theory, he could do that. 

Ollstein: Yes, and a lot of anti-abortion activists are very frustrated that the administration has not done that yet. They could have done that a year ago, theoretically put out a new OLC memo. Of course … 

Rovner: OLC, the Office of Legal Counsel. 

Ollstein: Yeah, which the Biden administration used to say that the Comstock Act cannot be used for cracking down on mail delivery of abortion pills. Of course, even if that happened â€” and there’s no sign that that’s necessarily imminent or something the administration would want to do ahead of the midterms potentially â€” but, you know, I think it’s notable to ask: How would they enforce that? This is private mail going to people’s private homes â€” short of mass surveillance and looking at everyone’s mail. I mean, logistically and constitutionally, it raises a lot of questions. 

Rovner: It does. Well, and now Sen. Susan Collins has cited it as one of the reasons that she’s going to vote against Blanche’s confirmation. Although I will quickly add that once Susan Collins announces she’s voting against something controversial, that usually means Republicans already have the votes they need and can let her go. â€¦ I see nodding. Do we think that’s the case here? 

Kenen: She’s always in tight races. For the past 30 years, she’s won. But you know, Maine is really obviously in play this year. None of us have a good enough crystal ball to know how this plays out. But the issue for her, in many ways, is just her [Supreme Court Justice Brett] Kavanaugh confirmation vote. So anything she does seen as further eroding abortion could really tip the election for her. So I’m not positive that this goes through. I think it’s likely, but [Sen. Bill] Cassidy, I don’t believe, has said what he’s going to do. [Sen. Lisa] Murkowski hasn’t said â€¦ if someone has more recent information, please update me. But my understanding …  

Rovner: As of this morning, Cassidy and Murkowski are still holdouts. 

Kenen: Right. And I’m not 100%, even though [Sen. John] Cornyn and [Sen. Thom] Tillis got him out of committee, they’re watching. They’re seeing, you know, what’s going on. Abortion is not the issue for them, but the weaponization, you know, what did he really mean by, you know, does his memo really stop it? What else are they going to do? I don’t think this is a done deal, as opposed to getting closer to being a done deal. But there’s no question that Collins had to vote against this. 

Rovner: We will see. All right. Well, over at the Department of Health and Human Services, things continue to be messy, which is also the description of an interview that Secretary Robert F. Kennedy Jr. gave to CNN’s Dana Bash on Sunday. Here’s how my colleague . I don’t think I can improve on this. “This morning, HHS Secretary Robert F. Kennedy Jr. sat down with Dana Bash on CNN’s State of the Union, and for 20 minutes it went about the way you’d expect. Both of them raised their voices, each accused the other of attacking them. He told her she’d committed press malpractice and that scaring people was the job of CNN. She told him he was causing inaccurate information to circulate. By 9:20 a.m. they were calling each other parrots.” By the way, this week saw publication of yet another large-scale study, 2.5 million children large, that found no association between autism and the measles, mumps, and rubella vaccine. But it raises the broader question: Does giving the secretary a mainstream platform like this actually make the media complicit in spreading the misinformation that he likes to spew? 

Ollstein: Things like this are such a Rorschach test because you had everyone on the left describing it as a crash out and, you know, a meltdown and something that made the secretary look really terrible, and you had people on the right who support him sharing it widely and saying, “Oh, he really gave it to the evil mainstream media.” And so, in terms of, you know, value to the public, I’m not sure. 

Seitz: I think you’re totally right, Alice. But what was really revealing is we have a health secretary who could not articulate what his plan is for any sort of outbreak, as there are multiple infectious disease outbreaks exploding throughout the country. And the one thing that he said he would do repeatedly was he would listen to doctors. Well, doctors on the front line of emergency rooms are saying, We are overwhelmed with measles. We are overwhelmed with infectious disease. Please, promote vaccines more. Please get your children vaccinated. So I think that was really just revealing. And again, it’s really troubling to see because everyone’s going to walk away from that conversation viewing it one way or the other, and not agreeing on anything, it seems. 

Rovner: Yeah, I will say, I mean, I watched it live. It was hard to watch. I don’t think it covered anybody with any kind of glory. Well, earlier this morning, speaking of breaking news, Kentucky Sen. Rand Paul’s Homeland Security and Governmental Affairs Committee voted to hold former NIH [National Institutes of Health] institute director and White House science adviser Anthony Fauci in contempt of Congress for pleading the Fifth, rather than answering their questions at a hearing last week. As former Trump surgeon general Jerome Adams quipped on X: “Your healthcare costs are exploding and the entire U.S. financing system is collapsing in real time… Meanwhile Congress is spending more energy debating whether to lock up an 85-year-old over his private journal entries about Barbra Streisand. Priorities.” At the same time, Politico is reporting that a top candidate for Fauci’s old job, running the National Institute of Allergy and Infectious Diseases, is a pharma executive who co-authored a book arguing that covid came from a lab leak and that fact was covered up by U.S. scientists. Steven Quay, who’s the nominee, has no training in infectious disease and was not selected for an interview by NIH staff for the NIAID job, but was instead handpicked by RFK Jr. Institute directors, I would hasten to add, are not usually political positions, unlike the director of NIH as a whole. So, what does this all suggest? 

Kenen: More of the same and worse. The Fauci situation is mind-boggling, even to people whose minds are now frequently boggles. Right? It’s â€¦ I think it’s safe to guess that he regrets writing certain things down on a government computer. And now they’ve got his phone. Sen. Johnson has his phone â€¦ or a copy of what his phone is. So I don’t know what’s going to come out about that, and how it will be interpreted. Remember that the measures that people are so angry about, several years later, were actually done during the Trump administration. They were not implemented by Biden. The national rules set at the, you know, the “six weeks to stop the spread” — that was Trump. Later regulations about opening restaurants and so forth, and other businesses and schools, and schools being the most contentious â€” churches are also contentious â€” that was done at the state level. Anthony Fauci did not go around the country locking churches. So public health made mistakes. But what people are forgetting about is that public health made mistakes dealing with a completely unprecedented and extremely complicated disease, which we still don’t understand all the sequel, all the stuff that people are still dealing with post-covid, right? And under emergency circumstances, in a politically volatile environment. And what we’re also forgetting is mistakes were made on the other side too. People were spreading quote-unquote “facts” that harmed people, that killed people. … I don’t mean they went out and murdered people, but things that led to unnecessary and avoidable deaths. So the whole debate, I mean, you can tell I’m â€” I’ll stop. Tony Fauci was not single-handedly making every decision, and the people trying to make public health decisions in a difficult environment were doing their best to save lives. And â€¦ it doesn’t matter what he said about Barbra Streisand. 

Rovner: And I would just add that it is Congress’ job to do things like examine the mistakes that were made and how things could have been done better, how communication could have been better. And I feel like, you know, Congress is just is so busy finding a scapegoat that it is not doing what could be a really useful exercise in an after-action report. Because there will be another pandemic, and, you know as we’ve said, we are having smaller-scale public health emergencies even as we speak, and nobody is dealing with it well. 

All right, moving on. Finally, this week, the House has decamped for its August recess, but the Senate is still here on Capitol Hill, trying to get a pretty ambitious list of things passed before it leaves at the end of the week, starting with a continuing resolution to keep the government open when the new fiscal year begins Oct. 1. The House passed a CR to run until after the midterms before it left in July. The Senate’s CR is similar with one big change that we have actually discussed lately. It would block, at least temporarily, a controversial rule from the Office of Management and Budget that would further politicize the grant-making process by allowing political appointees to decide whether individual grants conform to the president’s agenda. Can this get back through the House, assuming the Senate passes it when the House comes back in September? Or is this going to come down to the wire and we’re going to have a fight over it as we approach Oct. 1? 

Kenen: Well, the other question that some researchers, you know, when I when I talk to some people about, well, they â€” and remember they’re not killing this rule; they’re halting its implementation. 

Rovner: They’re delaying it, right? 

Kenen: Right. You know, one of the scientists’ first response was, “Yeah, well, just because Congress passes a law doesn’t mean the administration will respect it.” There are other ways to politicize, and I mean, they’ve been cutting funding and stopping grants and virtually shutting down agencies. Science has already been hurt. So whatever happens in the House, which, and I think Julie is right, I don’t think they just come back and say, “OK, we’re going to just agree.” I think there’ll be some kind of fight â€” how it fits into other trade-offs between the House and the Senate. And there are things other than health that we don’t pay as much attention to that are also out there, including a couple of wars. So yes, there’ll be some fighting about it. No, we don’t know how it turns out. But at the end of the day, if the administration really wants to further politicize an already politicized grant-making process, they will probably find a way of doing so. 

Rovner: Well, speaking of which, the administration has figured out other ways to effectively gut programs. Case in point: Head Start, which is a bipartisanly popular preschool education, nutrition, and healthcare program for low-income kids, just this morning, HHS is dropping new rules that would basically eliminate many of the required standards for Head Start programs, including things like teacher-to-student ratios. This administration is nothing if not creative, because this is not â€” you know, last year they were delaying the money going out for Head Start. Now they’re just going to say, Well, we’re just going to take away the rules, and you can sort of take this money and do whatever you want. Amanda, you’re nodding. 

Seitz: Yeah. Well, I found this really striking because I was with Secretary Kennedy a few months ago at a Head Start in Toledo, [Ohio], where he talked about the importance of the program, that it was inspired by his uncle, and he he said he really stood up against the White House to make sure â€¦ it was still funded last year, and he demanded that. And the other thing that really struck me about that visit is the Head Start’s owner had flown in from New York in this tailored suit to take photos with Kennedy and greet him personally. And I was a little confused why this person from New York is owning this Head Start. And it turns out a lot of private equity firms have been buying up daycares across the country, and this was the case for this Head Start. So, you know, pulling back the regulations of Head Start around class sizes â€” that seems like it would benefit more the private equity firms than the teachers and the children in the classrooms. 

