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

Julie Rovner: Hello, from �������ýҕ�l Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for �������ýҕ�l 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. 10, 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 Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

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

Joanne Kenen: Hi, everybody. 

Rovner: And my colleague Amanda Seitz of �������ýҕ�l Health News. 

Amanda Seitz: Hi, great to be here. 

Rovner: Later in this episode, we’ll have my interview with Lauren Sausser, who reported and wrote the latest �������ýҕ�l Health News “Bill of the Month.” It’s about a breast cancer screening that’s not necessarily considered covered preventive care. But first, this week’s news. 

So, welcome to the sprint to the midterms. As we have talked about all year, affordability — or, to be more specific, unaffordability — is the topic that seems to be most on voters’ minds this fall. And healthcare is at or near the top of that list of things that voters are finding increasingly unaffordable. So the news from the past few weeks that healthcare costs are likely to go up even more next year, not only pushing up premiums but in many cases prompting employers to cut back on coverage, is probably not going to make consumers any happier. These are some of the steepest increases in healthcare costs that we’ve seen since the early 2000s —that’s when frustration prompted the debate that became the Affordable Care Act. What’s driving these increases, and what is it likely to lead to? 

Kenen: There’s multiple causes, right? We’re in an era — we’ve had high inflation overall. We … have had the number of insured people drop, which means there’s more uninsured, uncompensated care, which means the rest of us who do have insurance end up paying for it. Some people would argue that the consolidation — in fact, many people would argue — that the consolidation in the healthcare sector has added to costs. Private equity has been part of that consolidation, and their business model is, you know, there’s still research …  

Rovner: Their business model is to take money out of healthcare, basically. 

Kenen: And you know, I mean, some people would say that, you know, it’s not just profit; it’s also greed. That’s not true across the healthcare system. That’s not true about everybody. But I think you could see it. 

Rovner: It’s certainly a good place to make money these days. 

Seitz: I think, as far as what’s to come, too, Julie, we got a very significant signal this morning of how nervous the White House is about all of this. Axios is reporting that [President Donald] Trump wants to send $500 checks to a million enrollees across 30 states just ahead of the Nov. 3 midterm elections. So it just shows the timing here could not be worse. And that is kind of always the case when it comes to the election and open enrollment. But with those big increases we’re expecting, it’s only going to get worse in the coming weeks because people haven’t actually begun to preview those health insurance costs, what they’ll look like for next year. It’s not … it’s typically available around October for most employers and for the Medicare and ACA marketplace. So those prices are going to be landing in people’s inboxes and mailboxes right as they’re making choices about who they’re going to vote for, and it’s just not very good timing for this administration. 

Rovner: Darn that fall! Well, one of the things we’ve seen is it’s not just prices; employers are also dropping popular but expensive benefits like GLP-1 coverage or coverage for infertility treatment. Could that eventually drive prices down because providers of those benefits will have no choice if nobody has insurance for their products or services? Or are they just going to become unaffordable for all but the very rich in our K-shaped economy? 

Seitz: I think that’s certainly a concern, and again, going back to … this is just such a visible example of the affordability issue that people are talking about. People are paying more, and they’re getting less. And that is a frustration across our economy, but healthcare is such a blatant example of that happening. And there are questions: Will care be out of reach for people? I mean, we’re seeing that happen, obviously, in certain markets. In rural marketplaces, for example, it’s now, you know, in some places a luxury to have a doctor nearby that you can go to. So I certainly think that’s a concern. 

Kenen: I mean, it’s partly the way we’ve always measured prevention. It’s not that prevention doesn’t save money over the long haul. You know, there’s a lot of …. there’s dispute among the economists. There’s a lot of data that prevention in the long haul is a good investment, but that prevention isn’t, like, if I’m a health plan, I have no necessarily, you know, economic interest in making sure that you’re healthy in 20 years. You’re my client. You’re my customer now. Maybe next year. Maybe the year after that. So what’s good for the overall health system and the public’s health, and arguably the economy in the long term … it’s bad short term when, you know, an insurer, a company that decides not to cover GLP-1s. Although I sort of wonder if we’re going to get to the point where it’s just put in the water supply as more and more things are discovered about it. I’m being a little facetious, but only a little. … It’s a smart short-term sticker-price move. It’s not necessarily a wise move in the long run, and it’s going to get people mad because people who are, you know, who have struggled with weight, who’ve done the right things, and who still have trouble losing weight, or who have diabetes. I mean, I’m not sure if they’re dropping it for diabetes or they’re dropping it for obesity. I don’t know enough about it. 

Rovner: I think they’re mostly dropping it — yeah, I don’t think they can get away with dropping it for diabetes — I think they’re dropping it for weight loss. 

Kenen: Right. But I mean, as it becomes more restricted, but it’s turning out not to just be weight loss. I mean, it’s like people who get on it for weight loss are finding out that their livers get healthier. You know, there’s increasing research and causative signs about addiction. There’s, you know, it’s a really interesting drug, which we don’t totally understand. But it’s expensive, and that’s what, you know, people … the American healthcare system, or even the American business sector, isn’t always really thinking about the long term, particularly when the sticker shock is so big right now. 

