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

Julie Rovner: Hello from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU public radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for KFF Health News. As always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, April 30. 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 Shefali Luthra of The 19th. 

Shefali Luthra: Hello.  

Rovner: Rachel Roubein of The Washington Post. 

Rachel Roubein: Happy to be here.  

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 lots of news. So let’s dive right in. I want to start with politics this week. The House Ways and Means Committee held a kind of remarkable hearing with some large hospital chain CEOs, at which members from both parties took great public umbrage at hospital pricing practices. The headline on the Ways and Means GOP chair Jason Smith’s opening statement was, quote, “,” and that was among the milder charges that he and other committee members lobbed at the witnesses. Yet Ways and Means members have been talking about things like site-neutral payments for Medicare and reining in the 340B Drug Pricing Program for literally years now without actually doing anything about them. Was this all just for show? Or might we actually see some action on hospital pricing this year?  

Kenen: They did take a bite at this, about the site-neutral payments, in a limited â€” on certain things. I looked it up last night because I figured Julie would know it by heart but I couldn’t remember. It was 2015. So they did a little bit of it, and they â€” it was bipartisan. And they did not solve the problem. They sort of nibbled around the edges. Consolidation of hospitals and acquisition of physician practices, etc., have intensified in the last decade. So there is a bipartisan willingness to nibble. We don’t know if there’s a bipartisan or even either side really having the stick-to-itness to get something done. I wasn’t in that room. Some of you may have been on the Hill more than I get there. I don’t feel that action is imminent, but I do think that the conversation is returning to hospitals in a way we haven’t seen it for a while. And hospitals are a lot of money.  

Rovner: That was my point is that hospitals are where the money is in healthcare. Rachel, you wanted to add something.  

Roubein: Oh yeah, and we saw in Trump 1 [President Donald Trump’s first term] some efforts around site-neutral at the Centers for Medicare & Medicaid Services. But just sort of politically speaking, why the rhetoric is interesting, it used to historically be a little harder for lawmakers to take aim at their friendly neighborhood hospital. They’re major employers in their districts, particularly rural areas, and they also support lawmakers. 

Rovner: Yes, and I would say for those who don’t follow this as weedily as we do, site-neutral payment is when hospitals who own outpatient clinics charge more for the same service in the hospital than they do in the clinic. The art justification is, Well, we have to help support the rest of the hospital facility, so we have to charge more. And this has been a point of contention for some time. 

Kenen: But that playing field has changed. So it’s more, there are more of them now than there were when there were more independent medical practices and more independently owned, either small chains or non-chain hospitals. The whole hospital industry has changed. And if I can add just one other quick fact why, I think politically, the targets have been insurers and drug companies, right? And that’s what the conversation’s been about for quite â€” the dominant conversation. And I think it’s because insurance prices are really high, and they go up every year, and you see it in your paycheck week after week. And drugs, most of us do go to a pharmacy or have a mail order. So many of us are confronted with paying out-of-pocket for a drug, and people who don’t have great insurance might pay a lot out-of-pocket for a drug, or they’re on a drug that’s not in their formulary, etc. It can be confusing. Most of us in any given year are not in a hospital. And sometimes, when we are in a hospital, we’re grateful for it. It’s not that everybody gets perfect care and there are no bad outcomes. Of course, there are. But if the hospital I gave birth at saved my kid, I’m grateful for that. And it was a long time ago. Eighth grade wasn’t so great, but the rest of his life is right. So we have a different relationship in terms of how we interact and how often we interact with our hospitals. 

Rovner: So building on that one hint of why Republicans might be feeling freer to criticize hospitals â€” who have long been, as Rachel points out, the most protected of all the healthcare stakeholders in Washington â€” came from . Quoting KFF President and CEO Drew Altman’s , which I will link to, quote: “What jumped out from the poll is the value voters place on villainizing health care’s big interests now. It’s like serving up a big fat slow curveball for every candidate to hit.” Putting on my cynical hat, maybe the message that politicians are taking here is to talk a big game on healthcare but don’t do things that will actually impact negatively the people who fund your campaigns. In other words, it is all for show and they’re not planning on doing it. 

Luthra: That’s kind of the interesting question, right? I was thinking a lot this morning about the really great  in The [New York] Times that Margot Sanger-Katz and Sarah Kliff wrote, and one of the points that they make is there’s less political pressure when people aren’t seeing firsthand the consequences for reform. And so if there isn’t really vocal outcry from consumers directly at hospitals as an institution, where does that political pressure come from? I don’t know that we have an answer that suggests it would be strong enough to outweigh what an important interest hospitals are. 

Rovner: Yeah. I want it noted that, in addition to going after Big Insurance and Big Pharma, members of Congress are now going after Big Hospital, which, as Joanne points out, is pretty rare. We will see if anything comes of it. 

Well, one of the reasons that healthcare is such a hard subject to, you know, legislate on is that there are almost always unintended consequences. Lawmakers want to give people stuff, and they want to give healthcare providers stuff, but they don’t want to figure out how to pay for it or who should pay for it. Case in point â€” those very popular weight loss drugs known as GLP-1s. The Trump administration last year announced a deal that would make the drugs made by Eli Lilly and Novo Nordisk â€” those are the two big makers of these popular drugs â€” would make those drugs available through a Medicare pilot program provided by insurers. But even with the drugmakers agreeing to dramatically slash the drugs’ prices, insurers have balked at the added cost, causing the pilot to be canceled. Now, Medicare plans to pay for the drugs itself, apparently, at least temporarily. But of course, that’s going to pile new costs on a program that itself is not financially stable, and run the risk of doing to Medicare what many employers are doing to their workers, cutting off coverage for these drugs after they’ve already started it. There’s no easy solution to giving people new, modern, even working technologies that are expensive, right? 

Kenen: As more and more research about the potential benefits of these drugs â€” and also they are still relatively new. We could be having a whole different conversation about long-term use in a few years. But right now, one finding after another shows that it’s not just weight loss and diabetes, that there may be a lot of other benefits which still have to be studied or understood better, and who would benefit, and all those questions for the scientists. But these could be, end up being as common as statins down the road, and very expensive. So then the question is: Who gets the savings? Is it going to be worth it if Medicare pays for the drugs and ends up with fewer hospitalizations for advanced diabetes complications and amputations and kidney failure and all the terrible things that can come from advanced, uncontrolled diabetes? Is an insurer â€” insurers don’t like to always pay long-term. They don’t like to spend something tomorrow where the benefits may be 10 years down the road, because that person might not be your customer anymore in 10 years. So you’re investing in their long-term health, but they’re gonna be paying their premiums to your competitor in 10 or 20 or 30 years. So I just see this is getting more and more and more expensive, or at least the demand, the more and more people. How are we defining â€” diabetes has a clinical definition, but obesity is a little fudgier, right? No pun intended. 

Rovner: Two points. One is that the one thing we know about prevention and people who are not children is that it doesn’t pay for itself. So if you keep these people from dying from their diabetes complications and other complications of obesity, they’re going to live longer and eventually are going to die of something else, and that’s going to be expensive. So probably not a savings from CBO’s [the Congressional Budget Office’s] point of view. But the other thing is that other countries aren’t having this issue, because they have price controls on drugs, and we don’t. And try as hard as President Trump seems to be doing to piggyback off of other countries’ price controls, at some point â€” and I guess this harkens back to the hospital conversation â€” at some point Congress, the president, could just bite the bullet and say: Hey, we’re not going to let you charge â€” we’re not going to buy your drugs if you’re going to charge this much. So charge us less. I don’t see that anytime soon, but it is a possibility, yes? 

Luthra: Certainly. And I think one thing we’re not thinking about as well is what happens â€” right? â€” when people have had access to these drugs and then suddenly they are no longer covered. And with GLP-1s in particular, it’s actually kind of complicated and fascinating, because we are seeing all of these compounding pharmacies, some â€” right? â€” more in compliance with regulations than others, developing knockoffs. And people, I’ve talked a lot of them, will just go to those places instead, buy those products at a price they can afford, but the safety, the quality, may or may not be guaranteed. And there’s just a very large conversation that we’re not having about all of these consequences and trade-offs that we can’t quantify, by nature of us kicking the can down the road on dealing with the pricing problem. 

Rovner: Yeah, there’s a lot of PhD theses that are going to come out of this. There are just so many tentacles of it to study. And Joanne’s right. We don’t know. 

Kenen: Right. Particularly, to combine PhDs. The sweet spot is going to be like an AI analysis of GLP spending, or some 20 years out or whatever. That’s going to be what all the PhD theses are. 

Rovner: Yes, well, going from insoluble problems, most of what we talk about is kind of by necessity, bad news or divisive news. So this week I wanted to highlight an actual good-news story in health policy. According to  in the Journal of the American Medical Association, youth suicides have dropped markedly in the two years following the implementation of the 988 suicide prevention hotline. And while it’s hard to attribute all of the improvement to the hotline’s existence, the researchers were able to tease out that suicides decreased most in states with higher volumes of answered 988 calls and that suicides didn’t change much in peer countries that didn’t implement a hotline, like in England. And even more good news, while the Trump administration ended a specific part of the program that was aimed at helping LGBTQ+ callers last year, HHS [Department of Health and Human Services] Secretary Robert F. Kennedy Jr. testified during his marathon of hearings last week that the department would reinstate that option. Now all of this was the result of a bipartisan push in Congress over several years. What are the chances that seeing something good come from working together might prompt more cooperation that things, that lawmakers might agree on? This is my non-cynic hat. 

Kenen: Maybe in an alternative universe. 

Rovner: Go head, Rachel. 

Roubein: I thought this was interesting, because, as you said, this was something that was rolled out with bipartisan support in 2022. And it came off of the heels of the pandemic, which really exposed issues with youth mental health. I remember writing about the time this number was replacing a 10-digit hotline number, and advocates, etc., weren’t sure how much people would know about it, how received it would be from that standpoint, because you really had to get the message out that this was out there. So I thought that these numbers a few years later were pretty striking. 

Rovner: Yeah, I thought it was striking how fast that we were able to sort of see a difference. 

Kenen: But also there’s a history going back at least 10-ish, and probably longer, years on mental health. There’s bipartisanship. There have been a number of bills, both on opioids and substance abuse and mental health in general, not just for kids. There’s several over, in recent years, about mobile clinics and just spending more money. And this is great news, right? It’s good. And I think it helps in this area. Like by, can you work on some youth issues? Or could you work on some, continue working in a bipartisan basis on mental health issues? Because this country has a lot of mental health challenges. So I think a success makes that lane broader and better lit, but I don’t think it necessarily spills over to fixing all the 800,000 other problems stacked up in Congress. But it’s good. It’s obvious, I think, not just good news but I also think it’s good news for moving ahead and doing something else good. 

Rovner: Yeah, I would say it’s good news on its own, but it’s also potentially good news on the Let’s make other policy and fix other problems in the healthcare system. All right, we’re going to take a quick break. We will be right back. 

