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

Julie Rovner: Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for �������ýҕ�l Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, March 6, at 10 a.m. As always, news happens fast and things might’ve changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

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

Joanne Kenen: Hey, everybody. 

Rovner: And my �������ýҕ�l Health News colleague Stephanie Armour. 

Stephanie Armour: Hi. Happy to be here. 

Rovner: Later in this episode, we’ll have my interview with Sandy West, who reported and wrote the latest �������ýҕ�l Health News “Bill of the Month,” about a runner who got hit by a car and his very expensive ambulance ride. But first, this week’s news. 

We’re going to start with the continuing drama over the Trump administration’s cuts to contracts and personnel across the government. Now, the Supreme Court has weighed in, sort of. As we’ve discussed, a federal judge ordered the administration to unfreeze some $2 billion in payments owed by the U.S. Agency for International Development to contractors for work that had already been done. And then when the administration didn’t make the payments, the judge gave them a deadline, which, instead of meeting, the administration appealed to the Supreme Court. 

Well, on Wednesday, in a 5-4 decision led by the chief justice, Justice Amy Coney Barrett, and the three liberals, the court said the original judge was within his rights to impose the deadline and basically sent the case back to him to order that the bills be paid. Now, this isn’t the cleanest case of the court saying, Yo, administration, you have no right to withhold money appropriated by Congress, but it suggests that maybe that’s the way it’s leaning when it gets a cleaner case. 

Armour: Yeah, I mean, to me what I found rather unexpected was the strength of the dissenting opinion and that many justices dissented. Some of the individuals I spoke with were saying they found that quite disconcerting. 

Rovner: Yes. That [Justices Samuel] Alito and [Clarence] Thomas and — right — and [Neil] Gorsuch and [Brett] Kavanaugh all said, Uh, maybe the administration does have the authority to withhold money appropriated by Congress. 

Armour: Exactly. 

Kenen: But there’s also a difference between this and the several dozen other pending cases, because this is things they’ve already bought. This isn’t just Congress saying you can or should or must go ahead and do the following programs. This is, like, stuff that’s sitting in warehouses or services that have already been provided. So they’re not paying bills for things they have purchased, which is different than, do they have the right to ignore congressional appropriations in the future or entitlements in the future? So in some ways it’s sort of surprising that you even have four of them saying, No, you don’t have to pay your bills. I don’t think it really necessarily tells us that much about what happens next. 

Rovner: Yeah, and I think there’s plenty to happen next. Well, in the meantime, we’ve learned a lot more about what USAID has not been paying for, including U.S. companies that make special pastes fed to literally starving children in Africa and elsewhere in the undeveloped world, programs to prevent polio and malaria, to ensure clean drinking water, and much more. And thanks to a USAID whistleblower who was summarily placed on administrative leave, as they say, after writing a detailed memo, we know that even though there were supposed to be waivers for humanitarian aid, that aid has basically ground to a halt. It’s not just a matter of soft power here doing good things for people and hopefully who will like us later. Some of these things that are not happening are disease prevention, of diseases that could come to the United States. Right? 

Weber: I mean, I think it’s important. We’ve learned that a lot of these ready-to-eat foods, a lot of these key nutritional shipments that would be sent out, have been paused, which doesn’t only just affect the children primarily in Africa, from what I have read, that would be receiving them. And for anyone — I’ve been to Madagascar. I’ve seen the use of these in person. It’s devastating to see starving children, and to know that there could be food that could help them that’s just sitting in warehouses in the United States has got to be infuriating for those that want to execute on these contracts. But on top of that, it’s also all the businesses in the U.S. that pay for that. 

You know, there was a great that talked about Plumpy’Nut’s company’s efforts — which by the way, every package says This is made for you in America on it — which said that, look, they haven’t been paid. They also contract out. They have a lot of small businesses they employ that now they’ve had to pause or deal with their contracts on. So, I mean, this is going to have a ripple effect, not only just for the people that are helped abroad by some of these lifesaving measures but also for the economics at home of those that support these companies that support industries like this. And that, too, could have impacts politically. 

