[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, June 25, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

Today, we are joined via videoconference by Maya Goldman of Axios News. 

Maya Goldman: Hello. 

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

Joanne Kenen: Hey, everybody. 

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

Rachana Pradhan: Hey, Julie. 

Rovner: No interview this week, but way too much news, so let’s see how much we can squeeze in. We’re going to start this week at the Department of Health and Human Services, where we have a pair of stories about grant funding passed by Congress and signed into law by President [Donald] Trump still not getting where it’s supposed to go. , our podcast pal Paige Winfield Cunningham reports that states and health organizations are waiting for nearly half a billion dollars for a variety of programs, including suicide hotlines and opioid addiction treatment centers, because of a convoluted clearance process that involves artificial intelligence and political appointee sign-offs to, quote, “ensure alignment with Agency priorities.” Quoting from Paige’s story: “One former career staffer at the CDC who served under four administrations said fewer than five or six grant notices in a year would typically get reviewed at the HHS level. Now it’s all of them.” , except this one is about delays in grant funding from the National Institutes of Health, where with just three months left in the fiscal year, 90% of the $37 million in grant funding from the National Institute on Disability, Independent Living, and Rehabilitation [Research] has yet to be released. I know I sound like a broken record, but that’s not how any of this is supposed to work, right? 

Goldman: Right. 

Pradhan: No, I think this is, more or less, some version of this has been going on since January, February of 2025, but I think now it’s being more institutionalized in federal policy. That’s what they’re attempting to do. Whereas in the first few months of the current Trump administration, it was instituted at â€” “haphazard” probably doesn’t really do it justice â€” but it was sort of this very chaotic process of instituting these new layers of political appointee review on what federal money was funding, ultimately, right? And whether political appointees decided that it was something that they thought the federal government should be doing. 

Rovner: At the beginning, they just froze everything. 

Pradhan: Right. 

Kenen: They cut everything. 

Pradhan: And then they— 

Rovner: Then they cut everything 

Pradhan: â€”started cutting things. Right. Things like which we’ve all talked about and done plenty of reporting on, right? Things that aren’t supported by political appointees, regardless of their scientific merit, right? And so now this has sort of taken on an even broader evolution, so that it is formal federal government policy regulation that political appointees can review every dollar that goes out for anything, almost, right? All grantmaking, which is just an extraordinary sum of money. 

Goldman: Yeah. 

Rovner: And Congress, remember Congress, which owns this spending power, said in last year’s appropriations, You will spend this money the way we are telling you to. And the president signed those bills, promising to do that, and now is not. Maya, you wanted to say something. 

Goldman: I was just going to say, I think there was so much focus â€” like Rachana said, when in the DOGE [Department of Government Efficiency] era â€” on federal funding in healthcare and getting trapped in this purgatory space, and I think there’s maybe a misconception that that has kind of stopped. But it’s still, like you said, it’s becoming institutionalized. It’s the opposite of stopped. And like you said, Congress, this was not Congress’ intention. So it’ll be very interesting to see what happens, especially as these OMB [Office of Management and Budget], this OMB guidance for— 

Rovner: Which we’ll get to in a second. But before we get there, this is not just happening at HHS. It’s happening in other parts of the Trump administration. Former KFF Health Newser Anna Maria Barry-Jester  that over at the State Department, the administration is defying congressional orders to continue to spend money on food, medicine, and other humanitarian foreign aid that used to go out under the auspices of USAID [the U.S. Agency for International Development], which the administration dissolved last year without congressional permission. As at HHS, State Department officials are not only not spending the money as Congress directed, but when members of Congress have asked, officials have simply not responded to their request. Not surprisingly, for those who have been paying attention, a lot of this circles back to Russell Vought at the Office of Management and Budget, who has said many times he believes that the president, rather than Congress, should exercise the majority of federal spending power, regardless of what the Constitution said. Is there a point where Congress, which is increasingly unhappy with the president over a lot of things right now, including a lot of Republicans, does take its spending power back? 

Kenen: But they can’t cut the check. Congress has made its displeasure on the spending, they voiced it before. Congress is getting a little friskier right now, but they yielded a lot of their power to the executive branch, and there’s a lot more tension going on right now on other things. They can yell and scream and pass bills, but if the executive branch of OMB, which has explicitly basically said: Congress, you give advice. You don’t decide. Even though that’s pretty much what they’ve said since 2025. So Congress can’t run over to the OMB and get into the federal treasury and take out a bunch of cash and go give it to some rural hospital somewhere, or NIH, or some scientists. They can pass the law, but they can’t â€” it’ll probably, this too, will end up with the Supreme Court at some point. But they’ve been reluctant to, certain battles they have, everybody’s sort of constitutional crises, they’ve tried to avoid to date, although not entirely. 

Pradhan: Well, like Joanne said: What can they really do? I’m not a lawyer. I don’t know. What beyond sort of kicking and screaming can they do? 

Kenen: Well, they can, I think they could probably take it to court on a separation of powers or constitutional powers, but I think that that’s the ultimate constitutional crisis that people have been afraid to hit that button. 

Rovner: There was a Supreme Court decision in the Nixon administration that said the administration can’t impound money appropriated by Congress, and that’s what Russell Vought would like to have go back to the Supreme Court, because he thinks this Supreme Court might overturn it, but they haven’t yet. I guess everybody’s afraid to kind of call the bluff. 

Kenen: Because it gets us into an even messier territory than we are already in, and we are in a very messy territory. 

Rovner: We are definitely in a very messy territory. Algae filled. 

Kenen: Algae-filled, yes. 

Rovner: We’ll get to that. Moving on, as Maya already hinted, there are these proposed new rules from the aforementioned Office of Management and Budget that would give political appointees even more power over how federal grant funding is distributed. It turns out that buried in that proposal is language that would effectively disqualify from funding most research into diversity, equity, and inclusion, what this administration defines as, quote, “woke.” I would add, this comes as the journal Science reports that  of scientists who are women or from underrepresented racial and ethnic groups found that those who participated in a special undergraduate program sponsored by the National Institutes of Health were twice as likely to earn their PhD than peers who didn’t participate in those programs. In other words, at least in this case, DEI works if your goal is to achieve more representation in science. But I guess that’s no longer the goal, right? 

Goldman: I think there’s also so many research questions that have real impact on people’s health that just must by nature incorporate words that would be flagged as DEI, and so we could miss out on real scientific breakthroughs if this goes through. 

Rovner: Yeah, they’ve apparently got these AI programs that are just grabbing off words like “gender” or things that might in scientific contexts have nothing to do with DEI. 

Pradhan: And I think one of the things about DEI, too, that probably gets lost in the current era is that it definitely has, of course, a racial and ethnic component, but also it has a big gender component. In science and across fields, DEI programs have benefited women, wholesale. So I think, and if that’s the goal, to undo these things, it won’t necessarily just have consequences for racial and ethnic minorities but women scientists in other fields also. 

Rovner: One of the big stories I covered in the early ’90s was the fact that women weren’t allowed to participate in most clinical trials, because scientists were afraid that they would, the fact that: Oh my God. They have hormones. They would mess up the results. And as a result, so many medical breakthroughs, we had no idea if they worked on women or not, because women were never tested. That only changed when women members of Congress insisted that the NIH start including women in their clinical trials. And again, a lot of these programs to bring more women into science have helped. There have been blind spots about gender, so it really has been, if not for quote-unquote “affirmative action” for women, there would be an awful lot of stuff that we simply would not know about women’s health. I only add that up as: These things in the 1990s were really bipartisan.  

So Wednesday was the fourth anniversary of the Supreme Court’s Dobbs decision that overturned the five-decade-old right to abortion under Roe v. Wade. And in a twist I don’t think any of us could have predicted, even though nearly half the states have banned or severely restricted abortion during that time, there were nearly twice as many abortions in 2025 as in 2021, the last full year before Roe was overturned. Rachana, how did this happen and how much does it have to do with mail order abortion drugs? 

Pradhan: Quite a lot. Yes, I don’t think this is something that anti-abortion groups at all expected or wanted to see. Certainly not what they wanted to see. After Roe v. Wade was overturned, pills being sent via telemedicine or telehealth is a big part of this. Even women in states that have enacted almost total bans on abortion are still able to get pills in the mail, and that is responsible for this, in large part. 

Rovner: And of course, anti-abortion groups are furious that the Trump administration’s FDA [Food and Drug Administration] has not rolled back the policy yet that the Biden administration put in during covid allowing the mailing of these pills. Now they’re agitating for acting attorney general Todd Blanche to drop the government’s defense of a case that was filed by Louisiana challenging that mail delivery of mifepristone. But even if that were to happen, medication abortions can continue just by using the second pill in the two-pill combination that’s used for abortion, which is misoprostol. And states can’t really ban misoprostol, because it’s used for so many other things, right? 

Pradhan: Right, they would be â€” I don’t know. Never say “never,” I guess. But it would be, it’s hard to see a path for that. Yeah, so our colleague Kate Wells, who’s based in Michigan, wrote this great story this week stating this exact thing, right? Because even though the research shows that the combination of two drugs for medication abortion, so mifepristone and misoprostol, taken together is the most effective, but that doesn’t mean the misoprostol alone does not work. And so it does work â€” it’s just not as effective. And there might be some greater potential for side effects â€” right? â€” if you only take the latter medication. So yeah, it’s not, so it’s not so easy â€” right? â€” to cut off access. 

Rovner: Meanwhile, let’s talk about the politics of this. Democrats who had been hoping to ride support for abortion rights to electoral ascendance may either be over- or underconfident. That’s according to  by our podcast panelist Alice Ollstein of Politico. Since Dobbs was overturned, voters, even in some pretty red states â€” I’m looking at you, Missouri â€” have approved ballot initiatives to ensure abortion rights in those states. But that hasn’t translated into votes for Democrats in many of those states. Voters approved the abortion rights referendums and voted back in Republicans who are anti-abortion. What’s up with this? 

Goldman: I think one interesting point that Alice made in that article is that a lot of voters think, OK, I voted for abortion rights, so now I can vote for other candidates based on other issues. Which is a super interesting trend to watch, especially to see if that trickles into other policy areas, too. 

Rovner: Yeah, I had not thought about that until I read Alice’s piece, and it’s like, yeah, that makes good sense. In the past, I think anti-abortion voters have very much been single-issue voters, but abortion rights voters have not. They want abortion rights, but they also want other things, and I think a lot of them in some of these states think, Well, we’re protecting abortion rights here in our state, so it’s OK to vote for this anti-abortion politician, even though they didn’t think all the way through that that anti-abortion politician in a federal office might vote for a federal ban that would override what you just voted for in your state. Joanne, you wanted to say something. 

Kenen: I think a lot of people don’t connect dots or don’t think things through. We know that in these very, very, very red, some of the most conservative states in the country, have voted big for Medicaid expansion when it became a ballot initiative, and then they went ahead and voted the same people who had fought it for years back into the governor’s mansion and back into the legislature. So I think, whether people don’t connect dots or that all of us can hold contradictory, more than â€” all human beings have some contradictory thoughts and impulses. I can’t explain exactly why this is happening . But it’s not only abortion. It’s particularly acute. Americans are for more gun control than our lawmakers, or gun regulation, than our lawmakers enact, and yet they keep voting in people who limit gun ownership or gun rights more stringently than the public in polls says they want. So this is one of several hot-button political issues â€” abortion and gun control, arguably the most domestically hot-button there are â€” that there is this inconsistency, and I don’t know that anyone’s really successfully explained it. It’s not just low information. It’s more than that. It’s, Yes, I want this, but I also want that. 

Rovner: Right. It’s holding two thoughts at the same time. You’re right. It’s a human thing. 