OK, we are back â€” and back to divisive stuff. The Supreme Court on Monday heard arguments in a case surrounding glyphosate. That’s the pesticide sold under the brand name Roundup, which Make America Healthy Again supporters and many scientists say causes, or at least contributes to, multiple types of cancers, and which the U.S. Environmental Protection Agency has determined is not carcinogenic. The case at issue concerns whether or not the maker of Roundup, Monsanto, should have included a warning label on its packaging. I’m less interested in the details of the case here, which involve whether states have the right to require labeling that the EPA does not, than the split it’s causing in the MAHA movement as the Trump administration backs the EPA’s finding that glyphosate is not carcinogenic, which MAHA supporters find to be a complete betrayal of their cause. Does this potentially have as much political oomph as the dispute over vaccines? Certainly not helping the MAHA movement be happy with the Trump administration. 

Roubein: This has definitely opened fissures between the Make America Healthy Again movement and the Trump administration. On top of that, I think one of the things that people in the MAHA movement were particularly upset about was Trump’s executive order earlier this year to boost domestic manufacturing of glyphosate. But at the same time, we have seen the Trump administration try and make nice with some MAHA leaders, inviting them to the White House. Some of them even spoke to Trump a little bit. So you’re kind of seeing that kind of divide here with the administration also trying to placate as well. 

Rovner: Yeah, this is sort of a fascinating political alliance that they’re on the one hand trying to protect and on the other hand trying to not allow, particularly when it comes to things like vaccines, not let it alienate people who are outside the movement, which as we have seen has turned out to be an extremely delicate dance. 

Luthra: And we’ve talked about this before, but I think one thing we still don’t really know is just how amorphous vs. cohesive MAHA as a movement is, and also its political potency. And there are Senate primaries that are good tests of this, [Sen.] Bill Cassidy an obvious one, given his vote on RFK and his stance on vaccines broadly. But we are still many months out from knowing if Trump alienating MAHA, if Republican institutions alienating parts of the MAHA movement, actually matters. Clearly a lot of Democrats think it might. That’s why we’re seeing so many of them court this constituency. But, yeah, I just think we really need to get a better sense as to how much of this is an influence that has been maybe a little bit hyped up, even by us in the press, and how much of it is actually substantial and influential. 

Rovner: Yeah, we know that the anti-abortion movement is powerful and turns out their voters, and when they make endorsements, when they get behind somebody or when they go against somebody, they have the money and the power and the clout and the vote to back that up. We don’t really know that yet about MAHA. I think that’s a really fair point. Joanne you wanted to add something? 

Kenen: No I think we don’t know as much. I think that the Trump people think they’re voters and that they think they helped them in 2024. But MAHA, I agree with what both of you just said. It’s amorphous. There are people whose primary issue is vaccines, and that’s how many of us think of MAHA, but it is also about healthy food. And some things that people could find common ground are the pesticides, the chemicals. Those are things that actually had been identified more with Democratic causes or Democratic voters in the past, those, some of the environmental issues. But I think, Julie, the question you asked is right. It’s a political force, but is it a political force that’s gonna gain power or just sort of dissipate? And there’s so many other things right now changing the politics of the country. I don’t think we could possibly know, even if you took a terrific poll today and found out they were mad. We have a pretty short news cycle. 

Rovner: Yeah, we do. We’ll see. All right. Well, meanwhile, elsewhere in the Trump administration, scientific retribution continues apace. The Justice Department this week announced the indictment of a former aide to Dr. Anthony Fauci for using his personal devices and email addresses to skirt public record laws and keep official communications private. Now this isn’t really news. The scientist, named David Morens, testified before a House hearing in 2024 and basically admitted what he did. So the question here is whether this criminal indictment is the beginning of a new effort to publicly punish those who the Trump administration accuse of unspecified wrongdoing regarding their handling of the covid pandemic. I would note that this week, obviously, we also got the indictment, again, of former FBI director Jim Comey. It’s not clear how much of this is the Justice Department trying to please President Trump and how much is sort of a new effort on this scientific front. 

Luthra: That’s such a good question. 

Rovner: Thank you. 

Luthra: No, I just, I think you’re right. It’s just not clear, because the acting attorney general hasn’t been in his role for very long. We know one of the reasons he has this job is because of dissatisfaction with how Pam Bondi approached the president’s goal of going after political opponents and targets. And so maybe, in a way, the why of it doesn’t matter if it creates a perception that this war on science is, in fact, renewed or accelerated or regaining steam in some way. If that’s how people feel and what the consequences look like, then there’s obviously a chilling effect that could be even greater than what we’ve already seen. 

Rovner: Yeah, and I would point out, it is a crime to use your personal devices to avoid public records laws. It is pretty common, but the actual indictment came so long after this. And is this the beginning of a series of, We’re gonna go punish the people who we think wronged us during the pandemic using whatever power we can find, or is this a one-off? And I guess we’ll have to see. 

Kenen: But I think he was sort of easy pickings because he had publicly admitted it. It’s up to the courts to decide if he’s guilty of an actual crime or just not following the rules. That’s not our decision. But it’s also, he was an easy target because he had admitted it, but he had also â€” it’s a sore spot. It’s the China lab thing. It’s not just some study or something to do with covid. It was very specifically, there are people who believe it was engineered and a lab leak that— 

Rovner: Oh, yeah, this clearly feeds into that. Right? 

Kenen: Into that conspiracy theory, which is unproven, and we may never know the full story of how covid emerged, but that’s a political button for a certain segment of Trump supporters. 

Rovner: Well, the administration’s ideologic purge continues as well. Late last week, the president fired all 22 members of the advisory board for the National Science Foundation. Now, the National Science Board is a bipartisan group that has advised the NSF since 1950. It is hardly full of political firebrands. Also this week, the Substance Abuse and Mental Health [Services] Administration announced it would no longer pay for test strips to see if drugs are adulterated with fentanyl or other potentially deadly substances, because it “facilitates,” air quotes, illegal drug use. Now there is a long and lively debate about whether such harm reduction policies protect lives or encourage illegal drug users to continue to use drugs, or both. But it does look kind of weird the week after the administration sought to loosen restrictions on both marijuana and hallucinogens. Yes? 

It doesn’t feel very consistent. Let’s put it that way. Though on the one hand, No more harm reduction, but we’re going to make it easier for you to use LSD and marijuana, because Joe Rogan thinks that it can help you with PTSD]. Which maybe it can â€” I’m not suggesting that was a wrong decision. I’m just suggesting that it does not look very consistent on a policy level. 

Kenen: That’s a good word, Julie. 

Luthra: No. You’re right, I think, to highlight the Joe Rogan maybe not manosphere but podcast-adjacent world where obviously you are trying to appeal to a very specific demographic by loosening regulations on marijuana or LSD in particular. And maybe it’s as simple as a lot of the party drug stimulants don’t fit into that demographic, at the risk of being incredibly reductive, like cocaine is associated with Brat summer. Brat summer is not â€” right? â€” the Joe Rogan-adjacent cultural force. I don’t know, maybe there’s something to there that this doesn’t fit into that same policy category because of who is seen as the people who end up sort of fitting into these different drug areas. 

Rovner: It does feel sort of overtly political, though, that going after particular groups of people who might or might not support you. Not that every, obviously, every administration is overtly political in some ways. They want to help the people who support them and not help the people who don’t support them. This just feels much more picking and choosing audiences. 

Kenen: I think you’re right, and it’s also a shift. I think that the country made a lot of progress in, again, that bipartisan mental health push we were talking about a few minutes ago. There was a greater understanding that addiction is a disease â€” there’s a criminal element, it’s an illegal drug, and there’s bad people involved in that market, obviously â€” but that this is not entirely a criminal justice issue. This is also a mental health and health issue, and that people need treatment. So we did sort of, not 100%, but we got much better at thinking about that. Chris Christie was one of the first appointees that Trump made in his first term on that initial opioid commission who really pressed that message. And this just seems to be a sort of demographic and class for subsectors of the population, who’s the Silicon Valley people who are into psychedelics vs. who’s using quote-unquote “street” drugs. So we’ll just have to see how this plays out. 

Roubein: Oh, I think with fentanyl strips, specifically, we’ve seen sort of a ping-pong with administrations, too. With, you’re talking about the politics, like Elinore McCance Katz, under Trump 1, who was the head of SAMHSA, opposed this. And then the Biden administration came in, and they had their drug strategy, which leaned heavily into harm reduction, which, as you mentioned duly, has been political. 

Rovner: Going back to needle exchanges in the early 2000s. It’s always been: Do you want to make it safer? And if you do make it safer, does that deter people from stopping using illegal drugs? That’s sort of the age-old debate about harm reduction. But you also don’t want when we had the overdose crisis, particularly when fentanyl first came on the scene. Do you really want people dying of fentanyl when they could have a test strip that costs a dollar and find out it’s, like: Ooh, this thing has been cut with fentanyl. Maybe I shouldn’t take it.  

Kenen: Right. Because if your goal is to get people into treatment and off of drugs, you can’t do that once they’re dead. 

Rovner: That is very true. All right. Finally, this week, there is vaccine news, because there is always vaccine news these days. The decision by the Department of Health and Human Services to drop the recommendation for the birth dose of the vaccine to protect against hepatitis B could result in hundreds of cases of the disease that could have been prevented and millions of dollars in additional healthcare costs to treat liver cancer and other complications. That’s according to   in this week’s JAMA Pediatrics journal. That’s partly because not every pregnant woman gets tested before giving birth, and also because there are other ways infants can contract the virus, that people keep saying, Oh, it’s only sexually transmitted. It’s not only sexually transmitted. There is such a thing as household transmission. I don’t suppose this study is going to change anybody’s mind who wanted the change on the hepatitis B vaccine in the first place, though, will it? 

Roubein: I think we’ve seen people in their camps on this one. The medical establishment, even some Republicans, Sen. Cassidy, etc., had been upset about this decision. 

Rovner: Yes, Sen. Cassidy, who is a liver specialist and is particularly unhappy with this decision, and yet, you know, science. So we will see if this also plays out. 

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

Luthra: Mine is from The Atlantic and KFF Health News by the wonderful Elisabeth Rosenthal. The headline is “.” And I would very much say that you should read this in installments, because it is very, very difficult to get through. It’s about how her husband died in the emergency room, and just the quality of care that he got, and for how long he was just boarded and â€” right? — kept without really getting the appropriate care, and how they knew that this was going to happen, because it had happened so many times and they’d gone to the ER. And she uses her experience as a journalist to also highlight how the problem of boarding has actually gotten a lot worse, which I didn’t realize, and we’ve all known for a long time that boarding is terrible, and being in the emergency department is actually really bad for you a lot of the time, even though it’s supposed to be a place for people in the midst of health crises. And I think there’s just a really effective blend of what her family’s story is and what the policy problems are. And â€” right? — by the end she realizes the only way to get appropriate care for her husband is to call somebody who she knows and see if they can get special treatment, which it just kind of is the way it is, I think, in a lot of these emergency departments. And I hope that when people read this and think about the experiences of their loved ones getting emergency care, they bring us to something where actually we can fix this. Because it feels like it’s something that, speaking of things that are easy to fix, everyone should want to. 

Rovner: Yeah, absolutely. It is quite the story. Rachel. 

