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

Julie Rovner: Hello from KFF Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Feb. 26, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

Today, we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: And Sheryl Gay Stolberg of The New York Times. 

Sheryl Gay Stolberg: Hi, Julie. 

Rovner: No interview this week, but more than enough news, so we will jump right in. So we watched all the nearly two hours of President [Donald] Trump’s longest ever State of the Union address, so you wouldn’t have to. And if you’re interested in what he had to say about health, you really only needed to tune in for about five minutes, during which he took a victory lap for lowering drug prices, which he kind of did and mostly didn’t, and announced that Vice President JD Vance will henceforth be in charge of fighting fraud in health and social programs, which we’ll talk more about in a moment. Yet, just last month, President Trump told House Republicans at their retreat that health should be front and center as an issue for the midterms. What happened to that strategy? 

Weber: I gotta be honest, I was shocked. I mean, KFF recently had a poll saying that health care costs are top of mind for voters, so the fact that he spent only five minutes of the longest State of the Union talking about health care, I think, is quite notable. And he had stuff he could have talked more about, on affordability, that he did mention when he got to it. I think some of it was a lot of the State of the Union did focus a lot on, you know, the hockey team and other various awards. 

Rovner: Yes, the Olympic hockey team came marching in through the press gallery. That was something I’ve not seen in my 38-something years as a State of the Union watcher … 

Weber: As a former high school field hockey goalie, I’m a big fan of the goalie getting the medal. But it did take away from some of the more policy topics. So again, health care costs â€” top of mind for people â€” seems like a missed opportunity. 

Stolberg: Here’s my take on that. First of all, I think we know why Trump said he was going to let Bobby [Health and Human Services Secretary Robert F. Kennedy Jr.] go wild on health. Because Trump doesn’t really care that much about health care. He finds it complicated. He has said so. I’m sure you remember from the first term, Who knew health care was so complicated? In addition, TrumpRx, I think, OK, he can point to that. Gonna say, he can trumpet that, no pun intended. But his health care plan is barely a concept of a plan. He doesn’t have a plan. His notion of directing money into health savings accounts to help people buy health care, quote-unquote “outright,” you know, is just not workable, and it’s vague. Republicans on Capitol Hill have a number of thoughts about how to achieve that, but he doesn’t really have anything to offer, and he’s got to deal with these Obamacare subsidies having been replaced. So I think this has always been a weakness for Republicans. And if there’s one strength that Trump has, it’s kind of the MAHA [“Make America Healthy Again”] movement, which is itself, and we’ll talk about this later, you know, fractured. And he didn’t mention that at all. 

Ollstein: Not only did he not spend a lot of time on this, but he exaggerated and sort of misrepresented the few things he has done. And I think there is a big political danger in that, if you say, We solved drug pricing, we brought down your drug prices, and the voters don’t feel that, when they go to pick up their drugs, they cost just as much. There could be a backlash there. And so I think there’s a risk to not focusing on this overriding issue enough, but I think there’s also a risk in overpromising and underdelivering to voters. 

Rovner: Yeah, you’ve anticipated my next question, which is to do a quick fact check on some of those claims, particularly the one that he lowered drug prices more than any previous president. He has indeed negotiated deals that have lowered some drug prices for some people, mostly those who buy their drugs without insurance coverage. But I think you could argue that Presidents [Bill] Clinton, [Barack] Obama, [Joe] Biden, and even George W. Bush, who signed the big Medicare prescription drug benefit bill â€” all those presidents signed legislation that had a much bigger impact on what Americans pay for their drugs than Trump has at least so far produced, even though he talks about it a lot. 

Stolberg: I think that’s a really good point. Medicare Part D was huge. You know, it had its flaws. It inserted the provision barring Medicare from negotiating directly with companies, which Joe Biden, you know, with the Inflation Reduction Act, partially overturned, or at least dug into. But I think that was an inflated statement, to say the least. 

Rovner: Yeah, and I think Alice is right. This is going to be lived experience for a lot of Americans. It’s like, Wait, I thought you said you lowered drug prices. I’m not seeing my drug prices much lower yet. 

Ollstein: Well, the Democrats found that as well when, you know, they passed meaningful things, but things that didn’t kick in before the election. And so the message didn’t line up with the lived experience, and it didn’t have the political benefit that they were hoping it would. 

Rovner: Yeah. Now, Trump also said, and I quote, that “I want to stop all payments to big insurance companies and instead give that money directly to the people.” Now I think he was talking about the Affordable Care Act subsidies, which have been the topic of much debate since last year. But the fact is that the federal government gives lots and lots of payments to big insurance companies through Medicare and Medicaid, particularly Medicare Advantage, which was part of that big bill that George W. Bush signed in 2003. I imagine this is giving health insurers some pretty major heartburn right now. 

Stolberg: It’s always easy to beat up on the insurance companies, right? Like, they’re a very easy target. But, you know, we had a fact-check team at the State of the Union address the other night. I was on it, and I fact-checked this statement, and I wrote, “This is misleading.” I said he’s, you know, proposed redirecting insurance subsidies into health savings accounts, which people could use to purchase health care services directly. And then, as I just stated earlier, it doesn’t offer specifics. And I quoted your analysis, at KFF, which says the president’s plan is vague, and without knowing more, it is impossible to say what the implications would be for people with preexisting conditions who rely on the ACA markets. So I think what’s bedeviling Trump is the expiration of these ACA extended tax credits, and he doesn’t have an answer for it. 

Ollstein: And the remarks at the State of the Union, I think, never say an issue is over, because we know in health care, things always come back in some form. Nothing’s ever over, but it could be read as the final nail in the coffin for the negotiations around reviving the ACA subsidies, if you have the president getting out there and saying no more money for big insurers, that doesn’t exactly help the few Republicans who are trying to negotiate something on Capitol Hill, get something done. 

Rovner: Although he has been on all sides of this issue. 

Ollstein: Oh, certainly. But in terms of messaging and the bully pulpit and where the energy is going, it’s not going into, hey, let’s cut a deal to bring down people’s rates, even if that includes giving money to the insurers, which, you know, of course, they’ve also misrepresented this issue. And, you know, where the money goes and what it’s used for has been, you know, sort of misrepresented. So it’s just a mess. 

Stolberg: If they called Obamacare “Trumpcare,” he’d give the money to the insurers. 

Rovner: That’s true. Maybe they should have done that at the time. Well, finally, about the speech about that fraud announcement on Wednesday, the day after the speech, HHS announced again that they plan to withhold Medicaid money from Minnesota based on fraud allegations. This is the latest in a series of efforts going after Minnesota and its Democratic governor and 2024 vice presidential candidate Tim Walz over what actually is a continuing Medicaid fraud problem that the state and the federal government have been working on for over a year. But now it’s complicated by the fact that, apparently, every single member of the federal task force that was working on the fraud cases from the U.S. Attorney’s Office in Minnesota have resigned over the feds’ immigration work. So they were working on fraud, but they’ve left for other reasons. When we talked about this last month, about the federal government withholding Medicaid funding from Minnesota, I asked the panel when other blue-state governors were going to start paying attention to feds’ withholding federal Medicaid funds from blue states. I guess that would be now. 

Weber: I mean, yeah, it’s a lot of money. I mean, Medicaid money would be a huge problem if a bunch of blue states lost it. We’ve seen selective targeting of blue states for public health funds. It seems reasonable to expect that to be coming for the Medicaid fraud. I think it’s important to note there is a fair amount of Medicaid fraud, and CMS [Centers for Medicare & Medicaid Services] has announced what looks to be a somewhat promising fraud initiative about stopping “pay and chase.” So, I mean, I think there’s a lot of story left on spool here on that front. 

Rovner: You have to say what pay and chase is. 

Weber: Oh, yes, so pay and chase. This is one of my one of my soapboxy things. I did an investigation with Sarah Jane Tribble back when I was at Kaiser Health News [Ñî¹óåú´«Ã½Ò•îl Health News] all about this. But essentially, the way the fraud system works here in the United States, which is kind of wild, is that people just pay the fraudsters money, and then the feds have to chase to get the money back, which is kind of crazy. It’s a system that many experts have explained to me is incredibly broken and leaves the taxpayer holding the bag, because often they don’t get the money back. So there is this new effort by CMS to utilize AI in a way that could really revolutionize how fraud is fought, but the selectiveness of which this seems to be being applied to Minnesota, or at least highlighted in Minnesota, leads to some political concerns. 

Rovner: I will add that part of this big new fraud effort is also going after fraud in durable medical equipment, which made me both smile and roll my eyes, because this has been a continuing problem ever since I started covering health care in the 1980s. Indeed, fraud is perennial. There’s a lot of money, some people are going to cheat to find it, and there’s always going to be an effort to work to ferret it out. 

Well, it was a busy news week beyond the State of the Union. Also on Capitol Hill this week, Casey Means, President Trump’s nominee to serve as surgeon general, finally got her confirmation hearing before the Senate Health, Education, Labor & Pensions Committee after she had to bow out of an earlier scheduled date last fall because she went into labor with her first child. Lauren, remind us who Casey Means is, and how’d the hearing go? Is she going to be our next surgeon general? 

Weber: So Casey Means is a health tech entrepreneur and someone with a large social media following who really got her bona fides from condemning the medical establishment, from leaving her residency and rising on podcasts and other talk shows, and through her entrepreneurship to promote this idea that the medical system is broken, and here’s how we can fix it. And when she finally got her hearing on the Hill, I think it’s really interesting, because she and her brother, Callie Means, really wrote the MAHA bible. They wrote this book called Good Energy, which a lot of MAHA principles are based off of. And what’s fascinating about a confirmation hearing for her is you see how MAHA, as a coalition, really doesn’t have a political home. There’s parts of it that Democrats really like, there’s parts of it that Republicans obviously really like, and there’s this awkward confrontation of that when you see this MAHA figure then questioned by both sides of the aisle. Something that she really exposed is a current deep issue in the MAHA movement, which I know Sheryl’s also , and she got a bunch of questions from both sides of the aisle on that. But the big takeaway, I think, a lot of people were focused on, as they should as surgeon general, was that she dodged a lot of questions about vaccination. She refused to explicitly say she would recommend the measles or flu vaccine, which is pretty shocking coming from a potential surgeon general candidate, but also in line with the MAHA movement and her political patron, Robert F Kennedy Jr. 

Rovner: And also, I mean, Sheryl, you and I were talking before we started taping that, I mean, she did, compared to some of the nominees for some of these jobs, she did a pretty good job. She was really smooth. She ducked questions in a way that one does duck questions, you know, saying thank you for asking that good question. But I know you were saying also, there’s some talk about whether or not she’s actually qualified to be surgeon general. 

Stolberg: That’s what I’m hearing today. I agree with you, Julie, that she was very smooth, and I was actually struck by how much her appearance reminded me of what confirmation hearings used to look like in the pre-Bobby Kennedy era, when nominees, you know, tried to entice politicians, tried to, you know, be engaging. She thanked Democrats. Thank you so much, Sen. [Patty] Murray, for engaging so deeply with these issues, you know, I want to thank you for our meeting that we had. I really enjoyed getting to talk with you, you know. And she is very knowledgeable, and she’s a smooth speaker, and she was, I think I told Lauren last night, she was like the Artful Dodger. Or maybe I should, I might have said that on social media. But there are questions about her credentials. So, her medical license is inactive. She has a license with the Oregon Medical Board. It is inactive. This means that she cannot prescribe medication, and she can’t treat patients right now. And there’s some question about whether or not one has to have an active medical license, not necessarily to be a surgeon general, but to be head of the Commissioned Corps of the [U.S.] Public Health Service, which the surgeon general is. 

Rovner: And which is basically the only â€¦ the surgeon general used to have a lot of line authority at HHS, and the only thing that’s left is being head of the Commissioned Corps. 

Stolberg: That’s exactly right, and the bully pulpit. And, you know, I looked at the statute last night. The statute also says that the surgeon general has to have, quote, I think, “experience in public health programs.” But it’s ill-defined. Like, what does that mean? But you are seeing some folks today, including, as you mentioned earlier, Julie, Jerome Adams, President Trump’s surgeon general, who are raising questions about her qualifications. And I think we may see more of this. 

Ollstein: I also thought it was notable that  this morning and said they find her unqualified, and raised concerns that her equivocation on vaccines could further contribute to the already diminishing trust, public trust in public health. And so the Wall Street [Journal] editorial board remains pretty influential among conservatives, so I think that is an interesting sign of where things could go. And, of course, raises the question if her nomination does collapse for lack of votes, who else could be nominated? 

Rovner: And I guess Jerome Adams doesn’t want to come back for the second term. 

Ollstein: I don’t know if he’d be welcomed back. 

Rovner: He’s burned his bridges. 

Weber: He’s not welcome back, if I had to guess, yeah, no. 

Stolberg: No, he doesn’t want to come back. He’s hawking his book. 

Rovner: Lauren, you wanted to add something? 

Weber: Yeah. I just wanted to add, I mean, it was interesting. She did get a couple stronger questions. [Sen. Lisa] Murkowski from Alaska, obviously, a Republican moderate who could be a potential “no” vote of the group, did question her pretty strongly on her stance on hepatitis B vaccines. She did get a question from [Sen. Jon] Husted about her thoughts on pesticides. That said, you know, [Sen. Bill] Cassidy also peppered her with some questions, but Cassidy also peppered Kennedy with a lot of questions, and then he was confirmed. So I think there is some chatter today about her credentials, but no Republicans brought up her credentials yesterday. The person who did was a Democratic senator, Sen. [Andy] Kim, I believe, and so, you know, we’ll have to see in this political moment what shakes out. 

Rovner: Before we leave this subject, Alice, like most of the high officials at HHS of late, she rather deftly ducked Chairman Cassidy’s question about whether the abortion pill mifepristone should be available without an in-person visit with a doctor. What did you take away from her answer? 

Ollstein: So, her comments on birth control got more attention, which we can talk about in a sec, but on mifepristone, it was very much in line with this administration just not wanting to talk about it and saying, Everybody shut up. We’re studying it behind closed doors. Just wait for us to do that, and then you can say something. So she very much kept in line with that. Didn’t want to tip her hand. 

Rovner: I would say it felt like she’d been given the talking points. 

Ollstein: Yes, exactly. And she was not really, like, free in sharing her personal views on the matter, because she was, you know, seemingly told to stick with the administration line. But I think Lauren can talk more about the birth control piece, and she’s researched that a lot. 

Weber: Yeah, I could chime in on that. And I also, just on the mifepristone piece, I think it was notable that [Sen. Josh] Hawley didn’t go after her for it. I felt like that was Hawley toeing the line, because, obviously, he, notably, in some of the RFK hearings, really went after that, and also has publicly, recently stated that he’s very disappointed in the FDA on mifepristone. So the fact that he had a pretty chummy exchange with her, some softball questions about AI chatbots, I mean, it was, I thought, notable in terms of toeing the line, on Hawley towing the mifepristone line. When it comes to birth control, Means does have a history of disparaging birth control and highlighting some of the known side effects and speaking about wanting more natural forms of contraception, which is, you know, somewhat common in the right-wing and wellness influencer space that she currently finds herself in. 

Rovner: Sheryl, do you want to add something before we move on? 

Stolberg: Abortion also is not a good issue for this administration. It’s not a good political issue. President Trump didn’t bring it up during his State of the Union. They don’t want to talk about it. It’s a loser for them. So I think that probably accounts for Hawley’s reticence in asking her about it, and, you know, sort of the muted answers that she gave, and she was very careful to say, I believe birth control should be available to all women, and she kind of said that her previous remarks, where she had said that it had horrific side effects, etc., were taken out of context. 

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

Well, while we were on the subject of abortion, to follow up on what Sheryl just noted, President Trump did not mention it during the State of the Union, a speech where he touched on lots of other things that were important to his base. He has been hinting that he wants to downplay abortion for a while now, but could this come back to bite him and other anti-abortion Republicans in the midterms, where some of his most motivated voters might just not turn out? 

Ollstein: So that’s the argument that anti-abortion advocacy groups have been, you know, shouting from the rooftops for months now. And you know, they recently put together their own polling to try to make that argument. And I think that different wings of the Republican Party are making different calculuses here. And you could argue that not doing enough on the issue is risking the votes of the conservative base, who are really fired up about this. You know, these voters are very motivated. They turn out. They knock on doors, these anti-abortion voters. But the administration seems to be making a calculus that there are a lot more people out there who are uncomfortable with the kind of national restrictions that the anti-abortion movement is demanding from the FDA, and so they, like Sheryl said, have calculated that this is a loser issue for them and they should lean away from it. And it’s just interesting because a midterm year is not the same as a presidential year in terms of who turns out, who gets fired up. And of course, there’s the primary versus general election dilemma, where doing one thing could really help you in a primary, but doing the opposite could really help you in the general, and so something you say on the campaign trail could come back to bite you later. 

Rovner: Sheryl, you want to add something? 

Stolberg: Yeah, I think it’s fascinating to look at Trump I versus Trump II. So when Trump was running for office in 2016, he made a deal with Marjorie Dannenfelser, one of the big leaders of the anti-abortion movement, that he was going to work to overturn Roe. And the anti-abortion movement just embraced Trump and said, you know, he was the most anti-abortion candidate ever, the most anti-abortion president ever. Well, now Roe has been overturned, and it’s a completely different climate, where we are seeing the effects of what it looks like in states where women do not have access to abortion. And it’s a dark picture out there. I mean, women are being injured, and this struggle is, it’s a different debate, and it’s a much harder debate. It was easier for Trump when Roe was intact. 

Rovner: Yeah, and we’ve, I mean, what we’re seeing, it’s also, it’s not just people, it’s not just women who want to get abortion. It’s women who can’t get care during pregnancy complications. â€¦ I think that’s the piece that’s upsetting so many people. And, you know, shoutout to ProPublica, who’s just continuing to do an amazing job with this. Lauren, you want to add something? 

Weber: Yeah, I think it’s notable that he didn’t talk about abortion in the State of the Union, but he did bring up fertility drugs, and how his TrumpRx can reduce the cost for fertility drugs. And obviously that could agitate some members of the anti-abortion â€¦ some of the more hard-core members of the anti-abortion movement who have issues with fertility treatments like IVF. But I think also, Trump’s making a calculus, as we’ve talked about: Are the anti-abortion voters gonna go vote for the left? Probably not. I don’t think so. So â€¦ 

Rovner: It’s just a question of whether they stay home. 

Weber: It’s â€¦ a question of whether they stay home. But I think he’s just playing to the fact that he thinks he has them in the bag to some extent. 

Rovner: Maybe they won’t stay home because they’d rather have him than â€¦ his candidates, those who would like to restore abortion. Well, also this week â€” I said there was a lot of news â€” while the administration isn’t moving very fast to try to rein in availability of the abortion pill, states are. There was a hearing in federal court this week in Louisiana about that state’s lawsuit calling for the FDA to rescind its rule allowing the mailing of mifepristone from out of state. Alice, I imagine the administration would much prefer this decision to ultimately be made by judges and take it out of their hands, right? 

Ollstein: Well, what they’re asking the court is to not make a decision at all. They’re asking them to hold it in abeyance, which is fancy judicial language for hit pause. Put it on freeze. Don’t do anything right now, like the messaging we were talking about in the confirmation hearing. What they are telling courts is: We’re working on this issue. You should defer to us and stop these states from suing us, and let us work on reviewing the abortion pill behind closed doors, and we will issue some sort of a decision at some point. And so that is, you know, what came up in court in Louisiana. The only other notable thing is that the judge did allow the makers of the pill, Danco and GenBioPro, to intervene in the case. So that happened because the Justice Department is not defending the regulations on the pill on the merits. They’re not saying, you know, the FDA went through a fair scientific process, and we are defending the decision they made to allow telemedicine and mail delivery of the pills. They’re not doing that. They’re saying, Hit pause. So the drug companies are the ones now in court, allowed to make the argument that the FDA should be, you know â€¦ their decision was based on science and not ideology, and that should be left alone. 

Rovner: Well, we’ll see how this all plays out. All right, moving on to news from the Department of Health and Human Services. Last week, we mentioned that Jay Bhattacharya, the director of the National Institutes of Health, has now also become the acting head of the Centers for Disease Control and Prevention. That’s awkward for a lot of reasons, not least of which is that the NIH is headquartered in Bethesda, Maryland, just outside Washington, D.C., and CDC is in Atlanta, Georgia. Bhattacharya is also the third interim director of the CDC in seven months, after the first interim chief, Susan Monarez, was confirmed by the Senate to lead the agency, then summarily let go when she refused to rubber-stamp the recommendations of the anti-vaxxers appointed to CDC’s vaccine advisory panel by Secretary RFK Jr. Monarez was replaced by HHS Deputy Secretary Jim O’Neill. He’s now been relieved of both jobs and is off to head the National Science Foundation. Adding to the confusion, the No. 2 at the CDC, Ralph Abraham, stepped down this week, effective immediately, citing, quote, “unforeseen family obligations.” Lauren, you said last week that this is all about the White House wanting to rein in HHS, in general, and its anti-vaccine activities, in particular, in advance of the midterms. But what might this continued churn mean for CDC, and are we ever going to see someone nominated to, you know, run the agency? 

Weber: Julie, I wish I had the answer to that question, because I would certainly have written that story if I had an answer to what will happen to the leadership at CDC. I don’t know. I mean, I think the bottom line is, is that this is an agency that has not had a steady leader for a very long time. It has certainly made some quite shocking moves for the CDC. Obviously, they overhauled the vaccine schedule at the beginning of January, and it remains to be seen how this will be going forward. I think it’s very difficult. Running a federal agency is a huge task. I mean, assuming that someone can run both equally is a tough sell. I do think he’s limited in terms of time, of how much time he would be interim. But the reality is, and I think , and it seems like there’s not a lot of people running the top of the CDC these days. 