Pradhan: Well, and Julie, you mentioned this, right? Which is that a single-issue voting on abortion on the left is not â€” yeah. And Alice says this in the lead of her story â€” right? â€” which is the main issues of the day right now are affordability concerns across gas, food, housing. That does seem to still be the driving concern, and understandably so, right? Everything is more expensive, much more expensive than it was two years ago. So people are hurting, and so I don’t know that abortion rights would surpass, or people who are more likely to support an abortion rights ballot initiative are ones that are also not going to be inclined to vote for Republicans on the ballot during the midterm elections, because they’re not happy with some of those other, broader affordability issues. 

Rovner: Yeah, I think affordability is clearly going to be the issue of the moment, probably still when we get to the midterms. But who knows. We’ve got a whole summer to get through. All right, we’re going to take a quick break. We’ll be right back. 

Moving on to vaccine policy, you might remember back in April when we talked about a study by researchers at the Centers for Disease Control and Prevention that found last year’s covid vaccine reduced hospital visits and hospitalizations by more than half. It was supposed to appear in the CDC’s journal, the Morbidity and Mortality Weekly Report, but it was spiked by NIH director and acting CDC director Jay Bhattacharya, who said the study had methodological issues. Well, apparently that wasn’t a problem for the peer reviewers at the Journal of the American Medical Association, because the study is in this week’s . But even though it’s out there now, how is the public to have any idea who to trust when it comes to science policy? We’re now here, we have peer-reviewed journals that are publishing one thing and the government saying, No, this is not good enough. Did the doubters win simply by sowing doubt? 

Goldman: It’s a great question, and I think that’s a very interesting dynamic with this administration, is that the health officials in this administration have rose to prominence on a platform of bringing trust back into federal health policy. And I think for many people you could argue that there is less trust than there was at the beginning of the administration. And certainly not for everybody, but it’s just there are a lot of wires being crossed in different directions, and it’s hard to know where to go. 

Pradhan: I think one of the things I think about when it comes to trust in the government, like Maya said, right? We have, OK, so there are definitely certain voters that now do not trust the CDC and the government nearly as much, if it all, because of who is in charge. So distrust has arisen among those people. But when I talk to people who are supporters of the “medical freedom” movement and who are very skeptical of vaccines for themselves, for their children, I’ve asked them sometimes, Look, you’re seeing these changes, even going back to last year. This year, the CDC Advisory Committee on Immunization Practices, they made a bunch of changes to the U.S.’ vaccine schedule. And I asked, I remember one time I did an interview and I said, “Well, do you trust the CDC now?” And it’s not a slam dunk. People who are so distrustful of institutions and government agencies and even the medical system or our healthcare system, it’s not like they’re like, “Oh, yes, please, like everything the government says now, you know, I’m just going to take it at face value and just believe it.” It’s almost like it’s like a misunderstanding. I kind of wonder this for the people who are in charge, like leaving government now. It’s like: Do you understand this? Because they’re not just automatically going to take what you say. It’s sort of antithetical to years of thinking, potentially, that they’ve had, right? So— 

Goldman: That’s such a good point. 

Pradhan: I don’t know that now, all of a sudden, are they going to become just a mouthpiece for what RFK Jr. [HHS Secretary Robert F. Kennedy Jr.] and his political appointees are saying. I don’t think so. 

Rovner: I think they’re just making everybody mistrust everything. Joanne, you wanted to add something. 

Kenen: I think, I do a lot of work on trust in healthcare, and I’ve been all over the country the last couple of months since our book came out, talking about it and being on panels. And it’s really, I mean, it’s a cliche to say distrust in healthcare or the health system or public health is an existential crisis. It’s a cliche we’ve heard all the time. But just because it’s a cliche doesn’t mean it’s not a crisis. The divisions in our country spill over from the politics into things that determine whether or not we and our families and our friends and our kids are healthy or not healthy, and I think this sort of whiplash of deep distrust of the other side is probably going to continue for some years as political officeholders and appointees change. But this, the CDC, I’m not â€” the last poll I saw, I’m not sure if it’s a record low of trust, but it’s definitely plummeted. But it’s the Democrats who used to trust the CDC, now don’t. Now, maybe that’ll rise again when the new CDC director, she’s confirmed, which is likely. Maybe she’ll be able to rebuild, and maybe things will get a little bit better. But right now, there’s so â€” a combination of deep distrust and a whole lot of mixed messaging. It can be very confusing to understand medical advice, and it can be very hard to access our medical system. So it’s just this really toxic brew of risk factors mixed in with the distrust. 

Rovner: Meanwhile, we had a real-world example of distrust and re-trust in public health this week. Secretary of Defense Pete Hegseth has quietly reinstated requirements for new military recruits to be vaccinated against the flu after a flu outbreak at Lackland Air Force Base sickened more than 200 recruits, with four people hospitalized. Hegseth had removed the mandate, which had been in effect since the end of World War II, with much fanfare back in April. Didn’t take long to kind of see why that mandate made sense, right? 

Kenen: Yes, because this is actually a force readiness issue. It’s not just, Oh, people got sick. Most young, healthy people, and most people in military service â€” most, not all â€” are young and healthy. These were recruits. These were young. Most of them are going to be OK. But first of all, not all of them are going to necessarily be OK. There’s one possible death. The last I heard that somebody had died, but it wasn’t necessarily from flu, and that was under investigation. And one of you may have more recent information than what I read a few days ago. So, we have four people hospitalized. We do not have a confirmed death. But it was 160 people, which is a whole lot of people. And if it happened here, it’s a big red flag, because your soldiers are supposed to be ready to fight, not in the bed with the flu. So, it happened in one particular location, but it really should have showed this national security interest. You really don’t want your fighting force with a 104 fever and feeling crappy. 

Rovner: I would say it’s also completely predictable that when you bring— 

Kenen: Yes. 

Rovner: â€”a whole bunch of people in and have them sleep together in close quarters and stress them physically and mentally, which is what basic training does, and then somebody gets sick, it’s going to spread. 

Kenen: It’s also one, that’s really one of the big causes of the spread of the 2018-2019 â€” I mean, excuse me, the 1918-1919 so-called Spanish flu, which it wasn’t. It was actually, a lot of it was spread â€” it was just as we were getting into World War I. There was a lot of young recruits. A lot of it’s â€” there’s argument about exactly what happened where, but certainly a base in Kansas was one of the big spreaders of that, of what became a global pandemic. 

Rovner: In other words, we’ve seen this TV program before. 

Kenen: We didn’t have —right. We didn’t have vaccines yet. It wasn’t— 

Rovner: We didn’t have TV either, but, yeah. 

Kenen: We had imagination, right? 

Rovner: Point taken. 

Kenen: We had carrier pigeons. 

Rovner: All right. 

Pradhan: I feel like anyone with school-age children or kids who are in college could’ve. It’s like, Oh, who could have predicted?&²Ô²ú²õ±è;³Û´Ç³Ü&²Ô²ú²õ±è;³ó²¹±¹±ð&²Ô²ú²õ±è;—&²Ô²ú²õ±è;

Rovner: Yeah, yeah. 

Pradhan: â€”massive numbers— 

Rovner: Any parent. 

Pradhan: â€”of people in a small place, and Oh, look, a flu outbreak. It’s as inevitable as things can be these days, right? I think that this probably is pretty high up there, right? 

Rovner: Yeah. All right. Well, so, moving on. In things I definitely did not have on my bingo card for 2026, Indiana is imposing price controls on hospitals. Under the new law, as reported by my Ñî¹óåú´«Ã½Ò•îl Health News colleagues Phil Galewitz and Samantha Liss, hospitals in the state will have to charge employer health insurance plans no more than a multiple of what they pay Medicare, or else run the risk of losing their tax-exempt status. Now, Vermont also does this, but Indiana is politically very much not like Vermont. Is this the leading edge of a Republican backlash to high healthcare prices? 

Kenen: Maybe. We just don’t know. You know — Indiana’s Indiana. But we have, and we’ve talked about it— 

Rovner: Indiana’s really red, though, and they have a really red governor who used to be a really red senator. 

Kenen: Yes, but we don’t know what’s going to spread, right? But what we’ve talked in the podcast frequently over the last couple of months, hospitals are in the spotlight about pricing in a way that they haven’t. We’ve been really focused on drug prices. And we’ve sort of, we have a different relationship with hospitals. And we also all don’t get hit by hospitals every year, where most of us do buy drugs, so â€” but hospitals are really getting a lot of attention, bipartisan, I mean, in red and blue states, in Congress. There have been hearings. It’s not like the tobacco executive hearings, but it is sort of a lot more skeptical of why do hospitals, are they â€” to use the buzzword of the day â€” why are they so unaffordable? Why are your bills so inexplicable? Why can’t you understand? So, the whole system is based on cost shift, and one reason hospitals have been pressed to charge a lot more than Medicare is they say that Medicare payments don’t cover their costs, and they â€” it’s the great big, the shell game of American healthcare. But I don’t know that we know what the next step is state-wise. But you know what? It may be a domino. We don’t know yet. 

Rovner: I know I’m interested watching the backlash of Republicans against high healthcare spending. They’re coming out against managed care. They’re coming out against hospital prices. I will point out that for my entire career, the person who’s been loudest about nonprofit hospitals overcharging has been [Sen.] Chuck Grassley. 

Kenen: Right. 

Rovner: Very Republican senator from Iowa. 

Kenen: It’s not just that they — right. He’s been consistent on this for decades, and he’s said that it’s not just that they charge a lot. It’s that: What are they really doing to deserve that? They’re supposed to get a tax break in exchange for community benefits. But show me the benefit. How are you defining and measuring? And is it truly a benefit to the community, as a layperson would think of, Oh, benefiting the community? Or is it some little niche thing that they say is their public service. 

Pradhan: And one thing about Indiana in particular, I think Samantha Liss, who’s one of the reporters on the story you mentioned. Right, Julie? Actually two years ago, what’s really interesting is she had written also about, I think, and this is sort of a case study, I think, somewhat â€” right? â€” in how consolidated your healthcare markets are. Right? I think that that’s a big driver as to whether a state or a governor or anyone wants to take action on these things. I remember she wrote about these two rival hospitals that were in Terre Haute, Indiana. They were seeking to merge, and then they pulled back their merger application because there were so much opposition, because it would have left â€” Terre Haute is like a city of maybe close to 60,000 people, and for that city and the surrounding area, they would have had only one hospital operator. So, and that was a big deal at the time. So I think Terre Haute, Indiana, is far from the only place where that is sort of a living reality, right? And that’ll be a big motivator, I think, sometimes, too. 

Rovner: But, yes, I will say that both Indiana and Vermont have a lot of these small, sort of midsize consolidated areas where hospitals can basically charge at will. Maya, did you want to say something? 

Goldman: Yeah, I was going to add, I think Indiana has been on the cutting edge of a lot of health policy, especially among red states. They’ve done a lot with price transparency and employer advocacy, and so it’s not surprising to see Indiana do this as much as it would be a different red state. I think it does really indicate to me that people in the state, state governments, and citizens are really frustrated that Congress isn’t acting fast enough for them. They’re, like Joanne said, there’s a lot of discussion happening in Congress around hospitals and needing to lower prices, but there’s not a lot of action happening. And people have power to do that at the state level, and they’re exercising it. So I think we will see more happen there. 

Rovner: Here’s another issue where states sort of have power. While we were talking about strange bedfellows, Colorado has become the second state, after Florida, to get FDA approval for a plan to import cheaper prescription drugs from Canada. Except Florida hasn’t been able to get its program up and running, because it can’t find a Canadian wholesaler that’s willing to sell the drugs to them. What makes Colorado think that they’re going to have any better luck? And mightn’t both of these states just take a page from Indiana and think about their own price controls, if that’s what they want, rather than importing Canada’s price controls? 

Kenen: I can’t imagine if Colorado decided to do price controls that it wouldn’t be stuck in court. We’ve joked over the years that if you want your child to have full employment for life, become a healthcare lawyer? I think that if Colorado were to do that, which it really just suggested, it would not be immediately reality for consumers. There’s so much cost shifting in healthcare, because our system is just insane, that everybody can say, honestly, I’m not the only culprit. The whole system is too expensive with all this indirect shifts of costs and confusing charges, and it’s hard for experts to understand. 