Roubein: My extra credit this week, the headline is “Big Companies Position Themselves for Payday From $50B Federal Rural Health Fund,” by KFF Health News’ Sarah Jane Tribble. She writes about the $50 billion pot of money Congress earmarked for rural healthcare in America, which came amid Trump’s One Big Beautiful Bill last summer, which also cut money to Medicaid. And Sarah, she writes about the tussle to get funds, which is kind of a persistent problem that we see in healthcare, and how small community healthcare providers may find they are sharing the billions with, as she called it, “an army of corporate giants before it reaches their patients.” And she talks about sort of a lack of digital infrastructure, which is generally an issue at rural hospitals, but how some state plans showed that a “heavy dose” of spending will go to companies that “increase the use of electronic health records, strengthen cybersecurity, and improve state and health system technology platforms.” I liked the story because I think it’s really interesting to see this fight over how to get funding for your healthcare system. 

Rovner: And making the point that they’re taking money away from everybody. And they say they’re giving back. First of all, they’re taking a trillion, $900 billion out and giving $50 billion back, so it doesn’t make up for the cuts. But also that the money that they’re giving back isn’t going to the places where they’re doing the cutting, which I think is sort of the broader point. Sorry. Go ahead. Joanne. 

Kenen: This is from ProPublica, by Anna Clark: “.” Basically, there’s now a new thread of disinformation that solar power is bad for us, not the power but that the process of capturing the sun’s power, that radiation is blocking things, and the noise, that there’s sort of, quote, “visual pollution.” So anyway, it’s interfering with the growth of, the spread of solar power in Michigan, which is one of the states that had been sort of â€” pretty far north and pretty cold â€” I hadn’t realized it was one of the targeted states for a big push for solar energy, but it is. We’ve seen health disinformation about pretty much everything, and the latest is the sun. 

Rovner: Yeah, really interesting story. My extra credit this week is from The New York Times, by Christina Jewett and Benjamin Mueller, and it’s called “.” The aide in question, Calley Means, is the brother of the wellness influencer nominated to serve as surgeon general, Casey Means. And now Calley Means is a full-time regular employee in the federal government. But for most of last year, when he was advising HHS Secretary Kennedy as a, quote, “special government employee,” he also continued to hold a large stake in the health company Truemed, which profits from people using money in their health savings accounts to pay for medical expenses insurance doesn’t cover. According to the story, that includes things like $10,000 saunas and radiation-blocking underwear. And health savings accounts were dramatically expanded last year in the Republican budget bill. Now, Calley Means says he didn’t work on HSA policy, but it’s hard to ignore just all the appearances of conflicts in this administration. And just because there are so many of them, shouldn’t really normalize it. So this has been really good shoe leather reporting here. 

OK, that is this week’s show. Before we go, some well-deserved kudos to some of our podcast panelists. [Bloomberg’s] Anna Edney has been named a winner of the annual NIHCM [National Institute for Health Care Management] health awards for her work on  about the high cost and often limited benefit of new cancer drugs, and [The Washington Post’s] Lauren Weber and our own Shefali Luthra here have been named finalists for the University of Michigan’s Livingston Award for young journalists, along with KFF Health News’ Aneri Pattani. I’m not kidding when I say we let you hear from the best and smartest reporters covering healthcare. 

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

Kenen: On  and . 

Rovner: Rachel. 

Roubein: On X, . Bluesky, . 

Rovner: Shefali. 

Luthra: On Bluesky, . 

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

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, April 9, at 9:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

Today, we are joined via video conference by Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, everybody. 

Rovner: And my fellow Michigan Wolverine this national championship week, Maya Goldman of Axios. Go, Blue! 

Maya Goldman: Go, Blue. 

Rovner: No interview this week, but plenty of news. So let’s get right to it. We’re going to start with reproductive health. On Tuesday, a federal judge in Louisiana ruled for the Trump administration and against anti-abortion forces in a lawsuit over the availability of the abortion pill mifepristone. Wait, what? Please explain, Alice, how the administration and anti-abortion groups ended up on opposite sides of an abortion pill lawsuit. 

Ollstein: Yeah. So this has been building for a while, and it is not the only lawsuit of its kind out there. There are several. A bunch of different state attorneys general, who are very conservative and anti-abortion, have been suing the FDA in an attempt to either completely get rid of the availability of the abortion pill mifepristone or reimpose previous restrictions on it. So right now, at least according to federal rules, not according to every state’s rules, you can get it via telehealth. You can get it delivered by mail. You can pick it up at a retail pharmacy. You don’t have to get it in person handed to you from a doctor like you used to. So these lawsuits are attempting to bring back those restrictions or get the kind of national ban that a lot of groups want. And so you have other ones pending: Florida, Texas, Missouri, you have a bunch of ones. So this is the Louisiana version. And the Trump administration, it’s important to note, they are not defending the FDA or the abortion pill on the merits. They are saying, we don’t want this lawsuit and this court to force us to do something. We want to go through our own careful process and do our own internal review of the safety of mifepristone, and then we may decide to impose restrictions. But they’re asking courts to give them the time and space to complete that process and saying, you know, This is our power we should have in the executive branch. And so, in this case, the judge, in ruling for the Trump administration, basically just hit pause. This doesn’t get rid of the case. It just puts a stay on it for now, and that’s important. In some of these other cases, the Trump administration has asked the courts to throw out the case, but that was not the situation here. So this doesn’t mean that abortion pills are going to be available forever. This doesn’t mean nothing’s going to happen, and they’re going to be banned. This just means, you know, we’re kicking the can down the road.  

Rovner: I was saying, just to be clear. I mean, we know that this FDA quote-unquote “study” â€” whether it is or isn’t going on â€” is part of, kind of, a delaying tactic by the administration, because they don’t want to really make abortion a big front-and-center issue in the midterms. So they’re trying to sort of run the clock out here. Is that not sort of the interpretation that’s going on right now?  

Ollstein: That’s what people on both sides assume is going on. It’s really been fascinating how everyone is being kept in the dark about what’s happening inside the FDA â€” and if this review is even happening, if it’s real, if it’s in good faith, what is it based on? And so it’s become this sort of Rorschach test, where people on the left are saying, you know, They’re laying the groundwork to do a national ban. This is just political cover. They just want to wait until after the midterms, and then they’re going to go for it. And people on the right are saying, you know, The administration is cowardly, and they aren’t really doing anything, and they’re just trying to get us to shut up and be patient. We don’t know if either of those interpretations or neither of them are true.  

Rovner: Lauren, you want to add something? 

Weber: I just think it’s pretty clear this is also just on a [Health and Human Services Secretary Robert F.] Kennedy [Jr.] priority. I mean, let’s go back. The man â€¦ comes from one of the top Democratic political families originally. You know, there’s obviously been a lot of chatter around his anti-abortion beliefs. Now, obviously, he’s on a Republican ticket. I think some of that plays into this as well. And he already has his hand on the stove on so many other hot issues that, [if] I had to guess, I don’t think that they’re trying to rock the boat on this one. â€¦ I think, some background context too, to some of what’s going on.  

Rovner: We’ll get to some of those hotter issues. But, meanwhile, the Journal of the American Medical Association [Internal Medicine] has a  suggesting that medication abortion is so safe that it could be provided over the counter â€” that’s without any consultation with a medical professional, either in person or online. This doesn’t feel like it’s going to happen anytime soon, though, right? While we’re still debating the existence of medication abortion in general. 

Ollstein: That’s right. I mean, there are a lot of people who can’t get this medication prescribed by a valid doctor right now, let alone over the counter. I will say it is common in a lot of parts of the world to get it over the counter, whereas in the United States, the most common way to have a medication abortion is with a two-pill combination, mifepristone and misoprostol. In a lot of parts of the world, people just use misoprostol alone, and it is effective and it is largely safe. It’s slightly less safe than using both pills together. And so I think there’s a lot of international data out there, and people point to that and advocate for this. And I will say there are activist groups in the United States who are setting up networks, underground networks, to get these pills to people with no doctor’s involvement. And so that is already going on. I think that a lot of people would prefer to get it from a doctor if they could. But because of bans and restrictions, they can’t. And so people are turning to these activist groups. 

Rovner: I will point out, as a person who covered the entirety of the fight to have emergency contraception â€” which is not the abortion pill â€” made over the counter, it took like, 15 years. It shortened my life covering that story. Lauren, did you want to add something?  

Weber: Yeah, I just wanted to say I find it really interesting. Obviously, reproductive issues end up taking 15 years, as you pointed out, to make it over the counter. But there are a lot of things that are considered potentially more dangerous that you can order up in a pretty basic telehealth visit or even just buy in not-so-sketchy ways that the administration is also even looking to deregulate. So I think the differences of access of this compared to other less studied, potentially more unsafe medication is quite striking. 

Goldman: Part of [President Donald] Trump’s “Great Healthcare Plan” is making more medications available over the counter. So this is certainly something that they have said they want to do, in general. This is a political nightmare, though, to do that for abortion. 

Ollstein: Yeah, and people have been pointing to this and a lot of other policies for a while to argue about something they call abortion exceptionalism, in which people apply a different standard to anything related to abortion, a different safety standard, a different standard of scrutiny than they do to medications for lots of other purposes. And you’ve seen that, and that comes up in lawsuits and political arguments about this. And I think, you know, people can point to this as another example. 

Rovner: So last week, we talked about the federal family planning program Title X, which finally got funded after months of delays. But Alice, you warned us that the administration was planning to make some big changes to the program, and now those have finally been announced. Tell us what the plan is for a program that’s provided birth control and other types of primary and preventive care since the early 1970s. 

Ollstein: Well, the changes have sort of been announced. They’ve more been teased. What we are still waiting for is an actual rule, like we saw in the first Trump administration, that would impose conditions on the program. And so what we saw recently, it was part of a wonky document called a “Notice of Funding Opportunity,” or NOFO, for those in the D.C. lingo. And basically it was signaling that when groups reapply â€” they just got this year’s money, but when they reapply for next year’s money â€” it sets up sort of new priorities and a new focus for the entire program. And what was really striking to me is, you know, this is a family planning program. It was created in the 1970s and it is primarily about delivering contraception to people who can’t afford it around the country, providing it to millions of people who depend on this program, and the word “contraception” did not appear in the entire 70-page document other than an assertion that it is overprescribed and has bad side effects. And instead, they signaled that they want to shift the program to focus on, quote, “family formation.” So this is really striking to me. I think we saw some signs that something like this was coming. You know, about a year ago, there was some Title X money approved to focus on helping people struggling with infertility. But that was sort of just a subset of the program, and now it looks like they want to make that, you know, an overriding focus of the program. So I think when the actual rule to this effect drops, and we don’t know when that will be â€” will they wait till after the midterms to, you know, avoid blowback? Who knows? I think there will certainly be lawsuits then. But I think right now, this is just sort of a sign of where they want to go in the future. And it’s important to note that it came very quickly on the heels of a big backlash from the anti-abortion movement over the approval of this year’s funding going out to all of the clinics that got it before, including Planned Parenthood clinics. The anti-abortion groups were agitating for Planned Parenthood to be cut off at once, you know, not in the future, right now. 

Rovner: Just to remind people that the ban on Planned Parenthood funding from last year was for Medicaid, not for the Title X program. 

Ollstein: Right.  

Rovner: And that’s why Planned Parenthood got money. 

Ollstein: Yes, and Planned Parenthood is not allowed to use any Medicaid or Title X money for abortions, but the anti-abortion groups say it functions like a backdoor subsidy, and so they wanted it to be cut off. So they were very pissed that this money went out to Planned Parenthood. And so very quickly after, the administration put out this document, saying, Look, we are taking things in another direction, and it is not the direction of Planned Parenthood. 