Kenen: It’s a cliche, but infectious disease doesn’t recognize borders. Diseases that we have eradicated, or in the case of measles thought we eradicated, they get imported, and we had a polio case two summers ago in New York. Luckily it didn’t spread. That was probably from overseas. Clearly we’re having a measles problem, and these little sporadic measles problems as big as the current Texas one have often been from a traveler, either someone from overseas visiting the United States or someone from the United States being overseas. HIV could mutate in ways that our current drugs might not work so well against them, if it becomes rampant again in Africa. Every single disease that we are trying to eradicate or control in Africa holds potential threat to people elsewhere in the world, including us. 

Rovner: I know one of the big concerns, it’s been tuberculosis, which is, again, contagious, mostly not here in the United States, although we do have a TB problem. But some, I remember — God, it must be 20 years now — there was a guy who got on an airplane with multidrug-resistant tuberculosis and it caused all manner of, sort of, hysteria. I mean, that, the idea of allowing, sort of, of not treating some of these diseases and then people get on airplanes and they go places and they’re contagious and you have a much bigger problem than you would’ve had just by doing what things that USAID has been doing now for a couple of generations. 

Armour: Well, the other thing I found somewhat disconcerting is how many examples there have been of things that were terminated and then brought back, like what Lauren was talking about with the paste for the malnourished children. That was an example where it was like, Oops, we do need this. Or as Elon Musk even brought up, the Ebola prevention efforts, although from what I understand, he said it was brought back, but I understand a lot of it still is on pause. So there’s been a little bit that seems sort of slapdash in the process— 

Rovner: Yeah. 

Armour: —that I think has been confusing for a number of the groups that have done a lot of the operations. 

Rovner: Well, adding to the confusion, the Supreme Court is obviously not the only court trying to put the brakes on the administration’s chain-sawing of federal personnel and programs. Last week, a federal judge in San Francisco said the Office of Personnel Management doesn’t have the authority to order the firings of probationary workers in any agency other than its own and ordered OPM to rescind directives aimed at several Cabinet departments and agencies. In Washington, a different federal judge ordered the reinstatement of a Democratic member of the Merit Systems Protection Board, which is the agency charged with protecting the rights of federal civil servants against, and a quote from the agency’s website, “partisan political and other prohibited personnel practices.” 

In other words, all of this stuff is illegal. Still, the administration seems to be trying to find ways around these rulings rather than just obeying them. In the case of probationary workers, OPM added a disclaimer to its instructions to other agencies about probationary workers, that it’s not directing specific actions, just strongly suggesting that maybe the agencies would want to fire them. Anybody else feel like this administration is trying to drag this out as long as it possibly can to cause the maximum chaos in the federal enterprise? Stephanie, that’s kind of what you were alluding to. 

Armour: Yeah, I think the big question that is still out there is how much the administration is going to abide by the courts. I mean, there’s been a lot of, if you keep your eye on X and some of the stuff that Elon Musk has been posting, is that these judges should be impeached, or why should we follow a judge, just one judge, which gets to the Supreme Court. But I still, with bated breath on tenterhooks, am waiting to see how this is going to play out, frankly. 

Rovner: Yeah. I mean, another example, apparently on Tuesday, the General Services Administration published a list of surplus federal buildings that included things like the Hubert H. Humphrey Building that houses HHS [the Department of Health and Human Services] and the Justice Department building and the FBI building and most of the Federal Triangle building that were for sale because they were not, quote-unquote, necessary to the “core” functions of the federal government. On Wednesday, apparently, a lot of the big buildings were taken off of that list, and apparently today the list has been disappeared entirely. 

Armour: Although that HHS building is ugly. They would never get a buyer. 

Rovner: Frankly, a lot of them are pretty ugly. The FBI building is not exactly a— 

Armour: DOJ is beautiful. That building’s gorgeous. Yeah. 

Rovner: That’s true. The Justice Department is beautiful, too. Actually, one of the nicer buildings in Washington is the Federal Communications Commission. I’m not sure that one was even on the list. Maybe they decided it was too nice a building. It seems like they’re trying to sell — I think I tweeted this — the confusion is the point here, that there is no certainty. I mean that people have been fired and unfired, and contracts have been canceled and uncanceled, and court orders have been evaded. I mean, it looks like, from outside, this is actually the strategy. 

Armour: Well, I think they even had said that, some of it, going into it, that they wanted to make it very, very unpleasant for federal workers. And I think that’s been borne out in what we’re seeing so far, that sense of chaos and uncertainty. 