Rovner: So another level of frustration — and something that we didn’t see the last time rising health costs were a top-tier political issue — is this whole trend of , or sometimes not-so-elective procedures, because so many patients now have multi-thousand-dollar deductibles, which we didn’t see the last time healthcare costs were spiking. That means many more patients could be blocked from getting needed care in the first place or, best-case scenario, fighting for months after that prepayment turned out to be too much. Ask me how I know about that latter part. I can’t help but think this is just going to increase the anger for voters. 

Raman: I mean, I really think so. We even, you know, last year I feel like there was so much outcry from folks when we were trying to see if Congress was going to extend the enhanced tax subsidies for the ACA. And, you know, all this talk about people maybe picking lower-tier plans because that is what they could afford. And I think we could see similar things now, where even if someone is still getting employer-sponsored insurance, maybe picking lower coverage than they want, not getting covered for as many things as they want. And, you know, feeding in with the prepayments, just so much more top of mind how much cost is going to be an issue in healthcare for folks. 

Rovner: Yeah, it’s one thing to have skin in the game. I say it’s another thing to have, you know, a limb in the game. Sorry, go ahead, Amanda. 

Seitz: Yeah, and I also think it will bring, that approach could backfire a little because it will bring a little bit more scrutiny to what providers are charging. A lot of times people get the bill after insurance has picked up a lot of the costs. Now you’re inviting them to look at it, you know, in advance and ask some questions that they might not have before afterwards. 

Rovner: Yeah. So what, if anything, are lawmakers proposing to do? Republicans seem to have retreated into the “let’s root out fraud” mode. President Trump is promising to send checks. Democrats seem to be proposing a lot of what I call “more of the same,” including rolling back the Republican cuts to the Affordable Care Act and Medicaid, and expanding Medicare benefits to things it doesn’t now cover, like dental and vision care. I feel like none of these things are really kind of meeting the moment of the intensity of the frustration. 

Seitz: I think it’s difficult to meet the moment in some ways because everyone knows that they won’t agree on anything. So, you know, it’s this sort of piecemealed approach of maybe what will stick, like trying to throw things at the wall and see what will stick. 

Kenen: There could be, like, a real bipartisan accord if, like, Trump agreed to put the $500 check into the mail-in ballot. [Hearty laughter] 

Rovner: Maybe you’re on to something, Joanne. 

Kenen: Probably not. Hypothetical. I think the one thing that, I mean, there’s a little bit of confounding is that people are upset about all prices, not just healthcare. There’s sort of an outrage, and not everybody is sick, and not everybody is, you know, facing a $10,000 prepayment. So it’s, I mean, I think people are aware and angry and angrier about healthcare, but it’s just sort of an affordability crisis, which healthcare is a component. And in some ways, it makes it easier for Congress to just sort of shout about it right now, before the elections. They’re really good at that, right? I mean, they’re all experts in shouting. 

Rovner: They’ve had lots of practice. 

Kenen: Yes, and, you know, I don’t really see … there’s going to be a fight on the left about single-payer, “Medicare for All,” but … I don’t think we yet know, outside of a couple of states, how … I haven’t really seen a unifying Democratic narrative on healthcare. You know, I see a fight about single-payer, but I don’t really see where they’re going. And … are they going to agree that the fight should be against the Republicans or against each other? That’s always a Democratic problem. Whereas the Republicans, I also don’t, you know, they tend to be, you know, more market-based, and they’re talking fraud, fraud, fraud, fraud, fraud. And, you know, there was just recently a big fraud bust on a Medicaid provider, not Medicaid beneficiaries. The way they talk about it, that can get confused. We all know there’s fraud. … Fraud is not the major driver of the healthcare costs in this country. But none of us would ever say there’s no fraud. There is. And we would all rather see less money spent on fraudsters and more money spent on making people healthy. But I think the Republicans right now are just going to keep shouting fraud. 

Rovner: Moving on, another trend we didn’t see as much in the early 2000s, when health prices were last spiking, was healthcare providers suing their patients over their unpaid bills. Our former podcast pal Sarah Kliff over at The New York Times has a really eye-popping story this week about how Kansas Republican Sen. Roger Marshall, who was an OB-GYN before being elected to Congress, and the headline tells you most of what you need to know: “ — a senator, I would add, who has voted to repeal both the Affordable Care Act and to cut Medicaid. I want to call this a scandal, but is it really? He’s not accused of doing anything illegal. His lawyers went after people who owed him money. Why has this story raised so very many eyebrows? 

Kenen: It’s an amazing story. You know, not only was he, and his response to these people … he wasn’t just, like, chasing them. They were arrested, and he was charging them 18% interest, and these people were, you know, most of them that we read about in that story were poor. So …  

Rovner: And some of them owed, like, $100! 