Rovner: Lauren, you want to add something? 

Weber: Oh, I just wanted to say Alice has really been owning the beat on all the Title X coverage, so â€¦ 

Rovner: Absolutely.  

Weber: â€¦ glad we are able to have her explain it to us. But just wanted to throw out a kudos for breaking all the news on that front.  

Goldman: Yeah, great coverage. 

Rovner: Yes. Very happy to have you for this. Turning to the budget, which is normally the major activity for Congress in the spring, we finally got President Trump’s spending blueprint last week. It does propose cuts to discretionary spending at the Department of Health and Human Services to the tune of about $15 billion, but those cuts are far less deep than those proposed last year. And, as we have noted, Congress didn’t actually cut the HHS budget last year by much at all. And many programs, like the National Institutes of Health, actually got small increases. Is this budget a reflection of the fact that the administration is recognizing that cuts to Health and Human Services programs aren’t actually popular with the public or with Congress, for that matter, going into a midterm election? 

Weber: I think it’s that last little piece you mentioned there, Julie. I think it’s the “going into the midterm election.” I think you hit the nail on the head there. Cuts are also not good economically for many Republicans. You know, we saw Katie Britt be one of the â€” the Alabama Republican senator â€” be one of the most outspoken senators in general about some of the cuts that were floated for the budget for HHS last year. So I think what you’re hinting at, and what we’re getting at, is that it’s not politically popular, it can be economically problematic, on top of the scientific advances that are not found. So I suspect you are right on that. 

Ollstein: The administration knows that this is “hopes and dreams” and will not become reality. It did not become reality last year. It almost never becomes reality. And I think you can see the sort of acknowledgement that this is about sending a message more than actually making policy in things like Title X, because at the same time they put out this guidance from HHS about the future of Title X, moving away from contraception, in the president’s budget he proposed completely getting rid of Title X, completely defunding it, which he has in the past as well. And so why would they put out guidance for a program that doesn’t exist? 

Goldman: I think, also, this is the second budget that they’re putting out in this administration, right? So now they are just a little more used to what’s going on, and they have more of their feet under them. 

Weber: As a preview for listeners, too, I’m sure we will have Kennedy asked about this budget when he appears in a series of so many hearings next week and the week after. And there were a lot of fireworks last year with him and various members of Congress about the budget. So I am sure that we will hear a lot more on this front in the weeks to come. 

Rovner: Yeah, I would say that’s one thing that the budget process does, is when the president finally puts out a budget, the Cabinet secretaries travel to all of the various committees on Capitol Hill to, quote, “defend the president’s budget,” which is sometimes or, I guess in the case of Kennedy, one of the few chances that they get to actually have him in person to ask him questions. But in the meantime, you know, we have the budget, then we have the president himself, who at an Easter lunch last week â€” that was supposed to be private, but ended up being live-streamed â€” said, and I quote, “It’s not possible for us to take care of day care, Medicare, Medicaid, all these individual things.” The president went on to say that states should take over all that social spending, and the only thing the federal government should fund is, quote, “military protection.” Did I just hear a thousand Democratic campaign ads bloom? 

Goldman: I think this is a prime example of when you should take Trump seriously, but not literally. I don’t think that there’s any world, at least in the foreseeable future, where the federal government isn’t funding Medicare. But, you know, you certainly have to watch at the margins. It’s like, it’s not a secret that this is something that they’re interested in cutting back spending on. It’s super politically difficult to do that, and they know that, and that’s part of why, which I’m sure we’ll talk about in a little bit, they bumped up the payment rate for 2027 to Medicare Advantage plans.  

Rovner: Which we will get to. 

Goldman: Yeah, so I mean, it’s certainly an eye-opening statement, and you should remember it. But I don’t think that we’re in immediate jeopardy here. 

Rovner: This is the president who ran in 2024, you know, saying that he was going to protect Medicare and Medicaid. I mean, it’s been, you know, against some of the recommendations of his own administration. I was just sort of shocked to see these words come out of his mouth. Lauren, you wanted to say something?  

Weber: I mean, it’s not that surprising, though. I mean, look at what the One Big Beautiful Bill [Act] did to Medicaid. He’s already pushed through massive Medicaid cuts, which are essentially being offloaded to the states. So, I mean, I think this ideology has already borne out and will continue to bear out, and obviously it’s happening amid the backdrop of a war. So that plays into, obviously, the commentary as well.  

Rovner: Well, meanwhile, Republicans are still talking about doing another budget reconciliation bill, the 2.0 version of last year’s Big Beautiful Bill, except this time it’s essentially just to fund the military and ICE [Immigration and Customs Enforcement] and border control, because Democrats won’t vote for those things, at least they won’t vote for additional military spending. What are the prospects for that to actually happen? And would Republicans really be able to do it if those programs are paid for with more cuts to Medicare and/or Medicaid, as some have suggested? 

Goldman: You know, my co-worker Peter Sullivan wrote about this last week, and there was a lot of blowback from politicos, from advocates, from, you know, kind of across the spectrum of groups there. I think that it would be extremely politically unpopular, especially going into the midterms, to use health care as an offset. But I would say that Republicans are pretty good at rhetoric, right? That’s one of the things that they’re known for right now, and there’s always a way to spin it. 

Rovner: Alice and I spoke to a group earlier this week, and I went out on a limb and predicted that I didn’t think Republicans could get the votes for another big budget reconciliation this year. I mean, look at how close it was last year. The idea of cutting any deeper seems to me unlikely, just given the margins that they have. 

Goldman: And I think that is something that you do in between election years. That’s not something you do in an election year. 

Rovner: That’s true, yes â€¦ you do tend to see these bigger bills in the odd-numbered years rather than the even-numbered years, but … 

Ollstein: And I think it’s important to remember that the reason Republicans are in this bind and that they feel like they have to keep reconciliation nearly focused on funding immigration enforcement is because Democrats refuse to fund immigration enforcement. And so they feel pressured to put all their effort and political capital towards that, and don’t want to mess that up by adding a bunch of other health care things that could cause fights and lose them votes.  

Goldman: The money has got to come from somewhere. 

Rovner: And health care is where all the money is. Speaking of Medicare and Medicaid, where most of the money is, there is news on those fronts, too. Maya, as you hinted on Medicare, the administration is out with its payment rule for private Medicare Advantage plans for next year. And remember, we talked about how HHS was going to really go after overbilling in Medicare Advantage and cut reimbursement dramatically? Well, you can forget all that. The final rule will provide plans with a 2.48% pay bump next year. That’s compared to the less than 1% increase in the proposed rule. That’s a difference of about $13 billion. The final rule also eliminated many of the safeguards that were intended to prevent overbilling. What happened to the crackdown on Medicare Advantage? Are their lobbyists really that good? 

Goldman: Their lobbyists are pretty good. This was a year where there were â€” I think CMS [the Centers for Medicare & Medicaid Services] said there were a record number of public comments on their proposed rate, flat rate increase, flat rate update. But I think it’s also not that surprising. Historically, the final rate announcement for Medicare Advantage is almost always a little higher than the proposed because they incorporate additional data from the end of the previous year that wasn’t available when first rate is proposed, the initial rate is proposed. But certainly they backed away from a big change to risk adjustment, or, like, the way to adjust payment based on how sick a plan’s enrollees are. You get more pay â€¦  

Rovner: Because that’s where the overbilling was happening, that we’d seen a lot of these wonderful stories that plans were basically, you know, inventing diagnoses for patients who didn’t necessarily have them or didn’t have a severe illness, and using that to get additional payments. 

Goldman: Right. And they did move forward with a plan to prevent diagnoses that are not linked to information that’s in a patient’s medical chart from being used for risk adjustment. But a lot of plans had said, like, Yeah, this is, that’s the right thing to do, and it’s not going to be that impactful for us. You know, overall, this is a win for health insurance. I think one thing to note is that Chris Klomp, the director of Medicare, said, We’re still really focused on trying to right-size this program. That’s still a priority for us as an administration, but we also want to safeguard it. And so I think insurers are not off the hook entirely. There’s still going to be a lot of scrutiny, but their lobbyists are pretty good. And you know, no one wants to be seen as the candidate that cuts Medicare. 

Rovner: And we have seen this before, that when Congress cuts “overfunding” for Medicare Advantage, the plans, seeing that they can’t make its big profits, drop out or they cut back on those extra benefits. And the beneficiaries complain because they’re losing their plans, or they’re losing their extra benefits, and they don’t really want to do that in an election year either, because there are a lot of people, many millions of people, who vote who are on these plans. So, in some ways, the plans have the administration over a political barrel, in addition to how good their lobbyists are.  

Well, apparently, one group that HHS is still cracking down on are legal immigrants with Medicare. Most of the publicity around the health cuts in last year’s budget bill focused on the cuts to Medicaid. But we at Ñî¹óåú´«Ã½Ò•îl Health News have a story this week about legal immigrants who’ve paid into the Medicare system with their payroll taxes for years and are now being cut off from their Medicare coverage. This is apparently the first time an entire category of beneficiaries are having their Medicare taken away. I’m surprised there hasn’t been more attention to this, or if it’s just too much all happening at once. 

Ollstein: I mean, there’s a lot happening at once, and even just in the space of immigrants’ access to health care, there is so much happening at once. And so this is obviously having a huge impact on a lot of people, but so are 100 other things. And I think, you know, the zone has been flooded as promised. And really, state officials who are also dealing with a thousand other things, Medicaid cuts, you know, these federal changes, work requirements, are grappling with this as well. 

Rovner: Lauren, you wanted to add something? 

Weber: Yeah. I mean, I thought it was, there was a striking quote in the story from Michael Cannon, who basically said, The reason this isn’t resonating is because this won’t upset the Republican base. And I think that’s a striking quote to be considered. 

Rovner: Michael Cannon, libertarian health policy expert, just kind of an observer to this one. But yeah, I think that’s true. I mean, or at least the perception is that these are not Republican voters, although, you know, as we’ve seen, you know, Congress has tried to take aim at people they think aren’t their voters, and it’s turned out that those are their voters. So we will see how this all plays out.  

Well, at the same time that this is all going on, the folks over at the newsletter “Healthcare Dive” are reporting that the Centers for Medicare & Medicaid Services are trying to embark on all these new initiatives on fraud, and work requirements, and artificial intelligence with a diminished workforce. While CMS lost far fewer workers in the DOGE [Department of Government Efficiency] cuts last year than many other of the HHS agencies â€” it was in the hundreds rather than the thousands â€” CMS has long been understaffed, given the fact that it manages programs that provide health insurance to more than 160 million Americans through not just Medicare and Medicaid, but also the Children’s Health Insurance Program and the Affordable Care Act. I know last week, FDA Commissioner Marty Makary said he wants to hire more workers to replace the 3,000 who were RIF’ed or took early retirement there at the FDA. And CMS does have lots of job openings being advertised. But it’s hard to see how replacing trained and experienced workers with untrained, inexperienced ones are going to improve efficiency, right? 