Kenen: Shock and awe. 

Rovner: Yeah. 

Armour: Yeah. 

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Armour: Good point. Right. 

Rovner: It really is. 

Kenen: Although it might just be shock and shock. 

Rovner: Yeah. I think we may be past the awe at this point, because now you expect every morning to wake up and see something. It’s like they’re going to do what today? Today’s executive order is to start the dissolution of the Education Department. So, it’s– 

Kenen: But the wording of that one, if you actually read the — is like to the extent allowable by law. So what is that one? Like, is that just completely symbolic knowing they can’t do that, or they said “law” and they’ll define law as they see fit. But it was sort of very caveat-ish. 

Rovner: But we into this, I mean, I went into this administration thinking that most executive orders were for show, and obviously, in this administration, executive orders have not been for show. They’ve been to require people to actually obey them and obey them in sort of ridiculously short time frames. 

Well, speaking of places that are in flux, let’s turn to the National Institutes of Health. Stanford University policy researcher and covid contrarian Jay Bhattacharya had his Senate confirmation hearing to become head of NIH, where things remain in a gigantic state of uncertainty. 

As with USAID, money that’s supposed to be going out the door is not. Credit cards have been canceled or had their limits reduced to a dollar. So workers can’t travel or order lab supplies. Many senior scientists who work from the agency’s Bethesda, Maryland, campus aren’t having their contracts renewed as is typically done. And now most workers are also being given early retirement offers. There were a lot of senators at the hearing on Wednesday who were very unhappy about some of the things that NIH is doing, including trying to limit indirect payments that come with grants to 15%. The indirect payments provided by NIH are much larger than that. Jay Bhattacharya basically seemed to duck most of the questions. Did we learn anything other than it seems likely that he’s going to be approved for this post? And will there be anything left of NIH when he finally gets there? 

Armour: Well, I think if you read Project 2025 — which I’m not saying is, you know, [President Donald] Trump had disavowed knowledge of — a lot of this is really cut and paste from that document, and if you read there, they very much were looking to eviscerate NIH. There was a lot of animosity in conservative circles in terms of NIH and [Anthony] Fauci’s role with covid, and I think we are possibly going to see that kind of play out in what happens to the agency going forward. 

Kenen: I think there’s something we keep forgetting. It’s both sort of sad and terrifying. We forget where we were when covid hit, as a country. We were afraid for ourselves and our relatives. We were afraid of what it was going to do to the economy. But if you look back at the polls from 2020, the country was not split. We were pretty unified. And the split came sort of roughly a year later. And then the split remains and is intensified and deep and sort of spread to everything to do with science and public health and vaccination and doctors, etc., etc. And it was Trump who was the president when it hit, and there was still, I mean, Democrats never liked Trump, but that initial public response was, We are in a crisis, and we’re in it together. And it was frittered — more than frittered — away. It was shredded and destroyed. 

So even then, the fact that NIH would be at risk is sort of something I don’t think any of us anticipated to this extent. That this sort of crown jewel of not just America but the world’s biomedical research, they’re basically saying: Well, we don’t want to try to cure cancer anymore. We’re just going to eat better. And I’m not against eating better. I think we should eat better. But diseases exist. Scientific mysteries still exist. And it’s also a great investment. One of the engines of our economy is scientific research. So— 

Rovner: Yeah, that’s what I was going to say. I mean, Joanne, you’re at the University of Minnesota this week. I assume that they’re a little freaked out about the idea — I mean, I think what DOGE [the Department of Government Efficiency] is sort of thinking that, well, NIH only exists here in the Washington area. NIH grants exist in every congressional district in every state. This could have huge economic repercussions in addition to the scientific repercussions, and I think that’s not being sort of talked about as much as it should be. 

Weber: No, I was going to say, I think that’s a great point, Julie, on the economic cost of that, and I think that’s what you’re seeing in these town halls across America, and that’s why you’re seeing senators all up in arms, because, I mean, they may be up for reelection much sooner than Donald Trump. And Elon Musk is not elected. So they don’t have to feel the pain, the economic hurt that these cuts to science will have in places all across the United States. I mean, I think there’s this perception that D.C. is a swamp that only exists in D.C., but these decisions have much broader implications for the economic viability of many, many communities outside of this area of town. 