Rovner: I feel like a lot of federal members of Congress have also sort of looked at these. Let’s import cheaper drugs from somewhere else.  

Kenen: Because it sounds good. 

Rovner: This has been going on since the ’90s. 

Kenen: Yeah. 

Rovner: And nobody’s been able to make it work. And Canada has said very clearly, it’s like: We can’t sell you all of our drugs or we won’t have enough drugs for the people here, which is who we buy drugs for. 

Kenen: But it sounds good. 

Rovner: It does sound good. 

Kenen: And that’s why it’s gone on for 30 years now, closer to 40. 

Rovner: Yeah it is 30 years now. 

Kenen: Yeah, and if you live in New England, you can go to Canada and get them, but there’s been sort of on-paper authorizations to do it for quite a â€” I don’t remember when the first one was, Julie. It was a long time ago. 

Rovner: Yeah. Well, they’re â€” yes, they allowed the FDA to allow states. The first one that actually sort of in theory became legal was the Florida one. And again, that was a couple of years ago, and it’s not off the ground. All right. Well, finally this week, in a drug price adjacent story, props to our podcast pal Lizzy Lawrence at Stat for the  of the week. Lizzy revealed that drugmaker Eli Lilly granted compassionate use to an unnamed 79-year-old individual to use its still-investigational obesity drug retatrutide, which trials have so far shown to be even more potent than Lilly’s other blockbuster obesity drug, tirzepatide. Now, compassionate use is supposed to allow people with terminal conditions to get early access to promising drugs that are not yet approved. Apparently, this patient is not only obese but has obstructive sleep apnea and pulmonary hypertension. Yet both of those conditions, while very serious, are not considered terminal. So the obvious question here is: Who is this 79-year-old patient, and is he named Donald Trump? So far, nobody’s been able to find out, though the White House has been very adamant, at least after Lizzy’s story came out, that it is not the president. So, why is everybody so excited about this story? 

Kenen: Because it’s weird. 

Rovner: Fair. 

Kenen: Lizzie’s story is great, but it’s just a strange saga, right? And in her first story, she said someone who was 79 at the time, which was a couple of months ago, because President Trump just turned— 

Rovner: Turned 80. 

Kenen: Right. The idea that one person and only one person would get this drug. And we all remember he did get â€” and that was life-threatening. I’m not saying he shouldn’t have gotten it, but he did get it, a monoclonal antibody, when he was hospitalized with covid in his first term. And it may have saved his life. But that was a life-threatening situation. 

Rovner: Yes, that’s what compassionate use is supposed to be used for. 

Goldman: Right. And I think it obviously does matter who, if this person is President Trump. But I think Lizzy does a really good job in the story of explaining that, regardless of who this person is, this is not typically how this program is used, and so it should raise eyebrows that the administration and Eli Lilly are allowing this to happen, regardless of who the person that’s getting this is. 

Kenen: And it could be somebody who has a connection to Lilly. It could be anything, right? It’s a tantalizing question, but we don’t know. 

Pradhan: Yeah, and I do think it sort of begs the question. The White House, after the story published, only firmly said it was not the president. Probably would have been very helpful for them to have said that prior to the story publishing. Why they— 

Rovner: And they were asked. 

Pradhan: Of course, they were asked, right? They were asked, and they did not directly answer. I don’t pretend to know why that decision was made, but I think it probably would have been a good public service to definitively say whether it was the president or not before the story first ran, before it sort of caused this big hullabaloo on social media and elsewhere, right? 

Rovner: And perhaps predictably, Democratic Sen. Maggie Hassan of New Hampshire has now written a stern letter to the administration, demanding — and I believe also to Lily â€” demanding to know if not who this is, at least how this happened, because it is an unusual use of the compassionate use exception. 

Pradhan: Can I ask a question also? This is one thing that I was wondering when reading Lizzy’s story is, so clearly certain people in the NIH and the FDA are HIPAA-protected individuals. So if they were to release or leak identifying information about this patient, that’s not allowed. But not everyone is, surely. Do we really think â€” someone must have seen the details of who this person is. And they would not be subject to HIPAA [the Health Insurance Portability and Accountability Act] if they were to cough up the name, right? 

Rovner: Well, I’m sure that people will continue to see, including those of us here at Ñî¹óåú´«Ã½Ò•îl Health News. All right, that is this week’s news. Now it’s time for our extra-credit segment. That’s where we each recognized 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, your extra credit involves the second-buzziest story of the week, the saga of the green Reflecting Pool. Please tell us about it. 

Kenen: OK, one story that’s my extra credit, and one story I’m also going to, related story, that I’m going to just give a shout out to. Sarah Kaplan at The [Washington] Post wrote “.” And basically she talks about climate change and health, and that the reason that there’s this algae â€” and actually there’s many kinds of algae. I’m not an expert on all the kinds of algae. But there is one called cyanobacteria, which is highly toxic. It is present â€” my understanding is it’s among several kinds of algae in the Reflecting Pool. But it is becoming more dominant because of climate change. And that’s toxic. That’s not a good thing to have. What I didn’t know â€” I don’t want to go on too long â€” but it’s sort of fascinating that they fill the Reflecting Pool with water from the Tidal Basin, which is the surrounding, the water that, for the people who aren’t in Washington, is the water around the Jefferson Monument and the cherry trees and all that, which in turn comes from the Potomac River, which is polluted. And painting a reflecting pool and then pouring in polluted water might not have been the smartest thing to do. And also apparently the American flag blue is darker than the old gray and it retains more heat and makes the problem worse. So sort of the big public health message is that â€” here the big joke is Making Algae Great Again â€” but that there is saying something about the state of our planet and the state of our water, and that even things that we think of as harmless are not necessarily harmless. And then, just relatedly, for anyone who’s really interested in good reporting on this and great writing on this is the cultural critic of The Washington Post, Philip Kennicott, has been writing a lot about the changes to Washington, and  the Reflecting Pool and called, he said it looked like a kale smoothie. 

Pradhan: Oh. 

Rovner: Vivid. OK, Maya. 

Goldman: My extra credit this week is from Stat. It is an article by O. Rose Broderick called “.” And I think this is a potentially very consequential move from the Trump administration that isn’t getting enough coverage. The SparkNotes version is that the Supreme Court held in 1999 a decision known as Olmstead that said you can’t have unjustified institutional isolation of people with disabilities â€” that’s a form of discrimination. The Trump administration put out a memo sort of reinterpreting what unjustified institutional isolation means. This notably doesn’t change existing laws around integration requirements for people with disabilities, but it signals where the Trump administration’s head is at with regards to disability rights. And the article also notes that the motivation for this change isn’t really clear, especially since community care is usually cheaper than institutional care. But it does mention that one possible factor could be to give the government more flexibility to tackle homelessness, perhaps by forced institutionalization. So, certainly one to watch. 

Rovner: Yeah, definitely. Rachana. 

Pradhan: So my extra credit is a story [“Arrests of Immigrant Parents Create Mental Health Crisis for Children”] written by our [Ñî¹óåú´«Ã½Ò•îl Health News] colleague Claudia Boyd-Barrett. It is just devastating. If I, so â€” grab a tissue box if you’re going to read it. She wrote about how, the consequences for children who have parents that are either detained by ICE [Immigration and Customs Enforcement] or deported out of the United States, and she has these incredible, really just heartbreaking stories of these children who have been separated from their parents and sort of the emotional toll that it is taking on them. So it’s, the way I think about it is it’s, during the first Trump administration there was a big thing about families being separated at the border, and it was the family separation crisis. But now it’s happening again, just not at the border necessarily. 

Rovner: Yeah. It is quite a story. Well, my story affects both immigration and disability. It’s from The Washington Post. It’s by Sylvia Foster-Frau, and it’s called “.” Now, this is a state program that’s separate from Medicaid, called Children’s Special Services, that helps low-income families with children with disabilities pay for critical things like wheelchairs and feeding tubes and ventilators. Until now, it has served families with no other way to get care, including those who are undocumented and therefore ineligible for Medicaid. But now, the 400 families on the program have been notified by the state that if they want to keep their benefits, their immigration status will be reported to federal authorities. The story profiles one family, asylum seekers from Honduras who have a 10-year-old with spina bifida and autism and whose care, including wheelchairs and catheters, has so far been paid for by the program. Now the mom says she’s going to have to drop out of the program rather than risk being deported, but she has no idea how she will pay for the care that her son needs. It is also pretty wrenching. 

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

Kenen: I am mostly on  and Bluesky, . 

Rovner: Maya. 

Goldman: I am also on  and still on X, . 

Rovner: Rachana. 

Pradhan: You can find me , , and , @rachanadpradhan. 

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

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

Julie Rovner: Hello, from 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, June 11, 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 Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hi there. 

Rovner: And Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

Rovner: Later in this episode, we’ll have my interview with my colleague Tricia Neuman, who’s stepping down from her post here as KFF senior vice president and executive director of the Program on Medicare Policy, after a long and distinguished career shaping and analyzing the nation’s most prominent health insurance program. But first, this week’s news. I want to start this week with kind of a slow-motion news story that I want to make sure doesn’t get overlooked. It’s the continuing signals of declining health insurance coverage in the U.S. The Commonwealth Fund reports this week that state Affordable Care Act marketplaces are seeing the predicted shedding of policies by consumers who can’t make their premium payments. In Maryland, for example, 13% of enrollees fell off their plans between open enrollment and April of this year. That’s compared to just 3% last year. At the same time, more people are becoming underinsured because they, quote, “bought down” coverage from gold- or silver-level policies to bronze, leaving them with lower premiums but often multi-thousand-dollar deductibles. Meanwhile, three Democrat-led cities and a Democrat-led county have sued the Department of Health and Human Services over the regulation governing sign-ups for next year’s Affordable Care Act plans, charging that changes like allowing non-network plans and still higher out-of-pocket caps violate the terms of the ACA itself. So what is the outlook for the ACA, now that it’s June and it seems pretty clear that Congress is not going to extend those additional subsidies that expired at the end of last year? 

Weber: I’d say it’s not looking good, Julie, the way you just laid it out. I mean, I think the bottom line is this is a train wreck we’ve been watching in slow motion for many, many months, in the sense that you’re going to see a lot of people lose coverage. This is not exactly happening during a booming economic time, so you’ve got people cutting back because of high grocery bills, high etc., and then they see their health care go up tremendously, and they can’t cut it. And then they end up in plans that could leave them with massive bills at the end of the day. I do think this will lead to more of a groundswell of outcry, because it’s hitting folks â€” most affected, as The Commonwealth Fund pointed out, are not those in the lowest category; it’s the folks â€¦ where the subsidies ran out kind of in the mid-tier. And so you’re getting some more middle-class or lower-middle-class folks that are seeing some very, very steep health care bills. 

Rovner: Yeah, and as you point out, at the same time they’re seeing their gas bills go up, and their grocery bill’s up and basically prices for everything else. But I mean, I think there was a lot of like real sticker shock with the insurance, because you know, well, you know, gas is up $1 a gallon, and it hurts to go from paying, you know, $25 or $30 to fill your tank to $45 or $50, it’s not like saying, Hey, you’re going to go from paying $300 a month to paying $1,300 a month, which is what we saw from a lot of people.  

Meanwhile, both doctor and patient groups are up in arms over the new Medicaid work rules issued by the Trump administration last week. Rather than allowing states to automatically exempt from the work requirement people with certain conditions that would qualify them as, quote, “medically frail,” the rules stipulate that beginning in 2028 Medicaid recipients will have to prove at least twice a year not just that they have a condition, but that that condition prevents them from working. Patient groups say that will result in people who most need health insurance losing it and possibly getting sicker. Doctors, including the American Medical Association, which was conveniently having one of its meetings this week, worry that the burden of making that determination is going to fall on them, and that doctors aren’t trained for these things. They also point out that many chronic conditions fluctuate, leaving people sometimes able to maintain daily activities, like working, and sometimes not. Might this get changed due to the outcry? I think the administration, so far, seems to be saying that not doing it this way lets too many people off the hook. 