Goldman: Tangentially, I was talking to a health insurance executive yesterday who was saying that his team is so much bigger than CMS, and they cover a fraction of the market, and they’re often the ones coming to CMS and proposing ideas and working with CMS on it. I don’t, I think that is a dynamic that far predates this administration, but â€¦ 

Rovner: Oh, absolutely. 

Goldman: But it’s certainly interesting. And â€¦ CMS has very ambitious plans, and not that many people to carry them out. But, you know, I think one thing that I also want to note is that when I talk to trade associations and stakeholders about this CMS, they are generally like, pretty support- â€¦ like, they say that they think they’re being heard, and they think that CMS and the career staff are doing, you know, the same kind of caliber of work that they’ve been doing, which I think is notable. 

Rovner: And as we have mentioned many times, you know, Dr. [Mehmet] Oz, the head of CMS, is very serious about his job and doing a lot of really interesting things. It’s just, it’s hard, you know, in the federal government, if you don’t have the resources that you want to â€¦ if you don’t have the resources to match your ambitions. Let’s put it that way.  

Well, meanwhile, on the Medicaid front, we’re already seeing states cutting back, and some of the results of those cutbacks.  on how psychiatric units are at risk of being shut down due to the Medicaid cuts, since they often serve a disproportionate number of low-income people and also tend to lose money. And The New York Times has a  of an Idaho Medicaid cutback of a program that had provided home visits to people living in the community with severe mental illness, until those people who lost the services began to die or to end up back in more expensive institutional care. Now the state has resumed funding the program, but obviously will end up having to cut someplace else instead. I know when Republicans in Congress passed the cuts last year, they said that people on Medicaid who were not the able-bodied working-age populations wouldn’t see their services cut. But that’s not how this is playing out, right?  

Weber: I just think the story by Ellen Barry, who you should always read on mental health issues in The New York Times, “,” is such an illustrative example of unintended consequences from these cuts. And the reason that they’re being reversed â€” by Republican legislators, no less â€” in Idaho, is because it’s more expensive to have cut the money from it than it is efficient. I mean, what they found was, is that after they cut the money to the schizophrenia program, they saw this massive uptick in law enforcement cases and hospitalizations, uninsured hospitalizations, that this avoided. And I think it’s a real canary in the coal mine situation, because we’re only starting to see these states cut these things off. And this was a pretty immediate multiple-death consequence. And I think we’re going to see a lot of stories like this, of a variety of programs that we all don’t even have any idea that exist in the safety net across the country that are being chipped away at.  

Rovner: Well, turning to other news from the Department of Health and Human Services, we’re getting some more competition here at What the Health? Health secretary Kennedy has announced he’ll be unveiling his own podcast, called The Secretary Kennedy Podcast, next week. He promises to, according to the trailer posted online on Wednesday, quote, “name the names of the forces that obstruct the paths to public health.” OK then, we look forward to listening.  

Meanwhile, in actual secretarial work, the secretary this week also unveiled changes to the charter of the Advisory Committee on [Immunization] Practices after a federal judge last month invalidated both the replacement members that he’d appointed last year and the changes made to the federally recommended vaccine schedule. So what’s going to happen here now? Will this get around the judge’s ruling by watering down the expertise that members of this advisory committee are supposed to have in vaccines? And why hasn’t the administration appealed the judge’s ruling yet? 

Goldman: You know, I don’t have actual answers to this, but I do wonder and speculate that this is going to end up being some kind of legal whack-a-mole situation where the secretary and HHS says, OK, you don’t like it that way? We’ll do it this way, and then they’ll do it another way, and advocates will sue, and we’ll see how this plays out going forward in the courts. I think this is not the end of the story. Even though the judge’s decision was a big win for vaccine advocates, it’s just we’re in the midpoint, if that. 

Rovner: And Lauren, speaking of vaccines, your colleague Lena H. Sun has  on HHS and vaccine policy. 

Weber: Yeah, Lena Sun is always delivering. She found out that the acting director of the CDC [Centers for Disease Control and Prevention] at the time delayed publication of a report showing that the covid-19 vaccine[s] cut the likelihood of emergency department visits and hospitalizations for healthy adults last winter by about half. So even though Kennedy is not talking more about vaccines, it appears that, based on this reporting, that some of his underlings are not necessarily touting the benefits of vaccine, so to speak. And I’m very curious, going back to Kennedy’s podcast, I found the rollout of that so interesting because the teaser was very leaning into the Kennedy that got elected, you know, someone who speaks about, you know, dark truths that are hidden from the public, and so on. And then the press team had these statements of, like, Kennedy will investigate the affordability of health costs and food and nutrition. And I think this dichotomy of who Kennedy is and who the White House and the press secretary and HHS want Kennedy to be before the midterms really could come to a head in this podcast. So I think we will all be listening to hear how that goes. 

Rovner: Yeah, we keep hearing about how the secretary is being, you know, sort of put on a leash, if you will. And, you know, told to downplay some of his anti-vaccine views and things like this. And that seems quite at odds with him having his own podcast. Alice, do you want to …? 

Weber: I guess, it depends on who’s editing the podcast and who they have on. I’m just very â€¦ you could even tell from the trailer to how his press secretary presented it, there was an interesting differential in framing, and I am curious how that plays out as we see guests on it. 

Ollstein: I mean, it’s also worth noting that this is an administration of podcasters. I mean, you have Kash Patel, you have so many of these folks who have a history of podcasting, clearly have a passion for it, just can’t let it go while working a full-time, high-pressure government job.  

Rovner: We shall see. Meanwhile, HHS, together with the Environmental Protection Agency, is waging war on microplastics, those nearly too impossible to detect bits of plastic that are getting into our lungs and stomachs and body tissues through air and water and food. The plan here seems to be to find ways to detect exactly how much microplastics we are all getting in our water and what the health impacts might be, since we don’t have enough information to regulate them yet. I would think this would be one of those things that pleases both MAHA [Make America Healthy Again] and the science community, right? Or is it just, as one MAHA supporter called it, theater? 

Goldman: I think this is a great example of the, you know, part of the reason why MAHA is so interesting to such a wide swath of people. Like, there’s a lot of legitimate concern, not that other concerns aren’t necessarily legitimate, but there’s a lot of concern over, from the scientific community, over microplastics. I’m honestly surprised that we’re this far into the administration with this announcement. I would have thought that this is something they would have done sooner, but they obviously had other priorities as well. 

Rovner: Well. Finally, this week, speaking of other priorities, HHS Secretary Kennedy and CMS Administrator Dr. Oz are declaring war on junk food in hospitals. Again, this seems like a popular and fairly harmless crusade; hospitals shouldn’t be serving their patients ultraprocessed food. Except, almost as soon as the announcement came out, I saw tons of pushback online from doctors and nurses who worried about patients for whom sugary food or drinks are actually medically indicated, or who, because of medications they’re taking, or illnesses they have, can only eat, or will only eat, highly palatable, often processed food. Nothing in health care is as simple as it seems, right?  

Weber: I think what’s also interesting is one of my favorite examples in the memo they put out was they hope that every hospital, as an example, could serve quinoa and salmon. And I just am curious to see how fast that gets implemented. And it’s a very valid â€” a lot of people complain about hospital food. It’s a very valid thing to push for better food. But I also question, as I understand it, this seems more like a carrot than a stick when it comes to the regulation they put out. 

Rovner: As it were. 

Weber: As it were. And so I’m curious to see how it gets implemented. That said, there are hospitals that have taken it upon themselves â€” the Northwell [Health] example in New York is a good example â€” to really improve their hospital food. And frankly, it’s a money maker. If your food’s better, people come to your hospital, especially in an urban area where there is hospital competition. So you know, like most MAHA topics, there’s a lot of interesting points in there, and then there’s a lot of what’s the reality and what’ actually going to happen. And so I’ very curious to see how this continues to play. 

Rovner: I did a big story, like, 10 years ago on a hospital chain that had its own gardens, that literally grew its own healthy food. So this is not completely new but, again, interesting. 

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

Ollstein: I have a piece from my co-worker Simon [J.] Levien, and it is called “.” This is about thousands of doctors around the country who are from other countries that are placed on, you know, a list by the Trump administration of places where they want to scrutinize and limit the number of immigrants coming from there. And so these are people who are already here, already practicing, have poured years into their training, have been living here, and, in some cases, are the only folks willing to work in certain areas that have a lot of medical shortages, and they just can’t practice because their paperwork isn’t getting processed in time. And so they’re sort of in this scary limbo, and that’s putting these hospitals and clinics that they work in in a really tough bind. And so they’re hammering the Trump administration to give them answers about what their fate is. You know, they’re not trying to deport them yet, but they’re not allowing them to continue working either.  

Rovner: For an administration that’s been pushing really hard to improve rural health care, this does not seem to be a way to improve rural health care. Maya. 

Goldman: My extra credit this week is called “Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records.” It’s a great KFF Health News scoop from Amanda Seitz and Maia Rosenfeld. It’s a really great example of the administration, you know, sort of moving in silence, doing these small regulatory announcements that could have big impact. Basically, the Office of Personnel Management is asking for personally identifiable medical information from health insurers, and its reasoning is to analyze costs and improve the health system, but they could get very detailed medical information from federal employees, including things like, did they get an abortion? Are they undergoing gender-affirming care? And, obviously, there is a strong concern that that could be used against them.  

Rovner: Yeah â€¦ this was quite a scoop. Really, really interesting story. Lauren. 

Weber: Mine was a pretty alarming story by Holly Yan at CNN: “.” And basically there’s this type of drug test that the scientists have found is not that effective, and it’s led to things like bird poop being scraped off a man’s car appearing on a drug test as cocaine, a great-grandmother’s medication testing positive for cocaine, and a toddler’s ashes registering as meth or ecstasy, and horrible legal and other consequences of this kind of misdiagnosis in the field. And the reason these drug tests are often done is because they’re cheaper. There’s a more expensive, more accurate version, but these are cheaper. They’re done in the field. But the potential side effects and horrible, wrongly accused effects are quite large, and so Colorado has passed this law to try and move away from this. And it’s curious to see if other states will follow suit. 

Rovner: Yeah, this was something I knew nothing about until I read this story. My extra credit this week is from The Atlantic by Katherine [J.] Wu, and it’s called “.” And it’s about how some of the very top career officials from the NIH [National Institutes of Health], the CDC, and other agencies have, after having been put on leave more than a year ago, finally been reassigned to far-flung outposts of the Indian Health Service in the western United States. They got news of their proposed reassignments with little description of their new roles and only a couple of weeks to decide whether to move across the country or face termination. Now, if these officials’ skills matched those needed by the Indian Health Service, this all might make some sense. But what the IHS most needs are active clinicians: doctors and nurses and social workers and lab technicians. And those who are now being reassigned are largely managers, including â€” and here I’m reading from the story, quote â€” “the directors of several NIH institutes, leaders of several CDC centers, a top-ranking official from the FDA tobacco-products center, a bioethicist, a human-resources manager, a communications director, and a technology-information officer.” The Native populations who are ostensibly being helped here aren’t very happy about this, either. Former Biden administration Interior Secretary Deb Haaland, a Native American who’s now running for governor in New Mexico, called the reassignment proposals, quote, “shameful” and “disrespectful.” Also, and this is my addition, not a very efficient use of human capital. 