Kenen: Right. And it’s unclear whether they even knew they had court dates. And his response was just like, you know, a political one for the ages, which is … I think it was his spokesman, not him, saying, you know, he didn’t jail them, he didn’t issue the subpoenas and the warrants or whatever it was; the court did. But he brought the case, so it just doesn’t … is it going to, like, affect his eventual reelection? No, but is it just sort of, say, something’s really broken here? Yeah. 

Rovner: Yeah, and I mean, these weren’t people having tummy tucks. These were people who were delivering babies, in some cases, really difficult deliveries. 

Kenen: In one case, they had lost the babies. 

Rovner: That’s right. 

Kenen: Twins, I think it was twins. Yeah. 

Rovner: I think it was. Sandhya, sorry. 

Raman: There were two things that kind of, you know, caught my eye with this. A) is that, you know, doctors do have discretion in how they go after this issue. I mean, even if one is allowed to go after folks for this, they don’t have to. There are other options. But two, you know, I think one of the reasons this really resonates is that right now with Sen. Bill Cassidy, you know, losing his primary, not going to be in the Senate next year, Sen. Roger Marshall is probably one of the top contenders to lead the HELP [Health, Education, Labor, and Pensions] Committee, if Republicans maintain control of the Senate. So he’s going to have a lot of power over health policy and setting the agenda for what that committee does. And, you know, when so much of the conversation has been, like we talked about before, you know, affordability and things like that, I think that that has, you know, really struck a chord with some folks as well. 

Seitz: I also think that, you know, I did see some people saying, Listen, he is entitled. He did this work. He is entitled to get paid for it. And certainly, people might sympathize with that. But in this particular case, Sen. Marshall has leaned in to this idea that he was this upstanding community doctor who helped deliver babies of poor women on Medicaid. So when you’re a U.S. senator and you’re using that sort of imagery, but people have a completely opposite experience, it is fair game for them to speak out about that. 

Kenen: No, I mean it’s also, it’s true. Not all OBs take Medicaid. It’s a good thing that he took Medicaid. But in that bio, he left out that he was also, what, the co-owner of a hospital making millions of dollars. So, like, going after some — putting somebody in jail for two days over, you know, an obstetrics bill is probably something he’s going to have to discuss at home. 

Rovner: Well, while we are on the “Eyebrow-Raising Story” beat, The Wall Street Journal last week had a — he of the hoodies and shorts — apparently not being all that interested in “senatoring” these days. Among the anecdotes in the story, all of which were provided by former staffers, is one where he declined to meet with the folks from the Children’s Hospital of Philadelphia, which is not just one of the top ���󾱱�������’s hospitals in the country, it’s one of the top hospitals in the country. They wanted to talk about Medicaid cuts. He reportedly said he wasn’t worried about Medicaid cuts, and they were just looking for an excuse to visit Washington. In more than 40 years of covering healthcare in Congress, I cannot remember an elected official dissing a major hospital in their own district. Have any of you ever seen …?  

Kenen: Particularly a ���󾱱�������’s hospital! 

Rovner: And yes, particularly a ���󾱱�������’s hospital. I mean, this is just so out of the ordinary. It’s hard for me to express. 

Kenen: Yeah, but that’s his middle name now: “out of the ordinary.” 

Seitz: It also just shows, like, you know, there’s so much when you talk to voters, they talk about how their elected officials don’t really care about them. And that was so on display in this article. 

Rovner: And, I mean, is there something different about hospitals these days? I guess that’s sort of what, the other thing that made it jump out to me. I mean, hospitals are sort of increasingly the bad guys in raising … costs. It used to be … the Republicans are all going after the big, greedy insurance companies. We’ve seen studies recently that said it’s not the insurance companies who are making more money these days; it’s the hospitals that are making more money these days, and premiums are going up because hospitals are charging so much. I’m just wondering if hospitals are kind of losing their luster a little bit on Capitol Hill. 

Seitz: I think so, and I think part of that is the consolidation, right? You have, no longer do you have, in all cases, community hospitals that really run … where you have, like, this great relationship with your local doctor and everyone knows who’s providing their healthcare. it’s become more corporate, and I think that makes it an easier target for sure. 

Rovner: Well, finally, on the “Scandalous Story” beat this week, while we were gone, The Guardian and The Associated Press that contradict testimony that HHS [Health and Human Services] Secretary Robert F. Kennedy Jr. gave to Congress when he denied that his 2019 trip to Samoa was related to vaccines. A letter he wrote to the Samoan prime minister before he went specifically said he wanted to study what happened with the MMR vaccine in the island nation, where two children died after receiving an improperly mixed version of the vaccine, and later a measles outbreak, after vaccinations declined, sickened thousands and killed 83 more people. In response to this story, Sen. Ron Wyden, who’s the ranking member of the Senate Finance Committee, has called for a criminal investigation into whether Kennedy lied to Congress. Of course, it seems unlikely that the current Justice Department would take up such a case. But if Democrats do take back the Senate, could they use this to try to oust the secretary? 

Raman: I think they could use it to bring him in. I mean, he wasn’t under oath when making these remarks about this during the hearing. But I think, I mean, that’s the main pull for Democrats in this presidency is if they do gain control of one or more chambers to be able to do more oversight on the things that they’re not getting answers to through other means. So I mean, we could see that … 

Rovner: I believe it is still a crime to lie to Congress, even if you’re not under oath. Just throwing that out there. 