Rovner: Fancy that! All right. Well, finally, finally, one of the things the Senate has managed to do this week is confirm Erica Schwartz as the director of the Centers for Disease Control and Prevention. That agency has been operating without a Senate-confirmed head since the departure of Susan Monarez last August, just weeks after she had been confirmed over differences with Secretary RFK Jr. over vaccine policy. How confident are we that Dr. Schwartz, who is a retired rear admiral in the U.S. Public Health Service Commissioned Corps and a self-proclaimed vaccine supporter, will last longer than her predecessor? 

Seitz: I think that is a huge question. I mean, we’re now on our third CDC nominee of this administration, second confirmed candidate, and we know that Secretary Kennedy and Susan Monarez never really got along. It was not, she was not his first choice. That has been made very clear with Schwartz as well, when he said that he was not even consulted really about the pick. So I think the big question is: Can these two work together, and how quickly will that potentially deteriorate? 

Rovner: Yeah, well, the clock is about to start. I guess as soon as she is sworn in. â€¦ She was just confirmed on Wednesday, so I don’t think she’s been sworn in yet. Alice, you want to add something? 

Ollstein: Yeah, I did think it was interesting, though. On Capitol Hill, you heard from some senators that, you know, they did have concerns about her ability to stand up to RFK and advocate for evidence-based medicine science, you know, particularly on the vaccine front. But because there hasn’t been a leader at this crucial agency for a year now, they wanted to vote to confirm her just for some stability and some leadership. I mean, look, we’ve got diarrhea lettuce, we’ve got salmonella eggs, we’ve got measles. We’ve got a lot of problems, and it’s never a great time to not have a leader of the CDC, but right now is really not a good time to not have a leader of the CDC. 

Rovner: Yeah, I think that’s what Tim Kaine of Virginia, a Democrat, said. I think he was the only Democrat that voted for her. More important to have somebody at the CDC leading it. 

All right, that is this week’s news, or as much of this week’s news as we could get to. Now we’ll play my “How Would You Fix It?” interview with New Jersey Democratic Sen. Andy Kim. Then we’ll come back with our extra credits. 

I am pleased to welcome New Jersey Democratic Sen. Andy Kim to “How Would You Fix It?” Sen. Kim’s a member of the Senate Health, Education, Labor, and Pensions Committee, and just introduced legislation to guarantee health coverage to every child up to age 26. Sen. Kim, welcome. 

Andy Kim: Yeah, thanks for having me. It’s a pleasure. 

Rovner: As I hope this series is highlighting, it appears the country is moving, albeit kind of slowly, towards another major debate over healthcare coverage and cost. What made you decide to step into these very choppy political waters? 

Kim: Well, first of all, I’ll say it is because of healthcare that I ran for Congress to start with. So, you know, eight years ago or so, when I first started running, it was because I had a little baby boy who had some real health issues right there as he was born, and I was one of those very scared, anxious parents trying to figure out what kind of care could my kid get. Meanwhile, we saw a debate in Congress where the Republican-led Congress in 2017 was trying to gut the Affordable Care Act. So that was why I actually got engaged in politics, [because] my congressman was leading that charge on trying to cut preexisting condition protections.  

The other aspect of this is right now things are just moving in the wrong direction. We have upwards of, you know, 1.75 million to 2 million more kids losing Medicaid over the last year and a half. We see the numbers already atrocious. You know, 4.4 million children in this country without health insurance, 23 million kids that are underinsured, which means they have coverage that doesn’t cover their full needs. I’m appalled by that. I’ll be honest with you. Like, you know, we’re the richest, most powerful country in the world. I’m here at the Capitol, where we’re right now having these debates about, you know, a $1.5 trillion defense budget and other things that, you know, just are pushing forward. Yet we are just for some reason just OK with, or at least just allowing this type of void when it comes to our healthcare. I just find it to be â€” I mean, just appalling and a real dereliction of our duty that we have not found a way to be able to ensure that every child is able to go see a doctor when they need to without breaking the bank. So I think, for me, this has just been years in the making, and right now I wanted to introduce this because I can’t just be talking about what I’m against. I have to be talking about what I’m for. What is the vision for this country? Not just to reverse things that I think are wrong from what this administration has done, but I owe it to my constituents and to the American people to lay out a vision forward for us to try to think through where we go from here. 

Rovner: So, how would this bill work? 

Kim: First of all, the bill is called MediKids. So, as you said, it would be a guarantee of healthcare from birth to 26. I think one of the more novel parts of this that is different from what we see right now is that there’s an automatic enrollment upon birth into MediKids, which is a foundation built upon Medicaid. So the idea right now is we’re seeing so many kids and families losing Medicaid or potentially losing Medicaid in part because of just the onerous paperwork, the bureaucracy, the different types of things that are meant right now, just the twice-annual requirements to be able to recertify. That’s what’s standing in the way here and preventing so much of the progress that we need. So I wanted to really tackle that and be able to make sure that people can be able to get the care that they need.  

And another part of it is that I chose to put the platform upon Medicaid because Medicaid, in many ways, was designed for kids. You know, when it comes to the early and periodic screenings and diagnostics and treatment, that whole system is, as I’ve looked at it, really the most comprehensive system for kids. What healthcare experts have really shared with me over the years, as I taught talk them, is we can’t just think of kids as little adults. But instead, like, having a system that is designed for kids, that is designed to be able to have the screenings at the appropriate times and age intervals, to be able to have that requirement, to be able to treat any and all problems that are determined, and to think about this as comprehensively â€” not just like healthcare here, dental and vision, but to think about it across all of it. All of that is necessary for kids because their bodies are developing, their brains are developing well into their 20s, which is why, again, I pushed meta kids out into the 20s. It’s like you want to make sure that all of these kids are able to get the care that they need, and that you don’t see the kind of withdrawal of or restriction of care that could have real consequences down the road. So that’s really what we were trying to do. 

Rovner: So, as you well know, Democrats have been fighting for decades now over whether to try for a really comprehensive overhaul of the nation’s healthcare system or something more incremental. Obviously, the Affordable Care Act was something more incremental, but also fairly comprehensive. Is that how you envision this? Where do you fall on the “Let’s pull it up and start over from scratch,” and the “Let’s try to fix it one step at a time” debate? 

Kim: Well, yeah. Well, look, I want to be bold, and I want something that can really push forward. Because look, I’ll be honest: The American people want something bold. Like, the problems that we are facing are enormous. No one is happy with the status quo, so we need to have that change. But I was also thinking through how to design something that I think will have enormous impact upon healthcare, but doing it in a way that is implementable. You know, so with MediKids, I’m not creating some new bureaucracy. I’m not creating some new agency or new department. I am taking something that is already, frankly, covering a large percentage of children in this country already, and I’m trying to make it available for everybody through that automatic enrollment, and taking something that is proven to be able to have that comprehensive approach and use that as a foundation. I really tried to design this in a way that is implementable. As I’ve been in Congress now for eight years, I see the types of bills that can get through parliamentarians and get through into passage, and I’ve really tried to design something that hits that sweet spot while still fundamentally reshaping how healthcare in this country will be attained by people. And I really do think that it will have a sizable impact tremendously. Not just in terms of providing that care for kids, but everyone knows healthier kids means healthier adults, which means a healthier workforce, which means a stronger economy, which means lower healthcare costs. The knock-on effects are so strong. So many of the challenges that we see amongst adults when it comes to chronic illnesses and other challenges are often things that have been exacerbated because of the lateness of diagnosis or the lack of treatment early on. So those are the things that we’re really trying to think through when it comes to this approach. 

Rovner: Back in 1994, when the Bill Clinton plan went down, the first big health reform that I covered, there was an effort, mostly spearheaded by Sen. Tom Harkin of Iowa, that they called “Kids First.” They said, well, let’s just cover kids. It still took three years, a lot of fighting, and sort of they luckily found a tobacco tax to help pay for it. But it was bipartisan. Do you have any thoughts that Republicans are going to maybe have some renewed interest in increasing healthcare coverage? 

Kim: Well, what I will say is, first of all, if ever there was an issue that should be bipartisan or, frankly, nonpartisan, it should be about our kids, right? And that’s why I wanted to focus on this too. I think it’s the strongest argument that we have in our country when it comes to guaranteed healthcare. I get it, eyes wide open, I was on the Senate floor last year when I saw my colleagues vote to cut Medicaid at such a dangerous level, so I have my eyes wide open. But what I will say is, I’ve gone around the Senate over the last period of time, like the last two weeks since I’ve introduced, is that it is sparking that conversation. And whether or not my colleagues on the other side of the aisle or both sides of the aisle agree with all the different principles and proposals that I have in MediKids, it is creating this dialogue and this debate about healthcare for our kids. And that’s what I want. Yeah, that’s what I want us to be able to do. And you’re right. Like, we’ve seen bipartisan support in the past for CHIP [the Children’s Health Insurance Program], for healthcare for kids in different ways, and I just saw that going in the wrong direction last year, which is why I wanted to release this now to try to move it back into the fold. I saw a real deprioritization of concerns raised by parents of kids with disabilities that were worried about how these Medicaid cuts would affect them. It’s not good enough for them to just get, like, a wink and a “trust us” type of message. We really need to make sure that we just never have parents with that type of anxiety about whether or not they’re going to lose care for their child. So, well, we’ll see going forward. But at least my early conversations with my colleagues from both sides of the aisle, certainly around the overarching principles of care for kids, is promising. And I’m hopeful to be able to make some gains as we move forward in both the Senate, as well as in the House, as we start to push forward on that debate there too. 

Rovner: Well, we’re all about keeping the conversation going forward. Sen. Andy Kim, thank you so much. 

Kim: Yeah, thanks so much 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. Joanne, why don’t you go first this week? 