Lawrence: Yeah, I mean, I think that this is one of those things â€” again, it’s starting in January 2028. There’s sort of a year tail. I’m curious â€¦ there’s enough time that this could keep getting pushed down the road and possibly reversed, and you know, there’s also legal challenges. I know that my colleagues wrote about the Legal Action Center saying that CMS [the Centers for Medicare & Medicaid Services] is exceeding its authority here, so definitely we should be watching to see what happens with that. 

Rovner: Like many people, I was surprised at the rules as they came out. But I’m also a little bit taken aback at how broad the backlash is, particularly to this part â€” to the really, you’re going to require people with cancer to prove that they can’t meet work requirements? And how are they going to do that? And are people on Medicaid really going to be able to get doctors to, like, write them notes to say this person should be exempted? I mean, it just, it seems like a huge bureaucratic morass. 

Lawrence: Absolutely. 

Raman: Oh, I was just gonna say, from all sides, you know, if you are on Medicaid, and maybe there’s the burden of just transportation to get to that appointment, and, you know, having the time and the energy if you have a chronic illness, but then also we’ve heard time and time again how workforce issues, doctors are already overworked and don’t have the time to do so many of the things they already have to do. This is another burden for them to be able to have to eventually do this with the limited time they do have. 

Rovner: Lauren. 

Weber: It also seems incredibly subjective. I mean, I know they said that they’re trying to get to it through the codes, but, as  [Miranda Ollstein], I mean, how does one even really evaluate that? And people can work in different stretches. Also, with the flexibility many people have now to work from home, there is an opportunity for some folks maybe to be able to work, depending on what their job is. It’s just a minefield of unintended consequences, probably. So we’ll see how that goes. 

Rovner: I’ll say, this has a long way to play out. Well, along similar lines, there are also concerns that the new crackdown on fraud that’s being spearheaded by the Trump administration is threatening people’s coverage as well. In Ohio, lawmakers rushing to address home healthcare fraud tried to speed through a bill that included a provision to ban family members from qualifying as care providers for people with disabilities. That was ultimately removed from the bill when it was pointed out that such a change could result in more people having to be institutionalized, costing the state far, far more than paying family members to help people. I’m sure we’re going to see similar efforts to crack down on fraud in more states, because the federal government is threatening to take away money. Although, as administration officials continue to claim widespread fraud throughout the home health and hospice care systems, I imagine that we’re going to see more give-and-take on this one too. 

Weber: It seems like another example of shoot first, look later. I mean, in general, that clearly would have been a very bad provision to keep in the bill. If you know anything about home healthcare, you know that most of the time it is a family member giving up much of their time and effort to keep a loved one in the home. And so wild that that was even in there to start with. I think in general this goes to this long-running conversation around fraud. Again, there is a lot of healthcare fraud. I think we should all be very clear. There’s a lot of fraud that needs to be addressed. But you can say a lot of things about fraud obliquely, but then when you get to the brass tacks, you got to be careful about what you’re doing. So this is just another example of that, and how we’ve seen the Trump administration move on this that may or may not end up in problematic outcomes. 

Rovner: Yeah, Dr. [Mehmet] Oz [the CMS administrator] keeps talking about, you know, family members who are helping carry in groceries or driving people to doctors’ appointments. That’s not what these paid caregivers are doing. These are people who are basically unable to work because they need to be with this person that they are caring for 24/7, 365. I mean, there’s a lot of work involved here that’s way more than I think a lot of people who are in Washington or, I guess in this case, in Baltimore writing these rules sometimes realize. And I think that was brought home rather vividly in Ohio when they tried to do this and then were suddenly given the facts on the ground and said, Oops, maybe we should try this another way. But Lauren, you’re right, it’s not to say that there isn’t plenty of fraud to be fought. 

Well, moving on, this week we also got the annual report from the trustees of Social Security and Medicare. Not much has changed from last year as far as when the trust funds that support the programs will technically become insolvent. For Medicare’s Hospital Insurance Trust Fund, it’s still 2033, but a quarter earlier â€” so three months’ difference. Still, that’s only seven years away. In earlier times, I’ve been doing this a long time, seven years to insolvency would set off alarm bells in Congress and the administration, and would prompt action, or at least attempted action. Are we yawning our way into a very large financial crisis impacting one of the most popular health programs in the country? 

Raman: I think it’s a combination of things. A) I feel like every year we are more loose with deadlines. We address them in Congress closer and closer to them. So something that several years ago would be a big conversation ahead of time, we push it closer. And I think also the appetite in Congress to get things done right now is low, to find bipartisan agreement. And so getting something done on this would be quite difficult right now with all the other competing priorities there. 

Rovner: I think they were floating the idea of another budget reconciliation bill â€” “Reconciliation 3.0,” I guess they were calling it. And my reading of the consensus is that it is not happening. Whether there’s not enough appetite or not enough votes, or combination of those two, it doesn’t look like Congress is ready to take on something as big as Let’s make sure that Social Security and Medicare are there for the retiring baby boomers and Gen Xers, who are going to shortly follow. 

Raman: Especially in a midterms year where they’re not in as much as they might be at other times. 

Rovner: Yes, that’s right. They are definitely in and out. All right. Well, we’re going to take a quick break. We’ll be right back. 

Meanwhile, over at the Department of Health and Human Services, our podcast colleague  of Secretary RFK Jr. over last weekend, saying he has, quote, “shown little interest in managing the details of work in his department,” and that he, quote, “is single-mindedly focused on his top priorities, including food recommendations and pesticide exposures, and hunting for evidence to support his long-held beliefs that vaccines are harmful.” And, indeed, the big press event Kennedy had this week was to tout his effort to get medical schools to teach their students more about nutrition, something most medical schools had already been doing, I hasten to add. And, of course, there are still no confirmed, and in some cases even nominated, heads for some major HHS agencies, including the FDA, the Centers for Disease Control and Prevention, and the Administration for Strategic Preparedness and Response, which oversees things like the Ebola outbreaks. I would note that Kennedy responded to Sheryl’s story just Wednesday â€” so, like, five days after it appeared, basically saying he’s doing much more than she realizes. What are we to make of this whole thing? 

Weber: I would encourage everyone to read Kennedy’s response, and then I would also be curious if Kennedy would like to show me where his public calendars are that he talks about in his tweet, because I would love to look at them, and I’m sure Sheryl would too. But I thought Sheryl’s framing of the story was very clear-headed and accurate. I mean, look, the bottom line is the secretary has not been publicly engaged on the Ebola response at all, which is somewhat surprising. He does not have any of these people in place. I mean, take your pick. I mean, it’s all these agencies are rudderless currently, and he has very clearly expressed serious interest in his pet projects, but has not been as engaged, according to Sheryl and all of our reporting, in some of these other issues. And I think it’s a fair look at what that means for his legacy going forward, and what that will mean in the months to come. 

Rovner: Right. And you know what’s going on actually in health right now. Over at FDA, they’ve apparently begun the safety study of mifepristone, the abortion pill, that the administration has been promising anti-abortion groups for more than a year now. But it appears that study won’t be ready before the midterms, which is actually what Republican strategists had advised, so it wouldn’t further inflame the campaign season. This is up your alley. Is this FDA acting Commissioner Kyle Diamantas’ effort to win the permanent job, or is this the White House still trying to kind of placate both sides to the debate for as long as it can possibly get away with? 

Lawrence: Yeah, so Kyle Diamantas has said to many different people that he doesn’t want the job, including to me via an HHS media spokesperson, so I tend to believe him. Although it seems likely that he will be in this role for a while, because of how many leadership positions the HHS needs to fill, and how few days there are of Congress. With the mifepristone study, it seems like, yeah, I mean, I think the timing is not lost on anyone. This seems to have worked out politically pretty well for the Trump administration, where it’s a six-month study, they can kind of see what happens in the midterms, and see, because you know, [Sen. Bill] Cassidy, this is a huge issue for him. Any FDA commissioner they’re going to put in front of him, he’s going to be hammering on mifepristone, pro-life issues. So, as long as they can pursue the strategy that they have been pursuing, of sort of just waiting and seeing and saying that they’re working and pushing it out. I think that’s what they’re going to keep doing. 

Rovner: I guess there’s this continuing promise that the administration will try to sort of rein back in on the mail-order abortion drugs, which is, I guess, what’s really â€¦ I don’t think anybody thinks that they’re going to try to revoke the approval of mifepristone. I think what the anti-abortion folks are hoping now is that they’re going to revoke the mail-order ability of people to get mifepristone, which, of course, we’ve seen people using in abortion-ban states to basically evade those abortion bans. It’s obviously a big deal for both sides that the administration would like to keep under wraps as long as it possibly can. Is that a fair assessment? 

Lawrence: Absolutely. Yeah, and I mean, there’s no safety reason to do that, so â€¦ there will be huge blowback from pro-choice advocates, but also within the agency, I would imagine, this would be a huge turning point. 

Rovner: Well, that’s the FDA. Then there is the National Institutes of Health, which actually does have a Senate-confirmed leader, Jay Bhattacharya, although he’s currently doing double duty, also overseeing CDC. But apparently things aren’t so great over at NIH. Last June, 300 NIH staffers published something they called the “Bethesda Declaration,” named for the location of NIH’s main campus, in which they said that the new administration’s policies were undermining the agency’s mission, wasting public resources, and harming the health of Americans and people across the globe. Now, one year later, about 70 NIH’ers have , including one we talked about last week that would give political appointees far more say about who gets research grants and how those grantees can behave. And another policy that would strip civil service protections from many senior employees, so they could more easily be fired for not going along with the administration’s political priorities. I guess this is this week’s trend. What seemed kind of shocking last year is now kind of status quo, right? I saw very little attention to any of these stories that are enormous changes from how the nation’s science agencies have operated over Republican and Democratic administrations in the 40 years I’ve been doing this. 

Raman: I think that one thing we’ve really seen is just how much some of these science-oriented groups have mobilized over some of these issues, just, you know, kind of stating that researchers that have been doing this kind of work for 20, 30, 40 years, that this is so out of the realm of anything they’ve seen before. This would, you know, jeopardize their research and their stability and just the way that they have been doing work for so many years. And I think even with both of the rules that we, that you mentioned, that has been something that has been really amplified by them. But I think it has been, given the number of other things happening, this space not really trickled down to the broader set of folks to really, you know, tap into. We have Ebola, we have so many other things that people, I think, are a little bit more top of mind, even though this is a huge change that under normal circumstances would have more attention paid to it. 

Rovner: Yeah, I think that’s fair. This is sort of the continuing shock and awe that we see of the administration trying to make all of the changes that it wants at once, so nobody gets a chance to focus on any of them. In sort of what we would consider normal times, any one of these would be the overwhelming story of the day. 

Well, all of this brings us to what I consider the wildest story of the week. There was plenty of drama at, of all places, the annual research meeting of the American Diabetes Association in New Orleans. And props, by the way, to the website MedPage Today for breaking this within hours of its happening last Friday. I will just read the original headline: “.” So the keynote address to open the conference was supposed to be given by NIH Director Bhattacharya, but he dropped out at the last minute. While the audience was inside listening to a talk instead from NIH senior adviser Richard Wojcik, five doctors and researchers, including the editor-in-chief of the association’s flagship medical journal, as well as a past president of the ADA, were outside handing out a thousand copies of an editorial from the journal criticizing the administration’s cuts to biomedical research. At the direction of the organization, those protesters â€” can you even really call them protesters? â€” were escorted out by security and told they could not return to the conference. And from there the backlash began. Sixty-five hundred people signed a letter of complaint to the association. Two top officials resigned, and, finally, five days later, the CEO apologized to the “editorial hander-outers” via a video. But I want to pose a larger question. This was a real-world playing out of the tensions that we were just talking about are boiling within science. Should they try to work with this administration, or should they try to fight it? It would appear that the answer to that is kind of still up for grabs. Isn’t that what this demonstrates? 