Rovner: Yeah. Well, remember when Monarez quit, most of the career leadership also quit. So, I mean … 

Weber: Right. The agency was also gutted when RFK Jr., you know, got rid of about a quarter of HHS at the beginning of his term. So the CDC is, certainly, is a very changed and in mangled shape currently. So I think it remains to be seen who ends up taking the reins of it. 

Rovner: Sheryl, how are things at CDC? 

Stolberg: They’re really difficult. I talk to people inside the agency, you know, they’re feeling really dispirited. A lot of the top leadership is gone, as we just said. The idea that Jay Bhattacharya could run the NIH and the CDC, two massive federal agencies with complementary missions â€” the NIH is the nation’s biomedical research agency; the CDC, public health â€” in two locations, Atlanta and Bethesda, is, honestly, I don’t know who came up with this idea. I heard â€¦ I don’t have evidence to back this up, but I heard that this was actually Trump’s idea, which kind of makes sense, if that is true, because maybe only President Trump would think up such a crazy thing that you could [laughs] … I think they recognized that they needed to put someone Kennedy trusts in there. That has really been kind of the big issue. And it is all about the midterms. It’s all about the pivot. The White House wants Kennedy to turn away from vaccines and toward healthy eating. That’s why we’re seeing him do this national “Eat Real Food” tour. And, you know, wearing the Mike Tyson tattoo and social media, etc. It’s a very, very difficult situation for a storied agency, and many, many people are worried that it is going to take a long time for the CDC to rebuild, if ever. 

Rovner: Lauren, you want to add something? 

Weber: Yeah, I just wanted to echo that, I think, what gets lost in a lot of D.C. circles and, frankly, around the country, is this is an agency that also was pocked with bullet holes just a couple months ago. I mean, if that had happened in D.C., I think you would see a very different response, to be quite honest. I was very taken aback and shaken to see the bullet holes when I went down after that happened. And I think the visuals of that got a bit lost in some of the conversation. But so this is an agency that not only is suffering with utter leadership turmoil, but has, frankly, been shot at. And so â€¦ 

Rovner: Right, they were physically attacked, their building was physically attacked. 

Weber: Physically attacked. And so the folks that are still left, I think, it’s a tough deal. And to Sheryl’s point on the midterms, and I have a , led by Rachel, you know, we found out that the MAHA piece of this is, look, I mean, they’re telling Kennedy to focus on foods because they see it as more popular. And honestly, MAHA is saying they’re gonna throw some cash. Tony Lyons â€” I mean, who knows that this will happen â€” but Tony Lyons told me they’re hoping to raise $100 million for midterm spending for Republicans. So, you know, there is that element of the coalition that I think they’re trying to make happy with this whole piece of it. 

Stolberg: One interesting note about the cash. Tony Lyons has already committed a million dollars to Cassidy’s primary challenger, which is really interesting. I mean, Cassidy voted reluctantly for RFK to be secretary, you know, and he fell on his sword for the administration, and now Kennedy’s people are working actively to unseat him. 

Rovner: Let us move to MAHA. I have a segment that I’m calling “MAHA Is Mad-Ha.” The Make America Healthy Again movement is big mad about RFK Jr.’s seeming reversal on the use of weed killers by Big Farm, not to be confused with Big Pharma. The HHS secretary Sunday night put out a lengthy statement arguing that while pesticides and herbicides used on crops are poisons, that U.S. agriculture is also dependent on them, and their use needs to be phased out, rather than cut off, in order to protect the nation’s food supply. MAHA advocates, though, see this as a complete betrayal. Sheryl, I want you to start â€¦ start by telling us where you are and why. 

Stolberg: So I’m in Austin, [Texas,] where there is a MAHA Action rally tonight, interestingly, an “Eat Real Food” rally. They’re not going to be talking about glyphosate, as far as I know, and they’re not going to be talking about vaccines. So, just an interesting sort of personal perspective: Last Wednesday, when Trump issued the executive order on glyphosate after business hours, right? Shocker, I was like â€¦  

Rovner: And glyphosate is the weed killer that’s used in Roundup, which has been the subject of many, many lawsuits that it’s a carcinogen. And some of those lawsuits were brought by RFK Jr., right? 

Stolberg: That’s right, who won a massive judgment in 2018, a $289 million judgment. And this weed killer, Roundup, this has really been an animating force behind a lot of the MAHA movement, the Moms Across America, led by Zen Honeycutt, is really wrapped up in this issue, in getting glyphosate out of American food. As Vani Hari, who calls herself the Food Babe, said to me, What good is it if you eat real food, if it’s sprayed with pesticides? So I was, you know, minding my own business that Wednesday night, Trump issues the executive order, and I sent a text to Kennedy’s spokesman, and I said, Does the secretary have any response? And I got a three-sentence reply, basically saying that, you know, Kennedy was supporting Trump. This was a matter of national security. That is how Trump framed his order. He said, We need to ramp up production of this weed killer because we have only one domestic producer, and we don’t want to rely on foreign nations to keep our food supply running in the event of a crisis. That three-sentence statement from Kennedy obviously did not sit well. His MAHA moms exploded. I can’t even begin to tell you the anger. My headline of the story that I wrote said “,” and then it quoted someone I interviewed from Turning Point USA, Charlie Kirk’s organization, saying, women feel like they were lied to. So the anger is very deep and real. And I guess Kennedy felt that he had to address it in some lengthier way to, you know, try to assuage this part of his movement that really helped power him to the position that he is in right now, and also aligned itself with Trump, perhaps foolishly, and helped, you know, they threw their weight behind a Republican. And now, I think, Lauren said earlier, they really kind of have no political home. 

Rovner: Yes, Lauren, did you want to add to that? 

Weber: Yeah, no. I mean, Sheryl hit all the points. I think it’s important to note that these people are mad, as she said. And, you know, Glyphosate Girl, Kelly Ryerson, who’s big on social media, told me some version of We feel lied to in the sense that we, you know, we showed up, we voted for this, and we’re seeing no results, and we may change our minds in the next election. Because a lot of these people were independents or Democrats or so on. And I think what’s really fascinating about that is it kind of goes back to when Kennedy was going to be in consideration to be a health czar or something else. I mean, the bottom line is, the man does not have control over the EPA [Environmental Protection Agency]. I mean, that’s not his jurisdiction. And I think that a lot of his followers really got on board with the MAHA movement under the pretense that he was going to come in, he was going to do all this stuff. But the political realities are just very different. And this MAHA coalition, you know, as I talked about earlier, is so fascinating because it talks all about “real food,” which is, as we’ve talked about on this podcast, was Michelle Obama, a Democrat-led issue 10, you know, a decade or more ago. It talks about glyphosate. Typically, you see that as often being a lefty issue that is now under this right tent. And then, obviously, vaccines, which kind of is a political horseshoe issue, which you often see on the far left and far right. And I think you see this fracture in MAHA, because it just does not fit very neatly within the partisan lines that D.C. is so accustomed to. 

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

Weber: Yeah. So I wanted to highlight an article that I did with my colleague Lena [H.] Sun and Caitlin Gilbert, and it’s titled “.” We did a deep dive into how Kennedy feels about the flu vaccine, and it turns out that he, in several instances, has linked it to his spasmodic dysphonia, which is a type of dystonia. It’s a neurological voice condition that causes his raspy voice. But the catch is, is that all the scientific experts that we spoke to said there’s no scientific evidence to support that. And as Kennedy has gone around saying this about his voice, he’s also disparaged the flu vaccine while in office on, you know, the day after he took office, last February, he moved to kill a national flu vaccine awareness campaign. And this January, he downgraded the recommendation for the flu vaccine for children. And public health officials that I spoke to are horrified. They’re very worried this could lead to more cases, more misery, potentially even deaths from the flu. And some of the otolaryngologists that I spoke to also pointed out that while Kennedy had linked this condition, which was also known as a dystonia, to his voice, and there was no scientific evidence to link it to vaccines, however, there is evidence of some association between drug use and dystonias. And they pointed out that that is an association. And as has been well reported in the past, Kennedy has spoken very openly about his heroin addiction. And so, you know, we spoke to a bunch of folks who just marked this sea change that we’ve seen. You know, Kennedy obviously has, has gone after vaccines, but the flu vaccine in particular appears to be personal. 

Rovner: It does. Really interesting story. Thank you for writing it. Sheryl.  

Stolberg: I was just going to say, if Lauren hadn’t written that story and wanted to talk about it, I’d have wanted to talk about it because it was such a good story. So the story that I think people need to read this week is by ProPublica, and it’s headlined, “.” And this is a really fascinating and troubling story about what’s happening in South Carolina. There are 973 reported cases of measles there. But because hospitals aren’t required to disclose it, doctors have no idea, and ordinary people have no idea where it’s happening. The story opened with a man who went to a meeting to talk about what happened to his wife. His wife was a schoolteacher, and she was vaccinated against measles, like pretty much all American adults are. But one of her kids in her class had measles, and she had a rare breakthrough infection, and she got very, very sick. And there was no way to foresee this. And I think that this is like a canary in a coal mine issue, where we’re seeing sort of a downgrading of the importance of knowing about infectious disease, especially measles, under this Trump-Kennedy health regime. And it’s putting people in danger. 

Rovner: Yeah. It was quite an interesting story. Alice. 

Ollstein: So I have a piece from Stat [“”] by my former colleague Daniel Payne and our co-podcast friend Lizzy Lawrence. And it is about how the FDA has become politicized and become a much bigger lobbying target than ever before. And they go into how a lot of decisions are being made by the White House. And so that has, you know, emerged as the center of power in FDA-related decisions. And thus, you know, companies that have business before the FDA feel that it’s worth it for them to pour lobbying efforts into this in order to influence processes that previously they felt they couldn’t influence. And so that’s raising a lot of concerns. So I highly recommend the piece. 

Rovner: Yeah, really interesting story. My extra credit this week is from my KFF Health News colleague and sometime podcast panelist Julie Appleby, and it’s called “When It Comes to Health Insurance, Federal Dollars Support More Than ACA Plans.” Now, this is something we have talked about before, and I have talked about a lot since the debate over the expiring ACA subsidies heated up. But it bears repeating: Just about everyone who gets health insurance in the U.S. gets some sort of federal subsidy. It’s not just people who buy it on the ACA marketplaces. Medicare and Medicaid are both paid for in large part through taxpayer dollars. Employers get a tax break from offering health insurance, and employees who get health benefits don’t pay taxes on them, which is one of the biggest subsidies in the federal budget. So the next time somebody complains about why people who buy their own health insurance should get federal help with the costs, remember that, in all likelihood, you do, too. 

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

Stolberg: I’m at @SherylNYTon both  and . 

Rovner: Lauren. 

Weber: I’m @LaurenWeberHP â€” the HP is for health policy â€” at  and . 

Rovner: Alice. 

Ollstein: I’m on Bluesky  and on X at . 

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

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and, starting this week, from WAMU public radio in Washington, D.C., and welcome to “What the Health?” I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Oct. 30, 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 video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Good to be here. 

Rovner: And we welcome back to the podcast one of our original panelists, Paige Winfield Cunningham of The Washington Post. So great to see you again. 

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

Rovner: Before we dive in, we have a little of our own news to announce. Starting this week, we’re partnering with WAMU, Washington D.C.’s public radio station, to distribute the podcast. That means you can also now find us on the NPR app. And welcome to all you new listeners. OK, onto the news. We are now 30 days into the federal government shutdown, and there is still no discernible end in sight. And this Saturday is not only the start of open enrollment in most states for the Affordable Care Act health plans, which we’ll talk more about in a minute. It’s also the day an estimated 42 million Americans will lose access to food stamps after the Trump administration decided to stop funding the SNAP [Supplemental Nutrition Assistance] program. That’s something the administration did keep funding during the last Trump shutdown in 2019, and, according to budget experts, could continue to do now. So what’s behind this? As I think I pointed out last week, not such a great look to deprive people of food aid right before Thanksgiving. 

Ollstein: So I think this follows the pattern we’ve seen throughout the shutdown, which is just a lot of picking and choosing of what gets funded and what doesn’t. The angle of this I’ve covered is that out of all of the uniformed forces of the government, the Trump administration dug around and found money to keep paying the armed members, but not the public health officers, who are also part of the uniformed branches of the country. And yeah, you’re seeing this in the SNAP space as well. President Trump and his officials have openly threatened to go after what they see as Democrat programs. So it’s just interesting what they consider in that category. But you’re seeing a lot of choices being made to exert maximum political pressure and force various sides of this fight to cave, but we’re not seeing that yet either. 

Rovner: Yeah, they are. I mean, it seems this is also backwards because it’s usually the Republicans who are shutting down the government, the Democrats who are trying to pressure them to reopen it. And now, of course, we’re seeing the opposite because the Democrats want the Republicans to do something about the Affordable Care Act subsidies, and the Republicans are going after previously what had been kind of sacrosanct bipartisan programs like food stamps and the WIC [the Special Supplemental Nutrition Program for Women, Infants, and Children] program, for pregnant and breastfeeding moms and babies. And now, apparently, they’re going to stop funding for Head Start, the preschool program for low-income families with kids. On the one hand, you’re right, they are programs that are very cherished by Democrats, but I feel like this whole shutdown is now sort of going after the most vulnerable people in America. 

Goldman: It’s also been interesting because [Health and Human Services] Secretary [Robert F.] Kennedy [Jr.] has tried to use SNAP as a vehicle for his Make America Healthy Again agenda, right? Trying to get states to limit the sugary drinks that their SNAP programs offer. And he’s, like, really touted that as part of the agenda. And now there does not seem to be any interest from HHS in speaking out about that. 

Rovner: Well, of course, and SNAP isn’t an HHS program. 

Goldman: Exactly. Exactly. 

Rovner: It’s a program in the Department of Agriculture, which is even more confusing, but you’re absolutely right. I mean, it’s odd that some of the things that he’s been pointing to are things that this administration is kind of trying to lay at the Democrats’ feet, as in, You want this program, reopen the government. So as I mentioned, Saturday is the start of Obamacare open enrollment in most of the states. And, Paige, you got a for plans in the 30 states that use the federal marketplace, which is now open for what we call window-shopping before open enrollment officially begins. What did you find? 

Winfield Cunningham: Yeah. So I got some documents at the end of last week showing that the average premium for the second-lowest-cost silver plan — which, of course, is what, we know … that’s what the subsidies are pegged to — is going up 30%, which is the second-highest premium increase. The highest we saw was 2017 to 2018. But this is a really, really significant increase. And of course, CMS [the Centers for Medicare & Medicaid Services] didn’t include that number in the document that it finally released this week. So the documents I saw had some sort of numbers like that, which were all stripped out of the official documents. But all of this is just so interesting because I was thinking about, back to 2017-2018, and the politics of this are so flipped right now because basically it was the Democrats then who didn’t want to talk about premium increases and the Republicans who were yelling about it. 

So it’s funny how that has changed. But I guess on the politics of this, it seemed for a while like Democrats were thinking maybe the Nov. 1 start of open enrollment would provide this out for them to pass the spending bill because they could say, like, OK, we tried. Now open enrollment has started, or the premiums are kind of baked, so we can’t really do anything to change it now. But I don’t think we’re going to have anything this week. It seems like both sides are pretty dug in still. I mean, I guess the other thing I would say on these costs, it’s really highlighting a weakness that we’ve known for a long time in the Affordable Care Act, which is that, like, yes, it made health insurance affordable for a lot of people, but there’s always been this smaller number of people that are above 400% federal poverty that have had no shield from insurance costs. They have the last four years, and now they’re not going to have one anymore. And it’s funny because Democrats are talking about this, but that’s sort of a problem they hadn’t wanted to acknowledge for a long time in the early years of the Affordable Care Act. And as you guys all know, there’s not going to be any political will for bipartisan work to create affordable options for these folks unless the subsidies get extended, which, of course, that doesn’t seem very likely at the moment from how things stand. 

Rovner: Yeah. Going back to what the Republicans sort of announced, their talking points, is that, well, first the premium increases aren’t that big and that the expiring extra subsidies aren’t that big a piece of it, both of which are actually kind of true. But, of course, that’s not where the sticker shock is coming from. The sticker shock is coming from the expiration of those tax credits that’s going to …  

So people who had been shielded from these very high premiums are no longer going to be shielded from them. And that’s why, if you look at social media, you see all these screenshots now of insurance that costs $3,000 a month for people who were paying $150 a month, which is obviously not affordable. Why is it so difficult to explain the difference? I’ve been working on different ways to explain it for the last three weeks. 

Goldman: I was trying to figure this out last night, when I was writing something for my newsletter today. And I think one of the really confusing parts about this is that, like Paige said, like Paige scooped, premiums are going up a certain amount, and that’s not actually what people are seeing. That’s not what almost anyone is going to actually face. Either you’re getting that huge sticker shock because you’re losing your subsidies that you had this year or you’re continuing to have subsidies, they’re not quite the same, but you’re still not going to pay a 30% increase. And so I think that that’s really confusing for me even, and hard to explain. 

Winfield Cunningham: I think one way to think about this is like the party that is going to bear the brunt of the premium costs to a large degree is the government because for people that are before 400% federal poverty, they are basically guaranteed under the Affordable Care Act that they’re not going to have to pay more for premiums over a certain percentage of their income. And so this just means, like, the subsidies are getting really expensive for the federal government, which goes back to the issue of kind of like why Democrats didn’t extend these enhanced premiums indefinitely — because it’s just expensive to do it. This is the government subsidizing private health insurance. And then it’s also significant again for those people over 400% poverty who had had a cap on what they would pay. I think it was 9.5% of their income under the enhanced … and now they have no cap. 

Rovner: I think 8.5% of their income, actually, under the enhanced premiums. 

Winfield Cunningham: Under the enhanced. OK. 

Rovner: It’s going to go back to 10%. 

Winfield Cunningham: Yeah. Yeah. But there’s no cap if you’re like over, over 400%. 

Rovner: 400%. 

Winfield Cunningham: Right. Yeah. Yeah. 

Rovner: That’s right. 

Winfield Cunningham: Yeah. But that’s why people are confused. And the other thing is, like, the administration is correct, that the vast majority of people in the marketplaces will continue to get subsidies. And we are basically going back to what the situation was before covid, but it’s that smaller number of people that are at the higher income levels. But the other thought I had was, of course, the health care industry and Democrats are talking a lot about this and spreading these huge premium increases far and wide and making sure everybody hears about them, but it’s like a relatively small number of people, if you think about it. 

And I think it’s only like a couple million people in the marketplaces who are at that higher income levels. And I wonder if that factors into Republicans’ calculations here, where they’re looking at how many voters are actually seeing these massive premium increases, having to pay for all of them. And in the whole scheme of the U.S. population, it’s not like a ton of people. So I just wonder if that’s one reason they’re sort of, like, seem to be increasingly dug in on this and very reticent to extend these subsidies. 

Rovner: Although I would point out that when the Affordable Care Act started, it was only a small number of people who lost their insurance, and that became a gigantic political issue. 

Winfield Cunningham: This is very true. 

Rovner: So it’s the people who get hurt who sometimes yell the loudest, although you’re right. I mean, at that point, the Democrats stayed the course and eventually, as Nancy Pelosi said, people came to like it. So it could work out the same way. It does help explain why everybody’s still dug in. Maya, you wanted to say something. 

Goldman: I was just going to say, I think it’ll be interesting to see, if subsidies aren’t extended, how this affects premiums next year for people and for the federal government, because if a couple million people drop out of the ACA marketplace because it’s too expensive, and those people tend to be healthier, then the remaining pool of people is sicker, and then that’s the death spiral, right? So … 

Rovner: Yeah. Although it is … 

Goldman: Obviously, that’s a lot of what ifs, but … 

Rovner: … only the death spiral that goes back to prior to covid, which — it was kind of stable at 12 million. I’m sort of amused by seeing Republicans complaining about subsidizing insurance companies. It’s like, but this was the Republicans’ idea in the first place, going back to the very origin of the ACA. 

Ollstein: And we should not forget that there is a group of people who are going to be losing all of their subsidies, not just the enhanced subsidies. And that’s legal immigrants, and that’s hundreds of thousands of people. So, like Maya said, that will probably mean a lot of younger, healthier people dropping coverage altogether, which will make the remaining pool of people more expensive to insure. So these things have ripple effects, things that impact one part of the population inevitably impact other parts of the population. And again, these are legal tax-paying immigrants with papers — will be subject to the full force of the premium increases because they won’t have any subsidies. 

Rovner: Yes, our health system at work. All right, we’re going to take a quick break. We will be right back with more health news.  

Moving on, the federal government is technically shut down, but the Trump administration is still making policy. You might remember last summer, a federal judge blocked a Biden administration rule that prevented medical debt from appearing on people’s credit reports. The Trump administration chose not to appeal that ruling, thus killing the rule. Now the administration is going a step further — this week, putting out guidance that tries to stop states from passing their own laws to prevent medical debt from ruining people’s credit, and often their ability to rent, or buy a house, or purchase a car, or even sometimes get a job. According to the acting head of the federal Consumer Financial Protection [Bureau], Russell Vought — yes, that same Russell Vought who’s also cutting federal programs as head of the Office of Management and Budget — states don’t have the authority to restrict medical debt from appearing on credit reports, only the federal government does, which of course he has already shown he doesn’t want to do. Who does this help? I’m not sure I see what the point is of saying we’re not going to do it and states, you can’t do it either. Part of this, I know, is Russell Vought has made no secret of the fact that he would like to undo as much of the federal government as he can. In this case, is he doing the bidding of, I guess it’s the people who extend credit, who, I guess, want this information, want to know whether people have medical debt, think that that’s going to impact whether or not they can pay back their loans, or is this just Russell Vought being Russell Vought? 