Armour: Well, didn’t Trump say in the State of the Union, there’ll just be a little — what was his — do you remember? It was like, there’ll just be a little bit of pain for a while. 

Rovner: Yeah, though I think he was talking about tariffs, but yes, I— 

Armour: Yes. All of the above. 

Rovner: I think politically, the National Republican Campaign Committee told members not to hold town halls for the moment, because they were, I guess I’m surprised that they were surprised that people are upset. We’ve seen all these Republicans saying, Oh, Democrats are being bused in by George Soros. I’ve seen an awful lot of very unhappy Republicans, because these are farmers who grow some of this food that we give away through USAID. And the universities, as we mentioned last week, are not accepting graduate students. They’re putting a lot of acceptances on pause because they don’t know if they’re going to have the funds. I mean, things that I think this administration didn’t appreciate that the federal government does and helps fund. It’s not just the big bureaucracy in Washington. 

Kenen: But the other thing is, when I looked at the list of where the NIH cuts were likely to go, it was really rough numbers. It was three quarters blue states, one quarter red. That was a rough number. There’s also the — and people like Sen. [Katie] Britt from Alabama. I mean, the University of Alabama is a premier medical institution, and it’s an economic engine of that state, and it does great science. They do a ton of good pediatrics there. They’re a really good research university and a really good health system, one of the best in the South. 

Rovner: And as you point out, a really important economic engine for the rest of the state. 

Kenen: Driver of economic activity and employment in the state. But we also don’t know. That NIH proposal could be really different at the end of the day. We don’t know what the scientific-money food fight looks like. We don’t know at the end of the day what political deals get cut. Maybe none. Maybe the courts will just say, You can’t do this, and the administration will listen. Maybe Elon Musk will say, Well, it’s another one of our whoopsies and I’ll fix it. Not so likely, but we don’t really know how the political and public opinion plays out. Remember, the graduate students are not only the scientific workforce of the future. They’re also the teachers of today. If you have a kid going to school for free in a state college, their seminar and section breakout leaders, they may have a big lecture with a professor, but their twice-a-week small groups is with a grad student, and that grad student won’t be there next year. 

These have all sorts of repercussions just day to day, now and in the future. We’re talking mostly about health and science, but of course also in the humanities and also in the non-biomedical science and physics and astro space and the stuff we don’t talk about on this podcast. The humanities and historians are not very popular nowadays, but all those other things that have helped us become the country we are are threatened. 

Armour: Although the other thing I would point out, and this is where I think there’s a real disconnect between voters and the administration, is I don’t get a sense that the administration really cares in terms of the reaction. I mean, look at the cuts they’re proposing for Veterans Affairs, which is health-related but yet not. But I’m just saying, or how the reaction to the town halls is just don’t have them. I get a sense, to some degree, they’re almost kind of inured to this pushback. And so that is where some of that disconnect is, because we are all seeing how this plays out, and the farmers and the bankruptcies going up for farmers. But the administration seems pretty stalwart in going forward with what it’s doing. 

Rovner: That’s what you were referring to when Trump said there’ll be some short-term pain— 

Armour: Exactly. 

Rovner: —for long-term gain. 

Armour: Right. The only time I’ve really got a sense that, yes, they do care is when the stock market dove and then they kind of pulled back on the tariffs. But other than that, it’s been kind of full steam ahead. 

Kenen: And some of the polls show there’s still support. I mean, I don’t think a lot of this has sunk in yet to the public. Yeah, oh, well, they’re evil and corrupt and wasteful and we don’t need this stuff, and they still believe what they’re being told. So I don’t know that we’ve seen a massive dissolution, then. And the impacts will be sporadic, right? If you have a family member who’s disabled and they’re trying to get an appointment and get themselves, despite a disability, to a Social Security office in person, and there’s no longer a Social Security office within a couple hundred miles, that family is going to experience that. But most of America won’t experience that, right? 

Rovner: Yeah. 

Kenen: The veterans, I think it, really, that’s politically explosive. When the VA health care goes sour, we see a public reaction to that, but it’s going to take a while for that to filter through. 

Rovner: I was going to say, though, it feels so shortsighted with the VA. They want to cut 80 — or they say, there’s a memo, that says they want to cut 80,000 people. Many if not most of those will be in VA health care. There was a huge scandal about veterans not being able to get health care. It wasn’t that long ago, and Trump, when he was president the first time, made VA health care a huge priority, and yet now they’re saying, Yeah, no, we’re going to take it all away. There’s something that doesn’t make sense about a lot of this. 

