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

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

Alice Miranda Ollstein: Hello. 

Rovner: Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

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

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

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

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

Winfield Cunningham: When is it not a healthcare election? 

Rovner: That may be. 

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

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

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

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

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

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

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

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

Rovner: It was a Republican idea! 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Which we rarely talk about! 

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

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

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

Rovner: Cassidy, the chairman of the relevant committee. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: Which was questionable, right? 

Andrews: Absolutely questionable. 

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

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

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

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

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

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

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

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

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

Andrews: Always no. Yes, exactly. 

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

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

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

Andrews: Thanks, Julie. 

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

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

Rovner: Good story. Paige. 

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

Rovner: Indeed. Anna. 

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

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

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

Ollstein: Mostly on Bluesky , and still on X . 

Rovner: Anna. 

Edney: All the places . 

Rovner: Paige. 

Winfield Cunningham: And I’m mostly on X . 

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

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

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

Tami Luhby: Hello. 

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

Joanne Kenen: Hi, everybody. 

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

Sarah Jane Tribble: Good to be here. 

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

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

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

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

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

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

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

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

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

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

Rovner: I was more thinking that it’s … 

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

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

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

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

Rovner: So for all of that effort! 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: The regulation, yeah. 

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

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

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

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

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

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

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

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

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

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

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

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

Rovner: No, to raise their drug prices. 

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

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

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

Rovner: Yeah. 

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

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

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

Rovner: It’s a he. 

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

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

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

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

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

Rovner: OK. Joanne. 

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

Rovner: And long lives!  

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

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

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

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

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

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

Rovner: Joanne. 

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

Rovner: Tami. 

Luhby: You can find me at . 

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