Lawrence: Yeah, I mean, I think that it’s a clear tension between what the members of these major medical organizations want, which, like you said, 6,500 people signed that letter. There is a real appetite to try to fight back and push back, but there’s a real fear among leadership to do anything. â€¦ This was just mind-boggling, and my colleague Liz wrote about the backlash, and their decision to escalate the situation in this way brought so much more attention than, you know, five people handing out a journal editorial would initially. So fear can lead people to do things that ultimately don’t serve their purposes. 

Rovner: Yeah, I left out the part about the ADA leaders sort of over the weekend trying to justify the expulsion of the “editorial hander-outers,” as I will call them, by saying, Oh, it could affect our 501(c)(3) status, or they were violating the code of conduct, for, you know, for the meeting. But not only did those things not fly, they did seem to make things worse. Lauren, you wanted to add something. 

Weber: I just want to say that’s probably the most press an ADA meeting has ever gotten in its entire life. So, I mean, if they â€¦ 

Rovner: Absolutely. 

Weber: At the end of the day, I mean, these, as you point out, Lizzy, I mean, this editorial guy read a lot more and got a lot more attention because of it, so we’ll see what happens from here. 

Rovner: Yeah, but I think it’s sort of a cautionary tale for leaders of these organizations who â€” do we want to fight or do we want to try to get along, and maybe you ought to ask your members first? We’ll see if this sort of comes out at other meetings. Now it’s the beginning of the summer, it’s when a lot of these scientific meetings happen. I’ll be watching more of them a little more closely. 

Well, finally, this week, it’s June, and that means it’s the season for working on the spending bills on Capitol Hill. This week we actually got a lengthy public markup of the bill that funds the majority of the Department of Health and Human Services. A reminder: FDA is funded in the Agriculture bill because food. Sandhya, how is the Labor-HHS bill shaping up? It looks like Congress isn’t going to go along with the big cuts proposed by the Trump administration, but that’s not saying there won’t be fights about funding, right? 

Raman: Yeah, so I would say you’re right. The big takeaway from this House markup is that it kind of bucked some of the White House’s suggestions on, you know, what to do with funding for this. They funded $111 billion for HHS, if this is made into law â€” so a much smaller cut â€¦ of what the White House was proposing. That included things like $100 million more for NIH, which has been something in the past worried about cuts; and funded some things that I think we’re interesting, you know, CDC’s office for smoking [Office on Smoking and Health], something that had been subject to the DOGE [Department of Government Efficiency] cuts last year; , something else that â€¦  

Rovner: Yeah, I want to address that separate, I want to get to the amendments in a second. But I mean, just sort of in terms of funding, I mean, and we should point out that $100 million for NIH â€” NIH has a budget of like $40-some billion, so yeah, it’s not a big increase. It’s a rounding error increase, but it’s not a cut. 

Raman: Yes, not a cut. So the next step for this would be the House floor, but we might get kind of stalled there just because the issue on the Senate side is they’ve not agreed to top-line numbers for funding yet, and they need those in order to shape out the individual bills. So, without that, we’re kind of in a standstill, and it might be a little bit more like we’ve seen in some of the years past, where the House goes through, they make a bill, they vote on the bill, and then the Senate doesn’t publicly do theirs, but then we get to an agreement a little further down the line. But what Sen. Susan Collins, who heads the Senate Appropriations Committee, has been saying is that, you know, she wants more for NIH than what’s been presented here. But without those top lines, we don’t know. So, we’ll see, you know, in years past, we’ve really just, the funding year deadline has been pushed and pushed and pushed, so â€¦ 

Rovner: Into the next funding year. Often. 

Raman: Yes, and I think, especially like I said, when it’s a midterms year, they’re going to be in far less than normal. It’s not clear when there’s going to be the appetite to get all of that done. 

Rovner: So, often these spending bills, when they move â€” and of course they haven’t moved when they were supposed to for the last however many years â€” but it does sometimes give a chance for lawmakers to express frustration or doubt or simply disapproval with things that the administration is doing. And one of the things that they seem to be expressing disapproval is the administration’s plan to use prior authorization, which is very controversial, in Medicare, and AI â€” in fact, an AI prior authorization in Medicare, and on a bipartisan basis. They voted to tell the administration, No, please don’t do this. I’m wondering, you know, it may not become law on this bill, but this does suggest that there is bipartisan concern in Congress about these efforts on behalf of Medicare, right? 

Weber: Well, I think this goes back to our Medicare insolvency conversation earlier. Who votes? It’s the people that are on Medicare. So, and how unpopular would it be if they were to be limited in what they can access for their health care services? So, I think at the end of the day, the reason that’s bipartisan is these lawmakers know who’s keeping them in office, and prior authorization has a very bad name. I mean, it’s very interesting, because CMS has said that this will help cut down costs, but also has, out of the other side of its mouth, in hearings and so on, Oz has decried insurers using prior authorization. So there’s a lot of “for thee but not for me” vibes going on here. But at the end of the day, it doesn’t seem like this will advance because of the bipartisan opposition. 

Rovner: And of course, Lizzy, your colleagues at Stat have talked about, you know, private companies using enhanced prior authorization, which nobody seems to think is a great idea, and now we have Medicare proposing it. 

Lawrence: Yeah, I was going to say prior authorization, already unpopular, add AI to the mix. I mean, there’s not â€¦ yeah, Bob and Casey, my colleagues, , but just, in general, there is not a lot of goodwill for the AI industry with data centers and all kinds of unpopular initiatives. So, yeah, it makes sense we’re seeing strong bipartisan disapproval of this.  

Rovner: If it doesn’t show up in this bill, I wouldn’t be surprised to see it show up in some other bill that’s more likely to make it to the finish line. All right, that is this week’s news. Now we’ll play my interview with KFF’s Tricia Neuman, and then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast my colleague and friend Tricia Neuman, who is retiring as KFF senior vice president and executive director of the Program on Medicare Policy, after a long and distinguished career here and on Capitol Hill, shaping, analyzing, and explaining Medicare policy to people like me, as well as to the nation’s decision-makers. Tricia, thanks for taking some time as you wrap things up. 

Tricia Neuman: Julie, thank you for having me. 

Rovner: So, let’s go back to the beginning, if you can remember that. What got you interested in pursuing Medicare as your health policy specialty? 

Neuman: You know, I didn’t think about it as Medicare, but I thought about it in the context of my family. I was â€¦ I remember watching my grandfather and seeing him struggle. He had Alzheimer’s, and he was trying to tie his shoe, and he couldn’t remember, and I somehow got interested in aging. And I was interested in government, and so I came to Washington ready to do policy, and I ended up at the Senate Aging Committee, which was perfect. And I got into Medicare because I had an older colleague who said, Look, you got to choose a specialty; you can do Social Security, pensions, retirement income, or you can do health and long-term care. Figure it out and go there. And so I did. 

Rovner: Yeah, and like me, you can stay forever if you want to. 

Neuman: And I seem to have stayed forever. 

Rovner: So, what’s the biggest misperception about Medicare as it exists today? People look at Medicare, and it’s like a chameleon. They see all these different things. 

Neuman: Boy, I could give you a few answers to that. I mean, one answer is people think Medicare is going broke. Medicare cannot go broke, but Medicare faces financing challenges. Interesting, you know, we talk about that today. Today’s the day that the “Medicare Trustees Report” came out, and actually, there wasn’t much of a change, a notable change. It was a slight tweak, but it’s still 2033 for the year that Medicare will be insolvent. What that means is that there won’t be enough money to pay all benefits, but it doesn’t mean the program is going broke. To me what it means is it’s time to think about how to finance care for an aging population, and what are the policy options that can do that. It’s generally reducing spending or finding new revenues, but it’s easier to do it in advance than â€¦ to wait until we’re at the precipice of a crisis. So that’s really what it signals to me. But it cannot go broke. 

Rovner: Over the years, Congress has dealt with these periodic, you know, predictions about Medicare insolvency in various ways that they have, you know, sometimes they’ve actually acted when insolvency has seemed relatively near, and sometimes they have acted to make insolvency closer. This Congress doesn’t seem to be as plugged into Medicare as many previous ones. Is that a fair way to put it? 

Neuman: I think it’s fair. Julie, when you and I were working on the Hill, as your beat at the time at the Ways and Means Committee, Medicare was front and center. Medicare was part of budget conversations. Medicare was part of legislation that we dealt with every year. And that meant every year members of Congress worked hard to tweak the program, achieve some savings, also make some improvements. But Medicare was the big story. Really, of late, really, since the ACA, the ACA has been the story, Medicaid has been the story, but Medicare, oddly, has been sort of a stepchild off to the side. 

Rovner: I like to describe Medicare as one of the biggest paradoxes in health policy. Simultaneously, it’s incredibly popular â€” I mean, one of the most popular programs ever created by the federal government â€” and yet it’s actually pretty lacking as a really comprehensive health coverage. I think if people actually had, quote-unquote, “Medicare for All” the way we have Medicare today, they wouldn’t be very happy with it. 

Neuman: I think that’s right. I mean, people I know on Medicare, and soon that will be me, are very happy with the program. They like the fact that â€¦ it’s reliable, they can count on it. There are some issues between people in traditional Medicare and Medicare Advantage. But it’s, you know, people are pretty happy. At the same time, there’s relatively high cost sharing, premiums are going up, and Medicare doesn’t cover some of the most expensive things for people as they grow older, such as dental, which is a big one, hearing aids, vision, which is to a lesser extent not quite as expensive. And the big one that nobody really wants to address is long-term services and support, home care for people who need help at home, assisted living, nursing home coverage, all of that is super expensive, and Medicare really doesn’t cover it. And that is a big surprise to families when all of a sudden they have a family member who needs this help and Medicare won’t pay for it. 

Rovner: Yeah, I feel like about every five years, another generation of health reporters discovers, Hey, Medicare doesn’t cover long-term care. I never knew that. 

Neuman: And a lot of time they’re discovering it because a family member of theirs needs long-term care. 

Rovner: So, I know you’re retiring, but I also know that you’re going to continue to stay engaged, because I know you. What do you think is the biggest challenge that you hope that lawmakers will address in Medicare in the next five, 10 years? 

Neuman: Oh, I have a wish list. I do hope that they’ll continue to put affordability at the top of the list. That means looking at these expenses that are not covered by Medicare, keeping an eye on premiums. Right now, 7 million people on Medicare pay more than 10% of their income on Part B premiums. That’s a big deal. So, keeping an eye on affordability is really important. I also think there should be some attention to simplification. Medicare used to be this easy program, you turned 65, you got on Medicare. It’s not so easy anymore. The average Medicare beneficiary has a choice of dozens of plans, the Medicare Advantage, prescription drugs. It’s too complicated. And it’s not like it’s a one-and-done decision when you turn 65. You really need to think about this each year, and I think that’s a tall order. And simplifying the program would make it a lot easier for our aging population. 

Rovner: Well, you may be retiring, but I’m still going to call on you as my Medicare expert. 

Neuman: Always. 

Rovner: Tricia Neuman, thank you so much. 

Neuman: Thank you, Julie. 

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. Lauren, you snagged this week’s most popular story. Start us off. 

Weber: Hats off to Annie Waldman’s “,” which published in ProPublica. I was green with envy upon reading this story. It’s not only beautifully crafted, but it’s just an incredibly incisive takedown, really, of this raw milk farm and all of the people it’s harmed, and how the government has really not stepped in. It hits at so many themes in this MAHA [Make America Healthy Again] moment â€” of free speech and, you know, free medical access, but also the questions of: Do consumers know the amount of risks that they’re taking on? And what is regulators’ role when you have this farm led by this evangelist for raw milk that has been at least linked to over 220 people’s illnesses, some of which are very severe, and continues to produce not only raw milk but milk that it puts into raw cheese that makes people sick. And very sick. This is not just, like, slightly sick, I mean it’s likely that this has potentially sickened way more than the numbers that are captured. It’s a very well-done piece. I could not recommend reading it more. 