Kenen: OK. This is a story that’s up online in The New York Times, and I believe it’ll be in the Sunday Magazine this weekend. It’s by Dr. Helen Ouyang, whose name I don’t know how to pronounce, so I’m just going to apologize for not knowing how to pronounce it. The story is “.” For me, it’s not great because I was working on the same story, talking to some of the same people, and you know that’s not going to happen now. But something like she used the number 4 million, and it’s probably closer to 6 million, kids, between roughly the ages of like 10 and 18 or 19, are in fact the major caregiver for a sick parent or grandparent, and they are trying to juggle some kind of attendance at school and then doing medically complicated things, plus the psychological burden and not being able to be a normal teen. And these are largely poor kids. They are disproportionately Black and Hispanic kids. We do not have a system for helping them. The answer is not let them be caregivers because no one would be a caregiver. The person would have no care. The question is, really, how do we support them? Make it easier. Make sure they’re connected to whatever community resources or state resources or health resources that are available. Make sure they’re maxing out on that. But it’s a really disturbing and very moving story what these kids go through, because even those of us who are adults who’ve taken care of grandparents or parents, it’s really hard. And if you’re 15 or 10, it’s even harder. 

Rovner: Yeah, and taking care of siblings too in a lot of cases. Amanda. 

Seitz: My pick this week is “,” by Katherine Long of The Wall Street Journal. This is a story about a surrogate who agreed to carry what ended up being triplets for a father overseas in China. What I just found really remarkable about the reporting is that it takes this really horrible case â€” these children have essentially been left in the U.S. with the surrogate mother because the father from China hadn’t been able to come over due to visa issues. And, but it takes this really complicated story and looks at just the overall perils of the surrogacy industry that has exploded while being completely unregulated, and how all of these cases are largely playing out in courts and being complicated by the immigration policies of the Trump administration. So it was just a really fascinating read. 

Rovner: Other things that policymakers could be doing with their time. Alice. 

Ollstein: My pick is from NOTUS. It is called “.” So we talked about the vote to hold Fauci in contempt, but this is a look at what inadvertently, I guess, happened as a result of Rand Paul, who, let’s remember, is a doctor himself as well as a senator, releasing a huge tranche of private documents from Fauci and not redacting people’s personal medical information about their diagnoses. And this article talks about how that happened and how little recourse the people involved have about their information being exposed, and how this is a pattern with the administration of failing to redact people’s sensitive information when they do these big document dumps. 

Rovner: Oops. Yeah. Well, my extra credit this week is also about the Fauci affair. It’s from our podcast pal Sheryl Gay Stolberg at The New York Times, and it’s called “.” And wouldn’t you just know it, but it turns out that HHS Secretary RFK Jr. and one of his sons, and Kentucky Republican Sen. Rand Paul, have all published books accusing Tony Fauci of various crimes and misdeeds, and that after last week’s hearing, sales of those books jumped. Wrote Sheryl, “Ethics experts say that Mr. Kennedy, his son and Mr. Paul did not cross any legal or ethical lines, but several said the secretary and the senator did cross a threshold for hypocrisy by using their platforms to sell books about Dr. Fauci while accusing the scientist of profiting from his own public service.” I will let you all draw your own conclusions. 

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 folks hanging these days. Alice? 

Ollstein: On Bluesky , and on X . 

Rovner: Joanne. 

Kenen: I’m mostly on  and on  . 

Rovner: Amanda. 

Seitz: And I am still tweeting from X on . 

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

Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Dan: Hey there. It was just a little more than a year ago, in May 2025, the last time I checked in with my colleague Julie Rovner. She’s the chief Washington correspondent for our pals at Ñî¹óåú´«Ã½Ò•îl Health News and in what I would call a normal world, like a little more than a year would be really, really soon to talk with her again on this show.

Cause when I started making An Arm and a Leg, I didn’t expect that trying to keep up with the news was gonna be anything I would really have to think about too much. Like, I was setting out to understand and explain a multi-trillion dollar chunk of the economy that isn’t the tech industry, so I was like, how fast could it possibly move? And Julie Rovner’s thing is fast-moving news. On her weekly podcast, What The Health?, she leads a round table of health policy experts and journalists, and pours over a steady stream of headlines. Like whatever happens, big or small, Julie is tracking it. 

And then came 2025, and suddenly there’s this avalanche of news, and it’s big. Like, the Trump administration was making these sweeping changes, cuts to federal health programs. It was a ton of change, and I wanted to talk to Julie to try and wrap my head around it. And she told me even she was struggling to keep up. 

Here’s what she said then.

Julie Rovner: I’m trying to keep a running list of what’s been cut and what’s been restored, yeah, and it’s virtually impossible because there’s 20 things every day.

Dan: Yeah. And a lot’s happened since then. Like, Congress has added work requirements to Medicaid. It allowed federal subsidies for Obamacare to expire for millions of people. And those are, like, the biggest picture items. The rest of it feels like a blur. So, pop quiz: do we have a permanent FDA commissioner, CDC director, surgeon general?

I looked it up. As of July 21 the answer is no, in all three cases. It is an avalanche. So I wanted to talk to Julie again to get a glimpse at that avalanche from, like, further up the mountain, so to speak. 

Julie, thank you so much for coming back.

Julie Rovner: Always a pleasure, Dan.

Dan: Well, we’ll see how much of a pleasure it is to talk about the American healthcare system, but let’s give it a shot. 

Dan: This is An Arm and a Leg, a show about why healthcare costs so freaking much and what we can maybe do about it. I’m Dan Weissmann. I’m a reporter. I like a challenge, so the job we’ve chosen here is to take one of the most enraging, terrifying, depressing parts of American life and bring you something entertaining, empowering, and useful. This time with help from Julie Rovner. Here we go.

Julie, last time we talked, you were astonished and worried about the pace of change and, like, destruction given all the cuts at the Department of Health and Human Services. And here’s what you said then…

Julie Rovner: How I’ve been thinking about this is that our healthcare system is a giant Jenga tower and it’s a little wobbly and what holds it up is everything that happens from the Department of Health and Human Services and they’re yanking out sticks from this Jenga tower as fast as they possibly can and when the whole thing comes down, it’s gonna be very not pretty.

Dan: So you said that a year and change ago, and just like the news I’m seeing this week, we’re taping more than a week before we’re gonna publish this, but there’s been a huge public health story in the news. You know, this outbreak of a foodborne parasite called cyclospora that causes explosive diarrhea.

Boris Sanchez: a warning to more sensitive viewers, this next story is kind of gross.

Caitríona Perry: If you are about to tuck into a bowl of raspberries or a big plate of salad, we’re very sorry because we may be about to put you off your food.

Dr. Richard Smith: If you’re somebody that’s into going to salad bars on a weekly basis Just give that a rest for a week or two

Dan: Yeah again, we’re taping this in mid-July, so maybe this all gets cleared up by the time we publish, but right now, like, I’m personally having early COVID flashbacks trying to figure out what fruits and vegetables are safe to eat and how long I have to cook them.

And you know, sure enough, folks are pointing out that among last year’s many cuts at HHS was federal tracking of a half dozen foodborne pathogens, including this one, cyclospora. So I mean, it all feels a little on the nose. Julie, how are you seeing all this play out?

Julie Rovner: Yeah, it does feel very on the nose, if you will, um, because we’re, like, a month into this outbreak, and it’s a very big outbreak. But we still don’t know what’s causing it. So now we’re having, you know, I saw this morning, uh, a recommendation from a doctor said, “Just don’t eat any fresh fruits and vegetables for the next week or so,” um, because this is unfortunately a parasite that doesn’t –  you can’t necessarily get rid of by washing.

Which is not to say don’t wash your fruits and vegetables. Do wash your fruits and vegetables, but that’s not enough in this case. Um, but yeah, in an, in a normal world, we would know by now what it was, and nobody knows what’s safe to eat, and that’s what happens when you pull those pieces out of the Jenga tower.

Dan: Yeah. And again, like, a week from now when we publish this, who knows what we’ll know, who knows what we’ll be eating. But it seems symbolic.

Julie Rovner: Yeah, I think one of the things that’s going on, you know, last year when we had sort of DOGE cutting and, you know, there were headlines everywhere, and this, these many people were being laid off, and these many people were taking early buyouts and, you know, there was, there was all of this sort of coverage if you will, of all of these cuts.

Things are still not happening, and things are still getting cut, and it’s much quieter. You know, money that officials promised would get distributed as Congress ordered, um, is not getting distributed as Congress ordered. 

So, you know, there are people who are waiting for grants that have not come. Things are still getting cut. Um, political appointees are still making decisions that often, that in the past were always made by career professional scientists, um, doctors, um, people with long experience. As we know, we’ve seen large cuts at a lot of these agencies, so there’s a lot of expertise that’s walked out the door.

So even if there are people still there, they don’t necessarily know as much as they used to. Um, things are sort of going on at that lower level that are not making headlines, but that are still, for the people who are involved in them, or at least what they tell me, are not great.

Dan: Yeah. And what are you seeing play out as a result of the cuts that we’ve seen so far? Like, what are you hearing about that I – like, what do I not know that my neighbors might be experiencing, but I just don’t happen to be hearing about?

Julie Rovner: What you don’t know is how many people are not getting needed medical care because they can’t afford it, whether because they lost their subsidies for the Affordable Care Act and they couldn’t continue to afford their insurance, or in even more cases, their subsidies went down and they bought down into less generous policies and now they have, you know, five-figure deductibles, and so they have insurance, but they still can’t afford to get care.

Or they may be legal immigrants who lost their eligibility for health insurance that they used to have, um, or they may be part of a mixed-status family that dropped insurance because they were afraid of getting targeted by immigration authorities even though, you know, some, some people in the family, were perfectly eligible for these programs.

And we have seen states that are starting to cut back on Medicaid in anticipation of some of these federal cuts that mostly take effect next January, but that are starting to take effect in states already. 

Adam Atchison: Some individual caregivers in Colorado are about to see their Medicaid funding cut.

Michael Perchick: Tonight, the major question remains what can North Carolina do to make up for that major funding shortfall? 

Justin Corr: One of the biggest issues we knew the Idaho Legislature would debate this year. Now Medicaid cuts are moving forward.

Julie Rovner: And we’re seeing states that are cutting back on optional programs, which, you know, members of Congress last year when they were debating this bill said, “Oh, we’re not gonna go after people, you know, who are seniors or who have disabilities.”