OK, that’s this week’s show. Thanks this week to our fill-in editor, Mary-Ellen Deily, 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 on X , or on Bluesky . Where do you guys hang these days? Maya. 

Goldman: I am on LinkedIn under my first and last name, , and on X at . 

Rovner: Alice. 

Ollstein: I’m on Bluesky  and on X . 

Rovner: Lauren. 

Weber: Still @LaurenWeberHP on both  and . 

¸é´Ç±¹²Ô±ð°ù:ÌýWe will be back in your feed next week. Until then, be healthy.

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, April 2, 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: Jessie Hellmann of CQ Roll Call. 

Jessie Hellmann: Thanks for having me. 

Rovner: And Sandhya Raman, now at Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

Rovner: Later in this episode, we’ll have my interview with Ñî¹óåú´«Ã½Ò•îl Health News’ Elisabeth Rosenthal, who reported and wrote the last two Ñî¹óåú´«Ã½Ò•îl Health News “Bills of the Month.” One is about a patient who got caught in the crossfire over prices between insurers and drug companies. The other is about a woman who, and this is not an April Fools’ joke, got her insurance canceled for failing to pay a bill for 1 cent. But first, this week’s news. 

So Congress is on spring break, but when they come back, health policy will be waiting. A new Gallup poll out this week found 61% of those surveyed said they worry about the availability and affordability of health care, quote, “a great deal.” That was 10 percentage points more than the economy, inflation, and the federal budget deficit, and it topped a list of 15 domestic concerns. And while we are still waiting for final enrollment numbers for Affordable Care Act plans, we do know that the share of people paying more than $500 a month for their coverage doubled from last year to 2026. Yet Axios this week is reporting that Republicans are considering still more cuts to the Affordable Care Act to potentially pay for a $200 billion war supplemental. What exactly are they thinking? And it’s looking more like Republicans are going to try for another budget reconciliation bill this spring. Isn’t that, right, Jessie? 

Hellmann: House Budget chair Jodey Arrington has kind of been pushing this idea really hard of going after what he says is fraud in mandatory programs like Medicare and Medicaid. He’s also talked about funding cost-sharing reductions, which is an idea that slipped out of the last reconciliation bill, and it’s a wonky kind of idea â€¦ 

Rovner: But I think the best way to explain it is that it will raise premiums for many people. That’s how I’ve just been doing it.  

Hellmann: Yeah, exactly. 

Rovner: Let’s not get into the details. 

Hellmann: It would reduce spending for the federal government but wouldn’t really help people who buy insurance on the marketplace. He hasn’t been very specific. He’s also talked about, like, site-neutral policies in Medicare, but it’s hard to see how all of this could make a serious dent in a $200 billion Iran supplemental. There’s also a new development. I think President [Donald] Trump threw a wrench in things yesterday when he said he wanted the reconciliation bill to focus on border spending and immigration spending to cover a three-year period, and now Senate Majority Leader John Thune is saying that there’s probably not room for much else in the bill. So, unclear what the path forward is for all of that. 

Rovner: Yeah, and of course, that was part of the deal to free up the Department of Homeland Security’s budget in the appropriation. It’s all one sort of big, tied-up mess at this point. Alice, I see you’re nodding. 

Ollstein: Yeah. I mean, what often happens with these reconciliation bills is it starts out with a tight focus and everyone’s unified, and then, because it can often be the only legislative train leaving the station, everybody gets desperate to get their pet issue on board, and then the more and more things get piled onto it, then they start losing votes, and people start disagreeing more. And so I think even though this is still in the ideas phase, you’re already seeing some signs of that happening. And when it comes to health care, it can be particularly fraught. And of course, you have lawmakers, especially in the House, with wildly different needs. Some of them need to fend off a primary from the right, and so they want to be as conservative as possible. Some are fighting to hang on in swing districts, and so they want to be more moderate. And these things are in conflict. And so these proposals to cut health spending, even more than the massive amount that was cut last year, are already, you know, raising some red flags among some moderate Republican members. And it’s very possible the whole thing falls apart. 

Rovner: Well, along those lines, we’re supposed to get the president’s budget on Friday, which is only two months late. It was due in February. And while I haven’t seen much on it, Jessie, your colleagues at Roll Call are reporting that the budget will seek a 20% cut to the National Institutes of Health. That’s only half the cut that the administration proposed last year. But given that Congress actually boosted the agency’s budget slightly this year, that feels kind of unlikely. 

Hellmann: Yeah, I don’t think that the appropriators are likely to go along with this. They have really strong advocates, and Sen. Susan Collins, who’s chair of the Senate Appropriations Committee. And, like you said, they rejected cuts last year. Kind of surprised. Twenty percent is not as deep as the Trump administration went last year. I was actually kind of surprised it wasn’t a bigger proposed cut. But either way, I don’t think Congress is going to go along with that.  

Rovner: Meanwhile, I saw a late headline that FDA is looking to hire back people after DOGE [Department of Government Efficiency] cut thousands of people last year. Sandhya, HHS [Department of Health and Human Services] is just in this sort of personnel churn at this point, isn’t it? 

Raman: Yeah, I think that HHS is kind of getting bit in the foot from, you know, we’ve had so many of these layoffs, and we’ve also had a lot of people just flee the various agencies over the past year because of some of this instability and all of these changes. And as we’re getting closer and closer to, you know, deadlines of things that they need to get done, they’re realizing that they do need more personnel to get some of those things done, as we’ve been passing deadlines. So I don’t think it’s something that’s unique to just FDA. But I think the way to solve this â€” it’s not an overnight thing for the federal government to staff up. It’s a longer process, but it’s really showing in a lot of areas right now. 

Rovner: Yeah, I would say this is not like TSA [Transportation Security Administration], where you can, you know, hire new people and train them up in a couple of months. These are â€¦ many of them scientists who’ve got years and years of training and experience at doing some of these jobs that, you know, the federal government is ordered to do by legislation. 

Raman: Yeah, those statutes are things that, you know, if they don’t meet those deadlines, those are things that are going to be challenged, and just further tie things up in litigation. And we already see so many of those right now that are making things more complicated.  

Rovner: Well, in news that is not from Congress or the administration, the Supreme Court this week said Colorado could not ban licensed mental health professionals from using so-called conversion therapy aimed at LGBTQ individuals, at least not on minors. What’s the practical impact here? It goes well beyond Colorado, I would think. 

Ollstein: Interesting, because a lot of people think of this as regulating health care, restricting providers from providing health care that is not helpful and maybe actively harmful to the health of the patients. 

Rovner: And that’s â€¦ I would say that’s been a state â€¦ 

Ollstein: Power. 

Rovner: â€¦ power. For generations.  

Ollstein: Absolutely. Right, I mean, you don’t want people selling sketchy snake oil pills on the street, etc. So many people view this as akin to that. But it has morphed in the hands of conservative courts into a free speech issue, and that, you know, these laws are restricting the speech of mental health workers who are against people transitioning. And so, yes, it definitely has national implications. And of course, we are in a national wave right now of both state and federal entities, you know, moving in the direction of rolling back trans rights in the health care space and beyond. 

Rovner: Yeah. In related news, regarding Colorado and minors and gender,  that Children’s Hospital Colorado has not yet resumed providing gender-affirming care for transgender youth. That’s despite a federal judge in Oregon having struck down an HHS declaration that would have punished hospitals for providing such services. Apparently, the hospital in Colorado is concerned that the judge’s ruling doesn’t provide it with enough legal cover for them to resume that care. I’m wondering, is this the administration’s strategy here to get organizations to do what they want, even if they might lack the legal authority to do it? Just by making them worry that they might come after them? 

Raman: I think the chilling effect is definitely a big part of this broader issue. I mean, we’ve seen it in other issues in the past, but just that if there is this worry that it’s a) going to stop on the provider side, new folks taking part in providing care, and also just it’s going to make patients, even if there are opportunities, even less likely to want to go because of the fears there. I mean, it goes broader than that. We’ve had FTC [Federal Trade Commission] complaints, where they have gone and investigated different places that provide gender-affirming care or endorse it. So I think it’s broader than this, and really part of that chilling effect.  

Rovner: And Alice, as you were saying, I mean, the subject of transgender rights, or lack thereof, remains a political hot topic. The Idaho Legislature this week passed a bill that now goes to the governor that would require teachers and doctors to out transgender minors to their parents. Parents could sue teachers, doctors, and child care providers who, quote, “facilitate the social transformation of the minor student.” That includes using pronouns or titles that don’t align with their sex at birth. I don’t know about teachers, but that definitely seems to violate patient privacy when it comes to doctors, right? 

Ollstein: There’s definitely patient privacy issues there. I also think, you know, it’s interesting that this kind of nonmedical transitioning is now coming under attack. Because, you know, you would think that there would be some support for letting a kid, you know, go by a different name for a few weeks, test it out, see how it feels. Maybe it’s a phase, then they discover that they don’t want to actually pursue taking medications and going through a medical transition. But this is sort of shutting down that avenue as well. You can’t even change your appearance, change how you present in the world, at a time when kids are really trying to figure out who they are. So I think the broad acceptance of hostility to medical transitioning for youth is now spilling over into this kind of social transitioning, and I wonder if we’re going to see more of that in the future. 

Rovner: Yeah, I feel like we started with minors shouldn’t have surgery. They shouldn’t do anything that’s not easily reversible. And now we’ve gotten down to, in the Idaho law, there’s actually mention of nicknames. You can’t â€¦ a kid can’t change his or her nickname. It feels like we’ve sort of reduced this way, way, way down. 

Ollstein: And I think we’ve seen these laws, laws related to bathrooms. We’ve seen these have negative impacts on people who are not trans at all, people who just are a tomboy or not looking like people’s stereotypes of what different genders may look like. And so there’s a lot of policing of people who are not trans in any way. You know, there’s media reports of people being confronted by law enforcement for going into a bathroom that does align with their biological sex. And so it’s important to keep in mind that these laws have an effect that’s much broader than just the very small percentage of people who do consider themselves trans. 

Rovner: Yeah, it’s kind of the opposite of not being woke. All right, we’re going to take a quick break. We will be right back.  

So while we’ve had lots of news out of the Department of Health and Human Services the past few weeks, it’s been mostly public health-related. But there’s a lot going on in the Medicare and Medicaid programs too. Item A: Stat News is reporting that HHS is studying whether to make the private Medicare Advantage program the default for seniors when they qualify for Medicare. Right now, you get the traditional fee-for-service plan that allows you to go to any doctor or hospital that accepts Medicare, which is most of them. You have to affirmatively opt into Medicare Advantage, which often provides extra benefits but also much narrower networks. What would it mean to make Medicare Advantage the default, that people would go into private plans instead of the government plan, unless they affirmatively opted for the traditional fee-for-service? 

Hellmann: Someone’s experience with â€¦ can vary greatly between being on traditional Medicare and Medicare Advantage. If you’re in Medicare Advantage, you could be exposed to narrow networks. You can only see certain doctors that are covered by your plan. You can be exposed to higher cost sharing. A lot of people are kind of fine with their plans until they have a medical issue and need to go to the hospital or they need skilled nursing care. So making this the default could definitely be a challenge for some people, especially people that have complex health needs. Some people on the early side of their Medicare eligibility are fine with Medicare Advantage, and then they get older and they’re not fine with it anymore. So it’s interesting that the administration would kind of float this idea because they’ve been critical of Medicare Advantage. 