Rovner: Lizzy. 

Lawrence: My piece that I chose for this week was from the Chicago Tribune: “,” by Christy Gutowski and Gregory Royal Pratt. Kind of similar to what Lauren was talking about, this is a story about regulatory failure, but in this case with a plastic surgeon operating in Chicago who has killed at least eight women during procedures like tummy tucks and liposuction â€¦ all women of color. He’s operating in a predominantly Latino neighborhood. And Chicago authorities started looking into him to try to revoke his license in 2020, but more than five years later nothing has happened. This was a truly horrifying story, and just major kudos to the reporters, for really, you know, they tracked down all of these women’s families. And in one case there was a complaint that the surgeon, you know, not only allegations that he killed people, but that he had carved his initials into someone. So it’s a really insane piece that I think, yeah, everyone should read. 

Rovner: Yeah. Sandhya. 

Raman: So I picked the story “, and it’s in CIDRAP from Liz Szabo. And this piece is part of a larger series for the 20th anniversary of the HPV [human papillomavirus] vaccine. But Liz just does a beautiful job juxtaposing, you know, one sister who battles and eventually, you know, lost a heartbreaking battle with cervical cancer, and how her sister was in the first batch of folks to get the HPV vaccine 20 years ago. And then, you know, the sister is talking about the importance of wanting her sons to get it that are pretty young. And it just really does a good job of showing the trajectory of how effective the vaccine has been in reducing cervical cancer since its rollout. 

Rovner: Yeah, this is one of the great medical miracles that’s suddenly become controversial again. It’s really good. You should read the whole series. I will post links to it. My extra credit this week is from my Ñî¹óåú´«Ã½Ò•îl Health News colleague Amy Maxman. It’s called “Anguished Parents. Doctors in Tears. Utah’s Long Measles Outbreak Takes a Toll.” Amy went to Utah and found that measles is taking a stronghold there for a whole variety of reasons, including the strength of the supplement industry that teaches residents to suspect mainstream medicine. It’s a really good read that shows the challenges public health still faces in things that we thought we had overcome years, if not decades, ago, like how to prevent childhood diseases like measles. 

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

Raman: I’m at  and on  @SandhyaWrites. 

Rovner: Lauren. 

Weber: I’m on  and on  as @LaurenWeberHP. The HP is for health policy. 

Rovner: Lizzy. 

Lawrence: I’m on  as @LizzyLaw_ and on  and  (Lizzy Lawrence). 

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

[Editor’s note: This transcript was generated using transcription software and a human’s light touch. 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, May 28, 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 Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Great to be here. 

Rovner: And Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: Later in this episode, we’ll have my interview about the ongoing Ebola outbreak with Céline Gounder, Ñî¹óåú´«Ã½Ò•îl Health News’ public health editor-at-large and, conveniently for us, an infectious disease specialist. But first, this week’s news. I want to start this week with more of a trend than actual news, and that is the continued decline in health insurance coverage in the U.S.  on the number of children falling off the Medicaid rolls. It’s down about 1.75 million from the beginning of Trump 2.0 through this past January. Now, I thought we were told that none of the Medicaid cuts that Congress made last year would affect the core Medicaid constituencies: pregnant women, children, seniors, and people with disabilities. What’s happening here? 

Goldman: So, the law does exempt kids and parents of young kids from the eligibility and enrollment changes, work requirements, more frequent eligibility checks. That doesn’t mean that there aren’t going to be spillover effects, and we’re seeing that already, Absolutely, even though most of these provisions haven’t gone into effect. And there are a couple of reasons for that, including chilling effects from immigration enforcement and people who are in mixed-status households maybe not feeling comfortable enrolling their children in public benefits, even though their children would qualify, or also just confusion around who’s eligible for what. Often kids are eligible for Medicaid and Children’s Health Insurance Program â€” its sister program, CHIP â€” at a much higher income level than their parents, and that’s not communicated well to parents very often. And so one theory â€¦ is that this year, when a lot of parents maybe saw how much their ACA [Affordable Care Act] premiums were going up and decided that they couldn’t afford health coverage anymore, they were just pulling their whole family out of health insurance, even though their kids might still actually be eligible for Medicaid. And â€¦ there are a lot of other trends percolating in this, but I think it’s concerning to see this, these figures, even before this has really started. 

Rovner: Yeah, it’s funny, when you’re applying for health insurance, they’ve set it up so that you get funneled to the right place for which you’re eligible. But when you’re dropping your health insurance, there’s no funnel to say, hey, your kids might still be eligible for this, even though you’re no longer going to be getting Affordable Care Act insurance. 

Goldman: Exactly, and navigators for ACA coverage have also â€” funding for those programs have been cut, and so that’s harder, even harder for that process to actually work. 

Rovner: Yeah, I’ve also noticed in the states that are starting things like their work requirements early, there was kind of a shocking anecdote  â€” one of the states that’s starting early â€” who’s blind, has multiple health problems, and a chemotherapy port, who was told that she might be required to work under these rules and was seeing about getting her port taken out when finally another person told her, No, you’re exempt. So, I mean â€¦ in some of the states that are speeding this up, there’s a lack of knowledge among the state workers, which I think was one of the big concerns about people who are going to be dropped off the rolls, not because they’re no longer eligible, but because of mistakes. 

Weber: We also know that, in general, Medicaid enrollment is a tricky process. Typically, there’s paper forms that may get lost in the mail. Parents may not get the forms for their kids. This was very eloquently actually described on The Pitt â€” which, shoutout for getting this part of health policy correct. Although I’m still irritated about their Medicare-Medicaid mix-up in one of the other episodes, but we’ll get over it. 

Rovner: Yeah, me too. There were two of those. 

Weber: Yes, but very eloquently show[ed] how a mom who had moved and missed some Medicaid paperwork was now really in a hole financially. And so, as Maya has reported out, you know, more of these children falling off the rolls really could lead to some dire consequences for the families to which they belong. 

Goldman: Yeah, and I think one important thing to mention is that a lot of these kids that are uninsured are still eligible, and when they go to the hospital, the hospital can help them enroll in retroactive Medicaid coverage, but they’re not getting their yearly checkup, or maybe, like in The Pitt, they miss their asthma medication, and so now they’re in the hospital, and costs are just going up for the whole health system. 

Rovner: Well, along those same lines, we have another story in our Ñî¹óåú´«Ã½Ò•îl Health News series called “Priced Out” about how people who can no longer afford comprehensive coverage are patching together other forms of insurance, or in some cases not even actual insurance, that leaves them on the hook for thousands of dollars if they end up needing actual medical care, which kind of raises the perennial question with our health system: Is it better to have bad insurance and not know it, or to have no insurance, so at least you know that you’re not prepared if something happens. 

Weber: I thought what was so striking in that story was it led off with a retired teacher who said, I recognize I am gambling. I mean, that’s what she said, she’s very clear. But to her, I think her cost had risen something like $900-something a month, and the other plans that she cobbled together were $300 a month, and so to her the short-term risk was worth it. But as we all know, hospital stays can run you several thousand dollars and, you know, you can get hit by a car. You may be a very healthy person, but something bad can happen, and you are left with large, large medical debt. And I think it seemed like the folks interviewed in the story were at least clear that these plans were less favorable, but I do think there is also this submarket where a lot of folks think that the health ministry plan that they’re in is going to save them in case of an issue. And we have found over and over again, and KFF, in particular, has found over and over again in reporting, that’s just not the case. And so this whole question of Is a bad plan better than no plan? I don’t know, but it’s striking to see people say I’m willing to take the gamble, because this is just what these increases in premiums have meant for me. 

Luthra: I just think what’s so interesting about these, these health shares, in particular, is when I’ve talked to people who’ve used them or considered them, they know these are not insurance, but I don’t think they always fully understand just how restrictive they are, and how often medical needs will be dismissed as lifestyle choices. I mean, obviously, often contraception is not covered, but something related to drug or alcohol use might not be covered, because that’s immoral, right? Let’s say the ministry says, “Oh, well, this accident you got into, maybe that’s because of alcohol use.” That’s a huge expense that you just might not have realized wouldn’t be covered at all. And the other thing that I was just so struck by is very often childbirth isn’t covered. Or you have to be enrolled for a very long time before childbirth is covered, which health insurance is required to cover childbirth. It is very, very expensive. It’s fascinating, also, because a lot of these [sharing ministries] are so religiously aligned and ostensibly pro-family, etc. And yet this, in particular, is just something where people will opt for this instead because it looks more affordable than insurance. But very often you end up paying a not-zero amount of money, and ultimately getting basically nothing for very expensive, even bankrupting medical needs. 

Rovner: Or you’re gambling, you know, maybe, maybe you’ll get reimbursed, and maybe you won’t. Although these days people feel that way about their health insurance. Maya, you want to say something? 

Goldman: I think a lot of young people also take for granted that health insurance will cover preexisting conditions. If you’ve come up, you know, post-ACA, and certainly I do. I’m 28, and that’s, like, something that never even crossed my mind that I would need to consider, and that really struck me in this article. A lot of these alternative plans are not bound to those requirements. 

Rovner: Well, Shefali, I wanted to ask you in particular about  about how abortion rights supporters are trying to adapt reproductive health to fit under the bigger affordability umbrella that seems to be the theme of this year’s midterm campaigns â€” that things like whether or not to get pregnant or whether to get unpregnant, that those are all wrapped up in all sorts of financial issues, as you just mentioned. Is this a natural fit, or do you think they’re kind of forcing it here? 

Luthra: I think it really depends on how you talk about it, and the context of where you are. And after the mifepristone case was before the Supreme Court, I spent a lot of time looking at different Senate campaigns and examining how they’re talking about it. And one example is Jon Ossoff in Georgia actually has a really interesting example where he talks about access to abortion and healthcare as part of this larger argument around the state of reproductive healthcare, talking about hospital closures, talking about Medicaid cuts, and putting all of this together as this broader policy ecosystem that is making your healthcare harder to come by and ultimately threatening your life. I think that’s very interesting. It could work. It makes sense logically to me. The other one that does come to mind â€” and this is not abortion, but it’s related â€” is in Maine, Graham Platner talking about IVF [in vitro fertilization] in the lens of affordability, saying, Oh, I couldn’t afford it in America. I traveled to Norway to try and get fertility treatments. Those are fascinating approaches, and a lot of people who work in abortion rights advocacy will say this has long been an economic argument, and many of them will look at polling and put it out that says when you frame this as an economic story, voters really, really do appreciate it and resonate with it. I think sort of the question is whether we actually see these candidates â€” and it’s not lost on me the two who I mentioned are both men â€” actually talk about the word “abortion” specifically, rather than saying “reproductive healthcare” more broadly. And you know those are very different, and they just register with voters differently when you single out something as specific as abortion versus whether you don’t. 

Rovner: And Graham Platner, for those who don’t know, is going to be the Democratic candidate running against Susan Collins in Maine. Jon Ossoff is the incumbent Democrat in Georgia, which always feels weird to say. There haven’t been a lot of Democratic senators from Georgia, but right now there’s two. 

So, moving on, the Trump administration says the declines in health insurance coverage are fine because they’re more about fraud and kicking people off of public health insurance rolls who aren’t actually eligible or â€” in the case of Affordable Care Act broker fraud â€” who don’t even know they’re covered. But a lot of the tools in last year’s big budget bill are pretty blunt, and they’re going to impact both those who maybe shouldn’t be there and those the administration says it wants to keep serving. This week’s example is a newly proposed rule to implement that law’s cap on something called state-directed payments, which is, in fact, a key way many states help ensure adequate funding for hospitals, nursing homes, and other healthcare providers. Now, this isn’t fraud, but it is what analysts like to call creative funding, and Congress has every right to limit it. But that’s not to say that it won’t have an impact on healthcare at the delivery level, right? It’s not just going to impact people that the administration says don’t deserve to be covered. 