Um, except those are the programs that are optional, and when states have to roll back their Medicaid programs, that’s what they roll back, and indeed, that’s what’s happening, and we’re seeing, you know, story after story. But again, these are happening a little more quietly, making fewer headlines. But for the people they’re hurting, they are really hurting.

Dan: Wow. Yeah, I mean, a couple of stories that I, you know, you’re reminding me of, right, that, um, new federal rules keep rolling out, and some of them include eligibility for Medicaid for, like, people giving care or, or what it means to be medically frail and not be able to work, right? Tightening those restrictions and saying, “Look, it’s, you’re gonna have to jump through a lot more hoops to prove that you can’t work.”

Julie Rovner: Yeah, almost all of these rules are being … Those are not finalized yet, but almost all of these rules are also being challenged in court, um, by states, by, uh, healthcare providers, who obviously wouldn’t get paid anymore for providing this care, um, and by patients. So we will see, you know, how these ultimately play out.

But there are, you know, a — this administration has been sort of cut first, answer questions later. That’s been kind of the theme from the beginning, and that is still what’s going on. You know, one of the things we’re gonna talk about, um, on our podcast this week, uh, are stories of family caregivers, people who are losing eligibility for their families, uh, to help take care of them. You know, and, uh, Dr. Oz, who’s the head of Medicare and Medicaid, you know, has been talking about people who are, you know, collecting money for, you know, going to the grocery store or bringing in the newspaper…

Dr. Oz: Something called personal care services. You’ve never heard of that. Personal care services, basically, you’re paying your kids to carry the groceries upstairs, but you’re not actually paying. The state’s paying, and then the federal government’s paying the state back.

Julie Rovner: That’s not what these people are doing. These are people who are changing feeding tubes and, you know, helping people who are not ambulatory in and out of bed and on and off the toilet. I mean, this is … these are very, very difficult jobs, um, that, yes, sometimes family members are paid to do, but if they make it impossible, a lot of these people don’t know where they’re going to get help, and in some cases, these patients are gonna end up in institutions, and that’s gonna end up costing the federal government and taxpayers even more money in the long run.

Dan: And, and these cutoffs are happening now? 

Julie Rovner: They are. 

Dan: Like, folks are, folks are getting notices or being told, like, “No, your check for taking care of mom isn’t coming this week. You’re not getting that.”

Julie Rovner: That’s exactly what’s going on. In, in, in my home state of Maryland, they are cutting off this program. I believe… I can’t remember the exact date. It may be, there may be another month or so, but it’s, you know, they are getting notices that these programs are ending and I think Maryland is one of a half a dozen states that’s doing that.

Dan: Wow. And it’s, it’s like you said, these huge stories, they’re not grabbing a lot of headlines. I mean, like recently on your show, you were like, “What was shocking last year is now kind of status quo,” like at least in terms of media attention. But you’re still tracking all of it. 

And, all this reminded me of what you said when I talked with you the first time last year. So our Zoom meeting started, we started rolling tape. I said, “How are you?” And this is what you said:

Julie Rovner: I have a shirt that says, “Up and not crying.” I also have a shirt that says, “This is not normal.”

Dan: And I wanted to ask you, like, how are you doing now? Are y- d- are those shirts still in your wardrobe?

Julie Rovner: They are, and I have another one that says, “This is my living in unprecedented times shirt.” And I kind of rotate them.

Dan: And, and how, because many of us have the option, I always figured I did, of like, “Yeah, I’m gonna, I’m gonna titrate my exposure to news. I’m gonna calibrate, like this is how much I, you know, is good for me, is healthy for me to have right now.” And you know, some people turn it off altogether. And you do not have that option, unless you choose to do something entirely different. But like, I wanna ask you personally, like what is that like for you? 

Julie Rovner: It’s exhausting. 

Dan: Yeah.

Julie Rovner: I mean, I, and I worry. I worry about people, um, who need healthcare and aren’t getting it. I worry about students who, um, are trying to decide whether they can actually pursue their dreams of becoming a healthcare practitioner or a scientific researcher who are seeing sort of their pipelines cut off. That’s, that’s a big concern for me right now.

And I see things like Ben Sasse, the former senator who was very near death from pancreatic cancer, suddenly being able to take a new drug. And he said that, you know, his cancer is 99% gone. I mean, you see these medical breakthroughs that frankly government-sponsored research has helped bring to us, um, and I worry about whether they’re gonna be there for the next generation.

I mean, that’s something that’s, that’s really sort of jumping out at me. It’s like, look at all the things that we can do. Do you know why we’ve been able to do this? We’ve had this bipartisan agreement that investing in science and medicine is a good thing. That’s separate and apart from the fact that our healthcare system is messed up and costs too much, which I know is what you concentrate on – thank you very much. Um, but, you know, both of them are in trouble right now. And as I say, it’s not so much … You know, last year it was all the headlines. Now it’s just sort of, as I said, it’s kind of become the status quo that things are crumbling, and that worries me even more than when it was all over the headlines.

Dan: Coming up, I get Julie’s take on what’s happening to the Affordable Care Act and what she thinks is gonna happen in 2028 and beyond. That’s next

Dan: This episode of An Arm and a Leg is produced in partnership with Ñî¹óåú´«Ã½Ò•îl Health News. That’s a nonprofit newsroom covering health issues in America.

The folks at Ñî¹óåú´«Ã½Ò•îl Health News are amazing journalists like, you know, today’s guest, Julie Rovner. Their work wins all kinds of awards every year, and we are honored to work with them

Dan: So, Julie, you know, since the last time we talked, as you noted: some Obamacare subsidies ended, and premiums went through the roof. Millions of people have dropped their insurance. And lots have signed up for cheaper plans that cover less.

And now, the Trump administration has been rewriting the rules for next year to encourage more people to sign up for plans that would cover a lot less, like including plans that require you to spend $30,000 or more to cover your family before insurance kicks in at all. And, you know, like, the two pillars of the Affordable Care Act were, like, let’s use subsidies to make non-crummy private insurance affordable for most people, and let’s expand Medicaid.

So, Republicans kept saying they just wanted to repeal the ACA, but, you know, they never did. And now I’m wondering, like, are we seeing something that’s, like, effectively kind of a slow motion repeal of the ACA by other means?

Julie Rovner: Oh, absolutely. No question about it. Um, most of the Affordable Care Act has been dismantled over, you know, th- th- this was … Several people have written this story. It’s like, you know, Republicans failed on their repeal and replace when they called it repeal. But basically, over the last 10 years, look at all the things we’ve taken away.

All the taxes that supported the financing of this have gone away. So the supporting taxes which were on mostly individ- you know, they were on health insurers, and drug companies, and, and large businesses, most of those have been, have gone away. Thank you lobbyists, you know, who came and said, “We don’t wanna pay these taxes.” Um, so basically the money’s just coming out of the treasury now. 

The- one of the things that the Republican budget bill did last year um, it didn’t roll back the explicit, expansion of Medicaid, but now we’re gonna have these work requirements, which, what we know from other states that have done work requirements end up, yes, taking off people who are, who simply refuse to work, but also because of the bureaucracy involved, end up cutting off people who are working, and who are eligible, and who do need the, the health insurance coverage. We have seen this.

You know, most of the people who end up getting kicked off the program get kicked off for what are called administrative reasons, which means they just could not navigate all of the required paperwork and bureaucracy. Um, so I mean, we really are seeing a slow motion repeal of the Affordable Care Act.

Dan: And so what might happen? I mean, Like, you’ve been looking at this for 40 years, and I’m, I am old enough to remember as a young person noticing that, like, when Bill Clinton ran for president in the early 1990s, you know, a big piece of the pitch was like, “Healthcare costs too much. Not enough people have insurance. We gotta do something about it.” And it, you know, they weren’t able to pass a law. But where might things go?

Julie Rovner: So let me tell you one of the things that kind of freaks me out. Um, would, and you go back to sort of the Affordable Care Act. I covered the Clinton health plan, and it- it died, as I like to describe, because, you know, everybody, all of those special interests wanted to cut off just one finger of it, and in the end, the patient bled to death. That’s sort of been my go-to metaphor for the Clinton healthcare plan. 

So what happened when they tried to put together the Obama healthcare plan is it like- like rather than have all of the special interest outside of the tent, let’s get all the special interest into the tent, and one of the ways they did that is said, “Look, if more people are insured, then you’re gonna get more of your bills paid.”

And particularly, you know, the hospitals and the drug companies said, “Yeah, that sounds good. We would like people to be able to pay for the things that we provide.” Um, well, so what are we doing now? We’re taking this apart, and we’re having people not be able to pay for things, and we’re having states not be able to pay for things.

States had used what was called creative financing for their portion of Medicaid, which remember, is a shared expense between the federal government and the states. So now you’ve got hospitals freaking out, and you also … I mean, we’re seeing hospitals close. It starts with rural hospitals. But, you know, I- I like to say it’s not just people without insurance who are gonna be impacted by this.

If health providers can no longer keep their doors open, then even if you have insurance, you may not have any place to go to get it. We’re already seeing healthcare deserts in, you know, less populated parts of the country. What is this gonna do when you see fewer people with health insurance, fewer people with Medicaid, fewer people with the Affordable Care Act?

Dan: Umm. Wow. 

Julie Rovner: Sorry, I’m just a continuing ray of sunshine.

Dan: No, no, no. No, no, you’re, you’re like– I’m asking you what might happen, you’re like, “Well, here’s the worst that might happen.” But, um, you know, what might a path look like to changing course?

Julie Rovner: Well, I feel like, you know, and when it comes to healthcare, the left is moving to the left and the right is moving to the right. Um, you know, we’ve always in, in the 40 years I’ve been doing this, um, and even going back to things like Medicare in 1965, what has gotten things done is when people, is when the two sides come together in a compromise. Those are the only big achievements in healthcare. Um, with the possible exception of the Affordable Care Act, which Republicans say, you know, “Oh, that wasn’t, you know, that w- that was only, that passed only with Democratic votes,” but it was a Republican idea. It was pulled from what Mitt Romney did in Massachusetts in 2006. So it was intended as a compromise, um, even if in the end the Republicans … The Republicans started moving right, I think, before the Democrats started moving left. 