Raman: I mean, I don’t know what they can do with this other than hold oversight, because I don’t see the DOJ or other enforcement kind of going after this. 

Rovner: Yeah. I guess I’m just wondering, I mean, of all the things that we know that Secretary Kennedy has not been completely truthful about, is this the one that they’re going to sort of want to run into the ground? 

Seitz: I totally agree. It might not. You know, there’s a lot of maybe half-truths that have been given at this point, and it’ll be interesting to see which ones the Democrats do go after, even if they do get power, which is very up in the air right now. 

Rovner: Right. 

Kenen: And there are rumors that Kennedy is — I mean, these rumors always happen at this time of year before an election — there’s, you know, rumors that he’ll be out anyway, but, you know, who knows? Because right now, you know, Trump seems to be embracing him again. There was some distance. Now there’s, you know, these things go up and down, and it’s not unique to Republicans. There are always rumors about Cabinet secretaries changing after the midterm, but this is sort of one of the ones that is circulating in D.C. that there could be a change. 

Rovner: No, we will see. All right. Speaking of HHS, Politico did a deep dive into what’s happened with personnel and has found that the number of political appointees in the agency has reached the highest level since the Clinton administration — even while career staffing has dropped by more than 20% — and that HHS actually now has the most non-Senate-confirmed political appointees in the federal government. That includes several departments that are far larger, like Defense. In some parts of HHS, even though hiring has resumed, those quitting still outnumber those coming in. And at the same time, agencies are failing to carry out policies and spend money appropriated by Congress. At some point, is Congress going to notice this and try to do something about it? I feel like I ask this question every single week. 

Seitz: I mean, this was such smart reporting because I think all of us have, at some point, been, like, you know, where’s this anti-vaccine ally of Kennedy’s? Why is he in this agency? So we’ve all noticed, like, this just influx of advisers — usually is how they label them. But in many ways, this wasn’t surprising. I mean, the CDC [Centers for Disease Control and Prevention], FDA, NIH [National Institutes of Health], the career staffers have really been cut out of the decision-making on so many things, whether it be autism research, tobacco, vaccines, the MAHA Report that relied more on AI than any actual in-house expertise. So, you know, RFK has been very vocal on how much he does not trust the people working in these agencies. So, like I said, in many ways it’s not surprising, but it is certainly … shocking to see those sort of numbers. 

Rovner: Yeah, I found the numbers really — I mean, anecdotally, and we’ve been talking about this for months. I mean, you know, this agency or that agency where everybody has left, or — I forgot, there’s still, you know, thousands of people who are being paid and are on administrative leave and not working. I mean, particularly at the CDC, there’s entire offices of people, of career people, that are simply out in limbo while these, you know, political appointees are doing all the policymaking.  

Well, one thing that Congress has appeared to notice is an interagency agreement in which HHS would let the Department of Defense tap into billions of dollars appropriated to the NIH for the DOD to use to study military biodefense programs. The agreement was . It’s quite an eye-popping story. I will link to it. Democratic Rep. Rosa DeLauro of Connecticut and Sen. Patty Murray of Washington, the ranking Democrats on the House and Senate Appropriations committees, are both furious. But it remains unclear what they can or will do. Is there anything they can do about this? I mean, it appears to be something that, you know, HHS has done with DOD, and it seems to be kind of a fait accompli. 

Raman: I mean, this whole situation has been kind of unusual. You know, we had the Democrats last week, you know, speaking out about how they’re very worried about this. We had the White House and the Republican leader of the House Appropriations Committee, you know, pushing back and saying that no money is changing hands and that it’s a partnership. And I think there’s still a lot of missing pieces that we’re still trying to figure out. I think a lot of groups have been trying to say, you know, are certain programs going to be cut to fund this, or there other things that are, you know, going to get de-emphasized, or is this just like a regular partnership? Because they do, you know, these two do work a lot on various biodefense issues over the years. That’s not unusual. I think one clue we might be able to look at is next week the Appropriations Committee is looking at the law that governs these interagency agreements, and so while it doesn’t explicitly say this agreement, I think that could come up a lot, and maybe, you know, pull out some leads in terms of what maybe is happening more here, and, you know, is money changing hands? Is it not? But that’s what I would kind of look to next. 

Rovner: Yeah, I do feel like Congress has sort of thrown up its hands about, Hey, we have the power of the purse, not you, administration. All right, we’re going to take a quick break. We’ll be right back. 

So, abortion is kind of receding as a leading issue for voters this fall, obviously in favor of affordability. But there’s some still pretty epic fights raging, particularly over the abortion pill mifepristone and whether it should remain available via telehealth. That’s a change made by the Food and Drug Administration during the Biden administration during the pandemic that was later made permanent. On Wednesday, a federal appeals court in New Orleans heard oral arguments in a case brought by Louisiana, charging that the FDA policy undermines its state’s ban and should be rolled back. Meanwhile, states where abortion remains legal argue that banning telehealth prescribing would violate their ability to make abortion available, which is what the Supreme Court’s Dobbs decision said they should be able to do. Sandhya, you listened to the arguments; they were pretty arcane. What is this case going to turn on? 