Goldman: Yeah, this came up when I was talking to children’s hospitals for the story on children’s coverage that I wrote this week. They’re saying, you know, this is going to affect all kids that we can care for. This is going to mean less money into our funds, and, you know, a lot of people argue that hospitals have enough money, but hospitals will say, “No, we don’t, not to take care of all the people that we need to take care of.” And this is going to be less money. And then it’s not just kids who are on Medicaid who are struggling, it’s all kids. And I think another interesting thing about this proposed rule is that it’s significantly more federal savings than was estimated originally. I think CBO, Congressional Budget Office, originally estimated that the state-directed payments provision would save about $150 billion, and this rule would save about $510 billion in federal funding. So hospitals are concerned. 

Rovner: Yes, this is always the issue. Are we overpaying hospitals? But when you take money out of it, what does that mean for the health system writ large? Which I imagine is going to continue to be a theme as we go forward. Well, the Trump administration is also going very high-profile in its health fraud-fighting effort. The president has put Vice President JD Vance in charge. Earlier this month, he announced that the administration will be withholding $1.3 billion in federal Medicaid funding from California, because, said the vice president, the state has not taken fraud very seriously. This is the second Democrat-led state the administration is taking the nearly unprecedented step of withholding funding from in advance, after Minnesota. California has responded that one reason the state’s home health bill has gone up is that it has raised wages for home healthcare workers, and it has expanded eligibility. It’s not because of fraud. Again, while there obviously is fraud â€” not just in Medicaid, but in all health programs, public and private, because there is so much money there â€” these blunt tools, I think, will probably punish more than just those who are defrauding the program. Right? 

Weber: I mean, absolutely. At the end of the day â€¦ look, it’s no coincidence that California is a blue state that seems to be getting targeted with that amount of cash. But let’s be very honest, there is a lot of fraud. I mean, all of us here have written stories about healthcare fraud. There is a lot of fraud to root out. So, to be very clear, I don’t think anyone should be upset about actual fraud being targeted. But there’s also a question of: What are the numbers? [Centers for Medicare & Medicaid Administrator Mehmet] Oz has gotten the numbers wrong before. The AP [Associated Press] had a great story on that a couple weeks ago. Show us the fraud, like, I want to see the actual fraud that we’re talking about. And, in addition, this reminds me of how the administration continuously says that they’re investing the most money in rural healthcare when they have this $50 billion rural healthcare fund. Well, the Medicaid cuts that [President Donald] Trump led is going to cut like triple that almost out of rural areas. So is this a talking point? Show us the money. I need to better understand what’s behind it. 

Rovner: Yeah, so far they’re doing well with a lot of very high-profile news events. We’ll see how much fraud they are actually able to ferret out. All right, we’re going to take a quick break, we will be right back. 

Let’s talk about Ebola. As you will hear later in this episode from our in-house expert, Dr. Céline Gounder, this is not likely to become the next covid or even a pandemic. But this administration, having hollowed out the Centers for Disease Control and Prevention and obliterated the U.S. Agency for International Development, is addressing this outbreak with many fewer arrows in its quiver. Lauren,  about someone close to this outbreak. Tell us about it. 

Weber: Yes, I was able to speak with an American missionary physician who was exposed to Ebola and actually evacuated to Prague and is sitting in basically like a bubble room waiting to see if he tests positive for Ebola. And what traumatizes him, as he was telling me, was that he’s sitting there, there’s all these people with endless gloves that are tending to him, he’s been evacuated, and stretchers with all this plastic and all these measures, and his colleagues that he worked alongside in the Congo are â€” you know, one died while we are in the middle of an interview, he learned of their death. And, in addition, they’re filling the hospitals themselves, that they say they don’t have enough gloves, they don’t have enough PPE [personal protective equipment]. There’s no vaccine to fight this current form of Ebola, and they’re in an environment in which people are very mistrustful. Ebola looks like malaria until it’s Ebola. And so you could send a family member into the hospital thinking it’s malaria, which is common in this part of the world, and then suddenly be told your relative has Ebola and died. A lot of people don’t believe it, and it’s leading to violence. And the usual public health measures and efforts by the international community to get in there are somewhat hampered. And Part Two, by the fact that this outbreak is happening in a really insecure region, where there’s roving militias and other violence. And there’s just a lot of concern that they caught this late, this could continue to explode, and case counts could really go up. But it was very humanizing to speak with this American missionary who obviously really put himself on the line to help these folks and is heartbroken to kind of be watching from afar as this continues to go poorly. 

Rovner: Well, meanwhile, the U.S. is banning foreign nationals who’ve been in any of these countries from entering the U.S. and also U.S. green-card holders who’ve been in countries where the virus is spreading. Not only that, but they’re not allowing exposed U.S. citizens to return, even though the U.S. has multiple facilities to care for exactly these types of patients. We have seen this before, just in the last 15 years. What happened to the medical freedom that this administration has been touting so much? 

Weber: It’s a real plot twist. I mean, these are the folks that said that they were the contrarians that oppose quarantine and mask mandates, and they are strictly having the hantavirus folks in Nebraska. They’re signing off on travel bans that go further than other administrations, and not allowing Americans back in and sending them to Kenya if they’re exposed. My colleague Lena Sun and I had a report a week ago about how the White House didn’t want exposed Americans back in the U.S., but the Kenya step is another step in that direction. Is really could have huge ramifications for the response as a whole, because it will likely limit the number of people that want to go. If you know that you’re not going to be able to be sent back, we saw, I think, yesterday the State Department union was like, look, our foreign service officers were sent here under the impression that they would be able to come back. I mean, this is somewhat completely uncharted territories in the vein of how they’re handling this. So we’ll see. 

Goldman: I’m very curious to see what the MAGA [Make America Great Again] base and the MAHA [Make America Healthy Again] base that were so anti-mask mandates and things like that during covid, like, what are they going to say? Are they going to say anything? Is it partially our responsibility as the media to point out this contradiction? 

Rovner: Yeah, and obviously there’s also so much else happening right now. It’s interesting that the hantavirus, which turned out to not be such a big deal, got so much play, and yet this, which could be a much bigger deal, is getting so much less attention. 

Weber: Do we think there’s maybe a reason for that? Let’s all be honest. The hantavirus cruise was a lot of wealthy, some Americans on a cruise sailing around Argentina and Antarctica. And then this outbreak is happening in Africa, and I think there’s less interest from the general public, as they feel like hantavirus is novel, whereas Ebola, they’ve heard about it before, so a depressing reality of some of that. 

Rovner: Yes, and also, you know, Americans and Europeans versus Africans. 

Weber: Yes, yes, exactly. 

Rovner: All right, moving on. I want to catch up on some drug price news, because there’s been a lot over the past few weeks. The Supreme Court earlier this month declined to hear a case challenging the Medicare drug price negotiation system that was implemented under the Biden administration, which ironically will probably redound to the credit of the Trump administration, even though it nominally opposed the Biden program. Also, earlier this month, the president announced a big expansion of his TrumpRx website, adding links to websites selling lower-cost generic drugs, including the site run by Mark Cuban, Cost Plus Drugs. But the most provocative drug price story I have seen this month came from my colleague Darius Tahir, noting that Trump himself was buying stock in drug companies just as he was negotiating with those companies to help bring drugs, particularly those GLP-1 medications that he likes to call “the fat drugs,” to more people. Now this isn’t technically illegal, although there are lots of efforts on Capitol Hill to outlaw individual stock trading by members. But I can’t help think if any other government official in any other administration ever did this, they would be out of a job instantly, if only for the appearance of the conflict of interest. This is just â€” Lauren, as you were saying â€” one in this whole long list of things that keeps happening, but every time I look at it, I’m like, he was doing what?! 

Weber: Julie, when I saw Darius’ story, I was blown away. First off, I feel like this should have been front-page news on every outlet. But secondly, it was a lot of money, it was like over $600,000. And now I understand they say that Trump himself, they don’t know whether he directed this or not. And in fairness, Trump’s not the only one. I mean, we’ve seen plenty of members of Congress that have done also questionable stock trades. But it is a very conflict-of-interest-looking-like thing, considering that CMS recently expanded massive access to these drugs. And so I do think conflicts of interest like this, especially in HHS [Department of Health and Human Services], which has constantly decried conflicts of interest, despite having many of them, are very important to highlight. And so, thank you to Darius for surfacing this. 

Rovner: Yes, we will never not have enough to do here as health reporters. Well, finally, this week I want to . President Trump this week had his third, quote, “annual” physical in the past 13 months â€” math does not math there â€” after which he said he checked out perfectly. But he is about to turn 80. He’s been caught on camera dozing off at public events in the Oval Office and has gone on hours-long social media rants in the wee hours of the night/morning. Now, much of this hasn’t been treated as news, because well, it’s pretty much par for the course for Trump, just more so. And therein lies the question: When does his increasingly aberrant behavior and obvious health issues, like visibly bruised hands and swollen ankles, become a public right-to-know issue? And is there a double standard for Trump compared to former President [Joe] Biden, when he began to show obvious signs of aging, and it was all over the news all of the time? I see raised eyebrows. 

Luthra: No, it’s such a good question. On the one hand, there was obviously a lot more scrutiny on Joe Biden’s age than there appears to be on Donald Trump’s. But part of it, I think, is that a lot of what you just highlighted, Julie, is out in the open. Everyone has seen the president dozing off on camera, whereas under the last administration, there were things that were not public that then became public, and that was obviously very important. That said, there’s certainly a level of focus on this issue that perhaps is lacking. Maybe it would be useful or newsworthy to put some more attention, even something that we already know, highlighting why it is important, putting together the fact that having this many physicals at this point in the presidency is actually more than normal. What could that mean, contextualizing it with everything we have seen publicly about the president’s sleep patterns, risk factors as you age, bruising, etc. But I think this kind of thing is complicated in terms of how you cover it appropriately and fairly, also just because you don’t want to assume things that you don’t have the evidence for. 

Rovner: And, in fair, I mean, Trump has not been transparent about his health, going back to when he was a candidate in 2016. He’s the only major presidential candidate, you know, he put out that, this famous letter from his personal doctor saying, you know, he’s the healthiest man I’ve ever seen. That’s pretty much what we get, having covered presidential health for a lot of administrations. We have much, much less information about Trump than we have had about previous presidents, which has been a continuing policy concern among doctors. I mean, this is not to single out Trump, who just happens to be president right now and turning 80. But this is, you know, an issue that goes back obviously to, you know, Dwight Eisenhower, to Woodrow Wilson, when he had a stroke, and they kept it a secret. Presidential health is a policy issue. 

Goldman: Yeah, I think that’s an important caveat, or note, I guess. Presidential health is not always as transparent as it claims to be, even going back, as you said. And so it’s not totally out of the ordinary that Trump wouldn’t be transparent about his health, even though, maybe ethically â€¦ presidents in general should be. 

Rovner: Obviously something else we will continue to watch. All right, that is this week’s news. Now we’ll play my interview with Céline Gounder. Then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast my colleague, Dr. Céline Gounder, Ñî¹óåú´«Ã½Ò•îl Health News’ editor-at-large for public health, a CBS News medical correspondent, and an internist, epidemiologist, and infectious disease doctor. I can’t think of anyone I trust more to explain what’s going on with Ebola than Céline. So, thank you very much for doing this. 

Céline Gounder: Oh, it’s my pleasure to be here, Julie. 

Rovner: So, when everybody was covering the hantavirus outbreak on that cruise ship a few weeks ago, experts like you were saying it was a cause for concern, but not likely to become a serious problem. All of those same experts seem much more concerned about this latest Ebola outbreak in Central Africa. How is this different from what we were just talking about with hantavirus, and how is it different from previous Ebola outbreaks? This is not the first one. 