But now you’re seeing, you know, most of the Democratic candidates, I’m looking in the midterms, you know, are, are back to the mantra of Medicare for All. Joe Biden was one of the few candidates in 2020 who did not endorse Medicare for All. He wanted to just expand the Affordable Care Act. That’s what was seen as a middle ground. 

Now nobody seems to want a middle ground. You know, the right wants to just take everything apart and get government out of healthcare in general and let people, you know, sort of give people a little bit of money and have them, you know, have the free market take over. And the left wants Medicare for All, which is, you know, the, the U.S. has tried to, to do what every other country has done and have universal coverage, and has so far not really succeeded at that. Although I will say at its peak, the, when the Affordable Care Act had the expanded subsidies, we were down to about an 8% uninsurance rate, which was the lowest since anybody had been keeping track. So it was, it was getting closer. 

Um, but now I see the parties moving apart. Will they move back together again at some point? I don’t know. Um, but, but for, I think, the immediate future, we’re seeing them retreat to their corners. And in healthcare that really, even though sometimes at the 30,000-foot level they’ve been fighting about that, at the 5,000-foot level they’ve been able to get together and do things. Um, a good example is the No Surprises Act, you know, the let’s get rid of surprise bills. 

Um, I’m not sure I even see them coming together on sort of the little stuff right now. Everybody is just very, very, very unhappy with everybody else.

Dan: Wow. Well. Okay. Uh, it’s not the cheerfulest thing I ever

Julie Rovner: You look like you’re, you’re processing that.

Dan: I am. I am. I am. I am. And of course, you know, as you say, during this period when people had, when the, the greatest proportion of people had insurance, uh, you know, I’m still doing this show. I mean, people have insurance, but having insurance doesn’t necessarily mean you have healthcare that you need and can afford.

Julie Rovner: Yes, everything. We will both be employed for as long as we want talking about the foibles of the U.S. healthcare system.

Dan: I mean…

Julie Rovner: That I am con- that prediction I am very confident of

Dan: I will never run out of material – that’s the crappy thing. But things are, like we said, they’re accelerating, they’re different, and I’m wondering how is all this changing how you see your job going forward?

Julie Rovner: Well, one thing that I’m, working towards myself, is I am predicting that we are going to have another major political throw down over healthcare in the coming years. Not necessarily next year, but probably, you know, the … I think this will be a big focus of the 2028 presidential campaign, and in 2029 we’re gonna have a big debate.

Are we gonna solve anything? I have no idea. But in preparation for that debate, I feel like there’s a whole generation that sort of didn’t live through the Clinton health plan, and that didn’t even live through the fight over the Affordable Care Act, and that one of the things that I would like to do as sort of a public service, um, is throw all of the options back on the table for people to see that, you know, that if this was easy, we would’ve solved it a long time ago. 

So I am … One of the things that we’re doing as part of our podcast is a special project called How Would You Fix It? I am sort of calling every smart person I know from across the ideological spectrum and asking them, “Okay, how would you fix it?”

I mean, I’m nearing retirement myself. I feel like I have this obligation to kind of, you know, shepherd the people who wanna learn through another round of this, um, so that we can have an educated debate and decide what we as a society wanna do about healthcare.

Dan: Wow. You think there will be a great big conversation, there will be a great big change. 

Julie Rovner: Uh, I think there will be a great big conversation. I don’t know that I think there will be great big change. I’ve, I’ve, I have covered enough of unsuccessful ones of these. I, I am not predicting its success, I am simply predicting the fight.

Dan: Fair, fair, fair. But, uh, even so, um, having a big public conversation seems better than not. 

Julie Rovner: As a journalist, I would think that. As somebody, and who’s … As somebody who cares about the, the, the sorry state of our healthcare system, I, I think it would be — I think it’s time.

Frankly, one of the reasons I think this is about to happen is that when in the early 2000s, when we were sort of building up to the fight over the Affordable Care Act, you could sort of see it coming because everybody was unhappy, and everybody wanted to sue for peace.

Um, you know, that the, the hospitals were unhappy, the drug companies were unhappy, the doctors were unhappy. You know, the, the employers were unhappy. The labor unions were unhappy. I feel like that is true again, and it’s more true.

And now even the haves, what we call them, the people who have insurance and don’t want, you know, are afraid of change, even the haves are unhappy. Everybody thinks they’re paying too much, which is why I’m predicting we’re gonna have another big public debate about this in the next four or five years.

Dan: I think the prospect of having a big public debate about a big public problem also strikes me as like an optimistic stance for anyone who cares about, you know, living in a democracy where people have a say in, in democracy where people have a say in what happens.  

Julie Rovner: It is, I, I’m sort of clinging to it as a, as a hope

Dan: Mm-hmm. I, uh, I just really appreciate that.

Julie Rovner, thank you so much for joining me. It’s been such a pleasure. Um, till next time, I’ll be listening to “How Did You Fix It?”

Julie Rovner: Thank you, Dan. And see, talking to you makes me feel better.

Dan: All right. That’s what I’m going for. That’s what I’m going for. Let, let’s stay in touch. 

Julie Rovner: We will. 

Dan: All right. Great. Take care. 

Julie Rovner: Thanks, Dan. 

Dan: Bye-bye. 

Dan: Okay, so I asked Julie Rovner how the avalanche of change has her thinking about her job description these days, and I wanna share how I’ve been thinking about mine.

You might have noticed over the last couple of months we’ve taken a break from producing podcast episodes, and here’s why. Basically, in April a few family health issues blossomed all at once. And as I turned my attention there, I realized I had some health issues of my own that needed attention. 

I started making this show eight years ago. I’ve been running it on a shoestring ever since, and that has meant running myself a little ragged sometimes. Honestly, too often and for too long. That’s not good for my health, and it’s not good for An Arm and a Leg, ’cause a ragged version of me does not make the best version of this show.

I needed some time just to break some habits — I called it detox from workaholism — and I needed to attend to my own health.

Like, earlier this year, I’d scheduled a little surgery, and I put it off ’cause I got sick from — you guessed it — running myself so ragged. And of course I was still trying to run so hard, I couldn’t imagine when I might reschedule it. So honestly, it wasn’t until I put myself on break for a minute that I even thought, “Oh yeah, I, I could do that surgery now.”

So surgery happened in early June. I’m all healed up, and I’ve been working with a really excellent therapist, and I’ve been incredibly grateful to my colleagues for their patience and for keeping things running. And together, we are starting to put together some new ways of doing things. It’s gonna be a work in progress.

There are so many things we wanna do. But I can’t be a workaholic anymore. So for our next episode, we’re gonna bring back one more favorite from our archives, give ourselves a running start, and then we’ve got some incredible, important stories and projects we just can’t wait to get back to. For now, thank you so much for sticking with us. It is a privilege to get to do this work, make this show for you, and to work with my incredible colleagues.

I will catch you soon. Till then let’s all take care of ourselves.

This episode of An Arm and a Leg was produced by Emily Pisacreta, with help from our summer intern, Lynn Barbera (welcome, Lynn!) — and edited by Ellen Weiss. 

Adam Raymonda is our audio wizard.

Our music is by Dave Weiner and Blue Dot Sessions. 

Claire Davenport is our engagement producer.

Amanda Boyd is our Operations Manager. Bea Bosco is our consulting director of operations. 

An Arm and a Leg is produced in partnership with Ñî¹óåú´«Ã½Ò•îl Health News. That’s a national newsroom producing in-depth journalism about health issues in America and a core program at KFF, an independent source of health policy research, polling, and journalism.

Zach Dyer is senior audio producer at Ñî¹óåú´«Ã½Ò•îl Health News. He’s editorial liaison to this show.

An Arm and a Leg is distributed by KUOW, Seattle’s NPR news station.

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor.

They allow us to accept tax-exempt donations. You can learn more about INN at INN.org.

Finally, thank you to everybody who supports this show financially.

You can join in any time at arm and a leg show, dot com, slash: support.

[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, July 30, 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 Rachel Cohrs Zhang of Bloomberg News. 

Rachel Cohrs Zhang: Hi, everyone. 

Rovner: Liz Essley Whyte of The Wall Street Journal. 

Liz Essley Whyte: Hello. 

Rovner: And Shefali Luthra of The 19^th. 

Shefali Luthra: Hello. 

Rovner: No interview this week, but more than enough news, so we’ll get right to it. I want to start with a story that I feel like is getting a little bit buried because it broke last Friday.  on a federal court filing in which the Trump administration admitted that it canceled $7.5 billion in clean-energy grants solely because they were located in states represented by Democrats that voted for Kamala Harris in 2024. In other words, the actions were purely political. Now, this is before the administration finalizes proposed rules that would give political appointees still more power over how grant funding is distributed. I heard one pundit say on cable news that in any other administration, this sort of information would lead to an immediate impeachment inquiry. But these days, it’s just another day that ends in “y.” Is the lack of public outcry about this because everyone already assumes that everything this administration does is political? Or is this considered just too inside baseball for most voters?  

Whyte: Well, I was gonna say I think this has long been people’s suspicions about why certain grants are cut in the way that they are, or some of these Medicare/Medicaid investigations are the way that they are. And so I think maybe the lack of outcry was just people shrugging their shoulders and saying, I mean, yeah, we guessed that, you know. I don’t know. 

Cohrs Zhang: It was really chaotic too, and hard to keep track of all these different things for people whose job it is to do so. So I feel like the fact that this is protracted for so long, we’re like, which DOGE [Department of Government Efficiency] cuts were those? And I think it is important, certainly, and I’m glad there’s been coverage of it, just for the record, and just kind of for history purposes and just understanding the limits of that kind of change to government at that speed. But yeah, I think it is just hard to break through in this news cycle, and it was very chaotic and confusing for everyone.  