Goldman: I guess, in theory, maybe it goes back to the idea that if you have consequences for medical debt, then people will pay their bills, and maybe that would help the health systems in the long run. But I also think that — I don’t know what health systems have said about this particular move, to be honest — but I think there’s an interest in making medical debt less difficult for people to bear in the whole health system. So I’m not sure how popular that is. 

Rovner: Yeah. Yes. Another one of those things that’s sort of like, we’re going to hurt the public to thwart the Democrats, which kind of seems to be an ongoing theme here. Well, as we tape this morning, the Senate health committee was supposed to be holding a hearing on the nomination of RFK Jr. MAHA ally Casey Means to be U.S. surgeon general. Casey Means was going to testify via video conference because she is pregnant, but, apparently, she has gone into labor, so that hearing is not happening. We will pick up on it when that gets rescheduled. Perhaps she will appear with her infant. 

Back at HHS, a U.S. district judge this week indefinitely barred the Trump administration from laying off federal workers during the shutdown, but at the Centers for Disease Control and Prevention, it appears the damage is already done. The New York Times’ global health reporter, Apoorva Mandavilli, reports that the agency appears to have had its workforce reduced by a third and that the entire leadership now consists of political appointees loyal to HHS secretary Kennedy, who has not hidden his disdain for the agency and the fact that he wants to see it dissolved and its activities assigned elsewhere around the department. What would that mean in practice if there, in effect, was no more CDC? 

Winfield Cunningham: Hopefully we don’t have another pandemic. There’s just a lot of stuff the CDC does. And it’s been really confusing to follow these layoffs because in this last round, I remember trying to figure out with my colleague Lena Sun how many people were sent notices and then hundreds were sort of, those were rescinded and they were brought back. But yeah, I mean, I think we’re going to see the effects of this over the next couple of years. When I’ve asked the administration broadly about the reductions to HHS, what they say is that the agency overall has grown quite a lot in its headcount through the pandemic, which is true. I think they got up to like 90,000 or so. And then, according to our best estimates, maybe they’re back around 80,000, although I’m not entirely sure if that’s accurate. Again, it’s really been hard to track this. 

Rovner: Yeah. I’ve seen numbers as low as 60,000. 

Winfield Cunningham: It may be lower. Yeah. Yeah. So I think actually the 80,000, that may have been the headcount before the pandemic. Anyway, all that to say, it did grow during the pandemic, and that’s kind of the argument that they’re making, is that they’re just bringing it back to pre-pandemic levels. 

Rovner: But CDC, I mean, it really does look like they want to just sort of devolve everything that CDC does to the states, right? I mean, that we’re just not going to have as much of a federal public health presence as we’ve had over these past 50, 60 years. 

Winfield Cunningham: For sure. They’ve definitely targeted CDC. I mean, they mostly left CMS alone and FDA because, statutorily, I think it’s easier for them to shrink CDC, but it definitely is going to have massive effects over the next couple of years, especially as we see future pandemics. 

Ollstein: And the whole argument about returning to pre-covid, that doesn’t fit with what they’re actually cutting. I mean, they’re gutting offices that have been around for decades — focused on smoking, focused on maternal health, all these different things. And so this is not just rolling back increases from the past few years. This is going deeper than that. 

Winfield Cunningham: Well, yeah, it’s not like they’re just cutting the roles that were added since the pandemic. 

Ollstein: Exactly. 

Rovner: It’s not a last-in, first-out kind of thing. Well, as I said, since it looks like public health is now mostly going to be devolved to the states, let’s check in on some state doings. In Florida, where state Surgeon General Joseph Ladapo last month announced a plan to end school vaccination mandates. My Ñî¹óåú´«Ã½Ò•îl Health News colleague Arthur Allen has a story about how health officials, including university professors and county health officials, who actually do believe in vaccinating children, are effectively being muzzled, told they cannot speak to reporters without the approval of their supervisors, who are likely to say no. Seeing the rising number of unvaccinated children in a state like Florida, where so many tourists come and go, raising the likelihood of spreading vaccine preventable diseases, this all seems kind of risky, yes? 

Goldman: Yes. That was a fantastic article from your colleague, and there was a really illuminating line, which I think had been reported before, but a reporter asked the surgeon general if he had done any disease modeling before making the decision. And he said, Absolutely not, because this to him was a personal choice issue and not a public health issue. And I think that just goes to show that we have no idea what is going to happen as a result of this public health decision and it could have massive ripple effects. 

Rovner: But what we are already seeing are the rise of vaccine-preventable diseases around the country. I mean, measles, first in Texas, now in South Carolina; whooping cough in Louisiana; I’m sure I am missing some, but we are already seeing the consequences of this dwindling herd immunity, if you will. Alice, you’re nodding your head. 

Ollstein: Yeah. And I’ve heard from experts that measles is really sort of the canary in the coal mine here because it’s so infectious. It spreads so easily. You can have an infected person cough in a room and leave the room, and then a while later, someone else comes in the room and they can catch it. Not all of these vaccine-preventable illnesses are like that. So the fact that we’re seeing these measles outbreaks is an indication that other things are probably spreading as well. We’re just not seeing it yet, which is pretty scary. 

Rovner: And of course, one of the things that the CDC does is collect all of that data, so we’re probably not seeing it for that reason, too. Well, meanwhile, in Texas, Attorney General and Republican Senate candidate Ken Paxton is suing the makers of Tylenol. He’s claiming that Johnson & Johnson spun off its consumer products division — that includes not just Tylenol, but also things like Band-Aids and Baby Shampoo — to shield it from liability from Tylenol’s causing of autism, something that has not been scientifically demonstrated by the way — even Secretary Kennedy admits that has not been scientifically demonstrated. My recollection, though, is that Johnson & Johnson was trying to shield itself from liability when it spun off its consumer products division, but not because of Tylenol, rather from cancer claims related to talc in its eponymous Baby Powder. So what’s Paxton trying to do here beyond demonstrate his fealty to President Trump and Robert F. Kennedy Jr.? 

Ollstein: I was interested to see some GOP senators distancing themselves from the Texas lawsuit and saying like, Look, there is no proof of this connection and this harm. Let’s not go crazy. But as I’ve reported, it’s just very hard to get good information out to people because there just isn’t enough data on the safety of various drugs, because testing drugs on pregnant women was always hard and it’s gotten even harder in recent years. And so, based on the data we have, this is a correlation, not causation. But it would be easier to allay people’s fears if we had more robust and better data. 

Rovner: Yeah. Does a lawsuit like this, though, sort of spread the … give credence to this idea that — I see you nodding, Maya — that there is something to be worried about using Tylenol when pregnant? Which is freaking out the medical community because Tylenol is pretty much the only drug that currently is recommended for pregnant women to deal with fever and pain. 

Goldman: Yeah. I think some of my colleagues have reported on the concern of another death spiral here, right? Where people get concerned, perhaps without basis, of taking Tylenol or any other drugs, vaccines even, because there are lawsuits and then the makers of these drugs say it’s not worth it for us to make these anymore. And then they don’t make them. And then it’s like a bad cascade of events. And so it’s obviously too soon to see if that’s what’s happening here, but it’s certainly something to watch. 

Rovner: But as we’ve pointed out earlier, not treating, particularly, fever can also cause problems. So … 

Ollstein: Right. Basically all of the alternatives are more dangerous. Not taking anything to treat pain and fever in pregnancy can be dangerous and can lead to birth effects. And taking other painkillers and fever reducers are known to have dangerous side effects. Tylenol was the safest option known to science. And now that that’s being questioned in the court of public opinion, people are worried about these ramifications. 

Winfield Cunningham: I think about the effect on moms who have kids with autism who are now thinking back to their pregnancies and thinking, Oh my gosh, how much Tylenol did I take? I know I took, I had pregnancies that I took plenty of Tylenol during. My nephew has autism, and I was talking to my sister about this, and she was like, “I took Tylenol.” And what they’re doing is, I guess, other reflection I have on it is, in general, there’s just less research on most things than we need. And there are some studies showing a correlation, which as we all know is not causation. And what it looks like the administration did was they took those tiny little nuggets of suggestions and have blown them up into this overly confident declaration of Tylenol and pregnancy and probably unnecessarily causing many women to blame themselves or think, Should I have done something differently during my pregnancy? when they were really just doing what their doctor recommended they do. 

Ollstein: I’m surprised that we haven’t seen legal action from Tylenol yet. I imagine we might at some point, especially if there is some kind of government action around this, like a label change. I think we will see some sort of legal action from the company because this is absolutely going to impact their bottom line. 

Rovner: Yeah. All right. Well, finally this week, more news on the reproductive health front. California announced it would help fund Planned Parenthood clinics so they can continue providing basic health services, as well as reproductive health services, after Congress made the organization ineligible for Medicaid funds for a year and the big budget bill passed last summer. California’s the fourth state to pitch in joining fellow blue states Washington, Colorado, and New Mexico. Meanwhile, family planning clinics in Maine are closing today due to that loss of Medicaid funding. And at the same time, the Health and Human Services Office of Population Affairs, which oversees the federal family planning program, Title X, is down apparently from a staff of 40 to 50 to a single employee, . Is contraception going to become the next health care service that’s only available in blue states, Alice? 

Ollstein: So Title X has been in conservatives’ crosshairs for a long time. There have been attempts on Capitol Hill to defund it. There have been various policies of various administrations to make lots of changes to it. Some of those changes have really limited who gets care. And so it’s been a political football for a while. Of course, Title X doesn’t just do contraception. It’s one of the major things they do, providing subsidized and sometimes even free contraception to millions of low-income people around the country. But they also provide STI testing, even some infertility counseling and other things, cancer screenings. And so this is really hitting people at the same time as the anticipated Medicaid cuts, and at the same time Planned Parenthood clinics are closing because they got defunded. And so it’s just one on top of another in the reproductive health space. Each one alone would be really impactful, but taken all together, yeah, there’s a lot of concern about people losing access to these services. 

Winfield Cunningham: I think the politics of this are more interesting to me than the practical effect. I mean, under the ACA, birth control has to be covered, right? by marketplace plans. Generally speaking, if people have insurance, they do have coverage for a range of birth control. But the Title X program is interesting because it seems to like overlap between the MAHA priorities and the social conservatives. Of course, as Alice said, this has long been a target of social conservatives. I think in Project 2025 called for any Title X, I believe. And then there’s this current in the MAHA movement that’s kind of like anti-hormonal birth control and there’s also these kinds of streams of pronatalist people, of have more babies, don’t take birth control. So that’s kind of interesting to me because there’s this larger narrative I think in HHS right now of the RFK MAHA people versus the traditional conservative, anti-abortion people. So that’s just like one program where I see overlap between the two. 

Rovner: One of my favorite pieces of congressional trivia is that Title X has not been reauthorized since 1984, which, by the way, is before I started covering this. But I’ve been doing this 39 years and I have never covered a successful reauthorization of the Title X program. So it’s obviously been in crosshairs for a very, very long time. Maya, did you want to add something? 

Goldman: I was just going to say to Paige’s point, telling women that they can’t take any painkillers during pregnancy is not a good way to raise the birth rate. 

Rovner: Yes. That’s also a fair point. Well, meanwhile, red states are trying to expand the role of crisis pregnancy centers, which provide mostly nonmedical services and try to convince those with unplanned pregnancies not to have abortions. In Wyoming, state lawmakers are pushing a bill that would prohibit the state or any of the localities from regulating those centers “based on the center’s stance against abortion.” This comes after a similar proposal became law in Montana, the efforts being pushed by the anti-abortion group Alliance Defending Freedom. Is the idea here to have crisis pregnancy centers replace these Title X clinics and Planned Parenthoods? 

Ollstein: I think there are a lot of people that would like to see that, but, as you said, they do not provide the same services, so it would not be a one-to-one replacement. Already, there are way more crisis pregnancy centers around the country than there are Planned Parenthood clinics, for example, but that doesn’t mean that everyone has access to all the services they want. 

Rovner: And many of these crisis pregnancy centers don’t have any medical personnel, right? I mean, some of them do, but … 

Ollstein: It’s really a range. I mean, some have a medical director on staff, or maybe there’s one medical person who oversees several clinics, some do not. Some offer ultrasounds, some don’t, some just give pamphlets and diapers and donated items. It’s just really a range around the country. And states have also been grappling with how much to, on the conservative side, support and fund such centers. And on the other side, states like California have really gone to battle over regulating what they tell patients, what they’re required to tell patients, what they can’t tell patients. And that’s gotten into the courts and they’ve fought over whether that violates their speech rights. And so it’s a real ongoing fight. 

Rovner: Yes, I’m sure this will continue. All right, that is the news for this week. Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read too. Don’t worry if you miss it; we’ll put the links in our show notes on your phone or other mobile device. Maya, why don’t you go first this week? 

Goldman: Sure. So this story is from Ñî¹óåú´«Ã½Ò•îl Health News and New England Public Media. It’s called “As Sports Betting Explodes, States Try To Set Limits To Stop Gambling Addiction,” by Karen Brown. And I think this stood out to me because I was just in Vegas last week for health, but this, I think, is a really interesting issue to explore through a public health lens, the issue of sports betting and betting addiction. And there are states that are trying to do a lot of work around this and just organizations. And then of course the gaming companies themselves have their own pushback on that, and I think this story just lays it out really well and it’s an important issue that gets very overlooked. 

Rovner: Yeah, it is a public health issue, an interesting one. Alice? 

Ollstein: I chose a story from ProPublica by reporter, Eric Umansky, and it’s called “.” So this is one of many examples that you could give of policies intended to target transgender folks having spillover effects and impacting cisgender folks, too. In this instance, it’s now harder for male veterans to qualify to get treatment for breast cancer. Men can get breast cancer. Let’s just say that. Men can and do get breast cancer, and it can be harder to detect and very lethal, and obviously very expensive to treat if you don’t have coverage. And so this story has a lot of sad quotes from folks who are losing their coverage, especially because they likely acquired cancer by being exposed during their service to various toxic substances. And so I think, yeah. 

Rovner: Yeah. A combination of a lot of different factors in that story. 

Ollstein: Definitely. 

Rovner: Paige? 

Winfield Cunningham: Yeah. So my story is by, actually, my colleague Mark Johnson. I sit next to him at The [Washington] Post, and the headline is “.” I was really struck by this story because it talks about how patients with advanced lung cancer, they were given the covid vaccines and it somehow had the effect of supercharging their immune systems. And, actually, their median survival rates went up by 17 months compared with those that weren’t given the vaccines. And, of course, this administration has really gone after the covid vaccines and the mRNA research, in particular, and canceled $500 million in funding for mRNA research. And all of the ACIP’s [Advisory Committee on Immunization Practices’] moves on vaccines have gotten so much attention. But I think the thing that also is going to be perhaps even more impactful is pulling back on this really promising research, because it has sort of become politicized because the covid vaccines have become politicized. And it seems a shame that we’re pulling back on this really promising research. So I thought that was a really interesting story by my colleague. 

Rovner: Yes. Yet another theme from 2025. My extra credit this week is from my Ñî¹óåú´«Ã½Ò•îl Health News colleague Bernard J. Wolfson, and it’s called “Many Fear Federal Loan Caps Will Deter Aspiring Doctors and Worsen MD Shortage.” And it’s a good reminder about something we did talk about earlier this year when the Republican budget bill passed. It limits federal grad school loans to $50,000 per year at a time when the median tuition for a year in medical school is more than $80,000. The idea here is to push medical schools to lower their tuition, but in the short run, it’s more likely to push lower-income students either out of medicine altogether or to require them to take out private loans with more stringent repayment terms, which could in turn push them into pursuing more lucrative medical specialties rather than the primary care slots that are already so difficult to fill. It’s yet another example of how everybody agrees on a problem: Medical education is way too expensive in this country. But nobody knows quite how to fix it.  

OK. That is this week’s show. Thanks this week to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder, “What the Health?” is now available on WAMU platforms, the NPR app, and wherever else you get your podcasts, as well as, of course, kffhealthnews.org. If you already follow the show, nothing will change. The podcast will show up in your feed as usual. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can find me at X, , or on Bluesky, . Where are you folks hanging these days? Maya? 

Goldman: I am on X as and I’m also on . 

Rovner: Alice? 

Ollstein: on Bluesky and on X.  

Rovner: Paige? 

Winfield Cunningham: I am still on X. 

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

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

Julie Rovner: Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, July 17, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Hello, everyone. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

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

Joanne Kenen: Hi, everybody. 

Rovner: No interview this week, but more than enough news. So we will get right to it. 

We’re going to start on Capitol Hill, where in the very wee hours of Thursday morning, the Senate approved the $9 billion package of rescissions of money already appropriated. It was largely for foreign aid and the Corporation for Public Broadcasting, which oversees NPR and PBS. Now, this bill represents pennies compared to the entire federal budget and even to the total of dollars that are appropriated every year, but it’s still a big deal because it’s basically Congress ceding more of its spending power back to the president. And even this small package was controversial. Before even bringing it to the floor, senators took out the rescission of funds for PEPFAR [the President’s Emergency Plan for AIDS Relief], the bipartisanly popular international AIDS/HIV program begun under President George W. Bush. So now it has to go back to the House, and the clock on this whole process runs out on Friday. Sandhya, what’s likely to happen next? 

Raman: I think that the House has been more amenable. They got this through quicker, but if you look— 

Rovner: By one vote. 

Raman: Yeah. But I think if you look at what else has been happening in the House this week that isn’t in the health sphere, they’ve been having issues getting other things done, because of some pushback from the Freedom Caucus, who’s been kind of stalling the votes and having them to go back. And other things that should have been smoother are taking a lot longer and having a lot more issues. So it’s more difficult to say without seeing how all of that plays out, if those folks are going to make a stink again about something here because some of this money was taken out. It’s a work in progress this week in the House. 

Rovner: Yeah, that’s a very kind way to put it. The House has basically been stalled for the last 24 hours over, as you say, many things, completely unrelated, but there is actually a clock ticking on this. They had 45 days from when the administration sent up this rescission request, and we’re now on Day 43 because Congress is the world’s largest group of high school students that never do anything until the last minute. So Democrats warned that this bill represents yet another dangerous precedent. They reached a bipartisan agreement on this year of spending bills in the spring, and this basically rolls at least some of that back using a straight party-line vote. What does this bode for the rest of Congress’ appropriations work for the fiscal year that starts in just a couple of months? 

Raman: I think that the sense has been that once this goes through, I think a lot of people have just been assuming that it’ll take time but that things will get passed on rescissions. It really puts a damper on the bipartisan appropriations process, and it’s going to make it a lot harder to get people to come to the table. So earlier this week we had the chair of the Appropriations Committee and the chair of the Labor, HHS [Health and Human Services], Education subcommittee in the House say that the health appropriations they were going to do next week for the House are going to get pushed back until September because they’re not ready. And I think that health is also one of the hardest ones to get through. There’s a lot more controversial stuff. It’s setting us up to go, kind of like usual at this point, for another CR [continuing resolution], because it’s going to be a really short timeline before the end of the fiscal year. But if you look at some— 

Rovner: Every year they say they’re going to do the spending bills separately, and every year they don’t. 

Raman: Yeah, and I think if you look at how they’ve been approaching some of the things that have been generally a little bit less controversial and how much pushback and how much more difficulties they’ve been having with that, even this week, I think that it’s going to be much more difficult to get that done. And the rescissions, pulling back on Congress’ power of the purse, is not going to make that any easier. 

Rovner: I think what people don’t appreciate, and I don’t think I appreciated it either until this came up, is that the rescissions process is part of the budget act, which is one of these things that Congress can do on an expedited basis in the Senate with just a straight majority. But the regular appropriations bills, unlike the budget reconciliation bill that we just did, need 60 votes. They can be filibustered. So the only way to get appropriations done is on a bipartisan basis, and yet they’re using this rather partisan process to take back some of the deal that they made. The Democrats keep saying it, and everybody’s like, Oh, process, process. But that actually could be a gigantic roadblock, to stopping everything in its tracks, right? 

Raman: I really think so. And if you look at who are the two Republicans in the Senate that voted against the rescissions, one of them is the Senate Appropriations chair, Susan Collins. And throughout this, one of her main concerns was when we still had the PEPFAR in there. But it just takes back her power as the highest-ranking appropriator in the Senate to do it through this process, especially when she wasn’t in favor of the rescissions package. 

So it’s going to make things, I think, a lot more complicated, and one of her concerns throughout has just been that there wasn’t enough information. She was pulling out examples of rescissions in the past and how it was kind of a different process. They were really briefed on why this was necessary. And it was just different now. So I think what happens with appropriations and how long it’ll take this year is going to be interesting to watch. 

Rovner: And it’s worth remembering that it’s when the appropriations don’t happen that the government shuts down. So, but that doesn’t happen until October. Well, separately we learned that — oh, go ahead, Joanne. 

Kenen: There’s also sort of a whole new wrinkle, is that rescissions is, if you’re a Republican and you don’t like something and you end up, to avoid a government shutdown or whatever reason, you end up having to vote for a bill, you just have the president put out a statement saying, If this goes through, I’m going to cut it afterwards. And then the Republican who doesn’t like it can give a floor speech saying, I’m voting for it because I like this in it and I know that the president’s going to take care of that. It really — appropriations is always messy, but there’s this whole unknown. The constitutional balance of who does what in the American government is shifting. And at the end of the day, the only thing we do know after both the first term and what’s happened so far even more so in the second term, is what [President Donald] Trump wants, Trump tends to get. 

So, Labor-H [the appropriations for Labor, HHS, Education and related agencies], like Sandhya just pointed out, the health bill is one of the hardest because there’s so much culture-war stuff in it. But, although, the Supreme Court has put some of that off the table. But I just don’t know how things play out in the current dynamic, which is unprecedented. 

Rovner: And of course, Labor-HHS also has the Department of Education in it. 

Kenen: The former Department of Education. 