Armour: I mean, at one point they spoke about Medicaid in terms of, I think it was R.F. [Robert F.] Kennedy Jr., about how important and a social safety net, yet look at the cuts that are being pondered in Congress now and supported by Trump. 

Rovner: Yeah. Well, speaking of RFK. Jr., it remains unclear how many HHS employees and contractors and grantees will be cut off. But the measles outbreak in Texas continues to grow. It’s up to nearly 160 cases, with one death of an unvaccinated child, and the aforementioned secretary of HHS, Robert F. Kennedy Jr., is now recommending vitamin A, which can be useful for measles in undeveloped areas where children with measles may also be malnourished, but there’s no evidence for it otherwise. And he’s urging families to, quote, “understand their options” when it comes to the vaccine. Meanwhile, Kennedy’s top spokesman, Assistant Secretary for Public Affairs Tom Corry, quit his job just two weeks after joining the department, reportedly over differences in how to handle the measles outbreak. Kennedy said at his confirmation hearings he would not stand in the way of people getting vaccines, but apparently he’s not going to encourage it either, is he? 

Armour: Well, one of the things that really surprised me was, at one point he did say that HHS was going to work on maintaining access and getting access to the vaccine, which I think was somewhat unexpected. The thing that has struck me, though, is the amount of — and I don’t see him really addressing this — the amount of misinformation there is about measles right now. I mean, there are individuals who believe that the child who unfortunately passed away was given the vaccine in the hospital and that’s why the child died, even though there’s no proof of that. Even RFK saying that these kind of outbreaks are normal, even though he kind of said, Yeah, HHS is going to promote the vaccine, he’s also at the same time playing it down and feeding into that misinformation with the kind of stuff that you just spoke about. 

Kenen: I don’t think he’s really promoting the vaccine. His first big statement on the measles outbreak really downplayed it and said, Oh, you know, this happens, and we get measles still, and it didn’t talk about vaccines. A couple of days later, I think two or three days later, we saw in which he said you should talk to your doctor. He did not endorse vaccines. He did say, We’re shipping some more to Texas. They did announce they’re sending some CDC [Centers for Disease Control and Prevention] experts as well. But he didn’t say, I’m going to stand between you and your vaccines. He said it is your choice. Talk to a doctor. So that’s not a blockade, but it was not a wholehearted endorsement saying — he was saying cod liver oil and vitamin A and all sorts of other things. 

So we don’t know who spoke to him in strong terms between Statement A and Statement B, but somebody probably did, whether it was the White House, whether it was Sen. [Bill] Cassidy — who knows, right? Something made him put out a more vaccine-friendly statement, but it wasn’t a, This vaccine is safe, and your child should get one if they haven’t. That’s the best way to stop this. That’s not what he said. 

Armour: I guess what I was saying is on the 3rd, March 3, when HHS put out the call to action and saying that the measles vaccine is safe and will protect children from measles, that to me, a number of people in the MAHA [Make America Healthy Again] movement went on X to say: How can you say this? You should know better, RFK. And that’s what I’m referring to. I think that that took some of his supporters by surprise. 

Kenen: But it’s not anything like — a lot of newspapers have published what Secretary [Alex] Azar said a few years ago — who was also a Republican, also served under Trump. Someone like Kennedy doesn’t like people who had worked for the pharma industry, which Secretary Azar had done, and they’re not going to see eye to eye. But if you look at what Secretary Azar said about vaccination, it was like a really full-blast endorsement of it, and that is not what some people thought could be the worst-case scenario with Kennedy, where he sat on them and said you can’t get them. That’s not happening. But I don’t think he’s putting them out there as one of many options along with cod liver oil. 

Armour: Well, one of the things, in addition to the measles, that I think piggybacks in terms of some of the concern is, he also paused the work on the oral covid vaccine, right as it was set with 10,000 participants for this study. And I spoke to Vaxart, and they’re in a situation where they don’t know if the whole contract’s going to be canceled, if they’re going to have to reenroll 10,000 people. And the stories that were out there that he’s reconsidering the bird flu vaccine that they’re working on, which is an mRNA base. So those are two things I’m watching really closely, I think. 