Raman: So it was interesting, but I will agree with you that there was a lot of arcane legalese here. So, Louisiana, during their arguments, was asking the court to, you know, pause what the FDA has done, but also to pause that their own decision because the Supreme Court right now has put a pause on letting any of the regulation change while the litigation plays out. So a pause of a pause. And so there was a little bit of talk of, you know, what can we do here as a court and, you know, the authorities there. I thought what was, you know, pretty interesting was that, you know, the FDA didn’t really say a lot in responses to the judges. They basically just said that Louisiana didn’t have standing. They didn’t answer a lot of the questions asked of them. You could tell the judges were kind of frustrated about that. And, you know, I think a little bit is understandable. You know, we’re in this position where the FDA is defending an abortion policy put in place by the former Democratic administration. They’re in an unusual spot. We still have the, you know, review of mifepristone happening at FDA that could, you know, decide something on the safety. We don’t know yet, depending on what it is that they’re going to look for. But I think it’ll be interesting to see what they say, just because it seemed like the judges were frustrated with many responses from different people. But whatever outcome we get here will definitely be appealed by whoever to the Supreme Court. I mean, we’ve seen that with other cases; it’s almost, you know, guaranteed here. 

Rovner: And of course, we’re still waiting for that FDA study that they’ve been promising that we expect, I guess, after the midterms, conveniently, because the administration didn’t want to further inflame both sides before the midterms. 

Well, along these same lines, while we were on break, Senate HELP Committee Chairman Bill Cassidy, who’s a strong abortion opponent from Louisiana, released the result of an investigation by Republicans on his committee that criticized the FDA’s handling of mifepristone regulation. Will this investigation and report have any ongoing impact — given that this is also being played out in the courts, maybe in confirmation hearings for Heidi Overton, the current White House health aide who’s been nominated to head the FDA? 

Raman: I think it’ll definitely come up in her confirmation hearings. I’m not sure how much this specific report is going to play a huge difference, because, I mean, we’ve had over the last several months a lot of different Republicans going and asking FDA for specific things to speed up this review, to do it in the first place, to do specific things, and it doesn’t seem like that has moved the needle and changed much. You know, they’ve kind of stuck to whatever it is that they had in mind on that. So, I mean, it could be something that they cite, but I don’t know that it’s going to have a drastic effect when they already have that underway. 

Rovner: I’m interested. We’re seeing a whole bunch of hearings for Senate confirmations for HHS officials, but not yet for Heidi Overton, who’s been working in the White House as a health official. Amanda, do you expect that we’re going to see anything about her before the election, or maybe they’re going to try to hold it over? 

Seitz: Yeah, I heard some chatter that there might be a possibility, but then of course we got the notice for the deputy secretary and for the surgeon general, and not her yet. So we will see. I, you know, I think obviously the hearings next week will be far less controversial people, and I think that’s, you know, key right now. 

Rovner: Yeah, I should say that Chris Klomp, who’s … at CMS now, but who’s basically been acting as deputy secretary and has been nominated to be deputy secretary. I don’t think anybody expects there to be a whole lot of controversy associated with that one. 

Seitz: Though I will say it’ll be interesting to see. I mean, certainly he’s going to get questions about vaccines, and I’m very curious to see how he responds to that, as well as the surgeon general. You know, those are not normally questions that these folks are fielding, but they’re going to have to answer them, and it’s going to be really, like, telling how they walk that line. 

Kenen: Klomp is one of the probably least controversial people at HHS. People think, people in both parties and in the private sector and the health sector think he’s very competent, and that, you know, apparently he’s a — I don’t know him personally — but he’s apparently, you know, someone one can talk to. So I don’t think this is a fireworks-y thing, other than the mandatory, you know, both parties always want to score some points, and they will be point-scoring. But you know, he’s — I think there are a lot of Democrats who are actually pretty glad he’s there. 

Rovner: Yeah, I’ve met him. He’s very smooth, and I mean that in a good way. I don’t mean that in a slick way. I mean he’s just, he’s one of these people who clearly is good at his job. 

Well, meanwhile, still on reproductive health, our friends at ProPublica are reporting, using federal health statistics, that the , those that implant outside the uterus, has doubled since 2020 compared with the six years before. Some of that was likely due to the pandemic, when healthcare was harder to access. But the rate has continued to grow, and it’s grown much faster in states that have implemented abortion bans. Other ProPublica reporting has shown how women with pregnancy complications, like ectopic pregnancies, have had trouble getting care in states with bans. I guess at some level this shouldn’t be that surprising, but it still kind of jumped out at me. 