Rovner: Thank you. That’s exactly what I was thinking. 

Hellmann: Yeah, they’ve talked about the federal government pays these plans too much, and it’s not for better quality in a lot of cases, and they’ve talked about reforms in that area. So I was a little surprised to see that. 

Rovner: Yeah, Republicans have been super ambivalent. I mean, Medicare Advantage was their creation. They overpaid them at the beginning when they, you know, sort of redid the program in 2003. And they purposely overpaid them to get people into Medicare Advantage. And then the Democrats pointed out that this is wasting money because we’re overpaying them. And now the Republicans seem to have joined a lot of their â€” at least some Republicans â€” seem to have joined a lot of the Democrats in saying, Yes, we’re overpaying them. We’re paying them too much. And you know, they talk about the big, powerful insurance companies, and yet they’re now floating this idea to make Medicare Advantage the default. So pick a side, guys. 

All right, well, in other Medicare news, the Electronic Frontier Foundation is suing Medicare officials to learn more about the pilot program that’s using artificial intelligence to oversee prior authorization requests in the traditional Medicare fee-for-service program. The idea here is to cut down on, quote, “low-value services,” things that doctors might be prescribing that aren’t either particularly necessary or shown to actually work. But the fear, of course, is that needed care for patients will be delayed or denied, which is what we’ve seen with prior authorization in Medicare Advantage. This is the perennial push-pull of our health care system, right? If you do everything that doctors say, it’s going to be too expensive, and if you second-guess them, it’s going to be, you know, it might turn out to be too constraining. 

Hellmann: Well, I was just going to say this is another issue that was kind of a little surprising to me, because there’s been so much criticism of the use of prior authorization and Medicare Advantage. And CMS [Centers for Medicare & Medicaid Services] looked at that and said, Oh, what if we did it in traditional Medicare? Like it was never going to go over well politically, and I think there are even some Republican members of Congress who are not in support of this, but they haven’t really made a huge stink about it. Yeah, this wasn’t something I really expected to see. 

Rovner: Yeah, we’ll see how this one plays out too. Well, meanwhile, regarding Medicaid, two really good stories this week from my Ñî¹óåú´«Ã½Ò•îl Health News colleagues Phil Galewitz, Rachana Pradhan, and Samantha Liss. Phil’s story found that efforts in multiple states to find enrollees who were not eligible for the program due to their immigration status turned up very few violators. While Samantha and Rachana detailed the hundreds of millions of dollars states and the federal government are spending to set up computer programs to track Medicaid’s new work requirement, despite the fact that we already know that most people on Medicaid either already work or they are exempt from the requirements under the new law. Is it just me, or are we spending lots of time and effort on both of these policies that are going to have not a very big return?  

Ollstein: Well, that’s what we’ve seen in the few states that have gone ahead and attempted this before, that it costs a lot, and you insure fewer people. And that’s not because those people got great jobs with great health care. You insure fewer people, and the level of employment does not meaningfully change. 

Rovner: I would say you insure fewer people who may well still be eligible. They just get caught in the bureaucratic red tape of all of this. 

Ollstein: Exactly. These tech systems that are being set up are challenging to navigate, if people even have a means to do it, if they even have a smartphone or a computer or access to Wi-Fi. There are not that many physical offices they can go to to work it out if they need to. And some of those are very far from where they live. And so you see some of these tech vendors, you know, are set to make off very well out of this system, and people who need the care not so much. And then, of course, you know, it’s not just the patients who will feel the impact. You have these hospitals around the country that are on the brink of closure. And if they have people who used to be insured â€” they used to be able to bill and get reimbursed for their services, suddenly they’re uninsured â€” and they’re coming in for emergency care that they can’t pay for, that the hospital has to throw out-of-pocket for, that puts the strain that some of these facilities can barely cope with. And so you’re seeing a lot of state hospital associations sounding the alarm as well. 

Raman: I would also say the timing is interesting. You know, we spent so much time and energy last year going through the reconciliation process to tighten these areas, to get in the work requirements, to reduce immigrant eligibility for Medicaid. And then, you know, as they’re gearing up to possibly do this again, to defer their crackdown on health care as part of that, instead of it saving money â€” that it’s not having as much of an effect and costing so much, in the case of the work requirements, where we’re not expected to see the return of it. 

Rovner: Yeah, that may be, although I guess the return is that people will not have insurance anymore, and so the federal government, the states, won’t be spending money for their medical care. They’ll be spending money on other things. All right, of course, there’s more news from HHS than just Medicare and Medicaid this week. We also have a lot of news about the Make America Healthy Again movement, which is a sentence that 2023 me would definitely not recognize.  about a new poll that finds the MAHA vote isn’t necessarily locked in with Republicans. Tell us about it. 

Ollstein: Yeah, that’s right. So Politico did our own polling on this, because we hadn’t really seen good data out there on who identifies as MAHA and what do they even believe about the different parties and about different issues. And so we found that, OK, yes, most people associate MAHA with the Republican Party â€” most, but not all. But a lot of voters who identify as MAHA, and a lot of voters who voted for Trump in 2024 don’t think that the Trump administration has done a good job making America healthy again. And they rank the Democratic Party above the Republican Party on a lot of their top priority issues, like standing up to influence from the food industry and the pharmaceutical industry. They rank Democrats as caring more about health. So, you know, we found this very fascinating, and it supports what we’ve been hearing anecdotally, where Democratic candidates, a handful of them, and Democratic electoral groups, are really seeing a lot of opportunity to go after MAHA voters and win them over for this November. And you know, we should remember that even if you don’t see a big swing of people voting for Democrats, even if MAHA voters are disillusioned and stay home, that alone could decide races. You know, midterms are decided by very narrow margins. 

Rovner: Well, two other really interesting MAHA takes this week. . It’s about the tension in and among medical groups, about how to deal with HHS Secretary [Robert F.] Kennedy [Jr.] and the MAHA movement. The American Medical Association seems to be trying to play nice, at least on things it agrees with the secretary about, lest it risk things like its giant contract to supply the CPT billing codes to Medicare. On the other hand, the American Academy of Pediatrics and the American College of Physicians have been more confrontational to the point of going to court. The other story, from  pushing MAHA. One thing I noticed is that all of the teens in the story seem to suffer from physical problems that are not well understood by the mainstream medical community, and so they turned online to seek advice instead, which is understandable in each individual case. But then they turn around and try to influence others. And you can see how easily misinformation can spread. It makes me not so much wonder â€” it makes me see how, oh, this is how this stuff sort of gets out there, because you see so much â€¦ and Alice, this goes back to what you were saying about MAHA is not a movement that’s allied with one particular political party. It’s more of sort of a mindset that doesn’t trust expertise. 

Ollstein: I think it spans people who identify as Democrats, identify as Republicans. And, you know, we’re not really interested in politics until the rise of Robert F Kennedy Jr., and so I think it does show a lot of malleability. And there is a fight for this, for this cohort right now, on the airwaves, on the internet, etc.  

Rovner: And, as The New York Times pointed out, you know, we’ve thought of this as being sort of a young men cohort. It’s now also a young woman cohort, too. So there’s lots of people out there to go and get, for these people who are pursuing votes.  

Well, turning to reproductive health, we have a couple of follow-ups to things we covered earlier. The big one is Title X, the federal family planning program, whose grants were set to end as of April 1. Sandhya, it looks like the federal government is going to fund the program after all? 

Raman: Yeah, the family planning grantees in this space have been on edge for so long, you know, waiting to see would they finally just issue the grant applications. And then it was such a short timeline for them to get them done. And then everyone that I talked to in the lead-up was expecting some sort of delay, just because it was such a short timeframe before they were set to run out of money. And so I think that they were all pleasantly surprised that HHS was able to turn things around when they confirmed that the money is going to go out the day before the deadline. It does take a couple of days to go through the process and get that done. But I think the new worry now is also that in the statements that the White House and HHS have made is just that they are still at work on getting Title X rulemaking out so that a lot of these groups would be ineligible if they also provide abortions. Or we also don’t know what will be in the rule â€” if it will be broader than what was under the last Trump administration, if it encompasses other restrictions. So a little bit of both there.  

Rovner: Yeah. And I also was gonna say, I mean, we know that anti-abortion groups are unhappy with the administration, so this would be one place where they could presumably throw them a bone, yes? 

Ollstein: So people on both sides have been a little mystified why we haven’t seen a new Title X rule yet. They were expecting that near the beginning of last year, especially if the administration was just planning to reimpose his 2019 version, that would be pretty straightforward and simple. And yet, here we are, more than a year into the administration, and we haven’t really seen this yet. The administration did confirm to me â€” we put this in our newsletter â€” that a new rule is coming. And they said it will align with pro-life values. And the White House’s comments to some conservative media outlets were very explicit that this will be the last time Planned Parenthood can get funding. Now I wonder if that statement will come back to bite them in court, because the rule previously was very careful not to name Planned Parenthood or name any specific organization. It just imposed criteria that applied to a lot of Planned Parenthood facilities, and in order to make them ineligible for Title X funding. And so I wonder if that will help Planned Parenthood sue later on. But we’ll put a pin in that and come back to it. But we have confirmed that some sort of new rule is coming, but we don’t know when, and we don’t know what it would entail. There’s a lot of speculation that this could go way beyond an attempt to kick Planned Parenthood out. There’s speculation it could involve restrictions on particular forms of birth control. There’s speculation that it could entail restrictions on gender-affirming care. There’s speculation that it could involve rules around parental consent, stricter parental consent requirements, which are currently something that’s not part of Title X. And so we just don’t know, you know, in order to mollify the anti-abortion groups that are upset, they are saying, Don’t worry, new rule is coming. But again, we don’t know when, and we don’t know what’s going to be in it. 

Rovner: Well, we’ll be here when it happens. Another topic we’ve talked about at some length is crisis pregnancy centers, which are anti-abortion organizations that sometimes offer some medical services.  who was told after an ultrasound at a crisis pregnancy center that she had a normal pregnancy, and three days later, ended up in emergency surgery because the pregnancy was not normal, but rather ectopic â€” in other words, implanted in her fallopian tube rather than her uterus, which could have been fatal if not caught. This is not the first such case, but it again raises this question of whether these centers should be treated as medical facilities, which we’ve talked about many states do.  

Raman: And I think a lot of the rationale that people have for trying to do some of these mandatory ultrasounds, you know, encouraging people to go to this is because the talking point is that you don’t know if you have an ectopic pregnancy, you don’t have another complication, so you should go here to instead of just taking a medication abortion. So â€¦ we’re coming full circle here, where this is also not helping the case, if you’re not finding the full information there. So I think that was an interesting point to me â€¦  

Rovner: Yeah, it’s going on both sides basically. It is fraught, and we will continue to cover it. 

All right, that is this week’s news. Now we’ll play my interview with Elisabeth Rosenthal at Ñî¹óåú´«Ã½Ò•îl Health News, and then we will come back and do our extra credits. 

I am pleased to welcome back to the podcast Ñî¹óåú´«Ã½Ò•îl Health News’ Elisabeth Rosenthal, who reported and wrote the last two “Bills of the Month.” Libby, thanks for coming back. 