Rovner: Lauren, you wanted to add something? 

Weber: Oh, I was just going to say, he later gave a full interview to Marc Siegel, and in that very long interview, if you watched or read the whole transcript, he talked about the vaccine injury. So it wasn’t exactly like he was waving the flag for everybody to get vaccinated, and I think it’s worth saying the measles vaccine is safe and effective despite Secretary Kennedy’s history of disparaging vaccination and linking it to autism. So I mean, I think it’s important to take the context of his whole statements as they continue to come out on this outbreak. 

Rovner: He seems to be trying to have it all ways for all people. 

Kenen: Or for one senator. 

Rovner: Well, I would say Trump gets away with it. We haven’t seen anybody else get away with it. We will watch this space. And finally this week— 

Armour: I will say— 

Rovner: Oh. Go ahead. 

Armour: I was going to say, one thing just to share, because I thought this was so fascinating, was I got a message yesterday from my personal physician that went out to all the patients, saying that they should feel free to come in and get their titers checked or see if you had a shot during these years you may need another. I don’t know how many people are getting things like that, but I was just, like, wow. 

Rovner: Yeah, that is the standard public health response right now, which is that — I think I may be in that group. I think I had my titers done the last time we had a measles outbreak, because if you were vaccinated between certain years, you possibly aren’t fully protected. 

Finally, this week, there is abortion news. As we predicted last November, the Trump administration is pulling out of a court case challenging Idaho’s abortion ban, which doctors say is so strict they’ve had to airlift pregnant women with severe complications to other states because they can’t perform abortions even in medical emergencies. 

For the moment, the temporary restraining order blocking the ban remains in effect because, anticipating that the U.S. government would drop the case, it was taken up instead by the state’s largest hospital system. We’ll have to watch how this plays out. Meanwhile, I would expect that if there are any staff left at HHS, they will officially be changing the interpretation that the Emergency Medical Treatment and Active Labor Act, EMTALA, requires hospitals to get Medicare funds to perform abortions in medical emergencies, sometime very soon. I would expect to see that. Yes? Seeing shrugs around.  

Well, and in abortion news from the states, a judge in Arizona has permanently enjoined the state’s 15-week ban after voters approved a constitutional amendment protecting the procedure. That also happened in Missouri. Voters approved an amendment protecting the procedure. But there, anti-abortion lawmakers are also pushing a bill that would let taxpayers avoid paying state income taxes if they give instead to anti-abortion crisis pregnancy centers. Points here for creativity. This is a new one that I have not seen this idea before. 

Kenen: I didn’t realize they were already doing it up to a point. Like you could get 70% of your state taxes waived. This would make it 100% of your state taxes. So instead of paying your state, which then spends money on public health and education, roads, all the other things that states do, 100% of what would’ve gone to your state will instead go to these crisis centers, which are basically anti-abortion centers, some of which do provide some medical and prenatal care, and some of which really don’t do anything except say: Don’t have an abortion. Here’s some diapers. Right? I mean, there is a range. As of a couple years ago, I think, some were providing enough medical services that they got a little bit of Medicaid money for a little bit of early prenatal care. They don’t do the whole— 

Rovner: And as we’ve pointed out, enough of them don’t provide enough medical services that they are not covered by HIPAA [the Health Insurance Portability and Accountability Act]. So there are no medical privacy protections for patients who go to some of these places. I was sort of struck, though, by the idea of, This is something that we probably can’t get away with as a state government, so we’re going to let you, the state taxpayer, divert your state taxes to it instead. That’s essentially what they’re doing. 

Kenen: And they advertise in ways that if you look for certain things, search about abortion, you’ll get these pregnancy crisis centers. And for someone who has an unplanned pregnancy and defines it as a crisis, they might think that’s where they can go to get the information, the full choices they may want to be interested in, as opposed to going to a place that exists to fight abortion. 

Rovner: Anybody else want to add anything? 

Weber: I mean, I would just say that the Missouri budget is not known for being in a surplus. So it’s wild that they would want to divert this amount of money from what could be potentially a massive shortfall if some of these Medicaid cuts come through, because Missouri would still be obligated to make up the difference. So it’s very interesting that this could be encouraged to divert some funds from what I would imagine would be needed in the state coffers, considering teachers hadn’t gotten a pay raise for a very long time. I mean, very, very interesting fiscal choice. 