Seitz: It’s such important work because it’s been so hard to measure the impact of these bans. You know, we heard anecdotally over and over again from doctors how difficult it was to treat patients in these states. We obviously heard the horrific stories of women being turned away or dying in some cases. But a lot of people have sort of dismissed that and said, “Oh, you know, this was a bad doctor, or someone who wasn’t following the law or wasn’t reading it close enough, or a bad hospital attorney.” This gives us such a clear picture of how drastically the overturning of Roe v. Wade has been in raw numbers that you really can’t refute, and I thought that was very important. 

Kenen: This is the one, not the one thing, but this is one thing that there’s no debate about: An embryo cannot develop outside the womb. It cannot. It cannot. It can’t. I mean, it’s … it got lost, basically. I mean, I think I’ve mentioned before. … I have had an ectopic pregnancy. I’ve had a heterotopic pregnancy. And it’s nothing … you know, in my case, it was very much a planned, wanted baby, and it was very upsetting for me. But I was, I got treatment. But, you know, for people to mess around with this who don’t understand it, I mean, there was one lawmaker, and I forgot who it was, and I also forgot whether it was state or federal, who said, “Why can’t they just move it where it belongs?” You know, you can’t. I mean, trust me, I would have chosen that. … This is, like, it’s not abortion. This is just a medical problem that no baby is going to come out of an ectopic pregnancy, and a woman can die. So the fact that this is, like, still being — that women are dying is, like, if you’re pro-life, you’re supposed to care about life. And, you know, partly because of some misunderstandings, and partly because there’s some politics, and partly just because of some — you don’t know you have one. I mean, I didn’t know I had an ectopic pregnancy. And it just shouldn’t — women should not die in 2026 in the United States of America or anywhere else. This is not an abortion. 

Rovner: Even the anti-abortion movement makes the semantic case that treating ectopic pregnancies is — they don’t consider treating ectopic pregnancies an abortion. 

All right. Well, finally, this week, an update on the political fight over the measles outbreak in Pennsylvania, which has pitted HHS Secretary RFK Jr. against the state’s Democratic governor and possible presidential candidate, Josh Shapiro. The Lancaster County coroner has now reported to the CDC that the two measles-related deaths in the state in August were both infants, both from Amish families, but only one died “from” measles. (She puts in air quotes.) The other died “with” measles. I feel like we’re already back to covid. Does this actually make a difference? 

Kenen: It depends. Like, I thought, one of the best summaries of this case, and it was actually some of the facts that have come out in the public … Paul Offit had a very — from Children’s Hospital, speaking of Children’s Hospital … 

Rovner: Children’s Hospital of Philadelphia, yes. 

Kenen: … and one of the leading vaccine researchers in the country, and someone who’s very good at explaining things. He had, like, a 10-paragraph … I think it was in MedPage, the other day … it was a little bit. … We’ve learned more about these cases since then, so I don’t know that he’s updated that. But the, you know, the basic idea was that in this “with measles,” in this particular case, might actually have been, like, without the measles, the baby might not have died, or the child might not have died. 

Rovner: This was a baby who died from a ruptured spleen. 

Kenen: And that the spleen could have been damaged because of the measles. And he didn’t say it’s definite. He said a number of tests needed to be performed to be sure one way or the other, and to the best of what had come out publicly before that, those tests had not … we didn’t know if those tests had been performed. So yes, it is possible that this was, the baby died because of the spleen damage, but that the spleen could have been because of the measles, and apparently we’re not really sure of it. But yeah, it matters because it’s part of the mix. You know, a baby died, a child died, a baby died, and getting in a fight about “with” doesn’t … it’s a risk factor. Period. 

Rovner: Well, one small silver lining: The Pennsylvania Department of Health says it has seen a surge in measles vaccines being given, nearly twice as many this August as is typical. Is that how this is going to go? People won’t get vaccinated until they see cases of the things they could have already been vaccinated to prevent? 

Seitz: It depends on who they trust, right? I mean, I think that is the unfortunate thing about this entire — I mean, there are so many unfortunate things about this entire case, and the first being that two babies are dead. But the other unfortunate thing is that people are now thoroughly confused, and it’s hard to discern, really, what happened. Even as a reporter who’s following this. Imagine being just, you know, a parent trying to decide what to do with your kid. So I think you’ll see some people that do go: OK, I don’t want to take this risk. I think you’ll see some that double down and go: You know, I’m not sure that the government’s being honest with me. And the nation’s health secretary also suggested that the Pennsylvania state government’s not being honest with me. So, unfortunately, I think we’re going to see all kinds of reactions to all of this. 

Rovner: And which government is not being honest with me — the federal government, or the state government, or the local government? Because now we’ve got the local coroner involved in this. So it’s, yeah, it is truly — I feel like this is a real microcosm of what’s going on with vaccines around the country. 