Rovner: To say, which is in the process of being dismantled. So that’s going to make that even more controversial this year. Moving back to the present, separately we learned this week that the administration plans to spend hundreds of thousands of dollars of taxpayer money to destroy stocks of food and contraceptives and other medical devices rather than distribute them through some of the international aid programs that they’re canceling. Now, in the case of an estimated 500 tons of high-energy biscuits bought by USAID [the U.S. Agency for International Development] at the end of the Biden administration, you can almost understand it because they’re literally about to expire next week. According to The Atlantic, which first reported , this is only a small part of 60,000 metric tons of food already purchased from U.S. farmers and sitting in warehouses around the world, where the personnel who’d be in charge of distributing them would’ve been fired or transferred or called back to the U.S. 

At the same time, there are apparently also plans to destroy an estimated $12 million worth of HIV prevention supplies and contraceptives originally purchased as part of foreign aid programs rather than turn them over or even sell them to other countries or nonprofits. This feels like maybe the not most efficient use of taxpayer dollars? 

Luthra: I think this is something we’ve talked about before, but it really bears repeating. As a media ecosphere, we’ve sort of moved on from the really rapid dismantling of USAID. And it was not only without precedent. It was incredibly wasteful with the sudden way it was done, all of these things that were already purchased no longer able to be used, leases literally broken. And people had to pay more to break leases for offices set up in other countries, all these sorts of things that really could have already been used because they had been paid for. And instead, the money is simply lost. 

And I think the important thing for us to remember here is not only the immense waste financially to taxpayers but the real trust that has been lost, because these were promises made, things purchased, programs initiated, and when other countries see us pulling back in such a, again, I keep saying wasteful, but truly wasteful manner, it’s just really hard to ever imagine that the U.S. will be a reliable partner moving forward. 

Rovner: Yeah, absolutely. I understand the food thing to some extent because the food’s going to expire, but the medical supplies that could be distributed by somebody else? I’m still sort of searching for why that would make any sense in any universe, but yeah I guess this is the continuation of, We’re going to get rid of this aid and pretend that it never happened. 

Well, meanwhile, it’s only been a couple of weeks, but we’re starting to see the politics of that big Trump tax and spending measure play out. One big question is: Why didn’t Republicans listen to the usually very powerful hospital industry that usually gets its way but did not this time? And relatedly, will those Republicans who voted with Trump but against those powerful hospital interests do an about-face between now and when these Medicaid cuts are supposed to take effect? We’ve already seen Sen. Josh Hawley, the Republican from Missouri who loudly proclaimed his opposition to those Medicaid cuts before he voted for them anyway, introduce legislation to rescind them. So is this the new normal? I think, Joanne, you were sort of alluding to this, that you can now sort of vote for something and then immediately say: Didn’t mean to vote for that. Let’s undo it. 

Kenen: You could even do it before you vote for it, if they play it right. If Congress passes these things, we’re not going to pay attention. We’re already in that moment. But also, when I was working on a Medicaid piece, the magazine piece like four or five months ago, one of the most cynical people I know in Washington told me, he said, Oh, they’ll pass these huge cuts because they need the budget score to get the taxes through, and then they’ll start repealing it. And it seemed so cynical at the time, only he might’ve been right. 

So I don’t think they’re going to cut all of it. Republicans ideologically want a smaller Medicaid program. They want less spending. They want work requirements. You’re not going to see the whole thing go away. Could you see some retroactive tinkering or postponement or something? Yeah, you could. It’s too soon to know. Hospitals are the biggest employer in many, many congressional districts. This is a power— 

Rovner: Most of them. 

Kenen: Most, yeah. I don’t think it’s quite all, but like a lot. It’s the biggest single employer, and Medicaid is a big part of their income. And they still by law have to stabilize people who come in sick, and there’s emergency care and all sorts of other things, right? They do charity care. They do uninsured people. They do all sorts. They still treat people under certain circumstances even when they can’t pay. But right now, the threat of a primary opponent is more powerful than the threat of your local hospital being mad at you and harming health care access in your community. So much in the Republican world revolves around not getting the president mad enough that he threatens to get you beaten in a primary. We’ve seen that time and again already. 

Rovner: Right. And I will also say there’s precedent for this, for passing something and then unpassing it. Joanne and I covered in 19— 

Kenen: But it wasn’t the plan. 

Rovner: Yeah, I know. But remember, back in 1997 when they passed the Balanced Budget Act, every year for the next — was it three or four years? They did what we came to call “give back” bills. 

Kenen: Or punting, right? 

Rovner: Yeah, where they basically undid, they unspooled, some of those cuts, mostly because they’d cut more deeply than they’d intended to. And then we know with the Affordable Care Act, I’ve said this several times, they passed all of these financing mechanisms for it and then one by one repealed them. 

Kenen: And the individual mandate — I mean everything- 

Rovner: And the individual mandate, right. 

Kenen: They kept the dessert and they gave away everything. They undid everything that paid for the dessert, basically. 

Rovner: Right. Right. 

Kenen: And so it was the Cadillac — because people don’t remember anymore — the Cadillac tax, the insurance tax, the device tax. They all were like, One at a time! And they were repealed because lobbying works. 

Rovner: The tanning tax just went. 

Kenen: Right, right. So that dynamic existed, passing something unpopular and then redoing it, but the dynamic now really just comes — basically this is Donald Trump’s town. He has had a remarkable success in not only getting Congress to do what he wants but getting Congress to surrender some of its own powers, which have been around since Congress began. This is the way our government was set up. So there’s a very, very different dynamic, and it’s still unpredictable. None of us thought that the biggest crisis would be the [Jeffrey] Epstein case, right? Which is not a health story, and we don’t have to spend any time on it except to acknowledge— 

Rovner: Please. 

Kenen: —that there’s stuff going on in the background that people who had been extremely loyal to the president are now mad. And we don’t know how long. He’s very good at neutralizing things, too. He’s blaming it on the Democrats. 

But there is a different dynamic. Congress has less power because Congress gave up some of its power. Are they going to want to reassert themselves? There is no sign of it right now, but who knows what happens. I thought they would cut Medicaid. I thought they would do work requirements. I thought they would let the enhanced ACA subsidies expire. But I did not think the cuts would go this deep and this extensive — really transformationally pretty historic cuts. 

Rovner: Shefali, you wanted to say something? 

Kenen: Not pretty historic cuts, very historic cuts. Unprecedented. 

Luthra: I was thinking Joanne made such a good point about how, for all of the talk now about trying to mitigate that backlash, a lot of this is in line ideologically with what Republicans want. They do want a smaller Medicaid program. And I think a really interesting and still open question is whether they are willing and able to actually create policy that does reverse some of these cuts or not, and even if they do, if it’s sufficient to change voters’ perception, because we know that these cuts are very unpopular. Democrats are talking about them a lot. Hospitals are talking about them a lot. And just the failed attempt to repeal the ACA led to the 2018 midterms. And I think there is a real chance that this is the dominant topic when we head into next year’s elections. And it’s hard to say if Josh Hawley putting out a bill can undo that damage, so—. 

Rovner: Well, I’m so glad you mentioned that, because The Washington Post has a about a clinic closing in rural Nebraska, with its owners publicly blaming the impending Medicaid cuts. Yet its Trump-supporting patients are just not buying it. Now in 2010, Republicans managed to hang the Affordable Care Act around Democrats’ necks well before the vast majority of the changes took place. Are Democrats going to be able to do that now? There’s a lot of people saying, Oh, well, they’re not going to be able to blame this on the Republicans, because most of it won’t have happened yet. This is really going to be a who-manages-to-push-their-narrative, right? 

Kenen: This really striking thing about that story is that the people who were losing access, they’re not losing their Medicaid yet, but they’re losing access to the only clinic within several — they have to drive hours now to get medical care. And when they were told this was because the Republican Congress and President Trump, they said, Oh no, it can’t be. First of all, a lot of people just don’t pay attention to the news. We know that. And then if you’re paying attention to news that never says anything negative about the president, that blames everything on Joe Biden no matter — if it rains yesterday, it was his fault, right? 

So the sort of gap between — there are certain things that are matters of opinion and interpretation, and there are certain things that are matters of fact, but those facts are not getting through. And we do not know whether the Democrats will be able to get them through, because the resistance, it’s almost magical, right? My clinic closed because of a Republican Medicaid bill? Oh no, it’s hospital greed. They just don’t want to treat us anymore. They just, it doesn’t compute, because it doesn’t fit into what they have been reading and hearing, to the extent that they read and hear. 

Rovner: Sandhya, you want to add something? 

Raman: The one thing that as I’ve been asking around on Capitol Hill about the Hawley bill — and there was one from Sen. Rand Paul, and a House counterpart, from [Rep.] Greg Steube, does sort of the opposite — it wants to move up the timeline for one of the provisions. So one important thing to consider is neither of these bills have had a lot of buy-in from other members of Congress. They’ve been introduced, but the people that I’ve talked to have said, I’m not sure. 

And I think something interesting that Sen. Thom Tillis had said was: If Republicans had a problem with what some of the impacts would be, then why were they denying that there would be an effect on rural health or some of those things to begin with? And I think a lot of it will take some time to judge to see if people will move the needle, but if we’re going to change any of these deadlines through not reconciliation, you need 60 votes in the Senate and you’ll need Democrats on board as well as Republicans. And I think one interesting thing to watch there is that I think some of the Democrats are also looking at this in a political way. If there’s a Republican that has a bill that is trying to tamp down some of the effects of their signature reconciliation law, do they want to help them and sign on to that bill or kind of illustrate the effects of the bill before the midterms or whatever? 

Rovner: A lot more politics to come. 

Raman: Yeah. Yeah. 

Rovner: Meanwhile, over at HHS [the Department of Health and Human Services], there is also plenty of news. Many of the workers who’ve been basically in limbo since April when a judge temporarily halted the Trump administration’s efforts to downsize have now been formally let go after the Supreme Court last week lifted that injunction. What are we hearing about how things are going over at HHS? We’ve talked sort of every week about this sort of continuing chaos. I assume that the hammer falling is not helping. It’s not adding to things settling down. 

Kenen: No. And then Secretary [Robert F.] Kennedy [Jr.] just fired two top aides because — no one knows exactly the full story but it’s — and I certainly do not know the full story. But what I have read is that the personality conflict with his top aide — and that happens in offices, and he’s not the first person in the history of HHS to have people who don’t get along with one another. But it’s just more unsettled stuff in an agency already in flux, because now in addition to all these people being let go in all sorts of programs and programs being rolled back, you also have some leadership chaos at the top. 

Rovner: Well, meanwhile, HHS Secretary Kennedy took office with vows to eliminate the financial influence of Big Pharma, Big Food, and other industries with potential conflicts of interests. But shoutout here to my Ñî¹óåú´«Ã½Ò•îl Health News colleague Stephanie Armour, who has this week about how the new vested interests at HHS are the wellness industry. Kennedy and four top advisers, three of whom have been hired into the department, wrote Stephanie, quote, “earned at least $3.2 million in fees and salaries from their work opposing Big Pharma and promoting wellness in 2022 and 2023, according to a Ñî¹óåú´«Ã½Ò•îl Health News review of financial disclosure forms filed with the U.S. Office of Government Ethics and the Department of Health and Human Services; published media reports; and tax forms filed with the IRS. That total doesn’t include revenue from speaking fees, the sale of wellness products, or other income sources for which data is not publicly available.” Have we basically just traded one form of regulatory capture for another form of regulatory capture? 

Kenen: And one isn’t covered by insurance. Some of it is, but there’s a lot of stuff in the, quote, “wellness” industry that providers and so forth, certain services are covered if there’s licensed people and an evidence base for them, but a lot of it isn’t. And these providers charge a lot of money out-of-pocket, too. 

Rovner: And they make a lot of money. This is a totally — unlike Big Pharma, Big Food, and Big Medicine, which is regulated, Big Wellness is largely not regulated. 

Kenen: I think Stephanie — that was a really good piece — and I think Stephanie said it was, what, $6.3 trillion industry? Was that— 

Rovner: Yeah, it’s huge. 

Kenen: Am I remembering that number right? It’s largely unregulated. Many of the products have never gone through any review for safety or efficacy. And insurance doesn’t cover a lot of it. It doesn’t mean it’s all bad. There are certain things that are helpful, but as an industry overall, it leaves something for us to worry about. 

Rovner: Well, in HHS-adjacent breaking news that could turn out to be nothing or something really big, an appeals court in Richmond on Tuesday ruled 2-1 that West Virginia may in fact limit access to the abortion pill, even though it’s approved by the FDA [Food and Drug Administration]. It’s the first time a federal appeals court has basically said that states can effectively override the FDA’s nationwide drug approval authority. And it’s the question that the Supreme Court has already ducked once, in that case out of Texas last year where the justices ruled that the doctors who were suing didn’t have standing, so they didn’t have to get to that question. But, Shefali, this has implications well beyond abortion, right? 

Luthra: Oh, absolutely. We are seeing efforts across the country to restrict access to certain medications that are FDA-approved. Abortion pills are the obvious one, but, of course, we can think about gender-affirming care. We can think about access to all sorts of other therapeutics and even vaccines that are now sort of coming under political fire. And if FDA approval means less than state restrictions, as we are seeing in this case, as we very possibly could see as these kinds of arguments and challenges make their way to the Supreme Court. The case you alluded to earlier with the doctors who didn’t have standing is still alive, just with different plaintiffs now. And so these questions will probably come back. There are just such vast ramifications for any kind of medication that could be politicized, and it’s something that industry at large has been very worried about since this abortion pill became such a big question. And it is something that this decision is not going to alleviate. 

Rovner: Yes. Speaking of Big Pharma, they’re completely freaked out by this possibility because it does have implications for every FDA-approved drug. 

Luthra: And they invest so much money in trying to get products that have FDA approval. There’s a real promise that with this global gold standard, you will be able to keep a drug on the market and really make a lot of money on it. There’s also obviously concerns for birth control, which we aren’t seeing legally restricted in the same way as abortion yet, but it is something that is so deeply subject to politics and culture-war issues that that’s something that we could see coming down the line if trends continue the way they are. 

Rovner: Well, we will watch that space. Moving on. Wednesday was the third anniversary of the federal 988 federal crisis line, which has so far served an estimated 16 million people with mental health crises via call, text, or chat. An estimated 10% of those calls were routed through a special service for LGBTQ+ youth, which is being cut off today by the Trump administration, which accused the program, run by the Trevor Project, as, quote, “radical gender ideology.” Now, LGBTQ+ youth are among those at the highest risk for suicide, which is exactly what the 988 program was created to prevent. Yet there’s been very little coverage of this. I had to actually go searching to find out exactly what happened here. Is this just kind of another day in the Trump administration? 

Raman: I think a lot of it stems back to some of those initial executive orders related to gender ideology and DEI [diversity, equity, and inclusion] and things like that. The Trump administration’s kind of argument is that it shouldn’t be siloed. It should be all general. There shouldn’t be sort of special treatment, even though we do have specialized services for veterans who call in to these services and things. But I— 

Rovner: Although that was only saved when members of Congress complained. 

Raman: Yeah. But I do think that when we have so much happening in this space focused on LGBTQ issues, it’s easier for things to get missed. I think the one thing that I did notice was that California announced yesterday that they were going to step up to do a partnership with the Trevor Project to at least — the LGBTQ youth calling from California to any of those local 988 centers would be reaching people that have been trained a little bit more in cultural competency and dealing with LGBTQ youth. But that’s not going to be all the states and it’s going to take time. Yeah. 

Rovner: Yeah, we’re going to continue to see this cobbled together state by state. It feels like increasingly what services are available to you are going to be very much dependent on where you live. That’s always been true, but it feels like it’s getting more and more and more true. Shefali, I see you nodding. 

Luthra: Something you alluded to that I think bears making explicit is public health interventions are typically targeted toward people who are in greater danger or are at greater risk. That’s not discrimination — that’s public health efficiency. And suggesting that we shouldn’t have resources targeted toward people at higher risk of suicide is counter to what public health experts have been arguing for a very long time. And that’s just something that I think really bears noting and keeping in mind as we see what the impact of this is moving forward. 

Rovner: Yeah, I think that’s a very good point. Thank you. 

Well, speaking of popular things that are going away, a federal judge appointed by President Trump last week struck down the last-minute Biden administration rule from the Consumer Financial Protection Bureau that tried to bar medical debt from appearing on credit reports. This had been hailed as a major step for the 100 million Americans with medical debt, which is not exactly the same as buying a car or a TV that you really can’t afford. People don’t go into medical debt saying, Oh, I think I’m going to go run up a big medical bill that I can’t pay. But this strikes me as yet another way this administration is basically inflicting punishment on its own voters. Yes? 

Kenen: Yes, except we just don’t know. Some red states are so red that you don’t need every voter. We don’t know who actually votes, and we don’t know whether people make these connections, right? What we were talking about before with Medicaid — do they understand that this is something that President Trump not just urged but basically ordered Congress to do? So do people pay attention? How many people even know if their medical debt is or is not on their credit report? They know they have the medical debt, but I’m not sure everybody understands all the implication, particularly if you’re used to being in debt. You may be somebody who’s lost a job or couldn’t pay your mortgage or couldn’t pay your rent. Some of the people who have medical debt have so many other financial — not all — that it’s just part of a debt soup and it’s just one more ingredient. 

So how it plays out and how it’s perceived? It’s part of this unpredictable mix. Trump is openly talking about gerrymandering more, and so it won’t matter what voters do, because they’ll have more Republican seats. That’s just something he’s floating. We don’t know whether it’ll actually happen, but he floated it in public, so— 

Rovner: So much of this is flooding the zone, that people — there’s so much happening that people have no idea who’s responsible for what. There’s always the pollster question: Is your life better or worse than it was last year? Or four years ago, whatever. And I think that when you do so much so fast, it’s pretty hard to affix blame to anybody. 

Raman: And most people aren’t single-issue voters. They’re not going to the polls saying, My medical debt is back on my credit report. There’s so many other things, even if with the last election, health care was not the number one issue for most voters. So it’s difficult to say if it will be the top issue for the next election or the next one after that. 

And I guess just piggybacking that a lot of the times when there’s these big changes, they don’t take effect for a while. So it’s easier to rationalize, Oh, it may have been this person or that person or the senator then, or who was president at a different time, just because of how long it takes to see the effects in your daily life. 

Rovner: Politics is messy. All right, well, this is as much time for the news as we have this week? Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We’ll put the links in our show notes on your phone or other mobile device. Shefali, why don’t you go first this week? 

Luthra: Sure. My piece is from The New York Times, by Apoorva Mandavilli. The headline is “” And she takes a look at when the head of the OMB [Office of Management and Budget] told the Senate that PEPFAR had spent almost $10 million advising Russian doctors on abortions and gender analysis. And she goes through and says this isn’t true. PEPFAR hasn’t been in Russia. They cannot fund abortions. And she talks with people who were there and can say this simply isn’t true and this is very easy to disprove. And I like this piece because it’s just a reminder that a lot of things are being said about government spending that are not true. And it is a public service to remind readers that they are very easily disproven. 

Rovner: Yeah, and to go ahead and do that. Sandhya. 

Raman: My extra credit is “,” and it’s from Cecilia Nowell for The Nation, my co-fellow through AHCJ [the Association of Health Care Journalists] this year. Cecilia went to Kiruna, which is an Arctic village in Sweden, to look at how they’re using mifepristone for abortions up to 22 weeks in pregnancy, compared to up to 10 weeks in the U.S. And it’s a really interesting look at how they’re navigating rural access to abortion in very remote areas. Almost all abortions in Sweden are done through medication abortion, and while the majority here are in the 60% versus high 90s. So just interesting how they’re taking their approach there as rural access is limited here. 

Rovner: Really interesting story. Joanne. 

Kenen: This is a piece in The New Yorker by Dhruv Khullar, and it’s “” And what I found interesting, we’ve been hearing about: Can AI do this? It’s sort of been in the air since AI came around. But what was so interesting about this article is there’s a nonprofit that is actually doing it, and they have this sort of whole sort of hierarchy of why a drug may be promising and why a disease may be a good target. And then the AI look at genetics and diseases, and they have four or five factors they look at. And then there’s this just sort of hierarchy of which are the ones we can make accessible. 

So A, it’s actually happening. B, it has promise. It’s not a panacea, but there’s promise. And C, it’s being done by a nonprofit. It’s not a cocktail for an individual patient. It’s trying to figure out: What are the smartest drugs to be looking at and what can they treat? And they give examples of people who have gone into remission from rare diseases. And also it says there are 18,000 diseases and only 9,000 have treatment. So this is huge, right? Rare diseases may only affect a few people, but there are lots of rare diseases. So cumulatively some of the people they strike are young. So for someone who doesn’t always read about AI, I found this one interesting. 

Rovner: Also, we read somebody’s story about how AI is terrible for this, that, and the other thing. It is very promising for an awful lot of things. 

Kenen: No. Right. 

Rovner: There’s a reason that everybody’s looking at it. 

All right, my extra credit this week is also from The New York Times. It’s called “,” by David Enrich, who’s The Times’ deputy investigations editor and, notably, author of a book on attacks on press freedoms. That’s because the story chronicles how UnitedHealth, the mega health company we have talked about a lot on this show, is taking a cue from President Trump and increasingly taking its critics to court, in part by claiming that critical reporting about the company risks inciting further violence like the Midtown Manhattan murder of United executive Brian Thompson last year. 

I hasten to add, this isn’t a matter of publications making stuff up. United, as we have pointed out, is a subject of myriad civil and criminal investigations into potential Medicare fraud as well as antitrust violations. This is still another chapter unfolding in the big United story. 

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

Raman: I’m at Bluesky, . 

Rovner: Sandhya. 

Raman: I’m and , @SandhyaWrites. 

Rovner: Joanne? 

Kenen: I’m mostly at Bluesky, , and I’ve been posting things more on , and there are more health people hanging out there. 