Luthra: One thing I have been thinking about, though, is when you think about these states where grants were canceled, there are a lot of people who live there who did, in fact, vote for Donald Trump. And depending on the size of the state, you probably have members of Congress who are actually in Republican districts. And that, I think, is really interesting. And I just wonder if eventually there is some sort of conversation. Those are probably in some cases members who might be a little bit more on the defensive in other ways, just given the political environment we are in. And is this an issue that Democrats can talk about and highlight and sort of bring to voters and say, you know, your representative is not here defending your interests because of these broader sort of punitive measures being taken by the White House. I think that’s an interesting thing that we don’t know the answer to yet. 

Rovner: I know I keep saying this, but I can’t believe that Republicans on the [Senate] Appropriations Committee aren’t being louder about this. This is the one power that they have. It’s why you get on the Appropriations Committee, is you get to steer money to your state or your district. That is the great perquisite of being in Congress, and the administration is basically taking it away. And they’re just letting them. I mean, Susan Collins told Politico, quote, “I obviously think that’s wrong.” But she doesn’t seem willing to do anything about this. I mean, she’s the chairman of the Senate Appropriations Committee! 

Cohrs Zhang: I think we’re, like, testing the checks-and-balances system to its fullest extent. This administration. They can only pick so many fights, you know. 

Whyte: Yeah, Susan Collins, especially, this whole administration has had to choose about when to say something and when to push behind closed doors, push publicly. I mean, there’s been lots of stuff that she hasn’t liked. 

Rovner: Yeah, for sure. Well, this is not the only case where the government has admitted to canceling grants for political reasons. In a case brought by researchers from the University of California, the administration confirmed it canceled some grants because  like “diversity,” “gender,” and “vaccine hesitancy” to cut off funding. The plaintiffs in that case argue that it’s a First Amendment violation. Again, we’ve known for some time that this has been happening. Are the courts just too slow to be able to deal with it, Rachel? That’s kind of what you were intimating. This has been dragging out, sort of bit by bit by bit. 

Cohrs Zhang: Yeah, I think it’s hard. And I â€” just like with these grants dragging out too, it has impact for the people who are supposed to be receiving this funding and how their cycles work and hiring and just all the â€¦ that grant process. But I think it’s hard to make that connection, back to the individual voter. And I think that’s just a tough hill to climb in terms of public communications. So I think, yeah, we’re seeing these similar themes play out. 

Luthra: And one thing that I think is really relevant that I keep coming back to is we did see a test run of this with the USAID [United States Agency for International Development] cuts at the beginning of the administration. Those happened very quickly. The courts took a very, very long time, and by the time there was any kind of real momentum in any direction, it was too late. People did not have money, firms had downsized, people had left their jobs, left the industry altogether. And, at the time, that seemed to me like a really striking test. If this is able to happen here, and it shows that things just continue, why not happen in other areas as well, where you have these grants being put out there that have maybe ideological tension with where the administration wants to be going? 

Rovner: So I wanted to talk about some specific impacts on health policy, notably AHRQ, the Agency for Healthcare Quality and Research, which, like USAID, the administration has all but eliminated, despite the fact that it was appropriated nearly $350 million for this year in a bill signed by President Trump. AHRQ, which is down to a fraction of its original staff and hasn’t funded any grants in more than a year, is actually a completely bipartisan creation from the 1990s. It was established to study healthcare quality and access issues, many of which go neatly hand in hand with the “Make America Healthy Again” agenda. Earlier this month, the administration stopped funding more than 100 grants, and an HHS [Department of Health and Human Services] spokeswoman told my Ñî¹óåú´«Ã½Ò•îl Health News colleague Arthur Allen only that the agency plans to establish a new, quote, “framework,” which I thought was the job of Congress. Again, too small to attract much notice? 

Luthra: Probably. I mean, voters don’t know what AHRQ is. Like, we know about it because of our jobs, but this is not something people wake up and think about or talk to their neighbors about. It just feels very divorced from a lot of people’s realities. Even though, to your point, the consequences are far-reaching. They are long-term, and, also, the significance in terms of, as Rachel pointed out, separation of powers, checks and balances are also very striking.  

Rovner: I mean, AHRQ studies things like patient safety. I’m old enough to remember when the, you know, the big Institute of Medicine [now National Academy of Science] report came out that said how many people were injured by medical errors. It was a huge, huge issue. I mean, for years. And that’s basically what AHRQ does, and that’s what this administration says that they care about. They care about gold-standard science. They care about fraud. They care about making the health system safer. And yet, you know, AHRQ is just, well, we don’t know what it is, so we’re going to make it go away, basically. 

Whyte: Obviously, the HHS has not been as clear on this as you might hope and expect for the “most transparent administration in history.” But it is clear that, like, Kennedy is looking for pots of money to do the things that he wants to do. And it seems like this is one of the pots they’ve landed on as something that can be shifted around. 

Rovner: Yeah, so it does. Well, one cut that is likely to be noticed is the administration’s decision to end the temporary subsidy for Medicare Part D that prevented the addition of an out-of-pocket cap on how much enrollees have to spend each year on prescription drugs from spiking those monthly premiums. This will almost certainly raise premiums for many, if not most, of the 25 million seniors who have stand-alone Part D drug plans. And they will see those increases right before Election Day, because Medicare open enrollment starts Oct. 15. And, by the way, seniors vote in disproportionate numbers in midterm elections. If I was a political adviser for this administration, I don’t think I would have advised doing this. Am I missing something here? 

Cohrs Zhang: I think you are seeing there’s an interesting shift happening in terms of the power of the fiscal conservative wing of the administration. And I think we’ll continue to see that play out. I will say it’s unclear, like, how much premiums would have increased anyway without this subsidy program ending, given that the premium increases are capped by statute, in the Inflation Reduction Act through 2029. So, I mean, there is a chance that they might have gone up 6% anyway. We’re maxing out that increase. But the messaging certainly was not stellar for them. And I think we saw some cleanup efforts on that, for them trying to say that, you know, most seniors will see, you know, no increase or an increase of less than $10 a month. 

Rovner: Or they’ll have, I think Dr. [Mehmet] Oz said, they’ll still have an option for a cheaper plan. Of course, that cheaper plan might not cover all their drugs, but â€¦ 

Cohrs Zhang: Yes. So I think that’s just like a â€¦ this is one, I think, data point in this larger theme I’m thinking about. And how do we see â€” as we move past the midterm elections and affordability may not be top of mind if there’s no electoral accountability for it â€” how does that change what we’re seeing out of these agencies? 

Rovner: I’m just old enough to remember when, you know, you don’t raise costs for Medicare beneficiaries right before a midterm election, which is what this will do. Well, it isn’t all cuts. The administration this week finally released the $600 million that Congress had appropriated for the global Vaccine Initiative, Gavi. That was money for last year and this year. The funding had been blocked by HHS Secretary Robert F. Kennedy Jr. even though it goes through the State Department, not the Department of Health and Human Services. Kennedy had been concerned that Gavi was paying for vaccines containing the preservative thimerosal, which has been accused, and cleared, of causing autism. Do we know what finally sprung this money loose? 

Cohrs Zhang: I think there was a deadline of Sept. 30, and the funding would have expired. And we did see kind of an exchange with Secretary of State Marco Rubio and Susan Collins, where he said, “You know, I’m going to take ownership of this, and we’re going to get it done.” And so I think there was a push by administration officials to get this funding pried loose. And I think there are questions about whether Gavi was kind of heading this way already with some of these vaccines. I think they were starting the transition, but I think there â€¦ we’ll see how the implementation works on it. But I think there might be an argument that maybe this transition might have happened maybe faster â€¦ or to a broader degree. 

Rovner: The transition away from using thimerosal. 

Cohrs Zhang: Yes, the states â€¦ there’s one hexavalent vaccine where countries could already apply to transition to a different formulation without thimerosal starting in 2023. So, but maybe an option would be broader. Just there’s kind of a lot up in the air as to actually how this gets operationalized in the timeline. 

Rovner: Yeah, I was thinking, though, this might have been one of the cases where Congress complaining, both publicly and privately, did actually have some impact. But also, I know a lot of it was Marco Rubio stepping in and saying, “Hey, this is a State Department thing.” And finally, you know, I say a year and eight months later, the money gets distributed. All right, we’re going to take a quick break. We will be right back.  

Well, speaking of things that may or may not be good politics, Republican Sen. Rand Paul of Kentucky called former NIH [National Institutes of Health] and White House science official Tony Fauci before his Homeland Security Committee Wednesday to rake him over the coals again over his handling of the covid pandemic. Fauci, who received a preemptive pardon from President Joe Biden as Biden was walking out of the Oval Office door in 2025, did not take the bait. He pleaded the Fifth, lest anything he said be used for a new prosecution for lying to Congress. Meanwhile, Paul says he’ll try to find Fauci in contempt of Congress, which, by the way, would take 60 votes, which feels a little unlikely. Separately, several red-state attorneys general say they now want to investigate Fauci since his pardon doesn’t cover state prosecutions. First, prosecute him for what? And is relitigating covid origins and lockdowns really good politics for Republicans? I’m sure it riles up the base, but it’s hard to see them running on this as their health agenda. 

Whyte: So Rand Paul actually said on TV last night that he just thinks his committee needs to do the contempt of Congress vote, and then they can refer it to the DOJ [Department of Justice]. So they may not need 60 votes. So that will be interesting. Meanwhile, [Sen.] Ron Johnson [R-Wis.] has also threatened to subpoena Fauci. And the Florida attorney general is opening an investigation. And Alabama Sen. Tommy Tuberville says if he becomes governor, he’s going to try to figure out a way to prosecute Fauci in Alabama. So there’s definitely a lot of focus on Dr. Fauci. 

Rovner: I repeat, though, prosecute him for what? 

Whyte: Well, you know, before the hearing, Rand Paul was saying, Yeah, his preemptive pardon covers stuff in the past, but if he lies again at this hearing, then we will, you know, go after him or whatever. 

Rovner: Right, and that’s why he didn’t, that’s why he pleaded the Fifth.  

Whyte: Right, which is why it was viewed as an â€¦ entrapment situation that he should probably steer clear of, and why he would not even answer, like, what is the color of the carpet. 

Rovner: And what color his tie was, or was it Sen. [Josh] Hawley’s tie? 