Rovner: Yes, that is for sure. All right, that is the news for this week. Now we will play my “Bill of the Month” interview with Sandy West, and then we will come back and do our extra credit. 

I am pleased to welcome to the podcast Sandy West, who reported and wrote the latest �������ýҕ�l Health News “.” Sandy, thank you for joining us. 

Sandy West: Thank you for inviting me. 

Rovner: So, tell us about this month’s patient — who he is, where he lives, and what happened to him. 

West: Jagdish Whitten lives in San Francisco. He’s a young man. A couple of years ago — he was 25 years old — he was running on a side street, was preparing to cross over a more major street in his neighborhood in San Francisco. And the next thing he knew, according to him, he was doing a, quote-unquote, “little flip” over a car. He’d been hit by a car, and he said he rolled around on the ground for a little bit, got himself up, got to the curb, and just was a little stunned about what happened. 

Rovner: So he ended up at a first hospital, but not by ambulance, right? 

West: No. He said that lookers-on were obviously very concerned. They’d seen the accident and they were wanting to call 911, and he said no. He said to me he was pretty sure he wasn’t going to die. So he knew that was expensive, and he did not want to do that. He had his friends drive him to the first hospital. It was a hospital that he had some familiarity with, and so his friends took him. 

Rovner: And he got checked out and the hospital seemed to think that he was OK, but they wanted to be sure, right? 

West: Yes. He said he was thoroughly checked out. His dad, Brian, said that they were very pleased with the care that he received at the first hospital, but the doctor said to him: Getting hit by a car is a trauma. It’s a really big deal. So even though we’ve checked you out, our standard of care is that you need to be seen at a Level 1 trauma center, which was about six miles away. So they said: You’re going to need to go in this ambulance. That’s how we do these things. This is the right way to take care of you, so you’re going to go be checked out by them. 

Rovner: And he went and got checked out, and they said everything at the first hospital was great and sent him home. Right? 

West: Yeah. They said: You’ve had the appropriate care where there’s not much we can do. You can go home now. 

Rovner: And then the bill came. 

West: Correct. Brian said that when they received the first couple of bills, Jag was 25 at the time, and he was still on his father’s insurance, and they felt like that the bills with the hospitals, they made sense to him for the care that Jag had received. But then Jag sent him a screenshot of an ambulance bill for the approximately six-mile ride that was close to $13,000. 

Rovner: And it was deemed out-of-network, right? 

West: Correct. On the explanation of benefits, it said that it was out-of-network and needed preapproval. 

Rovner: So we’ve talked at length about the federal No Surprises Act that’s supposed to stop these enormous out-of-network bills for things that you cannot control, like when they tell you you have to go by ambulance to this other hospital. Why wasn’t this covered under the No Surprises Act? 

West: So when legislators were putting together the federal No Surprises Act, it’s my understanding that there was some fairly intense lobbying pressure to not include ground ambulances. Part of the reason is that there’s a mixture of public and private ambulance services throughout the country. Locations can have both public and private. There are some places where they are all just public. It’s just a hodgepodge across the country, and there are different rules and regulations in every state. So having a blanket law might be difficult, although the experts say not impossible and it needs to happen. 

Rovner: For exactly reasons like this. 

West: Yes. 

Rovner: So what eventually happened with this bill? 

West: So, Brian had put in a request for the insurance company to review the claim, and ultimately the insurance company did pay their standard payout on these kinds of bills. But with a $13,000 bill, what insurance covered wasn’t going to be everything. So Brian and his family were left with a close to $3,000 bill. 

Rovner: For a six-mile ambulance ride? 

West: Correct. Correct. Jag tried to get to the bottom of it. Brian was trying to allow that process to play out, but he was becoming concerned. It had been a couple of months. He didn’t want it to affect Jag’s credit rating, so he went ahead and paid the bill in January. When I contacted him, we were going back and forth about dates and other stuff. Brian went back and started looking through old credit card statements and discovered that he had been reimbursed the full amount that he had paid to the ambulance company. He doesn’t recall seeing a letter or an email. Neither does Jag. They had not been aware. They were delighted, of course. So they got their money refunded, which apparently is pretty rare. 

Rovner: So, what’s the takeaway here? 