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

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

Julie Rovner: Hello from KFF Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Feb. 26, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

Today, we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: And Sheryl Gay Stolberg of The New York Times. 

Sheryl Gay Stolberg: Hi, Julie. 

Rovner: No interview this week, but more than enough news, so we will jump right in. So we watched all the nearly two hours of President [Donald] Trump’s longest ever State of the Union address, so you wouldn’t have to. And if you’re interested in what he had to say about health, you really only needed to tune in for about five minutes, during which he took a victory lap for lowering drug prices, which he kind of did and mostly didn’t, and announced that Vice President JD Vance will henceforth be in charge of fighting fraud in health and social programs, which we’ll talk more about in a moment. Yet, just last month, President Trump told House Republicans at their retreat that health should be front and center as an issue for the midterms. What happened to that strategy? 

Weber: I gotta be honest, I was shocked. I mean, KFF recently had a poll saying that health care costs are top of mind for voters, so the fact that he spent only five minutes of the longest State of the Union talking about health care, I think, is quite notable. And he had stuff he could have talked more about, on affordability, that he did mention when he got to it. I think some of it was a lot of the State of the Union did focus a lot on, you know, the hockey team and other various awards. 

Rovner: Yes, the Olympic hockey team came marching in through the press gallery. That was something I’ve not seen in my 38-something years as a State of the Union watcher … 

Weber: As a former high school field hockey goalie, I’m a big fan of the goalie getting the medal. But it did take away from some of the more policy topics. So again, health care costs â€” top of mind for people â€” seems like a missed opportunity. 

Stolberg: Here’s my take on that. First of all, I think we know why Trump said he was going to let Bobby [Health and Human Services Secretary Robert F. Kennedy Jr.] go wild on health. Because Trump doesn’t really care that much about health care. He finds it complicated. He has said so. I’m sure you remember from the first term, Who knew health care was so complicated? In addition, TrumpRx, I think, OK, he can point to that. Gonna say, he can trumpet that, no pun intended. But his health care plan is barely a concept of a plan. He doesn’t have a plan. His notion of directing money into health savings accounts to help people buy health care, quote-unquote “outright,” you know, is just not workable, and it’s vague. Republicans on Capitol Hill have a number of thoughts about how to achieve that, but he doesn’t really have anything to offer, and he’s got to deal with these Obamacare subsidies having been replaced. So I think this has always been a weakness for Republicans. And if there’s one strength that Trump has, it’s kind of the MAHA [“Make America Healthy Again”] movement, which is itself, and we’ll talk about this later, you know, fractured. And he didn’t mention that at all. 

Ollstein: Not only did he not spend a lot of time on this, but he exaggerated and sort of misrepresented the few things he has done. And I think there is a big political danger in that, if you say, We solved drug pricing, we brought down your drug prices, and the voters don’t feel that, when they go to pick up their drugs, they cost just as much. There could be a backlash there. And so I think there’s a risk to not focusing on this overriding issue enough, but I think there’s also a risk in overpromising and underdelivering to voters. 

Rovner: Yeah, you’ve anticipated my next question, which is to do a quick fact check on some of those claims, particularly the one that he lowered drug prices more than any previous president. He has indeed negotiated deals that have lowered some drug prices for some people, mostly those who buy their drugs without insurance coverage. But I think you could argue that Presidents [Bill] Clinton, [Barack] Obama, [Joe] Biden, and even George W. Bush, who signed the big Medicare prescription drug benefit bill â€” all those presidents signed legislation that had a much bigger impact on what Americans pay for their drugs than Trump has at least so far produced, even though he talks about it a lot. 

Stolberg: I think that’s a really good point. Medicare Part D was huge. You know, it had its flaws. It inserted the provision barring Medicare from negotiating directly with companies, which Joe Biden, you know, with the Inflation Reduction Act, partially overturned, or at least dug into. But I think that was an inflated statement, to say the least. 

Rovner: Yeah, and I think Alice is right. This is going to be lived experience for a lot of Americans. It’s like, Wait, I thought you said you lowered drug prices. I’m not seeing my drug prices much lower yet. 

Ollstein: Well, the Democrats found that as well when, you know, they passed meaningful things, but things that didn’t kick in before the election. And so the message didn’t line up with the lived experience, and it didn’t have the political benefit that they were hoping it would. 

Rovner: Yeah. Now, Trump also said, and I quote, that “I want to stop all payments to big insurance companies and instead give that money directly to the people.” Now I think he was talking about the Affordable Care Act subsidies, which have been the topic of much debate since last year. But the fact is that the federal government gives lots and lots of payments to big insurance companies through Medicare and Medicaid, particularly Medicare Advantage, which was part of that big bill that George W. Bush signed in 2003. I imagine this is giving health insurers some pretty major heartburn right now. 

Stolberg: It’s always easy to beat up on the insurance companies, right? Like, they’re a very easy target. But, you know, we had a fact-check team at the State of the Union address the other night. I was on it, and I fact-checked this statement, and I wrote, “This is misleading.” I said he’s, you know, proposed redirecting insurance subsidies into health savings accounts, which people could use to purchase health care services directly. And then, as I just stated earlier, it doesn’t offer specifics. And I quoted your analysis, at KFF, which says the president’s plan is vague, and without knowing more, it is impossible to say what the implications would be for people with preexisting conditions who rely on the ACA markets. So I think what’s bedeviling Trump is the expiration of these ACA extended tax credits, and he doesn’t have an answer for it. 

Ollstein: And the remarks at the State of the Union, I think, never say an issue is over, because we know in health care, things always come back in some form. Nothing’s ever over, but it could be read as the final nail in the coffin for the negotiations around reviving the ACA subsidies, if you have the president getting out there and saying no more money for big insurers, that doesn’t exactly help the few Republicans who are trying to negotiate something on Capitol Hill, get something done. 

Rovner: Although he has been on all sides of this issue. 

Ollstein: Oh, certainly. But in terms of messaging and the bully pulpit and where the energy is going, it’s not going into, hey, let’s cut a deal to bring down people’s rates, even if that includes giving money to the insurers, which, you know, of course, they’ve also misrepresented this issue. And, you know, where the money goes and what it’s used for has been, you know, sort of misrepresented. So it’s just a mess. 

Stolberg: If they called Obamacare “Trumpcare,” he’d give the money to the insurers. 

Rovner: That’s true. Maybe they should have done that at the time. Well, finally, about the speech about that fraud announcement on Wednesday, the day after the speech, HHS announced again that they plan to withhold Medicaid money from Minnesota based on fraud allegations. This is the latest in a series of efforts going after Minnesota and its Democratic governor and 2024 vice presidential candidate Tim Walz over what actually is a continuing Medicaid fraud problem that the state and the federal government have been working on for over a year. But now it’s complicated by the fact that, apparently, every single member of the federal task force that was working on the fraud cases from the U.S. Attorney’s Office in Minnesota have resigned over the feds’ immigration work. So they were working on fraud, but they’ve left for other reasons. When we talked about this last month, about the federal government withholding Medicaid funding from Minnesota, I asked the panel when other blue-state governors were going to start paying attention to feds’ withholding federal Medicaid funds from blue states. I guess that would be now. 

Weber: I mean, yeah, it’s a lot of money. I mean, Medicaid money would be a huge problem if a bunch of blue states lost it. We’ve seen selective targeting of blue states for public health funds. It seems reasonable to expect that to be coming for the Medicaid fraud. I think it’s important to note there is a fair amount of Medicaid fraud, and CMS [Centers for Medicare & Medicaid Services] has announced what looks to be a somewhat promising fraud initiative about stopping “pay and chase.” So, I mean, I think there’s a lot of story left on spool here on that front. 

Rovner: You have to say what pay and chase is. 

Weber: Oh, yes, so pay and chase. This is one of my one of my soapboxy things. I did an investigation with Sarah Jane Tribble back when I was at Kaiser Health News [Ñî¹óåú´«Ã½Ò•îl Health News] all about this. But essentially, the way the fraud system works here in the United States, which is kind of wild, is that people just pay the fraudsters money, and then the feds have to chase to get the money back, which is kind of crazy. It’s a system that many experts have explained to me is incredibly broken and leaves the taxpayer holding the bag, because often they don’t get the money back. So there is this new effort by CMS to utilize AI in a way that could really revolutionize how fraud is fought, but the selectiveness of which this seems to be being applied to Minnesota, or at least highlighted in Minnesota, leads to some political concerns. 

Rovner: I will add that part of this big new fraud effort is also going after fraud in durable medical equipment, which made me both smile and roll my eyes, because this has been a continuing problem ever since I started covering health care in the 1980s. Indeed, fraud is perennial. There’s a lot of money, some people are going to cheat to find it, and there’s always going to be an effort to work to ferret it out. 

Well, it was a busy news week beyond the State of the Union. Also on Capitol Hill this week, Casey Means, President Trump’s nominee to serve as surgeon general, finally got her confirmation hearing before the Senate Health, Education, Labor & Pensions Committee after she had to bow out of an earlier scheduled date last fall because she went into labor with her first child. Lauren, remind us who Casey Means is, and how’d the hearing go? Is she going to be our next surgeon general? 

Weber: So Casey Means is a health tech entrepreneur and someone with a large social media following who really got her bona fides from condemning the medical establishment, from leaving her residency and rising on podcasts and other talk shows, and through her entrepreneurship to promote this idea that the medical system is broken, and here’s how we can fix it. And when she finally got her hearing on the Hill, I think it’s really interesting, because she and her brother, Callie Means, really wrote the MAHA bible. They wrote this book called Good Energy, which a lot of MAHA principles are based off of. And what’s fascinating about a confirmation hearing for her is you see how MAHA, as a coalition, really doesn’t have a political home. There’s parts of it that Democrats really like, there’s parts of it that Republicans obviously really like, and there’s this awkward confrontation of that when you see this MAHA figure then questioned by both sides of the aisle. Something that she really exposed is a current deep issue in the MAHA movement, which I know Sheryl’s also , and she got a bunch of questions from both sides of the aisle on that. But the big takeaway, I think, a lot of people were focused on, as they should as surgeon general, was that she dodged a lot of questions about vaccination. She refused to explicitly say she would recommend the measles or flu vaccine, which is pretty shocking coming from a potential surgeon general candidate, but also in line with the MAHA movement and her political patron, Robert F Kennedy Jr. 

Rovner: And also, I mean, Sheryl, you and I were talking before we started taping that, I mean, she did, compared to some of the nominees for some of these jobs, she did a pretty good job. She was really smooth. She ducked questions in a way that one does duck questions, you know, saying thank you for asking that good question. But I know you were saying also, there’s some talk about whether or not she’s actually qualified to be surgeon general. 

Stolberg: That’s what I’m hearing today. I agree with you, Julie, that she was very smooth, and I was actually struck by how much her appearance reminded me of what confirmation hearings used to look like in the pre-Bobby Kennedy era, when nominees, you know, tried to entice politicians, tried to, you know, be engaging. She thanked Democrats. Thank you so much, Sen. [Patty] Murray, for engaging so deeply with these issues, you know, I want to thank you for our meeting that we had. I really enjoyed getting to talk with you, you know. And she is very knowledgeable, and she’s a smooth speaker, and she was, I think I told Lauren last night, she was like the Artful Dodger. Or maybe I should, I might have said that on social media. But there are questions about her credentials. So, her medical license is inactive. She has a license with the Oregon Medical Board. It is inactive. This means that she cannot prescribe medication, and she can’t treat patients right now. And there’s some question about whether or not one has to have an active medical license, not necessarily to be a surgeon general, but to be head of the Commissioned Corps of the [U.S.] Public Health Service, which the surgeon general is. 

Rovner: And which is basically the only â€¦ the surgeon general used to have a lot of line authority at HHS, and the only thing that’s left is being head of the Commissioned Corps. 

Stolberg: That’s exactly right, and the bully pulpit. And, you know, I looked at the statute last night. The statute also says that the surgeon general has to have, quote, I think, “experience in public health programs.” But it’s ill-defined. Like, what does that mean? But you are seeing some folks today, including, as you mentioned earlier, Julie, Jerome Adams, President Trump’s surgeon general, who are raising questions about her qualifications. And I think we may see more of this. 

Ollstein: I also thought it was notable that  this morning and said they find her unqualified, and raised concerns that her equivocation on vaccines could further contribute to the already diminishing trust, public trust in public health. And so the Wall Street [Journal] editorial board remains pretty influential among conservatives, so I think that is an interesting sign of where things could go. And, of course, raises the question if her nomination does collapse for lack of votes, who else could be nominated? 

Rovner: And I guess Jerome Adams doesn’t want to come back for the second term. 

Ollstein: I don’t know if he’d be welcomed back. 

Rovner: He’s burned his bridges. 

Weber: He’s not welcome back, if I had to guess, yeah, no. 

Stolberg: No, he doesn’t want to come back. He’s hawking his book. 

Rovner: Lauren, you wanted to add something? 

Weber: Yeah. I just wanted to add, I mean, it was interesting. She did get a couple stronger questions. [Sen. Lisa] Murkowski from Alaska, obviously, a Republican moderate who could be a potential “no” vote of the group, did question her pretty strongly on her stance on hepatitis B vaccines. She did get a question from [Sen. Jon] Husted about her thoughts on pesticides. That said, you know, [Sen. Bill] Cassidy also peppered her with some questions, but Cassidy also peppered Kennedy with a lot of questions, and then he was confirmed. So I think there is some chatter today about her credentials, but no Republicans brought up her credentials yesterday. The person who did was a Democratic senator, Sen. [Andy] Kim, I believe, and so, you know, we’ll have to see in this political moment what shakes out. 

Rovner: Before we leave this subject, Alice, like most of the high officials at HHS of late, she rather deftly ducked Chairman Cassidy’s question about whether the abortion pill mifepristone should be available without an in-person visit with a doctor. What did you take away from her answer? 

Ollstein: So, her comments on birth control got more attention, which we can talk about in a sec, but on mifepristone, it was very much in line with this administration just not wanting to talk about it and saying, Everybody shut up. We’re studying it behind closed doors. Just wait for us to do that, and then you can say something. So she very much kept in line with that. Didn’t want to tip her hand. 

Rovner: I would say it felt like she’d been given the talking points. 

Ollstein: Yes, exactly. And she was not really, like, free in sharing her personal views on the matter, because she was, you know, seemingly told to stick with the administration line. But I think Lauren can talk more about the birth control piece, and she’s researched that a lot. 

Weber: Yeah, I could chime in on that. And I also, just on the mifepristone piece, I think it was notable that [Sen. Josh] Hawley didn’t go after her for it. I felt like that was Hawley toeing the line, because, obviously, he, notably, in some of the RFK hearings, really went after that, and also has publicly, recently stated that he’s very disappointed in the FDA on mifepristone. So the fact that he had a pretty chummy exchange with her, some softball questions about AI chatbots, I mean, it was, I thought, notable in terms of toeing the line, on Hawley towing the mifepristone line. When it comes to birth control, Means does have a history of disparaging birth control and highlighting some of the known side effects and speaking about wanting more natural forms of contraception, which is, you know, somewhat common in the right-wing and wellness influencer space that she currently finds herself in. 

Rovner: Sheryl, do you want to add something before we move on? 

Stolberg: Abortion also is not a good issue for this administration. It’s not a good political issue. President Trump didn’t bring it up during his State of the Union. They don’t want to talk about it. It’s a loser for them. So I think that probably accounts for Hawley’s reticence in asking her about it, and, you know, sort of the muted answers that she gave, and she was very careful to say, I believe birth control should be available to all women, and she kind of said that her previous remarks, where she had said that it had horrific side effects, etc., were taken out of context. 

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

Well, while we were on the subject of abortion, to follow up on what Sheryl just noted, President Trump did not mention it during the State of the Union, a speech where he touched on lots of other things that were important to his base. He has been hinting that he wants to downplay abortion for a while now, but could this come back to bite him and other anti-abortion Republicans in the midterms, where some of his most motivated voters might just not turn out? 

Ollstein: So that’s the argument that anti-abortion advocacy groups have been, you know, shouting from the rooftops for months now. And you know, they recently put together their own polling to try to make that argument. And I think that different wings of the Republican Party are making different calculuses here. And you could argue that not doing enough on the issue is risking the votes of the conservative base, who are really fired up about this. You know, these voters are very motivated. They turn out. They knock on doors, these anti-abortion voters. But the administration seems to be making a calculus that there are a lot more people out there who are uncomfortable with the kind of national restrictions that the anti-abortion movement is demanding from the FDA, and so they, like Sheryl said, have calculated that this is a loser issue for them and they should lean away from it. And it’s just interesting because a midterm year is not the same as a presidential year in terms of who turns out, who gets fired up. And of course, there’s the primary versus general election dilemma, where doing one thing could really help you in a primary, but doing the opposite could really help you in the general, and so something you say on the campaign trail could come back to bite you later. 

Rovner: Sheryl, you want to add something? 

Stolberg: Yeah, I think it’s fascinating to look at Trump I versus Trump II. So when Trump was running for office in 2016, he made a deal with Marjorie Dannenfelser, one of the big leaders of the anti-abortion movement, that he was going to work to overturn Roe. And the anti-abortion movement just embraced Trump and said, you know, he was the most anti-abortion candidate ever, the most anti-abortion president ever. Well, now Roe has been overturned, and it’s a completely different climate, where we are seeing the effects of what it looks like in states where women do not have access to abortion. And it’s a dark picture out there. I mean, women are being injured, and this struggle is, it’s a different debate, and it’s a much harder debate. It was easier for Trump when Roe was intact. 

Rovner: Yeah, and we’ve, I mean, what we’re seeing, it’s also, it’s not just people, it’s not just women who want to get abortion. It’s women who can’t get care during pregnancy complications. â€¦ I think that’s the piece that’s upsetting so many people. And, you know, shoutout to ProPublica, who’s just continuing to do an amazing job with this. Lauren, you want to add something? 

Weber: Yeah, I think it’s notable that he didn’t talk about abortion in the State of the Union, but he did bring up fertility drugs, and how his TrumpRx can reduce the cost for fertility drugs. And obviously that could agitate some members of the anti-abortion â€¦ some of the more hard-core members of the anti-abortion movement who have issues with fertility treatments like IVF. But I think also, Trump’s making a calculus, as we’ve talked about: Are the anti-abortion voters gonna go vote for the left? Probably not. I don’t think so. So â€¦ 

Rovner: It’s just a question of whether they stay home. 

Weber: It’s â€¦ a question of whether they stay home. But I think he’s just playing to the fact that he thinks he has them in the bag to some extent. 

Rovner: Maybe they won’t stay home because they’d rather have him than â€¦ his candidates, those who would like to restore abortion. Well, also this week â€” I said there was a lot of news â€” while the administration isn’t moving very fast to try to rein in availability of the abortion pill, states are. There was a hearing in federal court this week in Louisiana about that state’s lawsuit calling for the FDA to rescind its rule allowing the mailing of mifepristone from out of state. Alice, I imagine the administration would much prefer this decision to ultimately be made by judges and take it out of their hands, right? 

Ollstein: Well, what they’re asking the court is to not make a decision at all. They’re asking them to hold it in abeyance, which is fancy judicial language for hit pause. Put it on freeze. Don’t do anything right now, like the messaging we were talking about in the confirmation hearing. What they are telling courts is: We’re working on this issue. You should defer to us and stop these states from suing us, and let us work on reviewing the abortion pill behind closed doors, and we will issue some sort of a decision at some point. And so that is, you know, what came up in court in Louisiana. The only other notable thing is that the judge did allow the makers of the pill, Danco and GenBioPro, to intervene in the case. So that happened because the Justice Department is not defending the regulations on the pill on the merits. They’re not saying, you know, the FDA went through a fair scientific process, and we are defending the decision they made to allow telemedicine and mail delivery of the pills. They’re not doing that. They’re saying, Hit pause. So the drug companies are the ones now in court, allowed to make the argument that the FDA should be, you know â€¦ their decision was based on science and not ideology, and that should be left alone. 

Rovner: Well, we’ll see how this all plays out. All right, moving on to news from the Department of Health and Human Services. Last week, we mentioned that Jay Bhattacharya, the director of the National Institutes of Health, has now also become the acting head of the Centers for Disease Control and Prevention. That’s awkward for a lot of reasons, not least of which is that the NIH is headquartered in Bethesda, Maryland, just outside Washington, D.C., and CDC is in Atlanta, Georgia. Bhattacharya is also the third interim director of the CDC in seven months, after the first interim chief, Susan Monarez, was confirmed by the Senate to lead the agency, then summarily let go when she refused to rubber-stamp the recommendations of the anti-vaxxers appointed to CDC’s vaccine advisory panel by Secretary RFK Jr. Monarez was replaced by HHS Deputy Secretary Jim O’Neill. He’s now been relieved of both jobs and is off to head the National Science Foundation. Adding to the confusion, the No. 2 at the CDC, Ralph Abraham, stepped down this week, effective immediately, citing, quote, “unforeseen family obligations.” Lauren, you said last week that this is all about the White House wanting to rein in HHS, in general, and its anti-vaccine activities, in particular, in advance of the midterms. But what might this continued churn mean for CDC, and are we ever going to see someone nominated to, you know, run the agency? 

Weber: Julie, I wish I had the answer to that question, because I would certainly have written that story if I had an answer to what will happen to the leadership at CDC. I don’t know. I mean, I think the bottom line is, is that this is an agency that has not had a steady leader for a very long time. It has certainly made some quite shocking moves for the CDC. Obviously, they overhauled the vaccine schedule at the beginning of January, and it remains to be seen how this will be going forward. I think it’s very difficult. Running a federal agency is a huge task. I mean, assuming that someone can run both equally is a tough sell. I do think he’s limited in terms of time, of how much time he would be interim. But the reality is, and I think , and it seems like there’s not a lot of people running the top of the CDC these days. 