Kenen: In some ways it’s, what some people in public health would say, the best possible scenario is that people do wake up to the fact. Now we haven’t had a lot of measles for many years. We have now had more measles, and people are learning about the danger of measles, and maybe that will change behavior and reverse some of the anti-vaccination movement. On the other hand, you also have people saying that, not just in this case, but that it wasn’t measles that killed so-and-so. You know that there have been cases where someone died, but no, it wasn’t measles. You know, it was bad care. It was lack of vitamin A. It was, you know, malpractice. It was bad luck. It was something else, right? So you have sort of … you hear in public health is, like, Oh the tragedy is it’s going to take measles deaths for people to rediscover the importance of vaccine, and we may be seeing a little of that. But the other, the simultaneous narrative is, you know, it’s not measles that’s killing you; you don’t need the vaccine, that’s worse. So there’s … two narratives. Right now we see the, you know, the pro-vaccine may be inching up, but I don’t think we know yet where we’re going to be in a few more months. The, you know, there’s a lot of measles out there. 

Rovner: Yeah, clearly more of this to come. All right, that’s this week’s news, or at least as much as we have time for. Now we will play my “Bill of the Month” interview with Lauren Sausser. Then we will come back with our extra credits. 

I am pleased to welcome back to the podcast my colleague Lauren Sausser, who reported and wrote the latest �������ýҕ�l Health News “Bill of the Month.” Hi, Lauren. 

Lauren Sausser: Hi. 

Rovner: So this month’s patient was doing what just about every medical expert recommends: getting preventive screenings for breast cancer. Tell us who she is, what kind of medical care she got, and why she needed something extra. 

Sausser: OK. So, the patient this month, her name is Stephanie Halver. She lives in Washington state, and her primary care physician recommended that she get a breast MRI in addition to her annual mammogram because of her age, partly. Stephanie is over 40. She has dense breast tissue, and she also has a family history of breast cancer. Her mother and her aunt were both diagnosed in the past. 

Rovner: So she was at high risk, and her doctor recommended this MRI in addition to the regular mammogram, and her insurance company preapproved it. So, how was there a fight over the bill, and how big was the bill? 

Sausser: So, this actually took me a minute to figure this out. So, Stephanie had gotten a preapproval letter from her insurer before she went to schedule the MRI. But then, several months later, she got a bill, a significant bill for over $1,000, and she didn’t understand why this was not covered in the same way that her annual mammogram was covered. And to figure that out, we have to go back to the Affordable Care Act, which says that insurers have to cover some screenings, some cancer screenings, at zero cost to patients. Mammograms are in that list. Colonoscopies are in that list. Breast MRIs are not in that list. So the question is, who comes up with this list? It’s a group that you probably have heard of before, called the U.S. Preventive [Services] Task Force, which looks at all the available scientific evidence and uses a really rigorous process to figure out which screenings are best suited for the entire population. So, anyway, at this point in time, the U.S. Preventive [Services] Task Force — which, I should say, is not an active group of scientists since Kennedy disbanded the group essentially last year. 

Rovner: Yes, and we talk about this on the podcast all the time. 

Sausser: OK, so you all are up to speed about that. But as the current guidelines are written, breast MRIs — the group does not, has not found enough evidence that they’re necessary for a large group of people. Now, interestingly, I recently spoke to the former head of the task force, and he concedes that that does not mean that breast MRIs are not the right choice for some people. There’s this tension between, you know, what’s good for a population and what’s good for individual patients. In this case, Stephanie Halver’s primary care doctor appropriately recommended a breast MRI, but because breast MRIs are not included in the task force recommendations, her insurer does not have to cover that at zero cost. Now, as you mentioned, she had that preapproval letter, so why did she get the bill? Well, in this case, Stephanie had a really high deductible. It was over $5,000. That’s not super high anymore, but it was high. So in this case, the cost of the MRI was just applied toward her deductible. So she got a bill for it. If it had happened later in the calendar year and she’d met her deductible at that point, she might not have gotten a bill, or maybe wouldn’t have gotten a bill that was for essentially the full amount of the MRI. 

Rovner: So it was covered. It just wasn’t covered as a no-out-of-pocket-cost preventive service? 

Sausser: Exactly, exactly. 

Rovner: Now … we’ll add one more level of complication to this. I know in your research you discovered that some states are actually requiring breast MRIs to be covered in certain situations, and Washington is one of those states. So why wasn’t it covered for her? 

Sausser: So yeah, this added another level of complexity because when Stephanie was researching, you know, why, how did this bill happen? I live in Washington state. There’s a state law in Washington state that requires insurers to cover this procedure — or this test, I should say. Those state laws don’t regulate the type of insurance that she has. So a lot of people, like Stephanie, like you and me, get their health insurance through their employer. Those employer-sponsored plans are regulated federally through the Department of Labor, and so state laws generally don’t touch that type of insurance. Now, if Stephanie had had a federal marketplace plan or some other type of insurance, it’s possible that that state law would have applied. But in her case, because she had insurance through her job, that state law didn’t benefit her. 

Rovner: This is why we needed the Affordable Care Act in the first place because state laws don’t cover many — all of those employer plans that are federally regulated, which is most employer plans, although it’s not all. 

Sausser: Right, and it’s really, it’s confusing for people. … Insurance regulation is so piecemeal, and these self- —they’re also called these self-insured plans. If you work for a very large employer, chances are the plan is self-insured, and that means, at a very basic level, that the employer, not the insurance company, is actually the one that decides which benefits will be paid for and how they will be paid for, and, in this case, Stephanie did check with her HR [human resources] department, which confirmed that breast MRIs are not covered in the same way that mammograms are covered. 