Whyte: Yeah, and what day of the week it was, yeah. Whether it’s good politics for Republicans, I think we’ll have to see. There’s an Ohio candidate that they’ve tried to get for being, you know, covid czar or whatever, and that really hasn’t gone anywhere in Ohio. She’s polling OK. So I think that’s a good question on whether voters still care about this or not. I think obviously a lot of them do, but, like, the suburban women who are, you know, the famous swing voters, what do they think about Dr. Fauci? Will be interesting to see. 

Rovner: Yeah, I mean, I guess just for watching the questioning, it seemed that they’re trying to, you know, that we know that Democrats have more enthusiasm going into this midterm than Republicans. And it looked like the Republicans were trying to, you know, reactivate the angry covid base, if you will, to get them to come out and vote. It’s just hard to know how many people are angry enough to come out, you know, six years later.  

All right. Well, speaking of buzzy stories, Liz, you  about how Trump might be pushing RFK Jr. on childhood vaccine policy rather than what we all assumed was the other way around. So tell us about it. 

Whyte: Yeah, this is a bit of a counterintuitive news development for two reasons. One, because everybody thinks RFK Jr. is the big vaccine skeptic in the administration. And two, because the White House had, you know, is widely reported that they were telling HHS to “ix-nay on the accines-vay” ahead of the midterms â€” like, just dial it down a little bit because of polling they had from the winter that showed while food and ag [agricultural] stuff was really popular, the other MAHA stuff, vaccine skepticism, was not, and they kind of wanted to tone it down. But the president does what he wants. He does not always listen to the polling. And he has been telling Kennedy since at least May, why aren’t you doing more to probe the connection, in his mind, between vaccines and autism? And this took Kennedy aback, actually, at a golf course lunch in May. He was surprised because he was still under the impression they were supposed to be dialing back. And President Trump told him, “You have the yips,” which I just think is such a funny word. 

Rovner: It’s a golf term. 

Whyte: Yes, it’s a golf term. And that has continued to be, actually, a point of tension between the two men, with the president venting his frustration to Kennedy at a mid-June Oval Office meeting. And part of the reason we’re seeing some of this increased action, even if it’s not, you know, really talked about much, but appeals to the federal appeals court to speed up the decision for the key vaccine advisory panel of the CDC [Centers for Disease Control and Prevention], and then also there was that EO [executive order] in May that Trump put out on the childhood vaccine schedule, and just kind of general scrambling behind the scenes to figure out, like, what they can deliver for the president, who is, I’m told, a results guy and wants to see results and thinks, you know, it’s been a year and a half, and why aren’t there results? So, we’ll see where that leads. 

Rovner: Well, meanwhile, if this puts Kennedy in hot water with the president,  what the newest, who the newest likely candidate is should RFK Jr. leave his post, either voluntarily or not so voluntarily. Tell us about your story. 

Cohrs Zhang: So I have been working on this story for a very long time. But I think we’ve seen kind of this surprise in Washington that Dr. Oz, who’s leading Medicare and Medicaid, has actually like navigated the Trump administration with great skill, and I think we were finally able to capture the scope of that, him translating that skill into personal relationships with the president, with the secretary, and getting himself a seat at the table on far more policy issues than a CMS [Centers for Medicare & Medicaid Services] administrator would normally get. And I think we saw, those of us who remember the first Trump administration, how ugly things got between HHS and CMS â€” was like very adversarial, like a really bad time in there, very toxic. But I think we’ve seen him take a more, like, cooperative approach. He wields his influence, is more explaining things. He is a medical doctor, his training, unlike the secretary. And I think there is just, like, a general trust and, like, personal friendship between the two of them that has translated into this interesting dynamic, where Dr. Oz kind of serves as a go-between on some of these issues between the White House and the secretary and gets everybody kind of to the place where they need to go. And he’s just a good communicator and has built a lot of trust and parlayed that into getting himself a seat at the table. 

Rovner: Yeah, and Liz â€¦ your story about Kennedy and Trump also suggested that Oz’s favor is rising, shall we say? 

Whyte: Yeah, the White House staff love Oz because they know they can send him to the Hill. They can put him on TV. Like, he’s going to do a great job. Rachel had this too. You know, the president calling and texting Oz and saying, you know, what about this issue? and it has nothing to do with CMS. He’s, you know, being called upon to do other stuff that is not in his portfolio. So yeah, every lobbyist is just, like, watching their clock and seeing when Oz takes over. I don’t know that it’s that straightforward. I think the president and secretary have a very warm friendship, and it took a lot for Kristi Noem to get let go, and I don’t think we’re anywhere near that. So we’ll have to see if the mood changes after the midterms. But it doesn’t seem to me that anything would be imminent. 

Rovner: I would add that I know Oz is the one person practically in the entire administration, not just at HHS, who actually does well when he goes to the Hill. Who, you know, is respectful and sort of understands how administration officials are supposed to conduct themselves when they are in front of the people who theoretically are responsible for them having their jobs.  

Whyte: Yeah, you’ll find the Democrat staffers are like, Oh, we actually like Oz, which is funny, I think.  

Rovner: He’s a good politician! What can I say? Rachel, do you want to add something? 

Cohrs Zhang: I will say, though, he did play a role in selling all these Medicaid cuts that are going to be coming down the pike. 

Rovner: He did. 

Cohrs Zhang: And so I think he is going to be the face of this when they actually go to implement it.  

Rovner: He will. 

Cohrs Zhang: So yeah, we’ll see how that goes.  

Rovner: We’ll see how that goes.  

Cohrs Zhang: What time frame they’ll be doing that in. But yeah, certainly. Yeah, it’s interesting. 

Whyte: They’ve kind of given up selling that, too. You know, it’s not something they’re being like, Oh, look at all the great stuff we did with Medicaid in the One Big Beautiful Bill. It’s very much pivoted to fraud.  

Rovner: Yeah, but when it starts, when it takes effect next year, I think there’s going to be, there will be lots of questions to answer. Shefali, do you want to add something before we move on? 

Luthra: The only thing that really just I keep thinking about is the long history of this relationship between Dr. Oz and the president, and, in particular, when during the 2016 campaign he was the one to talk about the president’s testosterone levels on TV and how they were excellent. And I just think it’s really special that we’ve come full circle in this way. 

Rovner: Yes, yes, it is, and we have. All right, moving on. One thing that Secretary RFK Jr. said this week that’s pretty clearly not true is that the department has the cyclospora parasite outbreak, quote, “under control.” A former deputy commissioner of food at the FDA under both the first Trump administration and President Biden told Politico this week that, quote, “it is starting to approach a catastrophic level in terms of how mismanaged it’s been on multiple fronts.” Rachel, you’re keeping an eye on this. What is the latest? What do we know about cyclospora and where it’s coming from? And are the recalls that are in existence enough to stop it? 

Cohrs Zhang: I don’t think they’re stopping it, by any means, especially with an incubation period of two weeks. I think we are continuing to see more cases reported, and I think, like you mentioned, there’s, I think, fingers pointing in all directions. Our team and others have done reporting on just how Taylor Farms has handled themselves behind the scenes. The public spat between Taylor Farms and the FDA was not something you usually see in an outbreak of this kind. It’s just worth probably pointing out that the FDA did DOGE much of its communications staff that has experience with this sort of outbreak. We have, you know, officials shifting around, and there’s some key vacancies at the FDA as well in a lot of these leadership positions. So I think there’s been complaints, certainly, at, like, the report you mentioned about the federal response, but also about the company and their speed and their clarity and communication, and whether that’s truly serving the public interest or not. And I think there are, if I’m not mistaken, some ongoing investigations into other potential causes. But we are seeing a lot of these cases tied back to lettuce from a specific part of Mexico. So I think they have gotten the word out now, but just the confusion and the back-and-forth. And I think former FDA commissioner Scott Gottlieb got on CNBC and said he would have expected more communication from the FDA on this issue. But it’s kind of a tough one when it’s a voluntary recall, and there’s a company, and they’ve used some restrictions, you know, and what they’re supposed to be talking about publicly. But I think there has just been so much consumer confusion, and that’s not in anyone’s interest. 

Rovner: And as we said, this is not a simple thing to track. It’s not like E. coli; you can’t really find it. Liz, you and your colleagues reported, though, on, you know, Taylor Farms going straight to the White House to try and sort of go over the heads of the FDA on this. 

Whyte: Yeah, Bloomberg and The Wall Street Journal had stories with different pieces of this, and it was, you know, in our story, you could see that they were trying to distance themselves from the outbreak before they got named publicly, which is kind of this new wild West of lobbying that we’re in, where it makes a lot of sense for companies to go straight to the White House and skip over dealing with career officials. And what was interesting was that the way all that played out with the communications is Taylor was able to say, FDA apologized to us, made this like really confusing statement. And the FDA, maybe because it didn’t have the comms folks with experience, like Rachel was talking about, at the FDA with, you know, various layers of people who have done this before, you know, it took them till the next day to say: By the way, our epidemiology on this is really good. It’s definitely still Taylor Farms. We just, like, had that one false positive. It was crazy to me how, like, twisted and turned that got. 

Rovner: It was not well handled from a public communications standpoint, shall we say? All right. Well, one thing that we know that RFK Jr. thinks highly of are peptides; those are the amino acids that wellness influencers say can build muscle, heal injuries, and burn fat, among other things. Last week, an FDA advisory committee voted, over the objections of FDA’s own scientists â€” who say evidence on the benefits of peptides is either skimpy or nonexistent — to nonetheless make it easier for compounding pharmacies to make and sell products containing several different specific peptides. Now, this is not just a scientific disagreement. Several members of this advisory panel are actual sellers of this product, right? 

Whyte: Yeah, the panel was a bunch of members who either worked for companies that sell peptides or had a clinic that offers them. And the HHS said these people went through a conflict process. It doesn’t seem like it could have been as rigorous as the previous conflict processes that were in place. I haven’t seen a ton of reporting on that. But, you know, predictably they greenlighted most of the peptides that they looked at over and against the strong recommendations from FDA staff scientists who said we don’t have evidence that these are safe. Like, this is kind of unprecedented. The argument in favor was, well, you know, we do something similar with supplements. You know, Secretary Kennedy has said people should be free to try these out, and you know he wants to end the war on peptides. And meanwhile, scientists with a traditional background in looking at risk and benefits are saying the risks are there, the benefits are not proven, and this almost creates a different paradigm for how we’re looking at medical interventions now. 