Rovner: Yeah. Well, remember when Monarez quit, most of the career leadership also quit. So, I mean … 

Weber: Right. The agency was also gutted when RFK Jr., you know, got rid of about a quarter of HHS at the beginning of his term. So the CDC is, certainly, is a very changed and in mangled shape currently. So I think it remains to be seen who ends up taking the reins of it. 

Rovner: Sheryl, how are things at CDC? 

Stolberg: They’re really difficult. I talk to people inside the agency, you know, they’re feeling really dispirited. A lot of the top leadership is gone, as we just said. The idea that Jay Bhattacharya could run the NIH and the CDC, two massive federal agencies with complementary missions â€” the NIH is the nation’s biomedical research agency; the CDC, public health â€” in two locations, Atlanta and Bethesda, is, honestly, I don’t know who came up with this idea. I heard â€¦ I don’t have evidence to back this up, but I heard that this was actually Trump’s idea, which kind of makes sense, if that is true, because maybe only President Trump would think up such a crazy thing that you could [laughs] … I think they recognized that they needed to put someone Kennedy trusts in there. That has really been kind of the big issue. And it is all about the midterms. It’s all about the pivot. The White House wants Kennedy to turn away from vaccines and toward healthy eating. That’s why we’re seeing him do this national “Eat Real Food” tour. And, you know, wearing the Mike Tyson tattoo and social media, etc. It’s a very, very difficult situation for a storied agency, and many, many people are worried that it is going to take a long time for the CDC to rebuild, if ever. 

Rovner: Lauren, you want to add something? 

Weber: Yeah, I just wanted to echo that, I think, what gets lost in a lot of D.C. circles and, frankly, around the country, is this is an agency that also was pocked with bullet holes just a couple months ago. I mean, if that had happened in D.C., I think you would see a very different response, to be quite honest. I was very taken aback and shaken to see the bullet holes when I went down after that happened. And I think the visuals of that got a bit lost in some of the conversation. But so this is an agency that not only is suffering with utter leadership turmoil, but has, frankly, been shot at. And so â€¦ 

Rovner: Right, they were physically attacked, their building was physically attacked. 

Weber: Physically attacked. And so the folks that are still left, I think, it’s a tough deal. And to Sheryl’s point on the midterms, and I have a , led by Rachel, you know, we found out that the MAHA piece of this is, look, I mean, they’re telling Kennedy to focus on foods because they see it as more popular. And honestly, MAHA is saying they’re gonna throw some cash. Tony Lyons â€” I mean, who knows that this will happen â€” but Tony Lyons told me they’re hoping to raise $100 million for midterm spending for Republicans. So, you know, there is that element of the coalition that I think they’re trying to make happy with this whole piece of it. 

Stolberg: One interesting note about the cash. Tony Lyons has already committed a million dollars to Cassidy’s primary challenger, which is really interesting. I mean, Cassidy voted reluctantly for RFK to be secretary, you know, and he fell on his sword for the administration, and now Kennedy’s people are working actively to unseat him. 

Rovner: Let us move to MAHA. I have a segment that I’m calling “MAHA Is Mad-Ha.” The Make America Healthy Again movement is big mad about RFK Jr.’s seeming reversal on the use of weed killers by Big Farm, not to be confused with Big Pharma. The HHS secretary Sunday night put out a lengthy statement arguing that while pesticides and herbicides used on crops are poisons, that U.S. agriculture is also dependent on them, and their use needs to be phased out, rather than cut off, in order to protect the nation’s food supply. MAHA advocates, though, see this as a complete betrayal. Sheryl, I want you to start â€¦ start by telling us where you are and why. 

Stolberg: So I’m in Austin, [Texas,] where there is a MAHA Action rally tonight, interestingly, an “Eat Real Food” rally. They’re not going to be talking about glyphosate, as far as I know, and they’re not going to be talking about vaccines. So, just an interesting sort of personal perspective: Last Wednesday, when Trump issued the executive order on glyphosate after business hours, right? Shocker, I was like â€¦  

Rovner: And glyphosate is the weed killer that’s used in Roundup, which has been the subject of many, many lawsuits that it’s a carcinogen. And some of those lawsuits were brought by RFK Jr., right? 

Stolberg: That’s right, who won a massive judgment in 2018, a $289 million judgment. And this weed killer, Roundup, this has really been an animating force behind a lot of the MAHA movement, the Moms Across America, led by Zen Honeycutt, is really wrapped up in this issue, in getting glyphosate out of American food. As Vani Hari, who calls herself the Food Babe, said to me, What good is it if you eat real food, if it’s sprayed with pesticides? So I was, you know, minding my own business that Wednesday night, Trump issues the executive order, and I sent a text to Kennedy’s spokesman, and I said, Does the secretary have any response? And I got a three-sentence reply, basically saying that, you know, Kennedy was supporting Trump. This was a matter of national security. That is how Trump framed his order. He said, We need to ramp up production of this weed killer because we have only one domestic producer, and we don’t want to rely on foreign nations to keep our food supply running in the event of a crisis. That three-sentence statement from Kennedy obviously did not sit well. His MAHA moms exploded. I can’t even begin to tell you the anger. My headline of the story that I wrote said “,” and then it quoted someone I interviewed from Turning Point USA, Charlie Kirk’s organization, saying, women feel like they were lied to. So the anger is very deep and real. And I guess Kennedy felt that he had to address it in some lengthier way to, you know, try to assuage this part of his movement that really helped power him to the position that he is in right now, and also aligned itself with Trump, perhaps foolishly, and helped, you know, they threw their weight behind a Republican. And now, I think, Lauren said earlier, they really kind of have no political home. 

Rovner: Yes, Lauren, did you want to add to that? 

Weber: Yeah, no. I mean, Sheryl hit all the points. I think it’s important to note that these people are mad, as she said. And, you know, Glyphosate Girl, Kelly Ryerson, who’s big on social media, told me some version of We feel lied to in the sense that we, you know, we showed up, we voted for this, and we’re seeing no results, and we may change our minds in the next election. Because a lot of these people were independents or Democrats or so on. And I think what’s really fascinating about that is it kind of goes back to when Kennedy was going to be in consideration to be a health czar or something else. I mean, the bottom line is, the man does not have control over the EPA [Environmental Protection Agency]. I mean, that’s not his jurisdiction. And I think that a lot of his followers really got on board with the MAHA movement under the pretense that he was going to come in, he was going to do all this stuff. But the political realities are just very different. And this MAHA coalition, you know, as I talked about earlier, is so fascinating because it talks all about “real food,” which is, as we’ve talked about on this podcast, was Michelle Obama, a Democrat-led issue 10, you know, a decade or more ago. It talks about glyphosate. Typically, you see that as often being a lefty issue that is now under this right tent. And then, obviously, vaccines, which kind of is a political horseshoe issue, which you often see on the far left and far right. And I think you see this fracture in MAHA, because it just does not fit very neatly within the partisan lines that D.C. is so accustomed to. 

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

Weber: Yeah. So I wanted to highlight an article that I did with my colleague Lena [H.] Sun and Caitlin Gilbert, and it’s titled “.” We did a deep dive into how Kennedy feels about the flu vaccine, and it turns out that he, in several instances, has linked it to his spasmodic dysphonia, which is a type of dystonia. It’s a neurological voice condition that causes his raspy voice. But the catch is, is that all the scientific experts that we spoke to said there’s no scientific evidence to support that. And as Kennedy has gone around saying this about his voice, he’s also disparaged the flu vaccine while in office on, you know, the day after he took office, last February, he moved to kill a national flu vaccine awareness campaign. And this January, he downgraded the recommendation for the flu vaccine for children. And public health officials that I spoke to are horrified. They’re very worried this could lead to more cases, more misery, potentially even deaths from the flu. And some of the otolaryngologists that I spoke to also pointed out that while Kennedy had linked this condition, which was also known as a dystonia, to his voice, and there was no scientific evidence to link it to vaccines, however, there is evidence of some association between drug use and dystonias. And they pointed out that that is an association. And as has been well reported in the past, Kennedy has spoken very openly about his heroin addiction. And so, you know, we spoke to a bunch of folks who just marked this sea change that we’ve seen. You know, Kennedy obviously has, has gone after vaccines, but the flu vaccine in particular appears to be personal. 

Rovner: It does. Really interesting story. Thank you for writing it. Sheryl.  

Stolberg: I was just going to say, if Lauren hadn’t written that story and wanted to talk about it, I’d have wanted to talk about it because it was such a good story. So the story that I think people need to read this week is by ProPublica, and it’s headlined, “.” And this is a really fascinating and troubling story about what’s happening in South Carolina. There are 973 reported cases of measles there. But because hospitals aren’t required to disclose it, doctors have no idea, and ordinary people have no idea where it’s happening. The story opened with a man who went to a meeting to talk about what happened to his wife. His wife was a schoolteacher, and she was vaccinated against measles, like pretty much all American adults are. But one of her kids in her class had measles, and she had a rare breakthrough infection, and she got very, very sick. And there was no way to foresee this. And I think that this is like a canary in a coal mine issue, where we’re seeing sort of a downgrading of the importance of knowing about infectious disease, especially measles, under this Trump-Kennedy health regime. And it’s putting people in danger. 

Rovner: Yeah. It was quite an interesting story. Alice. 

Ollstein: So I have a piece from Stat [“”] by my former colleague Daniel Payne and our co-podcast friend Lizzy Lawrence. And it is about how the FDA has become politicized and become a much bigger lobbying target than ever before. And they go into how a lot of decisions are being made by the White House. And so that has, you know, emerged as the center of power in FDA-related decisions. And thus, you know, companies that have business before the FDA feel that it’s worth it for them to pour lobbying efforts into this in order to influence processes that previously they felt they couldn’t influence. And so that’s raising a lot of concerns. So I highly recommend the piece. 

Rovner: Yeah, really interesting story. My extra credit this week is from my KFF Health News colleague and sometime podcast panelist Julie Appleby, and it’s called “When It Comes to Health Insurance, Federal Dollars Support More Than ACA Plans.” Now, this is something we have talked about before, and I have talked about a lot since the debate over the expiring ACA subsidies heated up. But it bears repeating: Just about everyone who gets health insurance in the U.S. gets some sort of federal subsidy. It’s not just people who buy it on the ACA marketplaces. Medicare and Medicaid are both paid for in large part through taxpayer dollars. Employers get a tax break from offering health insurance, and employees who get health benefits don’t pay taxes on them, which is one of the biggest subsidies in the federal budget. So the next time somebody complains about why people who buy their own health insurance should get federal help with the costs, remember that, in all likelihood, you do, too. 

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

Stolberg: I’m at @SherylNYTon both  and . 

Rovner: Lauren. 

Weber: I’m @LaurenWeberHP â€” the HP is for health policy â€” at  and . 

Rovner: Alice. 

Ollstein: I’m on Bluesky  and on X at . 

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

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and, starting this week, from WAMU public radio in Washington, D.C., and welcome to “What the Health?” I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Oct. 30, 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 video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Good to be here. 

Rovner: And we welcome back to the podcast one of our original panelists, Paige Winfield Cunningham of The Washington Post. So great to see you again. 

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

Rovner: Before we dive in, we have a little of our own news to announce. Starting this week, we’re partnering with WAMU, Washington D.C.’s public radio station, to distribute the podcast. That means you can also now find us on the NPR app. And welcome to all you new listeners. OK, onto the news. We are now 30 days into the federal government shutdown, and there is still no discernible end in sight. And this Saturday is not only the start of open enrollment in most states for the Affordable Care Act health plans, which we’ll talk more about in a minute. It’s also the day an estimated 42 million Americans will lose access to food stamps after the Trump administration decided to stop funding the SNAP [Supplemental Nutrition Assistance] program. That’s something the administration did keep funding during the last Trump shutdown in 2019, and, according to budget experts, could continue to do now. So what’s behind this? As I think I pointed out last week, not such a great look to deprive people of food aid right before Thanksgiving. 

Ollstein: So I think this follows the pattern we’ve seen throughout the shutdown, which is just a lot of picking and choosing of what gets funded and what doesn’t. The angle of this I’ve covered is that out of all of the uniformed forces of the government, the Trump administration dug around and found money to keep paying the armed members, but not the public health officers, who are also part of the uniformed branches of the country. And yeah, you’re seeing this in the SNAP space as well. President Trump and his officials have openly threatened to go after what they see as Democrat programs. So it’s just interesting what they consider in that category. But you’re seeing a lot of choices being made to exert maximum political pressure and force various sides of this fight to cave, but we’re not seeing that yet either. 

Rovner: Yeah, they are. I mean, it seems this is also backwards because it’s usually the Republicans who are shutting down the government, the Democrats who are trying to pressure them to reopen it. And now, of course, we’re seeing the opposite because the Democrats want the Republicans to do something about the Affordable Care Act subsidies, and the Republicans are going after previously what had been kind of sacrosanct bipartisan programs like food stamps and the WIC [the Special Supplemental Nutrition Program for Women, Infants, and Children] program, for pregnant and breastfeeding moms and babies. And now, apparently, they’re going to stop funding for Head Start, the preschool program for low-income families with kids. On the one hand, you’re right, they are programs that are very cherished by Democrats, but I feel like this whole shutdown is now sort of going after the most vulnerable people in America. 

Goldman: It’s also been interesting because [Health and Human Services] Secretary [Robert F.] Kennedy [Jr.] has tried to use SNAP as a vehicle for his Make America Healthy Again agenda, right? Trying to get states to limit the sugary drinks that their SNAP programs offer. And he’s, like, really touted that as part of the agenda. And now there does not seem to be any interest from HHS in speaking out about that. 

Rovner: Well, of course, and SNAP isn’t an HHS program. 

Goldman: Exactly. Exactly. 

Rovner: It’s a program in the Department of Agriculture, which is even more confusing, but you’re absolutely right. I mean, it’s odd that some of the things that he’s been pointing to are things that this administration is kind of trying to lay at the Democrats’ feet, as in, You want this program, reopen the government. So as I mentioned, Saturday is the start of Obamacare open enrollment in most of the states. And, Paige, you got a for plans in the 30 states that use the federal marketplace, which is now open for what we call window-shopping before open enrollment officially begins. What did you find? 

Winfield Cunningham: Yeah. So I got some documents at the end of last week showing that the average premium for the second-lowest-cost silver plan — which, of course, is what, we know … that’s what the subsidies are pegged to — is going up 30%, which is the second-highest premium increase. The highest we saw was 2017 to 2018. But this is a really, really significant increase. And of course, CMS [the Centers for Medicare & Medicaid Services] didn’t include that number in the document that it finally released this week. So the documents I saw had some sort of numbers like that, which were all stripped out of the official documents. But all of this is just so interesting because I was thinking about, back to 2017-2018, and the politics of this are so flipped right now because basically it was the Democrats then who didn’t want to talk about premium increases and the Republicans who were yelling about it. 

So it’s funny how that has changed. But I guess on the politics of this, it seemed for a while like Democrats were thinking maybe the Nov. 1 start of open enrollment would provide this out for them to pass the spending bill because they could say, like, OK, we tried. Now open enrollment has started, or the premiums are kind of baked, so we can’t really do anything to change it now. But I don’t think we’re going to have anything this week. It seems like both sides are pretty dug in still. I mean, I guess the other thing I would say on these costs, it’s really highlighting a weakness that we’ve known for a long time in the Affordable Care Act, which is that, like, yes, it made health insurance affordable for a lot of people, but there’s always been this smaller number of people that are above 400% federal poverty that have had no shield from insurance costs. They have the last four years, and now they’re not going to have one anymore. And it’s funny because Democrats are talking about this, but that’s sort of a problem they hadn’t wanted to acknowledge for a long time in the early years of the Affordable Care Act. And as you guys all know, there’s not going to be any political will for bipartisan work to create affordable options for these folks unless the subsidies get extended, which, of course, that doesn’t seem very likely at the moment from how things stand. 

Rovner: Yeah. Going back to what the Republicans sort of announced, their talking points, is that, well, first the premium increases aren’t that big and that the expiring extra subsidies aren’t that big a piece of it, both of which are actually kind of true. But, of course, that’s not where the sticker shock is coming from. The sticker shock is coming from the expiration of those tax credits that’s going to …  

So people who had been shielded from these very high premiums are no longer going to be shielded from them. And that’s why, if you look at social media, you see all these screenshots now of insurance that costs $3,000 a month for people who were paying $150 a month, which is obviously not affordable. Why is it so difficult to explain the difference? I’ve been working on different ways to explain it for the last three weeks. 

Goldman: I was trying to figure this out last night, when I was writing something for my newsletter today. And I think one of the really confusing parts about this is that, like Paige said, like Paige scooped, premiums are going up a certain amount, and that’s not actually what people are seeing. That’s not what almost anyone is going to actually face. Either you’re getting that huge sticker shock because you’re losing your subsidies that you had this year or you’re continuing to have subsidies, they’re not quite the same, but you’re still not going to pay a 30% increase. And so I think that that’s really confusing for me even, and hard to explain. 

Winfield Cunningham: I think one way to think about this is like the party that is going to bear the brunt of the premium costs to a large degree is the government because for people that are before 400% federal poverty, they are basically guaranteed under the Affordable Care Act that they’re not going to have to pay more for premiums over a certain percentage of their income. And so this just means, like, the subsidies are getting really expensive for the federal government, which goes back to the issue of kind of like why Democrats didn’t extend these enhanced premiums indefinitely — because it’s just expensive to do it. This is the government subsidizing private health insurance. And then it’s also significant again for those people over 400% poverty who had had a cap on what they would pay. I think it was 9.5% of their income under the enhanced … and now they have no cap. 

Rovner: I think 8.5% of their income, actually, under the enhanced premiums. 

Winfield Cunningham: Under the enhanced. OK. 

Rovner: It’s going to go back to 10%. 

Winfield Cunningham: Yeah. Yeah. But there’s no cap if you’re like over, over 400%. 

Rovner: 400%. 

Winfield Cunningham: Right. Yeah. Yeah. 

Rovner: That’s right. 

Winfield Cunningham: Yeah. But that’s why people are confused. And the other thing is, like, the administration is correct, that the vast majority of people in the marketplaces will continue to get subsidies. And we are basically going back to what the situation was before covid, but it’s that smaller number of people that are at the higher income levels. But the other thought I had was, of course, the health care industry and Democrats are talking a lot about this and spreading these huge premium increases far and wide and making sure everybody hears about them, but it’s like a relatively small number of people, if you think about it. 

And I think it’s only like a couple million people in the marketplaces who are at that higher income levels. And I wonder if that factors into Republicans’ calculations here, where they’re looking at how many voters are actually seeing these massive premium increases, having to pay for all of them. And in the whole scheme of the U.S. population, it’s not like a ton of people. So I just wonder if that’s one reason they’re sort of, like, seem to be increasingly dug in on this and very reticent to extend these subsidies. 

Rovner: Although I would point out that when the Affordable Care Act started, it was only a small number of people who lost their insurance, and that became a gigantic political issue. 

Winfield Cunningham: This is very true. 

Rovner: So it’s the people who get hurt who sometimes yell the loudest, although you’re right. I mean, at that point, the Democrats stayed the course and eventually, as Nancy Pelosi said, people came to like it. So it could work out the same way. It does help explain why everybody’s still dug in. Maya, you wanted to say something. 

Goldman: I was just going to say, I think it’ll be interesting to see, if subsidies aren’t extended, how this affects premiums next year for people and for the federal government, because if a couple million people drop out of the ACA marketplace because it’s too expensive, and those people tend to be healthier, then the remaining pool of people is sicker, and then that’s the death spiral, right? So … 

Rovner: Yeah. Although it is … 

Goldman: Obviously, that’s a lot of what ifs, but … 

Rovner: … only the death spiral that goes back to prior to covid, which — it was kind of stable at 12 million. I’m sort of amused by seeing Republicans complaining about subsidizing insurance companies. It’s like, but this was the Republicans’ idea in the first place, going back to the very origin of the ACA. 

Ollstein: And we should not forget that there is a group of people who are going to be losing all of their subsidies, not just the enhanced subsidies. And that’s legal immigrants, and that’s hundreds of thousands of people. So, like Maya said, that will probably mean a lot of younger, healthier people dropping coverage altogether, which will make the remaining pool of people more expensive to insure. So these things have ripple effects, things that impact one part of the population inevitably impact other parts of the population. And again, these are legal tax-paying immigrants with papers — will be subject to the full force of the premium increases because they won’t have any subsidies. 

Rovner: Yes, our health system at work. All right, we’re going to take a quick break. We will be right back with more health news.  

Moving on, the federal government is technically shut down, but the Trump administration is still making policy. You might remember last summer, a federal judge blocked a Biden administration rule that prevented medical debt from appearing on people’s credit reports. The Trump administration chose not to appeal that ruling, thus killing the rule. Now the administration is going a step further — this week, putting out guidance that tries to stop states from passing their own laws to prevent medical debt from ruining people’s credit, and often their ability to rent, or buy a house, or purchase a car, or even sometimes get a job. According to the acting head of the federal Consumer Financial Protection [Bureau], Russell Vought — yes, that same Russell Vought who’s also cutting federal programs as head of the Office of Management and Budget — states don’t have the authority to restrict medical debt from appearing on credit reports, only the federal government does, which of course he has already shown he doesn’t want to do. Who does this help? I’m not sure I see what the point is of saying we’re not going to do it and states, you can’t do it either. Part of this, I know, is Russell Vought has made no secret of the fact that he would like to undo as much of the federal government as he can. In this case, is he doing the bidding of, I guess it’s the people who extend credit, who, I guess, want this information, want to know whether people have medical debt, think that that’s going to impact whether or not they can pay back their loans, or is this just Russell Vought being Russell Vought? 