Rovner: So, what’s the takeaway here? If you’re a patient and you find yourself in a similar situation, and your doctor recommends this care, I mean, is there a way to, like, save some money? 

Sausser: There is. One thing that you can do is shop around for the best price. So you’re going to pay more for a breast MRI probably through a hospital than you are through sort of a freestanding imaging center. The other thing that you might consider doing is, if you have a very high deductible — let’s say, you know, $10,000 or $20,000 — you might consider paying cash because you’re probably going to be quoted a lower cash price than if the provider bills the MRI through your insurance. The other thing is that you could consider scheduling this after you’ve met your deductible. So let’s say that Stephanie had decided to wait till the end of her plan’s calendar year, and she had met her deductible at that point. She probably wouldn’t have had to pay very much for this MRI. There are also advocacy groups that can help patients who are struggling to pay the bill, find a lower-cost alternative. There are programs through Medicaid that help patients get screened. The takeaway, to answer your question, is don’t ignore your doctor’s recommendation. If you need a breast MRI, there are probably ways to lower your cost if you know going into it that you may be on the hook for all or part of the bill. 

Rovner: Well, as always, it’s buyer beware in the healthcare marketplace. Lauren Sausser, thank you very much. 

Sausser: Of course. Thanks for having me. 

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

Raman: So my extra credit this week is called “.” It’s from my colleagues at Bloomberg Government, Erin Durkin and Claire Hebert. So something some folks might not know is that Medicaid is a significant funding source for special-needs services in K through 12 public schools. And so they took a look at Indiana, which has, you know, been aggressively cutting Medicaid enrollment, seeing some of the biggest drops in child health insurance compared to other states, and just looking at some of the effects there, you know, in part by the tax law that Republicans passed last year, and just Indiana laws that also made similar changes. So it’s a good deep dive into this. 

Rovner: It is. Joanne. 

Kenen: This is a story from ProPublica in collaboration with the Oregon paper, The Oregonian, I believe it was: “.” It’s by Audrey Dutton. It’s about Idaho, which is, there’s a community that’s been there for, like, 100 years that did not believe in medical intervention. They believe that if a baby is dying, then that’s, you know, what God wanted. It is not … there’s an astonishing, a disturbing number of cases. They are under Iowa state, excuse me, Idaho state law. They are not prosecuted. They are under state law. They are allowed to let their children die. And there are some voices in that story about the police who have to go and how disturbing it is for them, and that ProPublic also had a retired pediatrician review the medical records. Many, many of these are avoidable deaths — something that would have responded to antibiotics. Something that would have, you know, simple, not terribly invasive surgery. There was a quote from a midwife that really stuck with me, talking about watching a child die, and she said, “It’s not pretty. They don’t just close their eyes.” It’s a very, very powerful story. 

Rovner: Amanda. 

Seitz: Yeah, I have two extra credits this week, but they both touch on the same topic. The first is “,” by Daniel Payne at Stat News. This story looks at how, ahead of all these Medicaid cuts, rural hospitals are sort of clinging on for dear life by getting the backing of a larger hospital system. They’re often out of town, and, actually, one of the hospitals my own mom works at, so that was kind of cool. But the article does a great job of raising the balance here — that while this approach is saving hospitals from closing, it changes the care that people are getting, and it could make it more expensive. And then my second article is by our �������ýҕ�l Health News colleagues Noam [N.] Levy and Hannah Norman. They published an article: A NY Hospital Tried To Close Its Birthing Center. This City United To Fight Back.” That looks at how this hospital in a small town of Troy, New York, was instructed to close its birthing center by the multibillion-dollar health system that’s out of town that it’s owned by. And there was this sort of herculean, bipartisan pushback over the proposed closure that stretched from, like, the local city to the state. Both of these articles just do a really great job, I thought, of showing the local impact of hospital consolidation and corporatization of those systems. 

Rovner: Well, my extra credit this week is from NBC News. It’s part of its “Disabled and Denied” series called “,” by Mike Hixenbaugh. And it’s about a new AI program being used in Nebraska. I guess we’re all looking at different states this week. And this program is being used in other states, too, to help determine how much Medicaid funding should be allocated to those living with disabilities — which sounds fine until he discovered that the algorithm basically penalizes families who’ve managed to care for their disabled loved ones at home. Because they’ve never been institutionalized, they’re suddenly deemed more able than they actually are, and funding that’s been allowing them to live is being cut dramatically. In one case, parents in their 70s caring for a pair of severely disabled sons in their 40s are facing a loss of more than $200,000 in Medicaid funding. That’s jeopardizing their ability to continue to keep their sons at home. The entire story is pretty wrenching. I really can’t recommend it strongly enough. 

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

Seitz: I am also on X . 

Rovner: Joanne? 

Kenen: I’m mostly on and . 

Rovner: Sandhya. 

Raman: I’m on and on @SandhyaWrites. 

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