West: So, the experts say, very clearly, even if you’re concerned about ambulance costs, if you are in a medical situation, you need to get into the ambulance. Your health is very much more important than the billing. The billing can be negotiated. There’s usually arrangements that can be made. But you have to take care of your health first. Experts believe that it is really time for the federal government to include ground ambulance in protection. There are several states that have no-surprises bills that include ambulances, but they don’t always cover everybody. Even in the Whittens’ case, California has a law that covers ground ambulance, but because their insurance coverage came through Brian’s employer, it is possible that the California law would not have helped them. So it’s very important for the federal government to have a law in place to try and mitigate these really scary bills that people can get for ambulance services. 

Rovner: And when all else fails, you can write to us. 

West: Yes. 

Rovner: Sandy West, thank you so much. 

West: All right, thank you. 

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

Kenen: This is a collaboration between the ProPublica regional reporting program and Capital News of Illinois. It’s by Molly Parker and Beth Hundsdorfer, which I may not be pronouncing right, but I’m doing my best. And the headline is, “.” In Illinois, if a parent says they’re homeschooling a child, that’s it. There’s no oversight. Not only to see whether the child is being schooled, or there’s no oversight of their health, abuse, supervision — just basically almost zero. And the child they wrote about was begging neighbors for food because he wasn’t being fed at home. He was bruised, he was beat, and this went on for quite a long time. Neighbors were calling in, and there was finally action, and he was taken away from the parent and parent’s partner immediately. But this child is one of many. Homeschooling, many states, I think all states, allow it, but this is a state, which is a liberal state, has basically close to zero oversight and therefore inability to detect harm either to their intellectual development or their physical safety. 

Rovner: Yeah. It’s quite a story. Lauren. 

Weber: My colleagues Fenit [Nirappil] and Elana [Gordon] had a great story out of Texas in the measles outbreak this week. It’s titled “.” And I thought it was a great piece because it talked to a lot of folks who chose not to get their children vaccinated and talked about how their child had gotten measles and recovered and that really only hardened their decision to not get their child vaccinated. Many of these parents were citing misinformation about how the vaccine is unsafe — the vaccine is safe — and various other things, and it gave a snapshot of these pockets of America where we have seen a lot of declines in vaccination rates and what can happen when something spreads like wildfire among them. 

Rovner: Stephanie. 

Armour: My story is in The New York Times, and it’s by Brian Rosenthal, Mark Hansen, and Jeremy White. It’s called “.” This was a great story, not just for what it uncovered but also for the way it’s laid out. It’s absolutely worth going and looking at. It has this amazing graphic that kind of shows you what’s occurring, which is: Individuals who are the sickest are supposed to be at the top of the transplant list. But what The New York Times discovered was happening is that a number of times, a number of hospitals were skipping the sickest and giving organs to individuals who were jumping the line, if you will. And it shows that both in the interviews but also in a really creative visual way, so it’s really worth looking at and giving a read. 

Rovner: Yeah, it’s a really cool infographic. 

Armour: Yeah. 

Rovner: My extra credit this week is from �������ýҕ�l Health News. It’s by Kylie Mohr, and it’s called “.” It’s about a change made by the Biden administration to ensure that female federal firefighters who develop breast, cervical, and certain other cancers will be covered because of their exposure to hazardous substances on the job. There’s a special program at the Department of Labor that provides a streamlined claims path for those with those covered conditions, but now the press release adding those female cancers to the list of things eligible for that streamlined path has been deleted from the Labor Department’s website, and a spokesperson was unable to provide any new information. This is the kind of story that in the regular world would get a lot of attention, but there’s now obviously so much else going on that it tends to get overlooked. But for the people who fought really hard to make sure that basically people who are out fighting fires and get injured as a result get some kind of compensation, this is a big deal, and we will continue to follow it. 

OK. That is this week’s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Thanks as always to our producer and editor, Francis Ying, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me at X, , and at Bluesky, . Where are you guys hanging these days? Joanne? 

Kenen: Mostly at BlueSky, , or I’m posting more stories on now. 

Rovner: Stephani.? 

Armour: I’m on X at , and I’m on , but I don’t know my handle, so … 

Rovner: That’s OK. People can find you. Lauren. 

Weber: I am now on Bluesky, so I’m on both and X, . 

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