Goldman: I guess, in theory, maybe it goes back to the idea that if you have consequences for medical debt, then people will pay their bills, and maybe that would help the health systems in the long run. But I also think that — I don’t know what health systems have said about this particular move, to be honest — but I think there’s an interest in making medical debt less difficult for people to bear in the whole health system. So I’m not sure how popular that is. 

Rovner: Yeah. Yes. Another one of those things that’s sort of like, we’re going to hurt the public to thwart the Democrats, which kind of seems to be an ongoing theme here. Well, as we tape this morning, the Senate health committee was supposed to be holding a hearing on the nomination of RFK Jr. MAHA ally Casey Means to be U.S. surgeon general. Casey Means was going to testify via video conference because she is pregnant, but, apparently, she has gone into labor, so that hearing is not happening. We will pick up on it when that gets rescheduled. Perhaps she will appear with her infant. 

Back at HHS, a U.S. district judge this week indefinitely barred the Trump administration from laying off federal workers during the shutdown, but at the Centers for Disease Control and Prevention, it appears the damage is already done. The New York Times’ global health reporter, Apoorva Mandavilli, reports that the agency appears to have had its workforce reduced by a third and that the entire leadership now consists of political appointees loyal to HHS secretary Kennedy, who has not hidden his disdain for the agency and the fact that he wants to see it dissolved and its activities assigned elsewhere around the department. What would that mean in practice if there, in effect, was no more CDC? 

Winfield Cunningham: Hopefully we don’t have another pandemic. There’s just a lot of stuff the CDC does. And it’s been really confusing to follow these layoffs because in this last round, I remember trying to figure out with my colleague Lena Sun how many people were sent notices and then hundreds were sort of, those were rescinded and they were brought back. But yeah, I mean, I think we’re going to see the effects of this over the next couple of years. When I’ve asked the administration broadly about the reductions to HHS, what they say is that the agency overall has grown quite a lot in its headcount through the pandemic, which is true. I think they got up to like 90,000 or so. And then, according to our best estimates, maybe they’re back around 80,000, although I’m not entirely sure if that’s accurate. Again, it’s really been hard to track this. 

Rovner: Yeah. I’ve seen numbers as low as 60,000. 

Winfield Cunningham: It may be lower. Yeah. Yeah. So I think actually the 80,000, that may have been the headcount before the pandemic. Anyway, all that to say, it did grow during the pandemic, and that’s kind of the argument that they’re making, is that they’re just bringing it back to pre-pandemic levels. 

Rovner: But CDC, I mean, it really does look like they want to just sort of devolve everything that CDC does to the states, right? I mean, that we’re just not going to have as much of a federal public health presence as we’ve had over these past 50, 60 years. 

Winfield Cunningham: For sure. They’ve definitely targeted CDC. I mean, they mostly left CMS alone and FDA because, statutorily, I think it’s easier for them to shrink CDC, but it definitely is going to have massive effects over the next couple of years, especially as we see future pandemics. 

Ollstein: And the whole argument about returning to pre-covid, that doesn’t fit with what they’re actually cutting. I mean, they’re gutting offices that have been around for decades — focused on smoking, focused on maternal health, all these different things. And so this is not just rolling back increases from the past few years. This is going deeper than that. 

Winfield Cunningham: Well, yeah, it’s not like they’re just cutting the roles that were added since the pandemic. 

Ollstein: Exactly. 

Rovner: It’s not a last-in, first-out kind of thing. Well, as I said, since it looks like public health is now mostly going to be devolved to the states, let’s check in on some state doings. In Florida, where state Surgeon General Joseph Ladapo last month announced a plan to end school vaccination mandates. My Ñî¹óåú´«Ã½Ò•îl Health News colleague Arthur Allen has a story about how health officials, including university professors and county health officials, who actually do believe in vaccinating children, are effectively being muzzled, told they cannot speak to reporters without the approval of their supervisors, who are likely to say no. Seeing the rising number of unvaccinated children in a state like Florida, where so many tourists come and go, raising the likelihood of spreading vaccine preventable diseases, this all seems kind of risky, yes? 

Goldman: Yes. That was a fantastic article from your colleague, and there was a really illuminating line, which I think had been reported before, but a reporter asked the surgeon general if he had done any disease modeling before making the decision. And he said, Absolutely not, because this to him was a personal choice issue and not a public health issue. And I think that just goes to show that we have no idea what is going to happen as a result of this public health decision and it could have massive ripple effects. 

Rovner: But what we are already seeing are the rise of vaccine-preventable diseases around the country. I mean, measles, first in Texas, now in South Carolina; whooping cough in Louisiana; I’m sure I am missing some, but we are already seeing the consequences of this dwindling herd immunity, if you will. Alice, you’re nodding your head. 

Ollstein: Yeah. And I’ve heard from experts that measles is really sort of the canary in the coal mine here because it’s so infectious. It spreads so easily. You can have an infected person cough in a room and leave the room, and then a while later, someone else comes in the room and they can catch it. Not all of these vaccine-preventable illnesses are like that. So the fact that we’re seeing these measles outbreaks is an indication that other things are probably spreading as well. We’re just not seeing it yet, which is pretty scary. 

Rovner: And of course, one of the things that the CDC does is collect all of that data, so we’re probably not seeing it for that reason, too. Well, meanwhile, in Texas, Attorney General and Republican Senate candidate Ken Paxton is suing the makers of Tylenol. He’s claiming that Johnson & Johnson spun off its consumer products division — that includes not just Tylenol, but also things like Band-Aids and Baby Shampoo — to shield it from liability from Tylenol’s causing of autism, something that has not been scientifically demonstrated by the way — even Secretary Kennedy admits that has not been scientifically demonstrated. My recollection, though, is that Johnson & Johnson was trying to shield itself from liability when it spun off its consumer products division, but not because of Tylenol, rather from cancer claims related to talc in its eponymous Baby Powder. So what’s Paxton trying to do here beyond demonstrate his fealty to President Trump and Robert F. Kennedy Jr.? 

Ollstein: I was interested to see some GOP senators distancing themselves from the Texas lawsuit and saying like, Look, there is no proof of this connection and this harm. Let’s not go crazy. But as I’ve reported, it’s just very hard to get good information out to people because there just isn’t enough data on the safety of various drugs, because testing drugs on pregnant women was always hard and it’s gotten even harder in recent years. And so, based on the data we have, this is a correlation, not causation. But it would be easier to allay people’s fears if we had more robust and better data. 

Rovner: Yeah. Does a lawsuit like this, though, sort of spread the … give credence to this idea that — I see you nodding, Maya — that there is something to be worried about using Tylenol when pregnant? Which is freaking out the medical community because Tylenol is pretty much the only drug that currently is recommended for pregnant women to deal with fever and pain. 

Goldman: Yeah. I think some of my colleagues have reported on the concern of another death spiral here, right? Where people get concerned, perhaps without basis, of taking Tylenol or any other drugs, vaccines even, because there are lawsuits and then the makers of these drugs say it’s not worth it for us to make these anymore. And then they don’t make them. And then it’s like a bad cascade of events. And so it’s obviously too soon to see if that’s what’s happening here, but it’s certainly something to watch. 

Rovner: But as we’ve pointed out earlier, not treating, particularly, fever can also cause problems. So … 

Ollstein: Right. Basically all of the alternatives are more dangerous. Not taking anything to treat pain and fever in pregnancy can be dangerous and can lead to birth effects. And taking other painkillers and fever reducers are known to have dangerous side effects. Tylenol was the safest option known to science. And now that that’s being questioned in the court of public opinion, people are worried about these ramifications. 

Winfield Cunningham: I think about the effect on moms who have kids with autism who are now thinking back to their pregnancies and thinking, Oh my gosh, how much Tylenol did I take? I know I took, I had pregnancies that I took plenty of Tylenol during. My nephew has autism, and I was talking to my sister about this, and she was like, “I took Tylenol.” And what they’re doing is, I guess, other reflection I have on it is, in general, there’s just less research on most things than we need. And there are some studies showing a correlation, which as we all know is not causation. And what it looks like the administration did was they took those tiny little nuggets of suggestions and have blown them up into this overly confident declaration of Tylenol and pregnancy and probably unnecessarily causing many women to blame themselves or think, Should I have done something differently during my pregnancy? when they were really just doing what their doctor recommended they do. 

Ollstein: I’m surprised that we haven’t seen legal action from Tylenol yet. I imagine we might at some point, especially if there is some kind of government action around this, like a label change. I think we will see some sort of legal action from the company because this is absolutely going to impact their bottom line. 

Rovner: Yeah. All right. Well, finally this week, more news on the reproductive health front. California announced it would help fund Planned Parenthood clinics so they can continue providing basic health services, as well as reproductive health services, after Congress made the organization ineligible for Medicaid funds for a year and the big budget bill passed last summer. California’s the fourth state to pitch in joining fellow blue states Washington, Colorado, and New Mexico. Meanwhile, family planning clinics in Maine are closing today due to that loss of Medicaid funding. And at the same time, the Health and Human Services Office of Population Affairs, which oversees the federal family planning program, Title X, is down apparently from a staff of 40 to 50 to a single employee, . Is contraception going to become the next health care service that’s only available in blue states, Alice? 

Ollstein: So Title X has been in conservatives’ crosshairs for a long time. There have been attempts on Capitol Hill to defund it. There have been various policies of various administrations to make lots of changes to it. Some of those changes have really limited who gets care. And so it’s been a political football for a while. Of course, Title X doesn’t just do contraception. It’s one of the major things they do, providing subsidized and sometimes even free contraception to millions of low-income people around the country. But they also provide STI testing, even some infertility counseling and other things, cancer screenings. And so this is really hitting people at the same time as the anticipated Medicaid cuts, and at the same time Planned Parenthood clinics are closing because they got defunded. And so it’s just one on top of another in the reproductive health space. Each one alone would be really impactful, but taken all together, yeah, there’s a lot of concern about people losing access to these services. 

Winfield Cunningham: I think the politics of this are more interesting to me than the practical effect. I mean, under the ACA, birth control has to be covered, right? by marketplace plans. Generally speaking, if people have insurance, they do have coverage for a range of birth control. But the Title X program is interesting because it seems to like overlap between the MAHA priorities and the social conservatives. Of course, as Alice said, this has long been a target of social conservatives. I think in Project 2025 called for any Title X, I believe. And then there’s this current in the MAHA movement that’s kind of like anti-hormonal birth control and there’s also these kinds of streams of pronatalist people, of have more babies, don’t take birth control. So that’s kind of interesting to me because there’s this larger narrative I think in HHS right now of the RFK MAHA people versus the traditional conservative, anti-abortion people. So that’s just like one program where I see overlap between the two. 

Rovner: One of my favorite pieces of congressional trivia is that Title X has not been reauthorized since 1984, which, by the way, is before I started covering this. But I’ve been doing this 39 years and I have never covered a successful reauthorization of the Title X program. So it’s obviously been in crosshairs for a very, very long time. Maya, did you want to add something? 

Goldman: I was just going to say to Paige’s point, telling women that they can’t take any painkillers during pregnancy is not a good way to raise the birth rate. 

Rovner: Yes. That’s also a fair point. Well, meanwhile, red states are trying to expand the role of crisis pregnancy centers, which provide mostly nonmedical services and try to convince those with unplanned pregnancies not to have abortions. In Wyoming, state lawmakers are pushing a bill that would prohibit the state or any of the localities from regulating those centers “based on the center’s stance against abortion.” This comes after a similar proposal became law in Montana, the efforts being pushed by the anti-abortion group Alliance Defending Freedom. Is the idea here to have crisis pregnancy centers replace these Title X clinics and Planned Parenthoods? 

Ollstein: I think there are a lot of people that would like to see that, but, as you said, they do not provide the same services, so it would not be a one-to-one replacement. Already, there are way more crisis pregnancy centers around the country than there are Planned Parenthood clinics, for example, but that doesn’t mean that everyone has access to all the services they want. 

Rovner: And many of these crisis pregnancy centers don’t have any medical personnel, right? I mean, some of them do, but … 

Ollstein: It’s really a range. I mean, some have a medical director on staff, or maybe there’s one medical person who oversees several clinics, some do not. Some offer ultrasounds, some don’t, some just give pamphlets and diapers and donated items. It’s just really a range around the country. And states have also been grappling with how much to, on the conservative side, support and fund such centers. And on the other side, states like California have really gone to battle over regulating what they tell patients, what they’re required to tell patients, what they can’t tell patients. And that’s gotten into the courts and they’ve fought over whether that violates their speech rights. And so it’s a real ongoing fight. 

Rovner: Yes, I’m sure this will continue. All right, that is the news for this week. Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read too. Don’t worry if you miss it; we’ll put the links in our show notes on your phone or other mobile device. Maya, why don’t you go first this week? 

Goldman: Sure. So this story is from Ñî¹óåú´«Ã½Ò•îl Health News and New England Public Media. It’s called “As Sports Betting Explodes, States Try To Set Limits To Stop Gambling Addiction,” by Karen Brown. And I think this stood out to me because I was just in Vegas last week for health, but this, I think, is a really interesting issue to explore through a public health lens, the issue of sports betting and betting addiction. And there are states that are trying to do a lot of work around this and just organizations. And then of course the gaming companies themselves have their own pushback on that, and I think this story just lays it out really well and it’s an important issue that gets very overlooked. 

Rovner: Yeah, it is a public health issue, an interesting one. Alice? 

Ollstein: I chose a story from ProPublica by reporter, Eric Umansky, and it’s called “.” So this is one of many examples that you could give of policies intended to target transgender folks having spillover effects and impacting cisgender folks, too. In this instance, it’s now harder for male veterans to qualify to get treatment for breast cancer. Men can get breast cancer. Let’s just say that. Men can and do get breast cancer, and it can be harder to detect and very lethal, and obviously very expensive to treat if you don’t have coverage. And so this story has a lot of sad quotes from folks who are losing their coverage, especially because they likely acquired cancer by being exposed during their service to various toxic substances. And so I think, yeah. 

Rovner: Yeah. A combination of a lot of different factors in that story. 

Ollstein: Definitely. 

Rovner: Paige? 

Winfield Cunningham: Yeah. So my story is by, actually, my colleague Mark Johnson. I sit next to him at The [Washington] Post, and the headline is “.” I was really struck by this story because it talks about how patients with advanced lung cancer, they were given the covid vaccines and it somehow had the effect of supercharging their immune systems. And, actually, their median survival rates went up by 17 months compared with those that weren’t given the vaccines. And, of course, this administration has really gone after the covid vaccines and the mRNA research, in particular, and canceled $500 million in funding for mRNA research. And all of the ACIP’s [Advisory Committee on Immunization Practices’] moves on vaccines have gotten so much attention. But I think the thing that also is going to be perhaps even more impactful is pulling back on this really promising research, because it has sort of become politicized because the covid vaccines have become politicized. And it seems a shame that we’re pulling back on this really promising research. So I thought that was a really interesting story by my colleague. 

Rovner: Yes. Yet another theme from 2025. My extra credit this week is from my Ñî¹óåú´«Ã½Ò•îl Health News colleague Bernard J. Wolfson, and it’s called “Many Fear Federal Loan Caps Will Deter Aspiring Doctors and Worsen MD Shortage.” And it’s a good reminder about something we did talk about earlier this year when the Republican budget bill passed. It limits federal grad school loans to $50,000 per year at a time when the median tuition for a year in medical school is more than $80,000. The idea here is to push medical schools to lower their tuition, but in the short run, it’s more likely to push lower-income students either out of medicine altogether or to require them to take out private loans with more stringent repayment terms, which could in turn push them into pursuing more lucrative medical specialties rather than the primary care slots that are already so difficult to fill. It’s yet another example of how everybody agrees on a problem: Medical education is way too expensive in this country. But nobody knows quite how to fix it.  

OK. That is this week’s show. Thanks this week to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder, “What the Health?” is now available on WAMU platforms, the NPR app, and wherever else you get your podcasts, as well as, of course, kffhealthnews.org. If you already follow the show, nothing will change. The podcast will show up in your feed as usual. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can find me at X, , or on Bluesky, . Where are you folks hanging these days? Maya? 

Goldman: I am on X as and I’m also on . 

Rovner: Alice? 

Ollstein: on Bluesky and on X.  

Rovner: Paige? 

Winfield Cunningham: I am still on X. 

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

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

Julie Rovner: Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, July 17, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Hello, everyone. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

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

Joanne Kenen: Hi, everybody. 

Rovner: No interview this week, but more than enough news. So we will get right to it. 

We’re going to start on Capitol Hill, where in the very wee hours of Thursday morning, the Senate approved the $9 billion package of rescissions of money already appropriated. It was largely for foreign aid and the Corporation for Public Broadcasting, which oversees NPR and PBS. Now, this bill represents pennies compared to the entire federal budget and even to the total of dollars that are appropriated every year, but it’s still a big deal because it’s basically Congress ceding more of its spending power back to the president. And even this small package was controversial. Before even bringing it to the floor, senators took out the rescission of funds for PEPFAR [the President’s Emergency Plan for AIDS Relief], the bipartisanly popular international AIDS/HIV program begun under President George W. Bush. So now it has to go back to the House, and the clock on this whole process runs out on Friday. Sandhya, what’s likely to happen next? 

Raman: I think that the House has been more amenable. They got this through quicker, but if you look— 

Rovner: By one vote. 

Raman: Yeah. But I think if you look at what else has been happening in the House this week that isn’t in the health sphere, they’ve been having issues getting other things done, because of some pushback from the Freedom Caucus, who’s been kind of stalling the votes and having them to go back. And other things that should have been smoother are taking a lot longer and having a lot more issues. So it’s more difficult to say without seeing how all of that plays out, if those folks are going to make a stink again about something here because some of this money was taken out. It’s a work in progress this week in the House. 

Rovner: Yeah, that’s a very kind way to put it. The House has basically been stalled for the last 24 hours over, as you say, many things, completely unrelated, but there is actually a clock ticking on this. They had 45 days from when the administration sent up this rescission request, and we’re now on Day 43 because Congress is the world’s largest group of high school students that never do anything until the last minute. So Democrats warned that this bill represents yet another dangerous precedent. They reached a bipartisan agreement on this year of spending bills in the spring, and this basically rolls at least some of that back using a straight party-line vote. What does this bode for the rest of Congress’ appropriations work for the fiscal year that starts in just a couple of months? 

Raman: I think that the sense has been that once this goes through, I think a lot of people have just been assuming that it’ll take time but that things will get passed on rescissions. It really puts a damper on the bipartisan appropriations process, and it’s going to make it a lot harder to get people to come to the table. So earlier this week we had the chair of the Appropriations Committee and the chair of the Labor, HHS [Health and Human Services], Education subcommittee in the House say that the health appropriations they were going to do next week for the House are going to get pushed back until September because they’re not ready. And I think that health is also one of the hardest ones to get through. There’s a lot more controversial stuff. It’s setting us up to go, kind of like usual at this point, for another CR [continuing resolution], because it’s going to be a really short timeline before the end of the fiscal year. But if you look at some— 

Rovner: Every year they say they’re going to do the spending bills separately, and every year they don’t. 

Raman: Yeah, and I think if you look at how they’ve been approaching some of the things that have been generally a little bit less controversial and how much pushback and how much more difficulties they’ve been having with that, even this week, I think that it’s going to be much more difficult to get that done. And the rescissions, pulling back on Congress’ power of the purse, is not going to make that any easier. 

Rovner: I think what people don’t appreciate, and I don’t think I appreciated it either until this came up, is that the rescissions process is part of the budget act, which is one of these things that Congress can do on an expedited basis in the Senate with just a straight majority. But the regular appropriations bills, unlike the budget reconciliation bill that we just did, need 60 votes. They can be filibustered. So the only way to get appropriations done is on a bipartisan basis, and yet they’re using this rather partisan process to take back some of the deal that they made. The Democrats keep saying it, and everybody’s like, Oh, process, process. But that actually could be a gigantic roadblock, to stopping everything in its tracks, right? 

Raman: I really think so. And if you look at who are the two Republicans in the Senate that voted against the rescissions, one of them is the Senate Appropriations chair, Susan Collins. And throughout this, one of her main concerns was when we still had the PEPFAR in there. But it just takes back her power as the highest-ranking appropriator in the Senate to do it through this process, especially when she wasn’t in favor of the rescissions package. 

So it’s going to make things, I think, a lot more complicated, and one of her concerns throughout has just been that there wasn’t enough information. She was pulling out examples of rescissions in the past and how it was kind of a different process. They were really briefed on why this was necessary. And it was just different now. So I think what happens with appropriations and how long it’ll take this year is going to be interesting to watch. 

Rovner: And it’s worth remembering that it’s when the appropriations don’t happen that the government shuts down. So, but that doesn’t happen until October. Well, separately we learned that — oh, go ahead, Joanne. 

Kenen: There’s also sort of a whole new wrinkle, is that rescissions is, if you’re a Republican and you don’t like something and you end up, to avoid a government shutdown or whatever reason, you end up having to vote for a bill, you just have the president put out a statement saying, If this goes through, I’m going to cut it afterwards. And then the Republican who doesn’t like it can give a floor speech saying, I’m voting for it because I like this in it and I know that the president’s going to take care of that. It really — appropriations is always messy, but there’s this whole unknown. The constitutional balance of who does what in the American government is shifting. And at the end of the day, the only thing we do know after both the first term and what’s happened so far even more so in the second term, is what [President Donald] Trump wants, Trump tends to get. 

So, Labor-H [the appropriations for Labor, HHS, Education and related agencies], like Sandhya just pointed out, the health bill is one of the hardest because there’s so much culture-war stuff in it. But, although, the Supreme Court has put some of that off the table. But I just don’t know how things play out in the current dynamic, which is unprecedented. 

Rovner: And of course, Labor-HHS also has the Department of Education in it. 

Kenen: The former Department of Education. 