Elisabeth Rosenthal: Thanks for having me.  

Rovner: So let’s start with our drug copay card patient. Before we get into the particulars, what’s a drug copay card? 

Rosenthal: Well, copay cards, or copayment programs, are things that the drug companies give patients. You know, when it says you could pay as little as $0, where they pay your copayment, which is usually pretty big â€” when you see a copay card, it means the price is big, and they’ll bill your insurance for the rest. So for patients, it sounds like a good deal, and it is a good deal when they work. 

Rovner: So tell us about this patient, and what drug did he need that cost so much that he required a copay card? 

Rosenthal: Well, the funny thing is â€” his name is Jayant Mishra, and he has a psoriatic arthritis. And the doctor told him, you know, there’s this drug called Otezla that would really help you. And he was, he was a little cautious, because he knew it could be expensive, so he did wait a few months, and his symptoms, his joint pain, in particular, got worse. He was like, OK, I’ll start it. So he started it the first month, and it worked really well.  

Rovner: “It” the drug, or “it” the copay card, or both? 

Rosenthal: Both seemed to work very well. So the copay card covered his copay of over $5,000 and he was like, Oh, this is great. And then what happened was, the next month, he tried to fill it, and it was like, Wait, the copay card didn’t work! And really what happens is copay cards, they are often limited in time and in the amount of money that’s on them. So depending on how much the copay is, they can run out, basically expire. You used all the money, and you have a drug that you’ve used that is working really well for you, and then suddenly you’re hit with a big bill. So they kind of get people addicted to drugs, which they then can’t afford.  

Rovner: And what happened in this case was the insurance company charged more than expected, right? 

Rosenthal: Well, Otezla, you know, there’s so many things about this, and many “Bill of the Month” stories that, you know, are eye-rollers. Otezla â€” there are biosimilars that were approved by the FDA in â€¦ 2021? â€¦ which everyone’s talking about, faster approval of biosimilars. Well, this was approved, but the drugmaker filed multiple suits and patent infringement, and so in the U.S., it won’t be on the market, the biosimilar, until 2028, so that’s a problem too. 

Rovner: So if you want this drug, it’s going to be expensive. 

Rosenthal: It’s going to be expensive. And the other problem is copay cards. Insurers used to say, OK, that will count towards your deductible, right? So you didn’t really feel it, right? Because you got a $5,000 copay card, and you had a $5,000 deductible if you had a high-deductible plan. And everything was good. Now, insurers kind of said, Whoa, we’re not sure we like these things. So yeah, you can use them, but it won’t count towards your deductibles. So they’re not nearly as useful as they might have been in the past. But patients are really stuck, because these are really expensive drugs that most people couldn’t afford without copay cards. 

Rovner: So what eventually happened to this patient, and how can other people avoid falling into the copay card trap? 

Rosenthal: So basically, because he had used up the amount on the copay card, which was $9,400 for the year, by the second month, he tried for the third month to kind of ration his drugs to take half as much, and his symptoms came back. And then the lucky thing for him was then it was January, right, copay cards are usually done for the year. So he got a new copay card for another $9,400 and he was good for January, and he paid with his health savings account for the first month’s copay, with the copay card the second month, with the copay card and his health savings account. And when this went to press, he wasn’t sure how he was going to pay for the rest of the year. And for him, it’s not a huge problem, because he has a very well-funded health savings account, which few of us do, but he was really up in the air for the rest of the year when we wrote about this. 

Rovner: So sort of moral of this story, be careful if you want to take an expensive drug, and the theory that when the drugmaker promises, Oh, you can have this for as little as $0 copay. 

Rosenthal: Well, I think it’s you have to understand what a particular card does. You have to understand what’s the limit on how much is on the copay card. You have to understand how many months it’s good for. You have to understand, from your insurer’s point of view, if that will count as your deductible or not. And then, man, you know, you’re kind of on your own, right? Sometimes your copay card will work great for you, and at other times it will work for a shorter amount of time. And you got to figure out what to do. I think the third, bigger lesson is getting biosimilars, which are these very expensive drugs approved, is not really the big problem in our country. The problem is the patent thickets that surround so many of these drugs that prevent them from getting to the patients who need them.  

Rovner: In other words, you can make a copy of this drug, but you might not be able to get it onto the market.  

Rosenthal: Right. You can make a copy this drug â€” it [a generic] was approved in 2021 â€” but that won’t help patients until 2028, which is really terrible. You know, it’s available in other countries, but not here. 

Rovner: So moving on, our March patient had insurance through the Affordable Care Act exchange and was benefiting from one of those zero-premium plans until she got caught in a literally Kafkaesque mess over a 1-cent bill that turned into a 5-cent bill. Who is she and what happened here? 

Rosenthal: Yeah, her name in this wonderful, terrible story is Lorena Alvarado Hill. And what happened here is she was on one of these $0 insurance plans through the Obamacare exchanges with that great subsidy, the Biden-era subsidy, and she and her mother were on the same plan, and her mother went on to Medicare, turned 65. So Lorena didn’t need the family coverage and told the insurer that. And the insurance, of course, automatically recalculates your subsidy, and her premium went from being zero to 1 cent. Now, no human would make that, you know, would say, Oh, that makes sense. And to Lorena, it didn’t really make sense either. She was like, I’m not sure how to pay 1 cent, like, will it work on my credit card? And some of the bills said, you know, you understand that this could impact the continuation of your insurance, but, you know, she was like, 1 cent, I don’t think so. And then she kept going to doctors, and the insurance still worked, and then at some point, four months later, she got a letter in November saying, Oh, your insurance was canceled in July, and you owe money for all these bills. 

Rovner: And what happened with this case? 

Rosenthal: Well, you know, like many of our “Bill of the Month” patients, I celebrate them for being real fighters, because her bill, since her premium was 1 cent a month, went from 1 cent to 2 cents to 3 cents to 4 cents to 5 cents, when they sent her the note saying your insurance has been canceled for the last four months. And what turns out, which is really interesting, is this is a known glitch in the way the subsidies were calculated, were administered. There’s a recalculation of subsidies every time there’s a life event, a kid goes off the plan, you change jobs, get married, you get divorced. So the recalculation happens automatically. And the Biden administration, understanding that this glitch could exist, they gave the insurers the option not to cancel insurance if the amount owed was less than $10. And there were apparently 180,000 people caught in this situation where their insurance could have been canceled for under $10 of a recalculated premium. The Trump administration revoked that rule because their feeling was, you owe something, you pay something. So it’s part of their “stamp out fraud and abuse,” and this was, in their view, abuse of a system when people didn’t pay what they owed.  

Rovner: One cent. 

Rosenthal: One cent, right. So what happened with her is, you know, a good bill-paying citizen sending her daughter to college with loans. She wrote her insurers, she wrote to the state, she wrote to everyone. And as a last resort, of course, someone said, Well, there’s this thing called Bill of the Month you could write to. So when we looked into this, at first HealthFirst, which was her insurer in Florida, said, Oh, she’s not insured through us. And I was like, Yeah, because you canceled her insurance. And then I gave them her insurance number, and they said, Well, yes, according to law, we did the right thing. She didn’t pay, so it was canceled. Somehow, through all of this, word got back to the hospital and the insurer, and they worked together, and her bills were suddenly zero on her portal. So that’s the good news for Lorena Alvarado Hill. It doesn’t really help all those other people whose insurance may have been canceled for premiums that were under $10. 

Rovner: So, basically, if you get a bill for 5 cents, you should pay it. 

Rosenthal: Yeah, you know, it was funny when this story went up, many people were sympathetic, but other commenters said, Well, she should have just paid $1 because you can pay that. And maybe there was a way to pay 1 cent. And I’m kind of with her, like, if I got a bill for 1 cent, life is busy. This is a woman who is a teacher’s aide and works on weekends at a store to help pay for her daughter’s college. Life is busy. You just can’t sweat over 1-cent bills and spend a lot of time figuring out how to pay them. And I guess the lesson is, what’s the worst that can happen in a very dysfunctional system where so much is automated now? The worst that can happen is always really bad. Your insurance could be canceled. 

Rovner: So basically, stay on top of it, I guess, is the message for both of these stories this month. Elisabeth Rosenthal, thank you so much. 

Rosenthal: Thanks, Julie, for having me. 

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

Hellmann: My story is from The Texas Tribune, from a group of reporters who I can’t name individually. There’s too many of them. But it is  in Texas after the governor issued an executive order a few years ago requiring that hospitals check patients’ citizenship. So the story found that hospital visits by undocumented people dropped by about a third, and the story also got into how this is bleeding into other types of health care at other facilities, free vaccine clinics are not being attended as widely anymore. People aren’t attending their preventive care appointments, like cancer screenings or prenatal care checkups. Some of these other health facilities are required to check citizenship status, but it’s definitely a chilling effect over the broader health care landscape in Texas. 

Rovner: Yeah. There have been a lot of good stories about that. Sandhya. 

Raman: My extra credit is from Science, and it’s by Jocelyn Kaiser, and the story is “.” In her story, she talks about how last year, you know, the administration cut a lot of staff at the Agency for Healthcare Research and Quality. They’ve canceled all of the open grants, but Congress still appropriated $345 million for the agency this year, and so supporters kind of want to revive what should be going on at the agency, which hasn’t been issuing any of the grants since the start of the fiscal year, and just kind of make progress on some of the things that this agency does do, like running the U.S. Preventive Services Task Force, which has been, you know, something that has been talked about this year. So thought it was an interesting piece.  

Rovner: Yeah, I’m old enough to remember when AHRQ was bipartisan. Alice. 

Ollstein: So a very harrowing story in The New York Times titled “.” And I will say, since this piece ran, we have seen that an oil shipment from Russia is going through to the island, but I don’t think that will be sufficient to completely wipe away all of the upsetting conditions that this piece really gets into, what is happening as a result of the ramped-up U.S. embargo and blockade of the island. People can’t get food, they can’t get medicine, they can’t get electricity, and that is having a devastating effect on health care. The Cuban health care system has been really miraculous over the years, just the pride of the government. It has meant, prior to this blockade, that their life expectancy was better than ours, and a lot of their outcomes were better. And so this has been really devastating. There’s, you know, harrowing scenes of people on ventilators having to be hand-pumped when the electricity cuts out, babies in incubators, you know, losing power. You know, people having to skip medications, etc. And so this is really shining a light on a foreign policy situation that this administration is behind. 

Rovner: Yeah, that’s really been an under-covered story, too, I think, you know, right off our shores. My extra credit this week is one I simply could not resist. It’s from New York Magazine, and it’s called “,” by Helaine Olen. And as the headline rather vividly points out, we are witnessing the rise of pet medical tourism, along with human medical tourism, which has been a thing for a couple of decades now. It seems that veterinary medicine is getting nearly as expensive as human medicine, and that one way to find cheaper care is to cross the border, which is obviously easier if you live near the border. I’m not sure how much cheaper veterinary care is in Canada, but as the owner of two corgis, I may have to do some investigating of my own.  

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 â€” 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 folks hanging these days? Sandhya. 

Raman: On  and on  . 

Rovner: Alice. 

Ollstein: On Bluesky  and on X . 

Rovner: Jessie. 

Hellmann: I’m on LinkedIn under Jessie Hellmann and on X . 

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