Gounder: Yeah, so to give you a sense of perspective, when I first heard the reports of a viral respiratory illness out of Wuhan in very late 2019, early 2020, I was terrified by what I was hearing. When I heard the reports of the hantavirus outbreak on the cruise ship, I was concerned for the other people on the cruise ship. I was not worried about a larger outbreak, and I would be very surprised, especially at this point, if we see any further cases. With respect to this Ebola outbreak, I am very concerned about a very large, huge, regional epidemic, where we may have some sporadic spread to other countries outside of the region. I am not worried about a pandemic. So, this is one difference: An epidemic is usually within a certain region. Pandemic is when it goes worldwide. So, I think this is going to be an epidemic in Central, possibly also East, Africa, but not going beyond that. 

Rovner: So, how is this different from â€¦ you worked in one of the past Ebola outbreaks. This one people seem to think is more serious than the last couple that we’ve seen. 

Gounder: Yeah, so I worked in Guinea during the 2014-2016 Ebola epidemic. I was there for two months. You have some of the same risk factors for a large epidemic, so you have urban areas affected, you have cross-border spread. There you had the epidemic start in Guinea, then move to Liberia, then Sierra Leone, then back to Guinea, and then you also had migrant workers that would go back and forth. And so you have those same, exact risk factors with this current outbreak, and then, secondly, you have large refugee populations in South Sudan. And so both of those issues also further complicate movement, both in and out of the area. Healthcare workers trying to get in to address issues. Healthcare workers being safe doing this kind of work, and also getting supplies, in particular, PPE â€” personal protective equipment â€” as well as tests into the area to help respond. 

Rovner: What about the U.S. pullback in foreign aid? We’ve obviously, you know, seen sort of the demise of USAID and a hollowing out of the CDC here. I imagine that’s impacting how we’re responding to this. 

Gounder: Yeah, so starting with USAID. So, USAID funded the people on the ground that would do the contact tracing, who might help set up Ebola triage, as well as treatment units. And that funding is gone. In fact, over the last week, I’ve been talking to some of the Congolese doctors who used to have jobs funded by USAID. And, in addition, USAID really supported the supply chain infrastructure for the area. So now you’ve seen a collapse of their ability to get personal protective equipment. There are shortages of this, which is also contributing to healthcare workers getting infected right now. And then also pharmaceutical supply chain. So, you know, even the most basic of medications is a challenge to get into the area. With respect to CDC, there have been tremendous layoffs related to the DOGE [Department of Government Efficiency] cuts from last year. We had the CDC shooting last August, and morale at the agency is â€¦ it’s horrible, it’s horrible. And just in the last day or so, Dr. [Jay] Bhattacharya, who’s the NIH [National Institutes of Health] director, and also, I guess he’s calling himself something else, because he can’t technically be acting CDC director anymore. But … 

Rovner: He’s nominally in charge of CDC, without being the acting director. 

Gounder: Right, exactly, whatever that means. But he has asked for CDC staff to volunteer to go over to Kenya, and staff a quarantine and, sounds like, treatment unit for any American healthcare workers who might get sick or be exposed while responding to the Ebola outbreak. And based on what we’re hearing, it sounds like they do not want anyone with Ebola coming back into the U.S., including the very people they’re asking right now to volunteer to go to this unit in Kenya. So I think that is also going to further complicate the response. You know, like, if you volunteer for the Marines, you enlist, and you get sent overseas, and you have an injury, you expect to be repatriated as quickly as is possible for treatment here in the United States, right? That is not the case. These are people who are similarly putting their lives on the line, who are responding to that call for help, and we are not seeing similar respect for that sacrifice. 

Rovner: And yet, I mean, the U.S. is set up to take care of people with seriously contagious diseases, right? 

Gounder: Oh, yeah, we have over a dozen units that were specifically created for this very purpose. Several of them have hands-on expertise, experience with this. So, in particular, Emory [University School of Medicine] in Atlanta, [NYC Health + Hospitals/] Bellevue in New York City, where I am, as well as University of Nebraska Medical Center. All three of those have experience with Ebola, not just having done preparations. And it’s really confounding why you would not want to make use of that. When somebody gets Ebola, particularly if you’re talking about an American, you know, who has put themselves in harm’s way â€” there are some real questions about fairness and equity of access to certain levels of care â€” but American aid workers, the expectation is that they would get the full-court press. And that might include being on a ventilator, that might include needing dialysis, for example, and to do those things when somebody has Ebola, and you need to do that in biosafety Level 4 conditions, I have a hard time seeing how they’re going to be able to put that together in Kenya on such short notice. 

Rovner: So we learned a lot of lessons from covid, not all of them good, obviously. You have a , which I will post a link to, about the psychology of pushback. Can you talk about that briefly? Because I think that has a lot to do with how the U.S. is responding to this. 

Gounder: Yeah, and I think a lot of people may actually identify with their own experiences during covid. You had a lot of people who didn’t want to wear a mask. In fact, we saw masks being burned, right? People not wanting to get vaccinated. And what happens is, when you have somebody who, for whatever reason, people don’t trust telling them to do something, they feel like they’ve been backed into a corner and they lash out. And so you tell them to do something, very often they want to do the exact opposite. And I saw this exact same thing when I was in Guinea over 10 years ago now. It was related to the presidential elections at the time, and it was a way of expressing dissent towards the current, at that time current, president and ruling party. And so, you know, for Ebola, the measures are pretty basic, particularly at that time: It really came down to contact tracing, testing, safe burials. And people would refuse to do some of those really basic things, and it was their way, what we called in Guinea and French, La réticence c’est la résistance, so reticence and resistance. And you saw that whole spectrum manifest there, and I think we’re seeing the same thing all over again, predictably so, in the DRC [the Democratic Republic of Congo] right now. 

Rovner: So, what could this administration be doing better, or be doing that they’re not doing that could maybe help us tamp this down, I mean, before it gets out of hand? 

Gounder: Well, I am concerned it’s already out of hand. They’re only following up on one out of every five contacts, so that means four out of every five contacts could be seeding new chains of transmission. So I think this is going to get a lot worse before things start to turn around. In fact, I would predict this is going to be a year or two to control. I mean, based on prior experiences with the 2018-2019 outbreak in the same area, as well as the 2014-2016 outbreak in West Africa. This has the potential to be even worse. What could the U.S. be doing? Well, we are currently adopting a very isolationist stance with respect to our public health policy. The dismantling of USAID is a big part of that, but it’s not the only thing. And I think what is happening now, frankly, gives me flashbacks to the 2014 Ebola news and midterm elections, and the way in which Ebola was politicized at that time. At that time, President Trump was not president; he wasn’t even a candidate yet, but he spoke very loudly about having travel bans. He called for President [Barack] Obama to resign because he allowed, in fact, facilitated the transport of infected Americans back to the U.S. for treatment. And so he’s on the record as having said he never wanted anybody with Ebola in this country. And I think the current policy that you’re seeing is consistent with that. We’re headed into midterm elections again. We’re seeing travel bans being instituted for real this time, not just talked about. And one of the other concerns around travel bans at that time, and again now, was what would it mean for healthcare workers and other aid workers, their willingness to volunteer to respond? And I remember Craig Spencer, a very good friend of mine, he was hospitalized at Bellevue with Ebola, and it was right around that time as well, Kaci Hickox, a nurse who had responded, she came back to Newark Airport. Chris Christie, as I recall â€¦ 

Rovner: Then the governor of New Jersey. 

Gounder: Yeah, right, governor of New Jersey, Chris Christie, at that time mandated that she be quarantined. So she did not have symptoms, but that she be quarantined due to her work on, I think, it was the tarmac at Newark Airport with a Porta Potty and a tent, something along those lines. And I had a lot of friends at that time who pulled out of volunteering â€” between Craig getting sick and Kaci and the mandated quarantine really under inhuman[e] and humiliating conditions. And I think this time it’s going to be even worse because not only are you having to face potentially getting sick, but you may not get to come home. And it’s really unclear at what stage, if you get sick, would you be allowed home. Do you have to wait until you recover? And what if you die? What happens then? Does your body get repatriated? Does your family, right, get to receive the body? That’s a big deal for a lot of families to have that closure. So I know, even among my friends who, like me, are Ebola veterans, there’s a lot of hesitance about stepping up again. 

Rovner: Well, I hope we can call on you as this continues, alas. Thank you so much. 

Gounder: Oh, of course, Julie. 

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. Maya, why don’t you start us off this week? 

Goldman: My extra credit this week is a story in The Texas Tribune by Terri Langford and Colleen DeGuzman titled “.” And you know, I think it’s obviously a very important political story in the fight over transgender rights, and specifically rights for transgender kids, and the medical practice around gender-affirming care. But one of the things that’s especially interesting to me about this settlement is that there’s not really demand for detransition services, at least at the level of having a dedicated clinic at a children’s hospital for them. And so this is basically a children’s hospital is going to put resources towards creating something that, or presumably put resources towards creating something that may not be used. And as hospitals are talking about how stressed they are for dollars, and just in general overextended, you know, I think this is a very interesting use of resources. 

Rovner: That’s one way to put it. Lauren. 

Weber: I have the New York Times investigation by Sarah Kliff and Margot Sanger-Katz â€” which, you know, as soon as you see those two names, you have to read it â€” titled “.” And it’s a great look and also builds upon, you know, some great reporting by The Wall Street Journal, I’ll have to shout them out as well in this area. But it details how, amid this focus on autism clinic fraud how â€¦ what that looks like on the ground. And it’s pretty terrible on the ground. A lot of these autism treatment clinics, the science is questionable on whether it really works. They’re encouraging people to send their kids there instead of to school. â€¦ There’s this horrific anecdote in the lede about how a child is woken up from a nap that can only last almost seven minutes, so they can bill more. I mean, it’s pretty gut-wrenching and gets at the clear issue in a lot of healthcare, which is that a lot of this is done to maximize profit and not necessarily for the patient. So it’s very well done. 

Rovner: Yeah, it is really scary. Shefali. 

Luthra: Mine is in the New York Times opinion section by Dr. Sejal Hathi. The headline is “.” She herself is a new mom, in addition to running the Oregon Health Authority, and she writes about how our postpartum care system is terrible. We do not care about new moms. We only care about infant checkups. We have very little medical care for people when they are postpartum, and that is not good, because pregnancy is really hard. You can have complications. Most pregnancy-related deaths happen after giving birth, not during. Most of them are preventable, and yet we don’t treat this as something that could be addressed, even though it very well could be, because in other countries they actually do make an effort to care about new moms. I love that she wrote about this from a personal and professional standpoint. I think it’s great, and I hope that it inspires some states to think about ways to improve postpartum health. 

Rovner: Yeah, that story made me so angry. Well, my extra credit this week is also about reproductive health. It’s from ProPublica by Pulitzer Prize-winning reporter Kavitha Surana. It’s called “.” And it’s about yet another case of a mom pregnant with her second child, a college-educated healthcare worker, whose membranes ruptured early, putting her at high risk of sepsis, but who couldn’t get the pregnancy terminated at the hospital where she worked, because the doomed fetus still had a heartbeat. This was a well-connected family. The patient’s father is a doctor. She was in the same sorority at the same college as Arkansas Gov. Sarah Huckabee Sanders, and she enlisted one of the top reproductive health lawyers in the country to plead her case with hospital officials. I won’t spoil the end for you, because you really should read the entire piece, but it underscores yet again that abortion bans can endanger people who don’t think they will ever want or need an abortion. 

All right, that is this week’s show. As always, 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 , and on Bluesky . Where are you guys hanging these days? Maya. 

Goldman: I am on LinkedIn under my name and on X . 

Rovner: Shefali. 

Luthra: On Bluesky . 

Rovner: Lauren. 

Weber: Still on  and  under @LaurenWeberHP. As I like to say, the HP is for health policy. 

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