Rovner: Yeah, and I think we’ve seen this across the FDA and across HHS. I mean, this is basically what they’re, you know, calling gold-standard science. That there’s a lot of people â€¦ go ahead, Rachel. 

Cohrs Zhang: I was just gonna say, and I’m â€¦ I think, looking forward, this creates a split decision, right, between the FDA scientists and the ag comm, and that’s gonna put the FDA in a tough position as to who what they’re going to choose because former commissioner Marty Makary loved to say he was siding with the career scientists, and now we have this forum to hear what they actually think, like, presented to the public. So I think that’s going to be a tough decision ahead, and that’ll tell us how things are working inside. 

Rovner: And of course, we only have an acting commissioner of FDA right now, so â€¦  

Cohrs Zhang: Yes, with instructions to not make news. 

Rovner: Finally, this week, news on reproductive health â€” because there is always news on reproductive health. Shefali, we had a decision in one of the court cases challenging how the FDA regulates the abortion pill mifepristone, but it’s not the case that we’ve all been watching, right? 

Luthra: No, this was the Virginia case. And what it reminds us is that there’s actually a million different mifepristone cases because you have people looking for more restrictions on mifepristone, and you also have people looking for fewer restrictions on mifepristone. And a lot of the folks who provide the drug, the doctors and manufacturers, have argued that, in fact, there are more restrictions than are actually appropriate. That this is actually much safer, and it does not need to be so hard to get because, for all of the concerns from conservatives and abortion opponents, it actually is very difficult to prescribe and make mifepristone available without going through a lot of hoops of certification. And so we see, right, in some cases, like here, an effort to try and loosen those restrictions a bit and say this could be more available, especially, I mean, people when they have miscarriages, it is actually very hard to get mifepristone, even though it actually would be very beneficial for management. But I think what this does, practically, is again not much changes for now because we have so much going through so many courts in different ways. Realistically, I mean, access to the drug stays as what it is: available in some places, not available in others. And the big case that we’re all waiting for, the Louisiana one, that could possibly bring restrictions in, that very briefly did bring restrictions in mifepristone earlier this year â€” we’ll probably see more on that closer to the election. And that could be very interesting because, as we’ve talked about so many times, this is not really an issue the White House or a lot of Republicans, frankly, would like to be in the news, because they know that restrictions on abortion just remain so unpopular and continue to be for a long time. 

Rovner: And this is almost certainly heading for the Supreme Court, right? We now have a court, you know, a lower court saying that the Biden administration’s restrictions were too tight, and one assumes that coming out of Louisiana, we will have a decision that says that they’re not tight enough. 

Luthra: I would be stunned if the Supreme Court did not hear a mifepristone case in the coming few years. It just seems like we’ve been building in this direction for a very long time. You’re totally right. The split circuit looming makes that more likely. And I mean, realistically, if I supported abortion rights, if I wanted to make this pill more available, as the folks arguing against the Biden restrictions are, I don’t know that I would be thrilled about this being something before the Supreme Court because this is known to be a more conservative court. A lot of members who think abortion should be far less available than it is â€” this is the same court that overturned Roe v. Wade. And so I think there’s a real possibility that as we see more and more abortion decisions make their way to the Supreme Court, the restrictions we have become even more so, and where we are now becomes a baseline for making this even more difficult for people to obtain. 

Rovner: We will have to see. Meanwhile, our podcast pal Alice [Miranda] Ollstein has a co-bylined story at Politico this week about how anti-abortion groups are pulling out all the stops to try to show that the increased use of . Now they have a study, commissioned by the group Students for Life, claiming that mifepristone is showing up in, quote, “significant levels” in waterways in Austin, Texas; Blacksburg, Virginia; and Carbondale, Illinois â€” all major college towns, not coincidentally. And while the science behind this remains questionable, the politics don’t, right? 

Luthra: Right. And this is a strategy they’ve been working on for quite some time, putting bills in state legislatures, talking to anyone who will listen about this, and saying, If we care about the environment, the left cares about the environment,why don’t we care about what they say is this mifepristone pollution in the water that they say is caused by medication abortions? And they want to use this argument as a different prong on the way to stop people from having mifepristone made available, of making medication abortions harder to obtain. We haven’t really seen this really yield fruit yet. However, this is part of, again, a longer-term strategy to lay groundwork. And studies like this, they create an intellectual groundwork as well. We saw that with the telehealth studies, the mifepristone safety and efficacy studies â€” and I perhaps should do “studies” in air quotes because a lot of mainstream researchers call these not very good science. But if you create a large-enough body to point to, then ultimately you can have people in positions of power say, “Well, we’ve looked at the evidence from all sides, and we see these real concerns, and we’re going to use them to inform policy.” I don’t know that that will happen anytime soon, but it’s certainly a goal that they’re building toward. 

Rovner: They’re talking points, basically. 

Luthra: Absolutely. 

Rovner: All right. Well, that is this week’s news. 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? 

Cohrs Zhang: Mine is from Ñî¹óåú´«Ã½Ò•îl Health News. The headline is “Trump Administration Demands Hospitals Share Emergency Room Records,” by Amanda Seitz, Maia Rosenfeld, and Darius Tahir. I think this is one installment, and that this broader arc of coverage that they have really owned â€” it’s so diffuse. There’s like states, and there’s providers, and there’s government officials involved, but I think it really illuminates kind of like where is the Trump administration looking for data? I think this is something that started during the DOGE era, where you had DOGE employees trying to get data from different government agencies. But you’re seeing it as, I think, we’ve talked about previously, like, there’s a desire for studies and, you know, things to move faster. Like, where are we looking for data? I think this whole arc of coverage has been really valuable in illuminating: Where are they looking. Is this precedented? Kind of how could these datasets be used? What are the patient potential issues? Are there privacy issues? Can this data be protected? That I think are going to be really important as we kind of look into the rest of this administration, because we’re only a year and a half in. Like, we got a ways to go. 

Rovner: And, oh I mean we say over many, many, many years it’s always been Republicans who have been, you know, very much into the federal government shouldn’t have its hands in people’s personal data, and yet here we have an administration that’s trying to get personal data from every single possible place. 

Cohrs Zhang: Right, it’s fascinating. And this just makes it so concrete. And I think it’s great accountability work, and they’ve clearly developed great sourcing on this. 

Rovner: Yeah. Liz. 

Whyte: Mine is a  by two doctors who are concerned about the burgeoning pediatric public health emergency, as they call it, about e-bikes and e-scooters. And I’ve been wondering about this for a long time because I see kids doing two, three kids on these scooters going so fast with no helmets. It’s always boggling my mind, but it’s apparently gotten really bad. They looked at data from 2020 to 2021 and saw an increase in injuries, up 71% in just one year â€” kid injuries with e-scooters and e-bikes. So that was 8,545 of those injuries in 2021. And the doctors discuss how, you know, these injury patterns that these kids get â€” I mean, they’re going up to like 28 mph â€” look very similar to when a child gets hit by a car. And that’s, it’s just real sad. So TBD on whether anybody does any kind of age-appropriate access standards or something like that that can help dial back these injuries. And then I guess I’m cheating Julie, but a shoutout to  recently, about how peptide med spa clinics have less regulation at the state level than your local restaurant or hair salon. She contacted all 50 states, and I thought it was just a really good supplement to the peptide news that we saw recently. 

Rovner: It was, and â€¦ forgive me for not mentioning it, and we will link to that one too. But I’m so glad you did the e-bike thing because if you hadn’t done that, I was going to, because the number of kids just in my neighborhood, little kids on motorized vehicles, it’s like: Shouldn’t they have to have driver’s licenses to do this? Anyway. Shefali. 

Luthra: My piece is by Aaron Carroll. It is an op-ed in The Washington Post. The headline is: “.” And what he talks about, I think, is just so smart. It’s about how it actually would be great if we had better and more research on SSRIs. However, the point he makes is that the government is actually not really approaching this from that kind of vantage. And instead the idea is to try and just cut back access to SSRIs, rather than learn more about them, learn how to make them work better, if they are as effective as they want them to be. And the point that he gets at the end as well is that while it is really good and worthwhile to investigate and study how well SSRIs work, one thing that we are actually getting into, which is really problematic, is stigmatizing use of them. And he talks about why that’s actually not good, and that is not actually helpful when it comes to thinking about how to make treatment for depression better and better and better. And I love this framing because we should try and make medications better for people. We should always be looking at treatments we have and saying, yes, they work. But what if we made them work better and better? What if we had fewer side effects? What if we made them more effective? That would be awesome. And I really love that he is putting those questions out there in a way that is smart and productive and forward-looking. 

Rovner: And not partisan. This has never been partisan. This is just so â€¦  it’s all so unprecedented. All right. My extra credit this week is from The Arkansas Times. It’s called “,” by Byron Tate. And it’s about exactly what the headline says. Since Congress gave states the option to extend Medicaid coverage to postpartum women for a full year after they give birth, 49 states have exercised that option â€” all but Arkansas, where that coverage still ends after 60 days. And Arkansas has one of the nation’s highest maternal mortality rates. So who’s against it? Apparently, the governor, Republican Sarah Huckabee Sanders, herself a mom. She says these women should be transitioning to other coverage, except apparently most of them are not. According to one study, 94% of those losing postpartum Medicaid are becoming uninsured instead. 

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 , and on Bluesky . Where are you folks hanging on socials these days? Rachel? 

Cohrs Zhang: I’m on X  and also on . 

Rovner: Shefali. 

Luthra: On Bluesky . 

Rovner: Liz. 

Whyte: I am on X  â€” with a “Y,” W-H-Y-T-E â€” and . You can Google me. 

Rovner: I’m sure people can find you. All right, we’ll be back in your feed next week. Until then, be healthy.