Rovner: To say, which is in the process of being dismantled. So that’s going to make that even more controversial this year. Moving back to the present, separately we learned this week that the administration plans to spend hundreds of thousands of dollars of taxpayer money to destroy stocks of food and contraceptives and other medical devices rather than distribute them through some of the international aid programs that they’re canceling. Now, in the case of an estimated 500 tons of high-energy biscuits bought by USAID [the U.S. Agency for International Development] at the end of the Biden administration, you can almost understand it because they’re literally about to expire next week. According to The Atlantic, which first reported , this is only a small part of 60,000 metric tons of food already purchased from U.S. farmers and sitting in warehouses around the world, where the personnel who’d be in charge of distributing them would’ve been fired or transferred or called back to the U.S. 

At the same time, there are apparently also plans to destroy an estimated $12 million worth of HIV prevention supplies and contraceptives originally purchased as part of foreign aid programs rather than turn them over or even sell them to other countries or nonprofits. This feels like maybe the not most efficient use of taxpayer dollars? 

Luthra: I think this is something we’ve talked about before, but it really bears repeating. As a media ecosphere, we’ve sort of moved on from the really rapid dismantling of USAID. And it was not only without precedent. It was incredibly wasteful with the sudden way it was done, all of these things that were already purchased no longer able to be used, leases literally broken. And people had to pay more to break leases for offices set up in other countries, all these sorts of things that really could have already been used because they had been paid for. And instead, the money is simply lost. 

And I think the important thing for us to remember here is not only the immense waste financially to taxpayers but the real trust that has been lost, because these were promises made, things purchased, programs initiated, and when other countries see us pulling back in such a, again, I keep saying wasteful, but truly wasteful manner, it’s just really hard to ever imagine that the U.S. will be a reliable partner moving forward. 

Rovner: Yeah, absolutely. I understand the food thing to some extent because the food’s going to expire, but the medical supplies that could be distributed by somebody else? I’m still sort of searching for why that would make any sense in any universe, but yeah I guess this is the continuation of, We’re going to get rid of this aid and pretend that it never happened. 

Well, meanwhile, it’s only been a couple of weeks, but we’re starting to see the politics of that big Trump tax and spending measure play out. One big question is: Why didn’t Republicans listen to the usually very powerful hospital industry that usually gets its way but did not this time? And relatedly, will those Republicans who voted with Trump but against those powerful hospital interests do an about-face between now and when these Medicaid cuts are supposed to take effect? We’ve already seen Sen. Josh Hawley, the Republican from Missouri who loudly proclaimed his opposition to those Medicaid cuts before he voted for them anyway, introduce legislation to rescind them. So is this the new normal? I think, Joanne, you were sort of alluding to this, that you can now sort of vote for something and then immediately say: Didn’t mean to vote for that. Let’s undo it. 

Kenen: You could even do it before you vote for it, if they play it right. If Congress passes these things, we’re not going to pay attention. We’re already in that moment. But also, when I was working on a Medicaid piece, the magazine piece like four or five months ago, one of the most cynical people I know in Washington told me, he said, Oh, they’ll pass these huge cuts because they need the budget score to get the taxes through, and then they’ll start repealing it. And it seemed so cynical at the time, only he might’ve been right. 

So I don’t think they’re going to cut all of it. Republicans ideologically want a smaller Medicaid program. They want less spending. They want work requirements. You’re not going to see the whole thing go away. Could you see some retroactive tinkering or postponement or something? Yeah, you could. It’s too soon to know. Hospitals are the biggest employer in many, many congressional districts. This is a power— 

Rovner: Most of them. 

Kenen: Most, yeah. I don’t think it’s quite all, but like a lot. It’s the biggest single employer, and Medicaid is a big part of their income. And they still by law have to stabilize people who come in sick, and there’s emergency care and all sorts of other things, right? They do charity care. They do uninsured people. They do all sorts. They still treat people under certain circumstances even when they can’t pay. But right now, the threat of a primary opponent is more powerful than the threat of your local hospital being mad at you and harming health care access in your community. So much in the Republican world revolves around not getting the president mad enough that he threatens to get you beaten in a primary. We’ve seen that time and again already. 

Rovner: Right. And I will also say there’s precedent for this, for passing something and then unpassing it. Joanne and I covered in 19— 

Kenen: But it wasn’t the plan. 

Rovner: Yeah, I know. But remember, back in 1997 when they passed the Balanced Budget Act, every year for the next — was it three or four years? They did what we came to call “give back” bills. 

Kenen: Or punting, right? 

Rovner: Yeah, where they basically undid, they unspooled, some of those cuts, mostly because they’d cut more deeply than they’d intended to. And then we know with the Affordable Care Act, I’ve said this several times, they passed all of these financing mechanisms for it and then one by one repealed them. 

Kenen: And the individual mandate — I mean everything- 

Rovner: And the individual mandate, right. 

Kenen: They kept the dessert and they gave away everything. They undid everything that paid for the dessert, basically. 

Rovner: Right. Right. 

Kenen: And so it was the Cadillac — because people don’t remember anymore — the Cadillac tax, the insurance tax, the device tax. They all were like, One at a time! And they were repealed because lobbying works. 

Rovner: The tanning tax just went. 

Kenen: Right, right. So that dynamic existed, passing something unpopular and then redoing it, but the dynamic now really just comes — basically this is Donald Trump’s town. He has had a remarkable success in not only getting Congress to do what he wants but getting Congress to surrender some of its own powers, which have been around since Congress began. This is the way our government was set up. So there’s a very, very different dynamic, and it’s still unpredictable. None of us thought that the biggest crisis would be the [Jeffrey] Epstein case, right? Which is not a health story, and we don’t have to spend any time on it except to acknowledge— 

Rovner: Please. 

Kenen: —that there’s stuff going on in the background that people who had been extremely loyal to the president are now mad. And we don’t know how long. He’s very good at neutralizing things, too. He’s blaming it on the Democrats. 

But there is a different dynamic. Congress has less power because Congress gave up some of its power. Are they going to want to reassert themselves? There is no sign of it right now, but who knows what happens. I thought they would cut Medicaid. I thought they would do work requirements. I thought they would let the enhanced ACA subsidies expire. But I did not think the cuts would go this deep and this extensive — really transformationally pretty historic cuts. 

Rovner: Shefali, you wanted to say something? 

Kenen: Not pretty historic cuts, very historic cuts. Unprecedented. 

Luthra: I was thinking Joanne made such a good point about how, for all of the talk now about trying to mitigate that backlash, a lot of this is in line ideologically with what Republicans want. They do want a smaller Medicaid program. And I think a really interesting and still open question is whether they are willing and able to actually create policy that does reverse some of these cuts or not, and even if they do, if it’s sufficient to change voters’ perception, because we know that these cuts are very unpopular. Democrats are talking about them a lot. Hospitals are talking about them a lot. And just the failed attempt to repeal the ACA led to the 2018 midterms. And I think there is a real chance that this is the dominant topic when we head into next year’s elections. And it’s hard to say if Josh Hawley putting out a bill can undo that damage, so—. 

Rovner: Well, I’m so glad you mentioned that, because The Washington Post has a about a clinic closing in rural Nebraska, with its owners publicly blaming the impending Medicaid cuts. Yet its Trump-supporting patients are just not buying it. Now in 2010, Republicans managed to hang the Affordable Care Act around Democrats’ necks well before the vast majority of the changes took place. Are Democrats going to be able to do that now? There’s a lot of people saying, Oh, well, they’re not going to be able to blame this on the Republicans, because most of it won’t have happened yet. This is really going to be a who-manages-to-push-their-narrative, right? 

Kenen: This really striking thing about that story is that the people who were losing access, they’re not losing their Medicaid yet, but they’re losing access to the only clinic within several — they have to drive hours now to get medical care. And when they were told this was because the Republican Congress and President Trump, they said, Oh no, it can’t be. First of all, a lot of people just don’t pay attention to the news. We know that. And then if you’re paying attention to news that never says anything negative about the president, that blames everything on Joe Biden no matter — if it rains yesterday, it was his fault, right? 

So the sort of gap between — there are certain things that are matters of opinion and interpretation, and there are certain things that are matters of fact, but those facts are not getting through. And we do not know whether the Democrats will be able to get them through, because the resistance, it’s almost magical, right? My clinic closed because of a Republican Medicaid bill? Oh no, it’s hospital greed. They just don’t want to treat us anymore. They just, it doesn’t compute, because it doesn’t fit into what they have been reading and hearing, to the extent that they read and hear. 

Rovner: Sandhya, you want to add something? 

Raman: The one thing that as I’ve been asking around on Capitol Hill about the Hawley bill — and there was one from Sen. Rand Paul, and a House counterpart, from [Rep.] Greg Steube, does sort of the opposite — it wants to move up the timeline for one of the provisions. So one important thing to consider is neither of these bills have had a lot of buy-in from other members of Congress. They’ve been introduced, but the people that I’ve talked to have said, I’m not sure. 

And I think something interesting that Sen. Thom Tillis had said was: If Republicans had a problem with what some of the impacts would be, then why were they denying that there would be an effect on rural health or some of those things to begin with? And I think a lot of it will take some time to judge to see if people will move the needle, but if we’re going to change any of these deadlines through not reconciliation, you need 60 votes in the Senate and you’ll need Democrats on board as well as Republicans. And I think one interesting thing to watch there is that I think some of the Democrats are also looking at this in a political way. If there’s a Republican that has a bill that is trying to tamp down some of the effects of their signature reconciliation law, do they want to help them and sign on to that bill or kind of illustrate the effects of the bill before the midterms or whatever? 

Rovner: A lot more politics to come. 

Raman: Yeah. Yeah. 

Rovner: Meanwhile, over at HHS [the Department of Health and Human Services], there is also plenty of news. Many of the workers who’ve been basically in limbo since April when a judge temporarily halted the Trump administration’s efforts to downsize have now been formally let go after the Supreme Court last week lifted that injunction. What are we hearing about how things are going over at HHS? We’ve talked sort of every week about this sort of continuing chaos. I assume that the hammer falling is not helping. It’s not adding to things settling down. 

Kenen: No. And then Secretary [Robert F.] Kennedy [Jr.] just fired two top aides because — no one knows exactly the full story but it’s — and I certainly do not know the full story. But what I have read is that the personality conflict with his top aide — and that happens in offices, and he’s not the first person in the history of HHS to have people who don’t get along with one another. But it’s just more unsettled stuff in an agency already in flux, because now in addition to all these people being let go in all sorts of programs and programs being rolled back, you also have some leadership chaos at the top. 

Rovner: Well, meanwhile, HHS Secretary Kennedy took office with vows to eliminate the financial influence of Big Pharma, Big Food, and other industries with potential conflicts of interests. But shoutout here to my Ñî¹óåú´«Ã½Ò•îl Health News colleague Stephanie Armour, who has this week about how the new vested interests at HHS are the wellness industry. Kennedy and four top advisers, three of whom have been hired into the department, wrote Stephanie, quote, “earned at least $3.2 million in fees and salaries from their work opposing Big Pharma and promoting wellness in 2022 and 2023, according to a Ñî¹óåú´«Ã½Ò•îl Health News review of financial disclosure forms filed with the U.S. Office of Government Ethics and the Department of Health and Human Services; published media reports; and tax forms filed with the IRS. That total doesn’t include revenue from speaking fees, the sale of wellness products, or other income sources for which data is not publicly available.” Have we basically just traded one form of regulatory capture for another form of regulatory capture? 

Kenen: And one isn’t covered by insurance. Some of it is, but there’s a lot of stuff in the, quote, “wellness” industry that providers and so forth, certain services are covered if there’s licensed people and an evidence base for them, but a lot of it isn’t. And these providers charge a lot of money out-of-pocket, too. 

Rovner: And they make a lot of money. This is a totally — unlike Big Pharma, Big Food, and Big Medicine, which is regulated, Big Wellness is largely not regulated. 

Kenen: I think Stephanie — that was a really good piece — and I think Stephanie said it was, what, $6.3 trillion industry? Was that— 

Rovner: Yeah, it’s huge. 

Kenen: Am I remembering that number right? It’s largely unregulated. Many of the products have never gone through any review for safety or efficacy. And insurance doesn’t cover a lot of it. It doesn’t mean it’s all bad. There are certain things that are helpful, but as an industry overall, it leaves something for us to worry about. 

Rovner: Well, in HHS-adjacent breaking news that could turn out to be nothing or something really big, an appeals court in Richmond on Tuesday ruled 2-1 that West Virginia may in fact limit access to the abortion pill, even though it’s approved by the FDA [Food and Drug Administration]. It’s the first time a federal appeals court has basically said that states can effectively override the FDA’s nationwide drug approval authority. And it’s the question that the Supreme Court has already ducked once, in that case out of Texas last year where the justices ruled that the doctors who were suing didn’t have standing, so they didn’t have to get to that question. But, Shefali, this has implications well beyond abortion, right? 

Luthra: Oh, absolutely. We are seeing efforts across the country to restrict access to certain medications that are FDA-approved. Abortion pills are the obvious one, but, of course, we can think about gender-affirming care. We can think about access to all sorts of other therapeutics and even vaccines that are now sort of coming under political fire. And if FDA approval means less than state restrictions, as we are seeing in this case, as we very possibly could see as these kinds of arguments and challenges make their way to the Supreme Court. The case you alluded to earlier with the doctors who didn’t have standing is still alive, just with different plaintiffs now. And so these questions will probably come back. There are just such vast ramifications for any kind of medication that could be politicized, and it’s something that industry at large has been very worried about since this abortion pill became such a big question. And it is something that this decision is not going to alleviate. 

Rovner: Yes. Speaking of Big Pharma, they’re completely freaked out by this possibility because it does have implications for every FDA-approved drug. 

Luthra: And they invest so much money in trying to get products that have FDA approval. There’s a real promise that with this global gold standard, you will be able to keep a drug on the market and really make a lot of money on it. There’s also obviously concerns for birth control, which we aren’t seeing legally restricted in the same way as abortion yet, but it is something that is so deeply subject to politics and culture-war issues that that’s something that we could see coming down the line if trends continue the way they are. 

Rovner: Well, we will watch that space. Moving on. Wednesday was the third anniversary of the federal 988 federal crisis line, which has so far served an estimated 16 million people with mental health crises via call, text, or chat. An estimated 10% of those calls were routed through a special service for LGBTQ+ youth, which is being cut off today by the Trump administration, which accused the program, run by the Trevor Project, as, quote, “radical gender ideology.” Now, LGBTQ+ youth are among those at the highest risk for suicide, which is exactly what the 988 program was created to prevent. Yet there’s been very little coverage of this. I had to actually go searching to find out exactly what happened here. Is this just kind of another day in the Trump administration? 

Raman: I think a lot of it stems back to some of those initial executive orders related to gender ideology and DEI [diversity, equity, and inclusion] and things like that. The Trump administration’s kind of argument is that it shouldn’t be siloed. It should be all general. There shouldn’t be sort of special treatment, even though we do have specialized services for veterans who call in to these services and things. But I— 

Rovner: Although that was only saved when members of Congress complained. 

Raman: Yeah. But I do think that when we have so much happening in this space focused on LGBTQ issues, it’s easier for things to get missed. I think the one thing that I did notice was that California announced yesterday that they were going to step up to do a partnership with the Trevor Project to at least — the LGBTQ youth calling from California to any of those local 988 centers would be reaching people that have been trained a little bit more in cultural competency and dealing with LGBTQ youth. But that’s not going to be all the states and it’s going to take time. Yeah. 

Rovner: Yeah, we’re going to continue to see this cobbled together state by state. It feels like increasingly what services are available to you are going to be very much dependent on where you live. That’s always been true, but it feels like it’s getting more and more and more true. Shefali, I see you nodding. 

Luthra: Something you alluded to that I think bears making explicit is public health interventions are typically targeted toward people who are in greater danger or are at greater risk. That’s not discrimination — that’s public health efficiency. And suggesting that we shouldn’t have resources targeted toward people at higher risk of suicide is counter to what public health experts have been arguing for a very long time. And that’s just something that I think really bears noting and keeping in mind as we see what the impact of this is moving forward. 

Rovner: Yeah, I think that’s a very good point. Thank you. 

Well, speaking of popular things that are going away, a federal judge appointed by President Trump last week struck down the last-minute Biden administration rule from the Consumer Financial Protection Bureau that tried to bar medical debt from appearing on credit reports. This had been hailed as a major step for the 100 million Americans with medical debt, which is not exactly the same as buying a car or a TV that you really can’t afford. People don’t go into medical debt saying, Oh, I think I’m going to go run up a big medical bill that I can’t pay. But this strikes me as yet another way this administration is basically inflicting punishment on its own voters. Yes? 

Kenen: Yes, except we just don’t know. Some red states are so red that you don’t need every voter. We don’t know who actually votes, and we don’t know whether people make these connections, right? What we were talking about before with Medicaid — do they understand that this is something that President Trump not just urged but basically ordered Congress to do? So do people pay attention? How many people even know if their medical debt is or is not on their credit report? They know they have the medical debt, but I’m not sure everybody understands all the implication, particularly if you’re used to being in debt. You may be somebody who’s lost a job or couldn’t pay your mortgage or couldn’t pay your rent. Some of the people who have medical debt have so many other financial — not all — that it’s just part of a debt soup and it’s just one more ingredient. 

So how it plays out and how it’s perceived? It’s part of this unpredictable mix. Trump is openly talking about gerrymandering more, and so it won’t matter what voters do, because they’ll have more Republican seats. That’s just something he’s floating. We don’t know whether it’ll actually happen, but he floated it in public, so— 

Rovner: So much of this is flooding the zone, that people — there’s so much happening that people have no idea who’s responsible for what. There’s always the pollster question: Is your life better or worse than it was last year? Or four years ago, whatever. And I think that when you do so much so fast, it’s pretty hard to affix blame to anybody. 

Raman: And most people aren’t single-issue voters. They’re not going to the polls saying, My medical debt is back on my credit report. There’s so many other things, even if with the last election, health care was not the number one issue for most voters. So it’s difficult to say if it will be the top issue for the next election or the next one after that. 

And I guess just piggybacking that a lot of the times when there’s these big changes, they don’t take effect for a while. So it’s easier to rationalize, Oh, it may have been this person or that person or the senator then, or who was president at a different time, just because of how long it takes to see the effects in your daily life. 

Rovner: Politics is messy. All right, well, this is as much time for the news as we have this week? Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We’ll put the links in our show notes on your phone or other mobile device. Shefali, why don’t you go first this week? 

Luthra: Sure. My piece is from The New York Times, by Apoorva Mandavilli. The headline is “” And she takes a look at when the head of the OMB [Office of Management and Budget] told the Senate that PEPFAR had spent almost $10 million advising Russian doctors on abortions and gender analysis. And she goes through and says this isn’t true. PEPFAR hasn’t been in Russia. They cannot fund abortions. And she talks with people who were there and can say this simply isn’t true and this is very easy to disprove. And I like this piece because it’s just a reminder that a lot of things are being said about government spending that are not true. And it is a public service to remind readers that they are very easily disproven. 

Rovner: Yeah, and to go ahead and do that. Sandhya. 

Raman: My extra credit is “,” and it’s from Cecilia Nowell for The Nation, my co-fellow through AHCJ [the Association of Health Care Journalists] this year. Cecilia went to Kiruna, which is an Arctic village in Sweden, to look at how they’re using mifepristone for abortions up to 22 weeks in pregnancy, compared to up to 10 weeks in the U.S. And it’s a really interesting look at how they’re navigating rural access to abortion in very remote areas. Almost all abortions in Sweden are done through medication abortion, and while the majority here are in the 60% versus high 90s. So just interesting how they’re taking their approach there as rural access is limited here. 

Rovner: Really interesting story. Joanne. 

Kenen: This is a piece in The New Yorker by Dhruv Khullar, and it’s “” And what I found interesting, we’ve been hearing about: Can AI do this? It’s sort of been in the air since AI came around. But what was so interesting about this article is there’s a nonprofit that is actually doing it, and they have this sort of whole sort of hierarchy of why a drug may be promising and why a disease may be a good target. And then the AI look at genetics and diseases, and they have four or five factors they look at. And then there’s this just sort of hierarchy of which are the ones we can make accessible. 

So A, it’s actually happening. B, it has promise. It’s not a panacea, but there’s promise. And C, it’s being done by a nonprofit. It’s not a cocktail for an individual patient. It’s trying to figure out: What are the smartest drugs to be looking at and what can they treat? And they give examples of people who have gone into remission from rare diseases. And also it says there are 18,000 diseases and only 9,000 have treatment. So this is huge, right? Rare diseases may only affect a few people, but there are lots of rare diseases. So cumulatively some of the people they strike are young. So for someone who doesn’t always read about AI, I found this one interesting. 

Rovner: Also, we read somebody’s story about how AI is terrible for this, that, and the other thing. It is very promising for an awful lot of things. 

Kenen: No. Right. 

Rovner: There’s a reason that everybody’s looking at it. 

All right, my extra credit this week is also from The New York Times. It’s called “,” by David Enrich, who’s The Times’ deputy investigations editor and, notably, author of a book on attacks on press freedoms. That’s because the story chronicles how UnitedHealth, the mega health company we have talked about a lot on this show, is taking a cue from President Trump and increasingly taking its critics to court, in part by claiming that critical reporting about the company risks inciting further violence like the Midtown Manhattan murder of United executive Brian Thompson last year. 

I hasten to add, this isn’t a matter of publications making stuff up. United, as we have pointed out, is a subject of myriad civil and criminal investigations into potential Medicare fraud as well as antitrust violations. This is still another chapter unfolding in the big United story. 

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

Raman: I’m at Bluesky, . 

Rovner: Sandhya. 

Raman: I’m and , @SandhyaWrites. 

Rovner: Joanne? 

Kenen: I’m mostly at Bluesky, , and I’ve been posting things more on , and there are more health people hanging out there. 

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